Musculoskeletal system (8%) Flashcards
Compartment syndrome is most commonly associated with what?
Long bone fractures
A complication of compartment syndrome is
Rhabdomyolysis
Findings of rhabdomyolysis
Myoglobinuria (coke colored urine, 3+ on urine dipstick but NO RBCs on micro)
Kidney failure: High potassium and phosphate, Low calcium
morning stiffness with osteoarthritis usually lasts
LESS than 30 mins
Heberden and Bouchard nodes are found with what condition
Osteoarthritis
MCP joints are spared with what condition?
Osteoarthritis
Bouchard node is what joint
PIP
Heberden node
DIP
These Xray findings are suggestive of what condition:
- Joint space narrowing
- Osteophyte formation
- Subchondral bone cysts
- Subchondral bone sclerosis
Osteoarthritis
Back pain that is worse in the morning and IMPROVES with rest is likely
Ankylosing Spondylitis
What Xray finding is suggestive of Ankylosing Spondylitis
Bamboo spine
HLA-B27 is associated with
Ankylosing Spondylitis
what findings would suggest cauda equina
- Saddle anesthesia
- Urinary retention = incontinence
- Bowel dysfunction
Dx of cauda equina
Emergent MRI
Tx cauda equina
Emergent neurosurgical consult for decompression
+ Spurling Maneuver = limb pain or paresthesia is produce is for what dx
cervical radiculopathy
Dx of cervical radiculopathy
MRI
what is podagra
gout of the foot, especially the big toe (MTP)
Negatively birefringent, needle like crystals indicate
Gout
Pseudogout is most commonly in the
Knee
what medication can cause pseudogout
Thiazide diuretics
Rhomboid shaped crystals and positively birefringent indicate
Pseudogout
Xray finding suggestive of pseudogout
Chondrocalcinosis
what is the primary cause of osteoporosis
Postmenopausal loss of estrogen
T score of -1.0 to -2.5
Osteopenia
T score <-2.5
Osteoporosis
what is the definition of severe osteoporosis
T score <-2.5 and fragility fracture
Two side effects of bisphosphonates
Jaw necrosis and pill esophagitis
What are two pharmacological approaches to treating osteoporosis
1) Antiresorptives (slow bone loss) ie bisphosphonates
2) Bone forming (anabolic) ie parathyroid hormone
When to screen for osteoporosis
Women 65yrs and older
Polymyalgia rheumatica is associated with what condition
Giant cell arteritis (temporal arteritis)
Epidemiology of polymyagia rheumatic
W>M, >50yrs
- Symmetrical aching pain in the shoulders and hip girdle with prolonged morning stiffness (>30 mins)
Likely polymyagia rheumatic
Tx of polymyagia rheumatic
Corticosteroids
What are two causes of Reactive arthritis
Recent GI infections (Campylobacter jejuni) OR STI infections (Chlamydia trachomatis)
- Arthritis in the lower extremities (knee)
- Ocular inflammation
- Urethritis, cervicitis
with preceding GI or STI infection
Reactive arthritis
Laboratory findings suggestive of Rheumatoid arthritis
+Rheumatoid factor
+anti-cyclic citrullinated peptide (ACCP) most specific
Xray findings are suggest of
- joint space narrowing
- periarticular osteopenia
- joint erosions
Rheumatoid arthritis
First line treatment of Rheumatoid arthritis
Methotrexate
Swan neck and boutonniere deformities are found with what condition
Reactive arthritis
pathophysiology of systemic lupus erythematosus (SLE)
inflammatory autoimmune disease, type III hypersensitivity reaction
How is the Malar rash of lupus different from the rash of Roscea
SLE butterfly rash - SPARES the nasolabial folds
Roscea does not spare the nasolabial folds
What laboratory studies are suggestive of SLE (lupus)
+ ANA
+ Anti-double stranded DNA
+ Anti-Smith antibodies
First line treatment of Lupus
Hydroxychloroquine or chloroquine
CREST syndrome is associated with
Scleroderma
what is CREST syndrome
Calcinosis
Raynaud phenomenon
Esophageal dysmobility
Sclerodactyly
Telangiectasias
what laboratory findings are suggestive of scleroderma
+ ANA
+ ANA-Scl-70 (diffuse scleroderma)
or + Anti-centromere antibodies (Limited scleroderma)
Pharmacology for Raynaud phenomenon
CCB
What are two complications of diffuse scleroderma
- Interstitial lung disease
- Pulmonary hypertension
what is sjogren syndrome
Chronic autoimmune inflammatory disorder causing destruction of exocrine glands (salivary and lacrimal)
Dry eyes / gritty feeling (keratoconjunctivitis)
Xerostomia (dry mouth and decreased saliva production) in a women 40-60yrs is most likely
sjogren syndrome
what laboratory findings are suggestive of sjogren syndrome
+antiSS-A (RO) and +antiSS-B (La) antibodies
what condition would a +Schirmer test be for
sjogren syndrome
Treatment of sjogren syndrome
- artificial tears
- Cholinergic agonists (pilocarpine)
Plain radiograph findings of midshaft of long bones lytic lesions with “onion skinning” is suggestive of what diagnosis
Ewing sarcoma
what is the 2nd most common malignant bone tumor in adolescents and young adults
Ewing sarcoma
What is the most common primary malignant bone tumor in children
Osteosarcoma
Plain radiograph findings of sunburst pattern (periosteal reaction) is suggestive of what diagnosis
Osteosarcoma
osteosarcoma is most often found where in long bones
metaphyseal region of long bones
What is osteomyelitis?
bone infection
what is the most common cause (organism) of osteomyelitis?
Staphylococcus aureus
What is the initial imaging for osteomyelitis VS the most sensitive imaging.
Initial: Xray
Most sensitive: MRI
Definitive diagnosis of osteomyelitis
Bone biopsy
What is the most common cause of septic arthritis?
Staph aureus
If a young and sexually active with risky sexual behaviors and practices presents with septic arthritis - what organism is likely the cause?
Neisseria gonorrhoeae
Septic arthritis most commonly affects what joint
Knee
how to confirm the diagnosis of septic arthritis
Arthrocentesis
Treatment of septic arthritis
Joint drainage or debridement and antibiotics (vancomycin plus ceftriaxone)
