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INTERNAL MED IP/OP > MSK/RHEUM > Flashcards

MSK/RHEUM Flashcards

1
Q

If flexion of the back or sitting relieves back pain the cause is likely what?

A

Spinal stenosis

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2
Q

Where do most lumbar discs rupture? Cervical?

A

Lumbar = L5 or S1

Cervical = C6 or C7

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3
Q

How do we treat herniated disc?

A

Exercise and PT – NOT bedrest

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4
Q

If you see a crescent sign or flattening on a hip xray – what does this indicate? What was the person most likely taking?

A

AVN

Most likely taking prednisone

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5
Q

If you see bumps on the DIP joints of the hands – what is it?

A

Heberden’s nodes (caused by OA)

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6
Q

If you see bumps on the PIP joints of the hand – what is it?

A

Bouchard nodes (caused by OA)

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7
Q

If a pt has rapid onset of pain, warmth, tenderness, and redness in a joint with decreased ROM – what should you think of?

A

Infectious arthritis

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8
Q

If a pt has a T score of less than 2.5 what do they have?

A

Osteoporosis

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9
Q

If a pt has a T score between 1-2.5 what do they have?

A

Osteopenia

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10
Q

When do we start DEXA scan?

A

After age of 65; then every 2 years

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11
Q

How do we treat osteoporosis?

A

Bisphosphonates

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12
Q

What should we remember about bisphosphonates?

A

Must be taken fasting, with 8oz of water, must remain upright x30minutes

Only take for 5 years, then a “drug holiday”

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13
Q

If a pt has symmetric joint pain for longer than 6 weeks and morning stiffness that doesn’t seem to go away – what might they have?

A

Rheumatoid arthritis

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14
Q

Does rheumatoid arthritis involve the DIP joints or spare them?

A

Spares them

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15
Q

How do we diagnose rheumatoid arthritis?

A

Rheumatoid factor and positive anti-ccp

Elevated ESR/CRP

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16
Q

How do we treat rheumatoid arthritis?

A

DMARDS – methotrexate

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17
Q

What if a pt fails the DMARDS?What if a pt fails the DMARDS?

A

Go to triple therapy (hydroxychloroquine, methotrexate, and sulfasalazine)
Or a biologic TNF inhibitor

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18
Q

What do all pts need before given a biologic?

A

screened for TB

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19
Q

How do we treat flares of RA?

A

NSAIDs or steroids

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20
Q

How do we treat a pregnant female with RA?

A

Hydroxychloroquine or sulfasalazine

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21
Q

How do we treat an acute gout attack?

A

NSAIDs or colchicine (third line is steroids)

22
Q

What classifies as chronic gout? How do we tx?

A

More than 2 attacks/year

Lifestyle modifications and Allopurinol

23
Q

Can you start allopurinol during an acute attack?

A

NO

24
Q

What medications can cause a gout flare?

A

Thiazides and ASA

25
Q

If a pt has an acute flare of gout, you aspirate and needle shaped crystals are seen – what’s the cause? What about rhomboid shaped crystals?

A 
Gout = needle shaped crystals; problem with uric acid
Pseudogout = rhomboid shaped; problem with calcium pyrophosphate
26
Q

What would xrays show in pseudogout?

A

Cartilage calcification

27
Q

If a pt has generalized aching, pain, fatigue, stiffness – what dx do you think of?

A

Fibromyalgia

28
Q

How do we treat fibromyalgia?

A

Exercise, heat, stress management, CBT

29
Q

What dz is more common in African americans and presents with a malar rash, arthritis, and a renal disorder?

A

SLE

30
Q

What does a pt need clinically to be diagnosed with SLE?

A

4 of 11 clinical features

Malar rash, discoid rash, photosensitive, oral/nasal ulcerations, arthritis in 2 or more joints, Serositis, renal disorder, neurologic disorder, hematologic disorders, immunologic disorder, and a positive ANA

31
Q

What labs must be done in order to dx SLE?

A

ANA, DS DNA that shows anti-smith antibodies

32
Q

How do we treat SLE?

A

NSAIDs and steroids (acute) Hydroxychloroquine

33
Q

If a pt is noted to have skin thickening in the fingers and hands with digital ulcers as well – dx?

A

Scleroderma

34
Q

What is scleroderma?

A

Autoimmune dz of unknown origin – causes fibrosis of the skin/organs AKA CREST syndrome

Calcinosis, raynauds, esophageal dysmotility, sclerodactyl, and telangiectasia

35
Q

How do we dx Scleroderma?

A 
ANA, anticentromere antibodies
 
PFT’s should also be done (for interstitial lung dz)
 
Biopsy of skin confirms
36
Q

How do we treat scleroderma?

A 
Tx organs involved
 
ACE for kidneys
 
Raynauds with CCB’s
 
GI dysmotility with PPI
37
Q

If an older woman presents with intense morning stiffness in her shoulders and pelvis – what do you think of?

A

Polymyalgia rheumatica

38
Q

How do we diagnose polymyalgia rheumatica?

A

Elevated ESR/CRP

ANA and RF factor negative

39
Q

How do we treat polymyalgia rheumatica?

A

Low dose corticosteroids

40
Q

What is often closely associated polymyalgia rheumatica?

A

Giante cell arteritis

41
Q

If a pt has post-infectious arthritis, urethritis, and conjunctivitis – what do you think of?

A

Reactive arthritis

42
Q

What is the cause of reactive arthritis, what is it associated with?

A

After GI or GU infection, MC bacteria (chlamydia, salmonella, shigella)

Associated with HLA-B27

43
Q

How do we treat reactive arthritis?

A

Arthrocentesis will be negative

Tx with NSAIDs

44
Q

If an xray shows a “sunburst” pattern – dx?

A

Osteosarcoma (young 20-30’s)

45
Q

What orthopedic tumor would not show up on an xray, why?

A

Chondrosarcoma (tumor of cartilage)

46
Q

If an xray shows a “moth eaten” pattern or a “onion peel” pattern – dx?

A

Ewing sarcoma

47
Q

How is a bone tumor definitively diagnosed?

A

Biopsy

48
Q

What are some lifestyle and vitamin recommendations we should make for those at risk of osteoporosis?

A

1200mg of calcium once over the age of 50

800IU of vit D3

Don’t smoke

Weight bearing exercise and balance training

49
Q

What types of fractures often indicate a bone mineralization problem?

A

Vertebral, hip, and wrist fractures

50
Q

What meds raise our concern for bone loss?

A

Antipsychotics, steroids, litihium, PPI’s, SSRI’s

INTERNAL MED IP/OP (9 decks)

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