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Acute onset of saddle anesthesia, bladder incontinence, & fecal incontinence. May be accompanied by bilateral leg numbness and weakness. Pressure on sacral nerve root results in inflammatory & ischemic changes to the nerves. It is a surgical emergency.
Cause Equina Syndrome
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Wrist pain on palpitation of the anatomic snuffbox. Pain on axial loading of the thumb, that mostly occurs after a history of falling forward with outstretched hand is what type of fracture?
Navicular Fracture (Scaphoid Bone Fracture)
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Fracture of the distal radius of the forearm along with the dorsal displacement of the wrist. History of falling forward with outstretched hand, is the most common type of wrist fracture.
Colles Fracture
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Genu recurvatum
Hyperextension or backward curvature of the knees
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Genu valgum
Knock knees (gun stuck together)
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Treatment for injured join?
- Rest
- Ice
- Compression
- Elevation
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What 2 physical exam tests check for torn ACL?
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Positive Lachman’s Sign
Probable ACL tear
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Positive Drawer Sign?
Probable ACL tear
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Finkelstein’s Test assesses for what?
De Quervain’s tenosynovitis (inflammation of the tendon at its sheath located at the base (dorsum) of the thumb)
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What test assesses for De Quervain’s tenosynovitis?
Finkelstein’s Test (positive if there is pain on the wrist (thumb side) upon ulcer deviation 👊🏼
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McMurray’s Test assesses for ?
Torn meniscus
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Which test is more sensitive to detecting ACL tear Lachman’s or Drawer Tesr?
Lachman’s
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Plantar foot pain that is worsened by walking/weight bearing. Worst during the first few steps in the morning. What is the most likely disgnosis?
Planter Fasciitis
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Treatment for plantar fasciitis?
- -NSAIDs
- -Stretching
- -Orthotic Foot appliance @ night
- -Lose weight (if overweight)
- -R/O heel spurs, fracture
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What is a Morton’s neuroma?
Inflammation of the digital nerve of the foot between the 3rd & 4th metatarsals. Some patients complain of a “pebble” between their 3rd and 4th toes.
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Inflammation of the digital nerve of the foot between the 3rd & 4th metatarsals is caused by?
Morton’s Neuroma
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Who is at highest risk for Morton’s Neuroma?
People who wear high heeled shoes, tight shoes, runners, dancers
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What is the test for Morton’s Neuroma?
How is it done?
Mulder Test - done by grasping the first & fifth metatarsals and squeezing. Positive test will result in pain for the patient.
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Bony nodules on the distal interphalangeal joints (DIP)?
Herberden’s nodes
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Bony nodules on the Promixal Interphalangeal joints (PIP)?
Bouchard’s Nodes
(B comes before H)
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Another names for Osteoarthritis?n
Degenerative Joint Disease
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One sided arthritis is most likely to be RA or OA?
OA
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Which joint stiffness lasts longer: RA or OA?
RA
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Which joint stiffness has a symmetrical distribution?
RA
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Which joint stiffness is worse the first 15 minutes of the morning but gets better with exercise: RA or OA?
OA
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Which is accompanied by systemic symptoms such as fatigue, fever, normocytic anemia: RA or OA?
RA
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Treatment for OA?
- NSAIDs
- Steroid Injections of inflamed joint
- Surgery
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Treatment for RA?
- Systemic Steroids
- Antimalarials (Plaquenil)
- Antimetabolites (Methotrexate)
- Biological (Humira, Enbrel)
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Systemic Lupus Erthematosus (SLE) has what classic symptom?
Macropapular Butterfly-Shaped Rash on the middle of the face (Malar Rash)
-Avoid the sun!
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Cauda Equina means what?
Horse tail — (paralysis at the tail causes saddle parasthesia)
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What condition is a chronic inflammatory disorder that affects the spine and sacroiliac joints?
Ankylosing Spondylitis
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What objective finding would you find in a patient with Ankylosing Spondylitis?
- -loss of ROM of spine
- -decreased Respiratory excursion
- -Uveitis (refer to optho)
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What lab values would you expect to see in a patient with RA?
- Elevated Sed Rate
- + RF factor
- Mild microcytic or normochromic anemia
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What is a contraindication of treating back pain?
Assigning bed rest except in severe cases - will cause deconditioning & increase the risk of pneumonia
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Pain that is felt in the forearm & elbow when twisting or grasping objects such as opening a jar or shaking hands is caused by what?
Lateral Epicondylitis (Tennis Elbow)
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Anterior Uveitis is a complication of what 2 diseases?
- RA
- Ankylosing Spondylitis
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If a patient has cauda Equina what should you do?
Refer to ED immediately - patient needs decompression
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The gold standard test for assessing joint damage is done through what diagnostic tool?
MRI
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Causation of ulnar nerve neuropathy, patient complains of numbness in the little finger. Seen in baseball players, golfers, bowlers?
Medial Epicondylitis (treated by TCAs, gabapentin, Phenytoin, Pain Meds)
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Which Grade sprain: slight stretching & some damage to ligament fibers, able to bear weight?
Grade I Sprain
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Which Grade sprain: moderate sprain, presence of ecchymoses, moderate swelling, & pain. Join tender to palpitation. Ambulation and weight-bearing painful.
Grade II Sprain - (consider X-ray & Referral)
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Which Grade sprain: inability to bear weight after the injury, inability to ambulate at least 4 steps, severe bruising, tenderness over posterior or medial malleolus.
Grade III (complete rupture of ligaments)
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What is a type of bursitis that is located behind the knee?
Bakers Cyst
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Who is a Baker’s Cyst most likely seen in?
Treatment?
Physically active patient who complains of a ball like mass behind one knee.
It is treated by RICE, NSAIDs, & possibly decompression with syringe.
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What can a ruptured Baker’s cyst cause?
Cellulitis of the Knee
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Which nerve is compressed that causes carpal tunnel syndrome?
Median Nerve
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What 2 tests can you do to determine if a patient has carpal tunnel?
Tinnel (tap on wrist) & Phalen Test (bend wrists)
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RA or OA: anterior groin pain when leaning over to tie you shoe?
OA
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Patient has a + straight leg raise, most likely diagnosis?
- Low back pain
- Acute radiculopathy
- Sciatica
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Positive painful Arc test where the patient complains of lateral deltoid pain
Impingement Syndrome - Rotator Cuff
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What is a common shoulder problem in Diabetic patients?
Adhesive capsulitis (frozen shoulder)
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Which arthritis most commonly occurs to weight bearing joints?
OA
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Herbeden’s Node is most likely to occur with which type of arthritis?
OA
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Buchard’s nodes are most likely to occur in patients who have which type of arthritis?
RA
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Podagra means?
Inflammation of great toe (gout)
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Glucosamine sulfate has been shown to be beneficial in cartilage growth & repair in what condition?
Osteoarthritis
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A knee that “locks” Is a classic symptom of what knee injury?
Meniscus
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When are imaging studies indicated in people who have back pain?
4 weeks
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