Rheum/Ortho Flashcards
What type of fracture is commonly seen after a FOOSH?
Collees fracture
Distal radius
Have to also worry about scaphoid fractures, carpal tunnel
at what age do people usually develop spinal stenosis
60s
Unusual to see it in the younger population
Best way to dx spinal stenosis?
MRI
Which antibodies are associate with SLE?
Anti-dsDNA and Anti-smith
What Ab levels can be used to monitor dz severity in SLE?
Anti-dsDNA
How do you treat a SLE pt that has mostly joint and cutaneous symptoms
Prednisone + plaquenil
Proximal muscle weakness
Elevated LFTs
Rash over dorsum of hand
Dx?
Dermatomyositis
IF you dx someone with dermatomyositis, what other work up do you need to do?
Cancer work up
Especially cervical, ovarian, pancreatic, stomach, bladder, lung
What is the best way to transport a severed digit?
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
Pts with rotator cuff injuries tend to say they have pain in which part of the shoulder?
Lateral
Irritable infant x 2 days Afebrile Hip is flexed, abducted, and externally rotated and does not move it voluntarily WBC, ESR, CRP elevated Dx?
Septic arthritis irritability + poor feeding + pseudo paralysis \+/- fever Elevated WBC, CRP, ESR Tx - surgical drainage + abs
Ab in Sjogren syndrome?
Anti-Ro SSA and anti-La/SSB
about 50% of pmts are positive for one of these
Sjogren’s syndrome is associate with which malignancy?
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
Pt traveled to carribean
Had a brief URI
Now months later has b/l symmetric polyarthralgia or the distal joints
Chikungunya fever
Mosquito borne
Most self-resolve, 30% of pmts have chronic arthralgia
Dx - PCR
Knee pain after landing from a jump
Anterior knee swelling
difficulty extending the knee or lifting leg off a table
Patellar tendon rupture
Tx - surgery
Teenager with recent Viral URI, maculopapular rash
Followed by polyarthritis - symmetric stiffness of small joints
Dx?
Parvo
Teens tend to get arthralgia
Dx - IgM antibodies
Pt with joint stiffness in 2nd and 3rd MCP joints, knees, ankles shoulders
Enlarged liver on exam
joint tap with rhomboid shaped crystals
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
Thoracic or lumbar prominence on forward bend test in a teen suggests?
Scoliosis. Get some X-rays
When do you intervene on Scoliosis Xray?
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
Most sensitive modality for dx’ing osteonecrosis?
MRI
Monosodium urate crystals
needle-shaped
Negative birefringent
Gout
1st line tx for acute gout?
Indomethacin
Colchicine if they have a contra to NSAIDs
What should you give patients that you start on chronic steroids for osteoporosis prevention?
Vit D and Calcium
back pain + sciatica exacerbated by bending forward
Dx?
Nerve root irritation
Has a + straight leg test
MVA passenger, knees hit dashboard
Worry about?
PCL injury
don’t always feel unstable
Pt with minor MSK injury now months later with localized burning, edema, skin changes, and decreased ROM
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
When would you not treat a pt with a Cobb angle between 10-40
IF they’re bones are mature (ie if they are Tanner 5)
avid athlete, pain over lateral ankle, + TTP, edema, NL X-rays
Tibial stress fx
For how long are kids allowed to have varus (or gapped) knees?
until 2 y/o
Tx options for gout in patient s/p renal transplant
injection
NSAID, colchicine, allopurinol are contra
Tx for polymyalgia rheumatica?
low dose pred
Tx for Paget’s disease
Bisphosphonates
Valgus laxity
Medial collateral ligament
Varus laxity
Lateral collateral
Dexa T score >2.5
Osteoperosis
Start bisphophonates
Dexas T score between 1.0 - 2.5
Osteopenia
Use FRAX to determine if bisphosphonate is indicated
Multi joint arthropathy
Shallow ulcers on penis
Recent Chlamydia infection
Reactive arthritis
painless shallow penile ulcer - circinate balanitis
Tx - abx, NSAIDs
What study is sometimes indicated pre-op for a carpal tunnel pt?
Nerve conduction studies. Quanitifies severity of entrapment
What two things can cause reactive arthritis?
GU infection/STI
GI infection
Which pt population is more likely to have reactive arthritis after a Chlamydia infection
People who are HLA-B27 positive (about 5x increased risk)
Test to confirm achilles rupture
No plantar flexion on calf squeeze (Thompson test)
Pathophys of developmental dysplasia of hip
Abn acetabular development
When diagnosed when in adolescents, can have hip OA and leg-length discrepancy
Tx of supracondular fx (ulnar olecranon)
Immobilization
Inability to extend knee
Loss of knee jerk reflex
Sensory loss over medial and anterior part of thigh
Concern for lesion in which n?
Femoral
Young adult Low back pain/stiffness x 3 months Decreased ROM in lumbar spine Limited chest expansion Concerning for?
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
Extra-articular manifestations of ankylosing spondylitis
Anterior uveitis
Aortic regurg
Pulmonary fibrosis (restrictive)
IgA nephropathy
proximal muscle weakness
Elevated LFTs and inflammatory markers
Age 40-50
Polymyositis
Increased risk of interstitial lung disease, infection, and pneumonitis d/t respiratory muscle weakness
GGO on CT
Kyphosis
Hunchback
Lordosis
Sway back (excessive anterior curvature of lumbar spine
Red flag symptoms in lumbar back pain
Fever Weight loss age >50 IVDU Immunosuppression Recent bacterial infection nocturnal pain h/o malignancy Get X-ray
Blunt chest trauma Tachypnea Tachycardia Shallow breathing Peripheral cyanosis Concerning for?
Flail chest
When should RA its start methotrexate?
If they have bony erosions or cartilage loss
What else should be given when a pt starts methotrexate?
Folate supplementation
Vaccines
Lab work if you suspect Polymyalgia Rhematica?
ESR/CRP
pediatric pt with hip pain
Obese, altered gait
abnormal looking xray
Slipped capital femoral epiphysis
Posteriorly displaced femoral head
Tx - immediate surgical pinning
What is a good option for BP treatment for a pt with gout?
ARBS
decreases uric acid levels
what is the consequence of avascular necrosis of a scaphoid fracture?
nonunion
young healthy female
cough, fatigue no infectious symptoms
CXR b/l hilar lymphadenopathy
Reduced FEV1, reduced diffusion capacity of CO
Sarcoid
Tx - steroids
Tx for Raynaud phenomenon
CCB
nifed or amlodipine
IF resistant to treatment, gt ANA, RF, CBC, BMP, UA
Tx of septic joint in a kid
IV vans
Covering staph and strep
Best way to prevent a fat embolism?
Early operative fixation
h/o Raynauds
presents with hypertensive emergency and AKI
Dx?
Scleroderma renal crisis
Tx - ACEI (captopril), nitroprusside if papilodepma is present
Child with a poor that resists ROM, plantar flexed, adducted, and inverted
Dx?
Clubfoot
Will need serial casting
Caused by deformity of the talus bone
kiddo was treated for Kawasaki and presenting for routine bcc. what do you do differently?
Delay vaccines until kiddo is11 months s/p IVIG because this reduces the efficacy of vaccines
