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UWorld > Rheumatology + Ortho > Flashcards

Rheumatology + Ortho Flashcards

1
Q

Femoral nerve innervates ___ muscle group

A

Quadriceps

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2
Q

Muscle weakness in the setting of femoral nerve damage is manifest as …

A

Inability to extend knee

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3
Q

Sensory loss in thigh in the setting of femoral nerve damage?

A

Sensory loss over anterior + medial thigh

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4
Q

Sensory loss in leg in the setting of femoral nerve damage?

A

Sensory loss over medial shin, arch of foot

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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)

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6
Q

Which reflex is diminished in setting of femoral nerve damage?

A

Knee jerk reflex

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7
Q

Which action of thigh is spared in setting of femoral nerve damage?

A

Leg adduction

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8
Q

Leg adduction results from activation of which nerve?

A

Obturator n.

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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

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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

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11
Q

DXA definition of normal bone density?

A

T score > -1

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12
Q

DXA definition of osteopenia?

A

T score between -1 and -2.5

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13
Q

DXA definition of osteoporosis?

A

T score < -2.5

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14
Q

Equation for calculating albumin-corrected calcium?

A

(Measured Ca2+) + 0.8*(4-albumin)

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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

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16
Q

Etiology of hypercalcemia is patient with recent trauma causing quadriplegia?

A

Immobilization … causes increased release of Ca2+ from bones

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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

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18
Q

Best treatment for hypercalcemia due to immobilization?

A

Bisphosphonates

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19
Q

53 yo male presents with arthropathy, DM, hepatomegaly – diagnosis?

A

Hereditary hemochromatosis

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20
Q

Inheritance pattern of Hereditary hemochromatosis?

A

AR

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21
Q

Which 2 joints are most commonly affected in Hereditary hemochromatosis?

A

2nd and 3rd MCP joints

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22
Q

Hallmark appearance of arthropathy on XR in setting of Hereditary hemochromatosis?

A

Hook-like osteophytes

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23
Q

Hallmark appearance of joint aspiration in setting of Hereditary hemochromatosis?

A

Calcium pyrophosphate dihydrate crystals … Rhomboid shape, (+) birefringence

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24
Q

Initial evaluation of Hereditary hemochromatosis should include …

A

Iron studies

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25
Q

Best treatment for Hereditary hemochromatosis?

A

Serial phlebotomy

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26
Q

Hereditary hemochromatosis is associated with increased risk of …

A

Hepatocellular carcinoma (HCC)

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27
Q

Hallmark PE finding of adhesive capsulitis (chronic joint contracture)?

A

Limited ROM … both active and passive

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28
Q

Best initial treatment for adhesive capsulitis (chronic joint contracture)?

A

ROM exercises

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29
Q

Best treatment for resistant adhesive capsulitis (chronic joint contracture) … does not respond to 2-3 months of ROM exercises ?

A

Glucocorticoid injection

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30
Q

Clinical presentation of intracapsular (femoral neck) hip fractures?

A

Pain WITHOUT significant bruising

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31
Q

Intracapsular (femoral neck) hip fractures are associated with a higher risk of …

A

Avascular necrosis

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32
Q

Clinical presentation of extracapsular hip fractures?

A

Pain WITH significant bruising

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33
Q

Extracapsular hip fractures are associated with a higher risk of …

A

Displacement

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34
Q

Best management of hip fracture in elderly patients who are stable and ambulatory prior to fracture?

A

Surgery within 48 hours

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35
Q

Benefit of surgery within 48 hours of hip fracture for elderly patients who were stable and ambulatory prior to the fracture?

A

Lower risk of pressure ulcer + PNA

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36
Q

Asymmetric oligoarthritis in patients with recent history of chlamydia infection is suggestive of …

A

Reactive arthritis

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37
Q

Typical joint aspiration results in setting of Reactive arthritis?

A

Increased WBC count, Negative culture

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38
Q

Additional screening recommended for males with HX of chlamydia proctitis?

A

Rectal screening … (MSM)

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39
Q

Common extra-articular manifestation of Reactive arthritis?

A

Circinate balanitis

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40
Q

Description of Circinate balanitis as an extra-articular manifestation of Reactive arthritis?

A

Shallow, painless ulcers on the glans penis; Not associated with inguinal lymphadenopathy

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41
Q

What feature differentiates Circinate balanitis from painless ulcers seen in syphilis and lymphogranuloma venereum?

A

Circinate balanitis is not associated with inguinal lymphadenopathy

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42
Q

New-onset reactive arthritis in a patients with history of chlamydia infection should prompt …

A

Repeat testing for chlamydia via NAAT on urine samples

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43
Q

Best treatment for reactive arthritis with active chlamydia infection?

A

ABX + NSAIDs

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44
Q

2 aspects of medical management associated with poor prognosis of acute lower back pain?

A

Prolonged bed rest, Opioid therapy

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45
Q

Patient presents with proximal muscle weakness and joint pain; Labs show elevated muscle enzymes (CK AST), and elevated inflammatory markers (CRP, ESR) – diagnosis?

A

Polymyositis

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46
Q

GI complication of Polymyositis?

A

Involvement of upper esophageal muscles … leading to dysphagia + aspiration PNA

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47
Q

Definitive diagnosis of Polymyositis?

A

Muscle biopsy

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48
Q

Next step of screening for Polymyositis?

A

Polymyositis may represent a paraneoplastic syndrome … so recommend age-appropriate screening for patient

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49
Q

Pulmonary complication of Polymyositis?

A

ILD, methotrexate-induced pneumonitis

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50
Q

Best treatment for Polymyositis?

A

Steroids + Methotrexate

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51
Q

Appearance of ILD on CT?

A

Ground-glass opacities, Reticular changes, Honeycombing, Patchy consolidation

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52
Q

Appearance of ILD on PFTs?

A

Decreased FVC, Decreased TLC, Decreased DCLO

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53
Q

2 lab tests that need to be ordered prior to beginning a patient on bisphosphonates?

A

Serum Ca2+, Vitamin D levels

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54
Q

Why must Serum Ca2+, Vitamin D levels be measured prior to beginning a patient on bisphosphonates?

A

Bisphosphonates often cause hypocalcemia

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55
Q

Recommendations for post-menopausal females for prevention of osteoporosis?

A

Adequate Ca2+ and Vitamin D intake; Regular weight-bearing exercise

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56
Q

Recommended Ca2+ intake for post-menopausal females?

A

1200mg daily

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57
Q

Recommended Vitamin D intake for post-menopausal females?

A

600-800mg daily

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58
Q

Occult supracondylar fractures involve which bone?

A

Distal humerus

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59
Q

Clinical presentation of supracondylar fractures?

A

Severe pain after FOOSH

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60
Q

Hallmark XR finding for supracondylar fracture?

A

Displaced posterior fat pad

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61
Q

Best management for non-displaced supracondylar fractures?

A

Splint placement for immobilization

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62
Q

Best management for displaced supracondylar fractures?

A

OR for reduction and pinning

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63
Q

3 physical exam findings for clavicular fracture in newborn?

A

Pain with passive UE movement, Crepitus over clavicle, asymmetric Moro reflex

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64
Q

Best management for clavicular fracture in newborn?

A

Gentle handling, parental reassurance … fracture will heal spontaneously

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65
Q

Radial head subluxation is caused by displacement of which anatomic structure?

A

Annular ligament

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66
Q

Best treatment for radial head subluxation?

A

Forearm hyper-pronation; Forearm supination/flexion

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67
Q

Most common carpal bone fracture?

A

Scaphoid

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68
Q

Location of pain in setting of scaphoid fracture?

A

Radial aspect of wrist in anatomic snuffbox

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69
Q

2 complications of untreated scaphoid fracture?

A

Nonunion, avascular necrosis

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70
Q

Best management of patients with nondisplaced scaphoid fracture who do not meet surgical criteria?

A

Short arm spica cast, serial XRs in 1-2 weeks (to monitor healing)

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71
Q

Best management of patients with displaced scaphoid fracture, osteonecrosis?

A

Referral to orthopedic surgery

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72
Q

Clinical presentation of Patellofemoral Pain Syndrome (PFP)?

A

Pain over anterior knee, worsened by activities that involve quad contraction (squatting, stairs)

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73
Q

Epidemiology of Patellofemoral Pain Syndrome (PFP)?

A

Females

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74
Q

Exam test that is highly specific for Patellofemoral Pain Syndrome (PFP)?

A

Patellofemoral compression test (pain elicitied by extending knee while compressing patella)

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75
Q

Best management of Patellofemoral Pain Syndrome (PFP)?

A

Stretching; Exercises that strengthen quad muscles

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76
Q

Next step of workup for patient with fracture following minor trauma (ground-level fall)?

A

Testing for osteoporosis with DEXA

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77
Q

Normal bone mineral density on DEXA scan?

A

T score = 0 to -1

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78
Q

Osteopenia bone mineral density on DEXA scan?

A

T score = -1 to -2.5

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79
Q

Osteoporosis bone mineral density on DEXA scan?

A

T score = < -2.5

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80
Q

Additional diagnostic factor for Osteoporosis?

A

HX of fragility fracture

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81
Q

5 risk factors for development of Osteoporosis?

A

Caucasian, FHX, Smoking, Steroid use, Postmenopausal

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82
Q

Indication for pharmacological therapy for osteoporosis in post-menopausal women?

A

T score < -2.5 … OR … HX of hip or vertebral fracture (regardless of T score)

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83
Q

DOC for treatment of osteoporosis in post-menopausal women?

A

Bisphosphonates

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84
Q

Recommended daily intake of Ca2+ for post-menopausal females?

A

1200 mg

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85
Q

Recommended daily intake of Vitamin D for post-menopausal females?

A

800 IU

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86
Q

How do glucocorticoids lead to accelerated bone resorption (increasing risk of osteoporosis)?

A

Decrease intestinal absorption of Ca2+, Increase Ca2+ excretion in urine

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87
Q

43 yo female is newly-diagnosed with SLE; Plan to treat with glucocorticoids – what additional treatment should be implemented?

A

Supplemental Ca2+ and Vitamin D

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88
Q

3 steps of evaluation for a patient with newly-diagnosed fibromyalgia?

A

TSH, CBC, ESR

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89
Q

Role of CBC in evaluation for a patient with newly-diagnosed fibromyalgia?

A

Look for anemia

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90
Q

Iron deficiency, even in the absence of anemia, increases the risk of …

A

Restless leg syndrome

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91
Q

Achilles (calcaneal) tendon is composed of …

A

Gastrocnemius-Soleus complex

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92
Q

Best physical exam test for assessing Achilles (calcaneal) tendon rupture?

A

Foot plantarflexion with calf squeeze

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93
Q

Diagnostic test for Achilles tendon rupture in patient with (-) Thompson test?

A

MRI

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94
Q

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?

A

Rapid-sequence intubation … for management of Acute respiratory failure

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95
Q

2 sedatives that can be used in Rapid-sequence intubation?

A

Etomidate, Propofol

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96
Q

2 paralytics that can be used in Rapid-sequence intubation?

A

Succinylcholine, Rocuronium

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97
Q

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?

A

Pulmonary embolism … from fat embolism

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98
Q

2 EKG findings that support a diagnosis of Pulmonary embolism?

A

R bundle branch block; ST segment elevation in inferior leads

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99
Q

Best diagnostic test for patient with suspected Pulmonary embolism, who is too HD unstable to undergo CT pulmonary angiogram?

A

Bedside ECHO

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100
Q

4 ECHO findings that support a diagnosis of pulmonary embolism?

A

RV dysfunction, decrease RV contractility, RV thrombus, Tricuspid regurgitation

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101
Q

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?

A

Polymyalgia Rheumatica (PMR)

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102
Q

Lab value associated with PMR?

A

Elevated ESR

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103
Q

Condition associated with PMR, but with TTP over facial arteries?

A

Giant Cell Arteritis

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104
Q

Next step of workup for patient with suspected Giant Cell Arteritis?

A

Temporal artery biopsy

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105
Q

Best management of PMR?

A

Low-dose corticosteroids

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106
Q

Best management of Giant Cell Arteritis?

A

High-dose steroids

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107
Q

2 initial lab tests for a patient with high clinical suspicion for RA?

A

Rheumatoid factor, CCP antibodies

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108
Q

DOC for relief of symptoms in a patient with high clinical suspicion for RA?

A

NSAIDs

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109
Q

On further evaluation of a patient with high clinical suspicion for RA – patient has elevated CRP levels; XR shows early joint destruction – DOC?

A

Methotrexate

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110
Q

Benefit of methotrexate treatment for patients with RA and signs of bone destruction on XR?

A

Methotrexate slows the pression of bony erosions + cartilage loss

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111
Q

Additional step of treatment for RA patients started on Methotrexate?

A

Folic acid supplements

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112
Q

Why do patients on Methotrexate require Folic acid supplements?

A

Methotrexate inhibits dihydrofolate reductase, blocking synthesis of purines in DNA

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113
Q

3 major side effects of Methotrexate?

A

Hepatotoxicity, Stomatitis, Bone marrow suppression

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114
Q

Clinical presentation of multiple myeloma?

A

CRAB – hypercalcemia, renal failure, anemia, bone FX

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115
Q

Best screening test for multiple myeloma?

A

Serum + urine protein electrophoresis

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116
Q

Appearance of bone lesions in setting of multiple myeloma?

A

Lytic

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3
4
5
Perfectly
117
Q

Change to serum protein in setting of multiple myeloma?

A

Elevated total protein, but normal albumin

118
Q

Etiology of Idiopathic Thrombocytopenic Purpura (ITP)?

A

Platelet destruction by anti-platelet Ig … directed against membrane proteins GP IIb/IIIa

119
Q

Clinical presentation for Idiopathic Thrombocytopenic Purpura (ITP)?

A

Petechia + Thrombocytopenia … (usually preceded by a viral syndrome)

120
Q

Best management of Idiopathic Thrombocytopenic Purpura (ITP) in a patient with active bleeding OR platelet count < 30,000?

A

Steroids, IVIG, Anti-D Ig

121
Q

Best management of Idiopathic Thrombocytopenic Purpura (ITP) in a patient with ONLY cutaneous symptoms?

A

Observation

122
Q

Best management of uncomplicated lower back pain?

A

NML moderate activity, NSAIDs

123
Q

Alternative pharmacotherapy for uncomplicated lower back pain that is unresponsive to NSAIDs?

A

Non-benzodiazepine muscle relaxants

124
Q

2 examples of non-benzodiazepine muscle relaxants?

A

Cyclobenzaprine, Tizanidine

125
Q

Best management of Stage 4 avascular necrosis of femoral head?

A

Total hip replacement

126
Q

What is the best imaging study for diagnosis of femoral head avascular necrosis?

A

MRI

127
Q

Appearance of femoral head avascular necrosis on MRI?

A

Flattening of femoral head with joint space narrowing

128
Q

2 risk factors for development of femoral head avascular necrosis?

A

Chronic steroid use (SLE), Excessive ETOH use

129
Q

Best strategy for prevention of acute episodes of lower back pain?

A

Regular exercise program

130
Q

Clinical presentation of Sjogren Syndrome?

A

Dry eyes, dry mouth (sicca)

131
Q

Complications of dry mouth in Sjogren Syndrome?

A

Dental caries, candidiasis, chronic esophagitis

132
Q

Initial lab to order in a patient with suspected SLE?

A

ANA

133
Q

More specific lab results for suspected SLE?

A

dsDNA

134
Q

What is the value of dsDNA in patients with suspected SLE?

A

Useful for following the course of disease; dsDNA correlates with disease activity

135
Q

Treatment of choice for patient with newly diagnosed SLE?

A

Hydroxychloroquine, low-dose prednisone (5-15 mg/day)

136
Q

Which motion is most likely to result in ACL tear?

A

Rapid change of direction, pivot

137
Q

Clinical presentation of ACL tear?

A

Popping sensation at time of injury, rapid onset hemarthrosis, joint instability

138
Q

2 maneuvers that are highly SN and SP for ACL tears?

A

Lachman test, Anterior drawer test

139
Q

Diagnosis of ACL tear is usually confirmed by which test?

A

MRI

140
Q

How can you distinguish MCL from ACL tears?

A

MCL tears are not typically associated with hemarthrosis

141
Q

Clinical presentation of ruptured popliteal cyst?

A

Pain and swelling at the posterior knee and calf resembling DVT; Hemarthrosis and effusion not seen

142
Q

Best management of osteoporosis?

A

Bisphosphonate therapy

143
Q

DEXA result for osteoporosis?

A

< -2.5

144
Q

DEXA result for osteopenia?

A

-1 to -2.5

145
Q

Best management of osteopenia?

A

Calculate 10-year fracture risk score

146
Q

At what point should patient with osteopenia be treated with bisphosphonates?

A

Hip fracture risk >3% … OR … Combined osteoporotic fracture risk > 20%

147
Q

Additional treatment for ALL patients with osteopenia or osteoporosis?

A

Vitamin D + Calcium supplementation, Weight-bearing exercise, Smoking + ETOH cessation

148
Q

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?

A

Transverse myelitis

149
Q

Event that typically precedes an episode of Transverse myelitis?

A

URI

150
Q

PE findings for Transverse myelitis?

A

Hyporeflexia + decreased muscle tone … then, hyperreflexia + increased muscle tone

151
Q

Workup for suspected Transverse myelitis should include …

A

Imaging to exclude compressive lesions that might cause similar symptoms

152
Q

Appearance of Colles fracture on XR?

A

Dorsal displacement

153
Q

Most common mechanism of injury responsible for Colles fracture?

A

FOOSH

154
Q

Major risk factor for Colles fracture?

A

Osteoporosis

155
Q

In addition to Colles fracture, what are 3 other injuries associated with FOOSH?

A

Ulnar styloid fracture, Scaphoid fracture, Carpal tunnel syndrome

156
Q

When would orthopedic consult be recommended in setting of Colles fracture?

A

Significant displacement or angulation … > 15-20 degrees

157
Q

2 aspects of clinical presentation for compartment syndrome?

A

Pain out of proportion to injury; Paresthesia

158
Q

Complication of compartment syndrome?

A

Acute renal failure (ARF)

159
Q

What accounts for development of ARF in setting of compartment syndrome?

A

Rhabdomyolysis .. causing release of myoglobin

160
Q

First step of workup for patient with suspected compartment syndrome?

A

Tissue pessure measurements

161
Q

Diagnostic pressure for compartment syndrome?

A

Pressure > 30 mmHg

162
Q

Definitive treatment for compartment syndrome?

A

Fasciotomy

163
Q

2 most important factors for determining prognosis of compartment syndrome?

A

Time to fasciotomy; High clinical index of suspicion

164
Q

2 aspects of clinical presentation for ankylosing spondylitis?

A

Reduced ROM of lumbar spine; Reduced chest expansion

165
Q

First step of workup for a patient with suspected ankylosing spondylitis?

A

XR to evaluate for Sacroiliitis

166
Q

Evidence of Sacroiliitis on XR?

A

Erosions of ischial tuberosity + iliac crest

167
Q

Evidence of ankylosing spondylitis on XR?

A

Squaring of vertebral bodies

168
Q

3 imaging studies that can monitor progression of disease in ankylosing spondylitis?

A

AP + lateral L-spine XR; Lateral C-spine XR; Pelvic XR

169
Q

5 clinical conditions associated with ankylosing spondylitis?

A

Restrictive lung disease, Anterior uveitis, Aortic regurgitation, IgA nephropathy, Restrictive lung disease

170
Q

What accounts for associated between ankylosing spondylitis and restrictive lung disease?

A

Limited costovertebral joint motion + apical pulmonary fibrosis

171
Q

Description of sclerodactyly seen in scleroderma?

A

Thickened, puffy digits

172
Q

2 pulmonary manifestations of scleroderma?

A

Pulmonary HTN, interstitial lung disease

173
Q

Screening test that should be performed for every patient with newly-diagnosed scleroderma?

A

PFTs

174
Q

Which movements make spinal stenosis pain better?

A

Spine flexion

175
Q

Which movements make spinal stenosis pain worse?

A

Spine extension

176
Q

Diagnostic test for spinal stenosis?

A

MRI

177
Q

Appearance of MRI in setting of spinal stenosis?

A

Hypertrophy of ligamentum flavum

178
Q

Reflex affected by L2-L4?

A

Patellar

179
Q

Sensory loss associated with L2-L4?

A

Anteromedial thigh, Medial shin

180
Q

Weakness associated with L2-L4?

A

Hip flexion, Hip adduction, Knee extension

181
Q

Sensory loss associated with L5?

A

Lateral shin; Dorsum of foot

182
Q

Weakness associated with L5?

A

Foot dorsiflexion, eversion; Toe extension

183
Q

Reflex affected by S1?

A

Achilles

184
Q

Sensory loss associated with S1?

A

Posterior calf; Sole, lateral foot

185
Q

Weakness associated with S1?

A

Hip extension; Foot plantarflexion

186
Q

Reflex affected by S2-S4?

A

Anocutaneous

187
Q

Sensory loss associated with S2-S4?

A

Perineum

188
Q

Weakness associated with S2-S4?

A

Urinary/fecal incontinence; Sexual dysfunction

189
Q

ABX of choice for treatment of osteomyelitis in patient with Sickle Cell Anemia?

A

Clindamycin + Vancomycin … (ceftriaxone for salmonella, vancomycin/clindamycin for MRSA)

190
Q

ABX that can predispose patient to patellar tendon tear?

A

Fluoroquinolones

191
Q

Clinical presentation of patellar tendon tear?

A

Swelling, pain in anterior knee … superior displacement of patella

192
Q

Which ROM is limited in patellar tendon tear?

A

Patient cannot fully extend knee; Cannot raise leg against gravity

193
Q

Mechanism that can lead to patellar tendon tear?

A

Strong quadriceps contraction

194
Q

Best management of patellar tendon tear?

A

Surgical repair

195
Q

Most common etiology of Bronchiolitis?

A

RSV

196
Q

Epidemiology of Bronchiolitis?

A

Age < 2 yo

197
Q

Clinical presentation of Bronchiolitis?

A

Nasal discharge + congestion, then respiratory distress

198
Q

Best management of Bronchiolitis?

A

Supportive care

199
Q

DOC for prevention of Bronchiolitis?

A

Palivizumab

200
Q

Most common cause of death in SLE?

A

Cardiovascular events

201
Q

What accounts for increased CAD risk in SLE?

A

Accelerated atherosclerosis

202
Q

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?

A

Infliximab

203
Q

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?

A

Anemia of Chronic Disease

204
Q

MOA of Infliximab in treatment of Anemia of Chronic Disease?

A

Anti-TNFa … management of underlying RA

205
Q

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?

A

IM epinephrine

206
Q

Diagnosis of anaphylaxis can be made based on allergic symptoms in ___ systems

A

2+

207
Q

What is the best management of anaphylaxis?

A

IM epinephrine

208
Q

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?

A

Perform US-guided renal biopsy

209
Q

When is renal biopsy indicated in workup of SLE nephritis?

A

Patients with significant renal involvement … proteinuria, elevated creatinine

210
Q

In setting of SLE nephritis (class 4), monitoring of which 2 factors is helpful?

A

Complement + Anti-dsDNA

211
Q

27 yo male presents to ED after MVA; during MVA, patient’s R knee struck front dashboard; Which structure was most likely injured?

A

PCL

212
Q

In addition to dashboard injury, what is another mechanism of injury for PCL tear?

A

Landing on flexed knee with foot in plantarflexion

213
Q

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?

A

Elevated WBC count with negative joint culture

214
Q

Which patient is most likely to develop reactive (Reiter’s)arthritis … HLA-B27 positive, Chlamydia infection, both?

A

Both HLA-B27 positive + Chlamydia infection

215
Q

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?

A

Complex Regional Pain Syndrome

216
Q

4 hallmark aspects of Complex Regional Pain Syndrome?

A

POOP, temperature change, edema, abnormal skin color

217
Q

Etiology of Complex Regional Pain Syndrome?

A

Injury causing increase sensitivity to sympathetic nerves

218
Q

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?

A

Anti-Ro, Anti-La antibodies

219
Q

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?

A

B cell non-Hodgkin lymphoma

220
Q

Which type of tendonitis typically affects the 3rd and 4th digits?

A

Duputren contracture

221
Q

Condition associated with Duputren contracture?

A

DM

222
Q

Which anti-HTN medication has a modest uricosuric effect, so is a good option for treating HTN in patient’s with gout?

A

ARBs (losartan)

223
Q

3 medications that should be avoided in patient’s with gout?

A

Thiazides, loop diuretics, ASA

224
Q

What is best management of acute anterior shoulder dislocation in patient with diminished sensation over R lateral shoulder?

A

Closed reduction with procedural sedation

225
Q

Which nerve is likely compressed during anterior shoulder dislocation?

A

Axillary

226
Q

What is best management of Paget’s disease?

A

Alendronate

227
Q

What is best management of Paget’s disease in patient who cannot tolerate bisphosphonates?

A

Calcineurin

228
Q

2 XR hallmarks of Paget’s disease?

A

Cortical thickening, sclerotic lesion

229
Q

Appearance of Paget’s disease on bone scan?

A

Increased uptake due to increased bone remodeling

230
Q

5 aspects of clinical presentation for sarcoidosis?

A

Bilateral hilar adenopathy, Erythema nodosum, Anterior uveitis, HyperCa2+, ELevated ACE levels

231
Q

4 aspects of clinical presentation for anterior uveitis?

A

Erythema at limbus, constricted pupil, blurry vision, moderate eye pain

232
Q

Serum sickness represents a Type ___ HSN reaction

A

3

233
Q

Etiology of Type 3 HSN reactions?

A

Immune complex mediated

234
Q

3 conditions that represent Type 3 HSN reactions?

A

Serum sickness, Polyarteritis nodosum, Glomerulonephritis

235
Q

___ should be considered in patients with RA who develop acute monoarthritis, especially those on immunosuppressive therapy

A

Septic arthritis

236
Q

What is best initial step of workup for patient with suspected Septic arthritis?

A

Joint aspiration

237
Q

Before beginning a patient with RA on Tumor Necrosis Factor inhibitor – what additional aspect of treatment should be pursued?

A

IFNg release assay, TB skin test

238
Q

Risk of starting Tumor Necrosis Factor inhibitor in patient with RA?

A

Increased risk of opportunistic infection, including TB

239
Q

How should an amputated digit be transported?

A

Wrapped in gauze, moistened with saline, placed in a sealed + sterile plastic bag; Over ice + saline

240
Q

Best diagnostic test for patient with suspected gout?

A

Arthrocentesis … needle-shaped urate crystals that are (-) birefringent

241
Q

DOC for acute gout flare?

A

NSAIDs

242
Q

2 NSAIDs of choice for acute gout flare?

A

Ibuprofen, indomethacin

243
Q

3 contraindications to treatment of acute gout flare with NSAIDs?

A

CKD, PUD, current anticoagulation use

244
Q

DOC for acute gout flare in which NSAIDs are contraindicated?

A

Colchicine

245
Q

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?

A

Measure ESR

246
Q

What is expected creatine kinase level in polymyalgia rheumatica (PMR)?

A

Normal CK

247
Q

Which 2 lab values are typically increased in polymyalgia rheumatica (PMR)?

A

Elevated CRP, Elevated ESR

248
Q

Best management of polymyalgia rheumatica (PMR)?

A

Low-dose corticosteroids

249
Q

22 yo female runner presents for R shin splints; What is most likely to be seen on XR of RLE?

A

No bony abnormalities

250
Q

How can stress fractures be diagnosed clinically (XR have low SN for stress fractures)?

A

Pain over a specific area that increases with jumping/running, associated with local swelling + point TTP

251
Q

Best method for prevention of pulmonary fat embolism?

A

Early immobilization and correction of fracture

252
Q

Clinical presentation of pulmonary fat embolism?

A

Triad of respiratory insufficiency, neurological impairment, petechial rash

253
Q

Timeframe in which pulmonary fat embolism typically occurs?

A

24-72 hours after severe trauma

254
Q

Definition of spondylolisthesis?

A

Bilateral pars interarticularis fractures with anterior slippage of vertebral body

255
Q

Most common location for spondylolisthesis?

A

L5, S1

256
Q

Clinical presentation of spondylolisthesis?

A

Back pain that worsens with extension

257
Q

Diagnostic test for spondylolisthesis?

A

Lateral x-rays of lumbar spine

258
Q

Best management of spondylolisthesis?

A

Simple analgesics, activity modification

259
Q

26 yo female is a long-distance runner; Reports LKMP about 3 years ago; Amenorrhea places patient at risk of which other condition?

A

Osteoporosis

260
Q

What accounts for increased risk of Osteoporosis in patients with exercise-induced amenorrhea?

A

Decreased secretion of LH

261
Q

Change to lipid panel in exercise-induced amenorrhea?

A

Hypercholesterolemia

262
Q

17 yo male presents with progressive muscle weakness and pain; PE shows delayed relaxation after contraction of thenar and hypothenar muscle – diagnosis?

A

Myotonic dystrophy

263
Q

Inheritance pattern for Myotonic dystrophy?

A

AD

264
Q

Etiology of Myotonic dystrophy?

A

CTG repeat expansion in DMPK gene

265
Q

2 aspects of clinical presentation for Myotonic dystrophy?

A

Temporal wasting, delay in muscle relaxation

266
Q

Inheritance pattern for Duchenne + Becker Muscular Dystrophy?

A

X-linked recessive

267
Q

Which medication prescribed to patients with renal transplant is associated with increased risk of gout?

A

Cyclosporine

268
Q

Appearance of gout on synovial fluid analysis?

A

(+)-ly birefringent needle-shaped crystals

269
Q

What is best management option for acute gout in patients with renal transplant?

A

NSAIDs are contraindicated, colchicine clearance is delayed by cyclosporine … so best option is intra-articular steroids (triamcinolone)

270
Q

In addition to trauma, what is another situation that can precede compartment syndrome?

A

Arterial occlusion + reperfusion

271
Q

4 aspects of clinical presentation for early compartment syndrome?

A

POOP, Increased pain on passive stretch, Rapid swelling, Paresthesia

272
Q

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?

A

Tendons

273
Q

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?

A

Sciatic nerve pain … lumbosacral radiculopathy

274
Q

PE finding associated with lumbosacral radiculopathy?

A

(+) straight leg raise

275
Q

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?

A

MCL injury

276
Q

Valgus laxity is associated with ___ injury

A

MCL

277
Q

Varus laxity is associated with ___ injury

A

LCL

278
Q

Quality of shoulder pain that suggests rotator cuff tendonitis?

A

Lateral shoulder pain

279
Q

Pain in rotator cuff tendonitis is typically aggravated by …

A

ABduction, ER

280
Q

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?

A

ESR

281
Q

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?

A

Giant cell arteritis

282
Q

Best management of patients with giant cell arteritis?

A

High-dose glucocorticoid

283
Q

What is the greatest risk factor for giant cell arteritis?

A

Age > 50

284
Q

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?

A

Vertebral compression fracture

285
Q

Etiology of vertebral compression fracture?

A

Loss of bone mineral density

286
Q

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?

A

Neuropathic arthropathy

287
Q

Treatment aim for neuropathic arthropathy?

A

Charcot arthropathy

288
Q

Etiology of neuropathic arthropathy?

A

Impaired sensation and joint proprioception

289
Q

3 homework XR findings for neuropathic arthropathy?

A

Phalangeal osteolysis (hourglass appearance), partial disappearance of metatarsal heads, sclerosis and subluxation of tarsal bones

290
Q

What is best management of neuropathic arthropathy?

A

Casting to reduce weightbearing

291
Q

36-year-old female with SLE is currently on daily prednisone for lupus nephritis; which medication should be administered to prevent bone loss inpatient?

A

Calcium, vitamin

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