NSG 555 QUIZ 3 MODULE 6 MUSCULOSKELETAL EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
workup for suspected bone ca
often labs are normal. if chronic indolent bone infection elevated WBC, ESR, CRP. ALP
elevated, Ca, phos, uric acid, LFTs, etc.
orthogonal digital radiographs, or possibly bone scan, pet scan, etc. coordinate with
orthopedic oncology if needed.
bursitis
inflammation of a the fluid sac between joints. common in pseudogout, repetition, RA,
TB, DM, immunosupression, etc.
neer and hawkins impingement signs
shoulder (subacromial)bursitis
olecranon bursitis
posterior elbow swelling, often due to septic bursitis by staph aureu. dx for this would be
fluid aspiration for culture and start abx
hip bursitis
Over greater trochanter of the femur - can
Create pressure over the bursa
Bursa - fluid filled sac that reduces friction
,Of tendons that cross the bony prominence.
When the bursa is irritated from too much
Pressure from the tendons, it becomes
Inflamed.
S/S - snapping of the hip when they climb
Stairs
TX - PRICES - reduce activity
fibromyalgia widespread pain index
# of areas the pt has had pain over last week, score # of areas.
Then score symptom severity during last 6 months and add if HA, pain/cramps in low
abd. and depression.
fibromyalgia diagnostic criteria
1. widespread pain index >7 and symptoms severity score >5 OR wpi of 4-6 and SSS of
>9
2. generalized pain (pain in at least 4 out of 5 regions)
3. symptoms present for at least 3 months
4. dx of fibromyalgia irrespective of other dx, does not exclude the presence of other
clinically important illnesses
pathophysiology FMS
unclear. more likely a CNS dysfunction and not muscle, autoimmune or viral.
pain at periphery processed in spinal cord and transmitted to brain. for some reason
becomes loud @ level of spinal cord and brain (central sensitization). prain responds
, with pain recognition @ lower thershold
decreased GH, insulin like growth factor (IGF) and possibly prolactin may contribute in
FMS patients, these are released during sleep, disturbance with non-REM sleep--
>fatiuge
tx with GH inc. IGF and improves pain and sleep but is $$$$$$$$$$$$$$$$
PE and presentation of fibromyalgia and myofascial pain syndrome
widespread pain + chronic fatiuge. may have other somatic fomplaints: cognitive
difficulties, nonrestorative sleep, auditory, ocular, rhinitis, ax, migraines, palpitations,
I/bs, etc
workup for fibromyalgia
mainly to rule out other differentials:
CBC, ESR or CROP
vit D
TSH
ANA, rheum. factor and ACPA ONLY if suggestive of RA or SLE
differential dx for fibromyalgia
lupus, myofascial pain syndrome, hypothyroid, bursitis, depression/anxiety, RA,
polymyalgia rheumatic, polymositis
tx of fibromyalgia
CBT, sleep, exercise, TCAs @ low toses like amitriptyline 10 mg 2-3 hrs before bedtime
flexeril (also a TC med)
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
workup for suspected bone ca
often labs are normal. if chronic indolent bone infection elevated WBC, ESR, CRP. ALP
elevated, Ca, phos, uric acid, LFTs, etc.
orthogonal digital radiographs, or possibly bone scan, pet scan, etc. coordinate with
orthopedic oncology if needed.
bursitis
inflammation of a the fluid sac between joints. common in pseudogout, repetition, RA,
TB, DM, immunosupression, etc.
neer and hawkins impingement signs
shoulder (subacromial)bursitis
olecranon bursitis
posterior elbow swelling, often due to septic bursitis by staph aureu. dx for this would be
fluid aspiration for culture and start abx
hip bursitis
Over greater trochanter of the femur - can
Create pressure over the bursa
Bursa - fluid filled sac that reduces friction
,Of tendons that cross the bony prominence.
When the bursa is irritated from too much
Pressure from the tendons, it becomes
Inflamed.
S/S - snapping of the hip when they climb
Stairs
TX - PRICES - reduce activity
fibromyalgia widespread pain index
# of areas the pt has had pain over last week, score # of areas.
Then score symptom severity during last 6 months and add if HA, pain/cramps in low
abd. and depression.
fibromyalgia diagnostic criteria
1. widespread pain index >7 and symptoms severity score >5 OR wpi of 4-6 and SSS of
>9
2. generalized pain (pain in at least 4 out of 5 regions)
3. symptoms present for at least 3 months
4. dx of fibromyalgia irrespective of other dx, does not exclude the presence of other
clinically important illnesses
pathophysiology FMS
unclear. more likely a CNS dysfunction and not muscle, autoimmune or viral.
pain at periphery processed in spinal cord and transmitted to brain. for some reason
becomes loud @ level of spinal cord and brain (central sensitization). prain responds
, with pain recognition @ lower thershold
decreased GH, insulin like growth factor (IGF) and possibly prolactin may contribute in
FMS patients, these are released during sleep, disturbance with non-REM sleep--
>fatiuge
tx with GH inc. IGF and improves pain and sleep but is $$$$$$$$$$$$$$$$
PE and presentation of fibromyalgia and myofascial pain syndrome
widespread pain + chronic fatiuge. may have other somatic fomplaints: cognitive
difficulties, nonrestorative sleep, auditory, ocular, rhinitis, ax, migraines, palpitations,
I/bs, etc
workup for fibromyalgia
mainly to rule out other differentials:
CBC, ESR or CROP
vit D
TSH
ANA, rheum. factor and ACPA ONLY if suggestive of RA or SLE
differential dx for fibromyalgia
lupus, myofascial pain syndrome, hypothyroid, bursitis, depression/anxiety, RA,
polymyalgia rheumatic, polymositis
tx of fibromyalgia
CBT, sleep, exercise, TCAs @ low toses like amitriptyline 10 mg 2-3 hrs before bedtime
flexeril (also a TC med)
