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Pance Re-Up > MSK Re-Up #1 > Flashcards

MSK Re-Up #1 Flashcards

1
Q

What is compartment syndrome?

What is the MC etiology of this?

A

-Muscle and nerve ischemia (decreased tissue perfusion) when the closed muscle compartment pressure > perfusion pressure.

Trauma (fracture of the long bones) especially involving the LE
-Others: crush injuries, constriction (tight casts, splints, circumferential burns)

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2
Q

Symptoms of compartment syndrome

A

-Pain out of proportion to injury***
-Pain with passive stretching (earliest exam finding)
-Tense compartment (firm or wood like feeling)
-Pulseless, pallor, paresis.

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3
Q

What is diagnostic for compartment syndrome?

What is the treatment?

A

-Increased intracompartmental pressure > 30 mmHg
-Increased CK and myoglobin

-Prompt decompression: emergent fasciotomy
–While waiting, place limb at level of heart without elevation. IVF, oxygen, remove tight dressings.

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4
Q

Acute osteomyelitis is infection of the bone. What are the MC bones affected in kids? In adults?

How is this MC spread in kids?

A

Femur and tibia in kids
Vertebrae in adults

acute hematogenous spread MC route of spread

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5
Q

Notable Organisms for Osteomyelitis:
-MC organism overall:
-Increased incidence after prosthetic joint placement, neonates, kids with indwelling catheters:
-Increased incidence in Sickle Cell Disease:
-Increased incidence in neonates:
-Puncture wounds through tennis shoes:

A

-MC overall: Staph Aureus
-Prosthetic Joints: Staph Epidermis
-Sickle Cell: Salmonella
-Neonates: Group B Strep
-Puncture Wounds: Pseudomonas

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6
Q

Symptoms of osteomyelitis

What is the initial imaging test that is ordered?

A

Fever, chills, malaise
-Bone pain, warmth, swelling, tenderness, limitation of function, refusal to bear weight, etc.

Radiographs usually initially ordered: periosteal reaction is seen early, about 2 weeks after symptom onset

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7
Q

However, ________ is the most sensitive test early in disease, but ______ is the gold standard.

A

MRI sensitive in early disease

Bone aspiration is GOLD

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8
Q

Treatment for the following types of osteomyelitis
-Group B Strep
-Staph Aureus
-MRSA
-Salmonella
-Pseudomonas

A

-Group B Strep (Neonates): Cefotaxime + Vanco/Ox/Nafcillin

-Staph Aureus: Nafcillin, Oxacillin, Cefazolin (Clinda or Vanco as PCN allergic)

-MRSA: Vancomycin

-Salmonella: 3rd Gen Ceph or Cipro/Levo

-Pseudomonas: Ceftazidime, Ciprofloxacin

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9
Q

Chronic Osteomyelitis, which is chronic infection of the bone (months to years) has a few different, more common sources in adults. Name them.

A

-Direct inoculation (surgery, trauma, prosthetic joint)
-Contiguous spread with vascular insufficiency (DM, PVD)

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10
Q

MRI is more sensitive than radiographs, and bone biopsy is still gold standard for chronic osteomyelitis, but what is seen on radiographs that you should remember (two words)

A

-Sequestrum: segment of necrotic bone that become separated from normal bone
-Involucrum: periosteal bone formation that surrounds necrotic bone (sequestrum)

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11
Q

Treatment for chronic osteomyelitis

A

-Surgical debridement + cultures initially
-Empiric ABX not usually recommended

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12
Q

Septic Arthritis is an infection of the joint cavity. This is a medical emergency as it can rapidly destroy the joint. What joint is MC affected in adults? How about in kids?

What is the MC organism in all age groups?
-How about in sexually active young adults?

A

-Knee MC involved in adults and older kids
-Hip joint MC involved in younger kids

-S. Aureus MC organism in all age groups
-Neisseria Gonorrhoae in sexual active young adults
-Pseudomonas: in immunocompromised (IVDU, older adults, trauma)

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13
Q

Symptoms of Septic Arthritis

What is the best initial test and what is seen?

A

-Swollen, warm painful tender joint with decreased ROM
-Fever, chills, malaise, diaphoresis, myalgias

-Arthocentesis: WBC > 50,000 primarily neutrophils

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14
Q

What other labs are shown in septic arthritis?

A

-Increased ESR and CRP**
-Blood cultures positive in 50%

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15
Q

Prompt IV ABX should be given if septic arthritis is suspected. What ABX is given in…
-No organism seen
-Gram Positive Cocci
-Gram negative Cocci (Gonoccocus)
-Gram Negative Rods

A

-No organism: Ceftriaxone + Vanco
-Gram Positive Cocci: Vanco for MSSA
-Gram Negative Cocci: Ceftriaxone
-Gram Negative Rods: Ceftazidime + Gentamicin

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16
Q

Polymyalgia Rheumatica is idiopathic inflammation of the joints, bursae, and tendons.

It is highly associated with what other condition?

What are symptoms of this condition?

A

-Giant Cell (Temporal) Arteritis

-Pain and stiffness in proximal joints and muscles (worse in morning). May have difficulty rising from a chair and combing hair.
-Low grade fever, fatigue, weight loss

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17
Q

On physical exam, patients with PMR have _______ strength of muscles.

What do labs show? Remember, there is something that differentiates PMR from polymyositis.

A

Normal muscle strength (no muscle inflammation or weakness)

-Increased ESR and CRP
-Normal muscle enzymes (CK and aldolase) distinguishes this from polymyositis

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18
Q

Treatment for PMR

A

-Low dose corticosteroids initially

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19
Q

On the other hand, polymyositis is an autoimmune condition leading to muscle inflammation.

What are symptoms of this condition?

A

Progressive symmetric proximal muscle weakness (shoulders, hips). May have problems rising from a chair, combing hair.
-Low grade fever, arthralgia, weight loss, fatigue

-Decreased muscle strength
-NO RASH

20
Q

Best initial test for polymyositis?

What antibodies are specific to this condition?

What is the definitive diagnostic?

A

-Increased muscle enzymes (CK and aldolase)

-Anti Jo-1 and Anti-signal recognition protein (most specific)

Muscle biopsy is definitive**

21
Q

Treatment for polymyositis?

A

High-dose glucocorticoids

22
Q

Again, how do you differentiate polymyositis and PMR?

A

-PMR: normal muscle strength. Normal muscle enzymes.

-Polymyositis: decreased muscle strength. Elevated muscle enzymes.

23
Q

Dermatomyositis is an autoimmune condition leading to muscle inflammation AND dermatologic manifestations. This is associated with cancer in 25% of cases.

What are symptoms of this condition?

A

Progressive symmetric proximal muscle weakness (shoulders, hips). May have problems rising from a chair or combing hair.
-Fever, weight loss, fatigue, dysphagia
-Decreased muscle strength
-Gottron’s Papules: raised scaly patches on dorsum of PIP and MCP joints
-Heliotrope Rash: edema and blue color of upper eyelids
-Malar Rash, Photosensitive Rash, SHAWL SIGN (erythema of shoulder, upper chest, and back)

24
Q

What is the best initial test for dermatomyositis?

What antibodies are associated with this condition?

What is definitive?

A

-Increased muscle enzymes (CK and aldolase)

-Anti Jo-1 and Anti-Mi-2 (most specific)

Muscle biopsy is definitive

25
Q

Treatment for dermatomyositis
-How about for skin lesions?

A

-High dose glucocorticoids

-Hydroxychloroquine for skin lesions

26
Q

Sjogren Syndrome is an autoimmune disorder primarily affecting the _________.

What are some symptoms of this condition?

What is the best screening test (specific antibodies)

A

-Exocrine glands

-Dry mouth (xerostomia), dry eyes (keratoconjunctivitis, sicca), vaginal dryness (dyspareunia), bilateral parotid gland enlargement, dental caries (complication of xerostomia)

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

27
Q

What other study can be done for Sjogren’s?

What is the definitive diagnostic?

A

-Positive Schirmer’s Test: decreased tear production (<5mm in 5 minutes)

Lip or parotid gland biopsy is definitive

28
Q

Management for Sjogren’s

What are patients with this condition at increased risk for ?

A

-Lifestyle: artificial tears, increase fluid intake, sugar-free gum, etc.
-Cholinergic Drugs: Pilocarpine or Cevimeline lead to increased secretions

-At increased risk for Non-Hodgkin Lymphoma

29
Q

What are some side effects of Pilocarpine, a cholinergic drug that increases lacrimation and salivation?

A

-Diaphoresis, sweating, flushing, bradycardia, diarrhea, vomiting, nausea, incontinence, blurry vision.

30
Q

What is scleroderma?

Explain the two types.

A

-Systemic autoimmune CTD where collagen deposition leads to fibrosis of the skin and internal organs.

-Limited (CREST) Syndrome: (MC). Tight, shiny, thickened skin involving face, neck, and distal to elbows and knees. Spares the trunk. Calcinosis Cutis (calcium deposits in skin), Raynaud’s, Esophageal motility disorder, Scerodactyly, Telangiectasias.

-Diffuse: tight, shiny thickened skin involving trunk and proximal extremities. Greater internal organ involvement (restrictive lung disease, myocardial fibrosis, etc.)

31
Q

What antibodies are specific to Limited (CREST)?

What antibodies are specific to diffuse disease?

A

-Anti-centromere antibodies (CREST)

-Anti-SCL-70-antibodies (diffuse)

32
Q

True or False: Treatment for Scleroderma is organ specific.

A

True

33
Q

What is Behcet’s Syndrome characterized by?

Who is it MC in?

A

-Recurrent, painful oral and genital ulcers, erythema nodosum, uveitis/conjunctivitis, arthritis, and CNS involvement (may mimic MS)

-MC in Asian, Middle Eastern, or Mediterranean

34
Q

Although Behcet’s Syndrome is a clinical diagnosis, and a biopsy gives a definitive diagnosis, what other thing CAN be diagnostic but is less common?

A

Pathergy: sterile skin papules or pustules from minor trauma (such as a needle stick)

35
Q

Treatment for Behcet’s Syndrome

A

Corticosteroids during flares

36
Q

Polyarteritis Nodosa (PAN) is systemic vasculitis primarily of medium sized vessels. This MC affects which three types of vessels?

What type is NOT involved (distinguishes PAN from other vasculitides)

A

-renal, CNS, Gi

Pulmonary vessels (lungs) not involved

37
Q

PAN has increased incidence with ______ & _______, and has symptoms such as ….

A

-Chronic Hepatitis B and C

-Hypertension (RAS), Abdominal pain worse with eating
-Mononeuritis Multiplex ()
-Livedo Reticularis ()

38
Q

Classic PAN is ______ negative

What is seen on renal or mesenteric angiography

A

ANCA negative

Renal or Mesenteric angiography: micro aneurysms with abrupt cut-off of small arteries (beading)

39
Q

What is definitive for PAN?

Treatment for PAN?

A

-Biopsy: definitive

-Glucocorticoids

40
Q

What is Kawasaki Syndrome?

Who is at risk for this?

A

-Medium and small vessel necrotizing vasculitis including coronary arteries

-Children < 5, boys, Asians

41
Q

Explain how “Warm + CREAM” Relates to Kawasaki Syndrome

A

-Fever > 5 days + 4 of the following 5
–Conjunctivitis
–Rash (erythematous or morbiliform or macular)
–Extremity (edema, erythema, Beau’s lines - transverse nail grooves)
–Adenopathy (cervical)
–Mucositis (strawberry tongue, lip swelling, fissures, pharyngeal erythema)

42
Q

What is one complication of Kawasaki Syndrome you should keep in mind?

What is the treatment for Kawasaki?

A

-Coronary vessel arteritis: coronary artery aneurysm

-IV Immunoglobulin + aspirin

43
Q

On the other hand, Takayasu Arteritis is chronic large-vessel vasculitis that affects the aorta and it’s primary branches (aortic arch and pulmonary arteries). What are some symptoms of this?

A

-Vessel ischemia: carotid arteries (TIA, stroke), renal artery (HTN crisis), arm claudication, lower extremity claudication.
-Bruits (carotid, subclavian, abdominal)
-Diminished pulses
-Asymmetric blood pressure measurements between arms (>10mmHg)
-Hypertension
-Symptoms of PAD

44
Q

What is necessary to confirm the diagnosis of Takayasu Arteritis?

A

-CT or MRA Angiography

45
Q

Treatment for Takayasu Arteritis

A

-High dose corticosteroids

Pance Re-Up (76 decks)

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