Musculoskeletal

Question 1

joints in the hand affected in RA

Answer 1

MCP and PIP joints (DIP are spared)

Question 2

joint pain and stiffness that worsens over the course of the day and are relieved by rest

Answer 2

OA

Question 3

a genetic disorder that is associated w/ multiple fx and blue sclerae; commonly mistaken for child abuse

Answer 3

osteogenesis imperfecta

Question 4

hip and back pain along w/ stiffness that improves w/ activity over the day and worsens w/ rest

Answer 4

suspect ankylosing spondylitis - check HLA-B27

Question 5

arthritis, conjunctivitis, and urethritis in young men. associated organisms?

Answer 5

reactive arthritis - most commonly associated w/ chlamydia (also consider campylobacter, shigella, salmonella, and ureaplasma)

Question 6

needle-shaped, negatively birefringent crystals. Dx? acute tx? chronic tx?

Answer 6

gout. acute tx = NSAIDs - indomethacin (not ASA); chronic tx = allopurinol or probenecid

Question 7

rhomboid-shaped, positively birefringement crystals

Answer 7

pseudogout (calcium pyrophosphate)

Question 8

back pain that is exacerbated by standing and walking and relieved by sitting and hyperflexion of the hips

Answer 8

spinal stenosis

Question 9

initial tx for OA

Answer 9

acetaminophen

Question 10

polymyalgia rheumatica vs fibromyalgia

Answer 10

polymyalgia rheumatica:

• s/s = older women (> 50) that presents w/ pain/tenderness is usually localized to the proximal muscles (usually shoulder and pelvic girdle); pain and stiffness in muscles upon awakening (muscle version of rheumatoid arthritis); associated w/ temporal arteritis
• labs = elevated ESR and poss. other labs (ie. CRP, CPK)
• tx = low-dose prednisone

fibromyalgia:

• s/s = middle aged women (30-50 yo) presents w/ pain/tenderness in several different points throughout the body (point tenderness)
• labs = no change
• tx = antidepressants, NSAIDs, rest

Question 11

onion skinning on x-ray in the diaphyseal regions of the femur

Answer 11

ewing sarcoma

Question 12

soap bubble apearance on x-ray in the epiphyseal/metaphyseal region of long bones

Answer 12

giant cell tumor of bone

Question 13

codmans triangle (periosteal new-bone formation at the diaphyseal end of the lesion) or a “sunburst pattern” on x-ray

Answer 13

osteosarcoma

Question 14

joint that is spared by RA, but is involved in OA

Answer 14

DIP

Question 15

CREST syndrome stands for?

Answer 15

calcinosis, raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias

Question 16

criteria for SLE

Answer 16

DOPAMINE RASH - discoid rash, oral uclers, photosensitivity, arthritis, malar rash, immunologic crisis, neuro symptoms (lupus cerebritis, seizures), elevated ESR, renal disease, ANA +, serositis (pleural or pericardial effusion), hematologic abnormalities

Question 17

SLE and RA both affect the MCP and PIP joints. what is the difference

Answer 17

SLE is non-deforming

Question 18

overuse apophysitis of the tibial tubercle causing localized pain, esp w/ quad contraction in active young boys. dx? tx?

Answer 18

osgood-schlater dz. tx w/ decreased activity for 2-3 months or until asymptomatic (+/- neoprene brace)

Question 19

red flags for LBP?

Answer 19

age > 50, > 6 wks of pain, previous cancer hx, severe pain, constitutional symptoms, neuro def, and loss of anal sphincter tone

Question 20

back pain + bowel or bladder dysfunction (urinary overflow incontinence) + impotence + saddle area anesthesia. dx? tx?

Answer 20

cauda equina syndrom. tx is emergent surgery

Question 21

nerve root L4 - associated motor, reflex, and sensory defect

Answer 21

motor = foot dorsiflexion
reflex = patellar
sensory = medial aspect of the lower leg

Question 22

nerve root L5 - associated motor, reflex, and sensory defect

Answer 22

motor = big toe dorsiflexion and foot eversion
reflex = none
sensory = dorsum of the foot and lateral aspect of the lower leg

Question 23

nerve root S1 - associated motor, reflex, and sensory defect

Answer 23

motor = plantar flexion and hip extension
reflex = achilles
sensory = plantar and lateral aspects of the foot

Question 24

pt w/ sudden onset of severe back pain. + straight leg raise. pain w/ sitting and lumbar flexion. dx? tx?

Answer 24

herniated disk. tx w/ NSAIDs and regular activities (no bed rest)

Question 25

pt w/ pain that radiates to the arms, butt, or legs. pain is worse w/ standing and walking. pain is improved w/ flexion at the hips and bending forward. dx? tx?

Answer 25

spinal stenosis. tx dependent upon stage. mild-mod - NSAIDs and PT; mod-severe - steroid injection; refractory - surgery