MSK Flashcards by Lexi Sarradet

OA you are thinking

Wear and tear problem

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Progressive joint disorder characterized by slow destruction of the normal collagen architecture

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After what age do we think wear and tear and is it an older or younger issue

After the age of 35 we think of OA it’s an older problem

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One or more joint involved and asymmetric

This is classic of OA you have wear and tear of the joint at multiple injuries at different points and due to overuse of one versus the other

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Pain with OA how does that look

Typical gets WORSE at the end of the day. If you are on your feet or knee all day

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In the morning patients with OA how does they present

Stiffness

The stiffness last less than 30 minutes a highlight of this disorder

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Common areas we find OA

Wrist the knees and the hips

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Classic findings on xray of OA

Narrowing of the joint and osteophytes like bone spurs

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RA patient population

Older and younger females

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Findings of RA are symmetrical or asymmetrical

Symmetrical

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Pain___________ with activity for RA

Improves

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How is the stiffness in the morning for a patient with RA

Lasts LONGER than 30 minutes me as they get moving the stiffness gets better

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celecoxib which is celebrex or meloxicam why sue

in OA common in clinical practice; once a day dosing long half life

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Xray findings of RA

Osteopenia

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some issues having prescribed an nsaid

block co 1 cascade and the big problem here u reduce the amount of mucus production and also affect the kidney so that’s one problem tend to develop gi bleeding and nephrotoxicity as well as worsening hypertension so for the elederly population

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If you’re pushing on a wound and you feel crepitus on like a area that has tissue not bone what are you thinking?

Necrotizing fasciitis

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Etiology of osteoarthritis

Wear and tear, over the age of 60 equals a 60% chance of developing osteoarthritis, after 55 women are affected more, are genetics, hematological, and endocrine conditions again, mechanism stressors, such as repetitive microtrauma, prior trauma, recent exposure to certain chemicals if a patient in a motor vehicle crash and there’s trauma to the knee any neurological disorders that again have repetitive

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Clinical manifestations of OA

Pain in one or more joints, stiffness of affected joint after prolonged sitting, grading or crepitus sensation during range of motion, feeling of instability, locking or bucking of the knees

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Physical findings of the OA but patient comes in with edema and red hot knee or elbow other differentials

Septic joint or foot flare. Admit but in case it is not OA

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Bony induration or enlargement of affect joints. These nodes** effusion with warm and or redness involved

Heberden and bouchards
Heberden is the DIP and Bouchard is the PIP

Angular deformed and limited ROM with palpable or audible creptius can lap have pain on palpation

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RA deformity classic presentation

Swan neck and boutiner

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RA patients typically develop

Ulnar deviation
The ulnar is going to deviate laterally

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tell me about heat and ice for OA

moist heat for day to day and ice for acute exaccerabtion

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The bouttanaire deformity tell me about the flexion and extension of the joints

Flexion PIP and extension DIP

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Tell me about the flexion and extension of swan neck

PIP hyperextended and DIP flexion

Lab and diagnostics for osteoarthritis

Plain x-rays, anterior posterior and lateral knee films as well as bilateral to compare, synovial fluid analysis, CBC, BMP, bone scans, MRIs and CT’s

Management of OA

The goals are to relieve symptoms, maintain or improve function, limit disability, as much as possible, avoid drug toxicity, a multidisciplinary approach is best, rest and joint protection may be warranted multimodal approach said twice***

Top way to reduce the wear and tear on a patients joints that are obese

Losing the weight

Management for RA

DDMARDS

Drugs and management for OA

Acute exacerbation ice therapy Moist heat for the day to day relief or to help with the morning stiffness Salisatye acid or aspirin good starting drug 650mg if they can’t take they can take acetaminophen. NSAIDs are going to give you the biggest relief but the biggest draw back block cox1casade reduce mucus production and affect kidney function GI bleeding worsening hypertension and AKI

Medication providing the biggest bang for your buck for OA

NSAIDS

Two fold problem with NSAIDS in the adult gero population

bleeding and worsening htn

issue with prescirbing cox 2 inhibitors

increase cardiovascular RISK SO IF YOU HAVE OA

With fractures one of the biggest concerns is not only the loss of continuity of bone but

Also type of damage to the surrounding tissue vasculature and nerves

Whenever you are assessing and diagnosis a fracture you always assess?

The he joint above and below the fracture that is a highlight

You always assess ______ in the distal extremity

CMS

Classification is there is no break in skin over that fracture

Closed

Open fractures vary how

Varying amounts of skin or soft skin is sure over the fracture type 1-3

Type one open fracture

One cm or less

Type two open fracture

One or greater moderate

Type 3 open fracture

Crushing injury very contaminated Working on a building site. A car or forklift went over the foot

Communited fractures

Little pieces

Green stick fracture

Not going through and through

Plain _____ are the standard of practice for fractures

Films. X-rays

___________ of odontoid ct not done

Swimmer open mouth

What kind of xray for complex fracture of ankle femur or humerus

Oblique

———— view of ankle fracture to check talus

Mortise

If spinal cord injury is involved we order what

An MRI

What labs and diagnostics would you order if you have Dino’s why or absent pedal pulses

Arteiogram

What would you order in a crush injury to check for myoglobinuria

A UA

Primary and secondary survey for your MSK system

Primary is your ABC and the MSK is considered your secondary assessment

Giving blood to a MSK injury patient

It’s a 1:1:1 blood cryo and platelets

Massive transfusion what are you building up and giving to your patients

Citrate toxicity and you give calcium

Management for open fractures for a broad spectrum antibiotic /prophylaxic option

Cephalosporin Ancef

Open fracture and risk of pseudomonas

Fluroquinolones The pseudomonas loves the moist area of a boot like stepping on the nail through the shoe

Open fracture and salt water what organism are you at risk for contracting

Vibrio

Coverage for vibrio

Doxycycline is a must

What is the antibiotic of choice for open fracture and clostridium is suspected

Clindamycin

Boxer fracture

Fourth and fifth

Rededuction of fractures

Refer to ortho to fractures use body tape, owner and rate of fractures split with ace simple hairline or green stick. The goal is to reduce and reduction improve alignment improve vascular perfusion decrease pain and muscle spasm and allow the patient to heal faster.

Complication where increased tissue pressure within a limited space compromises the circulation and function of the contents within that space

Compartment syndrome

Long bone fracture complication to watch for

Fat embolism

Complication of an open fractures vary can be infection so it’s….

Osteomyelitis

Avascular necrosis complication

Osteo nectrosis. Hip injury necrosis the vascular injury Also giving patients corticosteroids can also result in this

Patients that have larger expanding

The pressure number we should know or memorize for diagnostic of compartment syndrome

Smeets 30 to 40

If a patient says that their pain is disproportionate to the injury, they’ve taken a couple Percocets and nothing has worked and it’s getting worse. What are you thinking?

Compartment syndrome

Lave and diagnostic workup for compartment syndrome what would you see?

You can see a WBC elevated you can see hyperkalemia as the muscle breakdown. The cells break releases potassium into the serum could also release some myoglobin being dumped into the urine very center similar to rhabdomyolysis elevated CPK elevated LDH and ECG peaked T wave changes.

delta diastolic blood pressure

This is your diastolic blood pressure subtracted or the difference between your diastolic blood pressure and your compartment pressure is less than 30 you have compartment syndrome and not only you have compartment syndrome a difference that is less than 25 usually requires you to call an emergency ortho surgery. 70 diastolic and 42 compartment pressure. Less than 25 emergency come in now to take care of this

First management of suspected compartment syndrome and they come in with a cast

Bivalve the cast relieving the pressure

The 6 Ps of the assessment

Pain Pallor Paresthesia Pulses Temp? Paralysis

Once you bivalve the cast do you elevate the extremity or level of the heart

Level of the heart

Two categories of osteomyelitis

Acute hematogenous and continugous inoculation

Practice eye pictures when you see this card

Practice ear pictures here

Bugs that cause be the culprits of osteomyelitis

Staph aureus but with continuous inoculation think about gram negative bugs

Clinical manifestations of osteomyelitis

Fever edema fatigue malaise tenderness and erythema

Wet gangrene

Diabetes mellilitis purulent drainage and pseudomonas tends to live there

Dry gangrene

Patients with PAD

Sinus track drain have occurs when

When hardwire

MSK Flashcards

(81 cards)