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Clin Med II > MSK Tx > Flashcards

MSK Tx Flashcards

1
Q

What should be taken with MTX?

A

folic acid

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2
Q

When should MTX be stopped prior to conception?

A

3 mo

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3
Q

MTX SE

A

GI upset, hair loss, oral ulcers, LFTs abnormality,

Increased risk of
infection,

Pancytopenia, allergic rxn, pneumonitis, renal failure, worsening of rheumatoid nodules

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4
Q

What baseline tests does Hydroxychloroquine ( HCQ) require?

A

eye exam and follow up to monitor retinal tox

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5
Q

Sulfasalazine monitoring requirements

A

CBC and CMP 2-4 weeks initially, with stable dose every 3 months

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6
Q

Methotrexate (MTX) monitoring

A

CBC, CMP with starting and adjusting the dose once stable can do q2mo

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7
Q

Leflunomide CI

A

pregnant women because of the potential for fetal harm

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8
Q

TNF inhibitor monitoring

A

CMB, CMP, hep B, C, TB test

get live vacc prior to Rx

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9
Q

TNF inhibitor CI

A

heart failure

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10
Q

TNF inhibitor SE

A

Increased risk of infections

TB reactivation

Demyelinating disorder

Autoimmune disorder (positive ANA ,
lupus like syndrome)

New onset and worsening of heart failure

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11
Q

Rheumatoid Arthritis

A

Early and aggressive tx is impt

NSAIDs

Steroids to ↓ sx rapidly

Daily calcium 1200 mg and vit D 1000-2000 IU

Must get CBC, EST< CRP, Hep B & C serologies and TB testing prior to meds

DMARDs
Methotrexate *MC (take w/ folic acid and avoid alcohol)

Hydroxychloroquine ( HCQ)- can take while pregnant

Biologic DMARDs

Managt HTN, DM, hypercholesterolemia
Smoking cessation

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12
Q

Spondyloarthritis

SpA

A

NSAIDs

Sulfasalazine/ Methotrexate for peripheral arthritis only

Biologics

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13
Q

Osteoarthritis

DJD

A

Mild-mod: Muscle strengthening exercises

Weight loss goal of >7.5% bw

NSAIDS, capsaicin

Mod-Severe: Duloxetine, intraatricular steroid, assisted devices, injection

Joint replacement

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14
Q

Osteosarcome

A

Pre-op chemo

Surgical resection- limb salvage or amputation

Post-op chemo x 1 yr

Blood work and imaging q3mo x 1 yr then q6mo x 2 yrs

Chest CT q6mo x 2 yrs (check for lung mets)

CBC to see effect on bone marrow and RBC prod

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15
Q

Chondrosarcoma

A

Surgical resection

Does not respond well to chemo or radiation

Great prognosis if you catch it early

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16
Q

Ewing Sarcoma

A

Surgery

Radiation

Chemo

70% 5 yr survival if local only 30% if mets

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17
Q

Ganglion Cysts

A

Surgical- open excision to take out entire capsule, requires post-op immobilization x 7 days

Recurrence is common

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18
Q

Septic Arthritis

A

Ortho emergency!

Surgical debridement and irrigation

IV abx (7-10 days)

Complications: osteomyelitis (bone infection)

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19
Q

Osteomyelitis

A

Surgical debridement and irrigation

IV abx (at least 6 wks)

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20
Q

Gonococcal Arthritis

A

Ceftriaxone 1g IM QD until signs and sx improve

Treat pt and partners emperically for Chlamydia (azithromycin or doxy)

Screen for complement deficiency of recurrent disseminated gonococcal infection

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21
Q

Lyme Arthritis

A

IM ceftriaxone 21-28 days if early disseminated

Doxycycline 21-28 days

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22
Q

Viral Arthritis

A

Self-limiting, resolves within 1-2 months

Does not cause destructive arthritis

NSAIDs

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23
Q

Septic Bursitis

A

IV antibiotics

Surgical debridement of bursa

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24
Q

Acute Gout

A

Self limiting but treat w/in first 24 hr bc will resolve quicker

Anti-inflam

Colchicine inhibits polymerization of microtubules inhibiting neutrophil chemotaxis

NSAIDs at antiimflam dose

Steroids

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25
Q

Chronic Gout

A

Lifestylye mod: weight loss, exercise, diet

Low Purine Diet

D/c or Δ meds: thiazide ot loop diuretics, niacin, cyclosporin

Δ to Losartan, CCB or statins due to protective effect

26
Q

CPPD: Pseudogout

A

Self limiting

Anti-inflammatories
Colchicine
NSAIDs
Steroids

No medication for chronic management

27
Q

Osteoporosis

A

Exercise, fall prevention

Calcium (1200-1500 mg/day)

Vit D (800 IU/day)

Avoid tobacco, limit ETOH

Hip protectors

Biphosphonates

Teriparatide (rhPTH)

Abaloparatide

Denosumab- can use for CKD pts

SERM

Calcitonin- max 6 mo

28
Q

Bisphosphonates MOA

A

inhibit bone RESORPTION

29
Q

Bisphosphonates CI

A

doNOTuseinpatients with Class IIIb or higher CKD

30
Q

Teriparatide (rhPTH) MOA

A

increases bone formation by osteoblasts

31
Q

Teriparatide (rhPTH) CI

A

Pagets

Unexplained alk phos elevation

Children and teens with open epiphyses

Pts with prior radiation therapy

Hyperparathyroidism

h/o hypercalcemia

32
Q

Abaloparatide CI

A

Paget disease,

Bone metastases

Skeletal malignancies

Unexplained elevation of alkaline phosphatase

Radiation therapy

Open epiphyses

33
Q

Abaloparatide MOA

A

Stimulation of osteoblast function and increased bone mass

34
Q

Denosumab indications

A

osteoporosis pts w/ CKD

35
Q

Impingement Syndrome

Rotator Cuff Syndrome or Rotator Cuff Disease

A

NSAIDs, rest, ice, activity modification

PT: cuff strengthening, stretching,
coordinated motion

Subacromial injection(s): lidocaine (Xylocaine) +
methylprednisolone (Solu-Medrol)

Surgery-rare

36
Q

Rotator Cuff Tears

A

Partial Tear
<50% NSAIDs, subacromial steroid inj, PT

> 50% → surg

Complete Tear→
Surgery

37
Q

Biceps Tendinitis

A

Conservative measures: rest, NSAIDs, and ROM exercises

US guided steroid injections in the bicipital sheath

Surgery for failed conservative approach

38
Q

Adhesive Capsulitis

“frozen shoulder syndrome”

A

Conservative therapy- ice, NSAIDs

Steroid injections

PT is very helpful = GS

Surgery if failed

39
Q

Glenohumeral Osteoarthritis

A

PT

NSAIDs- caution in elderly, weight risks/benefits

Mod of activities

Steroid inj (generally not done due to delay in labral healing)

Surgery- joint arthroplasty

40
Q

Lateral Epicondylitis

tennis elbow

A

Rest and NSAIDs (short term) very successful

PT: US, icing, friction massage

Steroid inj for immediate relief but
no LT benefits

Arthroscopic debridement
(outcomes are no better than conservative measures)

41
Q

Medial Epicondylitis

golfer’s elbow

A

Rest, NSAIDs, friction massage, ultrasound, icing

Splinting- don’t want to do LT bc of muscle atrophy

Steroid inj

Activity mod x 1 mo

Surgery: debridement, bone spur shaving, release of flexor muscle

42
Q

Olecranon Bursitis

A 
Conservative → 
compression
splinting
\+/- aspiration
\+/- steroid
injection

Surgery→ reserved for failure of conservative tx or in the
pt w/ infective bursitis→
debridement/
bursal excision

43
Q

De Quervain Disease/Tenosynovitis

mommy thumb

A

Activity modification
Ice
NSAIDs

Thumb spica splint

Injections along tendon sheath

44
Q

Duuytren’s Contracture

A

Early in the disease→ adjust work environment (wear appropriate gloves, cushion tape, built-up handles, etc.)

Persistent symptoms →
Intralesional steroid inj
or
Surgical repair (if contracture present)→ open fasciotomy

45
Q

Polymyositis

A

Induction- IV steroids then po prednisone 1 mg/kg/day

Maintenance Methotrexate or Imuran

Mycophenolate Mofetil (esp for ILD)

Tacrolumus (esp for ILD)

IVIG

Rituximab

46
Q

Dermatomyositis

A

Induction- IV steroids then po prednisone 1 mg/kg/day

Maintenance Methotrexate or Imuran

Mycophenolate Mofetil (esp for ILD)

Tacrolumus (esp for ILD)

IVIG

Rituximab

47
Q

Inclusion Body Myositis

A

Low response rate to immunosupp

PT

48
Q

Rhabdomyolysis

A

aggressive IV hydration

49
Q

Polymyalgia Rheumatica

A

Rapid response to corticosteroids

24 hr imrpovement w/ 10-20 mg po prednisone

Slow taper→ prevent relapse

Steroid-dependent (if relapse when tapering) → methotrexate to facilitate steroid taper

50
Q

Giant Cell Arteritis

Temporal Arteritis

A

Induction
Prednisone 60 mg po qd

If visual loss → Solumedrol 1 g IV qd x 3 d

Maintenance
wean prednisone slowly (1 mg/kg/day for 2-4 wks)

15-17 mo tx duration

If flare → add DMARD (methotrexate or tocilizumab)

51
Q

Fibromyalgia

A

Pt edu

Analgeisa

Correct sleep disturb

Aerobic exercise*- walking, pool

PT

CBT

Tx of associated d/o

Pharm- SNRI (Duloxetine or Minacipran), ACAs, anticonvulsants (Pregablin), muscle relaxant, ace, NSAIDs

Avoid opiods or narcotics

Most pts will still experience sx despite tx

52
Q

Cervical Radiculopathy

A

Conservative mgmt

NSAIDs and tylenol

Muscle relaxers

PT once pain controlled

Many pts get better w/o tx

Refer for surgery → for weakness and persistent sx

53
Q

Cervical Myelopathy

A

Conservative management (not ideal)

Surgical Decompression (anterior or posterior)→ goal is to stop from getting worse (won’t cure sx just prevent progression)

54
Q

Radiculopathy
or
Sciatica

A

Conservative mgmt

Selective nerve inj

Surgery

Narcotics DON’T do much for neuropathic pain

55
Q

Acute back pain mgmt

A

Conservative Management
Activity modification

Bed rest 2-3 days MAX

Low stress aerobic exercise to minimize debility caused by inactivity

Core strengthening, PT

Analgesics

NSAIDs and Acetaminophen

Opiates may be required in the acute phase (not for > 2 weeks)

Muscle relaxers, probably more effective than placebo but have not been shown to be more effective than NSAIDs

56
Q

Lumbar Spinal Stenosis

A

Conservative mgmt

Epidural steroid inj

Usually eventually need surgical decompression → elective and usually have sx >1 yr before doing this

57
Q

Spondylolisthesis

A

surgery→ fusion

58
Q

CaudaEquinaSyndrome

A

Surgical emergency!

Immediate surgical decompression w/ lumbar laminectomy

59
Q

SLE

A

Sunscreen, NSAIDS

Glucocorticoids (low dose if not organ threatening)

If organ/life threatening →
High dose glucocorticoids

Immunosuppression

Plaquenil

60
Q

Scleroderma

A

Treat contractures w/ PT

Sx benefit from plaquenil

ACE-I for renal crisis

PPI for esophageal dysfn

Cyclophosphamide for ILD

Sildenafil for pulm HTN

61
Q

Thromboangiitis Obliterans

A

Vascular surgery

STOP smoking

Clin Med II (19 decks)

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