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PANCE REVIEW > MSK/Rheumatoid > Flashcards

MSK/Rheumatoid Flashcards

1
Q

Wegner’s

A

AKA Granulomatosis with polyangitis

  • positive C-ANCA
  • URI, lower respiratory involvement, progressively worsening glomerulonephritis
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2
Q

Most specific antibodies for SLE

A

Anti-dsDNA

ANTI-smith

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3
Q

SLE management

A

Sun protection
Hydroxychloroquine (for leaions)
NSAID for pain
Cytotoxic drugs if severe

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4
Q

Antibodies for anti-phospholipid syndrome

A

Anticardiolipin AB

*causes clots and miscarriages

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5
Q

CREST Syndrome

A 
C-calcinosis
R-Raynaud 
E-esophageal dysmotility
S-sclerodactyly
T-telangiectasia
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6
Q

Antibodies associated with limited systemic sclerosis (scleroderma)

A

Anti-centromere AB

*limited to face, neck, distal to elbows and knees

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7
Q

Antibodies associated with diffuse systemic sclerosis (scleroderma)

A

Anti-SCL-70 AB

*diffuse dz has multiple organ involvement

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8
Q

Treatment for Raynaud’s

A

Vasodilators (CCB)

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9
Q

In what dz do you see a “moth eaten” appearance of muscle fibers on bx

A

Fibromyalgia

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10
Q

Treatment for fibromyalgia

A

TCA, duloxitine, pregabalin

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11
Q

What does Sjögren’s attack

A

Experience glands specifically the salivary glands= xerostomia (dry mouth)

Lacrimal glands=dry eyes

Parotid enlargement

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12
Q

Sjögren specific antibodies

A

Anti-ro

Anti la

(May also see ANA)

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13
Q

What is PMR?

A

Polymyalgia rheumatica

  • synovitis, tenosynovitis, bursitis of large proximal joints such as neck, shoulder, pelvis
  • PAIN no weakness
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14
Q

PMR treatment

A

Low dose steroids

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15
Q

What is poly myositis/ dermatomyositis?

A

Idiopathic symmetric muscle weakness of the large proximal joints with little pain.

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16
Q

Lab values/antibodies associated with PM or DrM

A
  • high muscle enzymes (aldolase, CK)
  • anti-Jo1*also seen with mechanic hands and interstitial fibrosis
  • anti-SRP (PM)
  • anti-Mi-2 (DRM)
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17
Q

Skin presentations of dermatomyositis

A

1) heliotrope rash: violet upper eyelid
2) Gottron’s papules: raises violet scales eruptions of the knuckles
3) Malay rash INVOLVING the nasolabial folds (SLE spares them)
4) photosensitivity rash

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18
Q

What is deposited in the joints in gout

A

Uric acid-byproduct of purine metabolism

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19
Q

What is deposited in pseudogout

A

Calcium pyrophosphate

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20
Q

Epidemiology of gout vs. pseudogout

A

Gout: men>30 , Podogra(MTP)

Pseudogout: women >60 (knee)
-associated with OA and hyperthyroid

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21
Q

Medications causing gout

A 
Diuretics
ACE
ARB (minus losartan)
pyrazinamide 
EthMbutol
ASA
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22
Q

Arthrocentesis findings in gout vs. pseudogout

A

Gout: negatively birefringent needle shaped crystals

Pseudo: positively birefringent rhomboid shaped

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23
Q

Acute and chronic gout management

A

Acute: NSAID, colchicine

Chronic: ALLOPURINOL*, colchicine, febuxostat, uricosuric drugs

*allopurinol can damage kidneys

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24
Q

Radiographic findings of gout vs pseudogout

A

Gout: lower extremity ; “mouse bite” punched out lesions

Pseudo: upper extremity knee ; chonedrocalcinosis-calcification of the cartilage

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25
Q

What causes RA?

A

T cell mediated joint destruction by PANNUS (granulation tissue that eroded into cartilage and bone)

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26
Q

Felty’s syndrome

A

RA+splenomegaly+ low WBC/recurrent infections

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27
Q

Caplan syndrome

A

RA+pneumoconiosis

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28
Q

Dx of RA BASED ON

A
  • Rheumatoid factor (initial)
  • anti-CCP (most specific)
  • multiple joint morning stiffness over 6 weeks
  • narrowed joint space on XR
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29
Q

What is polyarteritis nodosa (PAN)

A

Systemic vasculitis of small arteries causing necrotizing inflammatory lesions

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30
Q

Organ systems involved and spared in PAN

A
  • Renal: HTN, renal failure
  • CNS: neuropathy, mononeuritis multiplex
  • constitutional: fever, myalgias
  • Dermatological: livedo ritucularis, purpura

***LUNGS ARE SPARED

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31
Q

Diagnostic work-up of PAN

A
  • ESR
  • classic is ANCA neg. (20% P-ANCA)
  • ANGIOGRAPHY
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32
Q

PAN management

A

Corticosteroids

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33
Q

What dz is PAN associated with ?

A

Hepatitis B

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34
Q

What is Reiter’s syndrome aka reactive arthritis

A

1) arthritis
2) conjunctivitis
3) urethritis

*in response to an infection in another part of the body MC chlamydia

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35
Q

Keratoderma blennorrhagicum

A

Hyperkeratotic lesions on palms and soles found in restive arthritis

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36
Q

Treatment of reactive arthritis

A

NSAIDS

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37
Q

Tarsal-metatarsal fracture (MC 2nd or 3rd)

A

Lisfranc fx

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38
Q

Carpel Tunnel Effects what nerve?

A

median nerve; check using phalen’s test

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39
Q

Risk Factors for carpel tunnel syndrome

A

Diabetes, pregnancy, and hypothyroidism, excessive wrist strain, RA, obesity

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40
Q

Lateral epicondylitis

A

Tennis Elbow

Injury to the tendon on extensor carpi radials brevis

Pain on forearm PRONATION and wrist EXTENSION

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41
Q

Medial epicondylitis

A

Golfers Elbow

Injury to the pronator trees-flexor carpi radialis

Pain with wrist FLEXION

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42
Q

What is MC ligament sprained in the ankle

A

The Anterior Talofibular ligament (this is the main stabilizer for inversion)

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43
Q

According to the Ottawa Ankle Rules, what are the criteria for getting an X-ray vs treating as just a sprain?

A
  1. Pain on lateral malleolus
  2. Pain on medial malleolus
  3. navicular (midfoot) pain
  4. 5th metatarsal pain
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44
Q

What level is MC for a herniated disc?

A

L5-S1

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45
Q

Herniated disc at the level of L4 would produce what symptoms?

A
  • ANTERIOR thigh pain
  • weak ankle DORSIFLEXION
  • loss of knee jerk
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46
Q

Herniated disc at the level of L5 would produce what symptoms?

A
  • LATERAL thigh/leg/hip pain
  • Loss of sensation to the DORSUM of the foot
  • Weak BIG TOE EXTENSION
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47
Q

Herniated disc at the level of S1 would produce what symptoms?

A
  • POSTERIOR leg/calf pain
  • sensory loss to the PLANTAR surface of the foot
  • weak PLANTARFLEXION
  • loss of ankle jerk
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48
Q

Drugs that can cause drug induced Lupus

A

Procanamide
Hydralazine
INH
Quinidine

**These patients with have anti-histone antibodies

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49
Q

Classic clinical triad of SLE

A
  1. Joint pain
  2. Fever
  3. Malar rash (SPARING nasolabial folds)
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50
Q

Clinical manifestations of SLE

A

SOAP BRAIN MD

  • Serositis (pleuritis, pericarditis)
  • Oral ulcers
  • Arthritis
  • Photosensitivity
  • Blood (anemic, leukopenia, thrombocytopenia)
  • Renal (proteinuria)
  • ANA
  • Immunologic (ds-DNA)
  • Neurologic (psych, seizures)
  • Malar rash (SPARES FOLDS)
  • Discoid rash
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51
Q

What is xerostomia?

A

Dry mouth

52
Q

management of Sjogren’s syndrome

A

Pilocarpine (anti-cholinergic drug)

53
Q

Antibodies found in Sjogren’s syndrome

A

Anti-Ro

ANti-La

54
Q

Management of pseudogout

A

Corticosteroid injections, NSAIDS, colchicine prophylaxis

55
Q

X ray findings in gout

A

Punched out “Rat bite lesions”

56
Q

What will the synovial fluid be described as in reactive arthritis?

A

WBC elevated, but culture will be ASEPTIC

57
Q

Treatment of osteoporosis

A
  1. Bisphosphonates
  2. Vitamin D
  3. SERM (raloxifen)
  4. Estrogen
58
Q

Bisphosphonates MOA

A

slows down bone loss by inhibiting osteoclast resorption

59
Q

Bisphosphonate examples

A
  • Alendronate
  • Risedronate

IV:
-Zoledronic acid

60
Q

Special instructions for taking bisphosphonates

A
  • Take on empty stomach
  • Take with a lot of water
  • Be sure to remain upright for at least 30 minutes
61
Q

Side effects of bisphosphonates

A
  • Jaw necosis
  • pill esophagitis
  • pathological femur fracture
62
Q

What is the MC type of shoulder dislocation?

A

Anterior

63
Q

What is a Hill-Sachs lesion

A

Groove on the head of humerus s/p shoulder dislocation from impact against glenoid

64
Q

What is a bankart lesion?

A

Fracture on the rim of the glenoid s/p shoulder dislocation

65
Q

What could cause a posterior shoulder dislocation?

A

MC cause are seizures and electric shock

66
Q

What X ray view is most helpful in determining the type of shoulder dislocation?

A

Axillary Y view

67
Q

3 types of shoulder separations

A

Class 1: simply a sprain of AC and CC ligaments (normal joint space)

Class 2: slight widening of joint space as the acromioclavicular ligament is ruptured but the coracoclaviular ligament is only sprained

Class 3: both are ruptured and severe joint widening

68
Q

What must be checked when a patient presents with a proximal humerus / humeral head fracture?

A

Deltoid sensation to rule out brachial plexus or axillary nerve injury

69
Q

A radial nerve injury would present as what?

A

Wrist drop

70
Q

What nerve injury must you rule out in a patient with a humeral shaft fracture?

A

Radial nerve (would present as a wrist drop)

71
Q

What is Volkmann ischemic contracture

A

A complication of a humerus fracture that involves injury to the median nerve and brachial artery.

-Causes a claw like deformity from ischemia with flexion/contracture of the wrist

72
Q

Clinical manifestation of an olecranon fracture that may distinguish it from another

A

inability to extend the elbow

73
Q

Complications of an olecranon fracture

A

Ulnar nerve dysfunction

74
Q

Management of an olecranon fracture

A

REDUCE; all of these are considered intraarticular

75
Q

What is a monteggia fracture?

A

Proximal ulnar shaft fx with anterior radial head dislocation

76
Q

What is a Galeazzi Fx?

A

Mid-distal radial shaft fracture with dislocation of distal radioulnar joint (DRUJ)

77
Q

What is a nursemaid’s elbow?

A

Radial head subluxation, MC in a child under 5 y/o

  • Radial head wedges into the stretched annular ligament
  • Child will have arm slightly flexed with refusal to use it
  • Reduce with pressure on the radial head, arm supination and flexion
78
Q

What is a hutchinson fracture?

A

radial styloid fracture; aka Chauffer’s fx

79
Q

What is the MC direction for an elbow to dislocate?

A

Posteriorly

80
Q

Manifestations and management of an elbow dislocation

A
  • Patient with flexed elbow & a marked olecranon prominence
  • Emergent reduction is necessary with a posterior splint
  • Rule out brachial artery and nerve injuries
81
Q

What is the MC carpal fx?

A

Scaphoid

82
Q

Management of a scaphoid fx

A

Thumb spica splint, get repeat x-rays even if it does not show fx and there is snuff box tenderness.

*High risk of avascular necrosis or nonunion

83
Q

What is a Colles fracture?

A

Distal radius fx with dorsal/posterior angulation, “dinner fork deformity”

-MC result of a FOOSH with wrist extension

84
Q

What is a Smith fx?

A

Distal radius fx with ventral/anterior angulation

-MC result of a FOOSH with wrist flexion

85
Q

What is a Barton fx?

A

Intra-articular distal radius fx with CARPAL displacement

86
Q

What is a Boxer’s fx?

A

Fracture of the 5th metacarpal neck

87
Q

Boxer’s fx management

A

Ulnar gutter splint with joints in @ least 60 deg. flexion

-Always check for bite wounds

88
Q

What is a Bennett Fracture?

A

Intraarticular fx between the base of the first MCP

***A rolando’s fracture is a comminuted Bennet’s fx

89
Q

Saltar Harris Classification of fractures

A

Type 1: Isolated growth plate fracture

Type 2: Growth plate + metaphysis (MC)

Type 3: growth plate + epiphysis

Type 4: growth plate + metaphysics + epiphysis (NEEDS REDUCTION)

Type 5: Growth plate compression

90
Q

What is the MC direction for a hip to dislocate

A

Posteriorly

91
Q

Clinical manifestation of a posterior hip dislocation

A

Shortened leg

INTERNALLY rotated

Adducted with hip/knee slightly flexed

92
Q

Clinical manifestation of an anterior hip dislocation

**this is also how a hip fracture would present

A

Shortened leg

EXTERNALLY rotated

Abducted

93
Q

Complications of a hip dislocation

A
  • avascular necrosis of the hip in 13%
  • Sciatic nerve injury
  • This is a true orthopedic emergency
94
Q

What is a greenstick fracture?

A

Bowing of the bones in children

95
Q

What is a buckle fracture?

A

incomplete fx with wrinkling or a bump

aka torus fx

96
Q

What is the best radiographic view for a patella fracture?

A

Sunrise view

97
Q

What is the MC complication of a knee dislocation

A

1/3 will have a popliteal artery injury

98
Q

Weber ankle fracture classifications

A

Weber A: fibular fx below syndesmosis

Weber B: fibular fx AT level of syndesmosis

Weber C: Fibular fx ABOVE mortise joint, with deltoid ligament damage or medial malleolar fx, this is unstable

99
Q

What is a maisonneuve fx?

A

Spiral Proximal fibular fx as a result of a distal medial malleolar fx or deltoid ligament tear

100
Q

What is a Jones fracture?

A

transverse fx through the diaphysis of the 5th metatarsal

101
Q

What is a lisfranc injury?

A

disruption between the articulation of the medial cuneiform and 2nd metatarsal

102
Q

Where does the axillary nerve innervate?

A

deltoid

103
Q

What part of the rotator cuff is MC injured?

A

Supraspinatus

104
Q

Special tests for a rotator cuff injury

A

1) Hawkins: 90 degree flexion in elbow and shoulder, pain illicited on IR
2) Drop Arm: Hold arm up and keep it there (try with and without lidocaine)
3) Neer test: arm fully pronated with pain during forward flexion

105
Q

Ligaments of the shoulder

A

Acromioclavicular ligament (AC)-if ruptured in isolation this is a grade 2 shoulder separation

Coracoclavicular ligament (CC) -If ruptured along with the AC ligament this is a grade 3 shoulder separation

106
Q

What is the MC fracture in children and adolescents?

A

Clavicular fracture

*suspect child abuse if under 2 years old

107
Q

What comorbidities are would increase the risk of adhesive capsulitis ?

A

DM

Hypothyroid

108
Q

What arteries and nerves run through the elbow that you must evaluate in the case of a an elbow dislocation?

A

Radial artery

Median nerve
Ulnar nerve
radial nerve

109
Q

What is Kienbock’s disease?

A

Avascular necrosis of the lunate bone

*a lunate fracture is the most serious carpal fx due to the fact that it occupies 2/3 of the radial articular surface

110
Q

What can be given after fractures to decrease the risk of developing Complex Regional Pain Syndrome?

A

Vitamin C

111
Q

What is Mallet finger and how does it present?

A

Direct blow to an extended finger causes an extensor tendon avulsion, leaving the finger flexed at the DIP

112
Q

What is a boutoniere deformity?

A

Flexed PIP joint and hyperextended DIP

113
Q

What is a swan neck deformity?

A

Finger hyperextended at the PIP and flexed at the DIP

114
Q

Gamekeeper’s thumb

A

sprain or tear of the ulnar collateral ligament of the thumb

  • Gamekeeper thumb if chronic condition
  • Skier’s thumb if acute injury
115
Q

What is the pathopneumonic fracture associated with an ACL tear?

A

Segond fx: this is an avulsion of the lateral tibial condyle

116
Q

What meniscal tear is most common, medial or lateral?

A

Medial *it is more fixed to the femoral head

117
Q

What is the Thompson test?

A

weak, or absent plantar flexion when gastrocnemius is squeezed.. indicative of chillies tendon injury

118
Q

Hallmarks of Acute Osteomyelitis

A

-MC seen in children causes by hematogenous spread of Staph Aureus (group B strep if less than 4 months old)

119
Q

Hallmarks of Chronic Osteomyelitis

A

-MC seen in adults 2ry to direct inoculation of an open wound with Staph Aureus

120
Q

Tests to make the diagnosis of Osteomyelitis

A
  • MRI (most sensitive early test)
  • WBC, ESR, CRP (if ESR normal it is most likely NOT osteo)
  • XRAY: shows periosteal reaction and sequestrum

-Bone aspiration is GOLD standard

121
Q

Duration of tx for osteomyelitis

A

4-6 weeks of abx with at least 2 weeks IV

122
Q

Tx regimens for osteomyelitis

A

Under 4 months: (group B strep) Nafcillin
Over 4 months:
(MSSA) Nafcillin or Cefazolin
(MRSA) vancomycin

Sickle Cell dz: (salmonella) 3rd gen. cephalosporin or FQ

Puncture Wound: (pseudomonas) Cipro

123
Q

What is the MC organism and body part affected by septic arthritis?

A

Staph Aureus effecting the knee.

124
Q

Dx of septic arthritis

A

Arthrocentesis with over 50,000 WBC, predominantly PMNs

125
Q

TX of septic arthritis

A

Gram + Nafcillin

Gram - or gonococcus Ceftriaxone + gentamicin if pseudomonas suspected

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