11 - 74 yo F with knee pain

Question 1

hemarthrosis with fat globules could be due to _________

Answer 1

osteochondral fracture

Question 2

a simple joint effusion produces what color of fluid? what are some possible causes of a simple joint effusion?

Answer 2

• clear, straw colored transudate

- osteoarthritis, degenerative meniscal injuries

Question 3

what are the 3 main side effects of NSAIDs?

Answer 3

• GI upset
• decrease effectiveness of HTN meds
• increase effect of sulfonylureas

Question 4

what is the USPSTF recommendation for AAA?

Answer 4

MEN ONLY 65-75 who have any history of smoking

Question 5

gout has what type of rods in the aspirate?

Answer 5

negatively birefringent rods

Question 6

pseudogout has what type of rods in the aspirate?

Answer 6

positively birefringent rhomboids

Question 7

joint stiffness, typically worse after effort?

Answer 7

osteoarthritis

Question 8

joint stiffness for more than 30 minutes in the morning?

Answer 8

RA

Question 9

ankylosing spondylitis is associated with what HLA haplotype?

Answer 9

HLA-B27

Question 10

what is a merchant’s view? what is its role?

Answer 10

• “top” view of the kneww obtained with the knee bent at a 45 degree angle, showing alignment of the patella in the groove of the femur
• helps evaluate the patellofemoral joint

Question 11

what are the major radiographic features (4) of OA?

Answer 11

• joint space narrowing
• subchondral sclerosis (hardening of tissue beneath cartilage. in OA there is increased periarticular bone density)
• osteophytes (spurs)
• subchondral cysts (fluid filled sacs in bone marrow)

Question 12

what is the diagnostic test of choice for carpal tunnel syndrome?

Answer 12

EMG

Question 13

what is the first choice analgesic for both short and long term treatment of mild to moderate pain related to OA? why? what is the max allowable dosage?

Answer 13

• acetaminophen
• tolerability and low side effect profile
• max dosage up to 4g per day in divided doses

Question 14

TCA antidepressants carry what type of side effect profile?

Answer 14

anticholinergic - dry mouth, constipation, urinary retention, blurred vision, paralytic ileus

Question 15

carbamazepine (tegretol) can interfere with other medication through what system?

Answer 15

cyp450 (inducer)

Question 16

what is the MOA of tramadol?

Answer 16

centrally acting analgesic with effects on:

• u-opioid receptor
• serotonin release (stimulates)
• inhibits reuptake of NE