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Internal Medicine > Orthopedics/Rheumatology Error List > Flashcards

Orthopedics/Rheumatology Error List Flashcards

1
Q

What is Guillin-Barre Syndrome

A

Ascending Weakness

Acute/Subacute inflammatory demyelinating polyradiculopathy with symmetric LOWER TO UPPER EXTREMITY WEAKNESS

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2
Q

What causes Guillain-Barre Syndrome

A

C. Jejuni
CMV
EBV
Immunizations (Flu)

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3
Q

Sx of Guillain-Barre Syndrome

A

Weakness and Paresthesias, usually symmetric
Decreased DTR
Tachycardia, Hypotension, HTN, Breathing Issues

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4
Q

Dx of Guillain-Barre Syndrome

A

CSF: High protein, Normal WBC

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5
Q

Tx of Guillain-Barre Syndrome

A

Plasmaphoresis to remove autoantibodies

IVIG to suppress inflammation and induced remyelination

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6
Q

What is Multiple Sclerosis

A

Autoimmune inflammatory demyelinating disease of CNS

Causes plaques and neurologic defeicits

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7
Q

What are the 3 different stages of MS

A

Relapsing-Remitting: Episodic Exacerbations
Progressive: Decline without acute exacerbations
Secondary Progressive: Relapse Remitting that becomes progressive

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8
Q

Sx of MS

A

Optic Neuritis: Unilateral eye pain worse with eye movement, Diplopia, Visual loss, color loss, blurry vision
Sensory deficits: Weakness, Parasthesias, Fatigue
Spinal Cord: Bladder or Bowel Dysfunction, Nystagmus, Staccato Speech

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9
Q

Dx of MS

A

MRI with Gadolinium is gold standard: see White Matter Plaques
CSF: See increased IgG

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10
Q

Tx of MS

A

Steroids for acute exacerbations
Beta-Interferon for Relapse-Remitting
Amantadine for fatigue

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11
Q

What are Generalized Seizures

A

Diffuse brain involvement

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12
Q

What is an Absence Seizure, Sx, Dx, Tx

A

Brief impairment of consciousness
Brief staring episodes, Eyelid Twitching
Dx: EEG see bilateral symmetric 3Hz spike and wave action or may be normal
Tx: Ethosuximide, Valproic Acid

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13
Q

What is a Tonic-Clonic Seizure, Sx, Dx, Tx

A

Loss of Consciousness with rigidity and arrest of respiration followed by repeitive jerking
Has post-ictal phase: Flaccid coma/sleep
Dx: EEG see generalized high amplitude rapid spiking
Tx: Valproic Acid, Phenytoin, Carbamazepine

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14
Q

What is Myoclonus seizure, Sx, Dx, Tx

A

Sudden brief sporadic involuntary twitching
No Loss of Consciousness
Tx: Valproic Acid, Clonazepine

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15
Q

What is Atonic Seizure, Sx, Dx, Tx

A

Drop Attacks, Sudden Loss of Postural Tone

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16
Q

What is Status Epilepticus, Sx, Dx, Tx

A

Repeated, Generalized seizures without recovery >30 min.

Tx: Lorazepam or Diazepam, Phenytoin, Phenobarbital

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17
Q

What is a Subarachnoid Hemorrhage

A

Due to ruptured aneurysms which are usually caused by HTN

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18
Q

Sx of SAH

A

Sudden onset, worst headache of my life, brief loss of consciousness, N/V, Meningeal Irritation (nuchal rigidity), seizures

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19
Q

Dx of SAH

A

CT scan without contrast (want to see hte blood)
If negative but still suspicious, do LP
If increased ICP and RBC present it’s SAH
Can also do CT angiography

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20
Q

Tx of SAH

A

Bedrest, no exertion, no straining
Anti-anxiety meds, stool softeners
BP control, seizure control

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21
Q

What is Friedrich’s Ataxis

A

Autosomal recessive that causes sx in children, teens, and young adults

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22
Q

Sx of Friedrich’s Ataxis

A

Starts as gait ataxia, difficulty walking, then worsens and spreads to arms and trunk
Loss of sensation in extremities
Reduced DTR, Scoliosis, Dysarthria, Chest Pain, SOB, heart palpitations, Vision Impairment

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23
Q

Dx of Friedrich’s Ataxia

A

Clinical

Electromyogram, Nerve Conduction Studies, EKG, Echo

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24
Q

Tx of Friedrich’s Ataxis

A

Ace-I
Digoxin
Physical Therapy

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25
Q

What is Fibromyalgia

A

Central Pain Disorder

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26
Q

Sx of Fibromyalgia

A

Aches, Pains, Fatigue, sleep distrubances, tender points

Anxiety, depression, IBS

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27
Q

Dx of Fibromyalgia

A

No lab test
Exclude thyroid disease
Diffuse pain in 11/18 pressure points for >3 months
Biopsy: Moth eaten appearance type I muscle fibers

28
Q

Tx of Fibromyalgia

A

TCA (Amitriptyline, Nortriptyline, Amoxapine, Clomipramine)

Pregabalin is the only FDA approved drug for Fibromyalgia

29
Q

What is Osteoarthritis

A

Chronic disease due to articular cartilage damage and degeneration
Seen in weight bearing joints (knees, hips, cervical/lumbar spine)

30
Q

Sx of Osteoarthritis

A

Evening joint pain and stiffness relieved with rest
Gets worse as day goes on and changes in weather
Herberden’s Nodes: Palpable Osteophytes at DIP
Bouchard’s Nodes: PIP Osteophytes

31
Q

Dx of Osteoarthritis

A

XRay: Assymetric joint space narrowing, osteophyte formation, subchondral cysts, sclerosis

32
Q

Tx of Osteoarthritis

A

Acetaminophen in elderly due to risk of bleeding
NSAIDS
Corticosteroid injections
Avoid high impact exercises

33
Q

What is Rheumatoid Arthritis

A

Chronic inflammatory idsease with persistent symmetric polyarthritis with bone erosions, cartilage destruction and joint structure loss

34
Q

Sx of Rheumatoid Arthritis

A

Prodome: Constitutional sx
Small Joint Stiffness
MCP, Wrist, PIP, KNee, MTP, Shoulder, Ankle
Worse with rest
Morning stiffness >60 minutes after initiating movement but gets better as day goes on
Swollen tender erythematous “boggy” joints
Swan neck deformity
Ulnar deviation at MCP joint
Rheumatoid Nodules: Hard and Bony Joints

35
Q

Dx of Rheumatoid Arthritis

A

+Anti-CCP (Most specific)
+RF
Arthritis >3 joints, morning stiffness, duration >6wks
Xray: Symmetric joint space narrowing, ulnar deviation of hand, subluxation, deformities

36
Q

Tx of Rheumatoid Arthritis

A

DMARDS like methotrexate, Azotriapine, Hydroxychloroquine
Anti-TNF
NSAIDS for pain, Low dose steroids

37
Q

What is Systemic Lupus Erythematous

A

Chronic systemic, multi-organ autoimmune disorder of connective tissue

38
Q

Who gets SLE

A

Young females, AA, Hispanics

39
Q

Sx of SLE

A

TRiad of joint pain, malar “butterfly” rash, fever
Rash spares nasolabial folds
Serosities: Pericarditis, Pleuritis
Discoid Lupus: Annular, Erythematous patches on face and scalp
Systemic: CNS, Glomerulonephritis, Retinitis, Oral Ulcers, Alopecia

40
Q

Dx of SLE

A

+Anti-dsDNA
+Anti-Smith Antibodies
+RF
+ANA

41
Q

Tx of SLE

A

SUn protection
Hydroxychloroquines for skin
NSAIDS, acetaminophen for arthritis

42
Q

What is Polyarteritis Nodosum

A

A vasculitis of medium/small vessels that leads to necrotizing inflammatory lesions

43
Q

What is Polyarteritis Nodosum associated with

A

Hepatitis B, Increased Microaneurysms

44
Q

Sx of Polyarteritis Nodosum

A

Renal: HTN, Renal Failure
CNS: Neuropathy, Mononeuritis Complex
Derm: Livedo Reticularis Purpura (reticular, lacy rash), ulcers, gangrene, Raynaud’s Phenomena

45
Q

Tx of Polyarteritis Nodosum

A

Steroids

Cyclophosphamide (immune-suppressant)

46
Q

What is Low back strain

A

Nerve root impingement
Suspected when pain is leg-dominant rather than back-dominant
Cauda Equina often presents with bowel or bladder sx

47
Q

Tx of Low Back Strain

A

Physical Therapy
NSAIDS, Corticosteroid injections
Surgery for cauda equina

48
Q

What is Spinal Stenosis

A

Narrowing of spinal canal with impingement of nerve roots and cauda equina
Seen in people >60yrs

49
Q

Sx of Spinal Stenosis

A

BAck pain with parasthesias on one or both extremities
Worse with extension, prolonged standing/walking
Relieved with flexion, sitting/walking uphill
Pain may radiate to thigh

50
Q

Tx of Spinal Stenosis

A

Steroid Injections at lumbar region to reduce inflammation
Physical therapy or bending over helps open canal which relieves sx
Definitive: Surgery, Decompression Laminectomy

51
Q

What is Raynaud’s Phenomenon

A

Paroxysmal Digital Ischemia

52
Q

What causes Raynaud’s Phenomenon

A

Cold or Emotional Stress

Excessive vasoconstriction leads to cyanosis of fingers followed by vasodilation leading to hyperemia and rubor

53
Q

What is Raynaud’s Phenomenon associated with

A

Scleroderma

54
Q

Tx of Raynaud’s Phenomenon

A

Keep warm, avoid stress

CCB are 1st line for vasodilation (Nifedepine, Amlodipine, Felodipine)

55
Q

What is Polymyalgia Rheumatica

A

Idiopathic inflammatory condition causing synovitis, bursitis, and tenosynovitis

56
Q

Who gets Polymalgia Rheumatica

A

Women >50yrs

57
Q

What is closely associated with Polymyalgia Rheumatica

A

Giant Cell Arteritis

58
Q

Sx of Polymyalgia Rheumatics

A

Aching/Stiffness of proximal joints (shoulders, Hip, Neck)
Bilateral proximal joint pain/stiffness, morning stiffness>30 minutes of pelvis and shoulder girdle
Difficultly combing hair, putting on coat, getting out of chair
No severe muscle weakness

59
Q

Dx of Polymyalgia Rheumatica

A

Clinical
Increased ESR
Anemia

60
Q

Tx of Polymyalgia Rheumatica

A

Corticosteroids

Methotrexate

61
Q

What is Ankylosing Spondylitis

A

Chronic inflammatory arthropathy of Axial Skeleton and Sacroiliac Joints with progressive stiffness

62
Q

Who gets Ankylosing Spondylitis

A

Young Males 15-30yrs

63
Q

Sx of Ankylosing Spondylitis

A

Chronic Low back pain, morning stiffness with reduced ROM
Back stiffness decreases with exercise/activity
Peripheral ARthritis: Saroilitis (Bilateral), Kyphosis, Large joint arthritis
Extra Skeletal: Pulmonary Fibrosis, Aortitis, Colitis, Amyloidosis, Sarcoidosis

64
Q

Dx of Ankylosing Spondylitis

A 
Increased ESR
\+HLA-B27
Negative ANA
Negative RF
Xray: Bamboo spine (squaring of vertebral bodies)
65
Q

Tx of Ankylosing Spondylitis

A

NSAIDS
Rest, physical therapy 1st line
TNF-alpha inhibitors (Infliximab)
Steroids

Internal Medicine (16 decks)

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