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
2
Q
PE: pulselessness, pallor, dec sensation. Capillary refill preserved
A
.compartment syndrome
3
Q
DX compartment syndrome
A
intracompartmental pressure >30 mm Hg or delta pressure <20-30. increased creatinine kinase & myoglobin.
4
Q
organisms in chronic osteomyelitis
A
s. aureus, staph epidermis, grm neg pseudomonas. e coli
5
Q
chr osteomyelitis tx
A
surg debridement and cultures
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
7
Q
common site for acute osteomyelitis
A
femur and tibia. Vertebra in adults.
8
Q
R/F: sickle cell ds, DM, immunocompromised
A
acute osteomyelitis
9
Q
common spreading source of acute osteomyelitis
A
acute hematogenous spread: common in children. Direct inoculation.
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
11
Q
acute osteomylitis
1( labs)
2. most sensitive test
3. gold standard
A
- CRP more useful. get ESR, WBC inc.
- MRI
- bone aspiration
12
Q
herberden node
A
DIP enlargement
13
Q
bouchard node
A
PIP enlargement
14
Q
felty syndrome
A
RA + splenomegaly + neutropenia
15
Q
Caplan syndrome
A
RA + pneumoconosis + pulmonary nodules
16
Q
RA
1) best Initial test
2) specific test
A
1) RF
2) anti-cyclic citrullinated peptide antibodies
17
Q
initial DMARD in RA pts
A
methotrexate
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.
19
Q
rf for hip dysplasia
A
breech, 1st born, female, FH
20
Q
Barlow manuever
A
gentle adduction w/out downward pressure to feel for dislocation, resulting in a click.
21
Q
ortolani manuever
A
abduction and elevation to feel for reducibility, resulting in a click
22
Q
hip dysplasia management < 6 months of age
and 6 mnths-2 years
A
pavlik harness
closed reduction in OR
23
Q
in infants > 3months, hip dislocation can be fixed and what test can be used instead
A
Galeazzi
24
Q
pelvic fx may have ecchymosis where on exam
A
perineal
25
hip dislocations is most common where
how do they present
posterior from axial loading on an adducted femur.
hip pain with leg shortened, IR, adn adducted with hip/knee slightly flexed.
26
Hip XR of anterior and posterior dislocations
MC type
anterior: femoral head appears larger and femur appears abducted
posterior(MC): femoral head appears smaller than contralateral side and femur appears adducted.
27
complications of hip dislocations
AVN if not closed by 6 hrs and sciatic nerve injury.
anterior: femoral nerve most commonly injured nerve
28
3 types of hip fractures
intra/extracapsular
AVN incidence
1) femoral neck (higher incidence of AVN), intracapsular
2) intertrochenteric-extracapsular
3) subtrochanteric-extracapsular
29
PE of hip fracture
pain with leg shortened, abducted, and ER
30
legg-calve-perthes disease
idiopathic Avascular osteonecrosis of femoral head in kids d/t to ischemia of capital femoral epiphysis.
31
rf for legg-calve-perthes disease
decreased rf
4-10 yo. 4 x more common in males, obese, coag abnormalities
blacks dec rf
32
painless limping for weeks. worse with continued activity esp at the end of the day
legg-calve-perthes disease
33
ROM of legg-calve-perthes disease
PE exam sign
loss of abduction and IR
crescent sign (microfx with collapse of bone)
34
crescent sign
legg-calve-perthes disease
35
tx for legg-calve-perthes disease
NonWB initially. self limiting w/in 2 yrs with revascularization.
36
what is slipped capital femoral epiphysis
displacement of the femoral head(epiphysis) from femoral neck through the growth plate
PAINLESS limping
37
RF for slipped capital femoral epiphysis
8-16 yo, obese, black, males during adolescent growth spurt
38
what if slipped capital femoral epiphysis is seen in children before puberty
suspect hormonal or systemic d/o
eg: hypothyroidism, hypopituitarism
39
hip, groin, or knee pain with a painful limp & worse with activity
slipped capital femoral epiphysis
40
PE of slipped capital femoral epiphysis
ER leg on affected side. (limited IR abduction and flexion on ROM of hip)
41
slipped capital femoral epiphysis XR
posterior displacement of femoral epiphysis.
42
knee(tibia-femoral) dislocations: vascular complication
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.
43
knee(tibia-femoral) dislocations neurological complication
peroneal(MC) or tibial nerve injuries
44
fx from axial loading from a tall height
complications
femoral condyle fx
peroneal nerve: foot drop or
popliteal artery injury
45
plateau most common with lateral plateau fx
complication
lateral.
often assoc with LMT(MC) and ligament.
46
noble test
positive if pain over distal IT band at 30 degrees of knee flexion with pressure applied to ITB
47
ober test
pain or resistance to adduction of leg parallel to the table in neutral position.
48
MC lateral ankle sprain
main stablilizer of ankle during inversion
ATFL.
49
Talar tilt test assesses what
Calcaneofibular ligament
50
ottawa ankle rules
pain along lateral malleolus
navicular(midfoot) pain-foot film
51
ottawa ankle rules
pain along medial malleolus
5th metatarsal pain- foot film
52
thompson test
+ if weak, absent plantar flexion when gastrocnemius is squeezed
53
how to splint an achilles tendon rupture
in mild planar flexion(resting equinus) with subsequent splinting employing gradual dorsiflexion toward neutral
54
anyone with a distal ankle fracture shoud have what performed
proximal films to rule of Maisonneuve fx
55
Maisonneuve fx
spiral fx of proximal third of fibular assoc with distal medial malleolar fx or rupture of deep deltoid ligament
56
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
Pilon (tibial plafound)
axial load from talus
57
what is a fx due to overuse or high impact activities. Females at increased risk.
what bones are commonly involved
stress/march fx
3rd metatarsal MC
usually metatarsals, tib/fib, navicular bones
58
s/s of march/stress fx
localized pain/swelling/TTP that increases with activity
59
high risk areas for fractures LE
prox 4 or 5th metatarsal, navicular, talus, patella
60
get xrays for showing a stress fx?
50% will be negative
61
plantar fasciitis common in who
females, 40-60, obese
62
describe plantar fasciitis s/s
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
63
plantar fasciitis pain increases with what motion
dorsiflexion of toes
64
tinel sign
tapping at tarsal tunnel(post med malleolus) to reproduce symptoms of post tibial nn compression
65
describe tarsal tunnel syndrome
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.
66
test for tarsal tunnel syndrome
tx
electromyography
rest/nsaids, propertly fitted shoes
67
pes planus
flat feet
68
hammer toe
deformity of PIP jt:
flexion of PIP and hyperextension of MTP and DIP
TTP to PIP
69
joint damage and destruction as a result of peripheral neuropathy from DM, PVD
neuropathic Charcot arthropathy
70
neuropathic Charcot arthropathy is from what dysfunction and repetitive _____ that leads to bone _____ and ________
autonomic
microtrauma,
resorption and weakening
71
neuropathic Charcot arthropathy affects the what parts? _______ arthritis can be seen with ______ & _____.
midfoot and ankle.
Neuropathic
DM & tabes dorsalis
72
neuropathic Charcot arthropathy
describe acute and chronic presentation
acute: erythmatous, swollen, TTP, warm
chronic: jt or foot deformity, alteration of shape of foot, ulcer/skin changes
73
what will the XR of neuropathic Charcot arthropathy show
tx
obliteration of the joint space, disorganization of the bone
rest, NWB, better footwear
74
obliteration of the joint space, fragmentation of the bone, inc bone density, disorganization of the bone
neuropathic Charcot arthropathy
75
neuropathic Charcot arthropathy labs and when to order MRI/bone scintigraphy
elev ESR. WBC and crp nml
to rule out osteomyelitis
76
morton's neuroma involves which nerve
2nd or 3rd interdigital nerve between the metatarsal heads
77
morton's neuroma risk factors
women 25-50 yo wearing tight fitting shows, high heels, or have flat feet
78
high heels tend to do what to your feet
over pronate
79
morton's neuroma commonly occurs where
between 3rd and 4th metarsals. it will be on the 3rd metatarsal.
80
Mulder's sign
clicking sensation when palpating involved interspace while simultaneously squeezing metatarsal joints
81
morton's neuroma dx testing
tx
clinical. u/s or MRI
metatarsal support/pad, broad toe shoes with firm soles 1st line. injection later if needed.
82
surg for morton's neuroma?
surg last due to complications of permanent numbness or residual stump.
83
jts affected with RA and OA
RA: wrists, MCP, PIP
spares DIP
OA: DIP, thumb(CMC)
84
stiffness with RA and OA
nodes
RA: worse after rest, morning stiffness over 60 min. No heberden nodes
OA: worse after effort, evening stiffness, morning stiffness under 60 min
85
jones fx is a ___ fx through the ____ of the ____ metatarsal at the ___ -diaphyseal junction
transverse diaphysis 5th
metaphyseal
86
jones fx tx
NWB short leg cast 6-8 weeks followed by repeat xrays due to risk of nonuntin or malunion
87
what a pseudojones fx? tx?
transverse avulsion fx through the base of the 5th metatarsal(tuberosity)
88
triad with eosinophilic granulamatosis with polyangitis
asthma + eosinophilia + chr rhinosinusitis
89
PAN increased assoc with wHAT
hep B and C
90
Lisfranc fx injury what 3 bones
1st, 2nd, 3rd metatarsal heads and their respective cuneiforms
91
tarsometarsal fx/dislocation
look for what on xray
lisfranc
fleck sign
92
fleck sign
fx at base of 2nd metatarsal pathognomic for lisfranc fx.
93
lisfranc tx
ORIF then NWB 12 weeks
94
discuss torus/buckle fx
incomplete fracture with bowing of metaphyseal-diaphyseal junction due to axial loading
95
what is the most common primary bone malignancy in kids and young adults
osteosarcoma
96
osteosarcoma usually occur where?
most common mets where?
pain worse when?
long bones(distal femur MC)
lungs
at night
97
codman's triangle, hair on end on xray
osteosarcoma
98
common sites for chondroscarcoma
proximal femur, pelvic bones, proximal humerus
99
punctate or ring& arc appearance on XR
chondrosarcoma
100
ages of osteosarcoma,
chondrosarcoma, and
ewings sarcoma
osteosarcoma under 20 y/o (80%)
chondrosarcoma (40-75 yo)
ewings sarcoma (5-25 y/o)
101
what is the 2nd most common primary bone malignancy in kids and young adults?
ewings sarcoma
102
what is due to translocation of chromosomes 11 and 22
ewings sarcoma
103
ewings sarcoma most common site
50% in long bones (femur MC),
pelvis, tibia, fibular, pelvis
104
ewings sarcoma s/s
bone pain and systemic symptoms
105
codman triangle and onion skin
ewings sarcoma
106
histology: sheets of monotonous small round blue cells. May have pseudo-rosettes
ewings sarcoma histology
107
most common benign bone tumor
osteochondroma
108
what is pedunculated and grows AWAY from the growth plate on xray
osteochondroma
109
osteochondroma ages
10-20 yo
110
what produces a high level of prostaglandins?
nidus from osteoid osteoma
111
fibromyalgia dx how
tenderness in at least 11 out of 18 trigger points + chronic pain > 3 months
112
fibromyalgia medication tx
TCA(amitripyline) if not responsive to conservative measures.
SSNI 2nd line: duloxetine.
Pregablin approved for fibromyalgia(esp for sleep)
113
what is polymyalgia rheumatica
assoc with what
idiopathic inflammation of joints, bursa, tendons
assoc with giant cell arteritis
114
polymyalgia rheumatica s/s
PE
pain and stiffness in proximal muscles/joints, worse in morning >2weeks.
NML muscle strength; maybe decreased ROM
115
trouble combing hair and rising from a chair
tx
polymyalgia rheumatica
low dose corticosteroids.
methotrexate alternative
116
rhabdomylosis patho
myoglobin from muscle breakdown is extremely toxic to renal tubular cells leading to acute tubular necrosis
117
triad: muscle pain, muscle weakness, dark tea colored urine
rhabdomylosis
118
rhabdomylosis workup
include muscle enzyme
and electrolytes
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
rhabdomylosis tx
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
polymyositis affects what muscles
ages?
proximal limbs, neck, pharynx.
may affect heart, lungs, GI
30-50
121
inflammatory myopathy due to CD8+ lymphocyte infiltration of the endomysium
polymyositis
122
polymyositis and dermatomyositis same s/s
progressive SYMMETRIC proximal muscle weakness.
difficulty combing hair, rising from chair, stairs
systemic and constitutional sx too
123
rash with polymyositis or dermatomyostitis
dermatomyostitis
124
best initial test for polymyositis
definitive test
inc muscle enzymes (CK and adolase)
muscle bx (D)
anti Jo and anti-signal recognition protein
125
anti Jo and anti-signal recognition protein
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
inc ESR, CRP and RF. Normocytic and normochromic anemia. inc muscle enzymes
think polymyositis or dermatomyositis
127
polymyositis tx
high dose glucocorticoids
128
main difference between polymyositis and polymyalgia rheumatica
polymyositis has decreased muscle strength
polymyalgia rheumatica has normal muscle strength, no objective weakness. nml muscle enzymes
129
anti Jo in what disorders
polymyositis and dermatomyositis
130
polymyositis and dermatomyositis;
which assoc with cancer
dermatomyositis has 25% chance
131
dermatomyositis affects what
proximal limbs, neck, and pharynx; may affect heart, lungs, GI
131
inflammatory myopathy due to CD4+ lymphocyte infiltration of the perimysium (perivascular involvement)
dermatomyositis
132
Gottrons papules, shawl sign, heliotrope rash
dermatomyositis
gottron: raised scaley patches on dorsum of fingers
heliotrope: blue purple discoloration of upper eyelids (pathognomonic)
133
pathognomonic for dermatomyositis
heliotrope rash
134
anti Jo and anti-Mi2
dermatomyositis
anti Mi2: most specific
135
muscle bx shows:
1) endomysial inflammation
2) perifasicular and perivascular inflammation
1- polymyositis
2-dermatomyositis
136
dermatomyositis tx
glucocorticoids high dose 1st line.
hydroxychloroquine for skin lesions.
137
SLE is a type ____ hypersensitivity reaction (Ag-Abimmune complexes)
population
type 3
young females, blacks, hispanics, native american. sun exposure, estrogen, genetic
138
SLE triad
joint pain, fever, malar rash (sparing nasolabial folds)
139
discoid lupus presentation
annular, erythematous patches on face and scalp that HEAL with scarring
140
SLE screening test of choice
pathognomonic
ANA (anti nuclear antibodies)
anti double stranded DNA and anti-smith
141
SLE anemia? complement levels?
dangers of antiphospholipid levels
pancytopenia, decreased C3 and C4
increased risk of arterial and venous thrombosis
142
belimumab
for SLE unresponsive to glucocorticoids
143
SLE mild tx
hydroxycholoroquine w/ or w/out NSAIDs
144
main drugs that can induce lupus
hydralazine, procainimide, INH, quinidine,
145
drug induced lupus has nml SLE symptoms except what
alopecia, hematologic, kidney injury, or CNS symptoms
146
hallmark for drug induced lupus
anti-histone antibodies, +ANA
No anti double stranded DNA antibodies
147
antiphospholipid syndrome can occur as primary disease or with what
SLE
148
antiphospholipid syndrome patho and triggers
autoantibodies activate complement mediated thrombosis
smoking, prolong immobilization, estrogen, malignancy, hyperlipidemia, HTN
149
livedo reticularis, valvular heart ds, neurologic sx
increased risk for arterial and venous thromboses
antiphospholipid syndrome
150
anticardiolipin antibodies, lupus anticoagulant, inc PTT, failure to correct PTT after mixing blood with plasma
antiphospholipid syndrome
151
prolonged russell viper venom test
for lupus anticoagulant. need 2 + results 12 weeks apart.
antiphospholipid syndrome
152
sjogren syndrome affects what glands? idiopathic?
gender age
exocrine
autoimmune
women 40-60
153
primary and secondary sjogren syndrome
primary occurs alone.
secondary occurs with other autoimmune do
154
sjogren syndrome s/s
dry mouth, dry eye, vaginal dryness, bil parotid gland enlargement, dental caries
155
screening tests for sjogren syndrome
tear test
def test
ANA, especially antiSS-A (Ro) and antiSS-B (La)
schirmer test: decreased production
lip or parotid gland bx: fibrosis and lymphocytic infiltration
156
rose bengal stain: abnormal cornea epithelium, +RF, anemia, leukopenia
sjogren syndrome
157
what drugs can lead to increases secretions
cholinergic: pilocarpine or cevimeline
158
pilocarpine for what disorders?
SE: SLUDD-C
sjogren syndrome and acute angle closure glaucoma
salivation, lacrimation, urination, defecation, digestion, constriction of pupil
159
scleroderma, collagen deposits where
gender age
skin, internal organs (lung, heart, kidney, GI)
women 30-50
160
CREST
limited scleroderma s/s (80%)
*spares the trunk
Calcinosis cutis
Raynauds
Esophageal motility do
Sclerodactyly(claw hand)
Telangiectasias
161
diffuse scleroderma s/s
(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
anti-centromere antibodies and
anti-SCL-70 antibodies (anti-topoisomerase)
scleroderma
anti-centromere antibodies(limited)
and
anti-SCL-70 antibodies (anti-topoisomerase)- diffuse; poorer prognosis
163
ANA in scleroderma
nonspecific but + in 90% pts with scleroderma
164
scleroderma tx is organ specific
GERD
HTN renal disease
Raynaud
Severe
pulm fibrosis
pulm htn
GERD: PPI
HTN renal disease: ACE
Raynaud: vasodilators CCB, prostaglandin
Severe: DMARDs, cyclophosphamide
pulm fibrosis: cyclophosphamide
pulm htn: sildenafil, bosentan, prostacyclin
165
Behcet's syndrome poplulation
autoimmune
asian, middle eastern, mediterranean
20-40
166
recurrent painful oral and genital ulcers, erythema nodosum, uveitis, CNS involvement(mimic MS)
Behcet's syndrome
167
Bx: leukocytoclastic vasculitis or lymphocytic vasculitit. Inc ESR, CRP, leukocytes
Behcet's syndrome
168
Pathergy: sterile skin papules or pustules from minor trauma.
Behcet's syndrome
169
Takayasu arteritis affects what part of body
aorta and its primary brances (arch and pulm arteries)
170
Takayasu arteritis vessel symptoms
lower extremity claudication
171
Takayasu arteritis PE
bruits, diminished pulses, asymmetric BPs, sx of PAD
172
Takayasu arteritis dx and tx
angiography (MRA or CTA)
tx: high dose corticosteroids
173
Kawasaki syndrome affects what vessels
population
medial and small vessel necrotizing vasculitis including the coronary arteries.
kids <5 y/o usually. boys and asians
174
Kawasaki syndrome tx
IV immunoglobulin and aspirin
175
Kawasaki syndrome s/s
Warm and CREAM
fever > 5 days
conjunctivitis
rash
extremity changes: edema, erythema,
desquamation of palms/soles
adenopathy(cervical)
mucositis(strawberry tongue)
176
polyarteritis nodosa affects what vessels
increased assoc with what
medial sized vessels; commonly renal, CNS, GI
pulm vessels not involved
chronic hep B and C
177
type 3 hypersensitivity rxn leads to ischemia and microanerysms of affected vessels.
men 40-60 yo
polyarteritis nodosa
178
S/S: HTN(due to renal artery stenosis), pain worse with eating, myalgias, mononeuritis complex, ~foot drop, livedo reticularis, purpura
no glomerulonephritis
polyarteritis nodosa
179
polyarteritis nodosa on labs is ___ neg
ANCA
180
polyarteritis nodosa imaging and diagnostic test
renal or mesenteric angiography: micronaneurysms with abrupt cut off (beading)
biopsy: necrotizing vasculitis and NO granulomas
181
churg strauss (eosinophilic granulamatosis with polyangitis)
triad and hallmark
asthma, eosinophilia, chronic rhinosinusitis
P ANCA +
bx: definitive
182
Wegener's (granulomatosis with polyangitis)
triad
upper resp tract + lower resp tract + GLOMERULONEPHRITIS
183
Wegener's (granulomatosis with polyangitis) best initial test and bx
C-ANCA+
lung usually. large necrotizing granulomas
184
tx for wegeners and microscopic polyangitis
glucocorticoids plus cyclophosphamide
185
microscopic polyangitis assoc with what vessels? not assoc with what?
small and medium vessel vascultitis; capillaries
nasopharyngeal symptoms, necrosis, granulamotous inflammation.
186
microscopic polyangitis main symptoms
palpable purpur, cough/hemoptysis, rapidly progressive acute glomerunephritis
187
microscopic polyangitis lab and bx
+P-ANCA
Bx: non granulomatous inflammation
188
henoch schonlein purpura is what
occurs when
population
acute systemic IgA mediated small vessel vasculitis
90% occur in kids (3-15 yo)
occurs after a URI
189
henoch schonlein purpura s/s
HSPA
hematuria(azotemia Inc BUN/Cr,
proteinuria
synovial: knee and ankle arthralgia
palpable purpura LE
Abd pain(maybe GI bleeding)
IgA
190
henoch schonlein purpura bleeding labs and definitive test
tx
nml PT, PTT, platelets
kidney bx: mesangial IgA deposits
supportive tx
191
which vascultitis do you not do steroids
henoch schonlein purpura
192
goodpastures disease
type 2 hypersensitivity rxn: IgG antibodies against type IV collagen of the alveoli and glomerular basement membrane of kidkey
193
goodpastures disease tx
glucocorticoids + cyclophosamide + plasmapheresis
194
+ anti glomerular basement membrane antibodies, bx shows linear IgG deposits, cresentic glomerulonephritis
goodpastures disease
195
reactive arthritis may be seen 1-4 weeks after what infection
chlmaydia trachomatis or GI infection
196
HLA B27+ and keratoderma blenorrhagicum
reactive arthritis
197
reactive arthritis triad
affects what joints
arthritis + ocular(Conjunctivitis or uveitis) + genital
affects mainly LE
198
medication triggers for gout
thiazide, loops, ACE, pyrazinamide, ethambutol, aspirin, ARBs
199
gout smear findings
negative bifringent, needle shaped crystals
200
gout xr
mouse or rat bite lesions
201
contraindication for colchicine
pts who cannot tolerate either NSAIDs or corticosteroids. safe in mild renal injury
202
chr gout mgmt 1st line
allopurinol- xanthine oxidase inhibition
203
dexa scan for who?
pts 65 and older
204
what gout med is safe in renal insuff?
allopurinol
205
med for acute gout refractory to NSAIDs or if NSAIDs are contraindicated
glucocorticoids
206
med that can be used in both acute and chronic gout
colchicine
207
1st line prophylaxis for chronic gout
allopurinol
208
what is probenecid
contraindication
uricosuric drug: increases urinary uric acid excretion
renal insuff or hx of prior uric acid renal calculi
209
adson test
thoracic outlet syndrome; loss of radial pulse with head rotated to affected side.
210
what is pegloticase
dissolves uric acid.
211
salmon pink migratory rash. daily fever. no iridocyclitis.
stills d/s
212
iridocyclitis(ant uveitis), <5 joints involved. medial and large joints.
kids <16 y/o.
lab
oligo pauci articular juvenile RA
+ ANA
213
monosodium urate crytstals
gout
214
dexa scan on osteoporosis
nml
T score -2.5 or less
nml: 1-2.5
215
herniated disc MC location
L5-S1
216
weakness for L4, L5, S1
L4: ankle dorsiflexion
L5: big toe dorsiflexion
S1: plantar flexion
217
reflexes for L4, L5, S1
L4: loss of knee jerk
L5: nml, maybe loss of ankle jerk
S1: loss of ankle jerk
218
sensation of L4, L5, S1
L4: ant thigh, loss to medial ankle
L5: lateral thigh/hip, groin, dorsum foot
S1: post leg/calf, butt, plantar foot
219
saddle anesthesia
dec sensation to butt, perineum, inner surface of thigh. ED
220
cauda equina syndrome is back pain plus one of the following
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
localized back pain with focal midline tenderness
what test is not necessary
vertebral compression fx
mri or CT
222
lumbar spinal stenosis
common etio
worse and better with what
test of choice
spondylolysis MC, esp > 60yo.
worsened with extension
better with flexion
MRI
223
lumbosacral sprain or strain does not what
back pain and spasms do not radiate to the leg and is not assoc with neurological symptoms.
224
spinal epidural abscess organism
rf
triad
st aureus
IV drug use, immunodeficiency
fever, spinal pain, neurological deficits
225
spinal epidural abscess test of choice
tx med
MRI with gadolineum
vanco plus cefotaxime or ceftriaxone
226
anti-cyclic citrullinated peptide antibodies
RA
227
85% of ankle sprains is what action and damaged structure
inversion; ATFL
228
osteomyelitis in kids occurs where most commonly
vertebra
229
shoulder **pain with motion and at rest.**
subacromial bursitis
230
pain with reaching/lifting and with overhead movements
crepitus noted on exam
subacromial impingement
231
pain increases when sleeping on shoulder and reaching overhead.
what muscle is causing the pain
painful arc; supraspinatus
rotator cuff tear
232
pain with resisted supination of elbow
biceps tendinits
233
MRI: popeye deformity
biceps tendinits
234
transient neuropraxia present in 5% of all shoulder dislocations
axillary nerve injury
235
insiduous onset of stiffness and pain to shoulder. It has **pain at rest. **
name PE exam
frozen shoulder
apley scratch test
236
neurovascular injury after distal humerus fx. compartment syndrome. "CLAW HAND"
Volkmann's ischemic contracture
237
what population is at risk for frozen shoulder
diabetics
238
supraspinatus eval tests
empty can or Jobes
239
teres minor and infraspinatus eval tests
resist ER with arms at side at 90 degrees
240
torticollis, contraction of what muscle
inherited. sternocleidomastoid
241
spuring test
for whiplast
242
unilateral radicular pain from foraminal stenosis
kemp sign
243
hammertoe is PIP Or DIP deformity
PIP
244
pain/numbess at medial melleolus/heel/sole. pain increases during day, worse at night, increases with dorsiflexion,
pain not better at rest
tarsal tunnel syndrome
245
epicondylitis that has pain with gripping, forearm pronation.
exam: wrist extension against resistance
lateral
246
epicondylitis that has pain with pulling.
exam: wrist flexion against resistance
medial
247
froment test
ulnar nn test, pinch.
suspect cubital tunnel syndrome
248
MC organism for suppurative flexor tendonitis
st aureus
249
kanavel's signs for what d/o
suppurative flexor tendonitis
250
d/o from lifting a baby so much
dequervain's tenosynovitis
251
finger deformity with flexion at DIP and can't extend
mallet finger
252
finger deformity with flattest presentations
swan neck
253
thumb hyperabduction injury
gamekeepers/skiier
254
distribution of medial nerve
palmer aspect of digits 1-3 and radial half of 4th
255
loss of thenar eminence
pronator teres syndrome
256
negative bifringment
gout
257
positive bifringement
pseudogout
258
medication 1st line for chronic gout and prob
allopurinol
