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Exam (elaborations)

APEA Orthopedic-Questions with Correct Answers/ Verified

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Osteoarthritis - Pain: exacerbated by activity; relieved by rest; sometimes occurring at night • AM stiffness resolving in ≤60 minutes • Tenderness to palpation of involved joints • Crepitus (audible) •Joint effusion may be present • Osteophytes palpable bony enlargements • Jo...

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  • August 21, 2024
  • 7
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
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MikeHarris
APEA Orthopedic-Questions with Correct Answers/ Verified

Osteoarthritis - ✔✔Pain: exacerbated by activity;

relieved by rest;

sometimes occurring at night

• AM stiffness resolving in ≤60 minutes

• Tenderness to palpation of involved joints

• Crepitus (audible)

•Joint effusion may be present

• Osteophytes palpable bony enlargements

• Joint space narrowing



Joint pain

• Age >50 years

• Presence of joint space narrowing and/or osteophyte on X-ray - ✔✔Osteoarthritis Diagnosis



Exercise: ROM and strengthening

• Weight loss if appropriate

• Patient education • Heat, ultrasound? - ✔✔Non-pharmacologic Osteoarthritis TX:



• Use ONLY when symptoms are present!

• NSAIDs (oral if no relief from topical) Watch for GI, cardiac, renal complications!

• Injectable steroids: not recommended Short duration of effect • Acetaminophen not first line
because no clinically significant effect on pain

• Opioids: NO! MANY side effects - ✔✔Pharm Management for osteoarthritis



rheumatoid arthritis - ✔✔Autoimmune disease

• Symmetrical, peripheral polyarthritis (leads to joint deformity and destruction)



• Rheumatoid factor (RF)

• Anti-CCP antibodies: citrullinated peptides/proteins (higher specificity than RF, similar sensitivity as
RF)

, • Acute phase reactants: ESR, CRP

• ANA: negative may exclude SLE

• CBC, LFTs, BUN, Cr, uric acid level, UA - ✔✔Rheumatoid Workup



Fibromyalgia - ✔✔Chronic widespread musculoskeletal pain >3 months; accompanied by fatigue,
sleep disturbances, and multiple somatic complaints (HA, bowel irritability, cognitive disturbances)

• Etiology and pathophysiology are unknown

• NO evidence of tissue inflammation

• Lab, radiology WNL

• PE normal (except for tenderness in 9 pairs of specific FM points on exam)

• ACR has preliminary diagnostic criteria



• Patient education

• Sleep hygiene

• Treat comorbids: mood, sleep disorders

• Exercise: aerobic conditioning, stretching, strengthening

• Med for pain: amitriptyline, duloxetine, pregabalin, others - ✔✔Fibromyalgia initial management?



1. Shoulder abducted 90 degrees



2. Shoulder is internally rotated and angled forward 30 degrees, thumb pointing to floor, then resist
(+) sign is pain/weakness - ✔✔Supraspinatus Test (Empty Can Test? checks for supraspinatus tear



impingement syndrome - ✔✔Hawkins Kennedy test checks for?



Rotator cuff tendinopathy (impingement syndrome) - ✔✔Anterolateral shoulder pain worsened by
reaching overhead

• Pain with supraspinatus testing

• Sub acromial bursa tenderness

• Normal passive ROM

• Normal strength, but pain with testing

• Impingement tests: Hawkins-Kennedy test

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