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2CK Smartbook > Musculoskeletal/Rhematology > Flashcards

Musculoskeletal/Rhematology Flashcards

1
Q

what test is used to diagnose avascular necrosis; what are the risk factors/predisposing factors

A

MRI of the hip; chronic steroid use, alcohol and hemoglobinopathies predispose to AVN

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2
Q

list some criteria for diagnosing osteoarthritis

A

age > 50, no morning stiffness, cold joint, bony tenderness, joint crepitus with motion, joint enlargement

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3
Q

what four areas are commonly tender in fibromyalgia

A

mid trapezius, costochondral junction, lateral epicondyle, greater trochanter

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4
Q

how is fibromyalgia treated

A
  1. exercise and education and sleep hygiene

2. TCAs and duloxetine if lifestyle management doesn’t work

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5
Q

a patient on cyclophophamide should be started on what medication as prophylaxis

A

mensa to prevent bladder carcinoma and acute hemorrhagic cystitis due to acrolein exposure

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6
Q

how can you differentiate pseudogout from gout

A

gout crystals are needle shaped and negatively birefringent (parallel=yellow, perpendicular=blue)

pseudogout crystals are weakly positively birefringent and rhomboid in shape

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7
Q

acute treatment of gout includes

A

NSAIDs, colchicine, steroids

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8
Q

fever, urticaria, polyarthralgia after treatment with a beta-lactam or sulfa drug is suspicious for what

A

serum sickness

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9
Q

what are the laboratory findings and treatment for serum sickness

A

hypocomplementemia, high inflammatory markers (ESR and CRP)

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10
Q

patients with Kawasaki disease have fever for >5 consecutive days and 4 out of 5 of which symptoms

A
  1. conjunctivitis (b/l, nonexudative)
  2. mucosal swelling/ strawberry tongue
  3. rash
  4. extremity findings: edema/erythema/desquamation of hands and feet
  5. cervical LAD (usually unilateral)
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11
Q

a child with fever, vesicles in buccal mucosa and small cutaneous lesions on palms and soles has what illness

A

Hand, foot and mouth disease; caused by Coxsackie virus

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12
Q

how do you differentiate between scarlet fever and Kawasaki’s

A

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

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13
Q

what are the two complications of Kawasaki’s

A

coronary artery aneurysm and myocardial infarction

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14
Q

what’s the most reliable sign for vertebral osteomyelitis?

what can’t you use to diagnose?

A

exquisite tenderness to gentle percussion of the spinous processes
you can’t use fever or leukocytosis as they are unreliable (may not be elevated)

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15
Q

what is the treatment for nursemaid’s elbow

A

supination and flexion of forearm OR hyperpronation of the forearm

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16
Q

what is the treatment for suspected scaphoid fracture

A

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)

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17
Q

how does osteoid osteoma present and what is seen on x-ray; how is it treated?

A

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

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18
Q

if you suspect giant cell arteritis based on clinical exam and the patient has visual symptoms what should your next step be?

A

high-dose steroids immediately

THEN get a temporal artery biopsy

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19
Q

what conditions are associated with erythema nodosum

A

recent strep infection, sarcoidosis, TB, histoplasmosis, IBD

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20
Q

what are the diagnostic criteria for polymyalgia rheumatica and how is it treated

A

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

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21
Q

lateral hip pain that is exacerbated by sleeping on the affected side is suspicious for what

A

trochanteric bursitis (caused by friction between the tendons of gluteus medius and tensor fascia lata)

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22
Q

what is Legg-Calve-Perthes disease

A

idiopathic avascular necrosis of the femoral capital epiphysis

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23
Q

how many major or minor criteria do you need to diagnose rheumatic fever

A

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

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24
Q

what is the most prominent extraarticular symptom of ankylosing spondylitis

A

anterior uveitis

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25
Q

risk factors for gout

A

ALCOHOL (ethanol–> lactate which competes with urate for renal excretion), obesity, male gender, post-menopausal women, thiazides

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26
Q

what are the main differences between primary Raynaud’s (disease) and secondary Raynaud’s (phenomenon)

A

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)

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27
Q

how do you treat Raynaud’s

A

in primary and secondary you treat with CCB’s; in secondary give aspirin if there is risk of ulceration

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28
Q

how does Morton’s neuroma present

A

pain upon palpation of the space between the 3rd and 4th metaphalyngeal joints

29
Q

what is pyoderma gangrenosum and how is it treated

A

a neutrophilic ulcerative skin disease associated with systemic diseases;
treat with steroids

30
Q

what is ecthyma gangrenosum

A

hemorrhagic pustules that develop into necrotic ulcers; associated with Pseudomonas aeruginosa and neutropenia

31
Q

inability to passively or actively move the shoulder joint is suspicious for what

A

adhesive capsulitis (frozen shoulder syndrome)

32
Q

rotator cuff tear vs. adhesive capsulitits

A

rotator cuff tear has normal passive range of motion

adhesive capsulitis has defective active and passive range of motion

33
Q

a patient with back pain and positive straight leg raise but no perianal or neurologic deficits should have what done next

A

early mobilization and NSAIDs; sciatica without concern for cauda equina syndrome can be managed without imaging

34
Q

most common cause of septic arthritis

A

staph aureus

35
Q

what is Behcet’s

A

an inflammatory disease involving recurrent oral ulcers, eye lesions (conjunctivitis, uveitis), skin lesions (erythema nodosum)

36
Q

what are the two mechanisms by which Carpal tunnel should develop

A

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

37
Q

what diagnostic test should a patient with recently confirmed SLE receive as part of early management

A

renal biopsy to assess severity and baseline

different classes of lupus nephritis are treated differently

38
Q

what autoantibodies are associate with dermatomyositis

A

anti-Jo1 (anti-synthetase) and anti-Mi2 (anti-helicase)

39
Q

what is a glomus tumor

A

a benign vascular tumor commonly found subungally that presents with tenderness and blue color

40
Q

what nerve is injured with:

  • midshaft humerus fracture
  • supracondylar fracture
  • neck of humerus fracture
  • medial epicondyle fracture
A
  • midshaft: radial nerve
  • supracondylar: median nerve
  • neck of humerus: axillary nerve
  • medial epicondyle: ulnar nerve
41
Q

what preventive measure should you take to avoid gout in a patient on chemo (susceptible to tumor lysis syndrome)

A

allopurinol (NOT HYDRATION; hydration is only helpful with probenecid use to prevent uric acid kidney stones)

42
Q

what is the most common pulmonary complication of diffuse scleroderma

A

interstitial fibrosis

43
Q

name three neuromuscular paraneoplastic disorders

A
  1. myasthenia gravis (often seen with thymomas)
  2. Lambert-Eaton (seen with small cell lung cancer)
  3. polymyositis/dermatomysitis
44
Q

what is spondylolisthesis

A

a developmental disorder in which the vertebrae slips forward (resulting in back pain, neurologic deficits and palpable step offs)

45
Q

how can you distinguish spinal stenosis from claudication as a cause of lower extremity pain with walking

A

spinal stenosis LE pain improves with flexion of the back (leaning forward, going uphill, sitting) and is posture dependent
claudication only improves with rest

46
Q

what are normal ankle brachial index values

A

anything between 0.9-1.4 (ankle brachial index= ankle BP/ brachial BP)

47
Q

if you see MCP and PIP arthritis that has occured acutely, has morning stiffness

A

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

48
Q

which part of

the spine is associated with rheumatoid arthritis

A

cervical spine involvement

49
Q

when do you start methotrexate in a patient diagnosed with rheumatoid arthritis

A

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

50
Q

a Down’s syndrome patient with ataxia, and upper motor neuropathies likely has which associated disorder

A

alantoaxial instability

51
Q

what is DeQuervain tenosynovitis

A

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

52
Q

common presentation of patellofemoral syndrome and how to diagnose

A

young female athelete; pain with using stairs

dx by pressing on patella while extending the knee –> elicits pain

53
Q

what is Osgood-Schlatter disease?

A

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

54
Q

back pain, hearing loss and femoral bowing should make you think…

A

Paget’s diseas of the bone

55
Q

what is the most serious side effect of hydroxychloroquine

A

retinopathy: eye exams every 6 months are required while on this medication

56
Q

what conditions can manifest with chondocalcinosis (-> pseudogout)

A

hypomagnesemia, hyperparathyroidism, hemochromatosis (look for hepatomegaly or DM or arthropathy)

57
Q

what is the classic triad of gonococcemia

A

polyarthralgia, tenosynovitis, and painless vesiculopustular lesions

58
Q

which cancer may develop from Paget’s

A

osteosarcoma

59
Q

what are charcot joints and how do they present

A 
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
60
Q

what two tests in the office suggest rotator cuff impingement (tendonitis)

A
  1. Neer test (passive lifting of hand over head elicits pain)
  2. injection into shoulder allows for movement with reduced pain
61
Q

explain the algorithm for managing hemodynamically unstable blunt abdominal trauma patients

A

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

62
Q

what can you give a patient for Lyme disease who can’t take doxycycline

A

amoxicillin (for children

63
Q

how can you tell where the likely location of vessel narrowing is in claudication

A

buttock claudication=> aortoiliac disease

calf claudication=>femoropoliteal disease

64
Q

what causes serum-sickness and how does it present

A

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

65
Q

when do you start erythropoetin treatments in a CKD patient and what are some possible side effects

A

start at Hgb

66
Q

hemarthrosis vs. hemophilic arthropathy in patients with hemophilia

A

hemarthrosis= acute, bleeding into joint causing swelling

hemophilic arthropathy= chronic, hemosiderin and iron deposition in joint leading to inflammation

67
Q

allergic vs. non-allergic rhinnitis: presentation and symptoms

A

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)

68
Q

what is the 1st and 2nd line treatment for restless leg syndrome

A
  1. pramipexole (dopamine agonist)

2. gabapentin (calcium channel ligand)

2CK Smartbook (18 decks)

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