MSK/Rheum/Derm Flashcards
SLE
Sx: SEIZURES, autoimmune thrombocytopenia, anemia of chronic dz, CAN HAVE FEVER (no white count)
Dx: ANA (v sensitive) then anti-dsDNA, anti-Smith
Tx: hydroxychloroquine (retinopathy) cyclophosphamide (bladder cancer, MESNA)
***a/w avascular necrosis, mixed cryoglobulinemia, anti-phospholipid syndrome, splenic rupture
In pregnancy: AV block, flare can look like pre-e +MALAR RASH, ARTHRITIS, RBC CASTS, ANA, dec C3
Avascular necrosis
Sickle cell, steroids (SLE), infx, alcohol, renal tplant, gradual increasing pain, may not see on XR early, MRI more sens
Supracondylar fx
More common in kids, brachial artery/median nerve, compartment syndrome (swelling + intact pulse and neuro)
Systemic sclerosis
Diffuse (scl, topoisomerase, ILD, dysphagia smooth muscle atrophy fibrosis) vs cutaneous (CREST, centromere)
Atlantoaxial instability
Downs, upper motor signs, incontinence
Ringworm
Tinea corporis, topical clotrimazole or terbinafine, if doesn’t work can try PO (azole > griseofulvin side effects), can look worse in immunocomp pts DM HIV
Takayasu arteritis
Asian women 10-40 yo, aorta/big vessels, autoimmune, claudication, bruit, bp discrepancy, dx CT/MRI arterial wall thickening, Tx glucocorticoids
Allergic contact dermatitis
Vesicular rash exposed surfaces sometimes streaks type 4 hypersensitivity
Ankylosing spondylitis
Enthesitis early sign, Dx by XR, HLA-B27 is 90% sensitive but 5% specific cannot use to diagnose
Giant cell tumor
Young adult women, soap bubble lesions
Pemphigus vulgaris
desmosomes, IgG C3 intercellular deposits, tombstones, FLACCID bullae, Nikosky sign
Complex regional pain syndrome
After trauma/surgery, pain out of proportion, looks like an infection but nl inflammatory markers
When to XR an ankle
Point tenderness over malleolus, posterior, can’t bear weight >4 steps
Clavicle fracture
Middle 1/3 usually no surg but nd angiogram
Carpal tunnel
Diabetes!!, severe=loss of strength (sensation doesn’t count) or evidence on nerve imaging studies)–>surgery, otherwise try splint first
Amyloidosis
Can be 2/2 cancer/IBD/infx/arthritis/vasculitis, HEART STUFF, S4 pretty much every organ, dx abd fat pad aspiration bx, tx colchicine
Juvenile idiopathic arthritis
Non migratory, slower onset, can bear weight, maybe mild fever SEPTIC CANT BEAR WEIGHT
Osteoarthritis
MC, posture-dependent pain (if spine), tx quad strengthening
Rheumatoid arthritis
Periarticular erosions, RF, citrillunated protein, DMARDs folate inhibiting (methotrexate check LFTs hepatotoxic), tx ASAP
atlanto-axial, can have pleural exudative effusion
Squamous cell vs basal cell
SCC: sun-exposed surfaces, central ulceration, immunocomp, scarring, neuro sx (head&neck cervical LN referred otalgia)
BCC: skin-colored, telangiectasias, non-healing, crusting, much more common
Polymyalgia rheumatica
head, neck, shoulders, hip girdle, high ESR/CRP give low dose pred don’t need confirmatory testing, a/w GCA (aortic aneurysm)
Lichen planus
Hep C ACEi HCTZ, 5 p’s polygonal papules, plaques, pink/purple, pruritis flexural surfaces tx topical steroids
vag: fucked up red/inflamed ulcers white striae NOT Behcet, bx make sure it’s not cancer
Psoriatic arthritis
DIPs, nails, prednisone
Tophaceous gout
Looks like giant nodules
Transient sinovitis
Can bear weight!! Can see b/l effusion on US, preceding viral illness
Charcot joint
Denervation leads to altered mechanics and joint deformation
Behcet disease
Middle eastern Turkish Asian, ulcers (oral and genital), erythema nodosum, uveitis
Polymyositis/Dermatomyositis
Anti-Jo, Anti-Mi-2, prox muscle weakness w/o pain, dermatomyositis +heliotrope rash +Gottrons finger nodules +periorbital edema, dx Ab CK or muscle bx, tx pred, a/w cancer
Quadriceps tendon rupture
Low patella (vs patellar tendon rupture patella will be high)
Antiphospholipid syndrome
LONG PTT (lab artifact) Anti-cardiolipin, anti-beta2-glycoprotein, CVA/other thrombotic event/preg probs, ACs for lyfe, if SLE add hydroxychloroquine (side effect retinopathy) pos RPR
Paget dz of bone
HA, may have no sx, Ca Phos nl, inc alk phos, inc urine hydroxyproline
LYTIC focal osteoClasts (MM systemic sx, osteomalacia diffuse)
Molluscum contagiosum
POXVIRUS flesh colored umbilicated papules, 6-12 mo, worse in HIV
SCFE
SURGICAL PINNING
Kawasaki disease
tx aspirin & IVIG
Myasthenia gravis vs LE
LE +autonomic sx (dry mouth), DECREASED DTRs, gets better w/ repetition, dx by repetitive nerve stimulation
MG nicotinic receptors, ptosis, ice pack test/edrophonium, get chest CT for thymoma, tx pyridostigmine, immunosuppresant
MYASTHENIC CRISIS acute resp failure tx plex or IVIG
Actinic keratosis
white flaky sun-exposed, can do nothing or cryo or fluorouracil topical if really bad, can turn into SCC
Secondary gout causes
PV or other myeloprolif disorder, Lesch-Nyhan, xanthine deficiency, CKD, thiazides
meniscal tear
Click w/ McMurray, MRI, surg if impairing function or effusion >3w
Felty syndrome
Untreated RA –> neutropenia<2,000, frequent sinus infx, splenomegaly
Pseudogout
Hemochromatosis/hyperPTH/hypothyroid, Ca crystals rhomboid positively birefringent, usually the knee/monoarticular, trauma/overuse/surgery/illness, chondrocalcinosis
Bullous pemphigoid
PD, MS, cancer pts, IgG C3 LINEAR along membrane, tx topical clobetasol
Langerhans cell histiocytosis
bones, skin, LAD, HSM, central diabetes insipidus, benign but locally destructive, tx prednisone or curettage
Epidermal inclusion cyst
comes and goes, can do nothing or I&D if infected
Lyme dz
Months–can get arthritis
Serum sickness-like reaction
1-2 w after penicillin, fever urticaria polyarthralgia kind of looks like ARF but in a pt who got tx
Age-related sicca syndrome
dry eyes and mouth, dec exocrine fxn, eye drops
Psoriasis
sudden onset severe HIV, can be exacerbated by contact irritation
Ichthyosis vulgaris
Chronic genetic condition scaling
Lumbar strain
NSAIDs, PT if persistent >6w
Septic arthritis
vanc for MRSA coverage, gram neg (klebsiella) also common, add CTX if not getting better RA IS A RF
Stress fracture
POINT TENDERNESS, skinny pt (shin splint will be diffusely tender, fat pt)
Shingles
NSAIDs, >4mo gabapentin or TCA
Henoch-Schonlein purpura
Abd pain, IgA, arthralgias, hematuria, INTUSSUSCEPTION
Pressure ulcers
Pillows
Midshaft humerus fx
Radial nerve
Pyoderma gangrenosum
Crohns, UC, granulomatosis w/ polyangiitis
Melanoma
A - asymmetric B - irregular borders C - colors D - diam>6mm E - evolution
Brown recluse spider bite
Ulcerated lesion–> eschar +/- debridement
Gout tx
Acute indo COLCHICINE if CV risk pt
Joint fluid analysis
nl: <200
OA: 200-2K
RA: 2-100K
Septic: 50-150K
How to treat a sunburn
NSAIDs
Iliotibial band syndrome
Lateral femoral epicondyle Noble test (pes anserina medial)
Erythema multiforme
a/w HSV, mycoplasma (don’t get mixed up w/ Lyme, these are a LOT of lesions usually extremities Lyme more truncal)
Acne step-up
Topical retinoids –> benzoyl peroxide –> (COMEDONAL salicylic acid) –> topical abx –> PO abx –> (CYSTIC PO istotretinoin)
Shoulder dislocation
Posterior=seizure
MCL tear
abduction (valgus) laxity NOT MENISCUS (meniscus has clicking Lachman’s test)
Duchenne muscular dystrophy
GOLD STANDARD DX genetic testing
Eczema herpeticum
HSV infx in pt w/ eczema (asthma/atopy on test), new lesions, ND ACYCLOVIR