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Step2CK > MSK Rheumo ortho Step Up > Flashcards

MSK Rheumo ortho Step Up Flashcards

1
Q

where is numbness in carpal tunnel

A

thumb, index and middle finger

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2
Q

most common shoulder dislocation

A

anterior

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3
Q

posterior shoulder dislocations occur with

A

seizures and electrical shock

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4
Q

deltoid malfunction, which nerve

A

axillary

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5
Q

most common hip dislocation

A

posterior

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6
Q

H and P for ligament tear

A

pain welling that is worse with joint stress
decreased ROM
ligament instability

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7
Q

what imaging confirms ligament tear

A

MRI

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8
Q

what is the knee triad injury

A

medical collateral
lateral meniscus
ACL

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9
Q

Tx for Mensical tear

A

NSAID, PT, arthroscopic repair or debridement

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10
Q

signs of compartment syndrome

A 
pain
pallor
poikilothermia
pulselessness
paresthesia
paralysis
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11
Q

best screening test for compartment syndrome

A

pain with passive stretchin

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12
Q

colles fracture

A

fall on outstretched hand

dinner fork appearance

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13
Q

what is the most common carpal fracture

A

scaphoid

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14
Q

what is the boxer fracture

A

5th metacarpal neck

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15
Q

fracture humerus puts what nerve at risk

A

radial

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16
Q

management for hip fracture

A

anticoagulate since at risk for AVN and DVTs

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17
Q

which bone fracture puts one at major risk for blood loss

A

pelvic

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18
Q

which back pain is worse at rest and better with activiy

A

ankylosing spondylitis

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19
Q

radiating pain that is worse with standing and walking

A

pseudoclaudication

relieved when leaning forward or walking uphill

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20
Q

deficits with S1 compression

A

achilles reflex
cannot foot evert or plantarflex
sensory deficit of lateral foot

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21
Q

deficits with L5 compression

A

cannot dorsiflex first toe

sensory deficits- lateral lower leg and first web space

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22
Q

deficits with L4 compression

A

patellar reflex
cannot foot dorsiflex
medial leg sensory loss

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23
Q

what is erb duchenne

A

superior trunk injury
caused from shoulder dystocia usually
will have waiteris tup

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24
Q

claw hand injury

A

ulnar nerve
will have weak finger adduction
poor 4th and 5th finger flexion
lumbrical weakness

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25
Q

clinical features of axillary nerve injury

A

cannot should abduct or elevate

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26
Q

klumpke palsy

A

posterior and medial cord injury from hyperabduction of the arm
will have claw hang, poor wrist and hand function assoc with horner syndrome

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27
Q

Tx for osteoporosis

A

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

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28
Q

why is hormone replacement not recommended anymore for osteoporosis

A

increased risk for breast cancer, DVTs, CAD and stroke

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29
Q

signs of osteopetrosis

A

increased fractures, blindness or deafness, bony compression of nerves, impaired healing

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30
Q

labs in osteopetrosis

A

decreased Hb, decreased Hct

increased acid phosphatase, increased CK

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31
Q

Tx for osteopetrosis

A

transfusion marrow components for osteoclast production, activity restriction

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32
Q

signs of paget disease of bone

A

deep bone pain, increased fractures, tibial bowing, kyphosis, increased cranial diameter, deafness

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33
Q

labs in pagets disease of bone

A

increased alk phos
increased urine hydroxyproline
normal Ca and phosphate

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34
Q

my hat no longer fits

A

paget disease

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35
Q

Tx pagets of bone

A

bisphosphonates and calcitonin

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36
Q

osteogenesis imperfecta

A

defective production collagen

fractures with minimal trauma, blue sclera, skin and teeth deformities, possible deatness, joint hypermobility

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37
Q

do not give this for acute attack gout

A

allopurinol

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38
Q

how does allopurinol work

A

inhibit uric acid formation

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39
Q

how does probeneci work

A

inhibits kidney uric acid resorption

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40
Q

what is pseudogout made of

A

Calcium pyrophosphate dihydrate deposition disease

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41
Q

joint aspirate is + birefringent, rhomboid crystals

A

pseudogout

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42
Q

Tx pseudogout

A

NSAIDs and colchicine

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43
Q

msot common cause septic joint

A

Staph sureus

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44
Q

labs in septic joints

A

increased WBC, inc ESR and CRP
joint aspiration will show numerous WBC with high Neutrophils
decreased glucose
+ cultures

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45
Q

Tx gonorrhea septic arthritis

A

IV ceftriazone and doxy

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46
Q

Tx S aureus septic joint

A

penicillinase R penicillin

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47
Q

Tx gram negative septic joint

A

aminoglycoside

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48
Q

msot common cause osteomyelitis in sickle cell patient

A

salmonella

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49
Q

common osteomyelitis in IV drug users

A

pseudomonas

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50
Q

erythema chronicum migrans

A

bulls eye

lymes

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51
Q

what happens in lymes early disseminated state

A 
myocarditis
cardiac arrhythmias
heart block
bells palsy
sensory-motor neuropathies, aseptic meningitis or meningoencephalitis
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52
Q

What happens in lymes late disseminated stage

A

few months to years later, chronic synovitis, monoarthritis or oligoarthritis, subacute encephalopathy or polyneuropathy

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53
Q

labs for lymes

A

ELISA and western blot for Ab

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54
Q

Tx lymes

A

doxycycline, amoxicillin or cefuroxime

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55
Q

what causes OA

A

chronic noninflammatory joint degeneration involving articular cartilage deterioration

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56
Q

risk factors for OA

A

advanced age, FMH, obesity, previous joint trauma, repetitive joint stress

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57
Q

joint stiffness and pain that worsens with activity and weight bearing
worse in DIP in hands with heberden nodes and PIPs bouchard nodes

A

degenerative joint disease

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58
Q

XR in degenerative joint disease

A

osteophyte formation, joint space narrowing, subchondral bone sclerosis and subchondral bone cyst formation

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59
Q

RA vs OA

A

RA affects both sides body in symmetric distribution
DIP joints spared
OA asymmetric may only affect one joint
DIP frequently involved

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60
Q

bony protuberances on DIP

A

heberden nodes

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61
Q

bony protuberances on PIP

A

bouchard nodes

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62
Q

Tx OA

A

activity modification, heat, analgesics, NSAIDs, weight loss, PT, corticosteroid, or hyaluronic acid injections

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63
Q

what causes RA

A

chronic inflammatory disorder. synovial hypertrophy with granulation tissue formation on articular cartialge (pannus)

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64
Q

HLA in RA

A

HLA DR4

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65
Q

signs Sx RA

A

PIP and MCP joints
symmetric polyarthropathy
morning stiffness with pain

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66
Q

swan neck deformity

A

flexed DIP with hyperextended PIP

RA

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67
Q

boutonniere deformity

A

flexed PIP

RA

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68
Q

other manifestations RA besides hand joints

A

subcutaneous nodules, pleuritis, pericarditis, scleritis

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69
Q

labs in RA

A

RF + in 75%
+ anti citrullinated peptide Ab ACPA
+ ANA in 40%
joint aspiration will show 5,000-50,000 luekocytes

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70
Q

false + RPR or VDRL

A

SLE

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71
Q

Ab in SLE

A

ANA
anti dsDNA
Anti-Sm

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72
Q

Ab in drug induced lupus

A

antihistone Ab

ANA

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73
Q

Ab in polymyositis or dermatomyositis

A

ANA

Anti-Jo1

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74
Q

Ab in Ankylosing spondylitis

A

HLA B27

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75
Q

Ab in scleroderma

A

anti Scl 70 ANA

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76
Q

Ab in CREST

A

anti centromere

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77
Q

Ab in mixed CT disease

A

anti TNP ANA

78
Q

Anti Ro and Anti La

79
Q

Tx RA

A

DMARDs like hydroxychloroquine or sulfasalazine
MTX or TNFa inhibitors
leflunomide, anakinra
glucocorticoids and NSAIDs for acute flares

80
Q

if starting TNFa inhibitor, need to check what

A

PPD for latent TB

81
Q

Risk factors SLE

A

young women

black asian or hispanic

82
Q

findings in SLE

A

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
Q

what drugs can present like SLE

A

sulfonamides, hydralazine, isoniazid and phenytoin and procainamide

84
Q

C’ in SLE

A

dec C3 and C4

85
Q

Tx SLE

A 
avoid sun
NSAIDs
hydroxychloroquine
corticosteroids
immunosuppresants
anticoag if hypercoagulable
86
Q

complications SLE

A

lupus anticoagulant and anticardiolipin ab increase miscarriage and fetal death

87
Q

risk factors for polymyositis and dermatomyositis

A

women blacks and elderly

88
Q

signs Sx for polymyositis and dermatomyositis

A

symmetric progressive proximal muscle weakness (legs first) and myalgias

89
Q

red heliotropic rash on face, upper extremities, chest back

violet discorloarion of eyelids

A

dermatomyositis

90
Q

labs in polymyositis and dermatomyositis

A

increased Cr, aldolase, CK, AST, ALT, LDH
ANA +
Anti jo1 if intersitial lung disease

91
Q

muscle Bx of dermatomyositis

A

inflammatory cells surrounding muscle fasicles and muscle degeneration

92
Q

muscle Bx polymyositis

A

inflammatory cells within muscle fasicles and muscle degeneration

93
Q

EMG of polymyositis

A

spontaneous fibrillations

94
Q

Tx polymyositis

A

high dose glucocorticoids 4-6 weeks with taper

IV Ig and rituximab for resistant cases

95
Q

complications polymyositis or dermatomyositis

A

interstitial lung disease, increased risk of malignancies

96
Q

polymyalgia rheumatica is assoc with what

A

temporal arteritis

97
Q

Sx polymyalgia rheumatica

A

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
Q

labs in polymyalgia rheumatica

A

decreased Hct
increased ESR
negative RF

99
Q

MRI in polymyalgia rheumatica

A

increased signal at tendon sheaths, and synovial tissue outside joints

100
Q

imaging for polymyalgia rheumatica

101
Q

Tx for polymyalgia rheumatica

A

low dose corticosteroids and after 1 day already have relief

102
Q

Dx polymyalgia rheumatica, next step?

A

workup for temporal arteritis

103
Q

presdisposition to what with fibromyalgia

A

hypothyroid
RA
sleep apnea

104
Q

Tx fibromyalgia

A 
stretching
TCAs
SSRIs
patient education
PT
105
Q

risk factorys of ankylosing spondylitis

A

20-40 years old
male >female
white >black

106
Q

Sx ankylosing spondylitis

A

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
Q

labs in ankylosing spondylitis

A

HLA B27 in 90%
increased ESR
neg RF and ANA

108
Q

radiology of ankylosing spondylitis

A

bamboo spine- vertebral fusions)

MRI can show increased signal in SI joints

109
Q

Tx for ankylosing spondylitis

A 
PT
NSAIDs
exercise
sulfasalazine
MTX
anti TNF drugs
110
Q

Arthritis in psoriasis

A

DIP joints and spine

111
Q

Sx psoriatic arthritis

A

asymmetic joint pain and stiffness, worse in morning gets better throughout day
pain with stress on joints
!! pitting in nails

112
Q

XR in psoriatic arthritis

A

highly destructive lesions of DIP and PUP joints

pencil in cup

113
Q

Tx psoriatic arthritis

A

NSAIDs, MTX, sulfasalazine, anti TNF

114
Q

Sx scleroderma

A

arthralgias, myalgias, hand swelling, raynaud, skin thickening, esophageal dysmotility
intestinal hypomotility, dyspnea, arrhythmias and HF

115
Q

CREST

A 
calcinosis
raynaud
Esophageal dysmotility
sclerdactyly
telangiectasias
116
Q

anticentromere

117
Q

anti scl 70 Ab

A

scleroderma

118
Q

Tx for scleroderma

A

supportive care, ACEI, CCB, avoid caffeine, nicotine
decongestants help with raynaud
MTX or corticosteroids

119
Q

complications scleroderma

A

pulm fibrosis, heart failure, acute renal failure from malignant renal HTN

120
Q

what helps with raynauds

A

decongestants

121
Q

mixed connective tissue disease

A

overlapping SLE scleroderma and polymyositis signs and Sx

122
Q

Ab in mixed connective tissue diseease

A

anti ribonuceloprotein RNP

123
Q

Tx for mixed CT disease

A

NSAIDs, corticosteroids, ACEI

124
Q

sjogrens

A

lymphocytic infiltraiton exocrine glands

125
Q

sjogren assoc with

A

RA SLE and primary biliary cirrhosis

126
Q

Sx signs sjogren

A

dry eyes mouth and enelarged parotid glands, purpura on legs, peripheral neuroapthy, symmetric arthritis

127
Q

sicca syndrome

A

sjogren without autoimmune association

128
Q

most common type of bone tumor in adults

129
Q

find bone tumor in adult, next step

A

full workup to look for tumor source

130
Q

osteosarcoma

A

most common primary malignant bone tumor
adolescents!
male>female

131
Q

where do osteosarcomas occur

A

distal femur, proximal tibia, proximal humerus

132
Q

risk factors osteosarcoma

A 
paget disease
p53 mutations
familial RB
radiation exposure
bone infarcts
133
Q

labs in osteosarcoma

A

inc alk phos, inc ESR LDH

134
Q

XR osteosarcoma

A

sunburst, codman triangle

135
Q

Tx for osteosarcoma

A

radical excision and chemo

136
Q

what tumors mets to bone

A

prostate, renal cell, thyroid, lung, lymphoma and breast

137
Q

tumor in diaphysis of long bones

A

ewing sarcoma

138
Q

Sx of ewing sarcoma

A

bony pain
tissue swelling
fever fatigue, weight loss, fractures with minor trauma and maybe a palpable mass

139
Q

labs in ewings

A

increased WBC, dec Hb, inc ESR need Bx

140
Q

Tx ewings

A

radiation, adjuvant chemo, radical excision

141
Q

survival ewings sarcoma

A

60% 5 year with both radiation or chemo

142
Q

what is the most benign bone tumor in metaphysis of long bones

A

osteochondroma

143
Q

where do osteochondromas occur

A

metaphysis of long bones

lower femur or upper tibia

144
Q

Signs osteochondroma

A

irritated soft tissues overlying mass, frequently nontender

145
Q

bony growth of long bone, on top of cortical bone and is non continuous with normal cancellous bone

146
Q

XR of osteochondroma

A

bony growth off metaphysis of long bone and cancellous portion is continuous with interior of lesion

147
Q

Risk factors for developmental dysplasia of the hip

A

female>male
firstborn child
babies in breech
oligohydramnios

148
Q

galeazzi sign

A

knees at unequal heights when hips and knees flexed

149
Q

asymmetric skin folds in infant

A

check for developmental dysplasia of hip

150
Q

Dx developmental dysplasia of hip

A

US

XR only helpful after 4 months of age

151
Q

Tx developmental dysplasia of hip

A

pavlik harness if less than 6 mo

closed or open reduction if > 6 mo

152
Q

risk factors slipped capital femoral epiphysis

A

adolescent, obese, black, hypothyroid

153
Q

thigh and knee pain, limp, limited internal rotation and abduction of hip
hip flexion causes external hip rotation

A

slipped capital femoral epiphysis

154
Q

XR slipped capital FE

A

posterior andmedial displacement femoral head from metaphysis

155
Q

Tx for slipped capital FE

A

surgical pinning, weight bearing restrictions

156
Q

increased risk for what with Slipped Capital FE

A

Avascular necrosis femoral head

157
Q

what is legg calve perthes disease

A

avascular necrosis of capital femoral epiphysis

158
Q

age of legg calve perthes

A

3-8 years olf

159
Q

Tx legg calve perthes

A

containment of hip in acetabulum with surgery or bracing

160
Q

osgood schlatter

A

inglammation of tibial tubercle- osteochondritis

161
Q

age for osgood schlatter

A

young boys during puberty

162
Q

Tx osgood schlatter

A

stretching exercises and NSAIDs

163
Q

salter harris physeal fracture I

A

physeal separation no extension into bone

164
Q

salter harris physeal fracture II

A

partial physeal separation with proximal extension into metaphysis, rare growth disturbance

165
Q

salter harris physeal fracture III

A

partial pyseal separation with distal extension into epiphysis

166
Q

salter harris physeal fracture IV

A

fracture through metaphysis, physis and epiphysis

167
Q

what is salter harris fracture V

A

crush injury of physis

168
Q

most common fracture in children

A

clavicular fracture

169
Q

how to correct nursemaids elbow

A

supination of arm with flexion of elbow from 0 to 90

170
Q

rickets

A

vit D deficiency

171
Q

what happens to bones in rickets

A

epiphyseal cartilage becomes hypertrophic without calcification

172
Q

Sx of rickets

A

bone pain, delayed walking, bowed legs, kyphoscoliosis, proximal leg weakness, decreased height, softened skull bones

173
Q

labs in rickets

A

inc alk phos
dec phosphorus
dec Ca and vit D with inc PTH in hypocalcemic
inc Vit D if hypophosphatemic

174
Q

XR rickets

A

transclucent lines in bones, flattening of skull, enlarged costal cartilages

175
Q

Juvenle idiopathic arthritis

A

nonmigratory affecting 1+ joints for > 3months

176
Q

XR for juvenile idiopathic arthritis

A

osteopenia and subchondral sclerosis around involved joints

177
Q

Tx for juvenile idiopathic arthritis

A

NSAIDs, MTX and corticosteroids

178
Q

pauciarticular juvenile arthritis

A

large joints (not hips)
2-3 years old
will have uveitis or iridiocyclitis
resolve in

179
Q

polyarticular juvenile arthritis

A 
5+ joint
2-5 yrs or 10-14 yrs
symmetric, spin involvement, hand deformities
dactylitis
growth retardation, fever
180
Q

which juvenile arthritis does not have growth retardation

A

pauciarticular

181
Q

systemic juvenile arthritis

182
Q

Tx for systemic juvenile arthritis

A

NSAIDs MTX, corticosteroids, cytotoxic drugs

183
Q

Duchenne muscular dystrophy

A

X linked from deficiency in dystrophin

184
Q

most common lethal muscular dystrophy

185
Q

when does duchenne muscular dystrophy start

A

2-6 years old

186
Q

Sx signs duchenne muscular dystrophy

A

clumsiness, fatiguability,, difficulty standing up and wlaking, gower maneuver, weakness from proximal mm to distal
pseudohypertophy of calf mm

187
Q

labs in duchenne muscular dystrophy

A

icnreased CK, muscle Bx shows muscle fiber degeneration and fibrosis with basophilic gibers

188
Q

Dx duchennes

A

immunostaining for dystrophin (which is absent)

189
Q

Tx duchenne

A

PT
corticosteroids
pulmonary support
ACEI decrease cardiac afterload

190
Q

complications duchenne

A

cardiac issues, scoliosis, flexion contractures

death by 20 years old from respiratory issues!!!

Step2CK (26 decks)

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