Rheumatology- Back & Upper extremity

Question 1

Low back Pain, worse at night and unrelieved with rest. Focal vertebral tenderness

Answer 1

Malignancy.

Look for Hx of malignancy, neurological deficits, hypercalcemia.

Question 2

Most common tumors that metastasize to bone

Answer 2

Lead Kettle: Pb KTL

Prostate
Breast	
Kidney
Thyroid
non- small cell Lung cancer 
non-hodgkin Lymphoma

Question 3

Etiology: Low back pain, with paraspinal tenderness and normal neurological examination, worse with activity better with rest

Answer 3

Mechanical/ Musculoskeletal (e.g. muscle strain)

Question 4

Etiology: low back pain, radiation bellow the knee, positive straight leg test, neurological deficits, worse with activity better with rest

Answer 4

Radiculopathy (e.g herniated disc)

Question 5

Etiology: low back pain, relief with leaning forward, pseudoclaudication, chronic

Answer 5

Spinal stenosis

Question 6

Etiology: low back pain, osteoporosis, onset following minor trauma,

Answer 6

Compression fracture

Question 7

Etiology: low back pain, recent infection, IV drug use, Fever, spinal tenderness

Answer 7

Osteomyelitis, discitis , abscess

Question 8

S&S carpal tunnel syndrome

Answer 8

Pain 
Paresthesia 
first 3 digits 
worse at night or with repetitive use
Relief from shaking

Question 9

Diagnosis carpel tunnel syndrome

Answer 9

Tinel and Phallen test (Limited)

Most accurate: nerve conduction studies

Question 10

Management of ankylosing spondylitis

Answer 10

Exercise (ROM) and PT
Initial: NSAIDs & celecoxib

Failure: TNF-a inhibitors & Anti IL-17

Question 11

TNF-a inhibitor drugs

Answer 11

Etanercept
Infliximab
Adalimumab

Question 12

IL-17 inhibitor drugs

Answer 12

Secukinumab