MSK/Rheum #4 Flashcards
Sjogren Syndrome is an autoimmune disease affecting what type of glands?
Exocrine glands
Symptoms of Sjogren Syndrome
- Xerostomia (dry mouth)
- Dry Eyes (Keratoconjunctivitis sicca)
- Vaginal dryness (Dyspareunia)
- Bilateral parotid gland enlargement
- Dental Caries
Screening labs for Sjogren Syndrome
-AntiSS-A (Ro) and antiSS-B (La) best initial
Other diagnostics for Sjogren’s
- Positive Schirmer Test: < 5 mm of tears production
- Rose Bengal Stain: abnormal corneal epithelium
- Definitive: Lip or parotid gland biopsy
Treatment for Sjogren’s Syndrome
- Artificial tears, Increase fluid intake, Fluoride treatments
- Cholinergic Drugs: Pilocarpine
With Sjogren’s, there is an increased risk of
Non-Hodgkin Lymphoma
Side effects of Pilocarpine
-Diaphoresis, flushing, sweating, bradycardia, diarrhea, nausea, vomiting, blurry vision
Describe the MC demographics and presentation of a patient with SCFE
13 year old African American athletic obese male with insidious hip/thigh/knee pain and a limp
-Externally rotated leg on affected side
What is seen on a radiograph of a patient with SCFE?
Posterior displacement of femoral epiphysis (ice cream slipping off cone)
-Best seen on frog leg lateral pelvis
Treatment for SCFE
Non-weightbearing with crutches followed by ORIF (increased risk of AVN)
Mechanism of action for a Smith and Colles Fracture
FOOSH
What is a Smith Fracture
Extra-articular distal radius fracture with ventral angulation of distal fragment
What is seen on physical exam for a smith fracture?
Garden spade deformity
Radiographs of a Smith Fracture show…
-Ventrally displaced or angulated fracture of the distal radius
Treatment for Smith Fracture
-Closed reduction followed by sugar tong splint or cast
What is spinal stenosis?
Narrowing of the spinal canal with impingement of the nerve roots
Symptoms of spinal stenosis
- Back pain, numbness, paresthesias
- Worse with extension
- Better with flexion (shopping cart sign), walking uphill, cycling
Diagnostic of choice for spinal stenosis
MRI
Treatment for spinal stenosis
- Conservative: Pain control, PT, injections
- Surgical: if refractory or no improvement
What is on history for a person with a synovial cyst?
MC in lumbar region of spine
- Back/leg pain that is better when sitting
- worse when standing/walking
Risk Factors for SLE
- Young female
- AA
- Sun exposure
- Estrogen (OCP
Clinical Manifestations of SLE
- Triad: Joint pain, fever, malaria rash
- Fever, night sweats, fatigue
- Oral ulcers, retinitis, alopecia, glomerulonephritis
Diagnostics and antibodies for SLE
- ANA: screening (not specific)
- Anti-double stranded DNA and Anti-Smith: specific for SLE
- Depressed levels of serum complement (C3 and C4)
- Antiphospholipid antibodies: increased risk of arterial and venous thrombosis
Treatment for SLE
- Sunscreen and avoid sun exposure
- Hydroxychloroquine for skin lesions
- With or Without NSAIDs
- For severe: high-dose glucocorticoids or intermittent IV pulses of Methylprednisone
what is the treatment for Torticollis
Conservative therapy
Torticollis can be congenital (_____) or acquired (____)
- Local trauma of soft tissues of neck during delivery
- Blunt trauma to head/neck, sleeping in awkward position, medications, infections, etc.
Transient Synovitis is the MC cause of acute hip pain in children aged 3-10 years old. What does it come after and what does it cause?
- Comes after recent URI, pharyngitis, bronchitis, or otitis media
- Arthralgia, unilateral hip or groin pain
Treatment for traumatic soft tissue injury
RICE and NSAIDs
What are some etiologies of a vertebral compression fracture?
- Burst fractures occur in children jumping/fall from height
- Elderly, malignancy
Symptoms of vertebral compression fracture
-Localized back pain with focal midline tenderness at level of fracture
An xray for a vertebral compression fracture shoes
-Loss of vertebral height ( <20%)
When a patient has an open wound on the hand, what should you do?
- Thoroughly irrigate, check for bite wounds
- ABX if bite wound
- May leave open depending on location and risk of infection
- Tetanus booster!
What organism is the most notable in all age groups for septic arthritis?
Staph Aureus
What other organism is prevalent in sexually active young adults for septic arthritis?
Neisseria Gonorrhea
Symptoms of septic arthritis
- Swollen warm, tender, painful joint with decreased ROM
- Fever, chills, myalgias, malaise
Best initial and most accurate test for septic arthritis
-Arthrocentesis: WBC > 50,000 (primarily neutrophils)
Treatment for Septic arthritis
- No organism seen (Empiric): Ceftriaxone + Vanco
- Gram Positive Cocci: Vanco
- Gram Negative Cocci/Gonorrhea: Ceftriaxone
Risk Factors for Developmental Dysplasia of the Hip
Breech presentation at delivery, first-born children, females, positive family history
Describe what Ortolani and Barlow Maneuvers do
Ortolani: reduces the hip joint
Barlow: dislocates the hip joint
Treatment for Developmental Hip Dysplasia of the Hip
< 6 months: Pavlik Harness
6 months - 2 years: closed reduction in OR
Routine hip radiographs until skeletally mature
Posterior hip dislocations are the MC Type of dislocation. What is seen on exam of a hip that is posteriorly dislocated?
Hip pain with leg shortened, internally rotated, and adducted
Treatment for posterior hip dislocation
Closed reduction under conscious sedation
Symptoms of osgood-Schlatter Disease
-Activity related anterior knee pain and swelling (swelling and tenderness to anterior tibial tubercle)
Risk Factors for Osgood-Schlatter Disease
- Males
- 10-15 years old
- During growth spurts
- Athletes
What ligament is most commonly injured in a lateral ankle sprain?
ATFL (main stabilizer during inversion)
In a medial ankle sprain, what ligament is usually injured?
Deltoid ligament
Regarding the Ottawa Ankle Rules, when should you get ankle films?
- Inability to walk > 4 steps at time of injury in the ER
- Pain along lateral malleolus
- Pain along medial malleolus
According the Ottawa Ankle Rules, when should you get foot films?
- Inability to walk > 4 steps at time of injury in the ER
- Navicular (mid foot) pain
- 5th metatarsal pain
Symptoms and Risk factors for Achilles Tendon Rupture
- Sudden heel pain after push-off movement, pop, sudden sharp calf pain
- Inability to bear weight
- Positive Thompson Test
- Weekend warrior athletes
- Fluoroquinolone use, corticosteroid injections, 30-50 years old
Best test to assess for Achilles Tendon Rupture
MRI
Weber Ankle Fracture Classification
- Weber A: fibular fracture below syndesmosis
- Weber B: fibular fracture at level of syndesmosis
- Weber C: Fibular fracture above mortise (deltoid ligament damage)
Tarsal Tunnel Syndrome is compression of the ____ nerve
Posterior tibial nerve
Symptoms of Tarsal Tunnel Syndrome
- Pain and numbness in the medial malleolus, heel, and sole.
- Pain increases throughout the day and does not improve with rest
- Positive Tinel Sign (tap posterior medial malleolus)
What diagnostic confirms tarsal tunnel syndrome?
Electromyography
