Rheum #5

Question 1

Common drug secondary cause of osteoporosis

Answer 1

corticosteroid prednisone equivalent dose >5.5mg day for at least 3 months

Question 2

what is the gold standard for dx of osteoperosis

Answer 2

DEXA

Question 3

DEXA scan values for osteoporosis

Answer 3

t-score less than -2.5 SD

Question 4

some radiological signs of osteoporosis

Answer 4

vertebral copression fx (wedge fx, requires 20% height loss)

Codfishing sign (biconcave vertebral discs)

Picture frame vetebra

Question 5

Clinical signs of fractures or osteoporosis (apparently)

Answer 5

weight < 51kg (Low BMI)

Wall-occiput distance > 0cm

Rib-pelvis distance < 2 finger breadth

Question 6

Per the osteoprosis risk stratification, what must you do with someone who is in the high risk category?

Answer 6

start pharmotherapy

Question 7

What is low, medium, high risk osteoperosis

Answer 7

low- 10 year fx risk <10%, reassess in 5

Medium- 10 year fx risk 10-20%, reassess in 1-3

high- 10 year fx risk >20%

Question 8

tx of osteoperosis (2 categories)

Answer 8

1. lifestyle
   - -Calcium/vit d 1000mg, exercise, stop smoking, lessen caffeine
2. Drug therapy- Bisphosphonate

Question 9

treatment specific to post-menopausal women

Answer 9

Raloxifene (1st line) is a selective estrogen receptor modulator –> helps prevent vertebral fractures

Hormone replacement therapy (combined estrogen + progesterone)

Question 10

what is septic arthritis and what is the biggest risk for it

Answer 10

Joint infection

–with a prosthetic joint

the more abnormal? the more likely
(prosthetic > RA > OA > normal joint

Question 11

etiology of septic arthritis (gonoccocal vs non-gonococcal)

Answer 11

N. gonorrhea (gonoccocal –> 75% of septic arthritis in young sexually active people)

S. Aureus, SAlmonella Spp(sickle), S pneumonia (children) (non-gonoccocal)

Question 12

gonococci vs nonconicoccle septic arthritis age

Answer 12

Gonococcal- <40

Non gonococcal- >80

Question 13

Big 3 investigations for septic arthritis

Answer 13

Arthrocentesis (joint aspirate will be cloudly, yellow incredibly high WBCs)

Plain x-ray (to rule out other stuff)

CRP (c-reactive protein monitors inflam response to therapy)

Question 14

best and most accurate investigation for septic arthritis

Answer 14

aspiration of the joint

Question 15

treatment for septic arthritis

Answer 15

empiric antibiotic therapy

ceftriaxone and vancomycin are best initial empiric therapies

Question 16

most common cause of septic arthritis

Answer 16

s. aureus

Question 17

in people with prior joint replacement, what should you consider as cause for septic arthritis

Answer 17

coagulase-negative staphylococcus1

Question 18

Most common route of infection for septic arhtritis

Answer 18

hematogenous

Question 19

most commonly affected joints (in descending order) for septic arthritis

Answer 19

knee, hip, elbow, ankle, sternoclavicular joint

Question 20

osteomyelitis (bone infection) most commonly caused by

Answer 20

staph aureus

Question 21

best diagnosis for osteomyelitis

Answer 21

X-ray, then go do MRI (or bone scan if cant do MRI)

Esr can be useful to follow response to therapy

Question 22

most accurate test for osteomyelitis

Answer 22

biopsy and culture

Question 23

how long will it take for osteomyelitis to show up on plain film x-ray

Answer 23

8-10 days after onset of infection

Question 24

tx for acute and chronic osteomyelitis

Answer 24

acute- IV antibiotics for 4-6w

chronic- surgical debridement, antibiotics

Question 25

2 aetiologies of compartment syndrome

Answer 25

intracompartamental- fracture

extracompartamental- constrictive dressing, poor position during surgery, circumferential burn

Question 26

5 P’s of compartment syndrome (these are late, do NOT wait for these to develop to diagnose hopefully)

Answer 26

Pain out of proportion not relieved by analgesics

• Pallor
• Parasthesia
• Paralysis
• Pulselessness

Question 27

most important sign of compartment syndrome

Answer 27

increased pain w/ passive stretch

Question 28

do we need investigations fo rcompartment syndrome?

Answer 28

no- clinical dx

Question 29

Complications of compartment syndrome

Answer 29

volkmann’s ischemic contracture- Ischemic nercrosis of mm folowed by secondary fibrosis

Rhabdomyolysis