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Master the Boards > MSK= rheum and ortho > Flashcards

MSK= rheum and ortho Flashcards

1
Q

absence of inflammation and normal lab tests

A

osteoarthritis

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2
Q

best initial analgesic in OA

A

acetaminophen

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3
Q

efficacy of glucosamine and chrondroitin sulfate

A

NO more effective than placebo

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4
Q

chronic gout

A

tophi–ANYWHERE in body
uric acid kidney stones
LONG ASYMPTOMATIC periods between attacks

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5
Q

most accurate test in gout

A

aspiration joint: needle shaped negative birefringence

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6
Q

what is essential to do in dx of gout

A

TAP JOINT– exclusion of infection

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7
Q

protein and glucose levels in synovial fluid

A

NOT HELPFUL in diagnosis of gout

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8
Q

acute attack lab findings in podagra

A

ELEVATED ESR and LEUKOCYTOSIS

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9
Q

x-rays in gout

A

NORMAL early on

EROSIONS of cortical bone occur latter

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10
Q

intial tx of gout

A
  1. NSAID’s
  2. STEROIDS
  3. colchicine– used when cannot use NSAIDs or steroids
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11
Q

when to use steroid injections in gout

A

RENAL INSUFFICIENCY or unrepsonsive to NSAIDs

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12
Q

diet change in gout

A
  • decrease beer
  • weight loss
  • decrease high purine foods: meat and seafood
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13
Q

side effects of colchicine

A

neutropenia

and diarrhea

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14
Q

benefit of colchicine in gout

A

effective in PREVENTING SECOND ATTACK of hout

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15
Q

gout drugs contraindicated if have renal insufficiency

A

probenecid
NSAIDs
sulfinpyrazone

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16
Q

gout drugs safe if have renal insufficiency

A

allopurinol

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17
Q

which gout drugs not okay to use in podagra

A

uricosuric agents– probenecid and sulfinpyrazone

or allopurinol

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18
Q

what drug to use if patient has high bp AND gout

A

losartan– since lowers uric acid aswell

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19
Q

2 big risk factors for pseudogout

A

HFE

hyperparathyroidism

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20
Q

confirmation dx of pseudogout= calcium pyrophosphate deposition disease= CPPD

A

MUST HAVE ASPIRATION OF JOINT– positively birefringent rhomboid crystals

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21
Q

initial tx of CPPD

A
  1. NSAIDS
  2. IA steroids
  3. colchicine– prevent subsequent attacks
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22
Q

lower back pain without neuro deficits etc.

A

NSAIDs. nothing more.

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23
Q

lower back pain with sensory loss, point tenderness over spine, hx of cancer, hyperreflexia

A

CORD COMPRESSION– malignancy

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24
Q

lower back pain with sensory loss, point tenderness over spine, hx of cancer, hyperreflexia AND FEVER AND INCREASE ESR

A

epidural abscess

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25
Q

MRSA epidural abscess

A

vancomycin or linezolid

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26
Q

acute neuro deficits, epidural abscess

A

systemic steroids

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27
Q

methicillin sensitive s.aureus epidural abscess

A

oxacillin, naficillin, cefazolin

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28
Q

leg pain in sciatica

A

buttocks and BELOW level of the knee

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29
Q

DIAGNOSTIC OF SCIATICA

A

positive SLR

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30
Q

L4

A

m: dorsiflex foot
s: inner calf
r: knee jerk

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31
Q

L5

A

m: dorsiflex toe
s: inner forefoot
r: -

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32
Q

S1

A

m: eversion foot
s: outer foot
r: ankle jerk

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33
Q

best initial test for: cord compression, epidural abscess, ank spon, CES

A

MRI

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34
Q

imaging for simple Lower back pain

A

NOOOOOO

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35
Q

imaging for positive SLR alone

A

NOOOOOOO

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36
Q

tx of cord compression

A

STEROIDS– more important to prevent paralysis first, then giving MRI imaging

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37
Q

tx CES

A

surgical decompression

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38
Q

tx of sciatica

A

NSAID’s and continue ordinary exercise. NO BED REST.

rapid and dramatic beneficts with steroid injections

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39
Q

leg pain worse with leaning backwards/ going down hill

A

lumbar spinal stenosis

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40
Q

leg pain better with leaning forward/cycling

A

lumbar spinal stenosis

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41
Q

only test for dx of spinal stenosis

A

MRI

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42
Q

tx spinal stenosis

A

surgical– dilate spinal canal

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43
Q

what is normal in spinal stenosis

A

ABI’s

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44
Q

labs in fibromyalgia

A

NORMAL LABS

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45
Q

best initial tx of fibromyalgia

A
  1. amtitryptiline
  2. milnacipran
  3. pregabalin
  4. trigger point injections with local anaesthetics
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46
Q

tx of fibromyalgia with steroids

A

NEVER THE RIGHT ANSWER

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47
Q

when is carpal tunnel pain worse

A

AT NIGHT

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48
Q

most accurate dx of carpal tunnel syndrome

A

electromyography

nerve conduction studies

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49
Q

MRI for carpal tunnel syndrome

A

NEVER ENVER NEVER NEVER

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50
Q

best initial tx carpal tunnel

A
  1. wrist splints
  2. avoid manual activity
  3. nsaids etc.
  4. steroid injection
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51
Q

curative tx carpal tunnel

A

surgical release

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52
Q

duputyrens contacture tx.

A
  1. triamcinolone
  2. lidocaine
  3. collagenase injection
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53
Q

severe tenderness at insertion of supraspinatous

A

ROTATOR CUFF INJURY

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54
Q

most accurate test in rotatory cuff injury

A

MRI

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55
Q

tx of rotatory cuff injury

A
  1. conservative: red, NSAIDs, physical tx

2. surgery– complete tear, unresponsive to conservative

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56
Q

which comes first– sensory or motor impairment in carpal tunnel syndrome

A

SENSORY

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57
Q

anterior knee pain after trauma to joint or meniscal tear

A

PATELLOFEMORAL SYNDROME

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58
Q

anterior knee pain WORSENS just after starting to walk

A

patellofemoral syndrome

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59
Q

anterior knee pain RELIEF after sitting for a prolonged period of time

A

patellofemoral syndrome

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60
Q

XR in PF syndrome

A

NORMAL

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61
Q

tx of PF syndorme

A

physical tx

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62
Q

surgery in PF syndrome

A

NOOOOO NEVER- because nothing to fix surgically

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63
Q

very severe pain in bottom of foot, near the calcaneus

A

plantar fasciitis

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64
Q

pain with plantar faciitis

A

WORSE– morning

RELIEF– walking few steps/use

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65
Q

tx of plantar faciitis

A
  1. stretching, arch supports, NSAIDs
  2. steroid injection
  3. RARELY surgical release of plantar facia
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66
Q

need an abnormal XR to diagnose RA?

A

NOOOOOOOOO

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67
Q

Point system dx of RA, >6 points

A
  1. joint involvement (up to 5 points)
  2. ESR or CRP (1 pt)
  3. duration > 6 weeks (1 pt)
  4. RF or anti-CCP (1 pt)
68
Q

MCC death in RA

A

CORONARY ARTERY DISEASE

69
Q

any patient with erosive disease in RA, start with at least….

A

METHOTREXATE

70
Q

erosive disease in RA=

A

joint space narrowing
physical joint deformities
XR abnormalities

71
Q

mild disease DMARD–

A

hydroxchloroquine

72
Q

what to do before hydroxychloroquine

A

DILATED EYE exam– since its toxic to the retina

73
Q

what RA drugs safe in pregnancy

A

sulfasalazine and hydroxchloroquine

74
Q

SE’s of sulfasalazine

A
  • bone marrow toxicity
  • hemolysis with G6PD
  • rash
75
Q

non- diagnostic criteria for SLE

A
  • alopecia
  • lung: pneumonia, alveolar haemorrhage, restrictive lung disease
  • ocular: photophobia, cotton wool spots, blindness
76
Q

acute exacerbation of SLE labs

A

decrease complement

and increase anti-dsDNA

77
Q

what do you patients with SLE die from

A

infection

78
Q

what do older patients with SLE die from

A

atherosclerosis

79
Q

asymptomatic ANA

A

DO NOT TREAT

80
Q

best initial test for APL

A

mixing study

81
Q

most specific test for APL

A

Russell Viper Venom Test: prolonged with APL Abs and does not correct on mixing with normal plasma

82
Q

asymptomatic APL antibody

A

DO NOT TREAT

83
Q

when to investigate APLS

A
  • two first trimester losses

- one second trimester loss

84
Q

preventing recurrence of spontaneous abortion with APL

A

heparin and aspirin

85
Q

pencillamine in scleroderma

A

NOT EFFECTIVE

86
Q

renal crisis tx in scleroderma

A

ACE inhibitors

87
Q

raynaud tx in scleroderma

A

CCBs

88
Q

pulmonary fibrosis tx in scleroderma

A

cyclophosphamide

89
Q

pulmonary HTN tx in scleroderma

A
  • bosentan
  • sildenafil
  • Prostacyclin analogs: iloprost, treprostinil, epoprostenol
90
Q

which cancers are associated with dermatomyositis

A

OVARY
LUNG
GI
LYMPHOMA

91
Q

best initial test for dermatomyositis

A

CPK and aldolase

92
Q

most accurate test for dermatomyositis

A

muscle biopsy

93
Q

anti-Jo antibodies associated with…

A

lung fibrosis

94
Q

very bad dental caries and need to constantly drink water

A

sjogrens syndrome

95
Q

most dangerous complication of sjogrens

A

lymphoma

96
Q

best initial test for sjogrens

A

schirmer test– filter paper placed against eye– wetness of filter paper

97
Q

most accurate test for sjogrens

A

lip or parotid gland biopsy

98
Q

intial tx of sjogrens

A

water the mouth
fluoride
artificial tears

99
Q

medical tx of sjogrens

A

pilocarpine and cevimeline: increase ACh

100
Q

cure for sjogrens

A

NOOOOOPE, just evaluate for lymphoma, and lifespan is NOT shortened

101
Q

foot drop ddx

A

peroneal nerve injury

  • lead poisoning
  • PAN
102
Q

multiple peripheral neuropathies– like radial nerve and perennial nerve and ulnar nerve and lateral femoral cutaneous nerve

A

MONONEURITIC MULTIplex

103
Q

mononeuritis multiplex associated with….

A

PAN

104
Q

stroke in a young person with vasculitis

A

PAN

105
Q

most accurate test for PAN

A

bx of symptomatic site

106
Q

test all patients with PAN for…..

A

hep B and hep C

107
Q

elevated ESR

normal CPK and aldolase

A

polymalgia rheumatica

108
Q

tx of polymyalgia rheumatica

A

LOW DOSE steroids

109
Q

giant cell arteritis complication….

A

aortic aneurysm

110
Q

blindness in GCA

A

IRREVERSIBLE

111
Q

c-ANCA

A

anti-proteinase 3

112
Q

p-ANCA

A

anti-myeloperoxidase

113
Q

best test for wegner

A

LUNG bx> renal bx

114
Q

least accurate bx in wegners

A

sinus biopsy

115
Q

recurrent URTI and LRTI with renal insufficiency – NOT resolving with antibiotics

A

wegners

116
Q

most accurate test churg-strauss

A

biopsy

117
Q

most accurate dx of HSP

A

bx

118
Q

most common dx of HSP

A

CLINICAL

119
Q

IgA levels for HSP

A

NOT RELIABLE for making the HSP diagnosis

120
Q

cryoglobulins are not the same as….

A

cold agglutinins

121
Q

lab tests in cryoglobulinemia

A

positive RF

make IC’s in the cold

122
Q

cryoglobulinaemia tx

A

NOT STEROIDS

tx underling– hep C: IFN and ribavarin

123
Q

complement decrease SLE

A 
C3 decreased 
(SLE= 3 letters)
124
Q

complement decrease hep C

A 
C4 decreased 
(hep C= 4 letters)
125
Q

oral ulcers, genital ulcers, skin lesions

A

bechets syndrome

126
Q

non-triad thing with bechets…

A

OCULAR LESIONS–> blindness

127
Q

pathergy

A

sterile skin pustules from minor trauma (like needle stick), associated with bechets syndrome

128
Q

HLA-B27

A

NEVER NEVER NEVER

  • most accurate
  • best initial
  • confirmatory
129
Q

back pain worsened by rest

A

ANK-SPON

130
Q

2 heart things with ank-spon

A

aortic insufficiency

AV block

131
Q

best initial test in ank-spon

A

XR of SI joint

132
Q

most accurate test in ank-spon

A

MRI– shows abnormalities years before XR is abnormal

133
Q

bamboo spine

A

LATE finding in ank-spon

134
Q

tx of ank spon

A
  1. NSAIDs
  2. exercise
  3. anti-TNF
135
Q

tx of psoriatic arthritis

A
  1. NSAIDs
  2. MTX
  3. anti-TNF
136
Q

specific test for reactive arthritis

A

NOOOOO specific test for reactive arthritis

137
Q

keratogerma blenorrhagicum

A

skin lesion unique to reactive arthritis that looks like pustular psoiasis

138
Q

what should be done for hot swollen joint

A

JOINT TAP– exclude septic joint

139
Q

tx of reactive arthritis

A
  1. NSAIDs

2. sulfasalazine

140
Q

antibiotics in reactive arthritis

A

OF no use if the joint pain has already started

141
Q

most accurate test in osteoporosis

A

DEXA scan

142
Q

blood tests in osteoporosis

A

NORMAL

143
Q

best initial tx of osteoporosis

A

vit D and calcium

144
Q

order of tx options in osteoporosis

A
  1. vit D and Ca
  2. bisphosphonates
  3. ERT
  4. raloxifene– post-menopausal woman: LESS breast cancer risk and REDUCES LDL
  5. teriperatide
  6. calcitonin
145
Q

calcitonin use in osteoporosis

A

reduces the risk of vertebral fractures

146
Q

side effects of teriperatide

A

hypercalcaemia

OSTEOSARCOMA IN RATS

147
Q

if presented with multiple tx options for osteoporosis

A

vit D, ca, bisphosphonates

148
Q

septic arthritis most commonly occurs in….

A

DAMAGED JOINTS

149
Q

empiric tx for septic arthritis

A

ceftriaxone and vancomycin

150
Q

GN bacilli septic arthritis tx

A
  • quinolones
  • aztreonam
  • cefotazime
  • piperacillin
  • aminoglycosides
151
Q

GP coci (sensitive) septic arthritis tx

A
  • oxacillin, naf
  • cefazolin
  • pip-tazo
152
Q

GP cocci (resistant) septic arthritis tx

A
  • linezolid
  • daptomycin
  • tigecycline
  • ceftaroline
153
Q

tx of prosthetic joint injection

A

LOOSENING OF joint

  1. remove joint
  2. 6-8 weeks antibiotics
  3. replace joint
154
Q

mcc prosthetic joint infection

A

staph epidermidis

155
Q

polyarthritis, tenosynovitis, petechial rash

A

= GONOCOCCAL ARTHRITIS

156
Q

when does gonococcal arthritis most often occur

A

during menses

157
Q

best initial tx for gonococcal arthritis

A

CEFTRIAXONE

NOTTTTTTTTTT— fluoroquinolones – since >5% are resistant

158
Q

recurrent gonococcal infection

A

TERMINAL COMPLEMENT DEFICIENCY

159
Q

OSTEOmyelitis kids

A

haematogenous

160
Q

OSTEOmyelitis adults

A

contiguous– ie. from nearby infection– diabetic ulcer

161
Q

best initial test for osteomyelitis

A

XR

162
Q

most accurate test for osteomyelitis

A

bone biopsy

163
Q

most appropriate next mgmt if normal XR and osteomyelitis

A

MRI or bone scan (bone scan if contraindicated MRI— pacemaker ex.)

164
Q

ESR use in osteomyelitis

A

follow response to tx

165
Q

culturing and drainage of osteomyelitis

A

NEVER NEVER NEVER NEVER NEVER correct answer– since cannot distinguish between colonization inside bone vs. causing infection

166
Q

E. coli tx osteomyelitis

A

ciprofloxacin– MUST CONFIRM SENSITIVITY to chipper before starting

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