High Yield MSK Things Flashcards
What nerve root would be affected if the bicep reflex is not present?
C5
What nerve root would be affected if the brachioradialis reflex is not present?
C6
What nerve root would be affected if the tricep reflex is not present?
C7
What nerve root would be affected if the achilles reflex is not present?
S1
What nerve root would be affected if the patellar reflex is not present?
L4
What nerve root would be affected if the bulbocavernosus reflex is not present?
S2-4
A patient is having trouble abducting their shoulder and flexing their elbow. What nerve root is this?
C5
A patient is having trouble flexing their elbow and extending their wrist what nerve root is this?
C6
A patient is having trouble extending their elbow and flexing their wrist and extending their fingers. What nerve root is this?
C7
A patient is having trouble with finger abduction, adduction, and flexion. What nerve root is this?
C8
A patient is having trouble with foot dorsiflexion. What nerve root is this?
L4
A patient is having trouble with big toe extension. What nerve root is this?
L5
A patient is having trouble with anal sphincter tone. What nerve root is this?
S2-4
What are the risk factors for osteoporosis?
Caucasian/asian-smaller bone structure
smoking
malnutrition
decreased physical activity
Which cancers metastasize to the bone?
Breast
Lung
Thyroid
Kidney
Prostate
How is dermatomyositis diagnosed?
(not specific labs): ESR elevated, aldolase, creatinine kinase
Anti-mi
Anti-Jo
Anti-SRP
MRI
EMG
Muscle biopsy can be helpful but is not necessary
What are the seronegative spondyloarthritis? (negative for RF)
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
arthritis associated with IBD
undifferentiated spondyloarthropathy
key words for bone tumors
nidus <1.5 cm: osteoid osteoma but improves with NSAIDs, nidus >2 cm = osteoblastoma
osteochondroma = cartilage-capped projection
enchondroma = in bone marrow
chondroblastoma: well-defined with sclerotic border
fibrous dysplasia: ground glass appearance
ossifying fibroma: well-circumscribed intracortical
non-ossifying fibroma: small, well-defined, eccentric, lytic
unicameral bone cyst: fallen leaf
aneurysmal: eggshell or soap bubble
osteosarcoma: moth eaten
chondrosarcoma: endosteal scalloping
ewing: onion skin
SLE lab studies
anti-dsDNA and anti-Smith
(also anti-SSB and anti-SSA but shared with sjogren)
chondroblastoma mets
lungs (benign)
Work up for osteoblastoma
xray followed by CT to determine size and extent
management of torticollis
remove underlying etiology
conservative therapy with NSAIDs, benzos, or other muscle relaxants
botox injections if unresponsive to conservative
if failure of botox, surgical release of SCM, selective denervation, dorsal cord stimulation
OA does not cause an elevation in what?
ESR. It is not inflammatory
Diagnostic modality of choice for OA
Radiographs
Treatment of OA
assistive devices
exercise program
weight loss
acetaminophen
can use voltaren gel
meloxican
intra-articular steroids
surgery
hyaluronic acid
when would you treat gout
treat arthritis with NSAIDs and use colchicene when symptomatic
when would you use corticosteroids for gout?
acute attack
if contrainidcation to NSAIDs
can use intra-articular injection of triamcinolone
when would you use urate-lowering therapy for gout and what are the drugs
acute arthritis
tophaceous deposits
CKD
minimum below 6
allopurinol and uloric
when would you use probenacid for gout
when xanthine oxide inhibitor cannot be used or does not reach
don’t use if crcl <50 mL/min
Moa increase uric acid excretion by kidney
ra
inflammatory disease with synovitis of multiple joints
pathologic findings in RA
formation of a pannus
clinical presentation of RA
symmetrical swelling for 30 minutes in AM and may recur after inactivity
deformity in rheumatoid arthritis
boutonniere and swan neck
clinical presentation of ra
nodules correlate with RF in serum
ocular dryness and mucous membranes ILD pericarditis flety and small vessel vasculitis
most specific blood test for RA
anti-CCP
earliest radiographic changes in RA
hands and feet and soft tissue swelling
treatment of RA
DMARDs: methotrexate
sulfasalazine 2nd line
TNF i added if needed (mab and enbrel)
types of jia
oligoarticular
polyarticular
systemic
enthesitis-associated
mc type of jia
oligoarticular
symmetric or asymmetric jia
asymmetric four or fewer joints –> leg length discrepancy
symmetric five or more joints jia
polyarticular
fever evanescent salmon pink macular rash jia
systemic jia
inflammation of tendinous insertions in jia
enthesitis associated
also see low back pain and sacroilitis
is jia inflammatory?
yep
rf small percentage
anti-CCP antibody
positive aNA in late onset HLA B27 enthesitis
joint fluid for jia
elevated white cells and low glucose
diagnosis of jia
radiographs initially mri shows joint damage
treatment of jia
nsaids: naproxen, ibuprofen, meloxicam
dmards second line for failure of nsaids: methotrexate/tnf inhibitors if mtx not tolerated
cs for jia
reserved for severe involvement
can inject local triamcinolone
treatment of uveitis in jia
corticosteroid and dilating agents
methotrexate if treatment failure, cyclosporine, TNF i
rehab
highest rate of jia remission
oligoarticular
rf positive often continues into adulthood
seronegative spondyloarteritis associated with
HLA-B27
s/s of ankylosing spondylitis
worse in morningn stiffness for hours
improves with activity
lumbar curve flattes and thoracic urve exaggerates
can see sausage swelling and enthesopathy in 50%
anterior uveitis
constitutional symptoms absent
diagnostics of ankylosing spondylitis
elevated esr
rf and anti-ccp negative
hla-b27
anemai
imaging of as
shiny corneer
bamboo spine
bilateral and symmmetric later
treatment of as
nsaids
tnf i for nsaid resistant
don’t use corticosteroids!
s/s psoriatic arthritis
RA symmetric
oligoarticular destruction
dip primarily affected
arthritis mutilans
spondylotic form hla b27 positive
nail pitting
sausage swelling
labs for psoriatic arthriits
increased esr rf neg
imaging of pa
sharpened pencil
treatment of pa
nsaids
methotrexate if no response
tnf i if refractory
reactive arthritis
urethritis
conjunctivitis
uveitis
mucocutaneous lesions
hlab27
in reactive arhtiritis
asymmetric of large weight-bearing joints
s/s reactive arthritis
stomatitis
keratoderma blennorhagicum
diagnostic rea a
inflammatory sync=ovial fluid
radiographic permanent or progressive joint disease
treatment of rea a
nsaids
prevent by treating std\
sulfasalazine, methotrexate if poor response
anti-tnf if refractory
peripheral arthritis in ibd
parallels bowel disease
spondylitis in ibd
independent of bowel disease
treatibd arthritis
control ibd
nsaids for spondylitis
dmards
corticosteroids
s/s gonococcal arthritis
migratory polyarthralgia
purulent monoarthritis
fever
ankles, feet, toes
few have GU symptoms
diagnostic of gonococcal
wbc elevated
urethral, throat, cervical, and rectal cultures
plain radiographs normal
treatment of gonococcal arhtritis
hospital admission with antibiotics ceftriazond and azithromycin
anti-dsdna and anti-smith
sle
anti-histone
drug induced
anti-mi-2
anti-jo
anti-srp
derm
derm/poly
derm/poly
anti-centromere
crestan
anti-ssa/ssb
sle/sjogren
anti-scl 70
systemic sclerosis
p-anca
sle, sjogrens, polymyositis
c-anca wga eg
procainamide and hydralazine increase risk for
sle`
sle treatment med thats all over the place
sle
