Ortho/Rheumatology Flashcards
Image after ___ weeks if failed conservative treatment for low back pain.
6
Pain in a dermatomal pattern w/ increased pain with coughing, straining, bending, and sitting is associated with a ______.
Herniated disc
- MC L5-S1
- *Pain may also radiate sown thigh/butt (Sciatica)
Dermatomal distribution…
Sensory: think ALP
- L4- Anterior thigh pain
- L5- Lateral thigh/leg, hip
- S1: Posterior leg/calf
Weakness:
- L4- Ankle dorsiflexion
- L5- Walking on heals
- S1- Walking on toes- plantar flexion
____ is MC seen in patients >60y. Pain is worsened with extension, prolonged standing, and walking. Pain is relieved by FLEXION :).
Spinal Stenosis
*Treatment- lumbar epidural injection of corticosteroids, decompression laminectomy
Pain is worse with _____ (inspiration/expiration) when suffering from chostochondritis.
Worse with Inspiration!
*Tietze Syndrome is chostochondritis + localized palpable edema (swelling), heat, and erythema. MC affects 2nd and 3rd chostochondral junctions.
_____ is stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis. MOI is excessive thumb use w/ repetitive action.
de Quervain’s
- Dx: (+) Finkelstein Test
- *Tx: Thumb spica splint x 3 weeks
_____ is associated w/ a prodrome of fever, fatigue, and weight loss. It is also associated with small joint stiffness that is worse with rest.
On PE: swollen, tender, erythematous, “boggy” joint.
Rheumatoid arthritis
*Boutonniere deformity & Swan neck deformity
**Felty’s syndrome- rare triad of RA + splenomegaly + decreased WBC
How is RA diagnosed?
Sensitive- (+) Rheumatoid Factor (good initial test)
Specific- (+) Anti-CCP antibodies
- Must have arthritis in >3 joints lasting for >6 weeks
- *Xray- may see ulnar deviation of hand w/ narrowed joint space
How do you treat RA?
- Start DMARDs- Methotrexate 1st line!!
- Screen for HBV and HCV for all DMARDs
- *ADR of DMARDs= Hepatotoxicity
- **Other options (non-biologics):
- Leflunomide
- Hydroxychloroquine- retinal toxicity ADR :(
- Sulfasalazine
How is the pain of RA addressed (what meds)?
- NSAIDs 1st line
- Corticosteroids 2nd line
_____ is associated with OSTEOPHYTE formation and narrowed joint space. Evening joint stiffness decreases w/ rest.
PE: hard, bony joints. Heberden’s and Bouchard’s nodes.
Osteoarthritis
*Treatment- Tylenol in elderly to avoid bleed risk although NSAIDs more effective in other populations
_____ is an autoimmune response to an infxn in another part of the body. it is associated w/:
- ARTHRITIS
- CONJUCTIVITIS
- URETHRITIS
Reactive arthritis or Reiter’s Syndrome
*Can get it 1-4 weeks post GC/Chlam or GI infxn
How is Reactive Arthritis diagnosed?
(+) HLA-B27
How is Reactive Arthritis treated?
NSAIDs!!! If no response, Methotrexate, steroids, or Anti-TNF agents
Attacks secondary to purine rich foods are associated with _____.
Gout
alcohol, liver, seafood, yeasts
What meds are known to precipitate gout?
Diuretics (thiazides, loop), ACEI, Pyrazinamide, Ethambutol, ASA, and ARBs (except Losartan which decreases uric acid levels)
How is gout diagnosed?
- Arthrocentesis- Negatively Birefringent Needle-Shaped Urate Crystals!
- Radiographs- Mouse/Rat bite, punched out erosions w/ overhanging margins
Acute treatment of gout involves…
- NSAIDs- Indomethacin, Naprosyn. AVOID ASA
2. Colchicine is 2nd line
Chronic treatment of gout involves…
Allopurinol- take w/ meals, caution if renal dz. (Febuxostat if so)
How is pseudogout diagnosed?
Positively Birefringent, Rhomboid Crystals!!
How is pseudogout treated?
Intra-articular corticosteroids are first line, colchicine
_____ is a multi-organ autoimmune disorder of connective tissues.
Systemic Lupus Erythematosus
Lupus can be triggered by genes, envt sun exposure, infxn, hormones (estrogen) or certain medications such as:
Procainamide, Hydralazine, INH, Quinidine
(+) ANTI-HISTONE ANTIBODIES
How is Lupus diagnosed?
Sensitive: Anti-Nuclear Ab (ANA)
Specific: Anti-Double Stranded DNA & Anti-Smith Antibody
*Antiphospholipid Ab Syndrome: increased risk of arterial and venous thrombosis!!
Treatment for SLE includes:
Skin: Sun protection, Hydroxychloroquine (for lesions)
Arthritis: NSAIDs or tylenol
There are 2 types of Osteoporosis- Primary and Secondary. A little more on this…
Primary:
- Postmenopausal
- Senile
Secondary: due to high cortisol states, chronic dz, hormones, medical therapy (heparin, anti-seizure)
Pathologic fractures common with osteoporosis are:
MC vertebral!!
Hip, distal radius (Colle’s) w/ or w/o trauma
What labs help diagnose osteoporosis?
Serum calcium, phosphate, PTH & ALP all usually NORMAL
LOW VITAMIN D, SCREEN FOR THYROID AND CELIAC DZ
Some values…
- Osteoporosis- bone density T score < -2.5
- Osteopenia- T score < -1.0- -2.5
- Normals= >1.0
How is osteoporosis managed?
- Vitamin D and exercise!!
- Biphosphonates are 1st line: Alendronate, Risedronate, Ibandronate
- Raloxifene and estrogen in post-menopausal women reduces progression and helps with s/s of menopause
ADRs of estrogen in post-menopausal women:
-Increased risk for endomentrial and breast cancers, CAD, stroke, VTE
Widespread muscular pain associated with fatigue that may be due to increased pain perception is known as ______.
Fibromylagia
*Dx- clinical and Muscle biopsy (“moth-eaten” appearance of type 1 muscle fibers)
**Treatment- exercise (swimming), Medical: TCAs, Duloxetine, SSRIs, Neurontin, Pregabalin
Plantar Fasciitis:
Pain worse with dorsiflexion of toes and after rest
Pain usually decreases throughout the day
*Corticosteroids used with caution (may cause fascia rupture)
