Musculoskeletal Flashcards
joints in the hand affected in RA
MCP and PIP joints (DIP are spared)
joint pain and stiffness that worsens over the course of the day and are relieved by rest
OA
a genetic disorder that is associated w/ multiple fx and blue sclerae; commonly mistaken for child abuse
osteogenesis imperfecta
hip and back pain along w/ stiffness that improves w/ activity over the day and worsens w/ rest
suspect ankylosing spondylitis - check HLA-B27
arthritis, conjunctivitis, and urethritis in young men. associated organisms?
reactive arthritis - most commonly associated w/ chlamydia (also consider campylobacter, shigella, salmonella, and ureaplasma)
needle-shaped, negatively birefringent crystals. Dx? acute tx? chronic tx?
gout. acute tx = NSAIDs - indomethacin (not ASA); chronic tx = allopurinol or probenecid
rhomboid-shaped, positively birefringement crystals
pseudogout (calcium pyrophosphate)
back pain that is exacerbated by standing and walking and relieved by sitting and hyperflexion of the hips
spinal stenosis
initial tx for OA
acetaminophen
polymyalgia rheumatica vs fibromyalgia
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
onion skinning on x-ray in the diaphyseal regions of the femur
ewing sarcoma
soap bubble apearance on x-ray in the epiphyseal/metaphyseal region of long bones
giant cell tumor of bone
codmans triangle (periosteal new-bone formation at the diaphyseal end of the lesion) or a “sunburst pattern” on x-ray
osteosarcoma
joint that is spared by RA, but is involved in OA
DIP
CREST syndrome stands for?
calcinosis, raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias
criteria for SLE
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
SLE and RA both affect the MCP and PIP joints. what is the difference
SLE is non-deforming
overuse apophysitis of the tibial tubercle causing localized pain, esp w/ quad contraction in active young boys. dx? tx?
osgood-schlater dz. tx w/ decreased activity for 2-3 months or until asymptomatic (+/- neoprene brace)
red flags for LBP?
age > 50, > 6 wks of pain, previous cancer hx, severe pain, constitutional symptoms, neuro def, and loss of anal sphincter tone
back pain + bowel or bladder dysfunction (urinary overflow incontinence) + impotence + saddle area anesthesia. dx? tx?
cauda equina syndrom. tx is emergent surgery
nerve root L4 - associated motor, reflex, and sensory defect
motor = foot dorsiflexion reflex = patellar sensory = medial aspect of the lower leg
nerve root L5 - associated motor, reflex, and sensory defect
motor = big toe dorsiflexion and foot eversion reflex = none sensory = dorsum of the foot and lateral aspect of the lower leg
nerve root S1 - associated motor, reflex, and sensory defect
motor = plantar flexion and hip extension reflex = achilles sensory = plantar and lateral aspects of the foot
pt w/ sudden onset of severe back pain. + straight leg raise. pain w/ sitting and lumbar flexion. dx? tx?
herniated disk. tx w/ NSAIDs and regular activities (no bed rest)
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?
spinal stenosis. tx dependent upon stage. mild-mod - NSAIDs and PT; mod-severe - steroid injection; refractory - surgery
