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Preclerkship > MSK > Flashcards

MSK Flashcards

1
Q

List the order of tests in an MSK physical exam

A 
Gait assessment
Inspection
Palpation
Range of Motion
Power Assessment 
Neuro & Vascular (esp back & wrists/hands)
Special tests
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2
Q

Acronym for MSK Inspection

A

SEADS = swelling, erythema, atrophy, deformities, scars/skin

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3
Q

Acronym for MSK Palpation

A

TESTCA = tenderness, effusions, swelling, temperature, crepitus, atrophy

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4
Q

4 muscles of the quadriceps

A

Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius

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5
Q

3 muscles of the hamstrings

A

Semimembranosus (medial)
Semitendinosus
Biceps femoris (short & long)

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6
Q

Innervation of the quadriceps

A

Femoral nerve

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7
Q

Innervation of the hamstrings

A

Sciatic nerve

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8
Q

Innervation of the gluteus

A

Superior/inferior gluteal nerves

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9
Q

Innervation of the adductors

A

Obturator nerve (except tibial for adductor magnus, femoral for pectineus)

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10
Q

Hip adductors

A

Adductor brevis, longus, magnus, minimus
Pectineus
Gracilis
Obturator externus

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11
Q

What is the only intracapsular ligament of the hip?

A

Ligamentum teres

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12
Q

There is less stability ___ to the hip, so hip is most likely to dislocate ____

A

Posteriorly (just the ischiofemoral, anterior has ileofemoral + pubofemoral + ligamentum teres)

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13
Q

2 phases of gait

A 
Swing phase (40%) (toe off --> heel strike)
Stance phase (60%) (heel strike --> toe off)
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14
Q

If pelvis drops on the swinging side, this indicates….

A

Weakness of hip abductors on opposite side

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15
Q

Antalgic gait

A

Stance phase shortened on affected side (pain on weight-bearing)

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16
Q

Bilateral hip abductor weakness –>

A

Waddling/Trendelenburg Gait

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17
Q

Exaggerated lumbar lordosis could indicate

A

Flexion contractor of the hip joint

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18
Q

Bony prominence on lateral aspect of him =

A

Greater trochanter

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19
Q

True leg length is measured from…

A

From ASIS to medial malleolus (crosses leg) (<1cm = normal)

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20
Q

Apparent leg length is measured from

A

Umbilicus to medial malleolus

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21
Q

Diff between true and apparent leg lengths?

A 
Apparent = issues at level of hip
True = issue below hip
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22
Q

To check internal hip rotation you move the foot which way?

A

Laterally!! and vv

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23
Q

Expected internal hip rotation, external hip rotation, abduction, adduction, extension

A 
Internal = 30o
External = 45
Abduction = 45
Adduction = 30
Extension = 20
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24
Q

Name 3 special tests in the hip exam and what they are looking for (not including leg length discrepancy)

A 
Thomas test (hip contracture)
FABER/Patrick's test (SI joint pathology (pain in lower back/gluts) or hip joint path (anterior/lateral pain))
Ober test (tight iliotibial band)
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25
Q

Fibularis longus/brevis AKA? Insertions?

A

Peroneus
Longus –> under foot to 1st metatarsal
Brevis = 5th metatarsal

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26
Q

4 arches of the foot

A

1) Medial longitudinal
2) Lateral longitudinal
3) Anterior/transverse metatarsal
4) Transverse mid-tarsal arch

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27
Q

Muscle compartments in thigh

A

Anterior: Rectus femoris, vastus muscles, sartorius
Medial: Adductor longus/brevis/magnus, gracilis
Posterior: biceps femoris, semitendinosus, semimembranosus

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28
Q

Muscle compartments in leg

A

Anterior: tib ant, EDL, EHL, fibularis tertius
Lateral: fibularis longus/brevis
Poterior superficial: triceps surae (gastroc/soleus), plantaris
Deep: Tib post, FDL, FHL

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29
Q

Define gonarthrosis & coxarthrosis

A

OA of knee (most common) and hip (2nd most)

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30
Q

OA leads to ___ formation of knee in early stage. Why?

A

Varus, medial cartilage lost first

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31
Q

What nodes are caused by osteophyte formation in the hands in OA?

A

Heberdens (DIPs)

Bouchards (PIPs)

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32
Q

4 possible radiograph findings in OA? Important note for diagnosis?

A

Subchondral cysts/sclerosis
Joint space narrowing
Osteophytes
OFTEN DON’T CORRELATE TO CLINICAL SYMPTOMS?FINDINGS, clinical features more important

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33
Q

Acetaminophen toxic dose

A

7.5-10 g in adults (boxes now say max 3 grams, docs can recommend up to 4)
150 mg/kg in children

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34
Q

Most common nontraumatic causes of osteonecrosis (2)

A

Chronic corticosteroid use (>20 mg prednisone, >2000 mg cumulative)
Alcohol consumption

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35
Q

What is SPONK?

A

Spontaneous osteonecrosis of the knee (femoral condyle or tibial plateau, usually in older women)

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36
Q

Tendon sheath

A

Synovial membrane layer surrounding tendons

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37
Q

Arthritides

A

Inflammatory joint diseases (does NOT include osteoarthritis which is degenerative)

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38
Q

Synovitis

A

Inflammation of synovial membrane

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39
Q

Septic arthritis

A

Bacterial infection of joint

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40
Q

Inflammation of tendon sheath = ?

Common in what disease?

A

Tenosynovitis

RA

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41
Q

What is enthesitis

A

inflammation where tendon inserts into bone

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42
Q

Palliation and provocation of pain in OA vs inflammatory arthritis

A

OA: exertion, evening; heat/rest help
A: rest, morning; movement/cold help

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43
Q

4 categories of inflammatory arthritis & demographics

A

RA (young/mid-age women)
SLE (young women)
Spondyloarthropathies (young men)
Gout (mid-age men, post-menopausal women)

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44
Q

2 most acute types of arthritis

A 
Gout (hyperacute)
Septic arthritis (acute)
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45
Q

Can joint distribution of arthritis be symmetrical if DIPs/PIPs are differentially affected?

A

Yes, as long as symmetrical DIGITS are affected

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46
Q

Classification of arthritis based on # of joints affected

A 
1 = monoarthritis
2-4 = oligoarthritis
5+ = polyarthritis
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47
Q

3 common differentials for acute monoarthritis

A

Gout (usually 1st MTP)
Pseudogout (CPPD deposition, usually knee)
Septic arthritis

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48
Q

Oligoarthritis presentation is common in _____

A

Spondyloarthropathies

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49
Q

Common axial spondyloarthritis

A

Ankylosing spondylitis

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50
Q

Common peripheral spondyloarthrites (3)

A

Enteropathic (IBD! usualy lower extremities)
Reactive (after bact infection GI/urethra, usually lower extrem)
Psoriatic (small joints esp hands)

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51
Q

Name 3 common features of spondyloarthritises (since peripheral ones don’t actually all impact the spine)

A

Enthesitis
Extra-articular manifestations (skin, eyes)
Seronegative (e.g. no rheumatoid factor)

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52
Q

2 patters of presentation in psoriatic arthritis

A 
Ray pattern (asymmetric polyarthritis)
Transverse involvement (across DIPs)
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53
Q

RA usually impacts what body part first?

A

Feet (symmetric)

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54
Q

Which small joints tend to be spared by RA?

A

CMC
DIPs
(more likely to be OA)

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55
Q

SLE arthritis presentation

A

Symmetric polyarthritis in small joints of hands (DIP mayyy be affected in addition to others)

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56
Q

Crystals that form in gout are what?

A

Monosodium urate

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57
Q

Repeated gout attacks cause aggregation of urate crystals & giant cells =

A

Tophi (bone or soft tissue)

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58
Q

What is inflammation caused by in gout?

A

crystals precip coated by IgG –> phagocytosis, cytokine release

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59
Q

Things that decrease UA excretion

A 
Meds (aspirin, loop/thiazide diuretics, etc)
CKD
Ketoacidosis
Post-menopause
Alcohol
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60
Q

Things that increase UA production

A

High-fructose corn syrup (pop)
Cell turnover (TLS, chemo, hemolytic anemia, psoriasis, cancers)
Enzyme defects
Obesity, hypercholetersol/TAGs, hypertension
Alcohol

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61
Q

Most common type of gout =

A

Podagra (1st MTP)

Knee (gonacra), fingers, ankle, wrist also possible

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62
Q

Gold standard diagnostic tool for gout

A

Arthrocentesis + synovial fluid analysis (if diagnosis uncertain or septic likely)

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63
Q

3 patient characteristics in gout diagnosis tool

A

Male
CV risk factors
History of prev attacks

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64
Q

4 features of attack in gout diagnostic tool

A

Onset within 24 hours
Joint erythema
1st MTP
Elevated serum UA (higher range of normal?)

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65
Q

Renal manifestations of chronic gout

A

Uric acid nephrolithiasis

Nephropathy

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66
Q

Gold standard for gout diagnosis (if unsure)

A

Arthrocentesis + synovial fluid analysis

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67
Q

Name 3 meds for acute gout flare

A

1) NSAIDS
2) Glucocorticoids (avoid giving w/ NSAIDs w/out PPI)
3) Colchicine (inhibits phagocytosis of crystals + neutrophil activation/degranulation)

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68
Q

NSAIDs from strongest to weakest

A

Indomethacin > naproxen (Aleve) > diclofenac (Voltaren) > ibuprofen (motrin/advil)

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69
Q

What MUST be done when initiating urate-lowering therapy for gout?

A

Give anti-inflamm prophylaxis for 1 week first (mobilizing urates increases acute flares) –> GCs, NSAIDs, or colchicine

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70
Q

Indications for urate-lowering therapy

A

Absolute: >2 attacks/year, tophi
Relative: CKD, high serum uric acid, urolithiasis

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71
Q

Name top 3 urate-lowering therapies and mechanisms

A

1) Xanthine oxidase inhibitors (Allopurinol/Febuxostat) - prevent UA formation from purines
2) Uricosurics (probenecid) - prevent UA reabsorption in PCT
3) Recombinant uricase (pegloticase) - breaks UA down to allantoin

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72
Q

Difference between rasburicase and pegloticase?

A

Pegloticase is conjugated to PEG to increase half-life and immunogenicity
Rasburicase used in TLS/pre-chemo

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73
Q

Tendinitis vs tendinosis

A 
Tendinitis = inflammation due to micro-tears
Tendinosis = collagen restructuring (immature/disorganized) due to chronic overuse & improper healing
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74
Q

Treatment goals/strategies in tendinitis vs tendinosis

A

Itis –> reduce inflamm (ice, NSAIDs, steroids)

Osis –> facilitate proper healing (heat unless inflamm episode, long-term physio)

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75
Q

What is adhesive capsulitis and what is a key indicator that this is the issue?

A

Frozen shoulder = reversible contraction of joint capsule

Won’t move actively OR passively

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76
Q

Most common cause of shoulder pain

A

Rotator cuff tendinopathy (usually supraspinatus tendon)

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77
Q

Distal tibiofibular syndesmosis = what type of joint?

A

Fibrous

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78
Q

Synchondroses are ___ joints. Examples?

A 
Cartilagenous
Epiphyseal plates (temp hyaline cartilage), b/w first 7 ribs & sternum
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79
Q

6 types of synovial joints

A

1) Plane (e.g. intercarpals)
2) Hinge (e.g. elbow, interphalangeal)
3) Pivot (proximal radioulner)
4) Condyloid (MCP joints)
5) Saddle (CMC of thumb)
6) Ball & socket (shoulder, hip)

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80
Q

The knee consists of one __ joint and 2 ___ joints

A 
1 plane (femoropatellar)
2 hinge (med/lat tibiofemoral)
(these are also the 3 compartments)
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81
Q

Define juvenile idiopathic arthritis

A

Rheumatic disease diagnosed <16yo with inflamm lasting >6 weeks

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82
Q

What part of the eye is often inflamed in JIA?

A 
Anterior uvea (uvea = iris + ciliary body + choroid; anterior = iris + ciliary body)
**often asymptomatic
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83
Q

Main diagnostic imaging technology in JIA?

A

Ultrasound (can see synovial hypertrophy, intraarticular fluid collection, bone erosions)

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84
Q

Define acute, subacute, and chronic back pain

A

Acute <6 weeks
Subacute = 6-12 weeks
Chronic > 12 weeks

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85
Q

Anterolisthesis

A

Anterior displacement of vertebral body relative to the one below

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86
Q

Anterolisthesis secondary to spondylolysis

A

Spondylolisthesis

87
Q

Displacement of vertebral body posterior relative to the one below

A

Retrolisthesis

88
Q

Define spondylosis

A

Degenerative arthritis of the spine (disc space narrowing, arthritic changes of facet joint)

89
Q

Radiculopathy

A

Impairment of nerve root –> radiating pain, numbness, tingling, muscle weakness in corresponding area

90
Q

Sciatica

A

Pain/numbness/tingling in distribution of sciatic nerve (posterior/lateral aspects of leg –> foot)

91
Q

Loss of bowel/bladder control and numbness in groin + weakness of lower extremities = ___ syndrome. Caused by what?

A

Cauda equina syndrome

Pressure on bottom of spinal canal and spinal nerve roots (bony stenosis, herniated disk)

92
Q

> 90% of radiculopathies involve what nerve roots?

A

L5 & S1 (–>sciatica)
*L5 goes from glut across front of leg to top of big toe
S1 stays down the back

93
Q

3 main categories of differentials for NONmechanical spine disease

A

Neoplasia
Infection
Inflammatory (usually HLA-B27 associated) - not usually RA!! (RA rarely affects spine except cervical)

94
Q

The vast majority of low back pain is ____ (97%) and 70% are specifically…

A

Mechanical

70% lumbar strain/sprain

95
Q

Pt presents with low back pain that is better when spine is flex or when seated, aggravated by walking downhill more than uphill, bilateral symptoms. Most likely diagnosis?

A

Spinal stenosis

96
Q

Pt presents with low back pain but WORSE leg pain, radiating below knee. Most likely diagnosis?

A

Herniated disk?

97
Q

Viral illness that can cause unilateral dermatomal back pain + rash?

A

Shingles

98
Q

In a herniation, the affected nerve root is above or below the level of disc herniation?

A

BELOW (e.g. L4-L5 disc herniation–> L5 radiculopathy)

99
Q

Leading causes of morality in SLE (4)

A

Heart disease
Malignancy
Infection
(also kidney disease)

100
Q

5 lab markers for SLE?

A

ANA >1:80 (v sensitive!)
Sm & dsDNA (both v specific!)
Low complement
Anti-phospholipid Ab

101
Q

2 types of rashes with SLE? (nonscarring & scarring)

A 
Malar = nonscarring, usually over bridge of nose
Scaring = discoid
102
Q

SLE nephritis is characterized by…(3)

A

Renal insufficiency
RBC casts
Proteinuria
(Full house glomerular deposits = IgG/M/A + complement)

103
Q

3 types of inflammatory myopathy

A

Polymyositis
Dermatomyositis
Inclusion body myositis

104
Q

Polymyositis & dermatomyositis affect ___ muscles

A

Proximal

105
Q

Name 4 cutaneous manifestations of DM

A 
Gottron papules (dorsum of hands)
Heliotrope rash (upper eyelids)
Mechanics hands (dirty-appearing fingers)
Photosensitive poikiloderma
106
Q

Name 5 muscle enzymes that can be elevated in myositis

A

Creatine kinase, aldolase

LDH, AST, ALT, myoglobin

107
Q

4 roles of electrophysiological studies (nerve conduction + electromyography) in diagnosis of myopathy

A

1) Exclude neuromuscular issue
2) Provide EMG evidence of myopathy
3) Characterize it (location, severity)
4) Identify target muscles for biopsy (contralateral!)

108
Q

MRI advantage over EMG for determining biopsy site?

A

You can biopsy the actual muscle you image not just contralateral

109
Q

Treatment for lupus

A 
Induction = oral GCs 
Maintenance = hydroxychloroquine (+methotrexate or azathioprine if needed)
110
Q

Treatment for giant cell arteritis

A

Steroids (high dose at first then low)

111
Q

Treatment for inflammatory myositis

A

Physical therapy
UV light protection in DM
Corticosteroids

112
Q

3 organ complications in inflammatory myopathy

A

Pneumonia (related to resp muscle failure) –> ILD/resp failure
Myocarditis –> arrhythmia
Esophageal muscle weakness –> aspiration pneumonia

113
Q

4 steps in approach to muscle weakness

A

1) Determine if true muscle weakness vs lassitude
2) Determine site of lesion
3) Determine cause of lesion
4) Evaluate for resp muscle weakness

114
Q

Objective muscle weakness can be broken down by general localization into…

A

Generalized (e.g. cachexia)
Localized asymmetric
Localized symmetric (proximal e.g. myopathy, distal, specific pattern)

115
Q

5 possible sites of lesion causing true muscle weakness

A 
Upper motor neuron
Anterior horn cell
Peripheral nerve
NMJ
Muscle
116
Q

Muscle strength testing scale

A 
0 = no contraction
1 = flicker 
2 = can move w/out gravity
3 = move against gravity
4 = move against limited resistance
5 = normal
117
Q

6 differential diagnostic categories for MSK lesions causing muscle weakness

A 
Inflammation
Infection
Toxins/drugs
Metabolic/endocrine
Genetic
Neoplastic
118
Q

5 common features of spondyloarthropathies

A 
Family history
HLA-B27 association
Enthesitis!!
Extra-articular manifestations (uveitis, psoriasis)
Seronegative (no RF)
119
Q

Major extra-articular manifestation of ankylosing spondylitis

A

Acute, unilateral anterior uveitis

120
Q

Anky Spon affects the spine &

A

SI joint!!

121
Q

Physical exam tests for ankyspon (5)

A 
Bilateral chest expansino
Modified Schober test
FABER test
Gaenslen test
Occiput-wall distance
122
Q

What might labs in an akyspon patient show (3)

A

High CRP/ESR
No auto-antibodies
High HLA-B27

123
Q

Best imaging for EARLY detection of ankyspon?

A

Pelvic MRI (very sensitive for sacroiliitis)

124
Q

Difference between syndesmophyte and osteophyte?

A

Syndesmophytes originate from annulus fibrosis & spinal ligaments in AnkySpon (inflammatory). Grow vertically –> bamboo spine
Osteophytes originate from vertebral bodies, usually in OA (degenerative). Grow horizontally
Both are ossifications

125
Q

Most important treatment for ankyspon

A

Physical therapy

126
Q

Respiratory complications of ankyspon

A

Breathing difficulties

Apical fibrosis of lungs (due to aspiration, defective ventilation, etc)

127
Q

Medications for ankyspon (4)

A

NSAIDs = first line
TNF-a inhibitors to reduce axial progression
DMARDs for associate peripheral arthritis
Temporary intra-articular GCs if severe

128
Q

Diagnostic approach to ankyspon:

A

Physical exam + history + pelvic x-ray

If inconslusive –> HLA B27 testing –> pelvic MRI

129
Q

Cardinal symptom of ankyspon

A

Nocturnal back pain (sacroiliitis) that improves w/ NSAIDs/movement (morning stiffness)
+ pain/stiffness along spine

130
Q

Scoliosis is characterized by ___ curvature (___ > ___) and __ of vertebral bodies
Most common curve?

A

Lateral curvature (Cobb angle >10)
Rotation
(most commonly R convex thoracic)

131
Q

Most idiopathic scoliosis is what class (by age)? Gender distribution?

A

80% adolescent (10+ years old)
Mostly females
(*for juveniles 4-9yo mostly males, equal below that)

132
Q

Do kids with scoliosis have pain?

A

Not usually (though adults may due to degeneration/compression of spinal nerves) - assess all kids as often discovered incidentally

133
Q

4 important things to note on spinal X-ray in scoliosis patient

A 
Major curvature
Minor curvatures (compensatory)
Cobb angle (>10)
Risser sign (skeletal maturity on iliac crest, rated 1-5)
134
Q

Based on Cobb angle, treatment for scoliosis progresses how?

A

Monitoring –> bracing (slows/halts progression but doesn’t fix underlying) –> surgery

135
Q

Which brace most common for scoliosis

A

Boston (fits under clothes)

136
Q

Congenital spine issues cause by failures of ___ or ___

A

Segmentation

Formation (e.g. hemivertebrae)

137
Q

Discs usually herniate in what direction?

A

Posterolaterally (posterior longitudinal ligament is thinner)

138
Q

Up to 80% of all disc herniations are ___

A

self-limiting (usually resolve within 4 weeks)

139
Q

When is imaging indicated for uncomplicated herniated disc or spinal stenosis?

A

After 6-wk trial conservative management & symptoms severe enough to consider surgery

140
Q

Trick to differentiate muscle/joint vs bone pain?

A

Give anti inflamm

If helps –> probably muscle/joint; won’t help bone

141
Q

Red flags indicating imaging required (6)

A

Suspected epidural abscess or hematoma, cancer, infection
Cauda equina syndrome
Severe/progressive neuro deficit
Suspected compression fracture

142
Q

Define cauda equina syndrome

A

A clinical syndrome caused by compression of nerves in the cauda equina (involving ≥ 2 of the L2–S5 nerve roots).

143
Q

4 symptoms of cauda equina syndrome

A

Back pain
Variable lower extremity neurological defects
Perianal/saddle anesthesia
Bowel/bladder dysfunction (retention or incontinence)

144
Q

Neurological claudication caused by ___ - when you do things your limbs feel “heavy”. Progresses into ____ (compression).

A

Spinal stenosis

Cauda equina syndrome

145
Q

Bloodwork in rickets (5)

A

Low: Vit D, Ca, Phosphate
High: PTH, ALP

146
Q

What are looser zones? In what disease are these seen

A

Pseudofractures = bands of low bone density on bone surfaces, look like fractures (e.g. in osteomalacia)

147
Q

name 3 features of rickets (bone deformities)

A 
Craniotabes (soft skull) & delayed closure of fontanelles
Knee deformities (genu varum)
Rachitic rosary
148
Q

Cupping, stippling, and fraying of growth plates are seen in what disease?

A

Rickets

149
Q

In case of spontaneous fractures, what neoplasm shoudl be tested for? How?

A 
multiple myeloma (plasma cells infiltrate BM)
Serum protein electrophoresis --> monoclonal peak (M spike) = abnormal M protein produced by monoclonal plasma cells
150
Q

___ is the primary mediator of bone resorption
___ is the endogenous inhibitor of the action of above
Ratio determines BMB

A

RANKL

OPG (decoy receptor)

151
Q

Define fragility fracture

A

Spontaneously or after minor trauma
- Fall form standing hight or sitting or supine <1m high
Fall missing 1-3 stairs
Coughing, twisting, etc.

152
Q

DIfference between Z-score and T-score in DEXA scan

A 
Z = diff from average person your age/sex
T = diff from 30yo same sex (more important!)
153
Q

T score cutoffs for osteoporosis & osteopenia

A
154
Q

Calcium, phosphate, and PTH levels in osteoporosis?

A

Normal (unless other pathology going on)

155
Q

What blood parameter may be elevated in osteoporosis

A

ALP

156
Q

Recommended biochemical tests for osteoporosis workup (7)

A 
Calcium (corrected for albumin)
CBC
Creatinine
ALP
TSH
Vit D
Serum protein electrophoresis (if vertebral fractures)
157
Q

Recommended dietary intake of Ca

A

1000 mg/d
1200 mg/d for women >50 and men>70
(avoid >2500 or >2000 if >50)

158
Q

Daily recommended Vit D

A

400-800 IU if <50

800-2000 IU if >50

159
Q

Name 6 treatment categories for osteoporosis + examples

A
  1. Exercise (balance + strength)
  2. Diet (Ca + vit D)
  3. HT (estrogen)
  4. SERMs (Raloxifene)
  5. PTH (teriparatide)
  6. mAbs (denosumab)
  7. Bisphosphonates (aldendronate)
160
Q

Why does PTH work as an osteoporosis treatment if it’s responsible for bone break down? Drug name example?

A

Teriparatide

Opposite affect if given INTERMITTENTLY vs continuously

161
Q

How does denosumab work?

A

Binds RANKL so it can’t bind RANK on osteoclasts

162
Q

What are the rare but serious side effects of bisphosphnoates?

A

Atypical femoral fracture (subtrochanteric insufficiency fracture)
Avascular necrosis of jaw

163
Q

Advantage of denosumab > bisphosphonates re bone?

A

Not incorporated iNTO the bone!

164
Q

Bisphosphonates mechanism of action

A

Bind bone surface –> taken up by osteoclasts –> impair their cellular function –> osteoclast apoptosis

165
Q

Name 2 oral bisphosphonates + 1 IV bisphosphonates

A

Oral: alendronate, risedronate
IV: zoledronate, pamidronate

166
Q

3 most important tests of synovial fluid

A

1) Culture + Gram stain
2) Cell count + differential
3) Crystal examination

167
Q

Synovial fluid analysis: %PMN in non-inflammatory, inflammatory, and infectious arthritis

A

Non-inflamm: <25%
Inflamm: >25%
Infectious: >75%

168
Q

How does infectious arthritis beget destruction of joint?

A

Inflamm –> effusion –> compress BVs –> necrosis of bones & cartilage
Bacterial proteases digest collagen

169
Q

Septic arthritis key triad

A

Joint pain + impaired ROM + fever

170
Q

Name 3 pathogens that can commonly cause septic arthritis?

A

Staphylococcus aureus
Mycobacterium tuberculosis
Borrelia (lyme)

171
Q

What are you looking for on arthrocentesis for septic arthritis?

A

High WBCs
Positive culture
R/O crystals

172
Q

What is the utility of ultrasound/X-ray/MRI in septic arthritis workup?

A

Hip/SI joints can’t be easily aspirated
R/O differentials (osteomyelitis, other joint diseases)
U/S —> effusions, soft tissue around
X-ray –> see osteolysis after a few weeks
MRI –> early detection of soft tissue infection

173
Q

What is Reiter syndrome?

A

Reactive arthritis with the whole triad (arthritis + urethritis + uveitis)

174
Q

Reactive arthritis is a sero___ ___arthritis

A 
Seronegative spondyloarthritis (HLA-B27 associated)
AUTOIMMUNE not infectious
175
Q

Name 4 common pathogens causing reactive arthritis

A

Shigella
Chlamydia
Salmonella
Campylobacter

176
Q

Arthrocentesis in reactive arthritis

A 
High WBCs (not as high as infectious)
Negative gram stain/culture
177
Q

Treatment for reactive arthritis (4 main groups)

A 
Self-limiting!
NSAIDs
Intraarticular/oral GCs if refractory
If >6mo (chronic) --> DMARDs, biologics (anti-TNF)
Local cryotherapy, physiotherapy
178
Q

4 specific MSK manifestations of reactive arthritis

A

Asymmetric olifoarthritis
Dactylitis
Enthesitis
Sacroiliitis

179
Q

ANA is a defining features of ____ autoimmune disorders, including (4):

A

Connective tissue

1) SLE
2) Scleroderma
3) Polymyositis/dermatomyositis
4) Sjogren’s syndrome

180
Q

Signs/features of MAS in JIA?

A

Pancytopenia
Liver insufficiency: high AST/ALT/PT/ferritin, low fibrinogen
UNREMITTING fever

181
Q

Interesting bloodwork sign in MAS

A

High CRP but LOW ESR because of lack of fibrinogen

182
Q

Steroids important in the case of what 2 JIA complications

A 
Anterior uveitis (topical)
Macrophage activation syndrome (parenteral)
183
Q

MAS is widespread ____ & ____ caused by activation & overproliferation of what cells?

A

Hemophagocytosis & cytokine release (macrophages + T cells)

184
Q

Most common JIA subtype = ?

Complication risk? Which joints most commonly involved? ANA?

A

Oligoarthritis
Anterior uveitis
Large joints (knee/ankle, wrist/elbow)
ANA+ (70%); RF-

185
Q

What pathogen/infection is associated with RA development? Why?

A 
Porphyromonas gingivalis (gingivitis)
PPAD enzyme (like endogenous PAD but not regulated) --> citrullination
186
Q

How does RA lead to anemia of chronic disease?

A

Inflamm cytokines (IL-6) –> hepcidin production in liver –> prevents iron absorption/release (so treating the RA can treat the anemia!)

187
Q

Clue that the diagnosis is RA and probably not reactive arthritis?

A

> 6 week duration

188
Q

4 important things of RA pathogenesis

A

1) Cirtrullination
2) Synovitis
3) Angiogenesis + pannus formation
4) Osteoclast activation + bone breakdown

189
Q

What are 2 important Abs in RF diagnosis?

A

RF (IgM against IgG)

anti-CCP (against citrullinated proteins)

190
Q

Useful imaging modality to monitor RA progression/response to treatment

A

Doppler U/S

MRI is good but need to be selective, x-ray can be good for bone dislocations, deformities, erosions

191
Q

4 steps of treatment of RA

A
  1. Non-pharmacological therapy
  2. Pain control
  3. Conventional synthetic DMARDS
  4. Biological and targeted synthetic DMARDS
192
Q

Non-pharm therapy for RA

A

Stop smoking
Physio, OT
Orthotics/splints

193
Q

name 3 csDMARDS for RA

A

Hydroxychloroquine
Methotrexate
Sulfasalazine

194
Q

What are tsDMARDS? Advantages?

A

Jak inhibitors
Small molecule, work better/safer (less infection) than biologics
e.g. Olumiant

195
Q

In OA the joint capsule is…

A

Thickened

196
Q

6 Ps of compartment syndrome

A

1) Pain
2) Pallor
3) Paresthesias
(later)
4) Poikilothermia (cold)
5) Pulselessness
6) Paralysis

197
Q

6 components of describing a fracture

A

1) Location on bone
2) Pattern
3) Displacement
4) Angulation
5) Articular involvement
6) Open or closed

198
Q

Describing fracture location

A

Epiphysis
Metaphysis
Diaphysis (proximal, mid, distal)

199
Q

Fracture pattern

A 
Transverse
Oblique (>30o)
Spiral
Segmented
Comminuted
200
Q

Fracture displacement

A

Describe distal relative to proximal
Shortened (impacted) vs distracted
Lateral/medial, palmar/dorsal, radial/ulnar

201
Q

Fracture angulation

A

Opposite of apex or say ___ apex
Dorsal vs palmar, varus vs vaLgus (L = lateral)
Radial vs ulnar

202
Q

Fracture articular involvement

A

Intra- or extra-articular

203
Q

Open fracture AKA

Requires what intervention?

A

Compound fracture

30 min of surgical lavash

204
Q

AB used for type I-III open fractures? What do you also add for type III?

A

Cefazolin (gram + coverage) for all

Gentamicin for type III (severe contamination)

205
Q

What is a salter-harris fracture? 5 types?

A 
Fracture through physis
I = transverse through entire physis
II = through physis + metaphysis
III = through physis + epiphysis
IV = through all 3 layers
V = crush fracture of physis
206
Q

Primary method for treating clubfoot

A

Ponseti method (serial casting)

207
Q

Name the 5 deformities associated with clubfoot

A

Hindfoot: equinus (short achilles), varus
Midfoot: cavus
Forefoot: adductus, supination/inversion

208
Q

Clubfoot detectable prenatally at ___ weeks via ___

A

12-13 weeks (after physiological shift away from equinovarus adductus position)
Transvaginal U/S

209
Q

Clubfoot AKA

A

Talipes equinovarus

210
Q

Common shoulder tendinopathy must be distinguished from ___ (reduced ROM), ____ (persistent weakness), and ____ (painful flexion)

A

Adhesive capsulitis
Rotator cuff tendon tear
Biceps tendinopathy

211
Q

Trick to differentiate tendinopathy from tear (shoulder)

A

Give lidocaine , if ROM improves it’s tendinopathy & vv

212
Q

Empty can test for ___ function

A

Supraspinatus

213
Q

___ = gold standard imaging for tendon disorders

A

Ultrasound (dynamic)

214
Q

____ and __ useful for evaluating & treating frozen shoulder respectively

A 
Arthrography
Arthroscopy (if conservative measures dont' work)

Preclerkship (25 decks)

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