MSK/Rheum Flashcards
most common cause of elevated Alk Phos in an elderly patient
Paget disease - osteoclastic dysfunction with defective osteoid formation, increase bone remodeling and focal hypertrophy
Pain with resisted extension and passive flexion of the wrist in an airport baggage handler
Lateral epicondylitis
Child with leg pain, polyuria, hypernatremia, rash on truck and groin. Skeletal survey shows well-defined, lytic distal femoral lesion
Langerhans cell histiocytosis
Inflammatory arthritis, splenomegaly, neutropenia
Felty syndrome
Patient presents with stroke like symptoms and positive ANA
Antiphospholipid antibody syndrome
- pt presents with a thrombotic event (DVT or arterial) or pregnancy morbidity
- Common in people with lupus
- Lupus anticoagulant causes prolonged PTT (not reversed on mixing studies)
- anticardiolipin antibody or anti-beta2-glycoprotein-1 antibody
female patient presents with difficulty rising from a seated position, erythematous rash on chest, periorbital edema
Dermatomyositis
- Proximal muscle weakness, UE=LE
- Gottron’s papules - violaceous, slighty scaly papules
- Heliotrope rash - periorbital edema
- elevated CPK
- anti-Jo-1 and anti-Mi-2
- internal malignancies are more common***
Methotrexate side effects
oral ulcers transaminitis alopecia pulm toxicity bone marrow suppresion (MTX is a folate antimetabolite)
Child with fever, conjunctivitis, red mouth and tongue, an enlarged anterior cervical lymph node. Recently returned from Japan
Kawasaki disease
- will also have extremity edema, desquamation of hands and feet, polymorphous rash
Patient with foot pain. Clicking sensation when palpating space between 3rd and 4th toes while squeezing the metatarsal joints (mulder sign)
Morton neuroma - mechanically induced neuropathic degeneration of the interdigital nerves
immune markers: SLE
ANA, anti-dsDNA, anti-Sm
*false-positive RPR or VDRL
immune markers: drug-induced lupus
antihistone antibodies, ANA
immune markers: RA
RF, anti-citrullinated peptide antibodies, ANA, HLA-DR4
immune markers: polymyositis or dermatomyositis
ANA, anti-Jo-1 antibodies
immune markers: ankylosing spondylitis
HLA-B27
immune markers: psoriatic arthritis
possible HLA-B27
immune markers: scleroderma
anti-scl-70
Teenager has progressive facial weakness, difficulty relaxing muscles after contraction (especially thenar and hypothenar), testicular volume is small for age, and difficulty swallowing
Myotonic muscular dystrophy
- autosomal dominant expansion of CTG repeats
- appears in teenagers
- can also have cataracts, arrhythmias, baldness
Enthesis (tenderness at tendon insertion sites) is a characteristic finding of
ankylosing spondylitis
Pt with long standing hx of joint pain in the hands with morning stiffness that lasts several hours. Sausage digits present (dactylitis), red demarcated patches on hands, and nail involvement (onycholysis - seperation from nail bed)
Psoriatic arthritis
Pt whose hard hat no longer fits. Elevated alk phos. CT show increased thickening of cranium with mixed lytic and osteoblastic lesions. Normal Ca and Phos. Nuclear bone scan shows increased uptake in skull and tibia
Paget disease of bone
- tx: bisphosphonates
9 month old with dorsal swelling of both hands and feet. Pt has a temp of 101.
Vaso-occlusive disease/early manifestation of sickle sell disease
teenage girl with point tenderness over anterior right shin. She is underweight with irregular menses
Stress fracture
Pt with pmhx of sarcoidodis who was recently on steroids presents with unilateral hip pain. Pain is worse with abduction and internal rotation.
Avascular necrosis of femoral head
immune markers: CREST syndrome
anticentromere antibodies
immune markers: mixed connective tissue disease
anti-RNP ANA
immune markers: sjogren syndrome
anti-Ro (ant-SSA) ANA
anti-La (anti-SSB) ANA
Pt presents with left LE pain. Sprained her ankle 1 month ago. Now has increased swelling, burning pain, pain with light palpation and x-ray shows patchy areas of osteopenia
Complex regional pain syndrome
Pt with DM develops increased foot and ankle pain. Both foot and ankle are deformed. X-ray shows bone loss, large osteophytes, several extraarticular bone fragments
Charcot joint due to diabetic neuropathy
Displaced supracondylar fractures of the humerus are at risk for damaging
Median nerve and brachial artery
Sensation of the foot
Dorsal surface: superficial peroneal 1st web space: deep peroneal Medial: saphenous Lateral: sural Sole: tibial
MOA of dantrolene
inhibiting calcium ion release from the sarcoplasmic reticulum, and thereby interfering with muscular contraction
Labs for polymyositis
increased creatine kinase, increased aldolase, anti-Jo-1 antibodies
- 50-70 year old lady with progressive weakness
saddle nose deformity and bilateral auricular inflammation who may have been treated on multiple occasions with antibiotics
Relapsing polychondritis
- cartilaginous inflammation
muscle that opens the vocal cords
posterior cricoarytenoid muscle
29 year old female with knee pain and a bone lesion in the epiphysis. Has a soap bubble appearance
Giant cell tumor (osteoclastoma)
Anterior shoulder dislocation *ext rotation and abduction) damages the
axillary nerve causing weakness in abduction (deltoid)
Muscle affected in lateral epicondylitis (tennis elbow)
extensor carpi radialis brevis
Muscle affected in medial epicondylitis (golfer’s elbow)
flexor carpi radialis
Osteosarcoma mets to
lungs - get a CT lung
Tx of acute gout in CKD 3 pt
steroids
16 year old with small round lucency on distal femur. Leg pain is worse at night and unrelated to activity
osteoid osteoma
- benign, bone-forming tumor usually in teenage boys
86 year old woman with history of right leg pain. x-ray of skull reveals areas of bone resorbtion and sclerosis. x-ray of the leg reveals cortical thickening with mild bowing.
Paget disease of bone
- normal calcium and phosphorus
- elevated alk phos and PINP/urine hydroxyproline
- giant cell tumor or osteosarcoma
- tx: bisphosphonates
SE of hydroxychloroquine (DMARD for lupus)
retinopathy
tx of hepatic encephalopathy (flapping tremor)
- fluids and abx
- decrease blood ammonia concentration with lactulose and rifaximin
70 year old male with pain and stiffness of neck, shoulders and hips. ESR of 85 and normocytic anemia
polymyalgia rheumatica
- tx: glucocorticoids
features of SLE, systemic sclerosis, and/or polymyositis with anti-U1 RNP antibodies
Mixed connective tissue disease
patient presents with white tongue, drooling, dysphasia with severe pain after ingesting an unknown substance
caustic ingestion
complex regional pain syndrome
Weakness of the affected side, autonomic disturbances (altered skin temperature, altered skin blood flow causing cyanosis or mottling, or increased sweating), and trophic changes (reduced hair or nail growth, skin atrophy)
