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U World Step 2 > Rheumatology/Orthopedics & Sports > Flashcards

Rheumatology/Orthopedics & Sports Flashcards

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1
Q

Ecthyma gangrenosum

A

Caused by Pseudomonas aeruginosa

Rapidly progressive skin lesions that develop into nontender nodules with central necrosis

Seen in immunocompromised patients

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2
Q

Neurogenic claudication

A

Symptom of spinal stenosis

Characterized by pain with extension of the spine (walking, prolonged standing)

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3
Q
A

Dermatomyositis

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4
Q

Distinguishing features of fibromyalgia, polymyositis, and polymyalgia rheumatica

  1. Clinical features
  2. Diagnosis
A
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5
Q

Manifestations of systemic lupus erythematosus

  1. Clinical symptoms
  2. Laboratory findings
A
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6
Q

Meniscal tear

  1. Causes
  2. Symptoms
  3. Exam
A

1. Causes

Results from twisting injuries

2. Symptoms

Impaired extension of the Knee

Instability

Exacerbation of pain with squatting

3. Examination

Joint line tenderness

Effusion

Locking or catching when joint is extended under load

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7
Q

Provocative maneuvers for meniscal tear

A
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8
Q

What structure is at risk?

A

Midshaft fracture of the humerus

Risk of damage to radial nerve (runs in groove on dorsal aspect of humerus)

  • Wrist and finger extensors
  • Sensation in dorsum of hand
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9
Q

Differential diagnosis of septic arthritis

A

Gram positive organisms: Younger age, no IV drug use

-staph aureus

Gram negative organisms: Older age, IV drug use

  • E. coli
  • Pseudomonas
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10
Q

Septic arthritis

  1. Risk factors
  2. Clinical features
  3. Diagnosis
  4. Initial treatment
A
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11
Q

Granulomatosis with polyangitis

  1. Clinical manifestations
  2. Diagnosis
  3. Management
A

White individuals 30-50

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12
Q
A

Pyoderma gangrenosum

Cutaneous manifestation of granulomatosis with polyangiitis

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13
Q

Henoch-Schonlein Purpura (HSP)

A

Half of cases are preceded by an upper respiratory infection

Ileo-ilial intussusception

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14
Q

Granulomatous vasculitities in children

A

Takayasu arteritis

Granulomatosis with polyangiitis (Wegener)

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

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15
Q
A

Strawberry tongue, feature of Kawasaki disease

Diagnostic criteria (fever for >=5 days with >=4 of the following findings)

Oral mucous membane changes (e.g., strawberry tongue, cracked lips)

Bilateral nonexudative conjunctivities with limbal sparing

Cervical lymphadenopathy (>1.5 cm node)

Polymorphous rash

Erythema or edema of the hands and feet

Treat with IVIG + aspirin

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16
Q

Rocky Mountain Spotted Fever

  1. Symptoms
  2. Treatment
A

Symptoms

Headaches

GI symptoms

Non-pruritic petechial rash that begins on extremitis (including palms/soles) and spreads centripetally

Fever

Conjunctival injection

Treatment

Doxycycline

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17
Q

Koplik spots (small white spots on bucal mucosa)

A

Classic in measles

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18
Q

Forscheimer spots (petechiae on soft palate)

A

Rubella

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19
Q

Tinel sign

Phalen test

A

Provocative tests for carpel tunnel syndrome (compression of median nerve)

Tinel sign: Precussion over the median nerve at the risk

Phalen test: Holding hands in extreme flexion

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20
Q

Risk factors for carpel tunnel syndrome

A

Obesity

Diabetes

Hypothyroidism

3rd trimester of pregnancy

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21
Q

De Quervain tenosynovitis

A

Overuse of the extensor pollicis brevis and abductor poolicis longus

Causes pain at the base of the thumb

Common after pregnancy due to lifting the newborn

Provocative maneuver: Finkelstein test

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22
Q

Ulnar nerve compression at the elbow

A

Compression occurs in the epicondylar groove (due to direct pressure) or the cubital tunnel (due to repetitive or prolonged flexion of the elbow).

Symptoms: Paresthesias in the 4th and 5th fingers and the medial forearm, and weakness of intrinsic hand muscles.

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23
Q

Roseola infantum

  1. Microbiology
  2. Epidemiology
  3. Clinical features
  4. Treatment
A
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24
Q
A

Kocksackie virus

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25
Measles (darker red spots)
26
Rubella (pink spots)
27
Reynaud phenomenon 1. Associations 2. Treatment
1. Associations: connective tissue disorders such as scleroderms 2. Treatment: Avoiding situations in which the fingers become cold; **Pharmalogic treatment with calcium channel blockers, e.g., nifedipine**
28
Growing pains 1. Clinical features 2. Treatment
Occur in 10-30% of children age 2-12 years
29
Osteoid osteoma Benign bone tumor Causes bone pain in the second decade of life Respond to NSAIDs
30
Osteosarcoma Malignant bone tumor
31
Systemic sclerosis 1. Pathogenesis 2. Clinical Features **3. Serology** 4. Complications
32
Antiocardiolipin
Anti-phospholipid syndrome
33
Anti-cyclic citrullinated peptide antibodies
Specific marker for Rheumatoid arthritis
34
Antimitochondrial antibodies
Primary biliary cholangitis (primary biliary cirrhosis) Fatigue, puritis, right upper quadrant discomfort Elevated serum Alkaline phosphatase
35
Anti-neutrophil cytoplastmic antibodies
Granulomatosis with polyangiitis Microscopic polyangitis
36
Anti-smooth muscle antibodies
Autoimmune hepatitis
37
Achalasia
38
Risk factors for osteoperosis 1. Nonmodifiable 2. Modifiable
39
Stress fracture 1. Risk factors 2. Clinical presentation 3. Management
40
Patellofemoral pain syndrome
Common cause of anterior knee pain in young women. Usually due to chronic overuse or malalignment Pain reproduced with patellofemoral compression test Management: Activity modification, NSAIDS, and stretching and strengthening exercises
41
Slipped capital femoral epiphysis (SCFE)
Displacement of the femoral head on the femoral neck due to disruption of the femoral growth plate. Commonly seen in obese adolescent boys. Presents with hip or knee pain of insidious obset that causes limping Exam: Loss of abduction and internal rotation Treatment: Surgical pinning of the slipped epiphysis to lessen risks of avascular necrosis.
42
Intussesception | ("Target sign" on ultrasound)
43
Drooping of the contralateral pelvis Caused by weakness of the gluteus minimus and gluteus medius, innervated by the superior gluteal nerve
44
Dentinogenesis imperfecta Common complication of osteogenesis imperfecta Osteogenesis imprefecta is associated with: blue sclerae, hearing loss, recurrent fractures, and opalescent teeth.
45
Radial head subluxation (nursemaid's elbow) 1. Mechanism 2. Physical findings 3. Treatment
46
Chronic tophaceous gout
47
Calcinosis cutis
48
Severe osteoarthritis Heberden nodes over distal interphalangeal joints Bouchard nodes over proximal interphalangeal joints
49
Psoriatic arthritis Nail changes common
50
Rheumatoid nodules Firm, flesh-colored, nontender Occur over pressure points such as elbow
51
Management of low back pain 1. Acute pain 2. Chronic pain 3. Secondary prevention
52
Fat embolism syndrome 1. Etiology 2. Clinical presentation 3. Diagnosis 4. Prevention and treatment
53
Juvenile idopathic arthritis
Clinical features Laboratory findings: Anemia results from chronic inflammation and iron deficiency (anemia of chronic disease)
54
Erythema marginatum Characteristic of acute rheumatic fever
55
Parvovirus B19 infection 1. Signs and symptoms 2. Diagnosis
Causes arthritis resembling RA in adults
56
Piaget disease of bone 1. Clinical featres 2. Pathogenesis 3. Laboratory testing 4. Imaging 5. Treatment
57
Risk factors for gout 1. Increased risk 2. Decreases risk
Gout can be triggered by medications that raise (e.g., thiazide diuretics, cyclosporine) or **lower** (e.g., **allopurinol**) uric acid levels. **Definitive diagnosis** is obtained via synovial fluid analysis showing inflammatory cells and needle-shaped, negatively birefringent urate crystals.
58
Reactive arthritis 1. Definition 2. Clinical features 3. Therapy
**Definition**: Seronegative spondyloarthropathy resulting from enteric or genitourinary infection **Clinical features**: Urethritis, conjunctivitis, mucocutaneous lesions, enthesitis, asymmetric oligoarthritis **Therapy**: NSAIDs
59
Common causes of shoulder pain (Diagnosis, Features) 1. Rotator cuff impingement/tendinopathy 2. Rotator cuff tear 3. Adhesive capsulitis: Frozen shoulder 4. Biceps tendinopathy/rupture 5. Glenohumoral osteoarthritis
60
Rotator cuff tear
61
Impingement syndrome
Feature of rotator cuff tendinopathy Refers to compression of soft tissue structers (supraspinatus tendon and subacromial bursa) between the humeral head and acromion.
62
Ewing's sarcoma
Highly malignant tumor most commonly found in the metaphysis and diaphysis of the femure, tibia, or humerus. Radiography: **Lamellated appearance or "onion skin" periosteal reaction**. Lesion is lytic, central, and accompanied by endosteal scalloping.
63
Screening for osteoperosis
**Dual-energy x-ray absorpiometry** in all women \>=65 and younger women who have an equivalent risk of osteoperotic fracture
64
Osteoperosis Osteopenia Definitions
Osteoperosis: bone density \>= 2.5 standard deviations below the mean for a young adult at peak bone density (T score \<= -2.5) Osteopenia: T score between -1 and -2.4
65
Joint fluid characteristics (Appearance, WBC count in mm^3, PMNs) 1. Normal 2. Noninflammatory (e.g., OA) 3. Inflammatory (e.g., crystals, RA) 4. Septic joint
66
Osteoarthritis
67
Chondrocalcinosis Calcification of joint cartilate, seenin calcium pyrophosphate dihydrate deposition (pseudogout).
68
Punched out erosions with a rim of cortical bone Characteristic of gout
69
X ray findings in septic arthritis
Normal joint space with swelling of adjacent soft tissues
70
X ray findings in rheumatoid arthritis
Periarticular osteopenia with erosions of the joint margin
71
1. Mechanism 2. Complications
Most common complication is entrapment of the **brachial artery** or **median nerve**
72
Erythema nodosum Represents a delayed hypersensitivity reaction to antigens associated with various conditions. Can be a sign of more serious disease: Strep infection, sarcoidosis, TB, coccidiomycosis, IBD, Behcet disease. Workup includes **chest X** ray to assess for sarcoidosis or TB
73
Osteoarthritis Proximal and distal interphalangeal joints
74
Avascular necrosis 1. Etiology 2. Clinical manifestations 3. Laboratory findings 4. Radiologic imaging
75
Treatment for rheumatoid arthritis
All patients diagnosed with RA should be started on disease-modifying antirheumatic agens (DMARDs) as soon as possible as joing damage begins early in its course.
76
Vitamin D deficiency rickets 1. Risk factors 2. Clinical manifestations 3. X-ray features 4. Serum laboratory findings
Vitamin D supplementation of 400 IU daily for babies who do not ingest fortified formula or baby food.
77
Popliteal (Baker) cyst 1. Etiology 2. Risk factors 3. Clinical presentation 4. Complications
78
Systemic sclerosis subtype characteristics 1. Limited cutaneous 2. Diffuse cutaneous
79
Patient with Down syndrome with upper motor neuron findings
Atlantoaxial instability 10-15% of patients with Down syndrome Symptoms result from compression of the spinal cord
80
Cystic hygromas Congential malformations of the lymphatic system, located in the posterior triangle of the neck. Often detected prenatally and have a high association with aneuploidy. Postnatal exam would reveal a fluctuant mass that transilluminates
81
Clinical features of dermatomyositis 1. Muscle weakness 2. Skin findings 3. Extramuscular findings 4. Diagnosis **5. Managment**
82
Heliotrope sign Characteristic of dermatomyositis
83
Pathognomonic for dermatomyositis
84
Causes of gout 1. Increased urate production 2. Decreased urate clearance
Hypoxanthine guanine phosphoribosyl transferase deficiency is Lesch-Nyhan syndrome
85
Complication of anterior shoulder dislocation
Damage to the axillary nerve causing shoulder abduction weakness
86
Ulnar nerve damage 1. Mechanism 2. Deficit
1. Mechanism: Fracture of the medial epicondyle of the humerus or deep lacerations of the anterior wrist 2. Deficit: Claw hand, resulting from paralysis of the intrinsic muscles of the hand and sensory loss of medial hand
87
Langerhans cell histiocytosis
Neoplastic process causing a solitary, painful, lytic long bone lesion with overlying swelling and hypercalcemia in a child
88
Ankylosing spondylitis 1. Inflammatory back pain 2. Examination findings 3. Complications 4. Laboratory 5. Imaging
89
Bamboo spine Fusion of vertebral bodies with ossification of intervertebral discs suggests **ankylosing spondylitis**
90
**Pathergy**: An exaggerated ulcerating skin response following minor injuries (e.g., needlestick)
91
Behcet disease 1. Epidemiology 2. Clinical findings 3. Evaluation
92
Indications for imaging in low back pain
**X ray:** Osteoperosis, compression fracture Suspected malignancy Ankylosing spondylitis **MRI:** Sensory/motor deficits Cauda equina syndrome Suscepted epidural abscess/infection **Radionucleotide bone scan or CT:** Indications for MRI but aptient not able to have MRI
93
Side effects of long-term cyclophosphamide
Acute hemorrhagic cystitis Bladder carcinoma
94
Mixed cryoglobulinemia syndrome Symptoms: Labs:
Immune complex deposition disorder commonly associated with chronic hepatitis C Symptoms: Fatigue, palpable purpura, arthralgias, renal disease, and peripheral neuropathies. Labs: Serum cryoglobulins, hypocomplementemia, positive rheumatoid factor, elevated transaminases, and kidney injury

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