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ortho/rheumatology > LA musculoskeletal 1 > Flashcards

LA musculoskeletal 1 Flashcards

comparment, osteomyelitis, OA, RA, septic arth

1
Q

pain out of proportion to injury. exam: pain with passive stretching.

A

compartment syndrome

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2
Q

PE: pulselessness, pallor, dec sensation. Capillary refill preserved

A

.compartment syndrome

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3
Q

DX compartment syndrome

A

intracompartmental pressure >30 mm Hg or delta pressure <20-30. increased creatinine kinase & myoglobin.

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4
Q

organisms in chronic osteomyelitis

A

s. aureus, staph epidermis, grm neg pseudomonas. e coli

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5
Q

chr osteomyelitis tx

A

surg debridement and cultures

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6
Q

Xr: soft tissue swelling, sequestrum(segments of necrotic bone that has become separated from nml bone),

Involucrum: new periosteal bone formation that surrounds necrotic bone(sequestrum).

A

chr osteomyelitis

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7
Q

common site for acute osteomyelitis

A

femur and tibia. Vertebra in adults.

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8
Q

R/F: sickle cell ds, DM, immunocompromised

A

acute osteomyelitis

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9
Q

common spreading source of acute osteomyelitis

A

acute hematogenous spread: common in children. Direct inoculation.

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10
Q

organisms in acute osteomyelitis
1) most common
2) coagulase neg
3) pathognomic for sickle cell ds
4) neonates
5) assoc with puncture wounds thru tennis shoes

A

1) most common: st. aureus
2) coagulase neg: st. epidermis
3) pathognomic for sickle cell ds: salmonella
4) neonates: group B strep
5) assoc with puncture wounds thru tennis shoes: pseudomonas aeruginosa

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11
Q

acute osteomylitis
1( labs)
2. most sensitive test
3. gold standard

A
  1. CRP more useful. get ESR, WBC inc.
  2. MRI
  3. bone aspiration
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12
Q

herberden node

A

DIP enlargement

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13
Q

bouchard node

A

PIP enlargement

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14
Q

felty syndrome

A

RA + splenomegaly + neutropenia

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15
Q

Caplan syndrome

A

RA + pneumoconosis + pulmonary nodules

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16
Q

RA
1) best Initial test
2) specific test

A

1) RF
2) anti-cyclic citrullinated peptide antibodies

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17
Q

initial DMARD in RA pts

A

methotrexate

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18
Q

septic arthritis tx
1) empiric
2) gm + cocci
3) gm neg cocci or gonococcus
4) gm neg rods

A

1) ceftriaxone + vanco (+/- p=anti-pseudomonas suspected)
2) vanco. naficillin (If MSSA suspected)
3) ceftriaxone. or ceftotaxime, ceftazidine, FQ
4) ceftazidime + gentamycine. cipro alternative if needed.

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19
Q

rf for hip dysplasia

A

breech, 1st born, female, FH

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20
Q

Barlow manuever

A

gentle adduction w/out downward pressure to feel for dislocation, resulting in a click.

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21
Q

ortolani manuever

A

abduction and elevation to feel for reducibility, resulting in a click

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22
Q

hip dysplasia management < 6 months of age

and 6 mnths-2 years

A

pavlik harness

closed reduction in OR

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23
Q

in infants > 3months, hip dislocation can be fixed and what test can be used instead

A

Galeazzi

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24
Q

pelvic fx may have ecchymosis where on exam

A

perineal

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25
Q

hip dislocations is most common where

how do they present

A

posterior from axial loading on an adducted femur.

hip pain with leg shortened, IR, adn adducted with hip/knee slightly flexed.

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26
Q

Hip XR of anterior and posterior dislocations

MC type

A

anterior: femoral head appears larger and femur appears abducted

posterior(MC): femoral head appears smaller than contralateral side and femur appears adducted.

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27
Q

complications of hip dislocations

A

AVN if not closed by 6 hrs and sciatic nerve injury.

anterior: femoral nerve most commonly injured nerve

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28
Q

3 types of hip fractures

intra/extracapsular

AVN incidence

A

1) femoral neck (higher incidence of AVN), intracapsular
2) intertrochenteric-extracapsular
3) subtrochanteric-extracapsular

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29
Q

PE of hip fracture

A

pain with leg shortened, abducted, and ER

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30
Q

legg-calve-perthes disease

A

idiopathic Avascular osteonecrosis of femoral head in kids d/t to ischemia of capital femoral epiphysis.

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31
Q

rf for legg-calve-perthes disease

decreased rf

A

4-10 yo. 4 x more common in males, obese, coag abnormalities

blacks dec rf

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32
Q

painless limping for weeks. worse with continued activity esp at the end of the day

A

legg-calve-perthes disease

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33
Q

ROM of legg-calve-perthes disease

PE exam sign

A

loss of abduction and IR

crescent sign (microfx with collapse of bone)

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34
Q

crescent sign

A

legg-calve-perthes disease

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35
Q

tx for legg-calve-perthes disease

A

NonWB initially. self limiting w/in 2 yrs with revascularization.

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36
Q

what is slipped capital femoral epiphysis

A

displacement of the femoral head(epiphysis) from femoral neck through the growth plate

PAINLESS limping

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37
Q

RF for slipped capital femoral epiphysis

A

8-16 yo, obese, black, males during adolescent growth spurt

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38
Q

what if slipped capital femoral epiphysis is seen in children before puberty

A

suspect hormonal or systemic d/o

eg: hypothyroidism, hypopituitarism

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39
Q

hip, groin, or knee pain with a painful limp & worse with activity

A

slipped capital femoral epiphysis

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40
Q

PE of slipped capital femoral epiphysis

A

ER leg on affected side. (limited IR abduction and flexion on ROM of hip)

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41
Q

slipped capital femoral epiphysis XR

A

posterior displacement of femoral epiphysis.

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42
Q

knee(tibia-femoral) dislocations: vascular complication

A

popliteal artery injury 1/3 of pts: must perform arteriography or arterial duplex if pulses diminished or absent. If ABI >0,9, serial exam can performed. If < 0.9, perform arteriography or arterial duplex.

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43
Q

knee(tibia-femoral) dislocations neurological complication

A

peroneal(MC) or tibial nerve injuries

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44
Q

fx from axial loading from a tall height

complications

A

femoral condyle fx

peroneal nerve: foot drop or
popliteal artery injury

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45
Q

plateau most common with lateral plateau fx

complication

A

lateral.

often assoc with LMT(MC) and ligament.

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46
Q

noble test

A

positive if pain over distal IT band at 30 degrees of knee flexion with pressure applied to ITB

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47
Q

ober test

A

pain or resistance to adduction of leg parallel to the table in neutral position.

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48
Q

MC lateral ankle sprain

main stablilizer of ankle during inversion

A

ATFL.

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49
Q

Talar tilt test assesses what

A

Calcaneofibular ligament

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50
Q

ottawa ankle rules

pain along lateral malleolus

A

navicular(midfoot) pain-foot film

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51
Q

ottawa ankle rules

pain along medial malleolus

A

5th metatarsal pain- foot film

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52
Q

thompson test

A

+ if weak, absent plantar flexion when gastrocnemius is squeezed

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53
Q

how to splint an achilles tendon rupture

A

in mild planar flexion(resting equinus) with subsequent splinting employing gradual dorsiflexion toward neutral

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54
Q

anyone with a distal ankle fracture shoud have what performed

A

proximal films to rule of Maisonneuve fx

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55
Q

Maisonneuve fx

A

spiral fx of proximal third of fibular assoc with distal medial malleolar fx or rupture of deep deltoid ligament

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56
Q

what is a fx of the distal tibia from impact with the talus, interrupting the ankle joint space. Fx extends into the ankle jt

what kind of load caused this

A

Pilon (tibial plafound)

axial load from talus

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57
Q

what is a fx due to overuse or high impact activities. Females at increased risk.

what bones are commonly involved

A

stress/march fx

3rd metatarsal MC

usually metatarsals, tib/fib, navicular bones

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58
Q

s/s of march/stress fx

A

localized pain/swelling/TTP that increases with activity

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59
Q

high risk areas for fractures LE

A

prox 4 or 5th metatarsal, navicular, talus, patella

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60
Q

get xrays for showing a stress fx?

A

50% will be negative

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61
Q

plantar fasciitis common in who

A

females, 40-60, obese

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62
Q

describe plantar fasciitis s/s

A

inferior heel pain(often sharp) usually worse after period of rest(or 1st few steps in the am). pain dec during day with gradual wb.

pain may return at night

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63
Q

plantar fasciitis pain increases with what motion

A

dorsiflexion of toes

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64
Q

tinel sign

A

tapping at tarsal tunnel(post med malleolus) to reproduce symptoms of post tibial nn compression

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65
Q

describe tarsal tunnel syndrome

A

alternating pain/numbness at medial malleolus, heel, & sole. pain increases throughout the day, worse at night, with dorsiflexion, and pain does not improve with rest.

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66
Q

test for tarsal tunnel syndrome

tx

A

electromyography

rest/nsaids, propertly fitted shoes

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67
Q

pes planus

A

flat feet

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68
Q

hammer toe

A

deformity of PIP jt:
flexion of PIP and hyperextension of MTP and DIP

TTP to PIP

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69
Q

joint damage and destruction as a result of peripheral neuropathy from DM, PVD

A

neuropathic Charcot arthropathy

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70
Q

neuropathic Charcot arthropathy is from what dysfunction and repetitive _____ that leads to bone _____ and ________

A

autonomic

microtrauma,

resorption and weakening

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71
Q

neuropathic Charcot arthropathy affects the what parts? _______ arthritis can be seen with ______ & _____.

A

midfoot and ankle.
Neuropathic
DM & tabes dorsalis

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72
Q

neuropathic Charcot arthropathy

describe acute and chronic presentation

A

acute: erythmatous, swollen, TTP, warm

chronic: jt or foot deformity, alteration of shape of foot, ulcer/skin changes

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73
Q

what will the XR of neuropathic Charcot arthropathy show

tx

A

obliteration of the joint space, disorganization of the bone

rest, NWB, better footwear

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74
Q

obliteration of the joint space, fragmentation of the bone, inc bone density, disorganization of the bone

A

neuropathic Charcot arthropathy

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75
Q

neuropathic Charcot arthropathy labs and when to order MRI/bone scintigraphy

A

elev ESR. WBC and crp nml

to rule out osteomyelitis

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76
Q

morton’s neuroma involves which nerve

A

2nd or 3rd interdigital nerve between the metatarsal heads

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77
Q

morton’s neuroma risk factors

A

women 25-50 yo wearing tight fitting shows, high heels, or have flat feet

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78
Q

high heels tend to do what to your feet

A

over pronate

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79
Q

morton’s neuroma commonly occurs where

A

between 3rd and 4th metarsals. it will be on the 3rd metatarsal.

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80
Q

Mulder’s sign

A

clicking sensation when palpating involved interspace while simultaneously squeezing metatarsal joints

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81
Q

morton’s neuroma dx testing

tx

A

clinical. u/s or MRI

metatarsal support/pad, broad toe shoes with firm soles 1st line. injection later if needed.

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82
Q

surg for morton’s neuroma?

A

surg last due to complications of permanent numbness or residual stump.

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83
Q

jts affected with RA and OA

A

RA: wrists, MCP, PIP
spares DIP

OA: DIP, thumb(CMC)

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84
Q

stiffness with RA and OA

nodes

A

RA: worse after rest, morning stiffness over 60 min. No heberden nodes

OA: worse after effort, evening stiffness, morning stiffness under 60 min

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85
Q

jones fx is a ___ fx through the ____ of the ____ metatarsal at the ___ -diaphyseal junction

A

transverse diaphysis 5th

metaphyseal

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86
Q

jones fx tx

A

NWB short leg cast 6-8 weeks followed by repeat xrays due to risk of nonuntin or malunion

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87
Q

what a pseudojones fx? tx?

A

transverse avulsion fx through the base of the 5th metatarsal(tuberosity)

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88
Q

triad with eosinophilic granulamatosis with polyangitis

A

asthma + eosinophilia + chr rhinosinusitis

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89
Q

PAN increased assoc with wHAT

A

hep B and C

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90
Q

Lisfranc fx injury what 3 bones

A

1st, 2nd, 3rd metatarsal heads and their respective cuneiforms

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91
Q

tarsometarsal fx/dislocation

look for what on xray

A

lisfranc

fleck sign

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92
Q

fleck sign

A

fx at base of 2nd metatarsal pathognomic for lisfranc fx.

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93
Q

lisfranc tx

A

ORIF then NWB 12 weeks

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94
Q

discuss torus/buckle fx

A

incomplete fracture with bowing of metaphyseal-diaphyseal junction due to axial loading

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95
Q

what is the most common primary bone malignancy in kids and young adults

A

osteosarcoma

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96
Q

osteosarcoma usually occur where?
most common mets where?

pain worse when?

A

long bones(distal femur MC)

lungs
at night

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97
Q

codman’s triangle, hair on end on xray

A

osteosarcoma

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98
Q

common sites for chondroscarcoma

A

proximal femur, pelvic bones, proximal humerus

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99
Q

punctate or ring& arc appearance on XR

A

chondrosarcoma

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100
Q

ages of osteosarcoma,
chondrosarcoma, and
ewings sarcoma

A

osteosarcoma under 20 y/o (80%)

chondrosarcoma (40-75 yo)

ewings sarcoma (5-25 y/o)

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101
Q

what is the 2nd most common primary bone malignancy in kids and young adults?

A

ewings sarcoma

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102
Q

what is due to translocation of chromosomes 11 and 22

A

ewings sarcoma

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103
Q

ewings sarcoma most common site

A

50% in long bones (femur MC),
pelvis, tibia, fibular, pelvis

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104
Q

ewings sarcoma s/s

A

bone pain and systemic symptoms

105
Q

codman triangle and onion skin

A

ewings sarcoma

106
Q

histology: sheets of monotonous small round blue cells. May have pseudo-rosettes

A

ewings sarcoma histology

107
Q

most common benign bone tumor

A

osteochondroma

108
Q

what is pedunculated and grows AWAY from the growth plate on xray

A

osteochondroma

109
Q

osteochondroma ages

A

10-20 yo

110
Q

what produces a high level of prostaglandins?

A

nidus from osteoid osteoma

111
Q

fibromyalgia dx how

A

tenderness in at least 11 out of 18 trigger points + chronic pain > 3 months

112
Q

fibromyalgia medication tx

A

TCA(amitripyline) if not responsive to conservative measures.

SSNI 2nd line: duloxetine.

Pregablin approved for fibromyalgia(esp for sleep)

113
Q

what is polymyalgia rheumatica

assoc with what

A

idiopathic inflammation of joints, bursa, tendons

assoc with giant cell arteritis

114
Q

polymyalgia rheumatica s/s

PE

A

pain and stiffness in proximal muscles/joints, worse in morning >2weeks.

NML muscle strength; maybe decreased ROM

115
Q

trouble combing hair and rising from a chair

tx

A

polymyalgia rheumatica

low dose corticosteroids.

methotrexate alternative

116
Q

rhabdomylosis patho

A

myoglobin from muscle breakdown is extremely toxic to renal tubular cells leading to acute tubular necrosis

117
Q

triad: muscle pain, muscle weakness, dark tea colored urine

A

rhabdomylosis

118
Q

rhabdomylosis workup

include muscle enzyme

and electrolytes

A

EKG most important first test to look for hyperkalemia

urine dipstick & UA next: + for heme but negative for RBCs.

urine myoglobin most specific test.

muscle enzymes: increased creatinine phosphokinase > 20,000, inc LDH,AST, ALT

electrolytes: hyperkalemia, hyperuricemia, HYPOcalcemia, HYPOphospatemia, inc creatinine classic

119
Q

rhabdomylosis tx

A

IV fluids 1st line with target urine output 0.5-1.0.

osmotic diuretic: mannitol or NA bicarb(alkalinization of urine).

hyperkalemia: calcium gluconate(stabilize cardiac membranes). insulin w/ glucose(shifts K++ intracellularly)

120
Q

polymyositis affects what muscles

ages?

A

proximal limbs, neck, pharynx.

may affect heart, lungs, GI

30-50

121
Q

inflammatory myopathy due to CD8+ lymphocyte infiltration of the endomysium

A

polymyositis

122
Q

polymyositis and dermatomyositis same s/s

A

progressive SYMMETRIC proximal muscle weakness.

difficulty combing hair, rising from chair, stairs

systemic and constitutional sx too

123
Q

rash with polymyositis or dermatomyostitis

A

dermatomyostitis

124
Q

best initial test for polymyositis

definitive test

A

inc muscle enzymes (CK and adolase)

muscle bx (D)

anti Jo and anti-signal recognition protein

125
Q

anti Jo and anti-signal recognition protein

A

best initial test for polymyositis

anti Jo: myositis specific antibody often assoc with interstitial lung fibrosis and mechanic hands- hyperkerototic palms with dirty appearance.

anti-signal recognition protein most specific for polymyositis

126
Q

inc ESR, CRP and RF. Normocytic and normochromic anemia. inc muscle enzymes

A

think polymyositis or dermatomyositis

127
Q

polymyositis tx

A

high dose glucocorticoids

128
Q

main difference between polymyositis and polymyalgia rheumatica

A

polymyositis has decreased muscle strength

polymyalgia rheumatica has normal muscle strength, no objective weakness. nml muscle enzymes

129
Q

anti Jo in what disorders

A

polymyositis and dermatomyositis

130
Q

polymyositis and dermatomyositis;
which assoc with cancer

A

dermatomyositis has 25% chance

131
Q

dermatomyositis affects what

A

proximal limbs, neck, and pharynx; may affect heart, lungs, GI

131
Q

inflammatory myopathy due to CD4+ lymphocyte infiltration of the perimysium (perivascular involvement)

A

dermatomyositis

132
Q

Gottrons papules, shawl sign, heliotrope rash

A

dermatomyositis

gottron: raised scaley patches on dorsum of fingers

heliotrope: blue purple discoloration of upper eyelids (pathognomonic)

133
Q

pathognomonic for dermatomyositis

A

heliotrope rash

134
Q

anti Jo and anti-Mi2

A

dermatomyositis

anti Mi2: most specific

135
Q

muscle bx shows:

1) endomysial inflammation

2) perifasicular and perivascular inflammation

A

1- polymyositis

2-dermatomyositis

136
Q

dermatomyositis tx

A

glucocorticoids high dose 1st line.

hydroxychloroquine for skin lesions.

137
Q

SLE is a type ____ hypersensitivity reaction (Ag-Abimmune complexes)

population

A

type 3

young females, blacks, hispanics, native american. sun exposure, estrogen, genetic

138
Q

SLE triad

A

joint pain, fever, malar rash (sparing nasolabial folds)

139
Q

discoid lupus presentation

A

annular, erythematous patches on face and scalp that HEAL with scarring

140
Q

SLE screening test of choice

pathognomonic

A

ANA (anti nuclear antibodies)

anti double stranded DNA and anti-smith

141
Q

SLE anemia? complement levels?

dangers of antiphospholipid levels

A

pancytopenia, decreased C3 and C4

increased risk of arterial and venous thrombosis

142
Q

belimumab

A

for SLE unresponsive to glucocorticoids

143
Q

SLE mild tx

A

hydroxycholoroquine w/ or w/out NSAIDs

144
Q

main drugs that can induce lupus

A

hydralazine, procainimide, INH, quinidine,

145
Q

drug induced lupus has nml SLE symptoms except what

A

alopecia, hematologic, kidney injury, or CNS symptoms

146
Q

hallmark for drug induced lupus

A

anti-histone antibodies, +ANA
No anti double stranded DNA antibodies

147
Q

antiphospholipid syndrome can occur as primary disease or with what

A

SLE

148
Q

antiphospholipid syndrome patho and triggers

A

autoantibodies activate complement mediated thrombosis

smoking, prolong immobilization, estrogen, malignancy, hyperlipidemia, HTN

149
Q

livedo reticularis, valvular heart ds, neurologic sx

increased risk for arterial and venous thromboses

A

antiphospholipid syndrome

150
Q

anticardiolipin antibodies, lupus anticoagulant, inc PTT, failure to correct PTT after mixing blood with plasma

A

antiphospholipid syndrome

151
Q

prolonged russell viper venom test

A

for lupus anticoagulant. need 2 + results 12 weeks apart.

antiphospholipid syndrome

152
Q

sjogren syndrome affects what glands? idiopathic?

gender age

A

exocrine

autoimmune

women 40-60

153
Q

primary and secondary sjogren syndrome

A

primary occurs alone.

secondary occurs with other autoimmune do

154
Q

sjogren syndrome s/s

A

dry mouth, dry eye, vaginal dryness, bil parotid gland enlargement, dental caries

155
Q

screening tests for sjogren syndrome

tear test

def test

A

ANA, especially antiSS-A (Ro) and antiSS-B (La)

schirmer test: decreased production

lip or parotid gland bx: fibrosis and lymphocytic infiltration

156
Q

rose bengal stain: abnormal cornea epithelium, +RF, anemia, leukopenia

A

sjogren syndrome

157
Q

what drugs can lead to increases secretions

A

cholinergic: pilocarpine or cevimeline

158
Q

pilocarpine for what disorders?

SE: SLUDD-C

A

sjogren syndrome and acute angle closure glaucoma

salivation, lacrimation, urination, defecation, digestion, constriction of pupil

159
Q

scleroderma, collagen deposits where

gender age

A

skin, internal organs (lung, heart, kidney, GI)

women 30-50

160
Q

CREST

A

limited scleroderma s/s (80%)
*spares the trunk

Calcinosis cutis
Raynauds
Esophageal motility do
Sclerodactyly(claw hand)
Telangiectasias

161
Q

diffuse scleroderma s/s

A

(20%) tight, shiny, thickened skin involving trunk and proximal extremities. assoc with greater internal organ involvement (restrictive lung disease due to pulm fibrosis, myocardial fibrosis)

162
Q

anti-centromere antibodies and
anti-SCL-70 antibodies (anti-topoisomerase)

A

scleroderma

anti-centromere antibodies(limited)
and
anti-SCL-70 antibodies (anti-topoisomerase)- diffuse; poorer prognosis

163
Q

ANA in scleroderma

A

nonspecific but + in 90% pts with scleroderma

164
Q

scleroderma tx is organ specific

GERD
HTN renal disease
Raynaud
Severe
pulm fibrosis
pulm htn

A

GERD: PPI
HTN renal disease: ACE
Raynaud: vasodilators CCB, prostaglandin
Severe: DMARDs, cyclophosphamide
pulm fibrosis: cyclophosphamide
pulm htn: sildenafil, bosentan, prostacyclin

165
Q

Behcet’s syndrome poplulation

A

autoimmune

asian, middle eastern, mediterranean

20-40

166
Q

recurrent painful oral and genital ulcers, erythema nodosum, uveitis, CNS involvement(mimic MS)

A

Behcet’s syndrome

167
Q

Bx: leukocytoclastic vasculitis or lymphocytic vasculitit. Inc ESR, CRP, leukocytes

A

Behcet’s syndrome

168
Q

Pathergy: sterile skin papules or pustules from minor trauma.

A

Behcet’s syndrome

169
Q

Takayasu arteritis affects what part of body

A

aorta and its primary brances (arch and pulm arteries)

170
Q

Takayasu arteritis vessel symptoms

A

lower extremity claudication

171
Q

Takayasu arteritis PE

A

bruits, diminished pulses, asymmetric BPs, sx of PAD

172
Q

Takayasu arteritis dx and tx

A

angiography (MRA or CTA)

tx: high dose corticosteroids

173
Q

Kawasaki syndrome affects what vessels

population

A

medial and small vessel necrotizing vasculitis including the coronary arteries.

kids <5 y/o usually. boys and asians

174
Q

Kawasaki syndrome tx

A

IV immunoglobulin and aspirin

175
Q

Kawasaki syndrome s/s

Warm and CREAM

A

fever > 5 days

conjunctivitis
rash
extremity changes: edema, erythema,
desquamation of palms/soles
adenopathy(cervical)
mucositis(strawberry tongue)

176
Q

polyarteritis nodosa affects what vessels

increased assoc with what

A

medial sized vessels; commonly renal, CNS, GI

pulm vessels not involved

chronic hep B and C

177
Q

type 3 hypersensitivity rxn leads to ischemia and microanerysms of affected vessels.

men 40-60 yo

A

polyarteritis nodosa

178
Q

S/S: HTN(due to renal artery stenosis), pain worse with eating, myalgias, mononeuritis complex, ~foot drop, livedo reticularis, purpura

no glomerulonephritis

A

polyarteritis nodosa

179
Q

polyarteritis nodosa on labs is ___ neg

A

ANCA

180
Q

polyarteritis nodosa imaging and diagnostic test

A

renal or mesenteric angiography: micronaneurysms with abrupt cut off (beading)

biopsy: necrotizing vasculitis and NO granulomas

181
Q

churg strauss (eosinophilic granulamatosis with polyangitis)
triad and hallmark

A

asthma, eosinophilia, chronic rhinosinusitis

P ANCA +
bx: definitive

182
Q

Wegener’s (granulomatosis with polyangitis)
triad

A

upper resp tract + lower resp tract + GLOMERULONEPHRITIS

183
Q

Wegener’s (granulomatosis with polyangitis) best initial test and bx

A

C-ANCA+

lung usually. large necrotizing granulomas

184
Q

tx for wegeners and microscopic polyangitis

A

glucocorticoids plus cyclophosphamide

185
Q

microscopic polyangitis assoc with what vessels? not assoc with what?

A

small and medium vessel vascultitis; capillaries

nasopharyngeal symptoms, necrosis, granulamotous inflammation.

186
Q

microscopic polyangitis main symptoms

A

palpable purpur, cough/hemoptysis, rapidly progressive acute glomerunephritis

187
Q

microscopic polyangitis lab and bx

A

+P-ANCA
Bx: non granulomatous inflammation

188
Q

henoch schonlein purpura is what

occurs when

population

A

acute systemic IgA mediated small vessel vasculitis

90% occur in kids (3-15 yo)

occurs after a URI

189
Q

henoch schonlein purpura s/s

HSPA

A

hematuria(azotemia Inc BUN/Cr,
proteinuria
synovial: knee and ankle arthralgia
palpable purpura LE
Abd pain(maybe GI bleeding)
IgA

190
Q

henoch schonlein purpura bleeding labs and definitive test

tx

A

nml PT, PTT, platelets

kidney bx: mesangial IgA deposits

supportive tx

191
Q

which vascultitis do you not do steroids

A

henoch schonlein purpura

192
Q

goodpastures disease

A

type 2 hypersensitivity rxn: IgG antibodies against type IV collagen of the alveoli and glomerular basement membrane of kidkey

193
Q

goodpastures disease tx

A

glucocorticoids + cyclophosamide + plasmapheresis

194
Q

+ anti glomerular basement membrane antibodies, bx shows linear IgG deposits, cresentic glomerulonephritis

A

goodpastures disease

195
Q

reactive arthritis may be seen 1-4 weeks after what infection

A

chlmaydia trachomatis or GI infection

196
Q

HLA B27+ and keratoderma blenorrhagicum

A

reactive arthritis

197
Q

reactive arthritis triad

affects what joints

A

arthritis + ocular(Conjunctivitis or uveitis) + genital

affects mainly LE

198
Q

medication triggers for gout

A

thiazide, loops, ACE, pyrazinamide, ethambutol, aspirin, ARBs

199
Q

gout smear findings

A

negative bifringent, needle shaped crystals

200
Q

gout xr

A

mouse or rat bite lesions

201
Q

contraindication for colchicine

A

pts who cannot tolerate either NSAIDs or corticosteroids. safe in mild renal injury

202
Q

chr gout mgmt 1st line

A

allopurinol- xanthine oxidase inhibition

203
Q

dexa scan for who?

A

pts 65 and older

204
Q

what gout med is safe in renal insuff?

A

allopurinol

205
Q

med for acute gout refractory to NSAIDs or if NSAIDs are contraindicated

A

glucocorticoids

206
Q

med that can be used in both acute and chronic gout

A

colchicine

207
Q

1st line prophylaxis for chronic gout

A

allopurinol

208
Q

what is probenecid

contraindication

A

uricosuric drug: increases urinary uric acid excretion

renal insuff or hx of prior uric acid renal calculi

209
Q

adson test

A

thoracic outlet syndrome; loss of radial pulse with head rotated to affected side.

210
Q

what is pegloticase

A

dissolves uric acid.

211
Q

salmon pink migratory rash. daily fever. no iridocyclitis.

A

stills d/s

212
Q

iridocyclitis(ant uveitis), <5 joints involved. medial and large joints.
kids <16 y/o.

lab

A

oligo pauci articular juvenile RA

+ ANA

213
Q

monosodium urate crytstals

A

gout

214
Q

dexa scan on osteoporosis

nml

A

T score -2.5 or less

nml: 1-2.5

215
Q

herniated disc MC location

A

L5-S1

216
Q

weakness for L4, L5, S1

A

L4: ankle dorsiflexion
L5: big toe dorsiflexion
S1: plantar flexion

217
Q

reflexes for L4, L5, S1

A

L4: loss of knee jerk
L5: nml, maybe loss of ankle jerk
S1: loss of ankle jerk

218
Q

sensation of L4, L5, S1

A

L4: ant thigh, loss to medial ankle
L5: lateral thigh/hip, groin, dorsum foot
S1: post leg/calf, butt, plantar foot

219
Q

saddle anesthesia

A

dec sensation to butt, perineum, inner surface of thigh. ED

220
Q

cauda equina syndrome is back pain plus one of the following

A

1- bil/unilateral leg radiation of pain/weakness (L3-S1)
2- saddle anesthesia
3- new onset urinary or bowel retention or incontinence
4- dec anal sphincter tone

221
Q

localized back pain with focal midline tenderness

what test is not necessary

A

vertebral compression fx

mri or CT

222
Q

lumbar spinal stenosis

common etio

worse and better with what

test of choice

A

spondylolysis MC, esp > 60yo.

worsened with extension

better with flexion

MRI

223
Q

lumbosacral sprain or strain does not what

A

back pain and spasms do not radiate to the leg and is not assoc with neurological symptoms.

224
Q

spinal epidural abscess organism

rf

triad

A

st aureus

IV drug use, immunodeficiency

fever, spinal pain, neurological deficits

225
Q

spinal epidural abscess test of choice

tx med

A

MRI with gadolineum

vanco plus cefotaxime or ceftriaxone

226
Q

anti-cyclic citrullinated peptide antibodies

A

RA

227
Q

85% of ankle sprains is what action and damaged structure

A

inversion; ATFL

228
Q

osteomyelitis in kids occurs where most commonly

A

vertebra

229
Q

shoulder pain with motion and at rest.

A

subacromial bursitis

230
Q

pain with reaching/lifting and with overhead movements

crepitus noted on exam

A

subacromial impingement

231
Q

pain increases when sleeping on shoulder and reaching overhead.

what muscle is causing the pain

A

painful arc; supraspinatus

rotator cuff tear

232
Q

pain with resisted supination of elbow

A

biceps tendinits

233
Q

MRI: popeye deformity

A

biceps tendinits

234
Q

transient neuropraxia present in 5% of all shoulder dislocations

A

axillary nerve injury

235
Q

insiduous onset of stiffness and pain to shoulder. It has **pain at rest. **

name PE exam

A

frozen shoulder

apley scratch test

236
Q

neurovascular injury after distal humerus fx. compartment syndrome. “CLAW HAND”

A

Volkmann’s ischemic contracture

237
Q

what population is at risk for frozen shoulder

A

diabetics

238
Q

supraspinatus eval tests

A

empty can or Jobes

239
Q

teres minor and infraspinatus eval tests

A

resist ER with arms at side at 90 degrees

240
Q

torticollis, contraction of what muscle

A

inherited. sternocleidomastoid

241
Q

spuring test

A

for whiplast

242
Q

unilateral radicular pain from foraminal stenosis

A

kemp sign

243
Q

hammertoe is PIP Or DIP deformity

A

PIP

244
Q

pain/numbess at medial melleolus/heel/sole. pain increases during day, worse at night, increases with dorsiflexion,

pain not better at rest

A

tarsal tunnel syndrome

245
Q

epicondylitis that has pain with gripping, forearm pronation.

exam: wrist extension against resistance

A

lateral

246
Q

epicondylitis that has pain with pulling.

exam: wrist flexion against resistance

A

medial

247
Q

froment test

A

ulnar nn test, pinch.

suspect cubital tunnel syndrome

248
Q

MC organism for suppurative flexor tendonitis

A

st aureus

249
Q

kanavel’s signs for what d/o

A

suppurative flexor tendonitis

250
Q

d/o from lifting a baby so much

A

dequervain’s tenosynovitis

251
Q

finger deformity with flexion at DIP and can’t extend

A

mallet finger

252
Q

finger deformity with flattest presentations

A

swan neck

253
Q

thumb hyperabduction injury

A

gamekeepers/skiier

254
Q

distribution of medial nerve

A

palmer aspect of digits 1-3 and radial half of 4th

255
Q

loss of thenar eminence

A

pronator teres syndrome

256
Q

negative bifringment

A

gout

257
Q

positive bifringement

A

pseudogout

258
Q

medication 1st line for chronic gout and prob

A

allopurinol

ortho/rheumatology (13 decks)

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