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Internal Medicine > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Ankylosing Spondylitis cause

A

seronegative spondyloarthropathy progressing to fusion of vertebrae; 3rd/4th decades of life

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2
Q

Ankylosing Spondylitis s/s

A

back or butt pain/stiffness, hip pain; worse in AM; restricted lumbar motion, shoulders, hips; synovitis of knees, plantar fasciitis, Achilles tendinitis; hip contractures, fixed cervical, thoracic, lumbar hyperkyphosis; uveitis, cardiac abnormalities, interstitial lung disease; difficulty w/ Schober test, cervical rotation, thoracolumbar rotation/flexion

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3
Q

Ankylosing Spondylitis dx

A

ESR/CRP (elevated); Thoracolumbar Xray (“bamboo spine”); HLA-B27 positive; generalized osteopenia

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4
Q

Ankylosing Spondylitis tx

A

physical therapy (posture, extension, breathing, swimming); NSAIDs

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5
Q

Back Strain/Sprain cause

A

mechanical use, muscle spasm

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6
Q

Back Strain/Sprain s/s

A

back pain, radiating down leg; sciatica; worse with standing, increased by walking, relieved by leaning forward

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7
Q

Back Strain/Sprain dx

A

CT/MRI (bony stenosis, nerve root involvement, herniated disk); imaging not necessary

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8
Q

Back Strain/Sprain tx

A

NSAIDs; muscle relaxers (valium, baclofen); physical therapy/postural exercises; surgery as needed

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9
Q

Lumbago (DJD, sciatica) cause

A

age related, degeneration of spine (dysfunction, instability, restabilization)

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10
Q

Lumbago (DJD, sciatica) s/s

A

local tenderness, contracted muscles, hypomobility, painful extension (dysfunction); “giving way”/”catching” of back w/ movement, pain w/ standing after flexion (instability); muscle tenderness, stiffness, reduced movement, scoliosis (restabilization); normal neuro exam; pain radiating down posterior lower extremity

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11
Q

Lumbago (DJD, sciatica) dx

A

MRI/CT Lspine; transforaminal selective nerve root blocks; CBC, ESR/CRP, HLA-B27, uric acid (r/o inflammatory, arthritis, ankylosing spondylitis, gout)

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12
Q

Lumbago (DJD, sciatica) tx

A

exercise/proper movements; muscle relaxants; NSAIDs; corticosteroid injections (epidural); lumbar decompression/discectomy

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13
Q

Cauda Equina Syndrome cause

A

midline disk herniation compressing nerve roots (L4/L5); injury, age

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14
Q

Cauda Equina Syndrome s/s

A

bowel/bladder impairment; leg pain, numbness, saddle anesthesia, paralysis

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15
Q

Cauda Equina Syndrome dx

A

clinical; CT/MRI

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16
Q

Cauda Equina Syndrome tx

A

surgical emergency

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17
Q

Herniated Nucleus Pulposus cause

A

mechanical degeneration, osteoporosis, stress/compression fracture

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18
Q

Herniated Nucleus Pulposus s/s

A

back pain, radiates down legs, difficulty with ROM; weakness, reflex change, dermatomal numbness

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19
Q

Herniated Nucleus Pulposus dx

A

MRI/CT (herniated disk)

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20
Q

Herniated Nucleus Pulposus tx

A

NSAIDs, muscle relaxants; physical therapy/chiropractic therapy; microdiscectomy

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21
Q

Scoliosis cause

A

UMN/LMN disease, myopathies; idiopathic (girls)

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22
Q

Scoliosis s/s

A

lateral curvature of the spine (usually T7/T8, right curve); asymmetry of shoulder and iliac height, scapular prominence, flank crease w/ bending forward; right thoracic and left lumbar prominence

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23
Q

Scoliosis dx

A

single, standing AP x-rays (>5 degrees); Cobb method (>15%)

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24
Q

Scoliosis tx

A

clinical eval q 6-12 months (10-15 degrees); serial AP x-rays q 3-4 months/6-8 months (15-20 degrees); bracing, e-stim, surgery (>20 degrees)

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25
Q

Kyphosis cause

A

increased convex curvature; Scheuermann disease (idiopathic, juvenile); TB; Pott’s disease (progressive kyphosis)

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26
Q

Kyphosis s/s

A

round back appearance (multiple vertebrae), angular curve (one vertebrae); result of faulty posture, resolves w/ spinal flexion; excessive lumbar lordosis

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27
Q

Kyphosis dx

A

standing lateral films

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28
Q

Kyphosis tx

A

exercises (curves 45-60 degrees); Milwaukee brace (curve >60 degrees); surgery (curve unresponsive to treatment)

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29
Q

Spinal Stenosis cause

A

idiopathic/developmental narrowing; narrowing event

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30
Q

Spinal Stenosis s/s

A

neural claudication and exacerbated pain w/ walking; relieved when leaning forward; variable back/leg pain

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31
Q

Spinal Stenosis dx

A

CT/MRI (diagnosis); X-rays (soft-tissue and thecal narrowing)

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32
Q

Spinal Stenosis tx

A

rest, isometric abdominal exercises, flexion exercises, NSAIDs, weight loss; epidural corticosteroid injections; decompression/fusion w/ neural compression

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33
Q

Osteoporosis cause

A

postmenopausal, age, malignancies, corticosteroid use, GI disorders, hormone imbalance, chronic electrolyte imbalance

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34
Q

Osteoporosis s/s

A

trabecular bone, vertebrae, hip, distal radius fracture (postmenopausal); trabecular/cortical bone, hip and pelvis fractures (poor calcium absorption)

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35
Q

Osteoporosis dx

A

DEXA scan (bone density); Ca, Ph, Alk Phos, serum protein electrophoresis

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36
Q

Osteoporosis tx

A

bisphosphonate; hormone replacement therapy/selective estrogen receptor modulators; calcitonin, teriparatide (PTH analogue); exercise, smoking cessation, calcium/Vit D supplements (preventative)

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37
Q

Acute Osteomyelitis cause

A

pyogenic organism (staph aureus); long bones of children; sickle cell risk (salmonella)

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38
Q

Acute Osteomyelitis s/s

A

pain, loss of motion, soft tissue swelling; drainage (rare)

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39
Q

Acute Osteomyelitis dx

A

blood culture/bone biopsy (organism); WBC, ESR/CRP (elevated); late sequestra and involucrum appear in several weeks

40
Q

Acute Osteomyelitis tx

A

IV antibiotics x6-8wks; immobilization and surgical drainage; surgical debridement

41
Q

Chronic Osteomyelitis cause

A

after original acute infection has completed appropriate treatment (abx, surgery), viable colonies of bacteria harbored in necrotic/ischemic tissue cause recurrence

42
Q

Chronic Osteomyelitis s/s

A

recurrent acute flare-ups of tender, warm, swollen areas; malaise, anorexia, fever, weight loss, night sweats; pain/drainage from sinus tract; bone necrosis, soft tissue damage, bone instability

43
Q

Chronic Osteomyelitis dx

A

blood culture/bone biopsy (organism); WBC, ESR/CRP (elevated); late sequestra and involucrum appear in several weeks

44
Q

Chronic Osteomyelitis tx

A

IV antibiotics x4wks-24mos; immobilization and surgical drainage; surgical debridement

45
Q

Osteoarthritis cause

A

older age, obesity, overuse, genetics

46
Q

Osteoarthritis s/s

A

decreased ROM, joint crepitus, pain gradually worsening throughout day; DIP joint (Heberden nodes), PIP (Bouchard nodules), wrist, hip, knee, spine

47
Q

Osteoarthritis dx

A

Xrays (asymmetric narrowing, subchondral sclerosis, bony cysts, marginal osteophytes)

48
Q

Osteoarthritis tx

A

Acetaminophen; NSAIDs, weight reduction, physical therapy, injections; total joint replacement

49
Q

Rheumatoid Arthritis cause

A

autoimmune, sex, obesity, family hx

50
Q

Rheumatoid Arthritis s/s

A

pain in small joints (DIP spared); pain worse in mornings; can cause changes in skin, lungs, kidneys, eyes, liver, blood system, heart

51
Q

Rheumatoid Arthritis dx

A

joint aspiration (yellow-opalescent, 3-5K WBC, 25-50 PMN, negative culture); ESR/CRP elevated; RF and antiCCP antibodies positive; 6/10 on diagnostic scale (joint involvement, serology, duration >6wks, ESR/CRP); X-rays (soft tissue swelling, articular demineralization)

52
Q

Rheumatoid Arthritis tx

A

DMARDs (methotrexate), NSAIDs; corticosteroids; physical therapy; reconstructive surgery

53
Q

Septic Arthritis cause

A

hematogenous spread of bacteremia, periarticular osteomyelitis, infection from diagnostic procedure or other localized infection; staph aureus, gonorrhea

54
Q

Septic Arthritis s/s

A

acute swelling, fever, joint warmth/effusion, tenderness to palpation, increase pain w/ minimal ROM; affects knee, hip, shoulder, ankle, wrist

55
Q

Septic Arthritis dx

A

joint aspiration w/ synovial fluid evaluation (yellow-green, >50K WBC, 75 PMN, positive culture)

56
Q

Septic Arthritis tx

A

IV antibiotics x2wks (ceftriaxone) followed by PO antibiotics x4wks; arthrotomy and arthrocentesis

57
Q

Reactive Arthritis (Reiter syndrome) cause

A

STDs (chlamydia) or GI (shigella, salmonella, yersinia, campylobacter)

58
Q

Reactive Arthritis (Reiter syndrome) s/s

A

asymmetric arthritis of large joints (knee, ankle); mucocutaneous lesions (balanitis, stomatitis); urethritis; conjunctivitis; (cant see, pee, or climb a tree)

59
Q

Reactive Arthritis (Reiter syndrome) dx

A

HLA-B27 positive; synovial fluid (negative culture)

60
Q

Reactive Arthritis (Reiter syndrome) tx

A

NSAIDs, physical therapy; antibiotics at time of infection (preventative)

61
Q

Gout cause

A

altered purine metabolism, sodium urate crystal precipitation

62
Q

Gout s/s

A

MTP initial attack (podagra) but can affect feet, ankles, knee; pain, swelling, redness, exquisite tenderness of joint

63
Q

Gout dx

A

joint fluid analysis (rod shaped, negatively birefringent urate crystals); serum uric acid >8; Radiographs (small, punched out lesions, interosseous tophi (chalky deposits of urate crystals adjacent to joint))

64
Q

Gout tx

A

NSAIDs (indomethacin), Colchicine, oral prednisone; colchicine, probenecid, allopurinol (prevention)

65
Q

Pseudogout (Calcium pyrophosphate dihydrate disease) cause

A

intraarticular deposition of calcium pyrophosphate

66
Q

Pseudogout (Calcium pyrophosphate dihydrate disease) s/s

A

painful inflammation of knee, wrist, and elbow (mimics gout)

67
Q

Pseudogout (Calcium pyrophosphate dihydrate disease) dx

A

joint fluid analysis (rhomboid-shaped calcium pyrophosphate crystals, positively birefringent); radiographs (fine, linear calcifications in cartilage)

68
Q

Pseudogout (Calcium pyrophosphate dihydrate disease) tx

A

NSAIDs, colchicine, intraarticular steroid injections

69
Q

Systemic Lupus Erythematosus cause

A

autoimmune, genetic

70
Q

Systemic Lupus Erythematosus s/s

A

malar rash, discoid rash, oral ulcers, photosensitivity, arthritis, serositis, renal disease, hematologic disorders (hemolytic anemia, leukopenia, thrombocytopenia), immunologic disorders, neurologic disorders

71
Q

Systemic Lupus Erythematosus dx

A

ANA positive; 4/11 criteria (above sx); CBC, BUN/Cr, UA, ESR, C3/C4; smith antigen antibodies, double stranded DNA, or depressed serum complement (progression of disease)

72
Q

Systemic Lupus Erythematosus tx

A

exercise, sun protection; NSAIDs; antimalarials (hydroxychloroquine, quinacrine); corticosteroids (topical, intralesional); methotrexate (arthritis)

73
Q

Polymyositis cause

A

unknown; occult malignancy

74
Q

Polymyositis s/s

A

insidious onset; painless, proximal muscle weakness (proximal limbs, neck, pharynx); dysphagia; skin rash (malar, heliotrope); polyarthralgias; muscle atrophy; dermatomyositis

75
Q

Polymyositis dx

A

CPK, aldolase (elevated); muscle biopsy (myopathic inflammatory changes)

76
Q

Polymyositis tx

A

high-dose steroids, methotrexate, or azathioprine (until resolved)

77
Q

Polymyalgia Rheumatica cause

A

unknown; associated with giant cell arteritis

78
Q

Polymyalgia Rheumatica s/s

A

stiffness and pain (neck, shoulder, pelvic girdles); bilateral, proximal, symmetrical; fever, fatigue, weight loss, depression; r/o giant cell arteritis (jaw claudication, scalp tenderness, headache, temporal tenderness, vision loss)

79
Q

Polymyalgia Rheumatica dx

A

ESR elevated (>50); biopsy (giant cell arteritis)

80
Q

Polymyalgia Rheumatica tx

A

low-dose corticosteroid (high-dose for giant cell arteritis)

81
Q

Polyarteritis Nordosa cause

A

unknown; associated w/ hepatitis B

82
Q

Polyarteritis Nordosa s/s

A

small/medium artery inflammation (skin, kidney, peripheral nerves, muscle, gut); fever, anorexia, weight loss, abdominal pain, peripheral neuropathy, arthralgias, arthritis; skin lesions (palpable purpura, livedo reticularis); hypertension, edema, oliguria, uremia

83
Q

Polyarteritis Nordosa dx

A

vessel biopsy or angiography; ESR/CRP (elevated); proteinuria; HBsAg positive; ANCA positive (antineutrophil cytoplasmic antibody -> Wegener’s granuloma, hemoptysis)

84
Q

Scleroderma cause

A

unknown; collagen buildup

85
Q

Scleroderma s/s

A

swelling/tightness of skin, heart lungs, GI tract, kidneys (diffuse); swelling/tightness of skin of face, neck, distal elbows, knees, pulmonary HTN (limited); swelling in fingers and hands worsens to trunk and face; vasospasm of digital arteries; CREST syndrome (calcinosis cutis, Raynaud phenomenon/blue fingers, esophageal dysfunction, sclerodactyly, telangiectasias)

86
Q

Scleroderma dx

A

ANA positive; anticentromere antibody positive; antiSCL70 positive

87
Q

Scleroderma tx

A

no cure; PPI (GERD), ACE (renal disease), CCB (Raynaud), immunosuppressive (pulmonary hypertension)

88
Q

Sjögren’s Syndrome cause

A

autoimmune; connective tissue disorder (RA, SLE, polymyositis, scleroderma)

89
Q

Sjögren’s Syndrome s/s

A

mucous membranes affected; dry mouth (xerostomia), dry eyes (xerophthalmia); parotid gland enlargement

90
Q

Sjögren’s Syndrome dx

A

RF present; ANA, anti-Ro antibodies, anti-La antibodies may be present; Schirmer test (evaluates tear secretions; wetting <5mm filter paper); biopsy of lower lip mucosa (lymphocytic infiltrate, gland fibrosis)

91
Q

Sjögren’s Syndrome tx

A

artificial tears and saliva, increase PO fluids, ocular and vaginal lubricants; pilocarpine (increased salivation); cyclosporine (ocular symptoms)

92
Q

Fibromyalgia cause

A

idiopathic; occur w/ RA, SLE, Sjogren

93
Q

Fibromyalgia s/s

A

nonarticular musculoskeletal aches, pains, fatigue, sleep disturbance, multiple tender “trigger” points; bilateral, axial pain above and below the waist, present >3 months; mood changes, cognitive disturbances, anxiety, depression, HA, IBS, dysmenorrhea, paresthesias

94
Q

Fibromyalgia dx

A

typical pattern (11/18 trigger points); r/o hypothyroidism, hep C, vit D deficiency

95
Q

Fibromyalgia tx

A

Pregabalin; SSRIs (fluoxetine), SNRIs (venlafaxine, duloxetine), TCAs (amitriptyline); exercise, education, stress reduction

Internal Medicine (9 decks)

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