Ortho/Rheum Flashcards
Pt p/w arthritic symptoms at multiple joints and has a positive anti-cyclic citrullinated peptide antibody blood test. Diagnosis?
Rheumatoid arthritis
What is the order of medications used in treatment of osteoarthritis?
Tylenol first then NSAIDs
What medications should be started in a newly diagnosed rheumatoid arthritis patient?
NSAIDs and a DMARD usually methotrexate first + a biologic like rituximab or infliximab
Patient presents with pain in a joint, the joint fluid comes back with 35k WBCs, likely diagnosis? Other options and why did you rule them out?
Dx Rheumatoid arthritis - 200-300 wbcs is usually OA, > 50k is usually septic joint
What is the typical sex of a Rheumatoid Arthritis patient?
Female
A 14 yo F p/w recent high fevers, salmon-pink maculopapular rash in the evenings, polyarthragias and myalgias for > 6 weeks. Pt has lymphadenopathy on exam. Dx? Treatment?
Juvenile rheumatoid arthritis: NSAIDs
What is the probability that a patient with juvenile RA will progress to full RA?
higher if positive for rheumatoid factor (10-15% of pts) but generally only 20%
What is the most common pathogen for septic arthritis?
S. Aureus usually following procedure
What is the typical starting treatment for septic arthritis?
IV ceftriaxone - 2 total weeks of IV abx then more PO
What is the treatment for hip septic arthritis?
requires arthrotomy for drainage before IV antibiotics for 2 weeks
Patient with finger arthritis has a Pencil in Cup deformity of the proximal phalynx on xray. Diagnosis?
psoriatic arthritis
Sausage fingers
psoriatic arthritis
Pitting nails with arthritis
psoriatic arthritis
What is the treatment for reactive arthritis?
NSAIDs
Patient with a painful joint has joint fluid analysis which shows rod-shaped, negatively birefringent urate crystals. Diagnosis?
Gout
What is the initial drug of choice in Gout?
NSAIDs, usually indomethacin, until symptoms resolve
A patient with a painful joint’s joint fluid analysis shows rhomboid-shaped calcium pyrophosphate crystals that are positively birefringent. Diagnosis?
Calcium pyrophosphate dihydrate disease (pseudogout)
What is the treatment for Calcium pyrophosphate dihydrate disease (pseudogout)?
NSAIDs, Colchicine, intra-articular steroids
Pt being treated for HTN with hydralazine develops poly articular arthritis, oral ulcers and a malar rash which have occurred for several days a month for the past 6 months. What is the next step in diagnosis?
Switch to a different medication for HTN management to see if symptoms subside. Hydralazine can cause a lupus-like syndrome
A 56 yo female presents with proximal muscle weakness, rash and dysphagia. CPK is elevated. What is the next step in diagnosis? What condition commonly is concurrent?
Muscle biopsy to r/p polymyositis, commonly concurrent with occult malignancy
What is the treatment for polymyositis?
high-dose steroids, methotrexate or azothioprine until symptoms resolve
62 yo F p/w stiff neck and b/l hip joints worst in the morning, she reports feeling under motivated recently and has just been placed on an SSRI by her PCP. Diagnosis?What associated condition should be ruled out?
Polymyalgia rheumatica, temoral arteritis should be ruled out by biopsy
What is the treatment for polymyalgia rheumatica?
slow long term steroid taper
43 yo F with h/o Hep B presents with minor weight loss, anorexia, arthralgia, palpable purpura and levido reticularis (red mottling of extremities). What is the likely diagnosis?
Polyarteritis nodosa
What is the treatment of polyarteritis nodosa?
high dose steroids
35 yo F patient with finger/hand swelling and raynauds p/w dysphagia and new facial skin changes. Likely diagnosis?
Scleroderma
Patient with decreased oral secretions has a biopsy of the lower lip which shows lymphocytic infiltrate and gland fibrosis. What is the diagnosis?
Sjogren syndrome
What is a medical management for the dry mouth associated with sjogren’s syndrome?
pilocarpine
What are the treatments for fibromyalgia? (3 fold)
- SSRIs, SNRIs, or TCAs
- Lyrica
- Aerobic exercise/sleep assistance
What type of osteomyelitis are people with sickle cell disease prone to?
salmonella
What is the most common site of bony metastasis?
The spine
If someone has a primary bony tumor, what is the most likely origin?
Primarily benign bone/soft tissue rather than primary malignancies
What is the most common malignant bone tumor?
multiple myeloma
When does routine DEXA scan monitoring begin for the general population?
Postmenopause for women with at least 1 risk factor (fracture, on HRT for extended periods, with RA) or at age 65
What is the diagnostic study of choice to diagnose an occult hip fracture?
MRI
What is the ideal timeline to the OR for an open fracture?
4-8 hours
What medical management is appropriate after an open fracture?
Assess tetanus status and treat with IV antibiotics 48 hours post op usually 1/2nd gen cef or aminoglycoside
What is the treatment for a greenstick fracture?
< 15 degrees - splint in a cast for 4-6 weeks. > 15 degrees requires surgery
How long is immobilization after a joint dislocation?
2-4 weeks
What is the most common location c-spine spondylosis chronic changes?
C5-C6
How soon should PT begin after a shoulder dislocation?
< 40 years after 3 weeks > 40 years after 1 week
What is the the treatment of a clavicle fracture?
Children - figure 8 sling for 4-6 weeks. Adults: regular arm sling for 6 weeks
What is the typical organism found in wound infections caused by human bite marks?
Eikenella
What is gamekeeper’s thumb?
Weakness/laxity of ulnar collateral thumb ligament leading to weak pinching and pain
Patient with pain in the elbow picking up grocery bags, diagnosis?
lateral epicondylitis (tennis elbow)
If someone with snuffbox pain has a normal xray, what should the management be?
Repeat xray 2-3 weeks later to rule out a scaphoid fracture, place in thumb spica splint anyway
87 yo M c/o back pain that increases with walking and is relieved by leaning forward. Diagnosis?
spinal stenosis
What degree of scoliosis requires intervention?
10-20: close monitoring, > 20 intervention
Pt with TB develops a haunched appearance, diagnosis?
TB of the spine leading to kyphosis (Potts disease)
At what degree is kyphosis treated? How?
45-60: frequent observation and lordosis, > 60 with a Milkwaukee brace, surgery only when unresponsive to other treatments
A 5 yo brought in by his mother for left groin pain and limp x 5 days. What is the work up? What are you most concerned about?
MRI for Avascular necrosis of the femoral head
12 yo F p/w left knee pain and lump, what is the concerning condition? Work up? treatment?
Slipped capital femoral epiphysis, xray work up then crutches for no weight bearing until surgical pinning and then no weight bearing during recovery
McMurray’s test and Apley test are positive, what’s the diagnosis?
Medial meniscal tear
What is the treatment for Osgood-Schatter disease?
RICE and limit physical activity for several months
Patient injures her knee. What is the significance of swelling over the course of the next 3-4 hours versus over the next several hours?
More immediate swelling is associated with cruciate ligamentous tear instead of meniscal tear
Patient has a positive Lachman test, what is the diagnosis?
ACL tear
What physical exam test assess the stability of the ankle?
anterior drawer test
What is the diagnostic work up for bunions (Hallux valgus)? What is the indication for intervention?
weight bearing xray will show the degree of valgus deformity. >15% deformity is considered severe but surgery is based on unremitting pain
patient complains of foot pain on the first few steps in the morning and at night. On exam he has pain at the calcaneal origin and inflexibility of the achilles tendon. What is the diagnosis? Tx?
Plantar fasciitis: NSAIDs, physical therapy and stretching. Will likely take 6-12 months to improve
