Rheumatology / Orthopaedic Flashcards
1
Q
What are the Main elements of SLE-15
A
RAS**HH** O**RR** PAI**NN**
2
Q
Dx lab test for Rheumatoid Arthritis -4
A
- Anti-CCP (Cyclic Citrullinated Peptide) = MOST SENSITIVE
- Rheumatoid Factor
- CRP
- ESR
3
Q
AOSD (Adult Onset Still’s Disease) characteristics - 4
A
AOSD
Aow HOT (Fever)
Ortho joint pains
Salmon colored bumpy rash
Diagnosis of Exclusion
Systemic onset juvenile RA
4
Q
Functions of Corticosteroids -6
A
⬆︎BIG ⬇︎FIB
5
Q
Joints affected in Osteoarthritis -7
A
- DIP - Heberden
- PIP - Bouchard
- MCP
- Shoulder (AC joints)
- Spine (Cervical/Lumbo/Sacral)
- Knees
- Feet
6
Q
Differences in sx between Polymyositis and Dermatomyositis
A
7
Q
[Antiphospholipid syndrome] etx
A
Lupus anticoagulant (2/2 SLE or idiopathic) –> [⬆︎Thrombosis and spontaneous abortion]
8
Q
[Antiphospholipid syndrome] dx -3
A
- Lupus anticoagulant
- Anticardiolipin (can cause false positive VDRL)
- [Anti B2 glycoprotein]
9
Q
SjoGren Syndrome sx -4
________________
Dx labs -2?
A
10
Q
What are the 4 most common causes of Myopathy (⬆︎ CK)
A
Statins Probably hurt Muscles
- Statins
- Polymyositis vs. Dermatomyositis (autoimmune)
- Muscular Dystrophy
- hypOthyroidism (OR HYPERthyroidism)
11
Q
Dx Labs for [Polymyositis and Dermatomyositis] -5
________________
What is the ultimate diagnostic for these?
A
MUSCLE BIOPSY showing mononuclear infiltrate is the ultimate diagnostic
12
Q
[Polymyositis and Dermatomyositis] Tx - 2
A
MTX
and
CTS (minimizes MTX side effects)
13
Q
Erythema and Warmth in joints indicates ⬜ or ⬜
A
[septic arthritis] vs [Gout crystalline arthropathy]
14
Q
[Scleroderma Systemic Sclerosis] (Diffuse vs CREST Limited) - etx
A
[Autoimmune endothelial injury] ➜
[tunica intima proliferation with collagen deposition] ➜ fibrosis ➜
[systemic sclerosis in skin/pulm/renal]
15
Q
Lab test for SLE -4
________________
Which lab test for SLE is first line?
A
Remember this:
“ANA & Dana saw HIS, Mr.Smith’s rash”
16
Q
Name PE finding
________________
what causes it-4
A
Livedo Reticularis
________________
- Atherosclerotic Emboli s/p cardiac catheterization
- SLE
- Antiphospholipid Syndrome
- Systemic Vasculitis
also may see Blue Toes, [Hollenhorst retinal a. plaques]
17
Q
Hydroxychloroquine is effective in treating the ___ and ___ from SLE.
________________
What type of drug is it? SE-2?
A
RASHH ORR PAINN
Rash; Arthritis
________________
Anti-Malaria drug
________________
SE = [Vision⬇︎] and Nausea
18
Q
DDx for Monoarticular Inflammation - 4
________________
1 joint
A
- Hemarthrosis
- Seronegative Spondyloarthropathy
- [GOUT crystalline arthropathy]
- Septic Arthritis
19
Q
DDx for Oligoarticular Inflammation - 3
________________
2-5 joints
A
- Seronegative Spondyloarthropathy
- [GOUT Crystalline arthropathy]
- Septic Arthritis
20
Q
DDx for Polyarticular Inflammation - 4
________________
> 5 joints
A
- RA
- SLE
- [GOUT Crystalline arthropathy]
- Septic Arthritis
21
Q
What is the morning manifestation of RA?
A
Morning stiffness lasting > 1 Hour for more than 6 weeks
22
Q
Short term tx for RA
A
prednisone
23
Q
tx for “Mild” RA -4
A
“NASH the mild RA”
- NSAIDs
- Azathioprine
- Sulfasalazine
- Hydroxychloroquine
24
Q
tx for “Moderate to SEVERE” RA -6
A
“treat Severe RA using MATTAR with an A”
- [MTX or Leflunomide PO weekly]
- [Abetacept CTLA4 agonist]
- [TNFα Blockers]
- [Tocolizumab anti-IL 6]
- [Anakinra anti-IL 1]
- [Rituximab anti-CD20]
25
"treat Severe RA using **MATTAR** with an A"
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name the 3 [**T**NFα Blockers]
*"treat Severe RA using* ***MATTAR*** *with an A"*
## Footnote
- Adalimumab
- Etanercept
- Infliximab
26
Why is Seronegative Spondyloarthropathy ...seronegative?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the gene association?
[**NO** Rheumatoid factor anti-IgG]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HLA-B27
27
* Seronegative Spondyloarthropathy is Arthritis w/out [Rheumatoid Factor anti-IgG] and consist of 4 conditions (PAIR)*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
Describe Psoriatic arthritis -3
1. Psoriasis
2. Arthritis asymmetrically *(includes pencil-in-a-cup XR)*
3. Dactylitis Sausage digits
28
*Seronegative Spondyloarthropathy is Arthritis w/out [Rheumatoid Factor anti-IgG] and consist of 4 conditions (PAIR)*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Describe [Reiter's Reactive Arthritis] -3
[Can't **See**, Can't **Pee**, Can't **Bend my Knee]** post GI/GUinfection's abx
**Conjunctivitis**
**Urethritis**
**Arthritis**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Tx = NSAIDs!!!*
29
Seronegative Spondyloarthropathy has similar tx to ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are 2 MAJOR differences to keep in mind?
**RA**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
1. Hydroxychloroquine worsens Psoriasis!!
2. For axial involvement use **TNF**α blockers
30
Identify
Dactylitis Sausage Digits - *Psoriatic Arthritis Spondyloarthropathy*
31
List the Immunosuppressants used to treat [SLE Lupus] -6
"Lucky needs his Charms & [SLE Lupus needs her **CHARMS**"]
1. **C**ycloPHOSphamide
2. **H**ydroxychloroquine
3. **A**zathioprine
4. [**R**ituximab antiCD20]
5. **M**ycopPHENolate
6. [**S**teroid prednisone]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
***RASH ORR PAINN***
32
*Interstitial Lung disease is a long term complication of Diffuse Cutaneous Scleroderma Systemic Sclerosis*
Tx for this specifically-2?
[**Mycophenolate** - inhibits Guanine synthesis]
[**Azathioprine** - 6-mercaptopurine that inhibits lymphocyte proliferation]
33
In [Scleroderma Systemic Sclerosis], list long term complications for each (Diffuse vs. Limited) (2 each)
[Diffuse Cutaneous (Anti Scl-70)] = Interstitial Lung Dz + Renal Crisis
[CREST Limited Cutaneous (AntiCentromere)] = pulmonary htn + Renal Crisis
34
What should be used to treat Renal Crisis in [Scleroderma Systemic Sclerosis]?
ACEk2 inhibitor
35
Common sx for Large vessel vasculitis -4
"You can **CHOC** on a *Large* vessel"
**C**laudication of Legs & Jaw
[**H**A & Stroke sx]
**O**cular blindness
**C**hest pain
36
*Giant Cell Temporal Arteritis*
Which vessels are affected -3
[Temporal External]/[Opthalmic Internal]/Vertebral of Aortic Branch]
## Footnote
*PMR pts with have NORMAL strength but be stiff and have pain*
37
*Giant Cell Temporal Arteritis*
Demographic
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx
Women \> 50 with Polymyalgia Rheumatica
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Temporal External] biopsy
*PMR pts with have NORMAL strength but be stiff and have pain*
38
Giant Cell Temporal Arteritis tx -2
[**HIGH DOSE** Corticosteroids w/slow taper] IMMEDIATELY --(follwed by)--\> [Temporal External a.] biopsy
## Footnote
*low dose CTS is only for [pMR w/out GCTA]*
39
Immunofluorescence pattern for [GoodPasture Type 1 Crescenteric RPGN] (2)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation (2)
Linear (anti-Basement membrane Ab) + Sieve effect
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**G**ood**P**asture
**G**lomerulus damage--\>Hematuria
**P**ulmonary damage--\> Hemoptysis
40
Clinical Presentation for [Microscopic Polyangiitis Type 3 Crescenteric RPGN] (2)
Hemoptysis
+
[Vasculitis with **NO** granulomas or asthma]
41
[Microscopic Polyangiitis Type 3 Crescenteric RPGN] MOD
**p**-ANCA attacks [MPO neutrophil antigen]
42
Clinical Presentation for [Churg Strauss Type 3 Crescenteric RPGN] (3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MOD
"**PAGE** Churg Strauss! "
**p**-ANCA / **A**sthma / **G**ranulomas / **E**osinophilia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**p**-ANCA attacks [MPO neutrophil antigen]
43
Tx for [Churg Strauss Type 3 Crescenteric RPGN] (2)
Cyclophosphamide
CTS
45
Clinical Presentation for [**AXS- A**lport **X**-linked **S**yndrome] (3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MOD
1. Hearing Loss
2. Hazy view (ocular disturbances)
3. Hematuria
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Type 4 Collagen thinning & splitting of Basement membrane]
48
What's the most common nephropathy worldwide?
[**B**r**IAN** - **B**erger **I**g**A** **N**ephropathy]
49
What systems are affected by Wegener Granulomatosis -3 ; Etx for this
50
Polymyalgia Rheumatica sx -3
**P**oly**M**yalgia **R**heumatica
[**P**ainful-Stiff Shoulders & Hips]
[**M**orning Stiffness & Malaise]
[**R**eally hot (Fever) +/- weight loss]
*PMR DOESNT HAVE TO BE IN CONCOMITANT WITH GIANT CELL TEMPORAL ARTERITIS. CAN OCCUR ALONE*
51
Labs for Polymyalgia Rheumatica -3
⬆︎ESR
⬆︎CRP
normal CK
*PMR pts have NORMAL strength but have stiffness and pain*
52
Tx for Polymyalgia Rheumatica
low - dose corticosteroids
## Footnote
*PMR DOESNT HAVE TO BE CONCOMITANT WITH GIANT CELL ARTERITIS! CAN BE SOLO DOLO*
53
Tx for Fibromyalgia -4
1st: Aerobic Exercise
2nd: TCAs / SNRIs / Anticonvulsants
54
Anti Scl-70 (anti-DNA topoisomerase I) specifically identifies what condition? ; What are the other Ab used for this condition?-2
[**Diffuse** Cutaneous Scleroderma Systemic Sclerosis]
but
AntiNuclear Ab
Anticentromere Ab are also used for SSS
55
What are the ESR and CK levels in
**Steroid** myopathy
Normal ESR / Normal CK
56
What are the ESR and CK levels in
**Inflammatory** myopathy (Polymyositis, Dermatomyositis)
⬆︎ ESR / ⬆︎ CK
57
What are the ESR and CK levels in
**Statin**-induced myopathy
Normal ESR / ⬆︎ CK
58
What are the ESR and CK levels in
**hypOthyroid** myopathy
Normal ESR / ⬆︎ CK
59
Which patient demographics is intubation relatively contraindicated? - 3
1. Facial/Cervical Trauma
2. Rheumatoid Arthritis
3. Down Syndrome
## Footnote
*These pts have ⬆︎ subluxation(misalignment) risk*
60
Clinical Presentation for [**DILE** - **D**rug **I**nduced **L**upus **E**rythematosus] (3).
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which drugs cause this (3)?
[**Sudden FAP** - **F**ever/**A**rthralgia/**P**leuritis];
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Drugs linked to Liver Acetylation --\>Procainamide/Hydralazine/INH)
*SLOW ACETYLATORS = INC RISK!*
61
Dupuytren Contracture etx
Fibroblast proliferation --\> collagen deposition --\> palmar fascia thickening and shortening (usually worst in Digits 4 and 5)
62
*Seronegative Spondyloarthropathy is Arthritis w/out Rheumatoid Factor and consist of 4 conditions*
Tx for [Reiter's Reactive Arthritis]
Can't **See**, Can't **Pee**, Can't **Bend my Knee**
*Tx = NSAIDs!!!*
63
Osteoid osteoma cp ; Where does this usually occur?
teenager bone pain worst at night and better with NSAIDs ; Proximal Femur (or any long bone)
## Footnote
*Sharply circumscribed lesion*
64
Ewing Sarcoma cp
Eww, Onions!
**Chronic** bone pain (weeks-months) that demonstrate multiple layers of new subperiosteal bone formation on Xray = ONION SKINNING
*Causes Onion Skin Appearance ("Eww, Onions!")*
65
Desribe Osteosarcoma X-ray findings - 2
1. **SUNBURST** desctruction of normal bone with indistinct margins, periosteal reaction and
2. Codman triangle
66
Why can you not r/o Septic Arthritis of the knee in a pt who has a hx of Gout and crystals on their arthrocentesis?
Pts with Gout hx will have crystals in their synovial fluid **in****between Gout attacks** at baseline so it doesn't r/o another disorder causing knee pain
67
Secondary Amyloidosis etx
complication of chronic inflammatory conditions (IBD, RA, Psoriasis) that --\> Extracellular fibril deposition in random organs --\> multi-organ dyssfunction
68
In what setting does Pseudogout typically occur?
surgery or medical illness that --\> chondro**calcinosis**
69
What's the most common injury in mid-age pts who fall on an outstretched hand?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How would you diagnose this?
Rotator Cuff tear
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MRI
70
What are the 2 lifestyle changes for Gout px? ; When are Rx indicated?-2
EtOH cessation and Weight loss
## Footnote
Rx needed when:
1. Attacks are reucrrent
2. Attacks are complicated (Tophi, renal stone of uric acid)
71
Why should pts with Lupus coming in with Hip or Thigh pain be given an MRI?
***RASHH ORR PAINN***
Lupus pts are also at risk for Osteonecrosis (especially if on CTS)!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx = NSAIDs
72
cp for Osteogenesis Imperfecta - 4
well you're an imperfect **HOBO**!
1. **H**earing loss
2. **O**palescent teeth
3. **B**LUE SCLERAE!
4. **O**steopenia --\> fx recurrently
AUTO DOM mutation
73
Which disease is Anti-neutrophil cytoplasmic associated with?
Wegener granulomatosis with polyangiitis
74
which disease is AntiSmoothMuscle ab associated with?
Autoimmune Hepatitis
75
Which disease is Antimitochondrial Ab associated with
PBC-Primary Biliary Cholangitis
## Footnote
*This only affects **INTRA**hepatic bile ducts*
76
What is the Esophageal dysmotility caused by in Scleroderma Systemic Sclerosis?
Atrophy with Fibrosis of lower esophagus --\> ⬇︎peristalsis and ⬇︎lower esophageal sphincter tone
## Footnote
*This is similar to Achlasia EXCEPT Achlasia will caused INCREASED LES tone*
77
A child presents with genu varum
What do they likely have?
Vitamin D deficiency rickets
78
Baker Popliteal Cyst etx
pts with underlying arthritis have synovial fluid leak from their knee joint into the Gastrocnemius or Semimembranosus bursa = cyst
If this cyst ruptures it --\> acute calf pain
79
Ewing Sarcoma can often be confused with Osteomyelitis
What are the X-ray findings for Osteomyelitis
central lytic bone defect with surrounding sclerosis = Brodie's abscess = osteomyelitis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ONION SKIN appearance ("Eww, Onions!") = Ewing Sarcoma
80
ALERT! ParvoB19 Arthritis can resemble inflammatory arthritis (RA, SLE)
How can you tell the difference?
Inflammatory Arthritis (RA, SLE) **will have ⬆︎inflammatory markers (ESR, CRP)**
## Footnote
ParvoB19 is transient
81
Juvenile Idiopathic Arthritis etx ; laboratory findings-3?
autoimmune **symmetric** arthritis of the BUE and BLE ;
1. Anemia
2. ⬆︎inflammatory markers
3. ⬆︎acute phase reactants (platelets)
82
What are the major cp for Ankylosing Spondylitis - 3
the fake AAA
1. **A**nkylosing bamboo sacroilitis improved with exercise a/w Enthesitis (pain at sites where tendon/ligament attaches to bone)
2. **A**NTERIOR Uveitis
3. **A**ortic Regurgitation and ⬇︎chest expansion
*a/w hlaB27*
83
What are the primary features of Osteoarthritis - 4
**B**ony **J**oints **R**eally **C**lose
1. **B**ony enlargement with sclerosis and osteophytes
2. **J**oint narrowing with effusion
3. **C**repitus with movement
4. **R**OM ⬇︎ +/- pain
Xray findings: narrowed joint space with osteophytes and subchondral sclerosis and cyst
84
iLiotibial band syndrome cp ; major cause?
Lateral knee pain, specifically at lateral femoral condyle ; overuse
85
cp for cervical sponylosis - 3 ; What's the most common thing to find on X-ray?
chronic neck pain **with**
1. sensory deficit from osteophyte(bone spurs) radiculopathy
2. limited neck rotation
3. limited lateral bending from OA
osteophytes
85
Pagets disease of bone etx
Accelerated **focal** bone remodeling
⬆︎osteoclast activity f/b rapid and **disorganized mosaic bone patterns** from osteoBlast
*tx = bisphosphonates*
86
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
When does this present?; How does this present? ; dx?
puberty (most common hip DO in teens!) ; **Months of vague hip/knee pain** without acute onsets ; plain pelvis XRay
## Footnote
*posterior displaement of capital femoral epiphysis thru cartilage growth plate*
87
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
Tx?
Surgical Pinning of femoral head to avoid avascular necrosis of femoral head and chondrolysis
## Footnote
*posterior displaement of capital femoral epiphysis thru cartilage growth plate*
88
What is Legg-Calve Perthes disease?
Idiopathic avascular necrosis of femoral head
*Tx = observation and bracing*
Happens in **L**ower age (4-10 y/o)
89
Paget disease of bone cp -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*most common cause of asymptomatic ALP ⬆︎ in elderly*
1. Enlarging cranial bones --\> ⬆︎hat size, HA, hearing loss from CN8 entrapment
2. [Bone & Joint Pain]
* bx: disorganized **mosaic** pattern of lamellar bone*
90
Patellofemoral syndrome is a VERY common cause of ______ and usually presents with _____ ; Demographic? ; Tx?
ANTERIOR Knee Pain-pain with pain upon **EXTENSION** of the knee ; Young Women ; Conservative (stretching, strengthen thigh muscles, NSAIDs)
91
Which groups of people should receive a DEXA of the spine and hips screening exam - 2
1. Women ≥65 yo
2. Women \< 65 with equivalent risk for osteoporotic fracture (Smoking, EtOH, sedentary, estrogen deficiency)
92
What is the cause of Lateral epicondylitis tennis elbow? ; cp-3
repetitive, forceful **wrist extension** --\> noninflammatory angiofibroblastic tendinosis at common extenor origin
1. Lateral Epicondyle tenderness
2. Pain reproduced with passive flexion of wrist OR
3. Pain reproduced with resisted extension of wrist
93
Juvenile Idiopathic Arthritis cp - 3
autoimmune **symmetric** arthritis of the BUE and BLE ;
1. ≥1 joint Arthritis ≥6weeks
2. **PINK MACULAR RASH**
3. **DAILY FEVER**
94
How long does it take for Acute Rheumatic Fever to onset after Strep Pharyngitis infection
2-4 weeks
95
Charcot Joint MOD ; What would you expect to find on imaging?
(AKA Neurogenic Arthropathy) complication of neuropathy (usually in DM) --\> unchecked repeated joint trauma that affects weight-bearing joints and --\> degenerative joint disease
loose bodies
96
Inflammatory Chronic Lower Back Pain cp - 2 ; etx?
1. **Lower Back Pain at night** that does NOT improve with rest but does **improve with activity** (if this occurs in a young pt think Ankylosing Spondylitis, psoriatic arthritis, reactive arthritis or arthritis a/w IBD)
2. gradual onset
etx = Inflammation at ligamentous insertions
97
Which joints does Psoriatic arthritis involve? ; cp?-3
Distal Interphalangeal Joint ;
1. Morning stiffness (like RA)
2. Dacylitis Sausage Digits
3. Nail abnormalities
*Tx = NSAIDs, MTX, Anti-TNFa*
98
Which conditions involve Morning Musculoskeletal Pain that improves with activity? - 2
1. RA
2. Seronegative Spondyloarthropathies
99
Which abx is associated with tendinopathy and tendon rupture? ; How will these pts preset?
Fluoroquinolone ; development of tendon pain **within 1 week** of starting Fluoroquinolone
## Footnote
*Tx = d/c abx, avoid excercise*
100
Crystal induced synovitis (Gout, Pseudogout) affects which areas of the body? - 6
1. **1ST METATARSAL PHALANGEAL JOINT**
2. Ankle
3. **KNEE**
4. Elbow
5. Wrist
6. hands - image
## Footnote
*Remember, Gout is caused by URATE Crystal deposition*
101
Behcet Syndrome cp-3 ; What is the major cause of morbidity in these pts?
1. Recurrent Painful Oral and Genital aphthous ulcers
2. Uveitis
3. Erythema Nodosum
Thrombosis = MAJOR MORBIDITY
102
Calcinosis Cutis
## Footnote
*Ca+ and Phosphorous skin deposits --\> scattered whitish lesions*
103
Which condition should you suspect in an older pt ( ≥65 yo) presenting with sx simliar to Sjogren syndrome?
Age related **SICCA** syndrome
## Footnote
Also, Sjogren has positive ANA
104
Lab values for Paget disease of bone - 4
1. ⬆︎ALP
2. ⬆︎Urine Hydroxyproline (measures bone turnover)
3. NORMAL CALCIUM
4. NORMAL PHOSPHOROUS
## Footnote
*bx: disorganized **mosaic** pattern of lamellar bone*
105
Why do pts with Giant Cell Temporal Arteritis require serial CXRs?
Women \> 50 with Polymyalgia Rheumatica **are at ⬆︎risk for Aortic Aneurysms due to vasculitis aortic branch involvement**
## Footnote
*PMR pts with have NORMAL strength but be stiff and have pain*
106
What type of Anemia does MTX cause?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
what are the other major side effects?-4
MACROCYTIC ANEMIA
## Footnote
other SE: stomatitis, hepatotoxicity, alopecia, ILD
prophylaxis = Folate B9
107
For Rheumatoid Arthritis, what is the ultimate tx? ; Which medications are used for acute symptomatic relief?
MTX ; NSAIDs or CTS
108
What is Anti-Histone a marker of?
Drug induced Lupus
## Footnote
***RASHH ORR PAINN***
109
Which bone tumor has the tendency to have a Soap Bubble Appearance on radiography?
Giant Cell Tumor
110
There are 8 common bone tumors
Name them and list their location of bone affected
111
How does Rotator Cuff injury clinically present? - 4
112
In Spinal Stenosis, pts pain is usually exacerbated with \_\_\_\_\_(flexion/extension) and \_\_\_\_\_. It is accompanied with ___ symptoms
spinal st**EEE**nosis
**E**XTENSION ; **E**xertion (vascular claudication) ; neurological
113
cp for DeQuervain Tenosynovitis ; Demographic affected by this?
passive stretch of the abductor pollicis longus and extensor pollicis brevis --\> Pain ; **New Mothers** who hold their infants with thumbs outstretched
114
cp for Trigger Thumb- 2
1. pain over the palmar aspect of the 1st MCP joint
2. locking of thumb in flexion
115
Tx for Paget disease of bone
Bisphosphonates
## Footnote
*bx: disorganized **mosaic** pattern of lamellar bone*
116
In Lumbar disc herniation, pts pain is usually exacerbated with \_\_\_\_\_(flexion/extension) and accompanied with ___ symptoms
**flexion** ; UNILATERAL radiculopathy and neurological sx
117
In Spinal Stenosis, pts pain is usually exacerbated with \_\_\_\_\_(flexion/extension) and \_\_\_\_\_
What is the most common cause of Spinal Stenosis?
**EXTENSION** ; exertion (vascular claudication)
Osteoarthritis degenerative joint disease
118
You see an elderly patient leaning over to relieve their back pain
Dx?
Spinal Stenosis secondary to Osteoarthritis joint degeneration
## Footnote
*Shopping cart sign - Spinal stenosis is exacerbated with extension and exertion*
119
What is the most common cause of [asymptomatic isolated ALP ⬆︎] in the elderly
Paget Disease of bone
## Footnote
* bx: disorganized **mosaic** pattern of lamellar bone*
* tx = bisphosphonates*
120
Dx for Paget disease of bone - 2
Xrays showing osteolytic or mixed lytic-sclerotic lesions --\> radionuclide bone scan for confirmation
## Footnote
*bx: disorganized **mosaic** pattern of lamellar bone*
121
What are all the causes of Raynauds phenomenon - 6
1. Primary idiopathic
2. Smoking
3. Connective tissue disease (Limited CREST Scleroderma)
4. Sympathomimetics
5. Hyperviscosity syndromes
6. Vibrating tools
122
cp for vertebral compression fracture
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
risk factors? -3
*most common cause = osteoporosis*
acute back pain and **point TTP** after strenuous activity
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
RF:
- trauma,
- osteoDISEASE (osteoporosis, osteomalacia, osteomyelitis, osteocancer)
- hyperparathyroidism
123
How does corticosteroids affect bone?
⬆︎risk for avascular necrosis osteonecrosis
## Footnote
*xrays will often be normal*
124
How do you blunt the side effects of MTX?
Folate B9 supplement
## Footnote
SE: Macrocytic anemia, stomatitis, hepatotoxicity, alopecia, ILD
125
Describe the clinical presentation for Pes Anserinus Pain Syndrome (PAPS)
Pain over the Anteromedial tibia just below the joint line (medial tibial plateau) that is NOT aggravated by valgus stress test
## Footnote
*if valgus stress exacerbates pain, consider MCL involvement*
126
Which part of the axial skeleton does Rheumatoid Arthritis affect?
**Cervical** and can cause cervical spine subluxation --\> spinal cord compression!
127
Takayasu arteritis is a ___ (small/medium/large) artery vasculitis that mostly affects which demographic?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp?-2
LARGE ; [Asian Woman \< 50yo]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
;
1. weak UE pulses with associated UE numbness and pain
2. Carotidynia
involves lumenal narrowing and aneursym formation
128
serum sickness like reaction cp - 3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which 2 drugs typically cause this?
1. Urticaria
2. Joint pain
3. fever
Bactrim and BLactams
129
Spondylolisthesis etx ; What's the most common physical exam finding for this?
developmental forward slip of L5 vertebrae over S1 after Spondylolysis occurs ; palpable step off in preteens
130
isolated ALP ⬆︎ in the elderly suggest \_\_\_\_\_\_
When this disease involves cranial bones what are the manifestations?- 3
Paget Disease of bone
1. frontal bossing
2. hearing loss
3. CN dysfunction
* bx: disorganized **mosaic** pattern of lamellar bone*
* tx = bisphosphonates*
131
cp for Anterior Cruciate Ligament tear
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
dx?-3
**POPPING** sensation in knee followd by rapid hemarthrosis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Lachman + Anterior Drawer] --\> MRI
132
cp for Temporomandibular Joint dysfunction (TMJ) - 2; tx?-2
1. Ear Pain worse with chewing
2. nocturnal teeth grinding
Tx =nighttime bite guard --\> surgery
133
What causes Osteomalacia? ; cp?-2
## Footnote
*Rickets is the pediatric version of Osteomalacia*
Vitamin D deficiency;
1. Bone **Pain**
2. Muscle weakness
*Imaging: ⬇︎Bone Density with Looser Zone Pseudofractures*
134
What are the radiographic findings for Osteomalacia?
## Footnote
*Rickets is the pediatric version of Osteomalacia*
⬇︎Bone Density with Looser Zone **Pseudofractures**
## Footnote
caused by Vitamin D deficiency
135
Rickets is caused by \_\_\_\_in children
Clinical findings for Rickets - 9
*Osteomalacia is the Adult version of Rickets*
Vitamin D deficiency
1. Delayed Fontanelle closure
2. Wide Sutures
3. Frontal Bossing
4. Craniotabes (softening of the skull)
5. Dental hypoplasia
6. Rachitic Rosary
7. Pes Carinatum
8. Joint swelling
9. Bowing of Legs
136
What are the major lab findings for Osteomalacia?-5
## Footnote
*Rickets is the pediatric version of Osteomalacia*
1. Vitamin D Deficiency which --\>
2. ⬇︎Ca+
3. ⬇︎Phosphorous
4. ⬆︎PTH
5. ⬆︎ALP
## Footnote
*Imaging: ⬇︎Bone Density with Looser Zone Pseudofractures*
137
List the functions of Parathyroid Hormone - 4
1. converts 25HydroxyVitD --\> 1-25DihydroxyVitD in Kidney
2. Reabsorbs Ca+ in Kidney
3. Excretes Phosphate in Kidney
4. converts OsteoBlast--\>preOsteoClast (once they mature this causes CaPhosphate bone resorption)
138
MOD for Osteoporosis
⬇︎Bone Density from [Trabecular Spongy bone loss] **despite normal mineralization and lab values**
## Footnote
*Drug causes: **T**hese **C**oag **C**anners ⬇︎ **S**pongybone*
139
Which drug classes are known for causing Osteoporosis? - 4
**T**hese **C**oag **C**anners ⬇︎**S**pongybone
1. **T**hyroid hormone
2. anti**C**oagulants
3. anti**C**onvulsants
4. **S**teroids
140
What is the gold standard diagnostic test for Duchenne Muscular Dystrophy
**GENETIC STUDIES** revealing ⬆︎Creatine Phosphokinase and ⬆︎Aldolase
## Footnote
*muscle bx can only support dx*
141
cp for Trochanteric Bursitis
Lateral Hip pain worst with direct pressure
142
Describe the X-ray findings for Gout?
Punched out erosions with a remaining rim of cortical bone
143
identify
**T**elangiectasia
