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Primary Care > Ortho/Rheumatology > Flashcards

Ortho/Rheumatology Flashcards

1
Q

Image after ___ weeks if failed conservative treatment for low back pain.

A

6

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2
Q

Pain in a dermatomal pattern w/ increased pain with coughing, straining, bending, and sitting is associated with a ______.

A

Herniated disc

  • MC L5-S1
  • *Pain may also radiate sown thigh/butt (Sciatica)
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3
Q

Dermatomal distribution…

A

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
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4
Q

____ is MC seen in patients >60y. Pain is worsened with extension, prolonged standing, and walking. Pain is relieved by FLEXION :).

A

Spinal Stenosis

*Treatment- lumbar epidural injection of corticosteroids, decompression laminectomy

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5
Q

Pain is worse with _____ (inspiration/expiration) when suffering from chostochondritis.

A

Worse with Inspiration!

*Tietze Syndrome is chostochondritis + localized palpable edema (swelling), heat, and erythema. MC affects 2nd and 3rd chostochondral junctions.

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6
Q

_____ is stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis. MOI is excessive thumb use w/ repetitive action.

A

de Quervain’s

  • Dx: (+) Finkelstein Test
  • *Tx: Thumb spica splint x 3 weeks
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7
Q

_____ 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.

A

Rheumatoid arthritis

*Boutonniere deformity & Swan neck deformity

**Felty’s syndrome- rare triad of RA + splenomegaly + decreased WBC

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8
Q

How is RA diagnosed?

A

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
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9
Q

How do you treat RA?

A
  1. 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
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10
Q

How is the pain of RA addressed (what meds)?

A
  • NSAIDs 1st line

- Corticosteroids 2nd line

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11
Q

_____ 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.

A

Osteoarthritis

*Treatment- Tylenol in elderly to avoid bleed risk although NSAIDs more effective in other populations

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12
Q

_____ is an autoimmune response to an infxn in another part of the body. it is associated w/:

  1. ARTHRITIS
  2. CONJUCTIVITIS
  3. URETHRITIS
A

Reactive arthritis or Reiter’s Syndrome

*Can get it 1-4 weeks post GC/Chlam or GI infxn

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13
Q

How is Reactive Arthritis diagnosed?

A

(+) HLA-B27

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14
Q

How is Reactive Arthritis treated?

A

NSAIDs!!! If no response, Methotrexate, steroids, or Anti-TNF agents

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15
Q

Attacks secondary to purine rich foods are associated with _____.

A

Gout

alcohol, liver, seafood, yeasts

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16
Q

What meds are known to precipitate gout?

A

Diuretics (thiazides, loop), ACEI, Pyrazinamide, Ethambutol, ASA, and ARBs (except Losartan which decreases uric acid levels)

17
Q

How is gout diagnosed?

A
  1. Arthrocentesis- Negatively Birefringent Needle-Shaped Urate Crystals!
  2. Radiographs- Mouse/Rat bite, punched out erosions w/ overhanging margins
18
Q

Acute treatment of gout involves…

A
  1. NSAIDs- Indomethacin, Naprosyn. AVOID ASA

2. Colchicine is 2nd line

19
Q

Chronic treatment of gout involves…

A

Allopurinol- take w/ meals, caution if renal dz. (Febuxostat if so)

20
Q

How is pseudogout diagnosed?

A

Positively Birefringent, Rhomboid Crystals!!

21
Q

How is pseudogout treated?

A

Intra-articular corticosteroids are first line, colchicine

22
Q

_____ is a multi-organ autoimmune disorder of connective tissues.

A

Systemic Lupus Erythematosus

23
Q

Lupus can be triggered by genes, envt sun exposure, infxn, hormones (estrogen) or certain medications such as:

A

Procainamide, Hydralazine, INH, Quinidine

(+) ANTI-HISTONE ANTIBODIES

24
Q

How is Lupus diagnosed?

A

Sensitive: Anti-Nuclear Ab (ANA)

Specific: Anti-Double Stranded DNA & Anti-Smith Antibody

*Antiphospholipid Ab Syndrome: increased risk of arterial and venous thrombosis!!

25
Q

Treatment for SLE includes:

A

Skin: Sun protection, Hydroxychloroquine (for lesions)

Arthritis: NSAIDs or tylenol

26
Q

There are 2 types of Osteoporosis- Primary and Secondary. A little more on this…

A

Primary:

  1. Postmenopausal
  2. Senile

Secondary: due to high cortisol states, chronic dz, hormones, medical therapy (heparin, anti-seizure)

27
Q

Pathologic fractures common with osteoporosis are:

A

MC vertebral!!

Hip, distal radius (Colle’s) w/ or w/o trauma

28
Q

What labs help diagnose osteoporosis?

A

Serum calcium, phosphate, PTH & ALP all usually NORMAL

LOW VITAMIN D, SCREEN FOR THYROID AND CELIAC DZ

29
Q

Some values…

A
  • Osteoporosis- bone density T score < -2.5
  • Osteopenia- T score < -1.0- -2.5
  • Normals= >1.0
30
Q

How is osteoporosis managed?

A
  • 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
31
Q

ADRs of estrogen in post-menopausal women:

A

-Increased risk for endomentrial and breast cancers, CAD, stroke, VTE

32
Q

Widespread muscular pain associated with fatigue that may be due to increased pain perception is known as ______.

A

Fibromylagia

*Dx- clinical and Muscle biopsy (“moth-eaten” appearance of type 1 muscle fibers)

**Treatment- exercise (swimming), Medical: TCAs, Duloxetine, SSRIs, Neurontin, Pregabalin

33
Q

Plantar Fasciitis:

A

Pain worse with dorsiflexion of toes and after rest

Pain usually decreases throughout the day

*Corticosteroids used with caution (may cause fascia rupture)

Primary Care (12 decks)

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