Rheumatology + Ortho Flashcards
1
Q
Femoral nerve innervates ___ muscle group
A
Quadriceps
2
Q
Muscle weakness in the setting of femoral nerve damage is manifest as …
A
Inability to extend knee
3
Q
Sensory loss in thigh in the setting of femoral nerve damage?
A
Sensory loss over anterior + medial thigh
4
Q
Sensory loss in leg in the setting of femoral nerve damage?
A
Sensory loss over medial shin, arch of foot
5
Q
Which nerve accounts for loss of sensation in medial shin + arch of foot in setting of femoral nerve damage?
A
Saphenous nerve … (branch of femoral nerve)
6
Q
Which reflex is diminished in setting of femoral nerve damage?
A
Knee jerk reflex
7
Q
Which action of thigh is spared in setting of femoral nerve damage?
A
Leg adduction
8
Q
Leg adduction results from activation of which nerve?
A
Obturator n.
9
Q
Who should be screened for osteoporosis by DXA scan?
A
Women > 65 yo; Post-menopausal women < 65 yo with low BMI, smoking, glucocorticoid use, family HX of hip fracture
10
Q
Which 3 conditions would make post-menopausal women eligible for bisphosphonate therapy?
A
HX of fragility fracture; Osteoporosis; Osteopenia with > 20% 10-year risk for ANY fracture; Osteopenia with > 3% 10-year risk for HIP fracture
11
Q
DXA definition of normal bone density?
A
T score > -1
12
Q
DXA definition of osteopenia?
A
T score between -1 and -2.5
13
Q
DXA definition of osteoporosis?
A
T score < -2.5
14
Q
Equation for calculating albumin-corrected calcium?
A
(Measured Ca2+) + 0.8*(4-albumin)
15
Q
What is albumin-corrected calcium in patient with Ca2+ = 12.8, albumin = 2.5?
A
(12.8) + 0.8*(4-2.5) = 14
16
Q
Etiology of hypercalcemia is patient with recent trauma causing quadriplegia?
A
Immobilization … causes increased release of Ca2+ from bones
17
Q
Which 2 groups of patients are at greatest risk for hypercalcemia after immobilization?
A
Adolescents, Paget’s disease … due to increased bone turnover
18
Q
Best treatment for hypercalcemia due to immobilization?
A
Bisphosphonates
19
Q
53 yo male presents with arthropathy, DM, hepatomegaly – diagnosis?
A
Hereditary hemochromatosis
20
Q
Inheritance pattern of Hereditary hemochromatosis?
A
AR
21
Q
Which 2 joints are most commonly affected in Hereditary hemochromatosis?
A
2nd and 3rd MCP joints
22
Q
Hallmark appearance of arthropathy on XR in setting of Hereditary hemochromatosis?
A
Hook-like osteophytes
23
Q
Hallmark appearance of joint aspiration in setting of Hereditary hemochromatosis?
A
Calcium pyrophosphate dihydrate crystals … Rhomboid shape, (+) birefringence
24
Q
Initial evaluation of Hereditary hemochromatosis should include …
A
Iron studies
25
Best treatment for Hereditary hemochromatosis?
Serial phlebotomy
26
Hereditary hemochromatosis is associated with increased risk of …
Hepatocellular carcinoma (HCC)
27
Hallmark PE finding of adhesive capsulitis (chronic joint contracture)?
Limited ROM … both active and passive
28
Best initial treatment for adhesive capsulitis (chronic joint contracture)?
ROM exercises
29
Best treatment for resistant adhesive capsulitis (chronic joint contracture) … does not respond to 2-3 months of ROM exercises ?
Glucocorticoid injection
30
Clinical presentation of intracapsular (femoral neck) hip fractures?
Pain WITHOUT significant bruising
31
Intracapsular (femoral neck) hip fractures are associated with a higher risk of …
Avascular necrosis
32
Clinical presentation of extracapsular hip fractures?
Pain WITH significant bruising
33
Extracapsular hip fractures are associated with a higher risk of …
Displacement
34
Best management of hip fracture in elderly patients who are stable and ambulatory prior to fracture?
Surgery within 48 hours
35
Benefit of surgery within 48 hours of hip fracture for elderly patients who were stable and ambulatory prior to the fracture?
Lower risk of pressure ulcer + PNA
36
Asymmetric oligoarthritis in patients with recent history of chlamydia infection is suggestive of …
Reactive arthritis
37
Typical joint aspiration results in setting of Reactive arthritis?
Increased WBC count, Negative culture
38
Additional screening recommended for males with HX of chlamydia proctitis?
Rectal screening … (MSM)
39
Common extra-articular manifestation of Reactive arthritis?
Circinate balanitis
40
Description of Circinate balanitis as an extra-articular manifestation of Reactive arthritis?
Shallow, painless ulcers on the glans penis; Not associated with inguinal lymphadenopathy
41
What feature differentiates Circinate balanitis from painless ulcers seen in syphilis and lymphogranuloma venereum?
Circinate balanitis is not associated with inguinal lymphadenopathy
42
New-onset reactive arthritis in a patients with history of chlamydia infection should prompt …
Repeat testing for chlamydia via NAAT on urine samples
43
Best treatment for reactive arthritis with active chlamydia infection?
ABX + NSAIDs
44
2 aspects of medical management associated with poor prognosis of acute lower back pain?
Prolonged bed rest, Opioid therapy
45
Patient presents with proximal muscle weakness and joint pain; Labs show elevated muscle enzymes (CK AST), and elevated inflammatory markers (CRP, ESR) – diagnosis?
Polymyositis
46
GI complication of Polymyositis?
Involvement of upper esophageal muscles … leading to dysphagia + aspiration PNA
47
Definitive diagnosis of Polymyositis?
Muscle biopsy
48
Next step of screening for Polymyositis?
Polymyositis may represent a paraneoplastic syndrome … so recommend age-appropriate screening for patient
49
Pulmonary complication of Polymyositis?
ILD, methotrexate-induced pneumonitis
50
Best treatment for Polymyositis?
Steroids + Methotrexate
51
Appearance of ILD on CT?
Ground-glass opacities, Reticular changes, Honeycombing, Patchy consolidation
52
Appearance of ILD on PFTs?
Decreased FVC, Decreased TLC, Decreased DCLO
53
2 lab tests that need to be ordered prior to beginning a patient on bisphosphonates?
Serum Ca2+, Vitamin D levels
54
Why must Serum Ca2+, Vitamin D levels be measured prior to beginning a patient on bisphosphonates?
Bisphosphonates often cause hypocalcemia
55
Recommendations for post-menopausal females for prevention of osteoporosis?
Adequate Ca2+ and Vitamin D intake; Regular weight-bearing exercise
56
Recommended Ca2+ intake for post-menopausal females?
1200mg daily
57
Recommended Vitamin D intake for post-menopausal females?
600-800mg daily
58
Occult supracondylar fractures involve which bone?
Distal humerus
59
Clinical presentation of supracondylar fractures?
Severe pain after FOOSH
60
Hallmark XR finding for supracondylar fracture?
Displaced posterior fat pad
61
Best management for non-displaced supracondylar fractures?
Splint placement for immobilization
62
Best management for displaced supracondylar fractures?
OR for reduction and pinning
63
3 physical exam findings for clavicular fracture in newborn?
Pain with passive UE movement, Crepitus over clavicle, asymmetric Moro reflex
64
Best management for clavicular fracture in newborn?
Gentle handling, parental reassurance … fracture will heal spontaneously
65
Radial head subluxation is caused by displacement of which anatomic structure?
Annular ligament
66
Best treatment for radial head subluxation?
Forearm hyper-pronation; Forearm supination/flexion
67
Most common carpal bone fracture?
Scaphoid
68
Location of pain in setting of scaphoid fracture?
Radial aspect of wrist in anatomic snuffbox
69
2 complications of untreated scaphoid fracture?
Nonunion, avascular necrosis
70
Best management of patients with nondisplaced scaphoid fracture who do not meet surgical criteria?
Short arm spica cast, serial XRs in 1-2 weeks (to monitor healing)
71
Best management of patients with displaced scaphoid fracture, osteonecrosis?
Referral to orthopedic surgery
72
Clinical presentation of Patellofemoral Pain Syndrome (PFP)?
Pain over anterior knee, worsened by activities that involve quad contraction (squatting, stairs)
73
Epidemiology of Patellofemoral Pain Syndrome (PFP)?
Females
74
Exam test that is highly specific for Patellofemoral Pain Syndrome (PFP)?
Patellofemoral compression test (pain elicitied by extending knee while compressing patella)
75
Best management of Patellofemoral Pain Syndrome (PFP)?
Stretching; Exercises that strengthen quad muscles
76
Next step of workup for patient with fracture following minor trauma (ground-level fall)?
Testing for osteoporosis with DEXA
77
Normal bone mineral density on DEXA scan?
T score = 0 to -1
78
Osteopenia bone mineral density on DEXA scan?
T score = -1 to -2.5
79
Osteoporosis bone mineral density on DEXA scan?
T score = < -2.5
80
Additional diagnostic factor for Osteoporosis?
HX of fragility fracture
81
5 risk factors for development of Osteoporosis?
Caucasian, FHX, Smoking, Steroid use, Postmenopausal
82
Indication for pharmacological therapy for osteoporosis in post-menopausal women?
T score < -2.5 … OR … HX of hip or vertebral fracture (regardless of T score)
83
DOC for treatment of osteoporosis in post-menopausal women?
Bisphosphonates
84
Recommended daily intake of Ca2+ for post-menopausal females?
1200 mg
85
Recommended daily intake of Vitamin D for post-menopausal females?
800 IU
86
How do glucocorticoids lead to accelerated bone resorption (increasing risk of osteoporosis)?
Decrease intestinal absorption of Ca2+, Increase Ca2+ excretion in urine
87
43 yo female is newly-diagnosed with SLE; Plan to treat with glucocorticoids – what additional treatment should be implemented?
Supplemental Ca2+ and Vitamin D
88
3 steps of evaluation for a patient with newly-diagnosed fibromyalgia?
TSH, CBC, ESR
89
Role of CBC in evaluation for a patient with newly-diagnosed fibromyalgia?
Look for anemia
90
Iron deficiency, even in the absence of anemia, increases the risk of …
Restless leg syndrome
91
Achilles (calcaneal) tendon is composed of …
Gastrocnemius-Soleus complex
92
Best physical exam test for assessing Achilles (calcaneal) tendon rupture?
Foot plantarflexion with calf squeeze
93
Diagnostic test for Achilles tendon rupture in patient with (-) Thompson test?
MRI
94
77 yo female presents to ED after femur fracture; Undergoes ORIF; On post-op day #3, patient develops tachycardia, tachypnea, persistent hypoxemia that is unresponsive to supplemental O2 – next step of workup?
Rapid-sequence intubation … for management of Acute respiratory failure
95
2 sedatives that can be used in Rapid-sequence intubation?
Etomidate, Propofol
96
2 paralytics that can be used in Rapid-sequence intubation?
Succinylcholine, Rocuronium
97
77 yo female presents to ED after femur fracture; Undergoes ORIF; On post-op day #3, patient develops tachycardia, tachypnea, hypotension, persistent hypoxemia that is unresponsive to supplemental O2 – what is causing the patient’s Acute respiratory failure?
Pulmonary embolism … from fat embolism
98
2 EKG findings that support a diagnosis of Pulmonary embolism?
R bundle branch block; ST segment elevation in inferior leads
99
Best diagnostic test for patient with suspected Pulmonary embolism, who is too HD unstable to undergo CT pulmonary angiogram?
Bedside ECHO
100
4 ECHO findings that support a diagnosis of pulmonary embolism?
RV dysfunction, decrease RV contractility, RV thrombus, Tricuspid regurgitation
101
70 yo male presents with stiffness of neck, shoulders, hips; Reports that pain is worse in AM; Also reports weight loss; PE shows no TTP over facial arteries; Labs show elevated ESR – diagnosis?
Polymyalgia Rheumatica (PMR)
102
Lab value associated with PMR?
Elevated ESR
103
Condition associated with PMR, but with TTP over facial arteries?
Giant Cell Arteritis
104
Next step of workup for patient with suspected Giant Cell Arteritis?
Temporal artery biopsy
105
Best management of PMR?
Low-dose corticosteroids
106
Best management of Giant Cell Arteritis?
High-dose steroids
107
2 initial lab tests for a patient with high clinical suspicion for RA?
Rheumatoid factor, CCP antibodies
108
DOC for relief of symptoms in a patient with high clinical suspicion for RA?
NSAIDs
109
On further evaluation of a patient with high clinical suspicion for RA – patient has elevated CRP levels; XR shows early joint destruction – DOC?
Methotrexate
110
Benefit of methotrexate treatment for patients with RA and signs of bone destruction on XR?
Methotrexate slows the pression of bony erosions + cartilage loss
111
Additional step of treatment for RA patients started on Methotrexate?
Folic acid supplements
112
Why do patients on Methotrexate require Folic acid supplements?
Methotrexate inhibits dihydrofolate reductase, blocking synthesis of purines in DNA
113
3 major side effects of Methotrexate?
Hepatotoxicity, Stomatitis, Bone marrow suppression
114
Clinical presentation of multiple myeloma?
CRAB – hypercalcemia, renal failure, anemia, bone FX
115
Best screening test for multiple myeloma?
Serum + urine protein electrophoresis
116
Appearance of bone lesions in setting of multiple myeloma?
Lytic
117
Change to serum protein in setting of multiple myeloma?
Elevated total protein, but normal albumin
118
Etiology of Idiopathic Thrombocytopenic Purpura (ITP)?
Platelet destruction by anti-platelet Ig … directed against membrane proteins GP IIb/IIIa
119
Clinical presentation for Idiopathic Thrombocytopenic Purpura (ITP)?
Petechia + Thrombocytopenia … (usually preceded by a viral syndrome)
120
Best management of Idiopathic Thrombocytopenic Purpura (ITP) in a patient with active bleeding OR platelet count < 30,000?
Steroids, IVIG, Anti-D Ig
121
Best management of Idiopathic Thrombocytopenic Purpura (ITP) in a patient with ONLY cutaneous symptoms?
Observation
122
Best management of uncomplicated lower back pain?
NML moderate activity, NSAIDs
123
Alternative pharmacotherapy for uncomplicated lower back pain that is unresponsive to NSAIDs?
Non-benzodiazepine muscle relaxants
124
2 examples of non-benzodiazepine muscle relaxants?
Cyclobenzaprine, Tizanidine
125
Best management of Stage 4 avascular necrosis of femoral head?
Total hip replacement
126
What is the best imaging study for diagnosis of femoral head avascular necrosis?
MRI
127
Appearance of femoral head avascular necrosis on MRI?
Flattening of femoral head with joint space narrowing
128
2 risk factors for development of femoral head avascular necrosis?
Chronic steroid use (SLE), Excessive ETOH use
129
Best strategy for prevention of acute episodes of lower back pain?
Regular exercise program
130
Clinical presentation of Sjogren Syndrome?
Dry eyes, dry mouth (sicca)
131
Complications of dry mouth in Sjogren Syndrome?
Dental caries, candidiasis, chronic esophagitis
132
Initial lab to order in a patient with suspected SLE?
ANA
133
More specific lab results for suspected SLE?
dsDNA
134
What is the value of dsDNA in patients with suspected SLE?
Useful for following the course of disease; dsDNA correlates with disease activity
135
Treatment of choice for patient with newly diagnosed SLE?
Hydroxychloroquine, low-dose prednisone (5-15 mg/day)
136
Which motion is most likely to result in ACL tear?
Rapid change of direction, pivot
137
Clinical presentation of ACL tear?
Popping sensation at time of injury, rapid onset hemarthrosis, joint instability
138
2 maneuvers that are highly SN and SP for ACL tears?
Lachman test, Anterior drawer test
139
Diagnosis of ACL tear is usually confirmed by which test?
MRI
140
How can you distinguish MCL from ACL tears?
MCL tears are not typically associated with hemarthrosis
141
Clinical presentation of ruptured popliteal cyst?
Pain and swelling at the posterior knee and calf resembling DVT; Hemarthrosis and effusion not seen
142
Best management of osteoporosis?
Bisphosphonate therapy
143
DEXA result for osteoporosis?
< -2.5
144
DEXA result for osteopenia?
-1 to -2.5
145
Best management of osteopenia?
Calculate 10-year fracture risk score
146
At what point should patient with osteopenia be treated with bisphosphonates?
Hip fracture risk >3% … OR … Combined osteoporotic fracture risk > 20%
147
Additional treatment for ALL patients with osteopenia or osteoporosis?
Vitamin D + Calcium supplementation, Weight-bearing exercise, Smoking + ETOH cessation
148
26 yo female presents with dull back pain, difficulty walking, urinary retention; PE shows decreased muscle strength, decreased LE reflexes, decreased pain sensation in LEs – diagnosis?
Transverse myelitis
149
Event that typically precedes an episode of Transverse myelitis?
URI
150
PE findings for Transverse myelitis?
Hyporeflexia + decreased muscle tone … then, hyperreflexia + increased muscle tone
151
Workup for suspected Transverse myelitis should include …
Imaging to exclude compressive lesions that might cause similar symptoms
152
Appearance of Colles fracture on XR?
Dorsal displacement
153
Most common mechanism of injury responsible for Colles fracture?
FOOSH
154
Major risk factor for Colles fracture?
Osteoporosis
155
In addition to Colles fracture, what are 3 other injuries associated with FOOSH?
Ulnar styloid fracture, Scaphoid fracture, Carpal tunnel syndrome
156
When would orthopedic consult be recommended in setting of Colles fracture?
Significant displacement or angulation … > 15-20 degrees
157
2 aspects of clinical presentation for compartment syndrome?
Pain out of proportion to injury; Paresthesia
158
Complication of compartment syndrome?
Acute renal failure (ARF)
159
What accounts for development of ARF in setting of compartment syndrome?
Rhabdomyolysis .. causing release of myoglobin
160
First step of workup for patient with suspected compartment syndrome?
Tissue pessure measurements
161
Diagnostic pressure for compartment syndrome?
Pressure > 30 mmHg
162
Definitive treatment for compartment syndrome?
Fasciotomy
163
2 most important factors for determining prognosis of compartment syndrome?
Time to fasciotomy; High clinical index of suspicion
164
2 aspects of clinical presentation for ankylosing spondylitis?
Reduced ROM of lumbar spine; Reduced chest expansion
165
First step of workup for a patient with suspected ankylosing spondylitis?
XR to evaluate for Sacroiliitis
166
Evidence of Sacroiliitis on XR?
Erosions of ischial tuberosity + iliac crest
167
Evidence of ankylosing spondylitis on XR?
Squaring of vertebral bodies
168
3 imaging studies that can monitor progression of disease in ankylosing spondylitis?
AP + lateral L-spine XR; Lateral C-spine XR; Pelvic XR
169
5 clinical conditions associated with ankylosing spondylitis?
Restrictive lung disease, Anterior uveitis, Aortic regurgitation, IgA nephropathy, Restrictive lung disease
170
What accounts for associated between ankylosing spondylitis and restrictive lung disease?
Limited costovertebral joint motion + apical pulmonary fibrosis
171
Description of sclerodactyly seen in scleroderma?
Thickened, puffy digits
172
2 pulmonary manifestations of scleroderma?
Pulmonary HTN, interstitial lung disease
173
Screening test that should be performed for every patient with newly-diagnosed scleroderma?
PFTs
174
Which movements make spinal stenosis pain better?
Spine flexion
175
Which movements make spinal stenosis pain worse?
Spine extension
176
Diagnostic test for spinal stenosis?
MRI
177
Appearance of MRI in setting of spinal stenosis?
Hypertrophy of ligamentum flavum
178
Reflex affected by L2-L4?
Patellar
179
Sensory loss associated with L2-L4?
Anteromedial thigh, Medial shin
180
Weakness associated with L2-L4?
Hip flexion, Hip adduction, Knee extension
181
Sensory loss associated with L5?
Lateral shin; Dorsum of foot
182
Weakness associated with L5?
Foot dorsiflexion, eversion; Toe extension
183
Reflex affected by S1?
Achilles
184
Sensory loss associated with S1?
Posterior calf; Sole, lateral foot
185
Weakness associated with S1?
Hip extension; Foot plantarflexion
186
Reflex affected by S2-S4?
Anocutaneous
187
Sensory loss associated with S2-S4?
Perineum
188
Weakness associated with S2-S4?
Urinary/fecal incontinence; Sexual dysfunction
189
ABX of choice for treatment of osteomyelitis in patient with Sickle Cell Anemia?
Clindamycin + Vancomycin … (ceftriaxone for salmonella, vancomycin/clindamycin for MRSA)
190
ABX that can predispose patient to patellar tendon tear?
Fluoroquinolones
191
Clinical presentation of patellar tendon tear?
Swelling, pain in anterior knee … superior displacement of patella
192
Which ROM is limited in patellar tendon tear?
Patient cannot fully extend knee; Cannot raise leg against gravity
193
Mechanism that can lead to patellar tendon tear?
Strong quadriceps contraction
194
Best management of patellar tendon tear?
Surgical repair
195
Most common etiology of Bronchiolitis?
RSV
196
Epidemiology of Bronchiolitis?
Age < 2 yo
197
Clinical presentation of Bronchiolitis?
Nasal discharge + congestion, then respiratory distress
198
Best management of Bronchiolitis?
Supportive care
199
DOC for prevention of Bronchiolitis?
Palivizumab
200
Most common cause of death in SLE?
Cardiovascular events
201
What accounts for increased CAD risk in SLE?
Accelerated atherosclerosis
202
48 yo female presents for increased fatigue, daytime sleepiness; HX of HTN, RA; PE shows conjunctival pallor BL hand joint deformities; Labs show Hgb 8.2, MCV 84, Iron NML, low TIBC, high ferritin, normal EPO, high ESR - what is next step in management?
Infliximab
203
48 yo female presents for increased fatigue, daytime sleepiness; HX of HTN, RA; PE shows conjunctival pallor BL hand joint deformities; Labs show Hgb 8.2, MCV 84, Iron NML, low TIBC, high ferritin, normal EPO, high ESR - diagnosis?
Anemia of Chronic Disease
204
MOA of Infliximab in treatment of Anemia of Chronic Disease?
Anti-TNFa … management of underlying RA
205
25 yo male presents to ED after stung by wasp; HR 108, O2 sat 94% on RA; PE shows urticaria, bilateral wheezes - what is best next step of management?
IM epinephrine
206
Diagnosis of anaphylaxis can be made based on allergic symptoms in ___ systems
2+
207
What is the best management of anaphylaxis?
IM epinephrine
208
32 yo female with HX of SLE presents for wellness visit; SLE is stable on hydroxychloroquine; Vitals show BP 150/90; PE shows mild pitting edema of BLE; Labs show Hgb 10.8, PL 140, Cr 2; UA significant for 2+ protein, 1-2 WBC, 20-30 RBCs, RBC casts - what is next best step in management?
Perform US-guided renal biopsy
209
When is renal biopsy indicated in workup of SLE nephritis?
Patients with significant renal involvement … proteinuria, elevated creatinine
210
In setting of SLE nephritis (class 4), monitoring of which 2 factors is helpful?
Complement + Anti-dsDNA
211
27 yo male presents to ED after MVA; during MVA, patient’s R knee struck front dashboard; Which structure was most likely injured?
PCL
212
In addition to dashboard injury, what is another mechanism of injury for PCL tear?
Landing on flexed knee with foot in plantarflexion
213
35 yo male presents 2 weeks after GI illness; Today reports pain in R knee, irritation of BL eyes, dysuria - what is most likely joint aspiration finding in Reiter’s arthritis?
Elevated WBC count with negative joint culture
214
Which patient is most likely to develop reactive (Reiter’s)arthritis … HLA-B27 positive, Chlamydia infection, both?
Both HLA-B27 positive + Chlamydia infection
215
46 yo female presents 3 weeks after injuring L knee while moving patient; Reports that light stimulation with bed sheets leads to abnormal pain and insomnia; Reports increased pain, swelling, sweating, warmth, and mottled blueish color of L knee; Reports associated poor sleep and fatigue - diagnosis?
Complex Regional Pain Syndrome
216
4 hallmark aspects of Complex Regional Pain Syndrome?
POOP, temperature change, edema, abnormal skin color
217
Etiology of Complex Regional Pain Syndrome?
Injury causing increase sensitivity to sympathetic nerves
218
48 yo female presents with symptoms suspicious for Sjogren’s Syndrome; Also has mobile, non-tender, 2x2 cm R-sided submandibular mass - what is next step in management?
Anti-Ro, Anti-La antibodies
219
48 yo female presents with symptoms suspicious for Sjogren’s Syndrome; Also has mobile, non-tender, 2x2 cm R-sided submandibular mass - what is most likely diagnosis for patient’s neck mass?
B cell non-Hodgkin lymphoma
220
Which type of tendonitis typically affects the 3rd and 4th digits?
Duputren contracture
221
Condition associated with Duputren contracture?
DM
222
Which anti-HTN medication has a modest uricosuric effect, so is a good option for treating HTN in patient’s with gout?
ARBs (losartan)
223
3 medications that should be avoided in patient’s with gout?
Thiazides, loop diuretics, ASA
224
What is best management of acute anterior shoulder dislocation in patient with diminished sensation over R lateral shoulder?
Closed reduction with procedural sedation
225
Which nerve is likely compressed during anterior shoulder dislocation?
Axillary
226
What is best management of Paget’s disease?
Alendronate
227
What is best management of Paget’s disease in patient who cannot tolerate bisphosphonates?
Calcineurin
228
2 XR hallmarks of Paget’s disease?
Cortical thickening, sclerotic lesion
229
Appearance of Paget’s disease on bone scan?
Increased uptake due to increased bone remodeling
230
5 aspects of clinical presentation for sarcoidosis?
Bilateral hilar adenopathy, Erythema nodosum, Anterior uveitis, HyperCa2+, ELevated ACE levels
231
4 aspects of clinical presentation for anterior uveitis?
Erythema at limbus, constricted pupil, blurry vision, moderate eye pain
232
Serum sickness represents a Type ___ HSN reaction
3
233
Etiology of Type 3 HSN reactions?
Immune complex mediated
234
3 conditions that represent Type 3 HSN reactions?
Serum sickness, Polyarteritis nodosum, Glomerulonephritis
235
___ should be considered in patients with RA who develop acute monoarthritis, especially those on immunosuppressive therapy
Septic arthritis
236
What is best initial step of workup for patient with suspected Septic arthritis?
Joint aspiration
237
Before beginning a patient with RA on Tumor Necrosis Factor inhibitor – what additional aspect of treatment should be pursued?
IFNg release assay, TB skin test
238
Risk of starting Tumor Necrosis Factor inhibitor in patient with RA?
Increased risk of opportunistic infection, including TB
239
How should an amputated digit be transported?
Wrapped in gauze, moistened with saline, placed in a sealed + sterile plastic bag; Over ice + saline
240
Best diagnostic test for patient with suspected gout?
Arthrocentesis … needle-shaped urate crystals that are (-) birefringent
241
DOC for acute gout flare?
NSAIDs
242
2 NSAIDs of choice for acute gout flare?
Ibuprofen, indomethacin
243
3 contraindications to treatment of acute gout flare with NSAIDs?
CKD, PUD, current anticoagulation use
244
DOC for acute gout flare in which NSAIDs are contraindicated?
Colchicine
245
76 yo female presents with achy pain in shoulder and pelvic girdle; Current medications include simvastatin; PE shows muscle tenderness to palpation; Labs show normal creatine kinase levels – what is best next step of workup?
Measure ESR
246
What is expected creatine kinase level in polymyalgia rheumatica (PMR)?
Normal CK
247
Which 2 lab values are typically increased in polymyalgia rheumatica (PMR)?
Elevated CRP, Elevated ESR
248
Best management of polymyalgia rheumatica (PMR)?
Low-dose corticosteroids
249
22 yo female runner presents for R shin splints; What is most likely to be seen on XR of RLE?
No bony abnormalities
250
How can stress fractures be diagnosed clinically (XR have low SN for stress fractures)?
Pain over a specific area that increases with jumping/running, associated with local swelling + point TTP
251
Best method for prevention of pulmonary fat embolism?
Early immobilization and correction of fracture
252
Clinical presentation of pulmonary fat embolism?
Triad of respiratory insufficiency, neurological impairment, petechial rash
253
Timeframe in which pulmonary fat embolism typically occurs?
24-72 hours after severe trauma
254
Definition of spondylolisthesis?
Bilateral pars interarticularis fractures with anterior slippage of vertebral body
255
Most common location for spondylolisthesis?
L5, S1
256
Clinical presentation of spondylolisthesis?
Back pain that worsens with extension
257
Diagnostic test for spondylolisthesis?
Lateral x-rays of lumbar spine
258
Best management of spondylolisthesis?
Simple analgesics, activity modification
259
26 yo female is a long-distance runner; Reports LKMP about 3 years ago; Amenorrhea places patient at risk of which other condition?
Osteoporosis
260
What accounts for increased risk of Osteoporosis in patients with exercise-induced amenorrhea?
Decreased secretion of LH
261
Change to lipid panel in exercise-induced amenorrhea?
Hypercholesterolemia
262
17 yo male presents with progressive muscle weakness and pain; PE shows delayed relaxation after contraction of thenar and hypothenar muscle – diagnosis?
Myotonic dystrophy
263
Inheritance pattern for Myotonic dystrophy?
AD
264
Etiology of Myotonic dystrophy?
CTG repeat expansion in DMPK gene
265
2 aspects of clinical presentation for Myotonic dystrophy?
Temporal wasting, delay in muscle relaxation
266
Inheritance pattern for Duchenne + Becker Muscular Dystrophy?
X-linked recessive
267
Which medication prescribed to patients with renal transplant is associated with increased risk of gout?
Cyclosporine
268
Appearance of gout on synovial fluid analysis?
(+)-ly birefringent needle-shaped crystals
269
What is best management option for acute gout in patients with renal transplant?
NSAIDs are contraindicated, colchicine clearance is delayed by cyclosporine … so best option is intra-articular steroids (triamcinolone)
270
In addition to trauma, what is another situation that can precede compartment syndrome?
Arterial occlusion + reperfusion
271
4 aspects of clinical presentation for early compartment syndrome?
POOP, Increased pain on passive stretch, Rapid swelling, Paresthesia
272
25 yo male presents to ED after bar fight; PE shows deep lacerated wound on palmar aspect of the R hand, extending from index finger at MCP joint to proximal phalanges of middle + ring fingers to middle phalanx of little finger; patient is unable to flex distal phalanges of these fingers; which of the following structures is most likely to have been injured?
Tendons
273
60 yo male presents with lumbar back pain, which radiates along posterior surface of R leg; Pain is worse with bending forward, better with laying flat - diagnosis?
Sciatic nerve pain … lumbosacral radiculopathy
274
PE finding associated with lumbosacral radiculopathy?
(+) straight leg raise
275
24 yo male presents after R knee injury; PE shows moderate laxity with valgus stress, pain with ER of R tibia with knee bent to 90 degrees - diagnosis?
MCL injury
276
Valgus laxity is associated with ___ injury
MCL
277
Varus laxity is associated with ___ injury
LCL
278
Quality of shoulder pain that suggests rotator cuff tendonitis?
Lateral shoulder pain
279
Pain in rotator cuff tendonitis is typically aggravated by …
ABduction, ER
280
69-year-old male presents with bilateral shoulder, thigh pain; reports pain is associated with prolonged morning stiffness; Also complains of right-sided headache with jaw pain; what is the most appropriate screening test for this patient?
ESR
281
69-year-old male presents with bilateral shoulder, thigh pain; reports pain is associated with prolonged morning stiffness; Also complains of right-sided headache with jaw pain; diagnosis?
Giant cell arteritis
282
Best management of patients with giant cell arteritis?
High-dose glucocorticoid
283
What is the greatest risk factor for giant cell arteritis?
Age > 50
284
67-year-old male presents for 2 days of back pain; states that he was moving boxes when the pain began; reports pain is relieved by laying down, increased with straining or cough; PE reveals point tenderness to palpation and percussion along midline at fourth lumbar vertebra; diagnosis?
Vertebral compression fracture
285
Etiology of vertebral compression fracture?
Loss of bone mineral density
286
68-year-old male presents after 2 months of right foot swelling, which began 2 days after striking his right foot against a table; history of type II DM; PE reveals warmth, edema, widening of right midfoot; XR of right foot demonstrates osteolysis of phalanges with hourglass appearance, partial disappearance of metatarsal heads, with appearance of soft candy; diagnosis?
Neuropathic arthropathy
287
Treatment aim for neuropathic arthropathy?
Charcot arthropathy
288
Etiology of neuropathic arthropathy?
Impaired sensation and joint proprioception
289
3 homework XR findings for neuropathic arthropathy?
Phalangeal osteolysis (hourglass appearance), partial disappearance of metatarsal heads, sclerosis and subluxation of tarsal bones
290
What is best management of neuropathic arthropathy?
Casting to reduce weightbearing
291
36-year-old female with SLE is currently on daily prednisone for lupus nephritis; which medication should be administered to prevent bone loss inpatient?
Calcium, vitamin
