MSK= rheum and ortho Flashcards
1
Q
absence of inflammation and normal lab tests
A
osteoarthritis
2
Q
best initial analgesic in OA
A
acetaminophen
3
Q
efficacy of glucosamine and chrondroitin sulfate
A
NO more effective than placebo
4
Q
chronic gout
A
tophi–ANYWHERE in body
uric acid kidney stones
LONG ASYMPTOMATIC periods between attacks
5
Q
most accurate test in gout
A
aspiration joint: needle shaped negative birefringence
6
Q
what is essential to do in dx of gout
A
TAP JOINT– exclusion of infection
7
Q
protein and glucose levels in synovial fluid
A
NOT HELPFUL in diagnosis of gout
8
Q
acute attack lab findings in podagra
A
ELEVATED ESR and LEUKOCYTOSIS
9
Q
x-rays in gout
A
NORMAL early on
EROSIONS of cortical bone occur latter
10
Q
intial tx of gout
A
- NSAID’s
- STEROIDS
- colchicine– used when cannot use NSAIDs or steroids
11
Q
when to use steroid injections in gout
A
RENAL INSUFFICIENCY or unrepsonsive to NSAIDs
12
Q
diet change in gout
A
- decrease beer
- weight loss
- decrease high purine foods: meat and seafood
13
Q
side effects of colchicine
A
neutropenia
and diarrhea
14
Q
benefit of colchicine in gout
A
effective in PREVENTING SECOND ATTACK of hout
15
Q
gout drugs contraindicated if have renal insufficiency
A
probenecid
NSAIDs
sulfinpyrazone
16
Q
gout drugs safe if have renal insufficiency
A
allopurinol
17
Q
which gout drugs not okay to use in podagra
A
uricosuric agents– probenecid and sulfinpyrazone
or allopurinol
18
Q
what drug to use if patient has high bp AND gout
A
losartan– since lowers uric acid aswell
19
Q
2 big risk factors for pseudogout
A
HFE
hyperparathyroidism
20
Q
confirmation dx of pseudogout= calcium pyrophosphate deposition disease= CPPD
A
MUST HAVE ASPIRATION OF JOINT– positively birefringent rhomboid crystals
21
Q
initial tx of CPPD
A
- NSAIDS
- IA steroids
- colchicine– prevent subsequent attacks
22
Q
lower back pain without neuro deficits etc.
A
NSAIDs. nothing more.
23
Q
lower back pain with sensory loss, point tenderness over spine, hx of cancer, hyperreflexia
A
CORD COMPRESSION– malignancy
24
Q
lower back pain with sensory loss, point tenderness over spine, hx of cancer, hyperreflexia AND FEVER AND INCREASE ESR
A
epidural abscess
25
MRSA epidural abscess
vancomycin or linezolid
26
acute neuro deficits, epidural abscess
systemic steroids
27
methicillin sensitive s.aureus epidural abscess
oxacillin, naficillin, cefazolin
28
leg pain in sciatica
buttocks and BELOW level of the knee
29
DIAGNOSTIC OF SCIATICA
positive SLR
30
L4
m: dorsiflex foot
s: inner calf
r: knee jerk
31
L5
m: dorsiflex toe
s: inner forefoot
r: -
32
S1
m: eversion foot
s: outer foot
r: ankle jerk
33
best initial test for: cord compression, epidural abscess, ank spon, CES
MRI
34
imaging for simple Lower back pain
NOOOOOO
35
imaging for positive SLR alone
NOOOOOOO
36
tx of cord compression
STEROIDS-- more important to prevent paralysis first, then giving MRI imaging
37
tx CES
surgical decompression
38
tx of sciatica
NSAID's and continue ordinary exercise. NO BED REST.
| rapid and dramatic beneficts with steroid injections
39
leg pain worse with leaning backwards/ going down hill
lumbar spinal stenosis
40
leg pain better with leaning forward/cycling
lumbar spinal stenosis
41
only test for dx of spinal stenosis
MRI
42
tx spinal stenosis
surgical-- dilate spinal canal
43
what is normal in spinal stenosis
ABI's
44
labs in fibromyalgia
NORMAL LABS
45
best initial tx of fibromyalgia
1. amtitryptiline
2. milnacipran
3. pregabalin
4. trigger point injections with local anaesthetics
46
tx of fibromyalgia with steroids
NEVER THE RIGHT ANSWER
47
when is carpal tunnel pain worse
AT NIGHT
48
most accurate dx of carpal tunnel syndrome
electromyography
| nerve conduction studies
49
MRI for carpal tunnel syndrome
NEVER ENVER NEVER NEVER
50
best initial tx carpal tunnel
1. wrist splints
2. avoid manual activity
3. nsaids etc.
4. steroid injection
51
curative tx carpal tunnel
surgical release
52
duputyrens contacture tx.
1. triamcinolone
2. lidocaine
3. collagenase injection
53
severe tenderness at insertion of supraspinatous
ROTATOR CUFF INJURY
54
most accurate test in rotatory cuff injury
MRI
55
tx of rotatory cuff injury
1. conservative: red, NSAIDs, physical tx
| 2. surgery-- complete tear, unresponsive to conservative
56
which comes first-- sensory or motor impairment in carpal tunnel syndrome
SENSORY
57
anterior knee pain after trauma to joint or meniscal tear
PATELLOFEMORAL SYNDROME
58
anterior knee pain WORSENS just after starting to walk
patellofemoral syndrome
59
anterior knee pain RELIEF after sitting for a prolonged period of time
patellofemoral syndrome
60
XR in PF syndrome
NORMAL
61
tx of PF syndorme
physical tx
62
surgery in PF syndrome
NOOOOO NEVER- because nothing to fix surgically
63
very severe pain in bottom of foot, near the calcaneus
plantar fasciitis
64
pain with plantar faciitis
WORSE-- morning
| RELIEF-- walking few steps/use
65
tx of plantar faciitis
1. stretching, arch supports, NSAIDs
2. steroid injection
3. RARELY surgical release of plantar facia
66
need an abnormal XR to diagnose RA?
NOOOOOOOOO
67
Point system dx of RA, >6 points
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
MCC death in RA
CORONARY ARTERY DISEASE
69
any patient with erosive disease in RA, start with at least....
METHOTREXATE
70
erosive disease in RA=
joint space narrowing
physical joint deformities
XR abnormalities
71
mild disease DMARD--
hydroxchloroquine
72
what to do before hydroxychloroquine
DILATED EYE exam-- since its toxic to the retina
73
what RA drugs safe in pregnancy
sulfasalazine and hydroxchloroquine
74
SE's of sulfasalazine
- bone marrow toxicity
- hemolysis with G6PD
- rash
75
non- diagnostic criteria for SLE
- alopecia
- lung: pneumonia, alveolar haemorrhage, restrictive lung disease
- ocular: photophobia, cotton wool spots, blindness
76
acute exacerbation of SLE labs
decrease complement
| and increase anti-dsDNA
77
what do you patients with SLE die from
infection
78
what do older patients with SLE die from
atherosclerosis
79
asymptomatic ANA
DO NOT TREAT
80
best initial test for APL
mixing study
81
most specific test for APL
Russell Viper Venom Test: prolonged with APL Abs and does not correct on mixing with normal plasma
82
asymptomatic APL antibody
DO NOT TREAT
83
when to investigate APLS
- two first trimester losses
| - one second trimester loss
84
preventing recurrence of spontaneous abortion with APL
heparin and aspirin
85
pencillamine in scleroderma
NOT EFFECTIVE
86
renal crisis tx in scleroderma
ACE inhibitors
87
raynaud tx in scleroderma
CCBs
88
pulmonary fibrosis tx in scleroderma
cyclophosphamide
89
pulmonary HTN tx in scleroderma
- bosentan
- sildenafil
- Prostacyclin analogs: iloprost, treprostinil, epoprostenol
90
which cancers are associated with dermatomyositis
OVARY
LUNG
GI
LYMPHOMA
91
best initial test for dermatomyositis
CPK and aldolase
92
most accurate test for dermatomyositis
muscle biopsy
93
anti-Jo antibodies associated with...
lung fibrosis
94
very bad dental caries and need to constantly drink water
sjogrens syndrome
95
most dangerous complication of sjogrens
lymphoma
96
best initial test for sjogrens
schirmer test-- filter paper placed against eye-- wetness of filter paper
97
most accurate test for sjogrens
lip or parotid gland biopsy
98
intial tx of sjogrens
water the mouth
fluoride
artificial tears
99
medical tx of sjogrens
pilocarpine and cevimeline: increase ACh
100
cure for sjogrens
NOOOOOPE, just evaluate for lymphoma, and lifespan is NOT shortened
101
foot drop ddx
peroneal nerve injury
- lead poisoning
- PAN
102
multiple peripheral neuropathies-- like radial nerve and perennial nerve and ulnar nerve and lateral femoral cutaneous nerve
MONONEURITIC MULTIplex
103
mononeuritis multiplex associated with....
PAN
104
stroke in a young person with vasculitis
PAN
105
most accurate test for PAN
bx of symptomatic site
106
test all patients with PAN for.....
hep B and hep C
107
elevated ESR
| normal CPK and aldolase
polymalgia rheumatica
108
tx of polymyalgia rheumatica
LOW DOSE steroids
109
giant cell arteritis complication....
aortic aneurysm
110
blindness in GCA
IRREVERSIBLE
111
c-ANCA
anti-proteinase 3
112
p-ANCA
anti-myeloperoxidase
113
best test for wegner
LUNG bx> renal bx
114
least accurate bx in wegners
sinus biopsy
115
recurrent URTI and LRTI with renal insufficiency -- NOT resolving with antibiotics
wegners
116
most accurate test churg-strauss
biopsy
117
most accurate dx of HSP
bx
118
most common dx of HSP
CLINICAL
119
IgA levels for HSP
NOT RELIABLE for making the HSP diagnosis
120
cryoglobulins are not the same as....
cold agglutinins
121
lab tests in cryoglobulinemia
positive RF
| make IC's in the cold
122
cryoglobulinaemia tx
NOT STEROIDS
| tx underling-- hep C: IFN and ribavarin
123
complement decrease SLE
```
C3 decreased
(SLE= 3 letters)
```
124
complement decrease hep C
```
C4 decreased
(hep C= 4 letters)
```
125
oral ulcers, genital ulcers, skin lesions
bechets syndrome
126
non-triad thing with bechets...
OCULAR LESIONS--> blindness
127
pathergy
sterile skin pustules from minor trauma (like needle stick), associated with bechets syndrome
128
HLA-B27
NEVER NEVER NEVER
- most accurate
- best initial
- confirmatory
129
back pain worsened by rest
ANK-SPON
130
2 heart things with ank-spon
aortic insufficiency
| AV block
131
best initial test in ank-spon
XR of SI joint
132
most accurate test in ank-spon
MRI-- shows abnormalities years before XR is abnormal
133
bamboo spine
LATE finding in ank-spon
134
tx of ank spon
1. NSAIDs
2. exercise
3. anti-TNF
135
tx of psoriatic arthritis
1. NSAIDs
2. MTX
3. anti-TNF
136
specific test for reactive arthritis
NOOOOO specific test for reactive arthritis
137
keratogerma blenorrhagicum
skin lesion unique to reactive arthritis that looks like pustular psoiasis
138
what should be done for hot swollen joint
JOINT TAP-- exclude septic joint
139
tx of reactive arthritis
1. NSAIDs
| 2. sulfasalazine
140
antibiotics in reactive arthritis
OF no use if the joint pain has already started
141
most accurate test in osteoporosis
DEXA scan
142
blood tests in osteoporosis
NORMAL
143
best initial tx of osteoporosis
vit D and calcium
144
order of tx options in osteoporosis
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
calcitonin use in osteoporosis
reduces the risk of vertebral fractures
146
side effects of teriperatide
hypercalcaemia
| OSTEOSARCOMA IN RATS
147
if presented with multiple tx options for osteoporosis
vit D, ca, bisphosphonates
148
septic arthritis most commonly occurs in....
DAMAGED JOINTS
149
empiric tx for septic arthritis
ceftriaxone and vancomycin
150
GN bacilli septic arthritis tx
- quinolones
- aztreonam
- cefotazime
- piperacillin
- aminoglycosides
151
GP coci (sensitive) septic arthritis tx
- oxacillin, naf
- cefazolin
- pip-tazo
152
GP cocci (resistant) septic arthritis tx
- linezolid
- daptomycin
- tigecycline
- ceftaroline
153
tx of prosthetic joint injection
LOOSENING OF joint
1. remove joint
2. 6-8 weeks antibiotics
3. replace joint
154
mcc prosthetic joint infection
staph epidermidis
155
polyarthritis, tenosynovitis, petechial rash
= GONOCOCCAL ARTHRITIS
156
when does gonococcal arthritis most often occur
during menses
157
best initial tx for gonococcal arthritis
CEFTRIAXONE
| NOTTTTTTTTTT--- fluoroquinolones -- since >5% are resistant
158
recurrent gonococcal infection
TERMINAL COMPLEMENT DEFICIENCY
159
OSTEOmyelitis kids
haematogenous
160
OSTEOmyelitis adults
contiguous-- ie. from nearby infection-- diabetic ulcer
161
best initial test for osteomyelitis
XR
162
most accurate test for osteomyelitis
bone biopsy
163
most appropriate next mgmt if normal XR and osteomyelitis
MRI or bone scan (bone scan if contraindicated MRI--- pacemaker ex.)
164
ESR use in osteomyelitis
follow response to tx
165
culturing and drainage of osteomyelitis
NEVER NEVER NEVER NEVER NEVER correct answer-- since cannot distinguish between colonization inside bone vs. causing infection
166
E. coli tx osteomyelitis
ciprofloxacin-- MUST CONFIRM SENSITIVITY to chipper before starting
