Musculoskeletal Flashcards
cause of osteoporosis
loss of bone matrix and mineral
risk factors for osteoporosis
- white or asian women
- small thin build
- smoking hx
- excessive ETOH
- sedentary lifestyle
- low calcium intake
primary osteoporosis
- post-menopausal (due to loss of estrogen)
- senile (calcium deficiency and decreased vit D intake)
secondary osteoporosis
- steroid use
- hyper or hypothyroidism
- hyperparathyroidism
- DM
- Cushing’s ds
age to get DEXA scan in women? men?
65 for women, 70 for men
nl for DEXA scan
t score within 1 SD of young adult reference
osteopenia
1 - 2.4 SD
osteoporosis
2.5 or more SD
when to do DEXA scan again
1 - 1.5 = q 5 yrs
- 5 - 2 = q 2 yrs
- 5 or greater = yearly
common fx with h/o osteoporosis
vertebral bodies
-also hip, pelvis, distal radius
non-med tx of osteoporosis
lifestyle modifications like:
- wt bearing exercise
- take calcium and vit D
- use walker/cane
- stop smoking, ETOH
- balanced diet
tx of osteoporosis
BISPHOSPHANATES (fosamax, boniva)
-can also use Raloxifene, HRT, Teriparatide (forteo, parathar), Miacalcin nasal spray
how do pt’s need to take bisphosphanates
take in AM on empty stomach and remain upright for 30 mins
increased pressure within a limited space that comprises circulation and function
compartment syndrome
cause of compartment syndrome
bleeding or edema into a closed compartment usually caused by trauma or crush injury
most common injury to cause compartment syndrome
tibial shaft fx
severe pain out of proportion to injury, paresthesia, paresis and pallor, pain with passive stretch, decreased sensation/strength/pulses
compartment sydrome
tx of compartment syndrome
urgent fasciotomy
ideopathic non-inflam arthritis
osteoarthritis
symptoms of OA
- morning joint stiffness relieved with activity
- pain with wt bearing, relief with rest
- crepitus
- joint swelling
- decreased ROM
Heberden’s nodes
on DIP joints
Bouchard’s nodes
on PIP joints
xray findings of OA
joint space narrowing. osteophytes, sclerosis of bone and bone cyst formation
tx of OA
first line = acetominophen
then NSAIDS, topical diclofenac, steroid injections, capsaicin, viscosupplementation
-surgery when QOL diminished
most common cause of acute osteomyelitis
s. aureus
common areas for acute osteomyelitis
kids - long bones
adults > 50 - spinne (DM pts)
dx of acute osteomyelitis
- increased WBC, ESR, CRP
- blood cx
- bone bx to confirm
- bone scan and MRI may help early
tx of acute osteomyletis
IV antibiotics for 4-6 weeks then oral for 6-8 weeks
- oxacillin/cefazolin/vanco if MRSA
- surgical debridement if no improvement of if spine involved
chronic osteomyelitis tx
- long term IV antibiotics (bacteria specific)
- surgical I & D
- possible amputation
cause of inflamed joint in pt younger than 30
septic arthritis - n. gonorrhea
in septic arthritis what is seen in joint fluid
WBC > 50K
polys > 80%
decreased glucose
tx of septic arthritis
rest, ice, elevation - admit to hospital
arthroscopic I & D
IV antibiotics 4-6 weeks (ceftriaxone if gonorrhea)
if no better in 2 days open I&D
most common benign tumor of wrist
ganglion cyst
tx of ganglion cyst
wrist splinting, aspiration with steroid inject, surgical excision
asymptomatic lesion, xray shows well defined lesion with sclerotic margins
benign bone tumor
pain and palp mass, xray shows permeatic lesion with lytic destruction and poorly defined margins
malignant bone tumor
cavity in bone filled with something other than bone
bone cyst
symptoms of bone cysts
usually asymptomatic until pathologic fx
tx of bone cyst
aspirate/inject with steroids or bone marrow
curettage and bone grafting
most common benign bone tumor
osteoid osteoma
where are osteoid osteomas found?
spine or long bones
symptoms of osteoid osteoma
night pain relieved by NSAIDS - usually young adults
tx of osteoid osteoma
symptomatic - will burn itself out over time
can remove surgically
most common primary malignant tumor of bone (other than multiple myeloma)
osterosarcoma
location of osteosarcoma
around the knee - distal femur or proximal tibia
what part of bone for osteosarcoma and what pt population?
metaphyseal - young men 15-25
what medical condition puts pt at higher risk for osterosarcoma
retinoblastoma
symptoms of osteosarcoma
persistent night pain and swelling
palpable mass
xray findings of osteosarcoma
destructive lesion with periosteal elevation and SUN RAY/SUNBURST appearance
tx of osteosarcoma
chemo and surgical resection
location of Ewings sarcoma
pelvis,distal femur and proximal tibia
what part of bone for Ewings sarcoma and what population
diaphysis (shaft) of bone - men 10-20
symptoms and labs for Ewings sarcoma
pain, mass, fever
increased ESR and WBC
increased LDH
what is seen on xray for Ewings
lytic lesion ONION SKIN APPEARANCE
tx of Ewings
surgical resection, chemo and radiation
fibromyalgia is associated with what other conditions?
hypothyroidism, RA, or sleep apnea in men
musculoskeletal pain around neck, shoulders, low back and hips with fatigue, numbness and h/as
positive trigger points
fibromyalgia
tx of fibromyalgia
PT eval
moderate exercise
meds: TCAs, SSRIs like Cymbalta, SSNRIs, Lyrica/neurontin, ultram/APAP, trigger point injections
fever, sudden onset of monoarticular joint swelling with exquisite pain and tense warm dusky red skin with uric acid > 7.5
Gout
fluid finding in Gout
+ sodium urate crystals that are negatively birefringent and needle like
tx of acute Gout
NSAIDS or intraarticular/IV/PO steroids
tx of chronic Gout
colchicine
tx of Gout if undersecretion?
tx if overprodutction?
under = probenicid or uricosuric agent over = allopurinol/febuxostat
fluid findings in Pseudogout
normal uric acid levels and rhomboid shaped crystals that are positively pirefringent
tx of Pseudogout
NSAIDS and intraarticular steroids if acute
colchciine for prophylaxis
fever, rash, lymphadenopathy, carditis, splenomegaly, arthritis in a pediatric pt
Still’s ds (systemic Juvenile PA)
types of JRA
systemic, polyarticular, oligo/pauciarticular
JRA with low grade fever and synovitis/arthritis in 5 or more joints
polyarticular JRA
JRA with synovitis in 1-4 joints with NO systemic symptoms
oligo/pauciarticular JRA
with oligo/pauciarticular JRA higher risk for what other conditions?
iridocyclitis/anterior uveitis
pediatric pt with intermittent fevers and stiffness and rash
JRA
what test has a high specificity for JRA?
anti-CCP
classification criteria of JRA
- age 6 weeks
- other causes excluded
tx of JRA
NSAIDS then methotrexate, night time splinting, exam with slit lamp q 2-4 yrs
JRA and RF
if + RF then more severe the ds and more likely to have it continue into adulthood
necrotizing arteritis of medium sized vessels
Polyarteritis Nodosa
polyarteritis nodosa can be caused by what virus?
Hep B
fever, malaise, wt loss, extremity pain, foot drop (mononeuritis multiplex), livedo reticularis,SQ nodules,
skin ulcers, digital gangrene, abdominal pain, N/V
polyarteritis nodosa
dx polyarteritis nodosa
tissue bx or angiogram
what has to be ruled out it pt has polyarteritis nodosa
Hep B
tx of polyateritis nodosa
high dose steroids
if Hep B + : prednisone, lamivudine, plasmaphoresis
progressive neck and proximal muscle weakness of UE and LE and reddish purple maculopapular rash or shoulders (like shawl) or heliotrope
polymyositis
dx of polymyositis
muscle bx
increased CPK and aldolase
may have + ANA and anti-Jo 1 antibodies
tx of polymyositis
steroids - oral and topical
methotrexate, azathioprine, IVIG
LOOK FOR MALIGNANCY
reactive arthritis was known as
Reiter’s syndrome
conjunctivitis, urethritis, septic arthritis and oral lesions,
may have enteritis or STD
Reactive Arthritis
symptoms of Reactive Arthritis
fever, arthritis (knee/ankle), urethral discharge, conjunctivitis, mucocutaneous lesions
seropositive test for Reactive Arthritis and tx
HLA-B27
NSAIDS and PT
less likely to develop if original infx tx’ed with antibiotics
