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PANCE/EOC > MSK/Rheum #3 > Flashcards

MSK/Rheum #3 Flashcards

1
Q

What are the most common bones affected in children in osteomyelitis?

A

Femur and tibia

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2
Q

What is the MC bone affected in adults in osteomyelitis?

A

Vertebrae

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3
Q

Risk factors for Osteomyelitis

A

Sickle cells disease, DM, immunocompromised, pre-existing joint disease

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4
Q

MC route of osteomyelitis spread in children?

A

Acute hematogenous spread

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5
Q

MC organism overall of osteomyelitis

A

Staph Aureus

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6
Q

What organism has an increased incidence after recent prosthetic joint placement, indwelling catheters, neonates

A

Staph Epidermidis

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7
Q

What organism is most common in osteomyelitis in those with Sickle Cell Disease

A

Salmonella

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8
Q

What organism has an increased incidence in neonates in osteomyelitis?

A

Group B Strep

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9
Q

What organism for osteomyelitis occurs in puncture wounds through tennis shoes?

A

Pseudomonas Aeruginosa

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10
Q

What is the MC JOINT affected in children in osteomyelitis?

A

Hip joint

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11
Q

Diagnostics for osteomyelitis

A
  • Labs: ESR and CRP increased
  • Xrays (initially)
  • MRI: (most sensitive)
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12
Q

What is the definitive diagnostic for osteomyeltitis

A

Bone aspiration

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13
Q

Treatment for Group B Strep Osteomyelitis (Birth - 3 months)

A

Cefotaxime + Vanco, Nafcillin, or Oxacillin

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14
Q

Treatment for S. Aureus Osteomyelitis (3 months - adults)

A

Nafcillin, Oxacillin, Cefazolin (Clinda or Vanco if PCN allergy)

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15
Q

If the patient has sickle cell and the organism is Salmonella for Osteomyelitis, what is the treatment?

A

3rd Gen Cephalosporin Or Fluoroquinolone

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16
Q

If the organism is Pseudomonas for osteomyelitis, what is the treatment?

A

Ceftazidime or Ciprofloxacin

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17
Q

Risk factors/Causes of Primary Osteoporosis

A
  • Postmenopausal
  • Senile
  • Caucasian
  • Low BMI (Thin body habitus)
  • Corticosteroid use
  • Smoking
  • CKD
  • Alcohol
  • Inactivity
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18
Q

What other drugs cause Secondary Osteoporosis?

A
  • Heparin
  • Glucocorticoids
  • Phenytoin
  • Lithium
  • Levothyroxine
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19
Q

Symptoms of Osteoporosis

A
  • Bone fractures: pathologic fractures, vertebrae most common
  • Spine compression: loss of vertebral height, kyphosis (hunchback), back pain
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20
Q

What is the best diagnostic test for osteoporosis

A
  • DEXA scan (bone densitometry)

- -T score of -2.5 or less is osteoporosis

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21
Q

What are the treatment options for osteoporosis

A
  • Adequate Vitamin D and Calcium supplementation
  • exercise (weight lifting, high impact)
  • Periodic height and bone mass measurements
  • Smoking cessation
  • Fall prevention
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22
Q

What is the first line pharm treatment for osteoporosis?

A

Bisphosphonates (-dronate)

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23
Q

What is the mechanism of action of Bisphosphonates?

A

-Inhibit osteoclast activity (decreasing bone resorption and turnover)

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24
Q

What are some considerations to remember when taking Bisphosphonates?

A
  • Taken with 8 ounces of water 1-2 hours before meals, aspirin, Ca, and antacids
  • Poor oral absorption
  • Calcium and Vitamin D supplementation recommended
  • Adverse effects include esophagitis: must stay upright for 30 minutes
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25
Q

What is the screening recommendation for Osteoporosis?

A

DEXA scan in patients 65 years or older

26
Q

Symptoms of Pes Anserine Bursitis

A
  • Inflammation of the bursa located between the tibia and 3 tendons of the hamstring muscles at the inside of the knee, 2-3 inches below the joint
  • Pain when arising from a chair, at night, or with using stairs
27
Q

Describe the most common history and PE findings for patients with plantar fasciitis

A

-Gradual onset of heel pain with first few steps in AM and at night

  • Local point tenderness to underside of the heel
  • Pain increases with dorsiflexion of toes
28
Q

Polymyalgia Rheumatica is ______ and is closely associated with _____

A
  • Idiopathic inflammation of the joints, bursae, and tendons

- Giant Cell Arteritis

29
Q

Symptoms of Polymyalgia Rheumatica

A
  • Pain and stiffness in the proximal joints and muscles
  • May have difficulty combing hair and rising from a chair
  • Normal muscle strength
  • May have decreased active and passive ROM
30
Q

Diagnostics for PMR

A
  • Increased ESR and CRP
  • Normal muscle enzymes
  • Increased platelets
31
Q

Treatment for PMR

A

-Low dose corticosteroids, NSAIDs, Methotrexate

32
Q

Symptoms of Polymyositis

A
  • Progressive symmetric proximal muscle weakness (shoulders, hips)
  • Decreased muscle strength
  • NO RASH
33
Q

Diagnostics/Antibodies for Polymyositis

A
  • Increased muscle enzymes (CK and aldolase): best initial test
  • Anti Jo-1 and Anti-signal recognition protein
34
Q

However, what is the definitive diagnostic for polymyositis

A

-Muscle biopsy (shows enodmysial inflammation)

35
Q

Treatment for Polymyositis

A

-High-dose glucocorticoids

36
Q

Symptoms of Posterior Tibial Tendon Dysfunction

A
  • Player of high-impact sports
  • Pain and swelling to medial foot and ankle
  • Flattened arch
  • “Too many toes sign”
37
Q

In a proximal humerus fracture, what is the treatment and what should you check for?

A
  • Sling/Swathe and ortho follow up in 24-48 hours

- Check deltoid sensation to rule out axillary nerve or brachial plexus injuries

38
Q

Reactive Arthritis/Reiter Syndrome is

A

Inflammatory arthritis in response to infection of inflammation in another part of the body.

-1-4 weeks after Chlamydia or GI infection

39
Q

What is associated with increased incidence of reactive arthritis?

A

HLA-B27

40
Q

Symptoms of Reactive Arthritis

A
  • Triad: arthritis + conjunctivitis + urethritis (can’t see, can’t pee, can’t climb a tree)
  • Keratoderma Blennorrhagicum: lesions on palms and soles
41
Q

What diagnostic should be done in reactive arthritis and why?

A

arthrocentesis to rule out septic arthritis

42
Q

Treatment for Reactive Arthritis

A
  • NSAIDs (1st line)

- Methotrexate (if no response)

43
Q

Etiologies of Rhabdomyolysis

A
  • Crush Injuries
  • Immobility
  • Seizures, Burns
  • Statins, Niacin, Fibrates
44
Q

Pathophysiology of rhabdomyolysis

A

-Myoglobin from muscle breakdown is extremely toxic to renal tubular cells, leading to acute tubular necrosis (acute kidney injury)

45
Q

Symptoms of rhabdomyolysis

A

Muscle pain + muscle weakness + dark (tea-colored urine)

46
Q

Diagnostics for Rhabdomyolysis

A
  • ECG: initial (most important) to look for hyperkalemia
  • Urine Dipstick and UA: positive for heme but negative for RBCs
  • Muscle enzymes: increased creatinine phosphokinase
  • Electrolytes: hyperkalemia, hyperuricemia, hypocalcemia
47
Q

Treatment of of Rhabdomyolysis

A
  • IVF saline hydration
  • Mannitol or Sodium Bicarbonate (alkalinization of the urine)
  • Calcium Gluconate: stabilize cardiac membranes
48
Q

Symptoms of Rheumatoid Arthritis

A
  • Systemic (fever, weiht loss, anorexia)
  • Joint pain: Morning stiffness > 1 hour, improves later in day
  • Affects small joints: wrist, MCP, PIP, MTP (spares DIP)
  • Symmetric, warm, boggy joints
  • Ulnar deviation of hand
  • Swan neck and boutonniere deformities
49
Q

Diagnostics and antibodies for RA

A
  • RF (best initial)
  • Anti-CCP (most specific)
  • Radiographs: symmetric joint narrowing, osteopenia, bone and joint erosions
  • -C1-C2 subluxation common
50
Q

treatment for RA

A
  • Methotrexate, Leflunomide (DMARDs) + NSAIDs (for pain control)
  • Glucocorticoids second-line for symptom control
51
Q

Methotrexate is a _______ and adverse effects include

A

Folic antagonist

-Liver, lung marrow. Hepatitis, interstitial pneumonitis, and bone marrow suppression

52
Q

What four muscles make up the rotator cuff muscles?

A
  • Supraspinatus
  • Infraspinatus
  • Teres Minor
  • Subscapularis
53
Q

What is the MC injured rotator cuff muscle?

A

Supraspinatus

54
Q

Symptoms of a rotator cuff muscle injury

A
  • Anterolateral shoulder pain with decreased ROM
  • Decreased ROM with overhead activities, ER, or abduction
  • Passive ROM > Active ROM
55
Q

What test has a 90% specificity for assessing supraspinatus involvement?

A

Empty Can Test

56
Q

What are three tests for impingement?

A
  • Hawkins Test: elbow flexed and pain with IR
  • Drop Arm Test: slowly lowering arm
  • Neer Test: arm pronated (thumbs down) forward flexion
57
Q

Treatment for a rotator cuff tear

A
  • Conservative: PT, NSAIDs, Injections

- Surgery: if failed conservative

58
Q

Regarding Scleroderma, what is Limited (CREST) Syndrome?

A
  • Tight, shiny thickened skin involving the face, neck, and distal to elbows and knees. Spares the trunk.
  • Calcinosis Cutis
  • Raynaud’s Phenomenon
  • Esophageal Motility Disorder
  • Sclerodactyly
  • Telangiectasias
59
Q

Diagnostics and Antibodies for Scleroderma

A
  • Anti-centromere antibodies (CREST specific)
  • Anti-SCL-70 antibodies/anti-topoisomerase (diffuse)
  • ANA positive but non-specific
60
Q

Symptoms of Diffuse Scleroderma

A
  • Tight, shiny, thickened skin involving the trunk and proximal extremities
  • Greater organ involvement

PANCE/EOC (63 decks)

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