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[2a] A ⼀ Step 2 OD USLME > Rheumatology / Orthopaedic > Flashcards

Rheumatology / Orthopaedic Flashcards

1
Q

What are the Main elements of SLE-15

A

RAS**HH** O**RR** PAI**NN**

Systemic Lupus Erythematosus
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2
Q

Dx lab test for Rheumatoid Arthritis -4

A
  1. Anti-CCP (Cyclic Citrullinated Peptide) = MOST SENSITIVE
  2. Rheumatoid Factor
  3. CRP
  4. ESR
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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

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4
Q

Functions of Corticosteroids -6

A

⬆︎BIG ⬇︎FIB

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5
Q

Joints affected in Osteoarthritis -7

A
  1. DIP - Heberden
  2. PIP - Bouchard
  3. MCP
  4. Shoulder (AC joints)
  5. Spine (Cervical/Lumbo/Sacral)
  6. Knees
  7. Feet
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6
Q

Differences in sx between Polymyositis and Dermatomyositis

A
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7
Q

[Antiphospholipid syndrome] etx

A

Lupus anticoagulant (2/2 SLE or idiopathic) –> [⬆︎Thrombosis and spontaneous abortion]

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8
Q

[Antiphospholipid syndrome] dx -3

A
  1. Lupus anticoagulant
  2. Anticardiolipin (can cause false positive VDRL)
  3. [Anti B2 glycoprotein]
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9
Q

SjoGren Syndrome sx -4

________________

Dx labs -2?

A
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10
Q

What are the 4 most common causes of Myopathy (⬆︎ CK)

A

Statins Probably hurt Muscles

  1. Statins
  2. Polymyositis vs. Dermatomyositis (autoimmune)
  3. Muscular Dystrophy
  4. hypOthyroidism (OR HYPERthyroidism)
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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

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12
Q

[Polymyositis and Dermatomyositis] Tx - 2

A

MTX

and

CTS (minimizes MTX side effects)

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13
Q

Erythema and Warmth in joints indicates ⬜ or ⬜

A

[septic arthritis] vs [Gout crystalline arthropathy]

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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]

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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”

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16
Q

Name PE finding

________________

what causes it-4

A

Livedo Reticularis

________________

  1. Atherosclerotic Emboli s/p cardiac catheterization
  2. SLE
  3. Antiphospholipid Syndrome
  4. Systemic Vasculitis

also may see Blue Toes, [Hollenhorst retinal a. plaques]

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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

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18
Q

DDx for Monoarticular Inflammation - 4

________________

1 joint

A
  • Hemarthrosis
  • Seronegative Spondyloarthropathy
  • [GOUT crystalline arthropathy]
  • Septic Arthritis
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19
Q

DDx for Oligoarticular Inflammation - 3

________________

2-5 joints

A
  • Seronegative Spondyloarthropathy
  • [GOUT Crystalline arthropathy]
  • Septic Arthritis
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20
Q

DDx for Polyarticular Inflammation - 4

________________

> 5 joints

A
  • RA
  • SLE
  • [GOUT Crystalline arthropathy]
  • Septic Arthritis
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21
Q

What is the morning manifestation of RA?

A

Morning stiffness lasting > 1 Hour for more than 6 weeks

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22
Q

Short term tx for RA

A

prednisone

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23
Q

tx for “Mild” RA -4

A

“NASH the mild RA”

  1. NSAIDs
  2. Azathioprine
  3. Sulfasalazine
  4. Hydroxychloroquine
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24
Q

tx for “Moderate to SEVERE” RA -6

A

“treat Severe RA using MATTAR with an A”

  1. [MTX or Leflunomide PO weekly]
  2. [Abetacept CTLA4 agonist]
  3. [TNFα Blockers]
  4. [Tocolizumab anti-IL 6]
  5. [Anakinra anti-IL 1]
  6. [Rituximab anti-CD20]
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25
Q

“treat Severe RA using MATTAR with an A”

________________

Name the 3 [TNFα Blockers]

A

“treat Severe RA using MATTAR with an A”

  • Adalimumab
  • Etanercept
  • Infliximab
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26
Q

Why is Seronegative Spondyloarthropathy …seronegative?

________________

What’s the gene association?

A

[NO Rheumatoid factor anti-IgG]

________________

HLA-B27

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27
Q
  • Seronegative Spondyloarthropathy is Arthritis w/out [Rheumatoid Factor anti-IgG] and consist of 4 conditions (PAIR)*
  • ________________*

Describe Psoriatic arthritis -3

A
  1. Psoriasis
  2. Arthritis asymmetrically (includes pencil-in-a-cup XR)
  3. Dactylitis Sausage digits
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28
Q

Seronegative Spondyloarthropathy is Arthritis w/out [Rheumatoid Factor anti-IgG] and consist of 4 conditions (PAIR)

________________

Describe [Reiter’s Reactive Arthritis] -3

A

[Can’t See, Can’t Pee, Can’t Bend my Knee] post GI/GUinfection’s abx

Conjunctivitis

Urethritis

Arthritis

________________

Tx = NSAIDs!!!

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29
Q

Seronegative Spondyloarthropathy has similar tx to ⬜

________________

What are 2 MAJOR differences to keep in mind?

A

RA

________________

  1. Hydroxychloroquine worsens Psoriasis!!
  2. For axial involvement use TNFα blockers
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30
Q

Identify

A

Dactylitis Sausage Digits - Psoriatic Arthritis Spondyloarthropathy

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31
Q

List the Immunosuppressants used to treat [SLE Lupus] -6

A

“Lucky needs his Charms & [SLE Lupus needs her CHARMS”]

  1. CycloPHOSphamide
  2. Hydroxychloroquine
  3. Azathioprine
  4. [Rituximab antiCD20]
  5. MycopPHENolate
  6. [Steroid prednisone]

________________

RASH ORR PAINN

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32
Q

Interstitial Lung disease is a long term complication of Diffuse Cutaneous Scleroderma Systemic Sclerosis

Tx for this specifically-2?

A

[Mycophenolate - inhibits Guanine synthesis]

[Azathioprine - 6-mercaptopurine that inhibits lymphocyte proliferation]

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33
Q

In [Scleroderma Systemic Sclerosis], list long term complications for each (Diffuse vs. Limited) (2 each)

A

[Diffuse Cutaneous (Anti Scl-70)] = Interstitial Lung Dz + Renal Crisis

[CREST Limited Cutaneous (AntiCentromere)] = pulmonary htn + Renal Crisis

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34
Q

What should be used to treat Renal Crisis in [Scleroderma Systemic Sclerosis]?

A

ACEk2 inhibitor

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35
Q

Common sx for Large vessel vasculitis -4

A

“You can CHOC on a Large vessel”

Claudication of Legs & Jaw

[HA & Stroke sx]

Ocular blindness

Chest pain

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36
Q

Giant Cell Temporal Arteritis

Which vessels are affected -3

A

[Temporal External]/[Opthalmic Internal]/Vertebral of Aortic Branch]

PMR pts with have NORMAL strength but be stiff and have pain

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37
Q

Giant Cell Temporal Arteritis

Demographic

________________

Dx

A

Women > 50 with Polymyalgia Rheumatica

________________

[Temporal External] biopsy

PMR pts with have NORMAL strength but be stiff and have pain

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38
Q

Giant Cell Temporal Arteritis tx -2

A

[HIGH DOSE Corticosteroids w/slow taper] IMMEDIATELY –(follwed by)–> [Temporal External a.] biopsy

low dose CTS is only for [pMR w/out GCTA]

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39
Q

Immunofluorescence pattern for [GoodPasture Type 1 Crescenteric RPGN] (2)

________________

clinical presentation (2)

A

Linear (anti-Basement membrane Ab) + Sieve effect

________________

GoodPasture

Glomerulus damage–>Hematuria

Pulmonary damage–> Hemoptysis

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40
Q

Clinical Presentation for [Microscopic Polyangiitis Type 3 Crescenteric RPGN] (2)

A

Hemoptysis

+

[Vasculitis with NO granulomas or asthma]

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41
Q

[Microscopic Polyangiitis Type 3 Crescenteric RPGN] MOD

A

p-ANCA attacks [MPO neutrophil antigen]

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42
Q

Clinical Presentation for [Churg Strauss Type 3 Crescenteric RPGN] (3)

________________

MOD

A

“PAGE Churg Strauss! “

p-ANCA / Asthma / Granulomas / Eosinophilia

________________

p-ANCA attacks [MPO neutrophil antigen]

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43
Q

Tx for [Churg Strauss Type 3 Crescenteric RPGN] (2)

A

Cyclophosphamide

CTS

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45
Q

Clinical Presentation for [AXS- Alport X-linked Syndrome] (3)

________________

MOD

A
  1. Hearing Loss
  2. Hazy view (ocular disturbances)
  3. Hematuria

________________

[Type 4 Collagen thinning & splitting of Basement membrane]

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48
Q

What’s the most common nephropathy worldwide?

A

[BrIAN - Berger IgA Nephropathy]

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49
Q

What systems are affected by Wegener Granulomatosis -3 ; Etx for this

A
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50
Q

Polymyalgia Rheumatica sx -3

A

PolyMyalgia Rheumatica

[Painful-Stiff Shoulders & Hips]

[Morning Stiffness & Malaise]

[Really hot (Fever) +/- weight loss]

PMR DOESNT HAVE TO BE IN CONCOMITANT WITH GIANT CELL TEMPORAL ARTERITIS. CAN OCCUR ALONE

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51
Q

Labs for Polymyalgia Rheumatica -3

A

⬆︎ESR

⬆︎CRP

normal CK

PMR pts have NORMAL strength but have stiffness and pain

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52
Q

Tx for Polymyalgia Rheumatica

A

low - dose corticosteroids

PMR DOESNT HAVE TO BE CONCOMITANT WITH GIANT CELL ARTERITIS! CAN BE SOLO DOLO

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53
Q

Tx for Fibromyalgia -4

A

1st: Aerobic Exercise
2nd: TCAs / SNRIs / Anticonvulsants

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54
Q

Anti Scl-70 (anti-DNA topoisomerase I) specifically identifies what condition? ; What are the other Ab used for this condition?-2

A

[Diffuse Cutaneous Scleroderma Systemic Sclerosis]

but

AntiNuclear Ab

Anticentromere Ab are also used for SSS

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55
Q

What are the ESR and CK levels in

Steroid myopathy

A

Normal ESR / Normal CK

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56
Q

What are the ESR and CK levels in

Inflammatory myopathy (Polymyositis, Dermatomyositis)

A

⬆︎ ESR / ⬆︎ CK

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57
Q

What are the ESR and CK levels in

Statin-induced myopathy

A

Normal ESR / ⬆︎ CK

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58
Q

What are the ESR and CK levels in

hypOthyroid myopathy

A

Normal ESR / ⬆︎ CK

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59
Q

Which patient demographics is intubation relatively contraindicated? - 3

A
  1. Facial/Cervical Trauma
  2. Rheumatoid Arthritis
  3. Down Syndrome

These pts have ⬆︎ subluxation(misalignment) risk

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60
Q

Clinical Presentation for [DILE - Drug Induced Lupus Erythematosus] (3).

________________

Which drugs cause this (3)?

A

[Sudden FAP - Fever/Arthralgia/Pleuritis];

________________

(Drugs linked to Liver Acetylation –>Procainamide/Hydralazine/INH)

SLOW ACETYLATORS = INC RISK!

61
Q

Dupuytren Contracture etx

A

Fibroblast proliferation –> collagen deposition –> palmar fascia thickening and shortening (usually worst in Digits 4 and 5)

62
Q

Seronegative Spondyloarthropathy is Arthritis w/out Rheumatoid Factor and consist of 4 conditions

Tx for [Reiter’s Reactive Arthritis]

A

Can’t See, Can’t Pee, Can’t Bend my Knee

Tx = NSAIDs!!!

63
Q

Osteoid osteoma cp ; Where does this usually occur?

A

teenager bone pain worst at night and better with NSAIDs ; Proximal Femur (or any long bone)

Sharply circumscribed lesion

64
Q

Ewing Sarcoma cp

A

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
Q

Desribe Osteosarcoma X-ray findings - 2

A
  1. SUNBURST desctruction of normal bone with indistinct margins, periosteal reaction and
  2. Codman triangle
66
Q

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?

A

Pts with Gout hx will have crystals in their synovial fluid inbetween Gout attacks at baseline so it doesn’t r/o another disorder causing knee pain

67
Q

Secondary Amyloidosis etx

A

complication of chronic inflammatory conditions (IBD, RA, Psoriasis) that –> Extracellular fibril deposition in random organs –> multi-organ dyssfunction

68
Q

In what setting does Pseudogout typically occur?

A

surgery or medical illness that –> chondrocalcinosis

69
Q

What’s the most common injury in mid-age pts who fall on an outstretched hand?

________________

How would you diagnose this?

A

Rotator Cuff tear

________________

MRI

70
Q

What are the 2 lifestyle changes for Gout px? ; When are Rx indicated?-2

A

EtOH cessation and Weight loss

Rx needed when:

  1. Attacks are reucrrent
  2. Attacks are complicated (Tophi, renal stone of uric acid)
71
Q

Why should pts with Lupus coming in with Hip or Thigh pain be given an MRI?

A

RASHH ORR PAINN

Lupus pts are also at risk for Osteonecrosis (especially if on CTS)!

________________

Tx = NSAIDs

72
Q

cp for Osteogenesis Imperfecta - 4

A

well you’re an imperfect HOBO!

  1. Hearing loss
  2. Opalescent teeth
  3. BLUE SCLERAE!
  4. Osteopenia –> fx recurrently

AUTO DOM mutation

73
Q

Which disease is Anti-neutrophil cytoplasmic associated with?

A

Wegener granulomatosis with polyangiitis

74
Q

which disease is AntiSmoothMuscle ab associated with?

A

Autoimmune Hepatitis

75
Q

Which disease is Antimitochondrial Ab associated with

A

PBC-Primary Biliary Cholangitis

This only affects INTRAhepatic bile ducts

76
Q

What is the Esophageal dysmotility caused by in Scleroderma Systemic Sclerosis?

A

Atrophy with Fibrosis of lower esophagus –> ⬇︎peristalsis and ⬇︎lower esophageal sphincter tone

This is similar to Achlasia EXCEPT Achlasia will caused INCREASED LES tone

77
Q

A child presents with genu varum

What do they likely have?

A

Vitamin D deficiency rickets

78
Q

Baker Popliteal Cyst etx

A

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
Q

Ewing Sarcoma can often be confused with Osteomyelitis

What are the X-ray findings for Osteomyelitis

A

central lytic bone defect with surrounding sclerosis = Brodie’s abscess = osteomyelitis

________________

ONION SKIN appearance (“Eww, Onions!”) = Ewing Sarcoma

80
Q

ALERT! ParvoB19 Arthritis can resemble inflammatory arthritis (RA, SLE)

How can you tell the difference?

A

Inflammatory Arthritis (RA, SLE) will have ⬆︎inflammatory markers (ESR, CRP)

ParvoB19 is transient

81
Q

Juvenile Idiopathic Arthritis etx ; laboratory findings-3?

A

autoimmune symmetric arthritis of the BUE and BLE ;

  1. Anemia
  2. ⬆︎inflammatory markers
  3. ⬆︎acute phase reactants (platelets)
82
Q

What are the major cp for Ankylosing Spondylitis - 3

A

the fake AAA

  1. Ankylosing bamboo sacroilitis improved with exercise a/w Enthesitis (pain at sites where tendon/ligament attaches to bone)
  2. ANTERIOR Uveitis
  3. Aortic Regurgitation and ⬇︎chest expansion

a/w hlaB27

83
Q

What are the primary features of Osteoarthritis - 4

A

Bony Joints Really Close

  1. Bony enlargement with sclerosis and osteophytes
  2. Joint narrowing with effusion
  3. Crepitus with movement
  4. ROM ⬇︎ +/- pain

Xray findings: narrowed joint space with osteophytes and subchondral sclerosis and cyst

84
Q

iLiotibial band syndrome cp ; major cause?

A

Lateral knee pain, specifically at lateral femoral condyle ; overuse

85
Q

cp for cervical sponylosis - 3 ; What’s the most common thing to find on X-ray?

A

chronic neck pain with

  1. sensory deficit from osteophyte(bone spurs) radiculopathy
  2. limited neck rotation
  3. limited lateral bending from OA

osteophytes

85
Q

Pagets disease of bone etx

A

Accelerated focal bone remodeling

⬆︎osteoclast activity f/b rapid and disorganized mosaic bone patterns from osteoBlast

tx = bisphosphonates

86
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

When does this present?; How does this present? ; dx?

A

puberty (most common hip DO in teens!) ; Months of vague hip/knee pain without acute onsets ; plain pelvis XRay

posterior displaement of capital femoral epiphysis thru cartilage growth plate

87
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

Tx?

A

Surgical Pinning of femoral head to avoid avascular necrosis of femoral head and chondrolysis

posterior displaement of capital femoral epiphysis thru cartilage growth plate

88
Q

What is Legg-Calve Perthes disease?

A

Idiopathic avascular necrosis of femoral head

Tx = observation and bracing

Happens in Lower age (4-10 y/o)

89
Q

Paget disease of bone cp -2

________________

most common cause of asymptomatic ALP ⬆︎ in elderly

A
  1. Enlarging cranial bones –> ⬆︎hat size, HA, hearing loss from CN8 entrapment
  2. [Bone & Joint Pain]
    * bx: disorganized mosaic pattern of lamellar bone*
90
Q

Patellofemoral syndrome is a VERY common cause of ______ and usually presents with _____ ; Demographic? ; Tx?

A

ANTERIOR Knee Pain-pain with pain upon EXTENSION of the knee ; Young Women ; Conservative (stretching, strengthen thigh muscles, NSAIDs)

91
Q

Which groups of people should receive a DEXA of the spine and hips screening exam - 2

A
  1. Women ≥65 yo
  2. Women < 65 with equivalent risk for osteoporotic fracture (Smoking, EtOH, sedentary, estrogen deficiency)
92
Q

What is the cause of Lateral epicondylitis tennis elbow? ; cp-3

A

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
Q

Juvenile Idiopathic Arthritis cp - 3

A

autoimmune symmetric arthritis of the BUE and BLE ;

  1. ≥1 joint Arthritis ≥6weeks
  2. PINK MACULAR RASH
  3. DAILY FEVER
94
Q

How long does it take for Acute Rheumatic Fever to onset after Strep Pharyngitis infection

A

2-4 weeks

95
Q

Charcot Joint MOD ; What would you expect to find on imaging?

A

(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
Q

Inflammatory Chronic Lower Back Pain cp - 2 ; etx?

A
  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
Q

Which joints does Psoriatic arthritis involve? ; cp?-3

A

Distal Interphalangeal Joint ;

  1. Morning stiffness (like RA)
  2. Dacylitis Sausage Digits
  3. Nail abnormalities

Tx = NSAIDs, MTX, Anti-TNFa

98
Q

Which conditions involve Morning Musculoskeletal Pain that improves with activity? - 2

A
  1. RA
  2. Seronegative Spondyloarthropathies
99
Q

Which abx is associated with tendinopathy and tendon rupture? ; How will these pts preset?

A

Fluoroquinolone ; development of tendon pain within 1 week of starting Fluoroquinolone

Tx = d/c abx, avoid excercise

100
Q

Crystal induced synovitis (Gout, Pseudogout) affects which areas of the body? - 6

A
  1. 1ST METATARSAL PHALANGEAL JOINT
  2. Ankle
  3. KNEE
  4. Elbow
  5. Wrist
  6. hands - image

Remember, Gout is caused by URATE Crystal deposition

101
Q

Behcet Syndrome cp-3 ; What is the major cause of morbidity in these pts?

A
  1. Recurrent Painful Oral and Genital aphthous ulcers
  2. Uveitis
  3. Erythema Nodosum

Thrombosis = MAJOR MORBIDITY

102
Q
A

Calcinosis Cutis

Ca+ and Phosphorous skin deposits –> scattered whitish lesions

103
Q

Which condition should you suspect in an older pt ( ≥65 yo) presenting with sx simliar to Sjogren syndrome?

A

Age related SICCA syndrome

Also, Sjogren has positive ANA

104
Q

Lab values for Paget disease of bone - 4

A
  1. ⬆︎ALP
  2. ⬆︎Urine Hydroxyproline (measures bone turnover)
  3. NORMAL CALCIUM
  4. NORMAL PHOSPHOROUS

bx: disorganized mosaic pattern of lamellar bone

105
Q

Why do pts with Giant Cell Temporal Arteritis require serial CXRs?

A

Women > 50 with Polymyalgia Rheumatica are at ⬆︎risk for Aortic Aneurysms due to vasculitis aortic branch involvement

PMR pts with have NORMAL strength but be stiff and have pain

106
Q

What type of Anemia does MTX cause?

________________

what are the other major side effects?-4

A

MACROCYTIC ANEMIA

other SE: stomatitis, hepatotoxicity, alopecia, ILD

prophylaxis = Folate B9

107
Q

For Rheumatoid Arthritis, what is the ultimate tx? ; Which medications are used for acute symptomatic relief?

A

MTX ; NSAIDs or CTS

108
Q

What is Anti-Histone a marker of?

A

Drug induced Lupus

RASHH ORR PAINN

109
Q

Which bone tumor has the tendency to have a Soap Bubble Appearance on radiography?

A

Giant Cell Tumor

110
Q

There are 8 common bone tumors

Name them and list their location of bone affected

A
111
Q

How does Rotator Cuff injury clinically present? - 4

A
112
Q

In Spinal Stenosis, pts pain is usually exacerbated with _____(flexion/extension) and _____. It is accompanied with ___ symptoms

A

spinal stEEEnosis

EXTENSION ; Exertion (vascular claudication) ; neurological

113
Q

cp for DeQuervain Tenosynovitis ; Demographic affected by this?

A

passive stretch of the abductor pollicis longus and extensor pollicis brevis –> Pain ; New Mothers who hold their infants with thumbs outstretched

114
Q

cp for Trigger Thumb- 2

A
  1. pain over the palmar aspect of the 1st MCP joint
  2. locking of thumb in flexion
115
Q

Tx for Paget disease of bone

A

Bisphosphonates

​bx: disorganized mosaic pattern of lamellar bone

116
Q

In Lumbar disc herniation, pts pain is usually exacerbated with _____(flexion/extension) and accompanied with ___ symptoms

A

flexion ; UNILATERAL radiculopathy and neurological sx

117
Q

In Spinal Stenosis, pts pain is usually exacerbated with _____(flexion/extension) and _____

What is the most common cause of Spinal Stenosis?

A

EXTENSION ; exertion (vascular claudication)

Osteoarthritis degenerative joint disease

118
Q

You see an elderly patient leaning over to relieve their back pain

Dx?

A

Spinal Stenosis secondary to Osteoarthritis joint degeneration

Shopping cart sign - Spinal stenosis is exacerbated with extension and exertion

119
Q

What is the most common cause of [asymptomatic isolated ALP ⬆︎] in the elderly

A

Paget Disease of bone

  • bx: disorganized mosaic pattern of lamellar bone*
  • tx = bisphosphonates*
120
Q

Dx for Paget disease of bone - 2

A

Xrays showing osteolytic or mixed lytic-sclerotic lesions –> radionuclide bone scan for confirmation

​bx: disorganized mosaic pattern of lamellar bone

121
Q

What are all the causes of Raynauds phenomenon - 6

A
  1. Primary idiopathic
  2. Smoking
  3. Connective tissue disease (Limited CREST Scleroderma)
  4. Sympathomimetics
  5. Hyperviscosity syndromes
  6. Vibrating tools
122
Q

cp for vertebral compression fracture

________________

risk factors? -3

most common cause = osteoporosis

A

acute back pain and point TTP after strenuous activity

________________

RF:

  • trauma,
  • osteoDISEASE (osteoporosis, osteomalacia, osteomyelitis, osteocancer)
  • hyperparathyroidism
123
Q

How does corticosteroids affect bone?

A

⬆︎risk for avascular necrosis osteonecrosis

xrays will often be normal

124
Q

How do you blunt the side effects of MTX?

A

Folate B9 supplement

SE: Macrocytic anemia, stomatitis, hepatotoxicity, alopecia, ILD

125
Q

Describe the clinical presentation for Pes Anserinus Pain Syndrome (PAPS)

A

Pain over the Anteromedial tibia just below the joint line (medial tibial plateau) that is NOT aggravated by valgus stress test

if valgus stress exacerbates pain, consider MCL involvement

126
Q

Which part of the axial skeleton does Rheumatoid Arthritis affect?

A

Cervical and can cause cervical spine subluxation –> spinal cord compression!

127
Q

Takayasu arteritis is a ___ (small/medium/large) artery vasculitis that mostly affects which demographic?

________________

cp?-2

A

LARGE ; [Asian Woman < 50yo]

________________

;

  1. weak UE pulses with associated UE numbness and pain
  2. Carotidynia

involves lumenal narrowing and aneursym formation

128
Q

serum sickness like reaction cp - 3

________________

Which 2 drugs typically cause this?

A
  1. Urticaria
  2. Joint pain
  3. fever

Bactrim and BLactams

129
Q

Spondylolisthesis etx ; What’s the most common physical exam finding for this?

A

developmental forward slip of L5 vertebrae over S1 after Spondylolysis occurs ; palpable step off in preteens

130
Q

isolated ALP ⬆︎ in the elderly suggest ______

When this disease involves cranial bones what are the manifestations?- 3

A

Paget Disease of bone

  1. frontal bossing
  2. hearing loss
  3. CN dysfunction
  • bx: disorganized mosaic pattern of lamellar bone*
  • tx = bisphosphonates*
131
Q

cp for Anterior Cruciate Ligament tear

________________

dx?-3

A

POPPING sensation in knee followd by rapid hemarthrosis

________________

[Lachman + Anterior Drawer] –> MRI

132
Q

cp for Temporomandibular Joint dysfunction (TMJ) - 2; tx?-2

A
  1. Ear Pain worse with chewing
  2. nocturnal teeth grinding

Tx =nighttime bite guard –> surgery

133
Q

What causes Osteomalacia? ; cp?-2

Rickets is the pediatric version of Osteomalacia

A

Vitamin D deficiency;

  1. Bone Pain
  2. Muscle weakness

Imaging: ⬇︎Bone Density with Looser Zone Pseudofractures

134
Q

What are the radiographic findings for Osteomalacia?

Rickets is the pediatric version of Osteomalacia

A

⬇︎Bone Density with Looser Zone Pseudofractures

caused by Vitamin D deficiency

135
Q

Rickets is caused by ____in children

Clinical findings for Rickets - 9

Osteomalacia is the Adult version of Rickets

A

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
Q

What are the major lab findings for Osteomalacia?-5

Rickets is the pediatric version of Osteomalacia

A
  1. Vitamin D Deficiency which –>
  2. ⬇︎Ca+
  3. ⬇︎Phosphorous
  4. ⬆︎PTH
  5. ⬆︎ALP

Imaging: ⬇︎Bone Density with Looser Zone Pseudofractures

137
Q

List the functions of Parathyroid Hormone - 4

A
  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
Q

MOD for Osteoporosis

A

⬇︎Bone Density from [Trabecular Spongy bone loss] despite normal mineralization and lab values

Drug causes: These Coag Canners ⬇︎ Spongybone

139
Q

Which drug classes are known for causing Osteoporosis? - 4

A

These Coag Canners ⬇︎Spongybone

  1. Thyroid hormone
  2. antiCoagulants
  3. antiConvulsants
  4. Steroids
140
Q

What is the gold standard diagnostic test for Duchenne Muscular Dystrophy

A

GENETIC STUDIES revealing ⬆︎Creatine Phosphokinase and ⬆︎Aldolase

muscle bx can only support dx

141
Q

cp for Trochanteric Bursitis

A

Lateral Hip pain worst with direct pressure

142
Q

Describe the X-ray findings for Gout?

A

Punched out erosions with a remaining rim of cortical bone

143
Q

identify

A

Telangiectasia

[2a] A ⼀ Step 2 OD USLME (21 decks)

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