MSK Rheumo ortho Step Up Flashcards
1
Q
where is numbness in carpal tunnel
A
thumb, index and middle finger
2
Q
most common shoulder dislocation
A
anterior
3
Q
posterior shoulder dislocations occur with
A
seizures and electrical shock
4
Q
deltoid malfunction, which nerve
A
axillary
5
Q
most common hip dislocation
A
posterior
6
Q
H and P for ligament tear
A
pain welling that is worse with joint stress
decreased ROM
ligament instability
7
Q
what imaging confirms ligament tear
A
MRI
8
Q
what is the knee triad injury
A
medical collateral
lateral meniscus
ACL
9
Q
Tx for Mensical tear
A
NSAID, PT, arthroscopic repair or debridement
10
Q
signs of compartment syndrome
A
pain pallor poikilothermia pulselessness paresthesia paralysis
11
Q
best screening test for compartment syndrome
A
pain with passive stretchin
12
Q
colles fracture
A
fall on outstretched hand
dinner fork appearance
13
Q
what is the most common carpal fracture
A
scaphoid
14
Q
what is the boxer fracture
A
5th metacarpal neck
15
Q
fracture humerus puts what nerve at risk
A
radial
16
Q
management for hip fracture
A
anticoagulate since at risk for AVN and DVTs
17
Q
which bone fracture puts one at major risk for blood loss
A
pelvic
18
Q
which back pain is worse at rest and better with activiy
A
ankylosing spondylitis
19
Q
radiating pain that is worse with standing and walking
A
pseudoclaudication
relieved when leaning forward or walking uphill
20
Q
deficits with S1 compression
A
achilles reflex
cannot foot evert or plantarflex
sensory deficit of lateral foot
21
Q
deficits with L5 compression
A
cannot dorsiflex first toe
sensory deficits- lateral lower leg and first web space
22
Q
deficits with L4 compression
A
patellar reflex
cannot foot dorsiflex
medial leg sensory loss
23
Q
what is erb duchenne
A
superior trunk injury
caused from shoulder dystocia usually
will have waiteris tup
24
Q
claw hand injury
A
ulnar nerve
will have weak finger adduction
poor 4th and 5th finger flexion
lumbrical weakness
25
clinical features of axillary nerve injury
cannot should abduct or elevate
26
klumpke palsy
posterior and medial cord injury from hyperabduction of the arm
will have claw hang, poor wrist and hand function assoc with horner syndrome
27
Tx for osteoporosis
prevention
bisphosphonates decrease osteoclast activity, increase bone densiity and decrease fracture risk
selective Estrogen R modulators like raloxifene help increase bone density
pulsatile teriparatide (recombinanat PTH) stimulates osteoblasts and bone remodeling
28
why is hormone replacement not recommended anymore for osteoporosis
increased risk for breast cancer, DVTs, CAD and stroke
29
signs of osteopetrosis
increased fractures, blindness or deafness, bony compression of nerves, impaired healing
30
labs in osteopetrosis
decreased Hb, decreased Hct
| increased acid phosphatase, increased CK
31
Tx for osteopetrosis
transfusion marrow components for osteoclast production, activity restriction
32
signs of paget disease of bone
deep bone pain, increased fractures, tibial bowing, kyphosis, increased cranial diameter, deafness
33
labs in pagets disease of bone
increased alk phos
increased urine hydroxyproline
normal Ca and phosphate
34
my hat no longer fits
paget disease
35
Tx pagets of bone
bisphosphonates and calcitonin
36
osteogenesis imperfecta
defective production collagen
| fractures with minimal trauma, blue sclera, skin and teeth deformities, possible deatness, joint hypermobility
37
do not give this for acute attack gout
allopurinol
38
how does allopurinol work
inhibit uric acid formation
39
how does probeneci work
inhibits kidney uric acid resorption
40
what is pseudogout made of
Calcium pyrophosphate dihydrate deposition disease
41
joint aspirate is + birefringent, rhomboid crystals
pseudogout
42
Tx pseudogout
NSAIDs and colchicine
43
msot common cause septic joint
Staph sureus
44
labs in septic joints
increased WBC, inc ESR and CRP
joint aspiration will show numerous WBC with high Neutrophils
decreased glucose
+ cultures
45
Tx gonorrhea septic arthritis
IV ceftriazone and doxy
46
Tx S aureus septic joint
penicillinase R penicillin
47
Tx gram negative septic joint
aminoglycoside
48
msot common cause osteomyelitis in sickle cell patient
salmonella
49
common osteomyelitis in IV drug users
pseudomonas
50
erythema chronicum migrans
bulls eye
| lymes
51
what happens in lymes early disseminated state
```
myocarditis
cardiac arrhythmias
heart block
bells palsy
sensory-motor neuropathies, aseptic meningitis or meningoencephalitis
```
52
What happens in lymes late disseminated stage
few months to years later, chronic synovitis, monoarthritis or oligoarthritis, subacute encephalopathy or polyneuropathy
53
labs for lymes
ELISA and western blot for Ab
54
Tx lymes
doxycycline, amoxicillin or cefuroxime
55
what causes OA
chronic noninflammatory joint degeneration involving articular cartilage deterioration
56
risk factors for OA
advanced age, FMH, obesity, previous joint trauma, repetitive joint stress
57
joint stiffness and pain that worsens with activity and weight bearing
worse in DIP in hands with heberden nodes and PIPs bouchard nodes
degenerative joint disease
58
XR in degenerative joint disease
osteophyte formation, joint space narrowing, subchondral bone sclerosis and subchondral bone cyst formation
59
RA vs OA
RA affects both sides body in symmetric distribution
DIP joints spared
OA asymmetric may only affect one joint
DIP frequently involved
60
bony protuberances on DIP
heberden nodes
61
bony protuberances on PIP
bouchard nodes
62
Tx OA
activity modification, heat, analgesics, NSAIDs, weight loss, PT, corticosteroid, or hyaluronic acid injections
63
what causes RA
chronic inflammatory disorder. synovial hypertrophy with granulation tissue formation on articular cartialge (pannus)
64
HLA in RA
HLA DR4
65
signs Sx RA
PIP and MCP joints
symmetric polyarthropathy
morning stiffness with pain
66
swan neck deformity
flexed DIP with hyperextended PIP
| RA
67
boutonniere deformity
flexed PIP
| RA
68
other manifestations RA besides hand joints
subcutaneous nodules, pleuritis, pericarditis, scleritis
69
labs in RA
RF + in 75%
+ anti citrullinated peptide Ab ACPA
+ ANA in 40%
joint aspiration will show 5,000-50,000 luekocytes
70
false + RPR or VDRL
SLE
71
Ab in SLE
ANA
anti dsDNA
Anti-Sm
72
Ab in drug induced lupus
antihistone Ab
| ANA
73
Ab in polymyositis or dermatomyositis
ANA
| Anti-Jo1
74
Ab in Ankylosing spondylitis
HLA B27
75
Ab in scleroderma
anti Scl 70 ANA
76
Ab in CREST
anti centromere
77
Ab in mixed CT disease
anti TNP ANA
78
Anti Ro and Anti La
sjogren
79
Tx RA
DMARDs like hydroxychloroquine or sulfasalazine
MTX or TNFa inhibitors
leflunomide, anakinra
glucocorticoids and NSAIDs for acute flares
80
if starting TNFa inhibitor, need to check what
PPD for latent TB
81
Risk factors SLE
young women
| black asian or hispanic
82
findings in SLE
malar and discoid rash, serositis, oral ulcers, arthritis, phosensitivity, CNS symptoms, cardiac Sx, renal Sx
fever malaise, weight loss, abdominal pain, vomiting, conunctivitis, blindness
83
what drugs can present like SLE
sulfonamides, hydralazine, isoniazid and phenytoin and procainamide
84
C' in SLE
dec C3 and C4
85
Tx SLE
```
avoid sun
NSAIDs
hydroxychloroquine
corticosteroids
immunosuppresants
anticoag if hypercoagulable
```
86
complications SLE
lupus anticoagulant and anticardiolipin ab increase miscarriage and fetal death
87
risk factors for polymyositis and dermatomyositis
women blacks and elderly
88
signs Sx for polymyositis and dermatomyositis
symmetric progressive proximal muscle weakness (legs first) and myalgias
89
red heliotropic rash on face, upper extremities, chest back
| violet discorloarion of eyelids
dermatomyositis
90
labs in polymyositis and dermatomyositis
increased Cr, aldolase, CK, AST, ALT, LDH
ANA +
Anti jo1 if intersitial lung disease
91
muscle Bx of dermatomyositis
inflammatory cells surrounding muscle fasicles and muscle degeneration
92
muscle Bx polymyositis
inflammatory cells within muscle fasicles and muscle degeneration
93
EMG of polymyositis
spontaneous fibrillations
94
Tx polymyositis
high dose glucocorticoids 4-6 weeks with taper
| IV Ig and rituximab for resistant cases
95
complications polymyositis or dermatomyositis
interstitial lung disease, increased risk of malignancies
96
polymyalgia rheumatica is assoc with what
temporal arteritis
97
Sx polymyalgia rheumatica
pain and stiffness in shoulder and pelvic girdle
difficulty getting out of bed or raising arms
unexplained weight loss, fever, minimal joint swelling
strength maintained but movement limited by pain
98
labs in polymyalgia rheumatica
decreased Hct
increased ESR
negative RF
99
MRI in polymyalgia rheumatica
increased signal at tendon sheaths, and synovial tissue outside joints
100
imaging for polymyalgia rheumatica
MRI
101
Tx for polymyalgia rheumatica
low dose corticosteroids and after 1 day already have relief
102
Dx polymyalgia rheumatica, next step?
workup for temporal arteritis
103
presdisposition to what with fibromyalgia
hypothyroid
RA
sleep apnea
104
Tx fibromyalgia
```
stretching
TCAs
SSRIs
patient education
PT
```
105
risk factorys of ankylosing spondylitis
20-40 years old
male >female
white >black
106
Sx ankylosing spondylitis
hip and low back pain that worse in morning and improves over course of day
limited ROM
painful kyphosis, relieved when bending forward
can have anterior uveitis
107
labs in ankylosing spondylitis
HLA B27 in 90%
increased ESR
neg RF and ANA
108
radiology of ankylosing spondylitis
bamboo spine- vertebral fusions)
| MRI can show increased signal in SI joints
109
Tx for ankylosing spondylitis
```
PT
NSAIDs
exercise
sulfasalazine
MTX
anti TNF drugs
```
110
Arthritis in psoriasis
DIP joints and spine
111
Sx psoriatic arthritis
asymmetic joint pain and stiffness, worse in morning gets better throughout day
pain with stress on joints
!! pitting in nails
112
XR in psoriatic arthritis
highly destructive lesions of DIP and PUP joints
| pencil in cup
113
Tx psoriatic arthritis
NSAIDs, MTX, sulfasalazine, anti TNF
114
Sx scleroderma
arthralgias, myalgias, hand swelling, raynaud, skin thickening, esophageal dysmotility
intestinal hypomotility, dyspnea, arrhythmias and HF
115
CREST
```
calcinosis
raynaud
Esophageal dysmotility
sclerdactyly
telangiectasias
```
116
anticentromere
CREST
117
anti scl 70 Ab
scleroderma
118
Tx for scleroderma
supportive care, ACEI, CCB, avoid caffeine, nicotine
decongestants help with raynaud
MTX or corticosteroids
119
complications scleroderma
pulm fibrosis, heart failure, acute renal failure from malignant renal HTN
120
what helps with raynauds
decongestants
121
mixed connective tissue disease
overlapping SLE scleroderma and polymyositis signs and Sx
122
Ab in mixed connective tissue diseease
anti ribonuceloprotein RNP
123
Tx for mixed CT disease
NSAIDs, corticosteroids, ACEI
124
sjogrens
lymphocytic infiltraiton exocrine glands
125
sjogren assoc with
RA SLE and primary biliary cirrhosis
126
Sx signs sjogren
dry eyes mouth and enelarged parotid glands, purpura on legs, peripheral neuroapthy, symmetric arthritis
127
sicca syndrome
sjogren without autoimmune association
128
most common type of bone tumor in adults
from mets
129
find bone tumor in adult, next step
full workup to look for tumor source
130
osteosarcoma
most common primary malignant bone tumor
adolescents!
male>female
131
where do osteosarcomas occur
distal femur, proximal tibia, proximal humerus
132
risk factors osteosarcoma
```
paget disease
p53 mutations
familial RB
radiation exposure
bone infarcts
```
133
labs in osteosarcoma
inc alk phos, inc ESR LDH
134
XR osteosarcoma
sunburst, codman triangle
135
Tx for osteosarcoma
radical excision and chemo
136
what tumors mets to bone
prostate, renal cell, thyroid, lung, lymphoma and breast
137
tumor in diaphysis of long bones
ewing sarcoma
138
Sx of ewing sarcoma
bony pain
tissue swelling
fever fatigue, weight loss, fractures with minor trauma and maybe a palpable mass
139
labs in ewings
increased WBC, dec Hb, inc ESR need Bx
140
Tx ewings
radiation, adjuvant chemo, radical excision
141
survival ewings sarcoma
60% 5 year with both radiation or chemo
142
what is the most benign bone tumor in metaphysis of long bones
osteochondroma
143
where do osteochondromas occur
metaphysis of long bones
| lower femur or upper tibia
144
Signs osteochondroma
irritated soft tissues overlying mass, frequently nontender
145
bony growth of long bone, on top of cortical bone and is non continuous with normal cancellous bone
malingant
146
XR of osteochondroma
bony growth off metaphysis of long bone and cancellous portion is continuous with interior of lesion
147
Risk factors for developmental dysplasia of the hip
female>male
firstborn child
babies in breech
oligohydramnios
148
galeazzi sign
knees at unequal heights when hips and knees flexed
149
asymmetric skin folds in infant
check for developmental dysplasia of hip
150
Dx developmental dysplasia of hip
US
| XR only helpful after 4 months of age
151
Tx developmental dysplasia of hip
pavlik harness if less than 6 mo
| closed or open reduction if > 6 mo
152
risk factors slipped capital femoral epiphysis
adolescent, obese, black, hypothyroid
153
thigh and knee pain, limp, limited internal rotation and abduction of hip
hip flexion causes external hip rotation
slipped capital femoral epiphysis
154
XR slipped capital FE
posterior andmedial displacement femoral head from metaphysis
155
Tx for slipped capital FE
surgical pinning, weight bearing restrictions
156
increased risk for what with Slipped Capital FE
Avascular necrosis femoral head
157
what is legg calve perthes disease
avascular necrosis of capital femoral epiphysis
158
age of legg calve perthes
3-8 years olf
159
Tx legg calve perthes
containment of hip in acetabulum with surgery or bracing
160
osgood schlatter
inglammation of tibial tubercle- osteochondritis
161
age for osgood schlatter
young boys during puberty
162
Tx osgood schlatter
stretching exercises and NSAIDs
163
salter harris physeal fracture I
physeal separation no extension into bone
164
salter harris physeal fracture II
partial physeal separation with proximal extension into metaphysis, rare growth disturbance
165
salter harris physeal fracture III
partial pyseal separation with distal extension into epiphysis
166
salter harris physeal fracture IV
fracture through metaphysis, physis and epiphysis
167
what is salter harris fracture V
crush injury of physis
168
most common fracture in children
clavicular fracture
169
how to correct nursemaids elbow
supination of arm with flexion of elbow from 0 to 90
170
rickets
vit D deficiency
171
what happens to bones in rickets
epiphyseal cartilage becomes hypertrophic without calcification
172
Sx of rickets
bone pain, delayed walking, bowed legs, kyphoscoliosis, proximal leg weakness, decreased height, softened skull bones
173
labs in rickets
inc alk phos
dec phosphorus
dec Ca and vit D with inc PTH in hypocalcemic
inc Vit D if hypophosphatemic
174
XR rickets
transclucent lines in bones, flattening of skull, enlarged costal cartilages
175
Juvenle idiopathic arthritis
nonmigratory affecting 1+ joints for > 3months
176
XR for juvenile idiopathic arthritis
osteopenia and subchondral sclerosis around involved joints
177
Tx for juvenile idiopathic arthritis
NSAIDs, MTX and corticosteroids
178
pauciarticular juvenile arthritis
large joints (not hips)
2-3 years old
will have uveitis or iridiocyclitis
resolve in
179
polyarticular juvenile arthritis
```
5+ joint
2-5 yrs or 10-14 yrs
symmetric, spin involvement, hand deformities
dactylitis
growth retardation, fever
```
180
which juvenile arthritis does not have growth retardation
pauciarticular
181
systemic juvenile arthritis
182
Tx for systemic juvenile arthritis
NSAIDs MTX, corticosteroids, cytotoxic drugs
183
Duchenne muscular dystrophy
X linked from deficiency in dystrophin
184
most common lethal muscular dystrophy
duchenne
185
when does duchenne muscular dystrophy start
2-6 years old
186
Sx signs duchenne muscular dystrophy
clumsiness, fatiguability,, difficulty standing up and wlaking, gower maneuver, weakness from proximal mm to distal
pseudohypertophy of calf mm
187
labs in duchenne muscular dystrophy
icnreased CK, muscle Bx shows muscle fiber degeneration and fibrosis with basophilic gibers
188
Dx duchennes
immunostaining for dystrophin (which is absent)
189
Tx duchenne
PT
corticosteroids
pulmonary support
ACEI decrease cardiac afterload
190
complications duchenne
cardiac issues, scoliosis, flexion contractures
| death by 20 years old from respiratory issues!!!
