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

Rheumatology/Orthopedics & Sports Flashcards

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
Q
A

Measles (darker red spots)

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26
Q
A

Rubella (pink spots)

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27
Q

Reynaud phenomenon

  1. Associations
  2. Treatment
A
  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
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28
Q

Growing pains

  1. Clinical features
  2. Treatment
A

Occur in 10-30% of children age 2-12 years

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29
Q
A

Osteoid osteoma

Benign bone tumor

Causes bone pain in the second decade of life

Respond to NSAIDs

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30
Q
A

Osteosarcoma

Malignant bone tumor

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31
Q

Systemic sclerosis

  1. Pathogenesis
  2. Clinical Features

3. Serology

  1. Complications
A
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32
Q

Antiocardiolipin

A

Anti-phospholipid syndrome

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33
Q

Anti-cyclic citrullinated peptide antibodies

A

Specific marker for Rheumatoid arthritis

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34
Q

Antimitochondrial antibodies

A

Primary biliary cholangitis (primary biliary cirrhosis)

Fatigue, puritis, right upper quadrant discomfort

Elevated serum Alkaline phosphatase

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35
Q

Anti-neutrophil cytoplastmic antibodies

A

Granulomatosis with polyangiitis

Microscopic polyangitis

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36
Q

Anti-smooth muscle antibodies

A

Autoimmune hepatitis

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37
Q
A

Achalasia

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38
Q

Risk factors for osteoperosis

  1. Nonmodifiable
  2. Modifiable
A
39
Q

Stress fracture

  1. Risk factors
  2. Clinical presentation
  3. Management
A
40
Q

Patellofemoral pain syndrome

A

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
Q

Slipped capital femoral epiphysis (SCFE)

A

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
Q
A

Intussesception

(“Target sign” on ultrasound)

43
Q
A

Drooping of the contralateral pelvis

Caused by weakness of the gluteus minimus and gluteus medius, innervated by the superior gluteal nerve

44
Q
A

Dentinogenesis imperfecta

Common complication of osteogenesis imperfecta

Osteogenesis imprefecta is associated with: blue sclerae, hearing loss, recurrent fractures, and opalescent teeth.

45
Q

Radial head subluxation (nursemaid’s elbow)

  1. Mechanism
  2. Physical findings
  3. Treatment
A
46
Q
A

Chronic tophaceous gout

47
Q
A

Calcinosis cutis

48
Q
A

Severe osteoarthritis

Heberden nodes over distal interphalangeal joints

Bouchard nodes over proximal interphalangeal joints

49
Q
A

Psoriatic arthritis

Nail changes common

50
Q
A

Rheumatoid nodules

Firm, flesh-colored, nontender

Occur over pressure points such as elbow

51
Q

Management of low back pain

  1. Acute pain
  2. Chronic pain
  3. Secondary prevention
A
52
Q

Fat embolism syndrome

  1. Etiology
  2. Clinical presentation
  3. Diagnosis
  4. Prevention and treatment
A
53
Q

Juvenile idopathic arthritis

A

Clinical features

Laboratory findings: Anemia results from chronic inflammation and iron deficiency (anemia of chronic disease)

54
Q
A

Erythema marginatum

Characteristic of acute rheumatic fever

55
Q

Parvovirus B19 infection

  1. Signs and symptoms
  2. Diagnosis
A

Causes arthritis resembling RA in adults

56
Q

Piaget disease of bone

  1. Clinical featres
  2. Pathogenesis
  3. Laboratory testing
  4. Imaging
  5. Treatment
A
57
Q

Risk factors for gout

  1. Increased risk
  2. Decreases risk
A

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
Q

Reactive arthritis

  1. Definition
  2. Clinical features
  3. Therapy
A

Definition: Seronegative spondyloarthropathy resulting from enteric or genitourinary infection

Clinical features: Urethritis, conjunctivitis, mucocutaneous lesions, enthesitis, asymmetric oligoarthritis

Therapy: NSAIDs

59
Q

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
A
60
Q

Rotator cuff tear

A
61
Q

Impingement syndrome

A

Feature of rotator cuff tendinopathy

Refers to compression of soft tissue structers (supraspinatus tendon and subacromial bursa) between the humeral head and acromion.

62
Q

Ewing’s sarcoma

A

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
Q

Screening for osteoperosis

A

Dual-energy x-ray absorpiometry in all women >=65 and younger women who have an equivalent risk of osteoperotic fracture

64
Q

Osteoperosis

Osteopenia

Definitions

A

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
Q

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
A
66
Q
A

Osteoarthritis

67
Q
A

Chondrocalcinosis

Calcification of joint cartilate, seenin calcium pyrophosphate dihydrate deposition (pseudogout).

68
Q
A

Punched out erosions with a rim of cortical bone

Characteristic of gout

69
Q

X ray findings in septic arthritis

A

Normal joint space with swelling of adjacent soft tissues

70
Q

X ray findings in rheumatoid arthritis

A

Periarticular osteopenia with erosions of the joint margin

71
Q
  1. Mechanism
  2. Complications
A

Most common complication is entrapment of the brachial artery or median nerve

72
Q
A

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
Q
A

Osteoarthritis

Proximal and distal interphalangeal joints

74
Q

Avascular necrosis

  1. Etiology
  2. Clinical manifestations
  3. Laboratory findings
  4. Radiologic imaging
A
75
Q

Treatment for rheumatoid arthritis

A

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
Q

Vitamin D deficiency rickets

  1. Risk factors
  2. Clinical manifestations
  3. X-ray features
  4. Serum laboratory findings
A

Vitamin D supplementation of 400 IU daily for babies who do not ingest fortified formula or baby food.

77
Q

Popliteal (Baker) cyst

  1. Etiology
  2. Risk factors
  3. Clinical presentation
  4. Complications
A
78
Q

Systemic sclerosis subtype characteristics

  1. Limited cutaneous
  2. Diffuse cutaneous
A
79
Q

Patient with Down syndrome with upper motor neuron findings

A

Atlantoaxial instability

10-15% of patients with Down syndrome

Symptoms result from compression of the spinal cord

80
Q
A

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
Q

Clinical features of dermatomyositis

  1. Muscle weakness
  2. Skin findings
  3. Extramuscular findings
  4. Diagnosis

5. Managment

A
82
Q
A

Heliotrope sign

Characteristic of dermatomyositis

83
Q
A

Pathognomonic for dermatomyositis

84
Q

Causes of gout

  1. Increased urate production
  2. Decreased urate clearance
A

Hypoxanthine guanine phosphoribosyl transferase deficiency is Lesch-Nyhan syndrome

85
Q

Complication of anterior shoulder dislocation

A

Damage to the axillary nerve causing shoulder abduction weakness

86
Q

Ulnar nerve damage

  1. Mechanism
  2. Deficit
A
  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
Q

Langerhans cell histiocytosis

A

Neoplastic process causing a solitary, painful, lytic long bone lesion with overlying swelling and hypercalcemia in a child

88
Q

Ankylosing spondylitis

  1. Inflammatory back pain
  2. Examination findings
  3. Complications
  4. Laboratory
  5. Imaging
A
89
Q
A

Bamboo spine

Fusion of vertebral bodies with ossification of intervertebral discs suggests ankylosing spondylitis

90
Q
A

Pathergy: An exaggerated ulcerating skin response following minor injuries (e.g., needlestick)

91
Q

Behcet disease

  1. Epidemiology
  2. Clinical findings
  3. Evaluation
A
92
Q

Indications for imaging in low back pain

A

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
Q

Side effects of long-term cyclophosphamide

A

Acute hemorrhagic cystitis

Bladder carcinoma

94
Q

Mixed cryoglobulinemia syndrome

Symptoms:

Labs:

A

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

U World Step 2 (22 decks)

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