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- Med School Review 🔥 > Rheumatology/Musculoskeletal > Flashcards

Rheumatology/Musculoskeletal Flashcards

1
Q

Low back pain with paraspinal tenderness + normal neuro exam

A

Mechanical

  • Muscle strain
  • Disc degeneration
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2
Q

Low back pain w/ radiation below knee, +straight leg raise test, neurologic deficits

A

Radiculopathy

(Herniated disc)

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3
Q

Low back pain w/ pseudoclaudication, relieved by leaning forward

A

Spinal stenosis

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4
Q

Low back pain worse w/ rest, improved with activity, with pain in the SI joints

A

Inflammatory

(spondyloarthropathies):

  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis
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5
Q

Low back pain, worsens w/ activity, relieved with rest

A

Lumbar osteoarthritis

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6
Q

Low back pain >50yo, worse at night, not relieved with rest

A

Metastatic cancer

(spinal mets)

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7
Q

Low back pain + IVDU or recent infection, fever, focal spine tenderness

A

Infectious

  • Osteomyelitis
  • Discitis
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8
Q

Low back pain + midline tenderness

A

Vertebral fracture

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9
Q

Enthesitis

(inflammation/tenderness at tendon insertion sites)

A

Spondyloarthropathies:

  • Ankylosing Spondylitis
  • Psoriatic Arthritis
  • Reactive Arthritis
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10
Q

Dry mouth, dry eyes, dysphagia, thrush, dental caries

A

Sjögren Syndrome

  • Anti-Ro, Anti-La; SSA, SSB respectively
  • Inflammation of exocrine salivary glands
  • Decreased lacrimation
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11
Q

Cochlear dysfunction is a side effect of

A
  • Cisplatin/Carboplatin
  • Aminoglycosides
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12
Q

Optic neuritis is a side effect of

A
  • Ethambutol (RIPE)
  • Hydroxychloroquine
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13
Q

Thyroid dysfunction is a side effect of

A
  • Amiodarone
  • Lithium
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14
Q

Gout is a side effect of this drug

A

Cyclosporine

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15
Q

Patients with suspected secondary Raynaud’s Phenomenon (>40yo) should be tested for ____

A

Autoimmune disorders

(ANA, Rf, Antitopoisomerase)

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16
Q

Localized pain on anteromedial tibia just below the knee

A

Pes Anserinus Pain Syndrome

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17
Q

Woman with anterior knee pain worsened by activity or prolonged sitting

A

Patellofemoral Syndrome

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18
Q

Painful swelling directly over patella, usually following trauma

A

Prepatellar bursitis

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19
Q

Painful LE ulcer with purulent base and violaceous borders, seen in IBD, RA, or AML pts

A

Pyoderma Gangrenosum

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20
Q

Painful subcutaneous nodules on anterior LE

A

Erythema Nodosum

(ASO Abs, TB test, CXR)

  • Benign
  • Streptococcal infection
  • Sarcoidosis
  • TB
  • Coccidiodomycosis
  • IBD
  • Behçet disease
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21
Q

Inhibits osteoclastic bone resorption

A
  • Bisphosphonates
  • Calcitonin
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22
Q

Tx of Paget disease of bone

A

Bisphosphonates

(inhibits osteoclasts and suppresses bone turnover)

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23
Q

Sensitive marker for SLE vs. Specific marker for SLE

A

ANA vs. Anti-dsDNA

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24
Q

Painless vesiculopustular skin lesions + Tenosynovitis + Polyarthralgias

A

DGI

(Disseminated Gonococcal Infection)

  • +/- Fevers
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25
Q

Charcot joint

A

Neurogenic arthropathy 2/2 nerve damage from long-standing diabetes, B12 deficiency, peripheral nerve damage, or SCI

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26
Q

Young female w/ exertional arm pain + BP difference in R and L arm

A

Takayasu Arteritis

  • Tx: Systemic glucocorticoids
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27
Q

Numbness, aching, or burning in the metatarsal heads of the third and fourth toes

A

Morton Neuroma

(mechanically-induced neuropathic degeneration of the interdigital nerves)

  • Tx: Metatarsal support: Bar or padded shoe inserts; Surgery if refractory
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28
Q

Methotrexate Side-effects in RA Tx

A
  • Macrocytic anemia
  • Stomatitis
  • Hepatotoxicity
  • ILD
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29
Q

Isolated elevated alk phos, ASx

A

Paget disease of bone

(osteoclast dysfunction)

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30
Q

Suspicion of MM

A

Skeletal survey

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31
Q

Tx for Polymyalgia Rheumatica vs. GCA

A

Low-dose vs. High-dose Prednisone

(respectively)

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32
Q

Drug-induced Achilles tendinopathy/tendon rupture

A

Fluoroquinolone use

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33
Q
  1. Thrombotic event OR adverse pregnancy outcome + 2. Positive anticardiolipin, anti-beta2-glycoprotein-I, or lupus anticoagulant
A

Antiphospholipid Syndrome

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34
Q

Oligoarthritis + urethritis

A
  • + fever = Gonococcal septic arthritis (abx)
  • + mouth sores = Reactive arthritis (NSAIDs)
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35
Q

Trigger point tenderness in trapezius, lateral epicondyles, or greater trochanters

A

FM

(Fibromyalgia)

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36
Q

Acute-onset monoarticular arthritis

(12-24 hours)

A

Gout

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37
Q

Acute-onset monoarticular arthritis

(24-72 hours)

A

Septic arthritis

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38
Q

Bony spurs in cervical spine x-ray

A

Cervical spondylosis

(usually presents w/ osteophyte-induced radiculopathy)

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39
Q

Elevated urine hydroxyproline

A

Paget disease of bone

(marker for breakdown of collagen)

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40
Q

Gout PPX

A
  • Alcohol cessation
  • Weight loss
  • Diet (low red meat, seafood, & added sugars)
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41
Q

Low back pain that increases w/ standing, walking, or lying on back

A

Vertebral Compression Fracture

(usually 2/2 osteoporosis)

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42
Q

>15% of dermatomyositis pts will develop

A

Malignancy

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43
Q

Anti-Jo-1

A

Dermatomyositis

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44
Q

Anti-Mi-2

A

Dermatomyositis

(against helicase)

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45
Q

>40yo w/ bone pain + HA + unilateral hearing loss

A

Paget disease of bone

(Osteoclast dysfunction)

  • +Elevated alk phos
  • +Increasing hat size
  • +Bowing
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46
Q

Migratory non-deforming arthritis + chronic malabsorptive diarrhea + low-grade fever + PAS+ macrophages

A

Whipple’s disease

  • Tropheryma whippelii (gram positive bacillus)
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47
Q

Nephrotic syndrome + hepatomegaly + S4 + recurrent pulmonary infections + palpable kidneys

A

Secondary amyloidosis (AA)

  • Tx/PPX: Colchicine
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48
Q

Low back pain worse at night, improves with rest

A

Spinal osteomyelitis

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49
Q

Low back pain worse in the morning, improves with activity, + diarrhea/abd pain

A

IBD-associated arthritis

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50
Q

Acute inflammatory arthritis in setting of surgery or medical illness

A

Likely pseudogout (CPPD)

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51
Q

Recurrent oral and genital ulcers + uveitis + non-vesicular rash

A

Behçet Disease

(Turkish, Middle-Eastern, Asian descent)

  • +venous/arterial thrombosis (small-medium vasculitis)
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52
Q

Primary Raynaud Phenomenon Tx

A

CCBs

(nifedipine, amlodipine) + stress or cold avoidance

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53
Q

Baker cyst is commonly concurrently seen with

A

OA

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54
Q

Female athlete triad of stress fractures

A
  • Oligo-/amenorrhea
  • Decreased caloric intake (anorexia/low BMI)
  • Osteoporosis
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55
Q

Knee popping sensation followed by pain and rapid-onset hemarthrosis

A

ACL injury

(meniscal tear would not have rapid-onset swelling/hemarthrosis)

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56
Q

20-30yo w/ chronic lower back pain & stiffness that is relieved w/ activity and worse at night

A

Ankylosing spondylitis

(HLA-B27)

  • +sacroiliitis on x-ray
  • +Reduced chest expansion
  • +Dactylitis (sausage digits)
  • +Uveitis
  • Dx: X-ray of sacroiliac joints
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57
Q

Older pt w/ cortical thickening of bone 2/2 osteoclast dysfunction

A

Paget disease of bone

(+elevated alk phos)

  • Can lead to hearing loss (skull/temporal bone enlargement)
  • Tx: Bisphosphonates
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58
Q

Acute knee pain + hypercalcemia

A

Pseudogout

(CPPD)

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59
Q

Evidence of cartilage calcification in setting of acute arthritis episode

A

CPPD

(Pseudogout: Calcium pyrophosphate dihydrate crystal arthritis)

  • Also a complication of chronic hypercalcemia in setting of hyperparathyroidism
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60
Q

Achalasia causes ___ LES pressure; Systemic Sclerosis causes ___ LES pressure

A

Increased; Decreased

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61
Q

Progressive groin, thigh, or buttock pain on weight bearing in setting of chronic glucocorticoid use that is worsened by activity, relieved by rest, and has reduced ROM

A

Avascular Necrosis

(Osteonecrosis of the femoral head)

  • Dx: MRI
  • SLE is also a strong risk factor for AVN
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62
Q

Exertion-dependent claudication

A

Vascular claudication

(2/2 aortoiliac atherosclerosis)

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63
Q

Postural-dependent claudication

A

Neurogenic claudication

(2/2 nerve root compression from degenerative arthritis)

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64
Q

Claudication seen in obstructive atherosclerotic arterial disease (e.g. 2/2 aortoiliac atherosclerosis)

A

Vascular claudication

  • Improves with rest
  • Abnormal ABI
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65
Q

Claudication due to lumbar spinal stenosis

A

Neurogenic claudication

(2/2 nerve root compression from noninflammatory degenerative arthritis, such as spondylosis)

  • Improves with position (shopping cart sign: pain lessens w/ spine flexion)
  • Does not improve immediately with rest (~10 min)
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66
Q

Preexisting joint disorders (e.g. gout, pseudogout, osteoarthritis) increase the risk for

A

Secondary joint infection

(septic arthritis)

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67
Q

Pain on resisted supination of forum + weakness of wrist extension & 3rd digit

A

Radial tunnel syndrome

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68
Q

Pain w/ passive wrist flexion or resisted wrist extension

A

Lateral epicondylitis

(Tennis elbow)

  • +tenderness at lateral epicondyle
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69
Q

Noninflammatory angiofibroblastic tendinitis at common wrist extensor origin from repetitive, forceful wrist extension

A

Lateral epicondylitis

(Tennis elbow)

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70
Q

Tx of Tendonitis

A

Rest > Immobilization

(Splinting) > Steroid injection

71
Q

Signs of Tendonitis

A
  • Focal Tenderness
  • Pain on Activation
  • Pain on Stretch
72
Q

Wrist extension + radial nerve

A

Lateral epicondyle

73
Q

Wrist flexors + Pronator teres; Median nerve

A

Medial epicondyle

74
Q

Best test for biceps tear

A

Supination

75
Q

Deltoid nerve innervation

A

Axillary nerve

76
Q

Burning hand pain that is worst when sleeping, driving, or holding a magazine

A

CTS

(Carpal Tunnel Syndrome)

77
Q

Bowing of knees (varus deformity), asymmetric joint space narrowing, DIPs swelling

A

Primary OA

78
Q

PIN, dorsal hand (sensory), extrinsic extension

A

Radial nerve

79
Q

AIN, sensory of thumb to half of ring; extrinsic flexion

A

Median nerve

80
Q

Forceful hyperextension of wrist in FOOSH

A

Scaphoid fracture

(pain at anatomic snuffbox)

81
Q

Pain w/ radial flexion of wrist and point tenderness over trapezium

A

Flexor carpi radialis tenosynovitis

82
Q

Positive Finkelstein test

A

De Quervain tenosynovitis

(grasping of flexed thumb into palm w/ fingers during wrist flexion)

83
Q

Mother w/ radial wrist pain

A

De Quervain tenosynovitis

  • Inflammation of abductor pollicis longus & extensor pollicis brevis tendons within fibrous sheath at radial styloid process
84
Q

Chronic low C4 (hypocomplementemia) + HCV +/- SLE

A

Cryoglobulinemia

85
Q

Fibromyalgia Tx

A
  • 1st Line: Regular exercise + Good sleep hygiene
  • 2nd Line: Amitriptyline
  • 3rd Line: Duloxetine (SSRI), Pregabalin, or Milnacipran
86
Q

Anti-topoisomerase

A

Systemic Sclerosis

(Anti-Scl-70)

87
Q

Anti-smooth muscle antibodies

A

Autoimmune hepatitis,

88
Q

Young to middle-aged woman w/ widespread pain, fatigue, cognitive/mood disturbances, and point muscle tenderness

A

???

89
Q

Stiffness in neck, shoulders, & hips + elevated ESR

A

Polymyalgia Rheumatica

(PMR)

  • Tx: Low-dose prednisone
  • Associated w/ GCA
90
Q

Stiffness in neck, shoulders, & hips + point tenderness

A

Fibromyalgia

(FM)

  • Tx: Aerobic exercise + Good Sleep Hygiene
  • 2nd Line: Amitriptyline
91
Q

Pain w/ exertion, Relief w/ rest

(Neurogenic vs. Vascular claudication?)

A

Vascular Claudication

92
Q

Relieved w/ walking, persists w/ rest or standing still (Neurogenic vs. Vascular claudication?)

A

Neurogenic Claudication

93
Q

Narrowed joint space on x-ray

A

OA

94
Q

OA Tx

A

Exercise/wt loss —> NSAIDs —> Steroid injections/Hyaluronic acid injections —> Surgery vs. Chronic Pain Management

(non-surgical candidates)

95
Q

Needle-shaped, negatively birefringent crystals

A

Gout

(YeLLow under ParaLLel light)

96
Q

Rhomboid-shaped crystals, weakly positively birefringent crystals

A

Pseudogout

(CPPD)

97
Q

Tophus deposits in external ear, olecranon bursa, or achilles tendon

A

Gout

98
Q

GCA Tx

A

High-dose methylprednisolone

99
Q

Sudden loss of vision + HA, abnormal fundoscopic exam, Elevated ESR

A

GCA

(Giant Cell Arteritis) [+/- jaw claudication]

100
Q

Extrusion of synovial fluid from knee joint into gastrocnemius or semimembranous bursa

A

Popliteal

(Baker) Cyst

101
Q

Twisting force on a fixed foot

A

Medial meniscus tear

  • Popping sound followed by pain
  • Crepitus, locking, or catching on exam +/- small effusion
102
Q

Anserine bursitis

A

Well-defined area of subacute medial knee pain and tenderness

(Pes anserinus pain syndrome)

103
Q

Crescent-shaped ecchymosis distal to medial malleolus

A

Popliteal

(Baker) cyst rupture (Crescent sign)

104
Q

Anterior knee pain that worsens w/ climbing or descending stairs

A

Patellofemoral Syndrome

(PFS)

  • Young female athletes
  • Dx: Patellofemoral compression test
  • Tx: Quadriceps strengthening exercises
105
Q

Tenderness at tibial tubercle

A

Osgood-Schlatter disease

(common during pre-adolescent/adolescent growth spurts

106
Q

Localized back pain worse at night, not relieved w/ rest

A

Spinal metastasis

(hx of lung/breast/prostate cancer)

107
Q

Positive straight leg test

A

Disc herniation

108
Q

Low back pain radiating down below knee

A

Spinal stenosis vs. Disc herniation

109
Q

Morning stiffness + Dactylitis

A

Psoriatic arthritis

110
Q

Dactylitis + Esophageal dysmotility + ILD + HTN + Anti-topoisomerase Abs (Anti-Scl-70)

A

Systemic Sclerosis (SSc)

111
Q

Joint pain that improves with activity vs. worsens with activity

A

Inflammatory vs. Noninflammatory Arthritis respectively

(RA vs. OA)

112
Q

Violaceous plaques, slightly scaly

A

Dermatomyositis

(Gottron’s Papules)

113
Q

Red plaques w/ silvery scaling

A

Psoriatic Arthritis

114
Q

Psoriatic Arthritis Tx

A

NSAIDs, MTX, & TNF-inhibitors

115
Q

Monosodium urate

A

Gout deposition crystal that creates tophi

116
Q

Swollen hands + Dactylitis (sausage digits) + Arthritis of DIPs + Nail changes

A

Psoriatic arthritis

(+red plaques w/ silvery scaling)

117
Q

>50 w/ shoulder & hip stiffness + can have GCA (Giant Cell Arteritis)

A

Polymyalgia Rheumatica

(elevated ESR/CRP)

118
Q

Polymyositis Tx

A

Prednisone +/- MTX or azathioprine

119
Q

Weakness that worsens w/ activity

A

Myasthenia Gravis

120
Q

Caplan syndrome

A

RA associated with pneumoconiosis

121
Q

Still’s disease = Juvenile RA w/ predominantly extraarticular manifestations

A

Juvenile RA w/ predominantly extraarticular manifestations

122
Q

TNF-alpha Inhibitor side-effects

A
  • Infection
  • Demyelination
  • CHF
  • Malignancy
123
Q

Hydroxychloroquine side-effects

A

Retinopathy

(requires baseline & periodic ophthalmologic assessments)

124
Q

RA patient + oral ulcers

A

MTX Toxicity

125
Q

RA patient w/ neutropenia & splenomegaly

A

Felty Syndrome

126
Q

MTX Toxicity side-effects

A
  • Oral ulcers/Stomatitis
  • Hepatotoxicity
  • Alopecia
  • BM suppression (cytopenias)
  • Pulmonary toxicity (ABBMNR)
  • Rash
127
Q

Folate antimetabolite

A

MTX

(first line Tx for RA)

  • Folic acid supplementation w/ chronic MTX Tx
  • Drugs that induce folate deficiency: “TMP”
    • TMP-SMX
    • MTX
    • Phenytoin
128
Q

Tenosynovitis + dermatitis + migratory polyarthralgias

A

DGI

(Disseminated Gonococcal Infection)

129
Q

Peeling of feet

A

Keratoderma blennorrhagicum

(Reactive arthritis 2/2 Chlamydia trachomatis or GI infection)

130
Q

Chrondrocalcinosis on joint x-ray

A

CPPD

(Calcium pyrophosphate dehydrate crystal deposition: Pseudogout), Causes:

  • Hyperparathyroidism
  • Hypothyroidism
  • Hemochromatosis (bronze diabetes)
131
Q

Anticitrullinated peptide Abs

A

Rheumatoid Arthritis

(Anti-CCP)

132
Q

Shoulder pain w/ active ROM but normal passive ROM

A
  • Rotator Cuff Tendinopathy
  • Rotator Cuff Tear (>40)
  • Biceps Tendinopathy
133
Q

Decreased active and passive ROM:

A
  • Adhesive capsulitis
  • Glenohumeral Osteoarthritis
134
Q

Decreased active ROM but normal passive ROM, >40

A

Rotator cuff tear

135
Q

Decreased active and passive shoulder ROM w/ hx of shoulder injury/trauma

A

Glenohumeral Osteoarthritis

136
Q

Chronic inflammation, fibrosis, and contracture of the shoulder joint

A

Adhesive Capsulitis

(Frozen Shoulder)

137
Q

Anterior shoulder pain w/ lifting/carrying/overhead reaching

A

Biceps tendinopathy/rupture

138
Q

Middle-aged w/ shoulder stiffness

A

Adhesive capsulitis

(frozen shoulder) vs. Polymyalgia Rheumatica (elevated ESR/CRP)

139
Q

Frozen Shoulder

A

Adhesive Capsulitis

140
Q

Neer/Hawkins positive + weakness w/ external rotation

A

Rotator cuff tear

141
Q

Normal ROM + positive Neer, Hawkins

A

Rotator Cuff Impingement or Tendinopathy

142
Q

Malignancy + symmetrical proximal muscle weakness

A

Dermatomyositis

(immune-mediated muscle injury)

143
Q

Erythematous rash over dorsum of fingers

A

Gottron’s sign

(Dermatomyositis)

144
Q

Erythematous rash over upper eyelids

A

Heliotrope eruption

(Dermatomyositis)

145
Q

Antibodies against presynaptic membrane

A

Lambert-Eaton myasthenic syndrome

(presents w/ proximal muscle weakness, dry mouth, ED, absent/diminished DTRs)

146
Q

Proximal muscle weakness + Raynaud phenomenon + polyarthritis + esophageal dysmotility

A

Dermatomyositis/Polymyositis

(+Gottron papules, heliotrope rash in dermatomyositis)

147
Q

Carpal tunnel syndrome structures

A

Transverse Carpal Ligament

  • Median nerve
  • Flexor digitorum profundus
  • Flexor digitorum superficialis
  • Flexor pollicis longus
148
Q

Thenar atrophy + weakness of thumb abduction/opposition

A

CTS

(Carpal Tunnel Syndrome)

149
Q

Sudden “grabbing” pain in lower back w/ lifting

A

Lumbar Strain

(Tx: NSAIDs + Continue moderate activity)

150
Q

First line Tx for RA

A

Methotrexate

(DMARDs: Disease-Modifying AntiRheumatic Agents)

  • Test for HBV, HCV, TB, and Pregnancy before beginning MTX therapy

Next level:

  • TNF-alpha inhibitors (etanercept, infliximab, adalimumab, rituximab, tocilizumab)
  • Non-biologic DMARDs (Hydroxychloroquine, sulfasalazine, azathioprine, leflunomide)
151
Q

Positive straight leg raise test

A

Sciatica

  • 2/2 irritation to sciatic nerve that travels down leg
  • Tx: Treat symptoms (pts experience spontaneous resolution)–NSAIDs or APAP; Maintain moderate activity
    • ​Cyclobenzoprine only if refractory
152
Q

Raynaud’s + Sausage digits + Fine crackles BL

A

Systemic Sclerosis (Scleroderma/CREST syndrome)

  • +Anti-topoisomerase I Abs (anti-Scl-70), Anticentromere+ (antiCRESTomere), ANA+ (nonspecific)
  • Path: Progressive tissue fibrosis & CT thickening from collagen deposition 2/2 fibroblast dysfunction & increased collagen + ground substance production
  • Can progress to obliteration of skin appendages (e.g. hair, follicles, sweat glands)
  • Raynaud component = vascular dysfunction
  • Extradermal complications: CREST
    • Calcinosis (CCBs)
    • Raynaud’s phenomenon (CCBs)
    • Esophageal dysmotility (PPI)
    • Sclerodactyly (penicillamine)
    • Telangiectasias
      • +Interstitial lung disease (fine crackles)
      • +HTN (renal involvement)
      • +Scleroderma renal crisis (oliguria, thrombocytopenia, MAHA)
      • +Myocardial fibrosis, pericarditis, pericardial effusion
153
Q

Dry eyes, dry mouth, dysphagia w/ solids only

A

Sjögren Syndrome (SS)

  • Autoimmune inflammation of exocrine glands seen in middle-aged women
  • +Schirmer test (strip of filter paper placed under lower eyelid & measured after 5 min for absorbed fluid
  • +histologic e/o lymphocytic infiltration of salivary gland
  • +Anti-SSA (Ro) and/or Anti-SSB (La)
  • Can also be seen w/ Raynaud, cutaneous vasculitis, arthralgia/arthritis, & ILD
154
Q

Nontender nodules on the elbow

A

RA

(Rheumatoid nodules–firm, nontender, subcutaneous, close to pressure points)

155
Q

Part of spine affected in RA

A

Cervical spine

(Cervical spine subluxation can lead to spinal cord compression)

  • Sacroiliac joints = seronegative PAIR spondylarthropathies
  • Thoracic = Disc herniation or other spinal d/o
  • Lumbar = Disc hernation, spinal stenosis
156
Q

Pain w/ extending the knee while compressing the patella

A

Patellofemoral syndrome

(young female athlete w/ chronic knee overuse)

  • P/w anterior knee pain
157
Q

Popliteal cyst (Baker cyst; posterior knee) is associated w/

A

Osteoarthritis

  • Thus, seen in older pts
158
Q

Rhomboid-shaped crystals on arthrocentesis

A

Pseudogout (CPPD)

  • Calcium pyrophosphate dihydrate deposition
  • +Chondrocalcinosis on XR
  • Can be 2/2:
    • Hyperparathyroidism (e.g. pt w/ chronic hypercalcemia)
    • Hemochromatosis (BDAC–bronze DM, arthritis, cardiomyopathy)
159
Q

The pes anserinus in the medial knee is formed by the joining of these 3 tendons

A
  1. Gracilis
  2. Sartorius
  3. Semitendinosus
160
Q

Male in 20s or 30s w/ LBP

A

Classically PAIR (seronegative spondylarthropathy)

  • LBP DDx: “MRS. C-Mii has LBP”
    • Mechanical (strain, spasm, paraspinal TTP)
    • Radiculopathy (+straight leg raise if sciatica)
    • Stenosis (worse w/ extension)
    • Compression fx
    • Metastasis (lung > breast > prostate > thyroid > kidney)
    • Inflammatory (PAIR)
    • Infection (osteo, discitis, abscess [IVDU])
161
Q

Testosterone type specific to adrenals

A

DHEAS

  • Ovarian T:
    • Testosterone
    • Androstenedione
    • DHEA
  • Elevated T + normal DHEAS suggests ovarian tumor > adrenal tumor (both p/w rapidly progressive hyperandrogenic symptoms)
162
Q

Extrusion of synovial fluid from knee joint into the gastrocnemius or semimembranosus bursa

A

Popliteal cyst (Baker cyst)

(chronic, painless bulge behind the knee)

  • Triggered by increased synovial fluid from RA or OA
  • Rupture of Baker’s cyst can extend into calf or form a “crescent sign” on calf or at ankle
163
Q

Tx & PPX of Amyloidosis

A

Colchicine

(also treats acute gout)

  • Gout PPX: Allopurinol
164
Q

Inhibits xanthine oxidase

A

Allopurinol

(Tx of hyperuricemia and gout PPX)

  • Acute gout: Colchicine
165
Q

Reactive arthritis usually follows ____ infections

A

GI or GU

(Tx: NSAIDs)

  • Salmonella
  • Shigella
  • Campylobacter
  • Chlamydia
  • Yersinia

Note: Reiter syndrome = Reactive arthritis w/ triad of arthritis, uveitis, & urethritis

166
Q

A mostly LE arthritis that can include

  • Assymmetric oligoarthritis
  • Urethritis (nongonococcal)
  • Conjunctivitis
  • Mucucutaneous lesions
  • Enthesitis (achilles tendon pain)
A

Reactive Arthritis

  • Usually follows GI or GU infection (1-4 weeks post)
  • PAIR arthritis, thus suspect when young male
  • Tx: NSAIDs
167
Q

LBP. MRI or XR?

A

MRI if:

  • Neuro deficits
  • Cauda equina syndrome features
  • Suspected epidural abscess

XR if:

  • Elevated risk of malignancy (e.g. nocturnal pain, progressive, hx of smoking or cancer, older, weight loss or other B symptoms)

Skeletal Survey if:

  • Suspect Multiple Myeloma (Bone pain + anemia + hypercalcemia + AKI)

Uncomplicated → NSAIDs

Persistent → PT

CT scan only if needs MRI but cannot tolerate it

168
Q

Achy pain in the shoulders & hips

A

PMR

(Polymyalgia rheumatica)

  • +Elevated ESR
  • >50yo
  • Often progresses to GCA
169
Q
  • BP discrepancies between R & LUE
  • Pulse deficits
  • Bruits
  • Fever, arthralgias, weight loss
  • Exertional arm pain
A

Takayasu Arteritis

(large-vessel vasculitis)

  • Asian Female <40
  • Mononuclear infiltrates & granulomatous inflammation
  • Arterial wall thickening w/ aneurysmal dilation or narrowing & occlusion
  • Elevated ESR/CRP
  • Tx: Systemic glucocorticoids

Note: if >50, suspect GCA, especially if more shoulders/hips (like PMR)

170
Q

Male heavy smoker w/ gangrenous digits

A

Thromboangiitis obliterans

(Buerger disease)

171
Q

Scalp tenderness + Jaw claudication

A

GCA

(Giant Cell Arteritis)

  • Temporal HA
  • Older
  • Elevated ESR
  • Shoulder & Hip pain (think of it like advanced PMR)
172
Q

Ankylosing Spondylitis pts have an increased risk of:

A
  • Aortic Regurgitation (early diastolic murmur)
  • Vertebral Fracture (2/2 bone loss from chronic inflammation & rigidity)
  • Anterior Uveitis
  • Dactylitis (swelling of fingers & toes)
  • Enthesitis (tenderness at tendon insertion sites)
173
Q

Are NSAIDs effective in treating CTS?

A

No

Tx:

Splinting → Steroids → Surgery (surgical decompression)

174
Q

Tx of Paget disease of bone

A

Bisphosphonates

(osteoclast inhibitors; like calcitonin but stronger)

- Med School Review 🔥 (23 decks)

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