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Musculoskeletal System | Nurse Practitioner (NP) School Study Aid

Osteoarthritis

Articular Cartilage Destruction

Biomechanical Stress

Aging

Asymmetric

Pain Decreases with Rest

Morning Stiffness Under 30 Minutes

Crepitus

DIP and PIP Joints

Lifestyle Changes

Acetaminophen or NSAIDs

2 mins

Rheumatoid Arthritis Assessment

Destruction of Connective Tissue and Synovial Membrane

Inflammation of Joints

Morning Stiffness

Nodules

Joint Deformities

1 min

Rheumatoid Arthritis Interventions

Heat and Cold Applications

Therapeutic Exercise

Balance Rest and Activity

NSAIDs

DMARDs

Glucocorticoids

PT/OT

Reconstructive Joint Surgery

2 mins

Osteoporosis Assessment

Postmenopausal Women

Long Term Corticosteroids

Kyphosis

Dowager's Hump

Loss of Height

Back Pain

Pathologic Fractures

Spinal Compression Fracture

1 min

Osteoporosis Interventions

Increased Calcium Intake

Vitamin D Supplements

Bisphosphonates

Raloxifene

Denosumab

Calcitonin

Teriparatide

Bone Densitometry (DEXA) Scan

Weight Bearing Exercises

2 mins

Osteomyelitis

Bone Infection

Warmth

Edema

Constant Bone Pain

Fever

IV Antibiotics

Implanted Beads

Hyperbaric Oxygen

Surgical Removal of Ischemic Tissue

Elevated ESR

3 mins

Scoliosis

S Shaped Lateral Spinal Rotation

Unequal Shoulder and Scapula Height

Uneven Gait

Impaired Oxygenation

Hump when Bending Forward

Body Braces

Worn 23 Hours/Day

Surgery

Adolescent Screening

3 mins

Muscular Dystrophy

X-linked Recessive

Muscle Weakness

Motor Problems

Gower Sign

Large Calves

Waddling Gait

Loss of Ambulation

Cardiac and Respiratory Failure

2 mins

Herniated Disc (Nucleus Pulposus)

Spine Trauma

Natural Degeneration

Spinal Stenosis

Pain

Weakness

Urinary and Fecal Incontinence

Brace

Medications

Outpatient Procedures

Surgery

2 mins

Gout Disease

Acute Inflammatory Monoarthritis

Primarily in Males

Precipitation of Monosodium Urate Crystals

Underexcretion of Uric Acid

Overproduction of Uric Acid

Negatively Birefringent, Needle-Shaped

Swollen, Red, Painful Joint

Asymmetric Joint Distribution

Podagra

Tophus

After Large Meal or Alcohol

2 mins

Gout Treatment

NSAIDs

Glucocorticoids

Colchicine

Impairs Leukocyte Chemotaxis

Inhibit Xanthine Oxidase

Allopurinol

Febuxostat

Inhibit Reabsorption of Uric Acid

Probenecid

1 min

Pseudogout

> 50 Years Old

Arthritis of Large Joints (Classically the Knee)

Calcium Pyrophosphate Crystals

Positively Birefringent

Chondrocalcinosis (On X-ray)

NSAIDs

Colchicine

Steroids

1 min

Osteogenesis Imperfecta

Autosomal Dominant

Decreased Type I Collagen Production

Phenotypically Diverse

Brittle Bone Disease

Fractures from Minimal Trauma

Confused with Child Abuse

Hearing Loss

Dental Imperfections

Blue Sclera

1 min

Ehlers-Danlos Syndrome Disease

Faulty Collagen Synthesis

Autosomal Dominant or Recessive

Various Severities

Hypermobile Joints

Hyperextensible Skin

Easy Bruising/Bleeding

Berry (Saccular) Aneurysm

Brighton Criteria

2 mins

Ehlers-Danlos Syndrome Types

Types 1 and 2 - Classical

Type V Collagen Mutation

Joints and Skin

Type 3 - Hypermobility

Most Common

Tenascin X Deficiency

Joint Instability

Type 4 - Vascular

Type III Collagen Mutation

Vascular and Organ Rupture

2 mins

Osteosarcoma

Osteogenic Sarcoma

Peak incidence men 10-20 years old

Metaphysis of Long Bones

Knee Region

Radiation

Familial Retinoblastoma

Paget's Disease

Codman Triangle

Sunburst Pattern from Elevated Periosteum

Grave Prognosis

2 mins

Giant Cell Tumor

Osteoclastoma

Epiphyseal End of Long Bones

Peak Incidence 20-40 Years

Benign

Knee Region

Soap Bubble Appearance on X-ray

Spindle-shaped Cells

Multinucleated Giant Cells

46 secs

Ewing's Sarcoma

Most Common in Boys < 15 years old

11;22 Translocation

Long bones, Pelvis, Ribs

Diaphysis

Small Blue Cells

Malignant

Aggressive

Onion-skin Appearance

Responsive to Chemotherapy

2 mins

Chondrosarcoma

Cartilaginous tumor

Malignant

Men 30-60 years old

Pelvic and femur bones

Glistening mass in medullary cavity

Can be primary in origin or from osteochondroma

Metastasize to lungs

1 min

Marfan Syndrome

Fibrillin-1 Mutation

Autosomal Dominant

Tall

Arachnodactyly

Pectus Excavatum

Hypermobile Joints

Aortic Aneurysm And Dissection

Mitral Valve Prolapse (MVP)

Subluxation of Lens (Superior)

2 mins

Baker's Cyst

Due To Enlargement of Bursa Between Gastrocnemius and Semimembranosus Muscles

Often Related to Rheumatoid Arthritis or Osteoarthritis

Often Asymptomatic

Mass or Swelling Behind Knee

Acute Pain If Rupture

Crescent Sign

Ultrasound

Treat Underlying Condition

Arthrocentesis

Glucocorticoid Injection

4 mins

Polymyalgia Rheumatica

Proximal Muscle Pain

Normal Muscle Strength

Morning Stiffness

Age Over 50

Associated With Temporal Arteritis

Elevated ESR, CRP

Normal CK

Corticosteroids

4 mins

Poliomyelitis

Poliovirus

Picornavirus

Fecal-Oral Transmission

Destruction of Anterior Horn

Flaccid Paralysis

Hyporeflexia

Fasciculations

Elevated CSF Lymphocytes and Proteins

Normal CSF Glucose

Viral Culture or PCR

Supportive Care

Vaccination

3 mins

Osteochondroma

Most Common Benign Bone Tumor

Males Under 25

Cartilage-capped Spurs

Metaphysis of Long Bones

Small Risk of Chondrosarcoma

Painless Mass near Joint

Painful if Growing or Malignant

X-Ray

MRI if Concern for Malignancy or Functional Limitation

Monitoring

Surgery

3 mins

Medial Epicondylitis (Golfer's Elbow)

Overuse Injury of Flexor Tendons

Wrist Flexion

Forearm Pronation

Pain over Medial Epicondyle

Conservative Management

Injections

Surgery

1 min

Lateral Epicondylitis (Tennis Elbow)

Overuse Injury of Extensor Tendons

Wrist Extension

Forearm Supination

Pain over Lateral Epicondyle

Conservative Management

Surgery

Injections

1 min

Chorea and Athetosis

Sudden Jerky Movements

Athetosis

Snake-like, Writhing Movements

Basal Ganglia Lesions

Huntington's Disease

Acute Rheumatic Fever

Treat Underlying Disorder

Tetrabenazine

1 min

Prepatellar Bursitis

Repetitive Trauma on Flexed Knee

"Housemaid's Knee"

Pain

Erythema

Septic Bursitis

Staphylococcus aureus

Aspiration

NSAIDs

Antibiotics

2 mins

Plantar Fasciitis

Inflammation of Plantar Fascia

Heel Pain

Worse in Morning and with Dorsiflexion

Lifestyle Changes

NSAIDs

Glucocorticoids

Surgery as Last Resort

2 mins

Ganglion Cyst

Benign

Fluid-filled Swelling

Water Balloon on a Straw

Herniation of Dense Connective Tissue

Dorsal Side of Wrist

Observation

Surgery

Resolves Spontaneously

1 min

Iliotibial Band Syndrome

Military Recruits, Runners, and Cyclists

Overuse Injury

Lateral Knee Pain

Positive Noble Compression Test

NSAIDs, Physical Therapy, Surgery

2 mins

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