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Step 3 > Rheum/Ortho > Flashcards

Rheum/Ortho Flashcards

1
Q

What type of fracture is commonly seen after a FOOSH?

A

Collees fracture
Distal radius
Have to also worry about scaphoid fractures, carpal tunnel

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2
Q

at what age do people usually develop spinal stenosis

A

60s

Unusual to see it in the younger population

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3
Q

Best way to dx spinal stenosis?

A

MRI

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4
Q

Which antibodies are associate with SLE?

A

Anti-dsDNA and Anti-smith

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5
Q

What Ab levels can be used to monitor dz severity in SLE?

A

Anti-dsDNA

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6
Q

How do you treat a SLE pt that has mostly joint and cutaneous symptoms

A

Prednisone + plaquenil

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7
Q

Proximal muscle weakness
Elevated LFTs
Rash over dorsum of hand
Dx?

A

Dermatomyositis

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8
Q

IF you dx someone with dermatomyositis, what other work up do you need to do?

A

Cancer work up

Especially cervical, ovarian, pancreatic, stomach, bladder, lung

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9
Q

What is the best way to transport a severed digit?

A 
Wrap in gause
Moisten with saline
put in sterile plastic bag
place in cooler filled with saline mixed with ice
Try to not cool below 40F
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10
Q

Pts with rotator cuff injuries tend to say they have pain in which part of the shoulder?

A

Lateral

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11
Q 
Irritable infant x 2 days
Afebrile
Hip is flexed, abducted, and externally rotated and does not move it voluntarily
WBC, ESR, CRP elevated
Dx?
A 
Septic arthritis
irritability + poor feeding + pseudo paralysis 
\+/- fever
Elevated WBC, CRP, ESR
Tx - surgical drainage + abs
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12
Q

Ab in Sjogren syndrome?

A

Anti-Ro SSA and anti-La/SSB

about 50% of pmts are positive for one of these

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13
Q

Sjogren’s syndrome is associate with which malignancy?

A

B cell non-Hodgkin’s lymphoma lymphoma
Because Sjogren’s is caused by B cell activation
Can present as lymphadenopathy, particularly in salivary glands
Risk is 5% for Sjogren’s patients, much higher than the gen pop

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14
Q

Pt traveled to carribean
Had a brief URI
Now months later has b/l symmetric polyarthralgia or the distal joints

A

Chikungunya fever
Mosquito borne
Most self-resolve, 30% of pmts have chronic arthralgia
Dx - PCR

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15
Q

Knee pain after landing from a jump
Anterior knee swelling
difficulty extending the knee or lifting leg off a table

A

Patellar tendon rupture

Tx - surgery

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16
Q

Teenager with recent Viral URI, maculopapular rash
Followed by polyarthritis - symmetric stiffness of small joints
Dx?

A

Parvo
Teens tend to get arthralgia
Dx - IgM antibodies

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17
Q

Pt with joint stiffness in 2nd and 3rd MCP joints, knees, ankles shoulders
Enlarged liver on exam
joint tap with rhomboid shaped crystals

A

Hemochromatosis
most often affects 2nd and 3rd MCP joints
50% of patients can have calcium pyrophosphate dehydrate crystals (rhomboid)
ar, typically presents at 40-60 y/o

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18
Q

Thoracic or lumbar prominence on forward bend test in a teen suggests?

A

Scoliosis. Get some X-rays

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19
Q

When do you intervene on Scoliosis Xray?

A

When Cobb angle is >10 degrees
Only dx with scoliosis when >10 degree
Low/medium risk 10-30; brace these kids
angle >40 degrees –> surgical intervention

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20
Q

Most sensitive modality for dx’ing osteonecrosis?

A

MRI

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21
Q

Monosodium urate crystals
needle-shaped
Negative birefringent

A

Gout

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22
Q

1st line tx for acute gout?

A

Indomethacin

Colchicine if they have a contra to NSAIDs

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23
Q

What should you give patients that you start on chronic steroids for osteoporosis prevention?

A

Vit D and Calcium

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24
Q

back pain + sciatica exacerbated by bending forward

Dx?

A

Nerve root irritation

Has a + straight leg test

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25
Q

MVA passenger, knees hit dashboard

Worry about?

A

PCL injury

don’t always feel unstable

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26
Q

Pt with minor MSK injury now months later with localized burning, edema, skin changes, and decreased ROM

A

Complex regional pain syndrome
stage 1 - burning, pain edema vasomotor changes
stage 2 - edema, skin thickening, atrophy
stage 3 - limited ROM and bone demineralization
Dx - autonomic testing or MRI
Tx - nerve block

27
Q

When would you not treat a pt with a Cobb angle between 10-40

A

IF they’re bones are mature (ie if they are Tanner 5)

28
Q

avid athlete, pain over lateral ankle, + TTP, edema, NL X-rays

A

Tibial stress fx

29
Q

For how long are kids allowed to have varus (or gapped) knees?

A

until 2 y/o

30
Q

Tx options for gout in patient s/p renal transplant

A

injection

NSAID, colchicine, allopurinol are contra

31
Q

Tx for polymyalgia rheumatica?

A

low dose pred

32
Q

Tx for Paget’s disease

A

Bisphosphonates

33
Q

Valgus laxity

A

Medial collateral ligament

34
Q

Varus laxity

A

Lateral collateral

35
Q

Dexa T score >2.5

A

Osteoperosis

Start bisphophonates

36
Q

Dexas T score between 1.0 - 2.5

A

Osteopenia

Use FRAX to determine if bisphosphonate is indicated

37
Q

Multi joint arthropathy
Shallow ulcers on penis
Recent Chlamydia infection

A

Reactive arthritis
painless shallow penile ulcer - circinate balanitis
Tx - abx, NSAIDs

38
Q

What study is sometimes indicated pre-op for a carpal tunnel pt?

A

Nerve conduction studies. Quanitifies severity of entrapment

39
Q

What two things can cause reactive arthritis?

A

GU infection/STI

GI infection

40
Q

Which pt population is more likely to have reactive arthritis after a Chlamydia infection

A

People who are HLA-B27 positive (about 5x increased risk)

41
Q

Test to confirm achilles rupture

A

No plantar flexion on calf squeeze (Thompson test)

42
Q

Pathophys of developmental dysplasia of hip

A

Abn acetabular development

When diagnosed when in adolescents, can have hip OA and leg-length discrepancy

43
Q

Tx of supracondular fx (ulnar olecranon)

A

Immobilization

44
Q

Inability to extend knee
Loss of knee jerk reflex
Sensory loss over medial and anterior part of thigh
Concern for lesion in which n?

A

Femoral

45
Q 
Young adult
Low back pain/stiffness x 3 months
Decreased ROM in lumbar spine
Limited chest expansion
Concerning for?
A

Ankylosing spondylitis
Get some X-rays for sacroilitis
May also see erosions of ischial tuberosity and iliac crest
Use Xrays and ESR to monitor disease progression
Also encourage PT and exercise

46
Q

Extra-articular manifestations of ankylosing spondylitis

A

Anterior uveitis
Aortic regurg
Pulmonary fibrosis (restrictive)
IgA nephropathy

47
Q

proximal muscle weakness
Elevated LFTs and inflammatory markers
Age 40-50

A

Polymyositis
Increased risk of interstitial lung disease, infection, and pneumonitis d/t respiratory muscle weakness
GGO on CT

48
Q

Kyphosis

A

Hunchback

49
Q

Lordosis

A

Sway back (excessive anterior curvature of lumbar spine

50
Q

Red flag symptoms in lumbar back pain

A 
Fever
Weight loss
age >50
IVDU
Immunosuppression
Recent bacterial infection
nocturnal pain
h/o malignancy
Get X-ray
51
Q 
Blunt chest trauma
Tachypnea
Tachycardia
Shallow breathing
Peripheral cyanosis
Concerning for?
A

Flail chest

52
Q

When should RA its start methotrexate?

A

If they have bony erosions or cartilage loss

53
Q

What else should be given when a pt starts methotrexate?

A

Folate supplementation

Vaccines

54
Q

Lab work if you suspect Polymyalgia Rhematica?

A

ESR/CRP

55
Q

pediatric pt with hip pain
Obese, altered gait
abnormal looking xray

A

Slipped capital femoral epiphysis
Posteriorly displaced femoral head
Tx - immediate surgical pinning

56
Q

What is a good option for BP treatment for a pt with gout?

A

ARBS

decreases uric acid levels

57
Q

what is the consequence of avascular necrosis of a scaphoid fracture?

A

nonunion

58
Q

young healthy female
cough, fatigue no infectious symptoms
CXR b/l hilar lymphadenopathy
Reduced FEV1, reduced diffusion capacity of CO

A

Sarcoid

Tx - steroids

59
Q

Tx for Raynaud phenomenon

A

CCB
nifed or amlodipine
IF resistant to treatment, gt ANA, RF, CBC, BMP, UA

60
Q

Tx of septic joint in a kid

A

IV vans

Covering staph and strep

61
Q

Best way to prevent a fat embolism?

A

Early operative fixation

62
Q

h/o Raynauds
presents with hypertensive emergency and AKI
Dx?

A

Scleroderma renal crisis

Tx - ACEI (captopril), nitroprusside if papilodepma is present

63
Q

Child with a poor that resists ROM, plantar flexed, adducted, and inverted
Dx?

A

Clubfoot
Will need serial casting
Caused by deformity of the talus bone

64
Q

kiddo was treated for Kawasaki and presenting for routine bcc. what do you do differently?

A

Delay vaccines until kiddo is11 months s/p IVIG because this reduces the efficacy of vaccines

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