rheumatology-1 - npng

[ArchivalUser]

1. A 36-year-old data entry clerk presents to your office complaining of tingling and pain in the right thumb and wrist, worse by the end of the day. Occasionally, she is awakened at night from the pain. Phalen's, Tinel's, and median nerve compression tests are positive. The hand and wrist appear otherwise normal, with full range of motion, good perfusion, and no focal signs of inflammation or trauma. Which of the following treatment modalities would be your first choice in alleviating pain in this patient?

A. Steroid and lidocaine injection into the carpal tunnel

B. Wrist splinting in neutral or slight extension

C. Trigger point injection

D. Surgical release of the transverse carpal ligament

E. Iontophoresis therapy

[ArchivalUser]

2. The following positive physical examination finding is helpful in diagnosing rotator cuff disease:

A. Drop arm test

B. œPopeye muscle

C. Adson's maneuver

D. Sulcus test

E. Spurling's test

[ArchivalUser]

A 20-year-old man with a history of epileptic seizure presents to the emergency room complaining of left shoulder pain following a grand mal seizure. He presents holding his left arm adducted and rotated inward. Which radiologic study is the most important for this patient's diagnosis?

A. True AP view

B. Transcapular lateral view

C. Axillary lateral view

D. Scapular Y view

E. Serendipity view

[ArchivalUser]

4. Which of the following diseases is associated with frozen shoulder (adhesive capsulitis)?

A. Diabetes mellitus

B. Osteoarthritis

C. Hypertension

D. Pregnancy

E. Gout

[ArchivalUser]

1- B
2-?????????
3- B
4- A

[ArchivalUser]

okay npng...
1.B
2.B
3.C
4.A

[ArchivalUser]

B
A
B
A

[ArchivalUser]

1. a
C. A trigger point is defined as the presence of discrete focal tenderness located in a palpable taut band of skeletal muscle, which produces both referred regional pain and a local twitch response. This patient had no signs of local inflammation. In the absence of a definable trigger point, dry needling or lidocaine injection is unnecessary. Local application of steroid and/or lidocaine, either by direct injection into the carpal tunnel space or by iontophoresis, may significantly alleviate the pain from soft tissue inflammation in carpal tunnel syndrome. Iontophoresis is the use of electric impulses from a low-voltage current to drive topical corticosteroids into soft tissue structures. Wrist splinting is a noninvasive, cost-effective treatment to relieve compression of the median nerve, but it requires a great deal of patient compliance. Surgery is not the first step in this patient's management but should be considered if all other treatment modalities fail.

[ArchivalUser]

2.
A. The drop arm test is helpful in diagnosing rotator cuff disease, with the patient unable to oppose even gentle downward force on the affected arm held in 90° abduction. Failure is primarily due to weakness in the supraspinatus muscle, one of the four (œSITS) rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The œPopeye muscle is a bulge associated with proximal biceps tendon rupture. Adson's maneuver tests for thoracic outlet syndrome, where the radial pulse is lost with shoulder extension and ipsilateral head rotation while holding the breath. The sulcus test indicates glenohumeral instability, where downward traction on the adducted arm results in dimpling of the skin distal to the acromion. Spurling's test is associated with cervical spine pathology, resulting in ipsilateral pain from lateral head flexion and rotation with compression

[ArchivalUser]

3.
C. The patient probably has a posterior shoulder dislocation based on the seizure history and his presentation of shoulder pain with an adducted and internally rotated arm. The first three views listed in the question (true AP, transcapular, and axillary lateral) should all be obtained for shoulder traumas. The axillary lateral view, however, is important to confirm the diagnosis of glenohumeral dislocation, especially posterior type.