MSK/Rheum/Autoimmune

Question 1

When do you go straight to an MRI for low back pain?

Answer 1

1. Signs of cord compression or cauda equina syndrome
2. Suspicion for epidural abscess

(For suspected malignancy, osteoporosis/compression fracture, and ankylosing spondylitis, get CXR+ESR first, then can get MRI if abnormal and necessary).

Question 2

What secondary injury can result from supracondylar fracture of the humerus?

Answer 2

Brachial artery and median nerve

Question 3

When do you do surgery for a meniscus tear?

Answer 3

Younger patient with persistent (>3-4 weeks) symptoms that impair activity

Question 4

Numbness/pain between 3rd and 4th toes with clicking felt between those toes when squeezing the metatarsals

Answer 4

Morton neuroma

Question 5

Anterior medial tibial pain not aggravated by valgus stress with normal x-rays

Answer 5

Pes anserinus pain syndrome (PAPS) a.k.a. anserine bursitis

Question 6

Markers of bone turnover that are more specific than alk phos (e.g. for Paget disease of bone)

Answer 6

Urine hydroxyproline and PINP

Question 7

X-ray findings in osteomalacia

Answer 7

Cortical thinning and pseudofractures

Question 8

Problems in ankylosing spondylitis other than arthritis (sacroiliitis)

Answer 8

1. Enthesitis (tenderness at tendon insertions)
2. Dacylitis (sausage fingers)
3. Anterior uveitis

Question 9

Inflammatory arthritis with DIP and nail involvement

Answer 9

Psoriatic arthritis (can see dactylitis/sausage fingers and can be destructive)

Question 10

Felty syndrome

Answer 10

1. Severe RA (with extraarticular manifestations)
2. Neutropenia (ANC < 1,500)
3. Splenomegaly

Question 11

Adult-onset Still’s disease

Answer 11

1. Persistent high spiking fevers
2. Arthritis/arthralgias
3. Non-pruritic salmon-colored bumpy rash
   (Labs show neutrophilic leukocytosis, elevated ferritin, and negative RA and ANA)

Question 12

Specific markers for lupus

Answer 12

SLE: Anti-dsDNA, anti-Smith

Drug-induced: Anti-histone

Question 13

Sjogren syndrome antibodies

Answer 13

Ro/SSA and La/SSB

Question 14

Dermatomyositis antibodies

Answer 14

anti-Jo-1 and anti-Mi-2

Question 15

Why should patients with temporal arteritis have serial CXRs?

Answer 15

Monitor for aortic aneurysm

Question 16

Limited cutaneous systemic sclerosis antibodies?

Diffuse cutaneous systemic sclerosis antibodies?

Answer 16

Limited (CREST): anti-centromere

Diffuse: anti-topo- I a.k.a. anti-Scl70) and anti-RNA pol III

Question 17

Sudden onset oliguric renal failure with severe HTN and microangiopathic hemolytic anemia and thrombocytopenia

Answer 17

Scleroderma renal crisis

Question 18

Key side effect(s) of hydroxychloroquine

Answer 18

Retinopathy (get baseline ophtho exam and annual screens starting at 5 years on the drug)

Question 19

Key side effect(s) of methotrexate

Answer 19

Hepatotoxicity, stomatitis (both same as sulfasalazine), and cytopenias

Question 20

Key side effect(s) of sulfasalazine

Answer 20

Hepatoxocity, stomatitis (both same as methotrexate), and hemolytic anemia
Can rarely lead to SJS/TEN

Question 21

Key side effect(s) of leflunomide

Answer 21

Hepatotoxicity and cytopenias (no stomatitis, unlike methotrexate and sulfasalazine)