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Family Medicine > Musculoskeletal + Integumentary > Flashcards

Musculoskeletal + Integumentary Flashcards

1
Q

Valgus stress test

A

Tests MCL

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2
Q

Varus stress test

A

Tests LCL

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3
Q

McMurry’s

A

Medial and Lateral Meniscus tests

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4
Q

Steinman’s

A

Medial and Lateral Meniscus tests

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5
Q

Lachman’s tests

A

ACL

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6
Q

Apley’s grind

A

Medial and Lateral Meniscus tests

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7
Q

Patella apprehension

A

Test patella dislocation

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8
Q

Patellar ballotment

A

Test for joint effusion

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9
Q

Patella grind

A

Patellar chondral surface test

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10
Q

Lateral injury to knee - what test is highest yield?

A

Valgus stress test

Lachman’s
Drawer tests

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11
Q

Back pain causes

A 
Infection
Neoplasm
MS stain
Osteoarthritis
Vertebral compression fx
Spondylothesis
- forward slip fo cephalad vertebra on caudal
- usually L4-L5, L5-S1

Lumbar disk herniation

  • radicular leg pain/sciatica
  • Tx w/ NSAIDs, steroids

Spinal stenosis

  • narrow of spinal canal
  • can get neurogenic claudication
  • Tx: steroid injection
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12
Q

Drugs accelerating bone loss

A 
Phenytoin
glucocorticoids, 
cyclosporine, 
phenobarbital, 
heparin
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13
Q

Hormone replacement therapy reduces risk of…

A

Osteoporosis

CRC after 5 yrs

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14
Q

Developmental dysplasia of hip

  • charac
  • tx
A

Developmental dysplasia of the hip encompasses both subluxation and dislocation of the newborn hip, as well as anatomic abnormalities.

It is more common in firstborns, females, breech presentations, oligohydramnios, and patients with a family history of developmental dysplasia.

1st step:
- refer to ortho

Tx: Closed reduction and immobilization in a Pavlik harness, with ultrasonography of the hip to ensure proper positioning, is the treatment of choice until 6 months of age

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15
Q

Myopathy

  • w/ elevated CPK
  • no elevated CPK
A

Elevated CPK

  • Polymyositis
  • Dermatomyositis
  • Drug-induced myopathy
  • Hypothyroid endocrinopathy

No elevated CPK

  • polymyalgia rheumatica
  • hyperthyroidism
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16
Q

Risk factors for osteoarthritis of the hip include

A

obesity, high bone mass, old age, participation in weight-bearing sports, and hypothyroidism

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17
Q

patients who are beginning long-term treatment with prednisone (≥3 months at a dosage ≥5 mg/day), or an equivalent, receive what supplements

A

Bisphosphanates
Calcium
Vit D

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18
Q

in cases where a joint effusion is accompanied by fever, what should be performed to help guide therapy

A

diagnostic arthrocentesis

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19
Q

Sx: minimally tender lesions with central ulceration and crust formation

Refractory to abx tx

Recently overseas in Iraq

What is it?

A

cutaneous leishmaniasis

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20
Q

Melasma or chloasma

A

is common in pregnancy

an acquired hypermelanosis of the face, with symmetric distribution usually on the cheeks, nose, eyebrows, chin, and/or upper lip.

UV sunscreen is important, as sun exposure worsens the condition.

Tx:
often resolves or improves post partum.

Persistent melasma can be treated with hydroquinone cream, retinoic acid, and/or chemical peels performed post partum by a dermatologist.

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21
Q

Cellulitis in patients after breast lumpectomy is thought to be related to

A

lymphedema.

Axillary dissection and radiation predispose to these infections.

Non–group A hemolytic Streptococcus is the most common organism associated with this infection.

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22
Q

Tx actinic keratosis

A

5-fluorouracil

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23
Q

Tx persistent leukoplakia

A

1st observe

Then bx

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24
Q

lesion is dome shaped and has a central plug

grows rapidly, heals spontaneously

What is it?

A

Keratoacanthoma

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25
Q

Lichen simplex chronicus,

A

the end result of habitual scratching or rubbing, usually presents as isolated hyperpigmented, edematous lesions, which become scaly and thickened in the center.

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26
Q

The pain from infiltration of local anesthetics can be decreased by

A

using a warm solution,

using small needles,

performing the infiltration slowly

adding sodium bicarbonate to neutralize the anesthetic since they are shipped at an acidic pH to prolong shelf life.
—An exception to this tip is bupivicaine (Marciane, Sensorcaine) as it will precipitate in the presence of sodium bicarbonate.

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27
Q

lesion is located dorsally between the web of his right third and fourth toes, and extends toward the ankle.

It is erythematous, and has a serpiginous track.

What is it?

A

cutaneous larva migrans, a common condition caused by dog and cat hookworms

Ancylostoma species

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28
Q

Sudden monoarticular non-traumatic joint pain after drinking lots of EtOH and being on thiazides

Afebrile

Edema
Erythema
Warmth

What is next dx step?
Most likely dx?
Next step tx?

A

Next dx step = Joint aspiration

  • -> blood uric acid levels can be nl b/c it all deposited in joints!
  • use uric acid levels to monitor tx effects b/n attacks

Most likely gout

Next step:

  • NSAID
  • Colchicine
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29
Q

Pseudogout

A

Joint pain 2/2 Calcium pyrophosphate dehydrate crystals in joints

Rhomboid, weakly + birefringence

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30
Q

Slipped capital femoral epiphysis

A

Pain with activity is the most common presenting symptom, as opposed to the nighttime pain that is typical of malignancy.

Usually in obese males

Pain mostly in anterior thigh

Limited internal rotation of hip

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31
Q

Meralgia paresthetica

A

is pain in the thigh related to entrapment of the lateral femoral cutaneous nerve, often attributed to excessively tight clothing

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32
Q

Legg-Calvé-Perthes disease

A

(avascular or aseptic necrosis of the femoral head)

is more likely to occur between the ages of 4 and 8 years.

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33
Q

Tx polymyositis/dermatomyositis

A

corticosteroids

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34
Q

What drug for RA can delay progression of disease?

A

Hydroxychloroquine

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35
Q

Joints involved in osteoarthritis vs. RA

A

Osteo -
PIP
DIP

RA -
MCP
PIP

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36
Q

What will reduce both pain and disability in patients with osteoarthritis of the knee

A

A therapeutic exercise program

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37
Q

Gout

A

High uric acid –> gouty attack/arthritis

highly negative birefringent, needle-shaped urate crystals

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38
Q

Tx midshaft tibial stress fractures

A

rest

A pneumatic stirrup leg brace has been found to be helpful during treatment

Wt bearing ok
DO NOT cast
NO US pulse tx

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39
Q

Common cause of heel pain

A

Plantar fascitis

  • burning pain in the heel
  • there is tenderness of the plantar fascia where it inserts onto the medial tubercle of the calcaneus.
  • The patient experiences heel or arch pain,
  • often is worse upon arising and taking the first few steps of the MORNING.

Examination reveals tenderness at the site and pain with dorsiflexion of the toes

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40
Q

Tx septic joint

A

Surgery to drain

IV abx

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41
Q

Tx rheumatoid arthritis

A 
PT
NSAIDs
Steroids
Dmards like sulfasalazine, MTX
Infliximab
Etanercept
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42
Q

Tx osteoarthritis

A 
Mobility exercises
Wt loss
Maintain ROM
Steroid injection q4-6 mo
Surgery if severe
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43
Q

Dx infectious arthritis

A

Joint aspiration

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44
Q

Sprained ankle. Next step?

A

No imaging

PRICE therapy

In acute ankle sprains, functional treatment with a semi-rigid brace that allows flexion and extension, or a soft lace-up brace is recommended over immobilization.

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45
Q

Ankle ligament most commonly injured

A

Anterior talofibular ligament

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46
Q

When do an X-ray for an ankle injury?

A

If there is bony tenderness of medial or lateral malleolus at tip

Or pt can’t bear weight for 4 steps immediately or while being examined

ankle radiograph series is required only if there is pain in the malleolar zone and bone tenderness of either the distal 6 cm of the posterior edge or the tip of either the lateral malleolus or the medial malleolus. Inability to bear weight for four steps, both immediately after the injury and in the emergency department, is also an indication for ankle radiographs.

Foot radiographs are required only if there is pain in the midfoot zone and bone tenderness at the base of the 5th metatarsal or the navicular, or if the patient is unable to bear weight both immediately after the injury and in the emergency department.

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47
Q

Sprain

A

Stretch or tear of ligament

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48
Q

Strain

A

Stretch or tear of muscle or tendon (muscle to bone)

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49
Q

When do a knee X-ray?

A

Any of the 5 criteria

> =55

Isolated patella tenderness

Tenderness of head of fibula

Can’t flex knee to 90 deg

Inability to bear wt for 4 steps

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50
Q

Types of melanoma

A

Superficial spreading
-most common

Lentigo maligna

  • usually in elderly.
  • superficial spreading

Acral lentiginous
- most common in AA and Asians

Nodular
- most aggressive

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51
Q

4 main stabilizers of shoulder

A

Supraspinatus = abduction
Infraspinatus = external rotation
Teres Minor = external rotation
Subscapularis = internal rotation

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52
Q

Knee sx - what do these suggest:

  • locking
  • popping
  • giving way
A

locking = a meniscal tear or loose body trapped

popping = ligamentous injury, probably complete rupture of a ligament (third-degree tear).

giving way = knee instability and may indicate patellar subluxation or ligamentous rupture.

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53
Q

Meniscal vs ligamentous presentation

A

Rupture of ligament = Rapid onset of effusion

Meniscal injury / ligament sprain = slower onset (24 to 36 hours) of a mild to moderate effusion

Meniscal injury = Recurrent knee effusion after activity

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54
Q

Global range of motion deficit in shoulder (both passive and active)….what do you suspect?

A

Adhesive capsulitis

Inflammation and thickening of shoulder capsule

Global ROM deficit - active AND passive (vs only active in impingement)

Insidious onset

Usually in non-dominant arm

Can be predisposed by endocrine dz, clinical depression, recent MI

Dx via hx and physical exam. No imaging.

Tx: PT, NSAIDs. Surgery if no improvement in 4-6 months

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55
Q

Tests for ACL or PCL injury

A

ACL - anterior drawer, lachmanns (best), pivot shift

PCL - posterior drawer

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56
Q

Tests for MCL or LCL injury

A

Valgus (MCL) and varus stress tests

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57
Q

Tests for meniscal injury

A

McMurray’s

Steinmans

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58
Q

Anterior dislocation of shoulder

  • no sign of neurovascular compromise
  • in ED already

What do you do next?

A

Xray for documentation

Reduction only if neurovascular compromise or on the court

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59
Q

Anterior knee pain ddx

A

Patellar subluxation or dislocation
Tibial apophysitis (Osgood-Schlatter lesion)
Patellar tendonitis
Chondromalacia patellae

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60
Q

Medial knee pain ddx

A

MCL sprain
Medial meniscal tear
Pes anserine bursitis
Medial plica syndrome

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61
Q

Lateral knee pain ddx

A

LCL sprain
Lateral meniscal tear
Iliotibial band tendonitis

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62
Q

Posterior knee pain ddx

A

Baker’s cyst

PCL injury

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63
Q

Giving-way episodes of knee
Mild effusion w/ patellar apprehension

What is going on?

A

Patellar subluxation

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64
Q

Anterior knee pain localized to tibial tuberosity

Young kid who recent went through growth spurt

A

Osgood-Schlatter lesion

  • stress on patellar tendon –> microavulsions of growth plate on tibial tubercle where patellar tendon inserts

Pain reproduced by extending knee against resistance

Can see on xray lifting of tubercle from shaft of tibia

Tx w/ activity restrict, stretching, NSAIDs

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65
Q

Overweight pt
Knee pain, no recent injury
hip flexed and externally rotated

Pain in hip w/ passive internal rotation or extension….what do you suspect?

A

Slipped capital femoral epiphysis

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66
Q

Vague, poorly localized knee pain
Morning stiffness
Recurrent effusion

Xray: osteochondral lesion or loose body in knee joint

What do you suspect?

A

Osteochondritis dissecans

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67
Q

Pain at medial aspect of knee
worsened w/ repetitive flexion and extension

TTP on medial aspect
no joint effusion
small swelling at insertion of medial hamstring muscles

A

Pes anserine bursitis

pes anserine bursa is associated with the tendinous insertion of the sartorius, gracilis, and semitendinosus muscles into the medial aspect of the proximal tibia

Valgus stress test fails to reproduce pain
Radiographs normal

Pain can be present overnight

Tender to palpation at area

Tx: RICE, steroid injections

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68
Q

Runner
Lateral knee pain
aggravated by activity, downhill running, climbing stairs
No joint effusion

+Noble’s test (flex and extend knee repeatedly)

A

Iliotibial band tendonitis

Popliteus tendonitis also possible but rarer

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69
Q

When is it best to do surgery on degenerative or torn meniscus?

A

If no arthritic changes present

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70
Q

1 cause of shoulder pain

A

supraspinatus tendinitis = impingement syndrome

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71
Q

Tx lateral epicondylitis

A

Splint forearm

PT

Rarely: injections

Lateral epicondylitis = tennis elbow = degeneration of extensor tendons of forearm

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72
Q

+ Finklestein test: pt clenches thumb under fingers when making fist, ulnar deviation of wrist

pain in radial aspect of wrist

What is it?

A

DeQuervain’s disease

Tx: thumb spica splint + NSAIDs
local cortisone injections OK

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73
Q

Numbness, pain or tingling in 1st 3 fingers
worse at night
can have pain along entire arm

What is likely?

A

Carpal tunnel

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74
Q

Tinel’s sign

A

Tap over medial nerve @ wrist –> paresthesias in median N distribution

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75
Q

Phalen’s test

A

Palmar flexion of wrist for 1 min –> paresthesias in median N distribution

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76
Q

How definitively dx carpal tunnel?

A

EMG and nerve conduction velocity study

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77
Q

radiographic findings in osteoarthritis

A

Joint space narrowing
osteophytes
subchondral sclerosis
subchondral cysts

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78
Q

Type 1 vs 2 osteoporosis

A

1 - loss of trabeuclar bone; vertebral compression and colles fractures more common

2 - equal loss of cortical and trabecular bone. older, both fem and male; fx femoral neck, humerus, pelvis common

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79
Q

Endocrine causes of osteoporosis

A

Hypogonadism in men
hyperthyroidisum
vit D deficiency

80
Q

Hx trauma
Pt tenderness at spine level
Pain worse w/ flexion and while pulling up from supine to sitting position and from sitting to standing position

A

Compression fx

81
Q

Leg pain greater than back pain
Worse w/ sitting
Can radiate to hip/thigh or below knee

A

Herniated nucleus pulposus

82
Q

Diffuse back pain w/ or w/o butt pain
worse w/ mvmt
better with rest

A

lumbar strain/sprain

83
Q

Leg pain more than back pain
pain worse with standing and walking
better with rest or spine flexed

A

Spinal stenosis

84
Q

Back pain in adolescents

Worse with spine extension and acitivty

A

Spondylolysis

85
Q 
Constant back pain
spinous process tenderness
No fever
normal CBC
elevated ESR or CRP
A

Vertebral diskitis/osteo

86
Q

1st line tx for low back pain

A

NSAIDs

87
Q

When does anterior fontanelle close? What if it closes early?

A

13.5 months on average

Serial head measurement circumference

The patient needs to be monitored for craniosynostosis (premature closure of one or more sutures) and for abnormal brain development

When craniosynostosis is suspected, a skull radiograph is useful for initial evaluation. If craniosynostosis is seen on the film, a CT scan should be obtained

88
Q

A positive flexion abduction external rotation (FABER) test that elicits posterior pain indicates involvement of which joint?

A

sacroiliac joint

anterior pain indicates hip involvement

89
Q

The three most common knee conditions in children and adolescents are

A

patellar subluxation, tibial apophysitis, and patellar tendinitis.

90
Q

Seizure d/o and chronic pain…which pain med do you have to be careful not to give?

A

Tramadol - causes seizures!

91
Q

The only approved treatments for male osteoporosis are

A

alendronate and recombinant parathyroid hormone.

92
Q

Meds causing increased falls in elderly

A

SSRIs, tricyclic antidepressants, benzodiazepines, and anticonvulsants have the strongest association with falls in the elderly

Reducing the number of medications a patient takes reduces the risk of falling

93
Q

Polymyalgia rheumatica

A

The clinical hallmarks of polymyalgia rheumatica are pain and stiffness in the shoulder and pelvic girdle.

Fever is common, with temperatures as high as 39°C (102°F) along with night sweats. Additional symptoms include depression, fatigue, malaise, anorexia, and weight loss.

94
Q

Tx polymyalgia rheumatica

A

Corticosteroids

helps a lot!

95
Q

treatment of severe osteoporosis, for patients with multiple osteoporosis risk factors, or for patients with failure of bisphosphonate therapy

A

Teriparatide

96
Q

erythema toxicum neonatorum

A

Lots of macule, papules, and pustules on baby

Normal to have

Eosinophils seen in scrapings of skin

97
Q

1 cause of erythema multiforme

A

HSV

98
Q

pyogenic tenosynovitis.

A

When early tenosynovitis (within 48 hours of onset) is suspected, treatment with antibiotics and splinting may prevent the spread of the infection. However, this patient’s infection is no longer in the early stages and is more severe, so it requires surgical drainage and antibiotics.

99
Q

Which one of the following tinea infections in children always requires systemic antifungal therapy?

A

Tinea capitis

100
Q

Most effective tx for plaque psoriasis

A

topical vitamin D analogues and topical corticosteroids.

101
Q

Intertrigo

A

is inflammation of skinfolds caused by skin-on-skin friction and is common on opposing cutaneous or mucocutaneous surfaces. Secondary cutaneous bacterial and fungal infections are common complications

102
Q

Erythrasma

A

is caused by Corynebacterium minutissimum and presents as small reddish-brown macules that may coalesce into larger patches with sharp borders.

Intertrigo complicated by erythrasma is treated with topical or oral erythromycin.

103
Q

Tx chronic paronychia.

A

This condition is often associated with chronic immersion in water, contact with soaps or detergents, use of certain systemic drugs (antiretrovirals, retinoids) and, as is most likely in a 6-year-old child, finger sucking.

Topical corticosteroids

104
Q

Patellofemoral pain syndrome

A

is a common overuse injury observed in adolescent girls.

The condition is characterized by anterior knee pain associated with activity.

The pain is exacerbated by going up or down stairs or running in hilly terrain. Can also c/o pain w/ sitting due to sustained flexion

It is associated with inadequate hip abductor and core strength;

Patients complain of popping, catching, stiffness, and giving way.
- EXAM: + J sign = patella moving from a medial to a lateral location when the knee is fully extended from the 90° position.

therefore, a prescription for a rehabilitation program is recommended

105
Q

BP med which decreases uric acid levels?

A

Losartan

106
Q

Spinal stenosis vs. herniated disk - how do you tell the difference?

A

Pain from spinal stenosis is relieved by sitting and aggravated by standing, whereas the opposite is true for pain from a herniated disk.

107
Q

Tx MRSA

A

clindamycin and doxycycline

minocycline and trimethoprim/sulfamethoxazole.

108
Q

Best initial therapy for rheumatoid arthritis

A

Methotrexate

109
Q

“sprained wrist” + tenderness in anatomic snuffbox.
What do you suspect?

Tx?

A

Fx of scaphoid

Radiographs can be negative initially

The scaphoid circulation enters the bone for the most part through the DISTAL half.

Fractures through the PROXIMAL 1/3 tend to cause loss of circulation and are slower to heal, and should be referred to an orthopedist because of the risk of nonunion and avascular necrosis.

Fractures through the middle or DISTAL one-third can be handled by the family physician in consultation with an orthopedist. The fracture is treated with a thumb spica cast for 10–12 weeks.

110
Q

Which bisphosphanates are best for preventing hip fx? vertebral fx?

A

Only zoledronic acid, risedronate, and alendronate have been confirmed in sufficiently powered studies to prevent hip fracture

Ibandronate, raloxifene, denosumab, and etidronate have been shown to reduce new vertebral fractures, but are not proven to prevent hip fracture.

111
Q

The antalgic gait occurs when

A

the stance phase of gait is shortened, usually because of pain during weight bearing

112
Q

Why in slipped capital femoral epiphysis hurt with the internal rotation?

A

Internal rotation of the hip increases the intracapsular pressure within the acetabulum.

113
Q

How can you find pathology in the sacroiliac joint?

A

The FABER test (Flexion, Abduction, External Rotation—the ipsilateral ankle placed on the contralateral knee and mild downward pressure placed on the ipsilateral knee) can find pathology located in the sacroiliac joint, often seen in rheuma- tologic disorders.

114
Q

Children with a septic hip joint will often lay with their hip

A

flexed, abducted, and externally rotated,

Any suspected septic joint must be aspirated.

115
Q

Congenital hip dysplasia tx

A

If the problem is found in the first few weeks of life, the child can be treated with splinting of the hip and normal development usually follows.

If diagnosed late, the treatment is often surgical.

116
Q

Transient synovitis is a

A

self-limited inflammatory response that is a common cause of hip pain in children.

It occurs typically in children ages 3 to 10 years, is more common in boys than in girls, and often follows a viral infection.

It is frequently seen as gradually increasing hip pain that results in a limp or refusal to walk.

low-grade or no fever, a normal white blood cell (WBC) count, and a normal ESR.

On examination, there is pain with internal rotation of the hip and the overall range of motion is limited by pain.

X-rays are either normal or show some nonspecific swelling

117
Q

Septic joint vs transient synovitis

A

A septic joint will have a purulent aspirate with a WBC count greater than 50,000/μL, elevated ESR, fever

transient synovitis will have a yellow/clear aspirate with a lower WBC count (<10,000/μL)

118
Q

Legg-Calvé-Perthes (LCP) disease

A

avascular necrosis of the femoral head that typically occurs in children ages 4 to 8 years.

Boys > girls

etiology of the disruption of blood flow is unknown.

gradual onset of hip, thigh, or knee pain, and limping over a few months.

Early in the course, x-rays of the hip may appear normal. Later radiographic findings include collapse, flattening, and widening of the femoral head.
Bone scans or magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis.

TX- conservative, with protection of the joint and efforts to maintain range of motion.

119
Q

Tx slipped capital femoral epiphysis

A

surgical pinning of the femoral head.

These patients must be closely followed, as approximately 33% will develop avascular necrosis and 33% will develop SCFE in the contralateral hip.

120
Q

Tx surgical site infections

A

Incision and drainage is the most important therapy for SSI.

Antibiotics are used solely in cases of significant systemic involvement.

121
Q

What is the correct study in a patient of any age with chronic neck pain and no history of trauma, malignancy, or surgery?

A

a complete cervical spine series that includes five views

If the radiographs are normal and the patient has neurologic signs or symptoms, the next step would be MRI

122
Q

Rosella rash

A

erythematous maculopapular eruption that starts on the trunk and spreads rapidly to the extremities, with sparing of the face

123
Q

The rash of scarlet fever looks like…

A

usually starts about 2 days after the onset of sore throat.

The rash consists of punctate, raised, erythematous eruptions that can become confluent and feel like sandpaper.

The rash tends to start on the upper trunk and spreads to the rest of the trunk and the extremities.

124
Q

Do you do MRI for sciatica?

A

MRI is not recommended for patients with sciatica unless the symptoms last for greater than 1 month or if the patient is not a candidate for surgery or epidural injection.

Conservative treatment involves NSAIDs, possibly short-course steroids, and avoidance of sitting.

125
Q

Spinal stenosis

A

congenital or acquired spinal canal narrowing that puts pressure on the spinal cord.

Sx:

  • lower back & leg pain
  • leg weakness
  • pseudoclaudication that occurs after walking different distances while the vascularity of the legs remains intact.
  • Pain is relieved by bending over or sitting.

Tx:
NSAIDs
physical therapy
epidural corticosteroids

126
Q

Vertebral compression fractures

A

more common in older people and those with osteoporosis or chronic steroid use.

This may happen after low-impact trauma or no trauma history at all.

pain is generally well localized to the spine and may be brought on by certain sudden movements.

Dx: X-ray

Tx:

  • pain control
  • calcitonin or alendronate.
  • conservative decreased mvmt until pain is tolerable
  • 2 weeks of pain - surgery; Surgical management includes vertebroplasty or kyphoplasty.
127
Q

Tx and Dx herniated disk

A

A herniated disc can be treated conservatively for 4 weeks before imaging has any proven benefit.

If symptoms persist after 1 month, then the MRI would be the correct choice.

X-rays do not show disks or nerve roots

128
Q

Lumbar strain

A

common,

generally resolves within a few weeks,

is treated with NSAIDs, muscle relaxants, and no more than 2 days of bed rest

129
Q

About a month after returning from the Middle East, an American soldier develops a papule on his forearm that subsequently ulcerates to form a shallow annular lesion with a raised margin. The lesion shows no signs of healing 3 months after it first appeared. He has no systemic symptoms.

The most likely diagnosis is:  (check one)
 A. leishmaniasis 
 B. schistosomiasis 
 C. malaria 
 D. trypanosomiasis 
 E. syphilis
A

Cutaneous leishmaniasis

130
Q

pityriasis rosea.

A

mild prodrome

then development of an ovoid salmon-colored, slightly raised herald patch, most commonly seen on the trunk.

then outbreak of multiple smaller, similar lesions that trend along Langer’s lines.

131
Q

Frozen shoulder is

A

an idiopathic condition that most commonly affects patients between the ages of 40 and 60.

Diabetes mellitus is the most common risk factor

Symptoms include shoulder stiffness, loss of active and passive shoulder rotation, and severe pain, including night pain.

Laboratory tests and plain films are normal;

diagnosis is clinical

132
Q

Sx: Pain occurs around the ankle, and there is decreased range of motion of the hindfoot and pain on foot inversion on examination.
Bilateral

A

Tarsal coalition

  • is the fusion of two or more tarsal bones.
  • It occurs in mid-to late adolescence and is bilateral in 50% of those affected.
133
Q

Os trigonum

A

results from non-ossification of cartilage.

Sx: unilateral and causes palpable tenderness of the heel.

134
Q

Sever’s apophysitis

A

is inflammation of the calcaneal apophysis,

causes pain in the heel.

135
Q

Tx Plantar fasciitis

A

Treatment strategies include relative rest, ice, NSAIDs, and prefabricated shoe inserts that provide arch support, as well as heel cord and plantar fascia stretching.

If conservative therapy fails, a corticosteroid injection may be useful.

Surgery is reserved for patients refractory to 6-12 months of uninterrupted conservative therapy.

136
Q

Spinal flexion vs extension increases spinal stenosis pain?

A

Extension

137
Q

Rosacea

A

Central facial erythema and telangiectasias are prominent early features that may progress to a chronic infiltrate with papules and sometimes sterile pustules.

The usual presenting symptoms are central facial erythema and flushing that many patients find socially embarrassing.

Ocular problems occur in half of patients with rosacea, often in the form of an intermittent inflammatory conjunctivitis with or without blepharitis.

Management:

  • avoidance of precipitating factors
  • use of sunscreen.
  • Oral metronidazole, doxycycline, or tetracycline also can be used, especially if there are ocular symptoms.
  • These are often ineffective for the flushing, so low-dose clonidine or a nonselective β-blocker may be added.
138
Q

In person w/ renal failure, what is first line tx for osteoarthritis of joint?

A

NOT NSAIDS!

Acetaminophen

139
Q

A 45-year-old female presents to your office with a 1-month history of pain and swelling posterior to the medial malleolus. She does not recall any injury, but reports that the pain is worse with weight bearing and with inversion of the foot. Plantar flexion against resistance elicits pain, and the patient is unable to perform a single-leg heel raise.
Which one of the following is true regarding this problem?

(check one)
A. The patient most likely has a medial ankle sprain
B. NSAIDs will improve the long-term outcome
C. Injecting a corticosteroid into the tendon sheath of the involved tendon is recommended
D. A lateral heel wedge should be prescribed
E. Immobilization in a cast boot for 3 weeks is indicated

A

The diagnosis of tendinopathy of the posterior tibial tendon is important, in that the tendon’s function is to perform plantar flexion of the foot, invert the foot, and stabilize the medial longitudinal arch. An injury can, over time, elongate the midfoot and hindfoot ligaments, causing a painful flatfoot deformity.

The patient usually recalls no trauma, although the injury may occur from twisting the foot by stepping in a hole. This is most commonly seen in women over the age of 40. Without proper treatment, progressive degeneration of the tendon can occur, ultimately leading to tendon rupture.

Pain and swelling of the tendon is often noted, and is misdiagnosed as a medial ankle sprain. With the patient standing on tiptoe, the heel should deviate in a varus alignment, but this does not occur on the involved side. A single-leg toe raise should reproduce the pain, and if the process has progressed, this maneuver indicates progression of the problem.

While treatment with acetaminophen or NSAIDs provides short-term pain relief, neither affects long-term outcome. Corticosteroid injection into the synovial sheath of the posterior tibial tendon is associated with a high rate of tendon rupture and is not recommended. The best initial treatment is immobilization in a cast boot or short leg cast for 2–3 weeks.

140
Q

Tx restless leg syndrome

A

lower-body resistance training

avoiding or changing medications that may exacerbate symptoms (e.g., antihistamines, caffeine, SSRIs, tricyclic antidepressants, etc.).

patients with a serum ferritin level < 50 ng/mL take an iron supplement

Ropinirole may be used if nonpharmacologic therapies are ineffective.

141
Q

Gradually worsening anterolateral hip joint pain that is sharply accentuated when pivoting laterally on the affected hip or moving from a seated to a standing position is consistent with

A

femoroacetabular impingement.

Reproduction of the pain on range-of-motion examination by manipulating the hip into a position of flexion, adduction, and internal rotation (FADIR test) is the most sensitive physical finding.

142
Q

What do you need to dx poly myalgia rheumatica?

A

There must be bilateral shoulder or hip stiffness and aching for at least one month in order to make the diagnosis of polymyalgia rheumatica.

erythrocyte sedimentation rate should be ≥40 mm/hr.

143
Q

Best to dx septic arthritis

A

Ultrasound

It is highly sensitive for detecting effusion of the hip joint.

If an effusion is present, urgent ultrasound-guided aspiration should be performed.

144
Q

CT is indicated for what MS path?

A

when cortical bone must be visualized.

145
Q

MRI is indicated for what MS path?

A

excellent visualization of joints, soft tissues, cartilage, and medullary bone.

Great for:
osteomyelitis, 
delineating the extent of malignancies, 
identifying stress fractures, 
diagnosing early Legg-Calvé-Perthes disease.
146
Q

Tx fibromyalgia

A

Exercise 1st

Then meds if fail tx:
amitriptyline
duloxetine

147
Q

Paget’s disease of bone

A

is a focal disorder of skeletal metabolism in which all elements of skeletal remodeling (resorption, formation, and mineralization) are increased.

Tx: bisphosphonates.

148
Q

What do you do for suspected melanoma?

A

The diagnosis of melanoma should be made by simple excision with clear margins.

Wide excision with or without node dissection is indicated for CONFIRMED melanoma, depending on the findings from the initial excisional biopsy.

149
Q

What should be obtained in any patient with suspected vitamin D deficiency?

A

Serum 25-hydroxyvitamin D = major circulating form of vit D
- this tells you if they are low on vit D

1,25-Dihydroxyvitamin D is the most active metabolite, but levels can be increased by secondary hyperparathyroidism.

150
Q

In persons with vitamin D deficiency, what can be used to replenish stores ?

A

ergocalciferol (vitamin D ) or cholecalciferol (vitamin D )

151
Q

The combination of arthritis with a typical palpable purpuric rash is consistent with a diagnosis of

A

Henoch-Schönlein purpura.

152
Q

It is now recommended that all infants and children, including adolescents, have a minimum daily intake of X of vitamin D, beginning soon after birth

A

400 IU

153
Q

A 40-year-old runner complains of gradually worsening pain on the lateral aspect of his foot. He runs on asphalt, and has increased his mileage from 2 miles/day to 5 miles/day over the last 2 weeks. Palpation causes pain over the lateral 5th metatarsal. The pain is also reproduced when he jumps on the affected leg. When you ask about his shoes he tells you he bought them several years ago.

Which one of the following is the most likely diagnosis?
(check one)
A. Ligamentous sprain of the arch
B. Stress fracture
C. Plantar fasciitis
D. Osteoarthritis of the metatarsal joint

A

A stress fracture causes localized tenderness and swelling in superficial bones, and the pain can be reproduced by having the patient jump on the affected leg.

154
Q 
An otherwise healthy 37-year-old male presents to your office with a 2-week history of redness and slight irritation in his groin. On examination a tender erythematous plaque with mild scaling is seen in his right crural fold. The area fluoresces coral-red under a Wood’s light.
Which one of the following would be the most appropriate treatment at this time?
  (check one)
 A. Amoxicillin 
 B. Erythromycin 
 C. Ketoconazole 
 D. Nystatin (Mycostatin) 
 E. Triamcinolone (Kenalog)
A

The characteristics of this lesion, including coral-red fluorescence under a Wood’s light, suggests Corynebacterium infection, which is associated with erythrasma. Tinea cruris caused by Microsporum infection fluoresces green, while intertrigo and tinea cruris caused by Epidermophyton or Trichophyton infections do not fluoresce. Erythromycin, either systemic or topical, is the treatment of choice.

155
Q

Tx impetigo

A

Limited area: mupirocin

Oral antibiotics are widely used, based on expert opinion and traditional practice, but are usually reserved for patients with more extensive impetigo or with systemic symptoms or signs.

156
Q

typical fibromyalgia trigger points lie along

A

the medial scapula borders,

posterior neck,

upper outer quadrants of the gluteal muscles,

medial fat pads of the knees

157
Q

Tx alopecia areata

A

> 10 yo or < 50% of the scalp = intralesional corticosteroid injections

< 10 yo or >50% scalp = Minoxidil

158
Q

Dupuytren’s disease is characterized by

A

shortening and thickening of the palmar fascia.

Early asymptomatic disease does not require treatment.

  • A series of cortisone injections over a period of months may lead to disease regression
  • Surgery is indicated if a metacarpal joint contracture reaches 30°, or with a proximal interphalangeal joint contracture of any degree.

There is a strong association between diabetes mellitus and Dupuytren’s disease

159
Q

A 39-year-old female presents with lower abdominal/pelvic pain. On examination, with the patient in a supine position, you palpate the tender area of her abdomen. When you have her raise both legs off the table while you palpate the abdomen, her pain intensifies.
Which one of the following is the most likely diagnosis?
(check one)
A. Appendicitis
B. A hematoma within the abdominal wall musculature
C. Diverticulitis
D. Pelvic inflammatory disease
E. An ovarian cyst

A

Carnett’s sign is the easing of the pain of abdominal palpation with tightening of the abdominal muscles. If the cause is visceral, the taut abdominal muscles could guard the source of pain from the examining hand. In contrast, intensification of pain with this maneuver points to a source of pain within the abdominal wall itself.

160
Q

Skin tags, or acrochordons, are associated with

A

diabetes mellitus and obesity.

The onset often occurs in early adulthood, and the most common locations are the neck and axillae.

These skin lesions are not associated with any significant cancer risk

161
Q

What has been used to tx external genital and perianal warts in patients 12 years of age and over?

A

imiquimod

162
Q

Dx Rheumatoid arthritis

A

clinical diagnosis

Anti-cyclic citrullinated peptide (anti-CCP) antibody most specific

163
Q

What provides pain relief within a few days in many patients with osteoporotic vertebral compression fractures?

A

Calcitonin, either intranasal or subcutaneous,

164
Q

What is + straight leg raise test?

A

Sciatica reproduced w/ elevations of leg < 60 deg

165
Q

What is the suggested etiology in:

Monoarticular joint pain

Multiple joint involvement

Symmetric polyarthritis

A

Monoarticular joint pain

  • infection,
  • gout,
  • pseudogout,
  • trauma,
  • toxic synovitis

Multiple joint involvement

  • connective tissue disease,
  • osteoarthritis,
  • RA.

Symmetric polyarthritis = RA

166
Q

RA xray findings

A

periarticular soft tissue swelling,
periarticular osteopenia,
uniform loss of joint space (nonuniform loss is more consistent with osteoarthritis),
bony erosions

167
Q

1st line tx osteoarthritis

A

Acetaminophen

NSAIDs have more side effects

168
Q

Tx RA symptoms

A

NSAIDs

MTX early on can help modify disease course

169
Q

Tx Gout

A

1st line = NSAIDs
Colchicine in attack

Allopurino not during attack but yes for ppx
Probenecid for ppx

170
Q

Shoulder pain w/ active ROM vs passive ROM - what defines a dx?

A

Pain with both active range of motion (AROM) and passive range of motion (PROM) suggests joint or ligament involvement,

pain with AROM but not PROM suggests muscular and/or tendon injury.

171
Q

woman taking steroids p/w hip pain - what happened?

A

Avascular necrosis of femoral head

Use MRI to dx

172
Q

Pagets disease lab values

A

high alp and urinary hydroxyproline

Nl all else

173
Q

Causes of Reactive arthritis

A

Chlamydia
GI pathogens

NOT gonorrhea

174
Q

Common sites of ankylosing spondylitis pain

A

2/2 Enthesitis

Heel
Tibial tuberosities
Iliac crests

175
Q

Temporal arteritis dx - what arteries involved? What do you follow pts with?

A

Ophthalmic
Branches of aorta

Follow with serial CXR to monitor for aortic aneurysm

176
Q

What puts you at increased risk for pseudogout?

A

Hyper PTH

Previous trauma

177
Q

+ anti topoisomerase I antibodies

A

Systemic sclerosis

178
Q

Antimitochondrial antibodies

A

primary biliary cirrhosis

179
Q

C-ANCA antibodies

A

Wegner’s granuloma

180
Q

Anti-smooth muscle antibodies

A

autoimmune hepatitis

181
Q

SLE manifestations

A 
Fatigue
Fever
Wt loss
non-deforming arthritis (usually in MCP and PIP)
oral ulcers
serositis
heme abnormalities
proteinuria
rash
182
Q

Osteoarthritis dx

A 
age > 50
minimal or no AM stiffness
bony tenderness
bony enlargement
crepitus on active motion
no warmth of joint
183
Q

1 cause of vertebral osteo in IVDU

A

Staph aureus

184
Q

How long does arthritis have to be present to dx RA?

A

6 weeks

185
Q

Charcot’s joint

A

Due to diabetic neuropathy, B12 def, etc
It is a neurogenic arthropathy

Nl neuro input lost –> pts unknowingly traumatize their wt bearing joints –> degenerative joint disease, joint deformation, functional limitation

Xray:
loss of cartilage
osteophytes
loose bodies

Tx:
tx underlying dz
providing mech support to assist wt bearing

186
Q

S/E hydroxychloroquine

A

good drug for SLE skin and joint involvement

Can cause retinopathy and corneal damage though

187
Q

Suspect new onset lupus nephritis - what do you do next?

A

Renal bx first!

- for baseline and tx options

188
Q

Morton neuroma

A

Mech-induced neuropathic degeneration

Sx
numbness + burning of toes
aching
burning in distal forefoot radiating forward from metatarsal heads to 3rd and 4th toes

Tx:
support w/ padded shoe inserts
surgery if conservative tx fails

189
Q

Punched out erosions w/ rim of cortical bone on xray - what is this?

A

Gout

190
Q

Xray shows periarticular osteopenia + joint margin erosions

A

rheumatoid arthritis

191
Q

Xray shows normal joint space w/ soft tissue swelling

A

infectious arthritis

192
Q

xray shows calcificatino of cartilaginous structures

A

pseudogout

193
Q

Tx symptomatic sarcoidosis

A

Steroids

194
Q

Dx secondary amyloidosis

A

Ab fat pad aspiration bx

195
Q

Facial swelling
b/l LE edema
Massive proteinuria

Hepatomegaly
Palpable kidneys
Ventricular hypertrophy

Chronic inflammatory dz pmh

What could this be

A

Secondary amyloidosis

  • tx underlying inflammatory dz (eg RA, bronchiectasis, TB, osteo, Crohns, Malignancy, vasculitits)
196
Q

Tx and ppx secondary amyloidosis

A

Colchicine

197
Q

Behçet’s syndrome

A

genital and oral ulcerations and relapsing uveitis.

Patients may develop arthritis, vasculitis, intestinal manifestations, or neurologic manifestations. This disease is also associated with cutaneous hypersensitivity; 60%–70% of patients will develop a sterile pustule with an erythematous margin within 48 hours of an aseptic needle prick.

Family Medicine (11 decks)

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