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PANRE 2016 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

cause of osteoporosis

A

loss of bone matrix and mineral

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2
Q

risk factors for osteoporosis

A
  • white or asian women
  • small thin build
  • smoking hx
  • excessive ETOH
  • sedentary lifestyle
  • low calcium intake
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3
Q

primary osteoporosis

A
  • post-menopausal (due to loss of estrogen)

- senile (calcium deficiency and decreased vit D intake)

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4
Q

secondary osteoporosis

A
  • steroid use
  • hyper or hypothyroidism
  • hyperparathyroidism
  • DM
  • Cushing’s ds
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5
Q

age to get DEXA scan in women? men?

A

65 for women, 70 for men

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6
Q

nl for DEXA scan

A

t score within 1 SD of young adult reference

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7
Q

osteopenia

A

1 - 2.4 SD

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8
Q

osteoporosis

A

2.5 or more SD

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9
Q

when to do DEXA scan again

A

1 - 1.5 = q 5 yrs

  1. 5 - 2 = q 2 yrs
  2. 5 or greater = yearly
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10
Q

common fx with h/o osteoporosis

A

vertebral bodies

-also hip, pelvis, distal radius

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11
Q

non-med tx of osteoporosis

A

lifestyle modifications like:

  • wt bearing exercise
  • take calcium and vit D
  • use walker/cane
  • stop smoking, ETOH
  • balanced diet
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12
Q

tx of osteoporosis

A

BISPHOSPHANATES (fosamax, boniva)

-can also use Raloxifene, HRT, Teriparatide (forteo, parathar), Miacalcin nasal spray

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13
Q

how do pt’s need to take bisphosphanates

A

take in AM on empty stomach and remain upright for 30 mins

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14
Q

increased pressure within a limited space that comprises circulation and function

A

compartment syndrome

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15
Q

cause of compartment syndrome

A

bleeding or edema into a closed compartment usually caused by trauma or crush injury

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16
Q

most common injury to cause compartment syndrome

A

tibial shaft fx

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17
Q

severe pain out of proportion to injury, paresthesia, paresis and pallor, pain with passive stretch, decreased sensation/strength/pulses

A

compartment sydrome

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18
Q

tx of compartment syndrome

A

urgent fasciotomy

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19
Q

ideopathic non-inflam arthritis

A

osteoarthritis

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20
Q

symptoms of OA

A
  • morning joint stiffness relieved with activity
  • pain with wt bearing, relief with rest
  • crepitus
  • joint swelling
  • decreased ROM
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21
Q

Heberden’s nodes

A

on DIP joints

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22
Q

Bouchard’s nodes

A

on PIP joints

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23
Q

xray findings of OA

A

joint space narrowing. osteophytes, sclerosis of bone and bone cyst formation

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24
Q

tx of OA

A

first line = acetominophen
then NSAIDS, topical diclofenac, steroid injections, capsaicin, viscosupplementation
-surgery when QOL diminished

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25
Q

most common cause of acute osteomyelitis

A

s. aureus

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26
Q

common areas for acute osteomyelitis

A

kids - long bones

adults > 50 - spinne (DM pts)

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27
Q

dx of acute osteomyelitis

A
  • increased WBC, ESR, CRP
    • blood cx
  • bone bx to confirm
  • bone scan and MRI may help early
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28
Q

tx of acute osteomyletis

A

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
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29
Q

chronic osteomyelitis tx

A
  • long term IV antibiotics (bacteria specific)
  • surgical I & D
  • possible amputation
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30
Q

cause of inflamed joint in pt younger than 30

A

septic arthritis - n. gonorrhea

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31
Q

in septic arthritis what is seen in joint fluid

A

WBC > 50K
polys > 80%
decreased glucose

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32
Q

tx of septic arthritis

A

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

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33
Q

most common benign tumor of wrist

A

ganglion cyst

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34
Q

tx of ganglion cyst

A

wrist splinting, aspiration with steroid inject, surgical excision

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35
Q

asymptomatic lesion, xray shows well defined lesion with sclerotic margins

A

benign bone tumor

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36
Q

pain and palp mass, xray shows permeatic lesion with lytic destruction and poorly defined margins

A

malignant bone tumor

37
Q

cavity in bone filled with something other than bone

A

bone cyst

38
Q

symptoms of bone cysts

A

usually asymptomatic until pathologic fx

39
Q

tx of bone cyst

A

aspirate/inject with steroids or bone marrow

curettage and bone grafting

40
Q

most common benign bone tumor

A

osteoid osteoma

41
Q

where are osteoid osteomas found?

A

spine or long bones

42
Q

symptoms of osteoid osteoma

A

night pain relieved by NSAIDS - usually young adults

43
Q

tx of osteoid osteoma

A

symptomatic - will burn itself out over time

can remove surgically

44
Q

most common primary malignant tumor of bone (other than multiple myeloma)

A

osterosarcoma

45
Q

location of osteosarcoma

A

around the knee - distal femur or proximal tibia

46
Q

what part of bone for osteosarcoma and what pt population?

A

metaphyseal - young men 15-25

47
Q

what medical condition puts pt at higher risk for osterosarcoma

A

retinoblastoma

48
Q

symptoms of osteosarcoma

A

persistent night pain and swelling

palpable mass

49
Q

xray findings of osteosarcoma

A

destructive lesion with periosteal elevation and SUN RAY/SUNBURST appearance

50
Q

tx of osteosarcoma

A

chemo and surgical resection

51
Q

location of Ewings sarcoma

A

pelvis,distal femur and proximal tibia

52
Q

what part of bone for Ewings sarcoma and what population

A

diaphysis (shaft) of bone - men 10-20

53
Q

symptoms and labs for Ewings sarcoma

A

pain, mass, fever
increased ESR and WBC
increased LDH

54
Q

what is seen on xray for Ewings

A

lytic lesion ONION SKIN APPEARANCE

55
Q

tx of Ewings

A

surgical resection, chemo and radiation

56
Q

fibromyalgia is associated with what other conditions?

A

hypothyroidism, RA, or sleep apnea in men

57
Q

musculoskeletal pain around neck, shoulders, low back and hips with fatigue, numbness and h/as
positive trigger points

A

fibromyalgia

58
Q

tx of fibromyalgia

A

PT eval
moderate exercise
meds: TCAs, SSRIs like Cymbalta, SSNRIs, Lyrica/neurontin, ultram/APAP, trigger point injections

59
Q

fever, sudden onset of monoarticular joint swelling with exquisite pain and tense warm dusky red skin with uric acid > 7.5

A

Gout

60
Q

fluid finding in Gout

A

+ sodium urate crystals that are negatively birefringent and needle like

61
Q

tx of acute Gout

A

NSAIDS or intraarticular/IV/PO steroids

62
Q

tx of chronic Gout

A

colchicine

63
Q

tx of Gout if undersecretion?

tx if overprodutction?

A 
under = probenicid or uricosuric agent
over = allopurinol/febuxostat
64
Q

fluid findings in Pseudogout

A

normal uric acid levels and rhomboid shaped crystals that are positively pirefringent

65
Q

tx of Pseudogout

A

NSAIDS and intraarticular steroids if acute

colchciine for prophylaxis

66
Q

fever, rash, lymphadenopathy, carditis, splenomegaly, arthritis in a pediatric pt

A

Still’s ds (systemic Juvenile PA)

67
Q

types of JRA

A

systemic, polyarticular, oligo/pauciarticular

68
Q

JRA with low grade fever and synovitis/arthritis in 5 or more joints

A

polyarticular JRA

69
Q

JRA with synovitis in 1-4 joints with NO systemic symptoms

A

oligo/pauciarticular JRA

70
Q

with oligo/pauciarticular JRA higher risk for what other conditions?

A

iridocyclitis/anterior uveitis

71
Q

pediatric pt with intermittent fevers and stiffness and rash

A

JRA

72
Q

what test has a high specificity for JRA?

A

anti-CCP

73
Q

classification criteria of JRA

A
  • age 6 weeks

- other causes excluded

74
Q

tx of JRA

A

NSAIDS then methotrexate, night time splinting, exam with slit lamp q 2-4 yrs

75
Q

JRA and RF

A

if + RF then more severe the ds and more likely to have it continue into adulthood

76
Q

necrotizing arteritis of medium sized vessels

A

Polyarteritis Nodosa

77
Q

polyarteritis nodosa can be caused by what virus?

A

Hep B

78
Q

fever, malaise, wt loss, extremity pain, foot drop (mononeuritis multiplex), livedo reticularis,SQ nodules,
skin ulcers, digital gangrene, abdominal pain, N/V

A

polyarteritis nodosa

79
Q

dx polyarteritis nodosa

A

tissue bx or angiogram

80
Q

what has to be ruled out it pt has polyarteritis nodosa

A

Hep B

81
Q

tx of polyateritis nodosa

A

high dose steroids

if Hep B + : prednisone, lamivudine, plasmaphoresis

82
Q

progressive neck and proximal muscle weakness of UE and LE and reddish purple maculopapular rash or shoulders (like shawl) or heliotrope

A

polymyositis

83
Q

dx of polymyositis

A

muscle bx
increased CPK and aldolase
may have + ANA and anti-Jo 1 antibodies

84
Q

tx of polymyositis

A

steroids - oral and topical
methotrexate, azathioprine, IVIG
LOOK FOR MALIGNANCY

85
Q

reactive arthritis was known as

A

Reiter’s syndrome

86
Q

conjunctivitis, urethritis, septic arthritis and oral lesions,
may have enteritis or STD

A

Reactive Arthritis

87
Q

symptoms of Reactive Arthritis

A

fever, arthritis (knee/ankle), urethral discharge, conjunctivitis, mucocutaneous lesions

88
Q

seropositive test for Reactive Arthritis and tx

A

HLA-B27
NSAIDS and PT
less likely to develop if original infx tx’ed with antibiotics

PANRE 2016 (2 decks)

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