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Ortho/Rheum Flashcards

1
Q

What is the treatment for dry eyes from Sjögren’s?

A

Cyclosporine

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2
Q

What condition is most commonly seen with Raynauds?

A

Scleroderma

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3
Q

Anti-Ro and Anti-la antibodies?

A

Sjögren’s

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4
Q

What condition does a Schirmer test help diagnose?

A

Sjögren’s

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5
Q

What condition is associated with CREST syndrome?

A

Scleroderma

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6
Q

Anticentromere antibody?

A

Scleroderma

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7
Q

What is the Dx? 20 year old female with pericarditis and rash.

A

Systemic lupus erythematosus (SLE)

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8
Q

Anti-smith antibodies?

A

Systemic lupus erythematosus (SLE)

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9
Q

List the causes of Reiters syndrome.

A

Chlamydia - Salmonella - Clostridium difficile - Campylobacter jejuni

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10
Q

Uveitis urethritis and oligoarthritis?

A

Reiter’s syndrome

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11
Q

What disease is associated with polymyalgia rheumatica?

A

Giant cell arteritis

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12
Q

What is the Dx? AM Stiffness in shoulders and hip girdle in a 50 year old.

A

Polymyalgia Rheumatica

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13
Q

Anti jo1 antibodies?

A

Polymyositis

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14
Q

What treatment is used for acute pseudogout?

A

Steroids and aspiration of the joint

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15
Q

What medications are used for acute gout?

A

Colchicine and indomethacin

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16
Q

What medication is used for chronic gout?

A

Allopurinol

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17
Q

Most common part of body to get a pseudogout attack?

A

Knee

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18
Q

Most common part of body to get a gout attack?

A

First MTP joint (AKA: Podagra)

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19
Q

Positive birefringent crystals?

A

Pseudo gout

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20
Q

Negative birefringent crystals?

A

Gout

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21
Q

How many fibromyalgia trigger points are needed for diagnosis?

A

Greater than 11 of 18

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22
Q

Fibromyalgia treatment?

A

Tricyclics (e.g. amitriptyline) - Patient education

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23
Q

Osteoporosis treatment?

A

First line: bisphosphonates consider denosumab - teriparatide

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24
Q

Swan neck deformity and ulnar deviationn associated with?

A

Rheumatoid arthritis

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25
Q

Boutonniere deformity associated with?

A

Rheumatoid arthritis

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26
Q

Bouchard nodes associated with?

A

Osteoarthritis

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27
Q

Heberden’s nodes associated with?

A

Osteoarthritis

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28
Q

What medication is often used to treat the pain and inflammation of Sjögren’s syndrome?

A

Hydroxychloroquine with steroids for the pain and inflammation

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29
Q

What antibodies are associated with Sjögren’s syndrome?

A

Anti-Ro and anti-La antibodies also known as SSA and SSB

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30
Q

What are two common complications associated with Sjögren’s syndrome?

A

Primary biliary cirrhosis and non-Hodgkin’s lymphoma

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31
Q

Which antibody is associated with scleroderma?

A

Anti-centromere antibody

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32
Q

Will a patient with scleroderma develop dysphagia to solids, liquids, or both liquids and solids?

A

Both liquids and solids

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33
Q

Patients with SLE are commonly treated with what two types of medications?

A

Corticosteroids and immune modulation medications like cyclophosphamide

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34
Q

Screening for SLE is performed using the ANA antibody. Which antibody is confirms the diagnosis?

A

Anti-Smith antibody

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35
Q

A 30 year old female presents with erythema over the cheeks and nose and pericarditis. What do you suspect?

A

Systemic lupus erythematosus

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36
Q

Which rheumatologic disorder may follow infection with Chlamydia, Campylobacter Jejuni or Clostridium difficile?

A

All three infections can lead to Reiter’s syndrome (also known as reactive arthritis)

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37
Q

What condition do you suspect in a 54 year old with stiffness specifically in the shoulders and hip girdle?

A

Polymyalgia rheumatica

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38
Q

How does polymyositis differ from myasthenia gravis?

A

Polymyositis does not cause facial or ocular weakness like that which is seen in myasthenia gravis

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39
Q

What is the diagnostic test of choice in a patient with dermatomyositis?

A

Muscle biopsy

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40
Q

A 50 year old man has a purplish mottled discoloration of the torso, muscle pain, extremity weakness, weight loss and HTN. What condition do you suspect?

A

Polyarteritis nodosa

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41
Q

What is the age of onset for psoriatic arthritis?

A

Between the ages of 30 to 50 (Skin involvement occurs before the joint involvement)

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42
Q

What is the age cut off for someone to have juvenile rheumatoid arthritis?

A

Joint stiffness for more than six weeks in a child 16 or younger

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43
Q

Name three deformities seen in rheumatoid arthritis.

A

Ulnar deviation - Swan neck deformity - Boutonniere deformity

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44
Q

Which bone cancer is most likely to start in the spine or pelvis of children?

A

Ewings sarcoma

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45
Q

What age group is osteosarcoma most likely to affect?

A

Second decade of life

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46
Q

What is the Dx? Patient in his 20s with progressive bone pain worse at night and a sunburst appearance on X-ray.

A

Osteosarcoma

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47
Q

What is the most common bone location for metastasis of other (non-ortho) cancers?

A

Spine

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48
Q

Which type of bone cancer is usually seen in patients over 50 years of age?

A

Chondrosarcoma

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49
Q

Name 3 types of Bone cancer.

A

Osteosarcoma - Chondrosarcoma - Ewings sarcoma

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50
Q

What pathogen can cause septic arthritis in healthy sexually active young adults?

A

Neisseria gonorrhoeae

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51
Q

Treatment for osteomyelitis?

A

Debridement - Blood and wound cultures - Antibiotics based on culture for 6 + weeks - Remove hardware if present

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52
Q

Is osteoarthritis or rheumatoid arthritis more likely to be associated with a pleural effusion?

A

Rheumatoid arthritis because it is a systemic disease process

53
Q

What hypertension medication can cause gout attacks?

A

Hydrochlorothiazide

54
Q

+ C-ANCA?

A

Wegner’s Granulomatosis

55
Q

+ Anti-Acetylcholine receptor antibody?

A

Myasthenia Gravis

56
Q

+ Anti-PM1 antibody, Anti-Jo antibody?

A

Polymyositis

57
Q

Anti-CCP (cyclic citrullinated peptide) is the most specific test for what disorder?

A

Rheumatoid Arthritis

58
Q

+ P-ANCA?

A

Churg-Strauss and ulcerative colitis

59
Q

+ Anti-basement membrane antibody?

A

Goodpasture’s Syndrome

60
Q

+ ASCA?

A

Crohn’s disease

61
Q

+ anticentromere antibody and anti-SCL 70 (AKA anti-topoisomerase)?

A

Scleroderma

62
Q

What type of fracture places patient at risk for fat embolism?

A

Long bone fracture

63
Q

What exam finding is pathognomonic for fat embolism?

A

Petechial rash after long bone fracture

64
Q

Treatment for compartment syndrome with high compartment pressure of 35-40 mmHg?

A

Fasciotomy

65
Q

5 Ps to look for if compartment syndrome is suspected?

A

Pain - Pallor - Pulselessness - Paresthesias - Paralysis

66
Q

What is the name for a 5th metatarsal diaphysis fracture?

A

Jones Fracture

67
Q

Treatment for Achilles tendon rupture?

A

Surgical repair

68
Q

What is the Dx? + Thompson test of the ankle patient can’t stand on toes

A

Achilles tendon rupture

69
Q

Most common type of ankle sprain?

A

Lateral sprain from inversion of the foot (Anterior talofibular ligament)

70
Q

What is the most likely injury with a + posterior drawer and posterior sag sign?

A

PCL injury/tear

71
Q

What is the most likely injury with a + anterior drawer test of the knee?

A

ACL injury/tear

72
Q

What is the most likely injury after a varus stress trauma to the knee?

A

LCL injury

73
Q

What is the most likely injury with a + McMurrays test of the knee?

A

Meniscal tear/injury

74
Q

What is the most likely injury with a + Lachman s test of the knee?

A

ACL injury

75
Q

Treatment for Osgood-Schlatter?

A

Conservative: Ice - NSAIDs - Protective pad over area

76
Q

Where is pain and swelling located with Osgood-Schlatter disease?

A

Tibial tubercle/tuberosity (the point of insertion of patellar tendon)

77
Q

Should DVT prophylaxis be provided to all hip FX patients (unless contraindicated) after ORIF of the hip?

78
Q

What is the Dx? Elderly patient after a fall with an externally rotated and shortened left leg.

A

Left hip fracture

79
Q

Name 2 common risk factors for developing a hip fracture.

A

Osteoporosis - Elderly

80
Q

What is the best imaging study for congenital hip dysplasia?

A

Ultrasound

81
Q

What is the Dx? Obese child with hip pain limp and altered gait.

A

Slipped capital femoral epiphysis

82
Q

What is the best imaging for avascular necrosis?

A

MRI of the hip

83
Q

What is the Dx? Persistent hip pain after trauma which is worse with weight bearing starts in groin and radiates to thigh.

A

Avascular necrosis

84
Q

How do claudication and pseudoclaudication differ?

A

Claudication occurs from decreased arterial flow - Pseudoclaudication occurs from nerve compression in spinal stenosis

85
Q

What is the Dx? Elderly patient with pain worse with walking and standing better lying down or leaning forward (grocery cart test).

A

Spinal stenosis with pseudoclaudication

86
Q

What extra articular manifestations can be seen in patients with ankylosing spondylitis?

A

Uveitis - Cardiac abnormalities - Interstitial lung disease - CAD - IgA nephropathy

87
Q

What is the Dx? Young man with chronic back pain and stiffness and +HLA-B27 and high ESR.

A

Ankylosing Spondylitis

88
Q

What age group usually presents with scoliosis?

A

Teenage girls at onset of puberty to the time of cessation of growth

89
Q

What is the Dx? Oblique X-ray of the Lumbar spine shows L5 with a Scottie dog with collar.

A

Spondylolysis

90
Q

What is the Dx? Back pain after lifting heavy boxes with lower extremity weakness decreased sensation and + straight leg raise.

A

Lumbar herniated nucleus pulposus (HNP)

91
Q

Name the syndrome. Hemisection of the spinal cord and loss of motor function/vibration/proprioception on same side, and loss of sensation/pain/temperature on opposite side.

A

Brown-Sequard Syndrome

92
Q

What is it called when a vertebral body slips anteriorly?

A

Spondylolisthesis

93
Q

What condition does bladder or bowel incontinence with back injury indicate?

A

Cauda equina syndrome (requires immediate neurosurgical consultation

94
Q

Which nerve root does the ankle reflex test?

95
Q

Motor nerve root for great toe?

96
Q

Is a clay shoveler’s fracture stable or unstable?

97
Q

Are Jefferson and hangman’s fractures stable or unstable injuries?

A

Both are unstable neck fractures

98
Q

What type of fracture consists of an avulsion fracture of the spinous process of C6 or C7?

A

Clay shoveler’s fracture

99
Q

What type of fracture has bilateral fractures in anterior and posterior arches of C1?

A

Jefferson Fracture

100
Q

What type of trauma is a hangmans fracture associated with?

A

Hyperextension and compression of the cervical spine

101
Q

What type of fracture occurs through the pedicles of C2 with anterior slip of C2 on C3?

A

Hangman’s fracture

102
Q

Describe a positive Spurling test.

A

Pain or radiculopathy with axial loading of the cervical spine

103
Q

What does a + Spurling test indicate?

A

Cervical nerve root compression

104
Q

What is the most likely Dx? Neck pain after MVA with paraspinal muscle tenderness. C-spine X-ray shows reversal of normal lordosis but no fracture.

A

Cervical Strain (Whiplash)

105
Q

What causes herpetic whitlow?

A

Herpes Simplex Virus (HSV)

106
Q

What is a felon?

A

An abscess in the tip of the finger

107
Q

Preferred treatment for Dupuytren’s contracture?

A

Surgical release

108
Q

How do you treat fractures of the fourth and fifth metacarpal?

A

Ulnar gutter splint

109
Q

Fourth and fifth metacarpal fracture?

A

Boxer’s fracture

110
Q

What complication are scaphoid fractures at risk for?

A

Avascular necrosis

111
Q

What is the treatment for a scaphoid fracture?

A

Thumb spica splint

112
Q

What does snuff box tenderness after a fall indicate?

A

Possible scaphoid fracture (Treat snuff box tenderness as a fracture)

113
Q

Treatment for Gamekeeper’s thumb injury?

A

Thumb spica splint

114
Q

What injury can occur with a fall on an abducted thumb?

A

Gamekeepers thumb (AKA: Skiers thumb)

115
Q

What bone is involved in both Colles and Smith fractures of the wrist?

A

Distal radius

116
Q

What is the most likely wrist fracture in a patient who fell with their hand closed or received a blow to the back of the wrist?

A

Smith fracture (AKA: Reverse Colles)

117
Q

What is the most common wrist fracture in a patient who fell with an out stretched hand?

A

Colles fracture: Results in a silver fork or dinner fork deformity

118
Q

Describe the symptoms of De Quervain’s tenosynovitis.

A

Pain and swelling at base of thumb may radiate to radial aspect of wrist

119
Q

What does a positive Finkelstein test indicate?

A

De Quervains tenosynovitis

120
Q

What is the Dx? Patient with numbness and tingling in 4th and 5th fingers (ulnar distribution).

A

Cubital Tunnel Syndrome

121
Q

What metabolic conditions are often associated with carpal tunnel syndrome?

A

Diabetes - Thyroid Disease - Pregnancy - EtOH abuse

122
Q

What condition does a positive Tinel’s and Phalen’s sign suggest?

A

Carpal tunnel syndrome

123
Q

Describe Phalen’s sign.

A

Phalen’s sign: Pain/tingling with maximal wrist flexion for several minutes

124
Q

Describe Tinel’s sign.

A

Tinel’s sign: Pain/paresthesias when you tap the volar wrist

125
Q

What is the Dx? Wrist/hand pain worse at night and with repetitive motions but alleviated by shaking hand

A

Carpal tunnel syndrome

126
Q

What type of subluxation usually occurs from quickly pulling on a childs lower arm?

A

Radial head subluxation (AKA: Nursemaid’s elbow)

127
Q

What does a Fat pad sign on an elbow X-ray indicate?

A

Elbow fracture

128
Q

What is the Dx? Acute swollen elbow after bumping it on a table.

A

Olecranon bursitis (AKA: Scholar’s elbow)

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