Master the Boards: Rheumatology 5

Question 1

Features of Morton Neuroma

Answer 1

• Painful burning sensation in interdigital space btwn 3rd and 4th toes
• Tenderness when pressure is applied btwn 3rd and 4th metatarsals
• Sharp intermitent pain radiating into toes that feels better without shoes

Question 2

Do you order x-ray for plantar fasciitis or tarsal tunnel syndrome?

Answer 2

no you might find spur but doesn’t change tx

Question 3

how to tell apart plantar fasciitis and tarsal tunnel syndrome?

Answer 3

tarsal tunnel gets worse with use and may need steroids and surgery. plantar fasciitis is worse in the morning and with first few steps, needs rest and stretching

Question 4

what types of joints are at increased risk for septic arthritis

Answer 4

prosthetic>RA>OA>normal

Question 5

3 most common organisms for septic joint 🦠

Answer 5

Staph Aureus (40%)
Strep (30%)
Gram- bacilli (20%)

Question 6

who to consult w septic joint

Answer 6

ortho always sometimes ID

Question 7

Emperic tx for septic joint

Answer 7

IV ceftriaxone and Vanc

Question 8

If you have prosthetic joint do you need extra abx for dental procedures

Answer 8

no

Question 9

Adhesive Capsulitis Presentation

Answer 9

• Diabetic w shoulder pain and immobility
• loss of passive and active ROM
• loss of abduction and external rotation

Question 10

Adhesive Capsulitis tx

Answer 10

• no imaging needed

- PT/streching/and steroid injections

Question 11

Medial Epicondylitis (Golfer’s elbow) presentation

Answer 11

pain, inside of elbow

Question 12

Medial Epicondylitis (Golfer’s elbow) tx

Answer 12

NSAID’s, ice, stretching

-occasionaly may need steroid injection

Question 13

Lateral Epicondylitis (Tennis elbow) presentation

Answer 13

pain, outside of elbow

Question 14

Lateral Epicondylitis (Tennis elbow) tx

Answer 14

NSAID’s, ice, stretching

-occasionaly may need steroid injection

Question 15

Rotator cuff tear presentation

Answer 15

pain in lateral deltoid
worse w overhead activity
weak external rotation

Question 16

Rotator cuff tear tx

Answer 16

MRI confirms
PT/exercise
occasional surgery

Question 17

Most common osteoporosis site

Answer 17

vertebrae

Question 18

When to screen women for osteoporosis

Answer 18

65 as early as 50 w risk factors

Question 19

first line tx for osteoporosis

Answer 19

Bisphosphonates or denosumab , Ca2+, Vit D

Question 20

Bisphosphonate MOA

Answer 20

inhibit osteoclasts

Question 21

Denosumab MOA

Answer 21

RANKL inhibitor

Question 22

Why is estrogen not first line for osteoporosis

Answer 22

risk of clots and endometrial cancer

Question 23

When to initiate 2nd line osteoporosis meds and options

Answer 23

@ 2year follow up if continued bone loss

• SERMS
• PTH analog like tripartite and abaloparatide
• 3rd line is calcitonin

Question 24

When to stop bisphosphonates before dental surgery

Answer 24

6 weeks

Question 25

Diagnostic testig for Paget dz of bone

Answer 25

• alk phos first, will be elevated
• nuclear bone scan-most accurate
• for CCS exam get urinary hydroxyproline, serum calcium (will be normal), serum phosphate (will be normal), bone scan.

Question 26

Paget dz of bone tx

Answer 26

bisphosphonates
2nd line calcitonin.
Bisphosphonates can cause flulike sx and jaw necrosis