MSK rheum ortho Uworld Flashcards
associated conditions with pyoderma gangrenosum
IBD
arthropathies
hematologic conditions
Tx pyoderma gangrenosum
local or systemic corticosteroids
Tx for non displaced scaphoid ractures
wrist immobilization for 6-10 weeks
rotator cuff tear
weakness with abduction and external rotation
young boy with single lytic lesion in humeral head
mild hypercalcemia
langerhans histiocytosis
solitary long bone lytic lesions
histiocytosis X or langerhans cell granulomatosis
Tx osgood schlatter
activity restriction, stretching and NSAIDs
young woman with fatigue weight loss, inflammatory arthritis and pericardial friction rub
also has edema and proteinuria
SLE
lab abnomralities in SLE
anemia, leukopenia, thrombocytopenia
+ANA and + dsDNA and +ant Sm
low Cā and increased IC
peak incidence acute rheumatic fever
5-15
major criteria for acute rheumatic fever
JONES joints-migratory arthritis carditis nodules- subcutnaeous erythema marginatum syndeham chorea
Tx for Acute rheumatic fever
penicillin to prevent
during strep pyogenes GAS infection
12 year old boy with low back pain and palpable step off
spondylolithesis
triad of gonococcemia
polyarthralgia, tenosynobitis and painless vesiculopistular lesions
purulent arthritis in sexually active individual
gonococcal arthritis until proven otherwise
common complaint of sjogrens patients
dyspareunia
Osteogenesis imperfecta
CT disorder
auto dominant
COL1A1
manifestations OI
blue sclerae, osteopenia, hearing loss, hypotonia, easy bruising
dentinogenesis imperfecta- weak enamel
fever and acute monoarticular arthritis
next step
synovial fluid analysis to rule out septic arthritis
when is it not necessary to treat metatarsus adductus
when the feet overcorrect both passively and actively into abduction
morton neuroma
pain between 3rd and 4th toes
clicking sensation when palpating this space and squeezing the metatarsal joints
tarsal tunnel syndrome
compression of tibial nerve at ankle causing burning, numbness and aching of distal plantar surface of foot/toes
violaceous slightly scaly papules over joints
gottrons papules- dermatomyositis
Ab with dermatomyositis
anti Jo 1 and ant Mi2- against helicase
high risk for what with dermatomyositis
internal malignancies
ovarian, lung, pancreatic, stomach and colorectal ca
non hodgkin lymphoma
acute monoarticular arthritis with chondrocalcinosis
pseudogout
if patient has pseudogout check for what else?
secondary cause
hyper PTH
hypothyroid
hemochromatosis
iron pannel in hemochromatosis
increased serum iron, ferritin and transferrin
Tx for herniated disk without neurologic Sx
early mobilization, muscle relaxants and NSAIDs
if have raynauds, order what
CBC with CMP
UA
ANA and RF
ESR and Cā levels
most common cause viral arthritis
parvo b19
msot significant risk factor for developing osteoporosis in someone who exercises is overweight drinks plenty of milk and alcohol
excess alcohol intake
coagulation abrnoamlity in antiphospholipid syndrome
APTT prolongation not fixed by plasma mixing
Ab in antiphospholipid Ab syndrome
anticardiolipin
anti beta 2 glycoprotein I
next step if patient presents with sciatica
back XR and ESR
how to prevent gout
weight loss low fat diet decreased seafood and red meat protein from vegetables avoidance organ rich foods like liver avoid beer avoid diuretics
Ab in systemic sclerosis
anti topoisomerase I
sequelae of systemic sclerosis
HTN
R heart failure from pulm arterial HTN
esophageal and gastric dymotility
anti mitochondrial Ab
Primary biliary cirrhosis
supracondylar fracture of humerus at risk for
injury to brachial artery
causes of acquired torticolis
URI, minor trauma and cervical lymphadenitits
Dx for torticollis
XR of cervical spine
adverse effect hydroxychloroquine
retinopathy
adverse effects of MTX
hepatotoxicity
stomatitis
cytopenias
side effects sulfasalazine
hepatotoxicity
stomatitis
hemolytic anemia
complications of kawasaki
coronary artery aneurysms
MI and ischemia
labs in pagets disease of bone
elevate alk phos
normal Ca and phosphorus
most common cause of asymptomatic elevation of alk phosphatase in elderly patient
pagets disease of bone
common heart finding in ankylosing spondylitlis
aortic regurg
what happens in systemic sclerosis that causes esophgeal dysmotility
smooth muscle atrophy and fibrosis
Tx pagets disease of bone
alendronate
what cause pagets
osteoclastic bone resorption
how do bisphosphonates work
inhibit osteoclast
which part of axial skeleton does RA affect
cervical spine
pain of hip OA is where
groin, buttock or pelvis that can radiate to lower thigh or knee
common XR findings in OA
loss of joint space, osteophytes and subchondral sclerosis
long term glucocorticoids can cause hip pain how
osteonecrosis of hip
bouchard and heberden nodules
OA
caucasian female with long Hx polyarthritis with fatigue, low grade fever, weakness weight loss
MTX, naproxen, ranitidine
deformed hand joints, soft tender mass in right popliteal fossa
mass is what?
inflamed synovium
patient has RA
Dx patellofemoral syndrome
patellofemoral compression test
pain inferior to patellar
patellar tendonitis
tenderness to gentle percussion over spine in IV drug user
vertebral osteomyelitis
rachitic rosary
enlarged costochondral joints
rickets
Tx for raynauds
CCB
triggers for gout
heavy alcohol consumption intake of urate rich foods trauma/surgery dehydration medications that raise uric acid like thiazide and cyclosporine
what is reactive arthritis
from chlamydia
Tx reactive arthritis
NSAIDs
most important risk factor for osteoporosis
post menopausal state then smoking, lack weight bearing low BMI heavy alcohol low Ca and Vit D corticosteroid use
recommended screening for osteoporosis
DEXA for all women >65
whipple disease presentation
malabsorptive diarrhea, protein losing enteropaty
weight loss
migratory arthritis
lymphadenopathy and low grade fever
What causes whipples
gram + bacillus tropheryma whippelii
Dx whipples
small intestine Bx and PCR
Bx findings in whipples
PAS+ macrophages in lamina propria with non acid fast gram + bacilli
giant cell arteritis Sx
HA, jaw claudication, muscle fatigue, visual disturbance
what is a complication of giant cell arteritis
aortic aneurysmā do serial CXR
hypodense lesion on XR in long bone in adolescent
osteoid osteoma
meniscal calcification occurs with what joint problem
pseudogout from more calcium pyrophosphate
abnormal hip maneuvers in child under 6 months old
hip US
abnomral hip maneuvers in child more than 6 mo old
hip XR
Tx RA
DMARD ASAP like MTX
before starting MTX check for
Hep B C and TB
exam findings in ankylosing spondylitis
arthritis
reduced chest expansion and spinal mobility
enthesitis (tenderness at tendon insertion sites)
dactylitis (swelling fingers and toes)
uveitis
viral arthritis
symmetric small joint inflammtory arthrits
complication ankylosing spondylitis
anterior uveitis
Tx radial head subluxation
hyperpronation
or supination with flexion at elbow
distal femur has centraly lytic lesion with onion skinning and moth eaten appearance with extension into soft tissue
ewings
amyloidosis can be secondary to
inflammatory arthritis chronic infections IBD malignancy vasculitis
Tx for amyloidosis
cochicine
nephrotic syndrome, hepatomegaly
ventricular hypertrophy and recurrent pulmonary infections
secondary amyloidosis
what antibiotics cause serum sickness like reaction
antibiotics (beta lactams sulfa)
clinical features serum sickness-like reactoin
fever, urticaria and polyarthralgia
HA edema, lymphadenopathy and splenomegaly
complication of RA in women
generalized bone loss and osteoporosis/osteopenia
what is dactylitis
sausage digit
psoriasis
pulmonary involvement in systemic sclerosis
interstitial lung disease- pulm fibrosis
next step after identifying hip fracture in elderly patient
EKG, cardiac markers and CXR
antimetabolit drug in RA
MTX
prolonged morning stiffness
RA
macrocytic anemia from drug, which one
MTX because interferes with folic acid
flexion helping with back pain
spinal stenosis
imaging if suspect ankylosing spondylitis
XR SI joint
clinical findings in behcet
recurrent painful oral apthous ulcers genital ulvers eye lesions skin lesions thrombosis
biopsy of behcet
nonspecific vasculitis of different sized vessels
ethnicities with behcets
turkish, middle eastern, asian
most common cause erythema nodosum
recent strep infection
causes of erythema nodosum
sarcoid, TB, histo, IBD
causes of gout
primary
myeloproliferative/lymphoproliferative
tymor lysis syndrome
leschnyhan
chronic kidney disease
thiazide/loop
pruritis after hot bath
polycythemia vera
neurogenic claudication
pain of spinal stenosis
worsens the narrowing of the canal when standing and walking
