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Boards Studying > MSK/Rheum > Flashcards

MSK/Rheum Flashcards

1
Q

most common cause of elevated Alk Phos in an elderly patient

A

Paget disease - osteoclastic dysfunction with defective osteoid formation, increase bone remodeling and focal hypertrophy

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2
Q

Pain with resisted extension and passive flexion of the wrist in an airport baggage handler

A

Lateral epicondylitis

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3
Q

Child with leg pain, polyuria, hypernatremia, rash on truck and groin. Skeletal survey shows well-defined, lytic distal femoral lesion

A

Langerhans cell histiocytosis

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4
Q

Inflammatory arthritis, splenomegaly, neutropenia

A

Felty syndrome

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5
Q

Patient presents with stroke like symptoms and positive ANA

A

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
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6
Q

female patient presents with difficulty rising from a seated position, erythematous rash on chest, periorbital edema

A

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***
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7
Q

Methotrexate side effects

A 
oral ulcers
transaminitis
alopecia
pulm toxicity
bone marrow suppresion
(MTX is a folate antimetabolite)
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8
Q

Child with fever, conjunctivitis, red mouth and tongue, an enlarged anterior cervical lymph node. Recently returned from Japan

A

Kawasaki disease

- will also have extremity edema, desquamation of hands and feet, polymorphous rash

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9
Q

Patient with foot pain. Clicking sensation when palpating space between 3rd and 4th toes while squeezing the metatarsal joints (mulder sign)

A

Morton neuroma - mechanically induced neuropathic degeneration of the interdigital nerves

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10
Q

immune markers: SLE

A

ANA, anti-dsDNA, anti-Sm

*false-positive RPR or VDRL

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11
Q

immune markers: drug-induced lupus

A

antihistone antibodies, ANA

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12
Q

immune markers: RA

A

RF, anti-citrullinated peptide antibodies, ANA, HLA-DR4

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13
Q

immune markers: polymyositis or dermatomyositis

A

ANA, anti-Jo-1 antibodies

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14
Q

immune markers: ankylosing spondylitis

A

HLA-B27

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15
Q

immune markers: psoriatic arthritis

A

possible HLA-B27

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16
Q

immune markers: scleroderma

A

anti-scl-70

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17
Q

Teenager has progressive facial weakness, difficulty relaxing muscles after contraction (especially thenar and hypothenar), testicular volume is small for age, and difficulty swallowing

A

Myotonic muscular dystrophy

  • autosomal dominant expansion of CTG repeats
  • appears in teenagers
  • can also have cataracts, arrhythmias, baldness
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18
Q

Enthesis (tenderness at tendon insertion sites) is a characteristic finding of

A

ankylosing spondylitis

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19
Q

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)

A

Psoriatic arthritis

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20
Q

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

A

Paget disease of bone

- tx: bisphosphonates

21
Q

9 month old with dorsal swelling of both hands and feet. Pt has a temp of 101.

A

Vaso-occlusive disease/early manifestation of sickle sell disease

22
Q

teenage girl with point tenderness over anterior right shin. She is underweight with irregular menses

A

Stress fracture

23
Q

Pt with pmhx of sarcoidodis who was recently on steroids presents with unilateral hip pain. Pain is worse with abduction and internal rotation.

A

Avascular necrosis of femoral head

24
Q

immune markers: CREST syndrome

A

anticentromere antibodies

25
Q

immune markers: mixed connective tissue disease

A

anti-RNP ANA

26
Q

immune markers: sjogren syndrome

A

anti-Ro (ant-SSA) ANA

anti-La (anti-SSB) ANA

27
Q

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

A

Complex regional pain syndrome

28
Q

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

A

Charcot joint due to diabetic neuropathy

29
Q

Displaced supracondylar fractures of the humerus are at risk for damaging

A

Median nerve and brachial artery

30
Q

Sensation of the foot

A 
Dorsal surface: superficial peroneal
1st web space: deep peroneal
Medial: saphenous
Lateral: sural
Sole: tibial
31
Q

MOA of dantrolene

A

inhibiting calcium ion release from the sarcoplasmic reticulum, and thereby interfering with muscular contraction

32
Q

Labs for polymyositis

A

increased creatine kinase, increased aldolase, anti-Jo-1 antibodies
- 50-70 year old lady with progressive weakness

33
Q

saddle nose deformity and bilateral auricular inflammation who may have been treated on multiple occasions with antibiotics

A

Relapsing polychondritis

- cartilaginous inflammation

34
Q

muscle that opens the vocal cords

A

posterior cricoarytenoid muscle

35
Q

29 year old female with knee pain and a bone lesion in the epiphysis. Has a soap bubble appearance

A

Giant cell tumor (osteoclastoma)

36
Q

Anterior shoulder dislocation *ext rotation and abduction) damages the

A

axillary nerve causing weakness in abduction (deltoid)

37
Q

Muscle affected in lateral epicondylitis (tennis elbow)

A

extensor carpi radialis brevis

38
Q

Muscle affected in medial epicondylitis (golfer’s elbow)

A

flexor carpi radialis

39
Q

Osteosarcoma mets to

A

lungs - get a CT lung

40
Q

Tx of acute gout in CKD 3 pt

A

steroids

41
Q

16 year old with small round lucency on distal femur. Leg pain is worse at night and unrelated to activity

A

osteoid osteoma

- benign, bone-forming tumor usually in teenage boys

42
Q

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.

A

Paget disease of bone

  • normal calcium and phosphorus
  • elevated alk phos and PINP/urine hydroxyproline
  • giant cell tumor or osteosarcoma
  • tx: bisphosphonates
43
Q

SE of hydroxychloroquine (DMARD for lupus)

A

retinopathy

44
Q

tx of hepatic encephalopathy (flapping tremor)

A
  • fluids and abx

- decrease blood ammonia concentration with lactulose and rifaximin

45
Q

70 year old male with pain and stiffness of neck, shoulders and hips. ESR of 85 and normocytic anemia

A

polymyalgia rheumatica

- tx: glucocorticoids

46
Q

features of SLE, systemic sclerosis, and/or polymyositis with anti-U1 RNP antibodies

A

Mixed connective tissue disease

47
Q

patient presents with white tongue, drooling, dysphasia with severe pain after ingesting an unknown substance

A

caustic ingestion

48
Q

complex regional pain syndrome

A

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)

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