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[2b] A- step 2 CK > Med-Rheum/Ortho > Flashcards

Med-Rheum/Ortho Flashcards

1
Q

What are the Main elements of SLE-15

A

RASH ORR PAINN

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2
Q

Dx lab test for Rheumatoid Arthritis -4

A
  1. Anti-CCP (Cyclic Citrullinated Peptide) = MOST SENSITIVE
  2. Rheumatoid Factor
  3. CRP
  4. ESR
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3
Q

AOSD (Adult Onset Still’s Disease) characteristics - 4

A

AOSD

Aow HOT (Fever)

Ortho joint pains

Salmon colored bumpy rash

Diagnosis of Exclusion

Systemic onset juvenile RA

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4
Q

Functions of Corticosteroids -6

A
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5
Q

Joints affected in Osteoarthritis -7

A
  1. DIP - Heberden
  2. PIP - Bouchard
  3. MCP
  4. Shoulder (AC joints)
  5. Spine (Cervical/Lumbo/Sacral)
  6. Knees
  7. Feet
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6
Q

Differences in sx between Polymyositis and Dermatomyositis

A
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7
Q

[Antiphospholipid syndrome] etx; what 3 labs are ordered for dx?

A

Lupus anticoagulant (2/2 SLE or idiopathic) –> [⬆︎Thrombosis and spontaneous abortion]

  1. Anticardiolipin (can cause false positive VDRL)
  2. Lupus anticoagulant
  3. [Anti B2 glycoprotein]
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8
Q

SjoGren Syndrome sx -4;

Dx labs -2?

A
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9
Q

What are the 4 most common causes of Myopathy (⬆︎ CK)

A

Statins Probably hurt Muscles

  1. Statins
  2. Polymyositis vs. Dermatomyositis (autoimmune)
  3. Muscular Dystrophy
  4. hypOthyroidism (OR HYPERthyroidism)
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10
Q

Dx Labs for [Polymyositis and Dermatomyositis] -5

What is the ultimate diagnostic for these?

A

MUSCLE BIOPSY showing mononuclear infiltrate is the ultimate diagnostic

tx = MTX with [CTS (reduces side MTX side effects)]

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11
Q

[Polymyositis and Dermatomyositis] Tx - 2

A

CTS and MTX(to minimize side effects of CTS)

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12
Q

Erythema and Warmth in joints indicates ___ vs ___

A

crystalline arthropathy vs infection

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13
Q

[Scleroderma Systemic Sclerosis] (Diffuse vs Limited) - etx

A

Autoimmune collagen deposition w/fibrosis –> systemic sclerosis (skin/pulm/renal)

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14
Q

Lab test for SLE -4 ; Which is first line

A

Remember this:

“ANA & Dana saw HIS, Mr.Smith’s rash”

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15
Q

Name PE finding and what causes it-4

A

Livedo Reticularis;

  1. Atherosclerotic Emboli into periphery s/p cardiac catheterization
  2. SLE
  3. Antiphospholipid Syndrome
  4. Systemic Vasculitis

also may see Blue Toes, [Hollenhorst retinal a. plaques]

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16
Q

Hydroxychloroquine is effective in treating the ___ and ___ from SLE. What type of drug is it? SE-2?

A

RASH ORR PAINN

Rash; Arthritis; Anti-Malaria drug; SE = [⬇︎Vision] and Nausea

Immunosuppressants=Prednisone/Azathioprine/Mycophenolate/Rituximab/Cyclophosphamide

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17
Q

DDx for Monoarticular Inflammation - 5

A
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18
Q

DDx for Oligoarticular Inflammation - 3

A
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19
Q

DDx for Polyarticular Inflammation - 4

A
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20
Q

What is the morning manifestation of RA?

A

Morning stiffness lasting > 1 Hour for more than 6 weeks

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21
Q

Short term tx for RA

A
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22
Q

tx for “Mild” RA -4

A
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23
Q

tx for “Moderate to SEVERE” RA -6

A
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24
Q

Why is Seronegative Spondyloarthropathy …seronegative? What’s the gene association? Demographic?

A

NO Rheumatoid factor

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25
Q

Seronegative Spondyloarthropathy is Arthritis w/out Rheumatoid Factor and consist of 4 conditions

Describe Psoriatic arthritis -3

A
  1. Psoriasis + Joint pain
  2. Asymmetrical
  3. Dactylitis Sausage digits
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26
Q

Seronegative Spondyloarthropathy is Arthritis w/out Rheumatoid Factor and consist of 4 conditions

Describe [Reiter’s Reactive Arthritis] -3

A

Can’t See, Can’t Pee, Can’t Bend my Knee

Conjunctivitis

Urethritis

Arthritis

  • Comes post GI/GU infection s/p abx*
  • Tx = NSAIDs!!!*
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27
Q

Seronegative Spondyloarthropathy has similar tx to ___. What are 2 MAJOR differences to keep in mind?

A

RA;

  1. Hydroxychloroquine worsens Psoriasis!!
  2. For axial involvement use TNF Biological agents
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28
Q

Identify

A

Dactylitis Sausage Digits - Psoriatic Arthritis Spondyloarthropathy

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29
Q

Most Gout attacks initially occur where?

A

Asymmetric Inflammatory Monoarthritis

1st MTP joint = Podagra

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30
Q

Which meds cause Gout attacks? -5

A

Asymmetric Inflammatory Monoarthritis

TALES

  1. THIAZIDES
  2. ASA 81
  3. Large Meals
  4. EtOH
  5. cycloSporine

Surgery and Dehydration also cause it

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31
Q

Gout or Pseudogout? ; Identify what lights A and C are

A

GOUT!

A = Perpendicular

C = Parallel light (Yellow)

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32
Q

Gout Etx -2

A

90% from underexcreted uric acid

10% from overproduction of uric acid (myeloproliferative disorders such as polycythemia vera)

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33
Q

Conditions associated w/Pseudogout -3

A
  1. Hemochromatosis
  2. HyperParathyroid
  3. Osteoarthritis
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34
Q

Acute Gout Tx -3

A
  1. NSAIDs
  2. Colchicine
  3. Steroids

Also Acute tx for Pseudogout

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35
Q

Long Term Gout Tx -3

A
  1. Febuxostat
  2. Allopurinol
  3. Probenecid

Gout px and short term tx = NSAIDs, colchicine, CTS

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36
Q

Px for Gout -3

A
  1. NSAIDs
  2. Colchicine
  3. Steroids

Same as Acute tx for Gout

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37
Q

List the Immunosuppressants used to treat SLE -6

A

RASH ORR PAINN

  1. Prednisone
  2. Hydroxychloroquine
  3. Azathioprine
  4. Mycophenolate
  5. Rituximab
  6. Cyclophosphamide
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38
Q

Interstitial Lung disease is a long term complication of Diffuse Cutaneous Scleroderma Systemic Sclerosis

Tx for this specifically-2?

A

[Mycophenolate - inhibits Guanine synthesis]

[Azathioprine - 6-mercaptopurine that inhibits lymphocyte proliferation]

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39
Q

In [Scleroderma Systemic Sclerosis], list long term complications for each (Diffuse vs. Limited) (2 each)

A

[Diffuse Cutaneous (Anti Scl-70)] = Interstitial Lung Dz + Renal Crisis

[CREST Limited Cutaneous (AntiCentromere)] = pulmonary htn + Renal Crisis

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40
Q

What should be used to treat Renal Crisis in [Scleroderma Systemic Sclerosis]?

A

ACEk2 inhibitor

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41
Q

Common sx for Large vessel vasculitis -4

A

“You can CHOC on a Large vessel”

Claudication of Legs & Jaw

[HA & Stroke sx]

Ocular blindness

Chest pain

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42
Q

Giant Cell Temporal Arteritis

A: Demographic

B: Which vessels are affected -3

C: Dx

A

A: Women > 50 with Polymyalgia Rheumatica

B: [Temporal External]/[Opthalmic Internal]/Vertebral of Aortic Branch]

C: [Temporal External] biopsy

PMR pts with have NORMAL strength but be stiff and have pain

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43
Q

Giant Cell Temporal Arteritis tx

A

[HIGH DOSE Corticosteroids w/slow taper] IMMEDIATELY –(follwed by)–> [Temporal External] biopsy

low dose CTS is only for pMR w/out GCTA

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44
Q

Immunofluorescence pattern for [GoodPasture Type 1 Crescenteric RPGN] (2)

and clinical presentation (2)

A

Linear (anti-Basement membrane Ab) + Sieve effect;

GoodPasture

Glomerulus damage–>Hematuria

Pulmonary damage–> Hemoptysis

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45
Q

A: Clinical Presentation for [Microscopic Polyangiitis Type 3 Crescenteric RPGN] (2)

B: MOD

A

A: Hemoptysis + [Vasculitis with NO granulomas or asthma]

B: p-ANCA attacks [Neutrophil MPO]

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46
Q

A: Clinical Presentation for [Churg Strauss Type 3 Crescenteric RPGN] (3)

B: MOD

A

“PAGE Churg Strauss! “

A: p-ANCA / Asthma / Granulomas / Eosinophilia

B: p-ANCA attacks [Neutrophil MPO]

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47
Q

Tx for [Type 3 Crescenteric RPGN] (2)

A

Cyclophosphamide vs. Steroids

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49
Q

A: Clinical Presentation for [AXS- Alport X-linked Syndrome] (3)

B: MOD

A

A:

  1. Hearing Loss
  2. Hazy view (ocular disturbances)
  3. Hematuria

B: [Type 4 Collagen thinning & splitting of Basement membrane]

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52
Q

What’s the most common nephropathy worldwide?

A

[BrIAN - Berger IgA Nephropathy]

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53
Q

What systems are affected by Wegener Granulomatosis -3 ; Etx for this

A
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54
Q

Polymyalgia Rheumatica sx -4

A

PolyMyalgia Rheumatica

[Painful-Stiff Shoulders & Hips]

Malaise & Morning Stiffness

Really hot (Fever) +/- weight loss

PMR DOESNT HAVE TO BE IN CONCOMITANT WITH GIANT CELL TEMPORAL ARTERITIS. CAN OCCUR ALONE

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55
Q

Labs for Polymyalgia Rheumatica -3

A

⬆︎ESR

⬆︎CRP

normal CK

PMR pts have NORMAL strength but have stiffness and pain

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56
Q

Tx for Polymyalgia Rheumatica

A

low - dose corticosteroids

PMR DOESNT HAVE TO BE CONCOMITANT WITH GIANT CELL ARTERITIS! CAN BE SOLO DOLO

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57
Q

Tx for Fibromyalgia -4

A

1st: Aerobic Exercise
2nd: TCAs / SNRIs / Anticonvulsants

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58
Q

Anti Scl-70 (anti-DNA topoisomerase I) specifically identifies what condition? ; What are the other Ab used for this condition?-2

A

[Diffuse Cutaneous Scleroderma Systemic Sclerosis]

but

AntiNuclear Ab

Anticentromere Ab are also used for SSS

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59
Q

What are the ESR and CK levels in

Steroid myopathy

A

Normal ESR / Normal CK

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60
Q

What are the ESR and CK levels in

Inflammatory myopathy (Polymyositis, Dermatomyositis)

A

⬆︎ ESR / ⬆︎ CK

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61
Q

What are the ESR and CK levels in

Statin-induced myopathy

A

Normal ESR / ⬆︎ CK

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62
Q

What are the ESR and CK levels in

hypOthyroid myopathy

A

Normal ESR / ⬆︎ CK

63
Q

Which patient demographics is intubation relatively contraindicated? - 3

A
  1. Facial/Cervical Trauma
  2. Rheumatoid Arthritis
  3. Down Syndrome

These pts have ⬆︎ subluxation(misalignment) risk

64
Q

Clinical Presentation for [DILE - Drug Induced Lupus Erythematosus] (3). Which drugs cause this (3)?

A

[Sudden FAP - Fever/Arthralgia/Pleuritis]; (Drugs linked to Liver Acetylation –>Procainamide/Hydralazine/INH)

SLOW ACETYLATORS = INC RISK!

65
Q

Dupuytren Contracture etx

A

Fibroblast proliferation –> collagen deposition –> palmar fascia thickening and shortening (usually worst in Digits 4 and 5)

66
Q

Seronegative Spondyloarthropathy is Arthritis w/out Rheumatoid Factor and consist of 4 conditions

Tx for [Reiter’s Reactive Arthritis]

A

Can’t See, Can’t Pee, Can’t Bend my Knee

Tx = NSAIDs!!!

67
Q

Osteoid osteoma cp ; Where does this usually occur?

A

teenager bone pain worst at night and better with NSAIDs ; Proximal Femur (or any long bone)

Sharply circumscribed lesion

68
Q

Ewing Sarcoma cp

A

Eww, Onions!

Chronic bone pain (weeks-months) that demonstrate multiple layers of new subperiosteal bone formation on Xray = ONION SKINNING

Causes Onion Skin Appearance (“Eww, Onions!”)

69
Q

Desribe Osteosarcoma X-ray findings - 2

A
  1. SUNBURST desctruction of normal bone with indistinct margins, periosteal reaction and
  2. Codman triangle
70
Q

Pseudogout is characterized by what findings on arthrocentesis?-2 ; What electrolyte abnormality is a risk factor for Pseudogout?

A

[Rhomboid Ca+ pyrophosphate crystals], [Positively Birefringent]

HYPERCalcemia (look for constipation!)

71
Q

Why can you not r/o Septic Arthritis of the knee in a pt who has a hx of Gout and crystals on their arthrocentesis?

A

Pts with Gout hx will have crystals in their synovial fluid inbetween Gout attacks at baseline so it doesn’t r/o another disorder causing knee pain

72
Q

Secondary Amyloidosis etx

A

complication of chronic inflammatory conditions (IBD, RA, Psoriasis) that –> Extracellular fibril deposition in random organs –> multi-organ dyssfunction

73
Q

In what setting does Pseudogout typically occur?

A

surgery or medical illness that –> chondrocalcinosis

74
Q

What’s the most common injury in mid-age pts who fall on an outstretched hand? ; How would you diagnose this?

A

Rotator Cuff tear ; MRI

75
Q

What are the 2 lifestyle changes for Gout px? ; When are Rx indicated?-2

A

EtOH cessation and Weight loss

Rx needed when:

  1. Attacks are reucrrent
  2. Attacks are complicated (Tophi, renal stone of uric acid)
76
Q

Why should pts with Lupus coming in with Hip or Thigh pain be given an MRI?

A

RASH ORR PAINN

Lupus pts are also at risk for Osteonecrosis (especially if on CTS)!

Tx for this is often NSAIDs once diagnosed

77
Q

cp for Osteogenesis Imperfecta - 4

A

well you’re an imperfect HOBO!

  1. Hearing loss
  2. Opalescent teeth
  3. BLUE SCLERAE!
  4. Osteopenia –> fx recurrently

AUTO DOM mutation

78
Q

Which disease is Anti-neutrophil cytoplasmic associated with?

A

Wegener granulomatosis with polyangiitis

79
Q

which disease is AntiSmoothMuscle ab associated with?

A

Autoimmune Hepatitis

80
Q

Which disease is Antimitochondrial Ab associated with

A

PBC-Primary Biliary Cholangitis

This only affects INTRAhepatic bile ducts

81
Q

What is the Esophageal dysmotility caused by in Scleroderma Systemic Sclerosis?

A

Atrophy with Fibrosis of lower esophagus –> ⬇︎peristalsis and ⬇︎lower esophageal sphincter tone

This is similar to Achlasia EXCEPT Achlasia will caused INCREASED LES tone

82
Q

A child presents with genu varum

What do they likely have?

A

Vitamin D deficiency rickets

83
Q

Baker Popliteal Cyst etx

A

pts with underlying arthritis have synovial fluid leak from their knee joint into the Gastrocnemius or Semimembranosus bursa = cyst

If this cyst ruptures it –> acute calf pain

84
Q

Ewing Sarcoma can often be confused with Osteomyelitis

What are the X-ray findings for Osteomyelitis

A

central lytic bone defect with surrounding sclerosis = Brodie’s abscess

ONION SKIN appearance (“Eww, Onions!”) = Ewing Sarcoma

85
Q

ALERT! ParvoB19 Arthritis can resemble inflammatory arthritis (RA, SLE)

How can you tell the difference?

A

Inflammatory Arthritis (RA, SLE) will have ⬆︎inflammatory markers (ESR, CRP)

ParvoB19 is transient

86
Q

Juvenile Idiopathic Arthritis etx ; laboratory findings-3?

A

autoimmune symmetric arthritis of the BUE and BLE ;

  1. Anemia
  2. ⬆︎inflammatory markers
  3. ⬆︎acute phase reactants (platelets)
87
Q

What are the major cp for Ankylosing Spondylitis - 3

A

the fake AAA

  1. Ankylosing bamboo sacroilitis improved with exercise a/w Enthesitis (pain at sites where tendon/ligament attaches to bone)
  2. ANTERIOR Uveitis
  3. Aortic Regurgitation and ⬇︎chest expansion

a/w hlaB27

88
Q

What are the primary features of Osteoarthritis - 4

A

Bony Joints Really Close

  1. Bony enlargement with sclerosis and osteophytes
  2. Joint narrowing with effusion
  3. Crepitus with movement
  4. ROM ⬇︎ +/- pain

Xray findings: narrowed joint space with osteophytes and subchondral sclerosis and cyst

89
Q

iLiotibial band syndrome cp ; major cause?

A

Lateral knee pain, specifically at lateral femoral condyle ; overuse

90
Q

Chondrocalcinosis (calcified articular cartilage) is seen in what condition?

Pts with this condition should be worked for what possible secondary causes - 3

A

Pseudogout - calcium pyrophosphate dihydrate arthritis

  1. HyperParathyroidism
  2. hypOthyroidism
  3. Hemochromatosis (dx = iron studies)

postively birefringent CPPD crystals

91
Q

cp for cervical sponylosis - 3 ; What’s the most common thing to find on X-ray?

A

chronic neck pain with

  1. sensory deficit from osteophyte(bone spurs) radiculopathy
  2. limited neck rotation
  3. limited lateral bending from OA

osteophytes

92
Q

Pagets disease of bone etx

A

Accelerated focal bone remodeling

⬆︎osteoclast activity f/b rapid and disorganized mosaic bone patterns from osteoBlast

tx = bisphosphonates

93
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

When does this present?; How does this present? ; dx?

A

puberty (most common hip DO in teens!) ; Months of vague hip/knee pain without acute onsets ; plain pelvis XRay

posterior displaement of capital femoral epiphysis thru cartilage growth plate

94
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

Tx?

A

Surgical Pinning of femoral head to avoid avascular necrosis of femoral head and chondrolysis

posterior displaement of capital femoral epiphysis thru cartilage growth plate

95
Q

What is Legg-Calve Perthes disease?

A

Idiopathic avascular necrosis of femoral head

Tx = observation and bracing

Happens in Lower age (4-10 y/o)

96
Q

Paget disease of bone cp -2

most common cause of asymptomatic ALP ⬆︎ in elderly

A
  1. Bone/Joint pain +/- fx
  2. Enlarging cranial bones –> ⬆︎hat size, HA, hearing loss from CN8 entrapment

  • bx: disorganized mosaic pattern of lamellar bone*
  • tx = bisphosphonates*
97
Q

Patellofemoral syndrome is a VERY common cause of ______ and usually presents with _____ ; Demographic? ; Tx?

A

ANTERIOR Knee Pain-pain with pain upon EXTENSION of the knee ; Young Women ; Conservative (stretching, strengthen thigh muscles, NSAIDs)

98
Q

Which groups of people should receive a DEXA of the spine and hips screening exam - 2

A
  1. Women ≥65 yo
  2. Women < 65 with equivalent risk for osteoporotic fracture (Smoking, EtOH, sedentary, estrogen deficiency)
99
Q

What is the cause of Lateral epicondylitis tennis elbow? ; cp-3

A

repetitive, forceful wrist extension –> noninflammatory angiofibroblastic tendinosis at common extenor origin

  1. Lateral Epicondyle tenderness
  2. Pain reproduced with passive flexion of wrist OR
  3. Pain reproduced with resisted extension of wrist
100
Q

Juvenile Idiopathic Arthritis cp - 3

A

autoimmune symmetric arthritis of the BUE and BLE ;

  1. ≥1 joint Arthritis ≥6weeks
  2. PINK MACULAR RASH
  3. DAILY FEVER
101
Q

How long does it take for Acute Rheumatic Fever to onset after Strep Pharyngitis infection

102
Q

Charcot Joint MOD ; What would you expect to find on imaging?

A

(AKA Neurogenic Arthropathy) complication of neuropathy (usually in DM) –> unchecked repeated joint trauma that affects weight-bearing joints and –> degenerative joint disease

loose bodies

103
Q

Inflammatory Chronic Lower Back Pain cp - 2 ; etx?

A
  1. Lower Back Pain at night that does NOT improve with rest but does improve with activity (if this occurs in a young pt think Ankylosing Spondylitis, psoriatic arthritis, reactive arthritis or arthritis a/w IBD)
  2. gradual onset

etx = Inflammation at ligamentous insertions

104
Q

Which joints does Psoriatic arthritis involve? ; cp?-3

A

Distal Interphalangeal Joint ;

  1. Morning stiffness (like RA)
  2. Dacylitis Sausage Digits
  3. Nail abnormalities

Tx = NSAIDs, MTX, Anti-TNFa

105
Q

Which conditions involve Morning Musculoskeletal Pain that improves with activity? - 2

A
  1. RA
  2. Seronegative Spondyloarthropathies
106
Q

Which abx is associated with tendinopathy and tendon rupture? ; How will these pts preset?

A

Fluoroquinolone ; development of tendon pain within 1 week of starting Fluoroquinolone

Tx = d/c abx, avoid excercise

107
Q

Crystal induced synovitis (Gout, Pseudogout) affects which areas of the body? - 6

A
  1. 1ST METATARSAL PHALANGEAL JOINT
  2. Ankle
  3. KNEE
  4. Elbow
  5. Wrist
  6. hands - image

Remember, Gout is caused by URATE Crystal deposition

108
Q

Behcet Syndrome cp-3 ; What is the major cause of morbidity in these pts?

A
  1. Recurrent Painful Oral and Genital aphthous ulcers
  2. Uveitis
  3. Erythema Nodosum

Thrombosis = MAJOR MORBIDITY

109
Q
A

Calcinosis Cutis

Ca+ and Phosphorous skin deposits –> scattered whitish lesions

110
Q

Which condition should you suspect in an older pt ( ≥65 yo) presenting with sx simliar to Sjogren syndrome?

A

Age related SICCA syndrome

Also, Sjogren has positive ANA

111
Q

Lab values for Paget disease of bone - 4

A
  1. ⬆︎ALP
  2. ⬆︎Urine Hydroxyproline (measures bone turnover)
  3. NORMAL CALCIUM
  4. NORMAL PHOSPHOROUS

bx: disorganized mosaic pattern of lamellar bone

112
Q

Why do pts with Giant Cell Temporal Arteritis require serial CXRs?

A

Women > 50 with Polymyalgia Rheumatica are at ⬆︎risk for Aortic Aneurysms due to vasculitis aortic branch involvement

PMR pts with have NORMAL strength but be stiff and have pain

113
Q

What type of Anemia does MTX cause? ; what are the other major side effects?-4

A

MACROCYTIC

other SE: stomatitis, hepatotoxicity, alopecia, ILD

prophylaxis = Folate B9

114
Q

For Rheumatoid Arthritis, what is the ultimate tx? ; Which medications are used for acute symptomatic relief?

A

MTX ; NSAIDs or CTS

115
Q

What is Anti-Histone a marker of?

A

Drug induced Lupus

RASH ORR PAINN

116
Q

Which bone tumor has the tendency to have a Soap Bubble Appearance on radiography?

A

Giant Cell Tumor of bone

117
Q

There are 8 common bone tumors

Name them and list their location of bone affected

118
Q

How does Rotator Cuff injury clinically present? - 4

119
Q

In Spinal Stenosis, pts pain is usually exacerbated with _____(flexion/extension) and _____. It is accompanied with ___ symptoms

A

spinal stEEEnosis

EXTENSION ; Exertion (vascular claudication) ; neurological

120
Q

cp for DeQuervain Tenosynovitis ; Demographic affected by this?

A

passive stretch of the abductor pollicis longus and extensor pollicis brevis –> Pain ; New Mothers who hold their infants with thumbs outstretched

121
Q

cp for Trigger Thump- 2

A
  1. pain over the palmar aspect of the 1st MCP joint
  2. locking of thumb in flexion
122
Q

Tx for Paget disease of bone

A

Bisphosphonates

​bx: disorganized mosaic pattern of lamellar bone

123
Q

In Lumbar disc herniation, pts pain is usually exacerbated with _____(flexion/extension) and accompanied with ___ symptoms

A

flexion ; UNILATERAL radiculopathy and neurological sx

124
Q

In Spinal Stenosis, pts pain is usually exacerbated with _____(flexion/extension) and _____

What is the most common cause of Spinal Stenosis?

A

EXTENSION ; exertion (vascular claudication)

Osteoarthritis degenerative joint disease

125
Q

You see an elderly patient leaning over to relieve their back pain

Dx?

A

Spinal Stenosis secondary to Osteoarthritis joint degeneration

Shopping cart sign - Spinal stenosis is exacerbated with extension and exertion

126
Q

What is the most common cause of asymptomatic isolated ALP ⬆︎ in the elderly

A

Paget Disease of bone

  • bx: disorganized mosaic pattern of lamellar bone*
  • tx = bisphosphonates*
127
Q

Dx for Paget disease of bone - 2

A

Xrays showing osteolytic or mixed lytic-sclerotic lesions –> radionuclide bone scan for confirmation

​bx: disorganized mosaic pattern of lamellar bone

128
Q

What are all the causes of Raynauds phenomenon - 6

A
  1. Primary idiopathic
  2. Smoking
  3. Connective tissue disease (Limited CREST Scleroderma)
  4. Sympathomimetics
  5. Hyperviscosity syndromes
  6. Vibrating tools
129
Q

cp for vertebral compression fracture ; risk factors?

most common cause = osteoporosis

A

acute back pain and point TTP after strenuous activity

RF: trauma, osteoporosis, osteomalacia, osteomyelitis, osteocancer, hyperparathyroidism

130
Q

How does corticosteroids affect bone?

A

⬆︎risk for avascular necrosis osteonecrosis

xrays will often be normal

131
Q

How do you blunt the side effects of MTX?

A

Folate B9 supplement

SE: Macrocytic anemia, stomatitis, hepatotoxicity, alopecia, ILD

132
Q

Describe the clinical presentation for Pes Anserinus Pain Syndrome (PAPS)

A

Pain over the Anteromedial tibia just below the joint line (medial tibial plateau) that is NOT aggravated by valgus stress test

if valgus stress exacerbates pain, consider MCL involvement

133
Q

Which part of the axial skeleton does Rheumatoid Arthritis affect?

A

Cervical and can cause cervical spine subluxation –> spinal cord compression!

134
Q

Takayasu arteritis is a ___ (small/medium/large) artery vasculitis that mostly affects which demographic? ; cp?-2

A

Asian Woman < 50yo ;

  1. weak UE pulses with associated UE numbness and pain
  2. Carotidynia

involves lumenal narrowing and aneursym formation

135
Q

serum sickness like reaction cp - 3 ; Which 2 drugs typically cause this?

A
  1. Urticaria
  2. Joint pain
  3. fever

Bactrim and BLactams

136
Q

Spondylolisthesis etx ; What’s the most common physical exam finding for this?

A

developmental forward slip of L5 vertebrae over S1 after Spondylolysis occurs ; palpable step off in preteens

137
Q

isolated ALP ⬆︎ in the elderly suggest ______

When this disease involves cranial bones what are the manifestations?- 3

A

Paget Disease of bone

  1. frontal bossing
  2. hearing loss
  3. CN dysfunction
  • bx: disorganized mosaic pattern of lamellar bone*
  • tx = bisphosphonates*
138
Q

cp for Anterior Cruciate Ligament tear ; dx?

A

POPPING sensation in knee followd by rapid hemarthrosis; MRI

prelim dx = Lachman test and ANT drawer sign

139
Q

cp for Temporomandibular Joint dysfunction (TMJ) - 2; tx?-2

A
  1. Ear Pain worse with chewing
  2. nocturnal teeth grinding

Tx =nighttime bite guard –> surgery

140
Q

What causes Osteomalacia? ; cp?-2

Rickets is the pediatric version of Osteomalacia

A

Vitamin D deficiency;

  1. Bone Pain
  2. Muscle weakness

Imaging: ⬇︎Bone Density with Looser Zone Pseudofractures

141
Q

What are the radiographic findings for Osteomalacia?

Rickets is the pediatric version of Osteomalacia

A

⬇︎Bone Density with Looser Zone Pseudofractures

caused by Vitamin D deficiency

142
Q

Rickets is caused by ____in children

Clinical findings for Rickets - 9

Osteomalacia is the Adult version of Rickets

A

Vitamin D deficiency

  1. Delayed Fontanelle closure
  2. Wide Sutures
  3. Frontal Bossing
  4. Craniotabes (softening of the skull)
  5. Dental hypoplasia
  6. Rachitic Rosary
  7. Pes Carinatum
  8. Joint swelling
  9. Bowing of Legs
143
Q

What are the major lab findings for Osteomalacia?-5

Rickets is the pediatric version of Osteomalacia

A
  1. Vitamin D Deficiency which –>
  2. ⬇︎Ca+
  3. ⬇︎Phosphorous
  4. ⬆︎PTH
  5. ⬆︎ALP

Imaging: ⬇︎Bone Density with Looser Zone Pseudofractures

144
Q

List the functions of Parathyroid Hormone - 4

A
  1. converts 25HydroxyVitD –> 1-25DihydroxyVitD in Kidney
  2. Reabsorbs Ca+ in Kidney
  3. Excretes Phosphate in Kidney
  4. converts OsteoBlast–>preOsteoClast (once they mature this causes CaPhosphate bone resorption)
145
Q

MOD for Osteoporosis

A

⬇︎Bone Density from Trabecular Spongy bone losing mass despite normal mineralization and lab values

Drug causes: These Coag Canners ⬇︎ Spongybone

146
Q

Which drug classes are known for causing Osteoporosis? - 4

A

These Coag Canners ⬇︎Spongybone

  1. Thyroid hormone
  2. antiCoagulants
  3. antiConvulsants
  4. Steroids
147
Q

What is the gold standard diagnostic test for Duchenne Muscular Dystrophy

A

GENETIC STUDIES revealing ⬆︎Creatine Phosphokinase and ⬆︎Aldolase

muscle bx can only support dx

148
Q

cp for Trochanteric Bursitis

A

Lateral Hip pain worst with direct pressure

149
Q

Describe the X-ray findings for Gout?

A

Punched out erosions with a remaining rim of cortical bone

[2b] A- step 2 CK (16 decks)

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