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Rheum or things that look like rheum > Joint and muscle probs > Flashcards

Joint and muscle probs Flashcards

1
Q

Parvo B19 in adults

A

Instead of slapped check, just has nonspecific rash

And polyarticular, symmetric arthritis in peripheral joints

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2
Q

Caribbean/West African mosquito
Always severe polyarthralgias
Low WBC and PLT

A

Chikungunya fever

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3
Q

Red/purple papules on dorsum of fingers (or upper eyelids)
Symmetrical, proximal muscle weakness
Polyarthritis, interstitial lung disease, Raynauds, esophageal dysmotility

A

=Gottron papules (=Heliotrope eruption)

Dermatomyositis (paraneoplastic
Inflammatory myopathy with immune-mediated muscle injury)

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4
Q

Knee injury: popping sounds, followed by acute pain

A

Meniscal tear

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5
Q

Patient stands on 1 leg with knee flexed 20 degrees, patients then rotates on flexed knee
-> pain, clicking or catching

A

Meniscal tear (Thessaly test)

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6
Q

Passive knee flexion and extension while holding knee in internal or external rotation
-> pain, clicking or catching

A

Meniscal tear (McMurray test)

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7
Q

Pain at anterior medial knee

No effusion or knee locking

A 
Anserine bursitis (pes anserinus syndrome)
From chronic overuse injury
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8
Q

Pain at outside of knee

No effusion or locking

A

Iliotibial band syndrome (chronic overuse injury)

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9
Q

Treatment of stress fractures

A

Rest and analgesics

If fifth metatarsal -> increased risk for nonunion -> more aggressive tx

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10
Q

Acute mono articular arthritis that progress to max intensity within 12-24hr

A

Gout

Triggered by alcohol, surgery/trauma, dehydration, meds (diuretics)

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11
Q

Delayed fontanel closure
Ping-pong ball skull, Enlarged skull, enlarged costochondral joints
Genu varum

A

=Craniotabes, frontal bossing, rachitic rosary

Rickets!

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12
Q

Bone or joint pain, fractures

Increase in hat size, headaches, or hearing loss

A

Paget disease of bone
(Osteoclasts dysfunction -> increased bone turnover -> enlarging cranial bones -> entrapment of CN 8 or encroachment on cochlea)

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13
Q

Back pain that gets worse with rest, better with activity

A

Inflammatory (spondyloarthropathy)
eg ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with IBD

Inflammation is at ligamentous insertions (enthesitis)

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14
Q

Back pain worse at night, not relieved with rest

A

Cancer

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15
Q

Back pain relieved by leaning forward (“shopping cart sign”)

A 
Spinal stenosis
(pseudoclaudication- leg pain from nerves)
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16
Q

Back pain -> radiation below the knee, positive straight leg test, neuro deficits

A

Radiculopathy (eg herniated disk)

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17
Q

Back pain -> normal neuro exam, paraspinal tenderness

A

Mechanical (muscle strain, disc degeneration)

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18
Q

Tx for rheumatoid arthritis

A

Start with methotrexate

If persistent sx for >6mo
Add step-up therapy (eg TNF inhibitor like infliximab or etanercept)
or parallel therapy (sulfasalazine, hydroxychloroquine)

NSAIDs are adjunctive tx but don’t affect progression

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19
Q

Recurrently high fevers
arthritis/arthralgias
salmon-colored macular/maculopapular rash

A

Adult Still disease

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20
Q

Lupus markers

A

ANA- sensitive, nonspecific
first test to get!

anti-dsDNA - more specific, can confirm dx

21
Q

anti-scl70 (anti-topoisomerase)

A

systemic sclerosis (scleroderma)

22
Q

cyclic citrullinated peptide antibodies (anti-CCP)

A

RA

23
Q

Joints involved in RA

A

Spares DIP
Most commonly cervical spine
Worse in morning

24
Q

Rapid onset of pain and swelling
Popping sensation
Hemarthrosis

A 
ACL injury
(Note that MCL injury usually doesn’t cause hemarthrosis)
25
Q

Lupus, esp on steroids
Decreased ROM in joint, pain
No erythema or swelling

A

Avascular necrosis

Get MRI!!

26
Q

Fibromyalgia vs. polymyositis vs polymyalgia rheumatica

A

Fibromyalgia: widespread pain with normal labs

Polymyositis: weakness, NO PAIN, elevated CK, anti-Jo. Dermatomyositis is the same but with heliotrope rash, shawl sign, Gottron papules on backs of hands

Polymyalgia rheumatica: STIFFNESS and pain. elevated ESR, CRP. associated with temporal arteritis. tx with steroids.

27
Q

Drug for RA causing macrocytic anemia

A

methotrexate (inhibits DHFR)

28
Q

Headache, jaw claudication, muscle fatigue, visual disturbance, Scalp tenderness, decreased temporal artery pulse. ESR >50

Complication?

A

Giant cell arteritis

Complication: aortic aneurysm. Follow with serial X-rays!

29
Q 
Recurrent painful oral aphthous ulcers
Genital ulcers
Uveitis, 
Skin (erythema nodosum)
Pathergy: exaggerated ulcerating skin response after minor injuries
thrombosis
A

Behcets

Note: oral ulcers in SLE are NOT painful

30
Q

Point tenderness at muscle insertion points and bony prominences

tx?

A

fibromyalgia

first line tx: tricyclic (amitriptyline)
others: pregabalin, duloxetine, milnacipran)

31
Q

hydroxycloroquine for SLE can cause what

A

retinopathy

32
Q

Gout vs pseudogout

A

Gout uric acid crystals are needle-shaped, neg birefringent, and first affect big toe. Middle aged binge-drinking makes. Prevent with allopurinol (decreases production). or probenicid (increases secretion). Treat accutely with NSAIDS or colchicine.

Pseudogout CPPD (calcium pyrophosphate dehydrate) crystals are rhomboid shaped, pos birefringenet, and first affect wrists and knees. Assoc with hemochromatosis, hyperPTH

33
Q

Ankylospondylitis

A

Fused sacroiliac joints. Squaring of lumbar vertebrae. Bamboo spine.

+HLA-B27
Elevated ESR, CRP
Negative RF, negative ANA.

Tx: NSAIDs
TNF inhibitors or sulfasalazine for refractory cases.

34
Q

Anti-Jo

A

polymyositis, dermatomyosis

35
Q

Anti-CCP

A

RA

36
Q

anti-histone

A

drug-induced lupus

37
Q

anti-mitochondrial

A

PBC

38
Q

anti-SCL70

A

systemic sclerosus (scleroderma, non-CREST)

39
Q

anti-Sm

A

lupus

40
Q

anti-smooth muscle

A

autoimmune hepatitis

41
Q

anti-topoisomeriase

A

systemic sclerosus

42
Q

anti-U1RNP

A

mixed connective tissue dz

43
Q

SANTA

Splenomegaly
Arthritis (rheumatoid)
Neutropenia
Thrombocytopenia
Anemia
A

Felty syndrome

RA + pancytopenia + splenomegaly

44
Q

anticentromere

A

CREST

45
Q

anti-Ro

A

neonatal SLE

46
Q

Treatment of lupus

A

Mild joint symptoms: NSAIDs
Acute exacerbations: corticosteroids

Isolated skin and joint involvement: hydroxychloroquine
Severe cases of lupus nephritis: cyclophosphamide

47
Q

What is Libman-sacks endocarditis?

A

Noninfectious vegetations on mitral valve

Associated with SLe and antiphospholipids

48
Q

Fibromyalgia treatment

A

Tx SSRIs

49
Q

Predisposition to osteonecrosis of femoral head

And definitive tx?

A

Steroid use, alcohol, SLE

Hip replacement is definitive tx

Rheum or things that look like rheum (1 decks)

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