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Shelf Exams > MSK/Rhuem > Flashcards

MSK/Rhuem Flashcards

1
Q

Stress fracture

A

Pain in forefoot of 2nd-4th, metatarsal bones, sharp, localized, worse with palpation. Insidious onset of pain.

Common in female athlete triad, repetitive activity.

Manage: reduce weight bearing for 4-6 weeks. X ray may be negative.

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2
Q

Morton Neuroma

A

pain in forefoot b/w plantar 3rd and 4th toes + clicking (Mulder sign) when palpating or squeezing.

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3
Q

Plantar fasciitis

A

Burning pain in plantar foot, worsening with first steps in the morning. Decreases with activity, then increases with prolonged weight bearing.

Common in runners due to repetitive microtrauma, localized point tenderness

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4
Q

Tarsal tunnel syndrome

A

Compression of tibial nerve due to fracture of ankle bone.

Sx burning, numbness, ache of distal plantar foot

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5
Q

Vertebral osteomyelitis

A

Risks: IVDU, sickle cell, immunosuppressed
Bugs: staph aureus, gram -
Sx: tenderness to percussion, +/- fever and white count, may have elevated platelets and high ESR
Dx by MRI

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6
Q

Ankylosing spondylitis

A

Back pain in young men, progressive decrease in ROM, worse in morning and improving with activity/day

Insidious onset, age 3 month. Nocturnal pain common..

Assoc with arthritis, sacroiliitis, reduced chest/spinal mobility, tedon insertion inflammation, dactylitis, anterior uveitis

Complications: osteoporosis, vertebral fracture, aortic regurg, cauda equina

Lab: elevated ESR, CRP, HLA-B27

Dx: X ray or MRI of sacroiliac joints

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7
Q

Lumbar spinal stenosis

A

Narrowing of spinal canal, compression of spinal roots.

Age >60.

Pain radiating to butt/thigh, worsen with walking and extension and improve with flexion.

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8
Q

Viral arthritis

A

Acute onset of morning sx, stiffness lasting

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9
Q

Giant Cell (Temporal) Arteritis

A

Sc headache, muscle fatigue, jaw claudication, visual disturbance, scalp tenderness

ESR >50

Associated with aortic aneurism, follow with serial CXR

Associated with PMR

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10
Q

Avascular necrosis

A

Risks: steroid use, alcohol use, SLE, APS, Hemoglobinopathy, osteomyelitis, HIV, transplant, decompression sickness

Sx: groin pain on weight bearing, pain on hip abduction & internal rotation
No erythema, swelling, or point tenderness

Lab: normal WBC, ESR, CRP

Rad: MRI, crescent sign (subchondral lucency) on plain XR if advanced

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11
Q

Paget Disease of Bone

A

Most common cause of asymptomatic elevated alkphos

Sx: headache, hearing loss, spinal stenosis, arthritis/fracture of long bones

Osteoclast dysfunction –> increased bone turnover

Lab: elevated alkphos, PINP, urine hydroxyproline. Ca nad Phos nl

Image: bone scan shows focal increase in uptake, xray shows osteolytic or sclerotic lesions

Tx bisphosphonates

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12
Q

Primary Raynaud’s

A

No underlying cause

Women

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13
Q

Secondary Raynaud’s

A

Connective tissue disease, usually men >40y, with tissue injury

May also be due to occlusive vascular disease sympathomimetic drugs, hyperviscosity syndrome, nicotine

Tx CCB for persistent symptoms, aspirin for pts at risk of ulcers

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14
Q

Managing low back pain

A

Acute: moderate activity, NSAIDS, acetaminophen. Consider muscle relaxants, spinal manipulation

Chronic: intermittent NSAIDs/acetaminophen, exercise therapy, consider TCA or duloxetine

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15
Q

Lateral epicondylitis

A

Tennis elbow.

Tenderness of lateral epicondyle, pain on resisted wrist extension and hand gripping

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16
Q

Medial epicondylitis

A

Golfers elbow

Tenderness of medial epicondyle, pain on resisted wrist flexion

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17
Q

Cubital Tunnel Syndrome

A

Entrapment of ulnar nerve

Pain and sensory/motor loss in ulnar region

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18
Q

Olecranon bursitis

A

“carpet-layers elbow”

Olecranon bursa develops effusion. Extremely tender, but no pain/restriction of ROM

19
Q

OA vs RA joints

A

OA: DIP
RA: MCP
Both may affect PIP

20
Q

Trochanteric bursitis

A

Pinpoint source (point with one finger) of hip pain over the greater trochanter of the femur. Pain with abduction of the hip.

Tx with corticosteroid.

21
Q

Meniscal tear

A

Twisting injury with popping or tearing, then swelling over several hours

Sx: clicking or locking of knee, pain on walking, esp stairs.

McMurray test: audible pop/snap, 97% specific
Pain along joint line: 76% sensitive

22
Q

Anserine bursitis

A

Focal pain on upper, inner tibia (on anteromedial aspect of lower leg below joint line of knee)

Often assoc with knee OA

Tx corticosteroid injection

23
Q

Patellofemoral pain syndrome

A

chronic knee pain, women

Anterior knee pain, worse with prolonged sitting and going up/down stairs

24
Q

PMR treatment options

A

Corticosteroids
Steroid-sparing agents: MTX

infilximab is NOT an effective steroid-sparing agent for PMR

25
Q

Gout

A

Monosidium urate crystals, needle-shaped

Tx NSAIDS, corticosteroids, colchicine

NSAIDS highly effective, contraindicated with renal impairment

Colchicine most effective in pts with monoarticular involvement, within 24 hours

Allopurinol/febuxostat: xanthine oxidase inhibitors, reduce uric acid levels. Do not use in acute attack, but do use to treat hyperuricemia. May use prophylactic colchicine/NSAID/steroid before beginning/adjusting dose to prevent flare

26
Q

Osteoarthritis of knee

A

Knee pain +
age >50, morning stiffness >30min, crepitus, bony tenderness, bony enlargement, absence of palpable warmth

XR osteopyts, sclerosis, cyst formation, joint-space narrowing

Manage with PT, quadriceps mucle training
also weight loss

27
Q

Osteoarthritis of first carpometacarpal joint

A

Localized tenderness, elicited by “grind test” (movement of thumb in circular motion).

Associated with Heberden nodes (DIP) or Bouchard nodes (PIP)

Tx: acute OA with NSAID, 2 tx with intraarticular steroid injections

28
Q

De Quervain tenosynovitis

A

Inflammation of abductor pollicic longus and extensor pollicis brevis

Pain on palpation of distal radial styloid, and Finkelstein test: flexing thumb into palm, closing fingers over thumb, and bending wrist in ulnar direction

29
Q

Empiric treatment of CA-septic arthritis with gram + cocci?

A

Vancomycin (to cover MRSA)

30
Q

Treating early RA

A

DMARD therapy within 3 months of onset:

Hydroxychloroquine
Methotrexate (contraindicated with alcohol due to hepatotoxicity)
Biologics: TNF alpha inhibitors, etanercept, highest efficacy in combination with MTX

31
Q

HIV associated psoriatic arthritis

A

exposive onset, widespread psoriasis with dactylitis, DIP involvement, asymmetric joint involvement

32
Q

Enteropathic arthritis

A

crampy abdominal pain, diarrhea, rectal urgency (IBD) + acute arthritis

33
Q

Whipple disease

A

Tropheryma wwhippelii

Diarrhea, malabsorption, arthritis, CNS sx, constitutional sx

joint involvement is chronic and migratory

34
Q

Fibromyalgia

A

Diffuse pain on both sides of body, above and below waist. 11 of 18 potential tender points.

Associated with fatigue, sleep disturbance, dry eyes nad mouth, IBS pelvic pain, mandibular pain

35
Q

Polyarteritis nodosa

A

Necrotizing inflammation of medium/small arteries

renal sx: HTN, renal insufficiency, proteinuria, hematoria

dx by sural nerve biopsy, kidney angiography (microaneurysm, beaded pattern of narrowing/dilation on arteries)

Biopsy likely to have false negative, high risk of bleeding 2/2 transsection of intrarenal aneurysm

36
Q

Cyclophosphamide

A

Alkylating agent, used as immunosuppression in SLE and vasculitis with renal or CNS symptoms

AE: hemorrhagic cystitis, bladder carcinoma 2/2 acrolein, a toxic metabolite.

37
Q

PMR

A

Age >50, bilateral pain/morning stiffness involving neck, torso, shoulders, proximal thigh/arm, with constitutional sx

Lab: ESR>40, high ERP, may have normocytic anemia

Tx glucocorticoids

38
Q

Baker cyst

A

soft mass in the popliteal fossa, common in RA, OA, and cartilage tears.

Occasionally burst, similar appearing to a DVT

39
Q

Felty syndrome

A

RA + neutropenia (ANC85, no other cause of neutropenia on smear or BM biopsy

Associated with severe, seropositive RA with extra-articular manifestations

40
Q

Adult onset still disease

A

Sx: daily fever, salmon-colored rash, arthritis, multisystem, lymphadenopathy

Elevated ferrritin>1000, abnl LFT, negative RF
Exclusion of leukemia/lymphoma

41
Q

Pes antine bursitis

A

Pain along anteromedial aspect of proximal tibia, distal to joint line
Worsens with stair climbing and at night

42
Q

Churg-Strauss

A

Eosinophilia, migratory pulmonary infiltrates, purpuric skin rash, and mononeuritis multiplex
Antecedent asthma/rhinitis/sinusitis
40% have p-ANCA opsitive

43
Q

Which vasculitides involve the kidney and lung?

A
  1. Microscopic polyangiitis – rapidly progressive GN, pulmonary hemorrhage, sometimes mononeuritis multiplex.
  2. Granulomatosis with polyangiitis - cavitary pulmonary infiltrates, often hemorrhage
  3. Churg Strauss – lung and kidney PLUS eosinophilia, antecedent atopy, and mononeuritis multiplex.

All of these can be ANCA positive.

Shelf Exams (2 decks)

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