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EOR Exam - Family Medicine > Orthopedics and Rheumatology > Flashcards

Orthopedics and Rheumatology Flashcards

1
Q

What are the most common causes of low back pain?

A

Low back strain and prolapsed intervertebral disc

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2
Q

Differentiate the features of low back pain associated with a musculoskeletal cause, sciatica, SI joint problems, and spinal stenosis.

A

MSK: Point tenderness and localized to one region
Scia: Pain in buttock, posterior thigh, posterolateral aspect of leg to lateral malleolus.
SI: Unilateral low back and butt pain that worsens with standing
Sten: Pain in elderly worsened by walking and better when leaning forward.

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3
Q

T/F: X-ray is the best test to use on initial exam of a patient with complaint of low back pain.

A

False: X-ray typically not required if neuro exam is normal

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4
Q

What are the red flag S/S of low back pain?

A

fever, weight loss, morning stiffness, IVDU or steroid use Hx, trauma, CA, saddle anesthesia, loss of anal sphincter tone, motor weakness (req emergent x-ray)

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5
Q

What are the best uses of CT and MRI in the patient with low back pain?

A

CT: identifying bony stenosis and lateral nerve root entrapment
MRI: cord pathology, neural tumors, stenosis, herniated discs, and infections

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6
Q

What is the recommended treatment for uncomplicated low back pain?

A

Rest for 2 days with support under knees and neck
NSAIDs
Progressive walking to normal activities
Postural exercises/PT
Imaging if no improvement in 6 weeks
Surgery if conservative therapy fails (about 5%)

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7
Q

Define bursitis.

A

Inflammation of the thin walled sac lined with synovial tissue located in larger moveable joints.

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8
Q

Describe the common S/S and treatment for bursitis.

A

S/S: pain and swelling that may persist for weeks

Tx: Rest, brace/support, stretching, NSAIDs, steroid injection

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9
Q

Define and state common S/S associated with tendonitis.

A

Tendon inflammation most commonly s/p overuse and arthritis. S/S = pain with movement, swelling, impaired function, commonly recurrs.

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10
Q

What is the treatment for tendonitis?

A

Rest, ice, stretching, NSAIDs, steroid injection, surgery if conservative therapy fails.

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11
Q

Define and state common S/S associated with costochondritis.

A

Inflammation of rib cage cartilage. S/S: tender, radiating pain down limbs, C/P - often with inspiration

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12
Q

What are the risk factors for costochondritis?

A

Age > 40, high impact sports, manual labor, allergies, RA, ankylyosing spondylitis, reactive arthritis

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13
Q

What is used in diagnosis and treatment of costochondritis?

A

Dx: clinical –> imaging, ECG, serum labs to r/o other conditions
Tx: NSAIDs, lifestyle changes, rest, ice

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14
Q

Define and state the S/S of fibromyalgia.

A

Central pain disorder. S/S: non-articular MSK pain, fatigue, sleep disturbance, mood changes, cognitive disturbance, multiple trigger points, dysmenorrhea, IBS

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15
Q

How is fibromyalgia diagnosed and what other conditions should be ruled out?

A

Dx of exclusion –> r/o hypothyroid, Hep C, vitamin D deficiency

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16
Q

Describe the treatment of fibromyalgia.

A

SSRIs, SNRIs, TCAs may be helpful
Gabapentin to reduce pain and improve sleep
Exercise without overtraining
Treat associated psych disorders –> CBT, sleep assistance, stress reduction, mindfulness

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17
Q

T/F: NSAIDs are an essential part of treatment for pain associated with fibromyalgia.

A

False: NSAIDs have no benefit

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18
Q

What is the most common soft tissue tumor of the hand and what are they caused by?

A

Ganglion cyst –> arise from torn or degenerated joint capsule or tendon

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19
Q

What are the most common locations for a ganglion cyst and what is the most common cause?

A

Location: wrist and fingers
Cause: repetitive activity

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20
Q

What are the most common S/S associated with ganglion cyst?

A

Obvious swelling or joint pain with no obvious cause

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21
Q

Describe the treatment of ganglion cyst?

A

Observation, needle aspiration, surgery.

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22
Q

T/F: Ganglion cysts typically recur regardless of the treatment modality.

A

True

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23
Q

Define gout.

A

Altered purine metabolism and sodium urate crystal precipitate into synovial fluid.

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24
Q

T/F: Men are at much higher risk of gout than women.

A

True until menopause, then risk is equal.

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25
Q

What S/S are most commonly associated with gout?

A

podagra (attack at MTP of great toe), pain, swelling, redness, exquisite tenderness, tophi in chronic gout.

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26
Q

What are tophi?

A

Swollen, outgrowths at the joints under the skin

27
Q

State diagnostic findings in gout.

A

Joint fluid: negatively birefringent rods
Serum uric acid > 8 –> common but not diagnostic
X-ray: small, punched out lesions

28
Q

Describe treatment options for gout.

A

Lifestyle: elevation, rest, decrease purines in diet (meat, seafood, ETOH), weight loss, inc protein
NSAIDs –> indomethicin = drug of choice
Colchicine –> effective between attacks but bad GI AEs
Allopurinol –> DOC between attacks

29
Q

What medications should be avoided by patients with gout?

A

ASA, thiazide diuretics

30
Q

T/F: Allopurinol is used to reduce attacks of gout but is best to start when an attack is active.

A

False: never start allopurinol during acute attack

31
Q

What is CPPD and what is the classic presentation?

A

Pseudogout –> usually older than 60 yoa, occurs in large joints in the lower extremities, S/S similar to gout but no tophi present.

32
Q

State diagnostic findings in pseudogout.

A

Joint fluid: positive birefringent –> rhomboid shaped Ca pyrophosphad crystals
X-ray: fine, linear calcifications in cartilage

33
Q

Describe treatment options for pseudogout.

A

NSAIDs for acute attacks (steroid injections an option)

Colchicine for prophylaxis (benefit controversial)

34
Q

Define osteoarthritis.

A

Progressive loss of articular cartilage with reactive changes in bone.

35
Q

T/F: Osteoarthritis is a clinical diagnosis in which imaging has no benefit.

A

False: 90% of osteoarthritis patients have evidence of disease on X-ray

36
Q

Describe the S/S of osteoarthritis.

A

Dec ROM, joint crepitus, morning stiffness with pain that worsens throughout the day

37
Q

What x-ray findings are indicative of osteoarthritis?

A

asymmetric joint narrowing, subcondral sclerosis, bony cysts, marginal osteophytes.

38
Q

What are the treatment options for osteoarthritis?

A

DOC = APAP

Weight reduction, moderate exercise, NSAIDs, intra-articular steroids, braces, canes, joint replacement

39
Q

Define osteoporosis.

A

Decrease in bone density s/p abnormal bone remodeling leading to increased risk of fracture.

40
Q

Differentiate between type 1 and type 2 primary osteoporosis.

A

1: Post-menopausal (most prevalent) –> loss of estrogen or testosterone in men
2: senile –> occurs equally in men and women.

41
Q

What bones are most commonly affected/fractured in primary osteoporosis?

A

1: Trabecular bone –> vertebrae, hip, distal radius
2: trabecular and cortical bone –> hip and pelvis

42
Q

What conditions most commonly cause secondary osteoporosis?

A

Malignancy, steroid use, GI disease, hormone issues

43
Q

What is the most beneficial method to evaluate patients for osteoporosis and when should it be used for screening?

A

DEXA scan –> Postmenopausal women < 65 yoa with one or more risk factor, Any woman > 65, women on HRT, osteopenia on x-ray, Fx with minimal trauma, patients with Hx of RA

44
Q

Describe the normal and abnormal findings of a DEXA scan.

A

T-score > -1 = normal
T-score between -1 and -2.5 = osteopenia
T-score < -2.5 = osteoporosis

45
Q

What are the management options for osteoporosis?

A

Prevention: weight bearing exercise, dec ETOH, ensure adequate Ca, Vitamin D, Phosphorus, smoke cessation
Bisphosphonate = DOC
HRT = risk for MI, breast cancer, blood clots

46
Q

Describe plantar fasciitis and state which patients are most susceptible.

A

Micro-tears in the plantar fascia and the calcaneal origin. Most common in runners and overweight patients.

47
Q

What S/S are most commonly associated with plantar fasciitis?

A

Pain with first few steps in the morning, heel pain at night, pain at calcaneal origin, inflexible achilles

48
Q

What findings on imaging are most common in plantar fasciitis?

A

X-ray: normal

MRI: calcifications of plantar fascia

49
Q

What treatment options are available for plantar fasciitis?

A

Conservative for first 6-12 months –> PT, stretching, heel pads, arch supports, massage with tennis ball
Steroid injections
Surgery only for extreme cases

50
Q

What is the risk of steroid injections to treat plantar fasciitis?

A

Rupture of plantar fascia –> use with caution

51
Q

What is another name for reactive arthritis and what is the classic triad of symptoms?

A

Reiter’s Syndrome –> “can’t see, can’t pee, can’t climb a tree” –> urethritis, oligoarthritis of large joints, uveitis.

52
Q

Other than the classic triad, what are other clinical features of reactive arthritis?

A

Usually preceded by an STI, asymmetric arthritis usually involving large joints below the waist, mucocutaneous lesions.

53
Q

What diagnostic findings are commonly present in reactive arthritis?

A

Most are HLA-B27 positive, synovial fluid culture is negative, evidence of permanent and progressive joint disease on x-ray.

54
Q

What is the best management for reactive arthritis?

A

NSAIDs = mainstay of treatment, PT, Abx at time of infection can lower risk but do not alleviate symptoms after development.

55
Q

Define rheumatoid arthritis.

A

Chronic inflammatory disease with synovitis affecting multiple joints and extra-articular manifestations.

56
Q

T/F: Women are more likely than men to have rheumatoid arthritis.

A

True: women are three times more likely

57
Q

What are the S/S of rheumatoid arthritis?

A

joint pain and deformity, muscle weakness, osteopenia, extra-articular changes in skin, lungs, kidneys, eyes, blood system, and heart.

58
Q

What lab and imaging findings are used to diagnose rheumatoid arthritis?

A 
ESR and CRP elevated (non-specific)
RF positive in 80% of patients
ACPA and anti-CCP positive in 95% of patients --> most specific test for RA
Absence of ANA used to exclude SLE
X-ray = juxta-articular demineralization
59
Q

How is rheumatoid arthritis treated?

A

Refer to rheumatology
PT and OT
Pharmacology early –> NSAIDs and DMARDs, combo therapy with steroids and biologics (newer DMARDs)
Reconstructive surgery in severe cases

60
Q

Define DMARDs and give some examples.

A

Disease Modifying Antirheumatic Drugs

Methotrexate (first line), sulfasalazine, hydroxychloriquine, leflunomide, azathioprine.

61
Q

What is the most commonly affected ligament in an ankle sprain?

A

Anterior Talofibular

62
Q

What is required to diagnose systemic lupus erythematosus?

A

At least four of the following: maloid rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disease, ANA, hematologic disorders, immunologic disorders (LE cell, anti-DNA, anti-SM), neuro disorders (seizures/psychosis) with no other cause

63
Q

What medications may induce SLE?

A

Procainamide, hydralazine, isoniazid, methyldopa, quinidine, chlorpromazine

64
Q

What serum labs are used to diagnose SLE?

A

ANA present 99% of the time but not specific to lupus
Presence of Anti-dsDNA is specific for lupus
Anti-Smith antibodies used to monitor disease progression.

EOR Exam - Family Medicine (15 decks)

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