Musculoskeletal/Rhematology Flashcards
what test is used to diagnose avascular necrosis; what are the risk factors/predisposing factors
MRI of the hip; chronic steroid use, alcohol and hemoglobinopathies predispose to AVN
list some criteria for diagnosing osteoarthritis
age > 50, no morning stiffness, cold joint, bony tenderness, joint crepitus with motion, joint enlargement
what four areas are commonly tender in fibromyalgia
mid trapezius, costochondral junction, lateral epicondyle, greater trochanter
how is fibromyalgia treated
- exercise and education and sleep hygiene
2. TCAs and duloxetine if lifestyle management doesn’t work
a patient on cyclophophamide should be started on what medication as prophylaxis
mensa to prevent bladder carcinoma and acute hemorrhagic cystitis due to acrolein exposure
how can you differentiate pseudogout from gout
gout crystals are needle shaped and negatively birefringent (parallel=yellow, perpendicular=blue)
pseudogout crystals are weakly positively birefringent and rhomboid in shape
acute treatment of gout includes
NSAIDs, colchicine, steroids
fever, urticaria, polyarthralgia after treatment with a beta-lactam or sulfa drug is suspicious for what
serum sickness
what are the laboratory findings and treatment for serum sickness
hypocomplementemia, high inflammatory markers (ESR and CRP)
patients with Kawasaki disease have fever for >5 consecutive days and 4 out of 5 of which symptoms
- conjunctivitis (b/l, nonexudative)
- mucosal swelling/ strawberry tongue
- rash
- extremity findings: edema/erythema/desquamation of hands and feet
- cervical LAD (usually unilateral)
a child with fever, vesicles in buccal mucosa and small cutaneous lesions on palms and soles has what illness
Hand, foot and mouth disease; caused by Coxsackie virus
how do you differentiate between scarlet fever and Kawasaki’s
scarlet fever does not have conjunctivitis and the rash is more sandpaper like with sparing of the palms and soles; furthermore, you would likely see pharyngitis
what are the two complications of Kawasaki’s
coronary artery aneurysm and myocardial infarction
what’s the most reliable sign for vertebral osteomyelitis?
what can’t you use to diagnose?
exquisite tenderness to gentle percussion of the spinous processes
you can’t use fever or leukocytosis as they are unreliable (may not be elevated)
what is the treatment for nursemaid’s elbow
supination and flexion of forearm OR hyperpronation of the forearm
what is the treatment for suspected scaphoid fracture
initial x-ray, then spica cast immobilization and repeat x-ray in 7-10 days (initial x-ray often misses dx b/c it takes 7 days for a non-displaced fracture to become visible on x-ray)
how does osteoid osteoma present and what is seen on x-ray; how is it treated?
presentation: pain at rest, worse at night, often in proximal femur
x-ray: small round radiolucency (hypodense)
tx: serial x-rays as it self resolves over years, NSAIDs very effective at managing pain
if you suspect giant cell arteritis based on clinical exam and the patient has visual symptoms what should your next step be?
high-dose steroids immediately
THEN get a temporal artery biopsy
what conditions are associated with erythema nodosum
recent strep infection, sarcoidosis, TB, histoplasmosis, IBD
what are the diagnostic criteria for polymyalgia rheumatica and how is it treated
age > 50, subacute- chronic pain in neck or shoulders or hips or , morning stiffness, constitutional sx (fever, weight loss), may see elevated ESR or CRP
Tx= steroids
lateral hip pain that is exacerbated by sleeping on the affected side is suspicious for what
trochanteric bursitis (caused by friction between the tendons of gluteus medius and tensor fascia lata)
what is Legg-Calve-Perthes disease
idiopathic avascular necrosis of the femoral capital epiphysis
how many major or minor criteria do you need to diagnose rheumatic fever
to dx rhematic fever you need preceeding strep infection + 2 major criteria or 1 major and 2 minor
note: minor criteria are fever, arthralgias, elevated ESR or CRP and prolonged PR interval
what is the most prominent extraarticular symptom of ankylosing spondylitis
anterior uveitis
risk factors for gout
ALCOHOL (ethanol–> lactate which competes with urate for renal excretion), obesity, male gender, post-menopausal women, thiazides
what are the main differences between primary Raynaud’s (disease) and secondary Raynaud’s (phenomenon)
primary: no tissue injury, women younger than 30
secondary: tissue injury, men over 40, associated underlying condition (SLE, CREST, cocaine, nicotine, vibratory tools, connective tissue diseases, thromboangitis obliterans, vasoocclusive disorders like DM)
how do you treat Raynaud’s
in primary and secondary you treat with CCB’s; in secondary give aspirin if there is risk of ulceration
how does Morton’s neuroma present
pain upon palpation of the space between the 3rd and 4th metaphalyngeal joints
what is pyoderma gangrenosum and how is it treated
a neutrophilic ulcerative skin disease associated with systemic diseases;
treat with steroids
what is ecthyma gangrenosum
hemorrhagic pustules that develop into necrotic ulcers; associated with Pseudomonas aeruginosa and neutropenia
inability to passively or actively move the shoulder joint is suspicious for what
adhesive capsulitis (frozen shoulder syndrome)
rotator cuff tear vs. adhesive capsulitits
rotator cuff tear has normal passive range of motion
adhesive capsulitis has defective active and passive range of motion
a patient with back pain and positive straight leg raise but no perianal or neurologic deficits should have what done next
early mobilization and NSAIDs; sciatica without concern for cauda equina syndrome can be managed without imaging
most common cause of septic arthritis
staph aureus
what is Behcet’s
an inflammatory disease involving recurrent oral ulcers, eye lesions (conjunctivitis, uveitis), skin lesions (erythema nodosum)
what are the two mechanisms by which Carpal tunnel should develop
accumulation of muccopolysaccharides in the carpal space (higher risk in hypotyroid patients)
Carpal tunnel in pregnancy is due to fluid accumulation in the carpal space
what diagnostic test should a patient with recently confirmed SLE receive as part of early management
renal biopsy to assess severity and baseline
different classes of lupus nephritis are treated differently
what autoantibodies are associate with dermatomyositis
anti-Jo1 (anti-synthetase) and anti-Mi2 (anti-helicase)
what is a glomus tumor
a benign vascular tumor commonly found subungally that presents with tenderness and blue color
what nerve is injured with:
- midshaft humerus fracture
- supracondylar fracture
- neck of humerus fracture
- medial epicondyle fracture
- midshaft: radial nerve
- supracondylar: median nerve
- neck of humerus: axillary nerve
- medial epicondyle: ulnar nerve
what preventive measure should you take to avoid gout in a patient on chemo (susceptible to tumor lysis syndrome)
allopurinol (NOT HYDRATION; hydration is only helpful with probenecid use to prevent uric acid kidney stones)
what is the most common pulmonary complication of diffuse scleroderma
interstitial fibrosis
name three neuromuscular paraneoplastic disorders
- myasthenia gravis (often seen with thymomas)
- Lambert-Eaton (seen with small cell lung cancer)
- polymyositis/dermatomysitis
what is spondylolisthesis
a developmental disorder in which the vertebrae slips forward (resulting in back pain, neurologic deficits and palpable step offs)
how can you distinguish spinal stenosis from claudication as a cause of lower extremity pain with walking
spinal stenosis LE pain improves with flexion of the back (leaning forward, going uphill, sitting) and is posture dependent
claudication only improves with rest
what are normal ankle brachial index values
anything between 0.9-1.4 (ankle brachial index= ankle BP/ brachial BP)
if you see MCP and PIP arthritis that has occured acutely, has morning stiffness
viral arthritis (Parvovirus B19 is a common cause)
viral arthritis mimics RA, but 6 weeks is needed for diagnosis of RA along with joint swelling
which part of
the spine is associated with rheumatoid arthritis
cervical spine involvement
when do you start methotrexate in a patient diagnosed with rheumatoid arthritis
ASAP: as soon as diagnosis is made
add a second therapy (non-biologic or biologic) if symptoms persist after 6 months
if inadequate response switch to TNF alpha inhibitor + MTX
a Down’s syndrome patient with ataxia, and upper motor neuropathies likely has which associated disorder
alantoaxial instability
what is DeQuervain tenosynovitis
commonly seen in new mothers who hold their children (thumb extended and abducted); involves pain on passive stretch of the abductor pollicis longus and extensor pollicis brevis tendons
common presentation of patellofemoral syndrome and how to diagnose
young female athelete; pain with using stairs
dx by pressing on patella while extending the knee –> elicits pain
what is Osgood-Schlatter disease?
anterior knee pain caused by repetitive strain on insertion site of patellar tendon on tibial tuberosity during adolescent growth spurt; on exam palpation of tibial tuberosity elicits pain
back pain, hearing loss and femoral bowing should make you think…
Paget’s diseas of the bone
what is the most serious side effect of hydroxychloroquine
retinopathy: eye exams every 6 months are required while on this medication
what conditions can manifest with chondocalcinosis (-> pseudogout)
hypomagnesemia, hyperparathyroidism, hemochromatosis (look for hepatomegaly or DM or arthropathy)
what is the classic triad of gonococcemia
polyarthralgia, tenosynovitis, and painless vesiculopustular lesions
which cancer may develop from Paget’s
osteosarcoma
what are charcot joints and how do they present
charcot joints (neurogenic arthropathy) is a condition characterized by chronic, repetitive trauma to the bones that is unperceived due to sensory deficits (proprioception, pain, touch, etc.) it is commonly seen in patients with DM, peripheral neuropathy, tertiary syphilis, etc. and presents as foot deformities; x-ray will show osteophytes, fractures and loss of cartilage
what two tests in the office suggest rotator cuff impingement (tendonitis)
- Neer test (passive lifting of hand over head elicits pain)
- injection into shoulder allows for movement with reduced pain
explain the algorithm for managing hemodynamically unstable blunt abdominal trauma patients
FAST exam; if positive for intrabdominal bleeding –> emergent laparotomy; if negative look for other areas of bleeding and stabilize, if no other areas of bleeding do abdominal CT; if FAST is inconclusive do a diagnostic peritoneal lavage to determine whether to go down laparotomy or investigation pathway
what can you give a patient for Lyme disease who can’t take doxycycline
amoxicillin (for children
how can you tell where the likely location of vessel narrowing is in claudication
buttock claudication=> aortoiliac disease
calf claudication=>femoropoliteal disease
what causes serum-sickness and how does it present
antibiotics (beta-lactams and sulfa drugs); presents with fever, urticaria and polyarthralgia (1-2 weeks after drug exposure), hypocomplementemia and high ESR on labs; Tx by removing drug and steroids if severe
when do you start erythropoetin treatments in a CKD patient and what are some possible side effects
start at Hgb
hemarthrosis vs. hemophilic arthropathy in patients with hemophilia
hemarthrosis= acute, bleeding into joint causing swelling
hemophilic arthropathy= chronic, hemosiderin and iron deposition in joint leading to inflammation
allergic vs. non-allergic rhinnitis: presentation and symptoms
allergic rhinnitis: chronic rhinnitis along with eye symptoms and identifiable triggers
non-allergic rhinnitis: chronic rhinnitis with no eye symptoms or triggers
Tx: for both treat with intranasal H1 antihistamines and intranasal glucocorticoids
(for severe symptoms use both in combo)
what is the 1st and 2nd line treatment for restless leg syndrome
- pramipexole (dopamine agonist)
2. gabapentin (calcium channel ligand)
