Rheumatology/Orthopedics & Sports Flashcards
Ecthyma gangrenosum
Caused by Pseudomonas aeruginosa
Rapidly progressive skin lesions that develop into nontender nodules with central necrosis
Seen in immunocompromised patients
Neurogenic claudication
Symptom of spinal stenosis
Characterized by pain with extension of the spine (walking, prolonged standing)
Dermatomyositis
Distinguishing features of fibromyalgia, polymyositis, and polymyalgia rheumatica
- Clinical features
- Diagnosis
Manifestations of systemic lupus erythematosus
- Clinical symptoms
- Laboratory findings
Meniscal tear
- Causes
- Symptoms
- Exam
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
Provocative maneuvers for meniscal tear
What structure is at risk?
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
Differential diagnosis of septic arthritis
Gram positive organisms: Younger age, no IV drug use
-staph aureus
Gram negative organisms: Older age, IV drug use
- E. coli
- Pseudomonas
Septic arthritis
- Risk factors
- Clinical features
- Diagnosis
- Initial treatment
Granulomatosis with polyangitis
- Clinical manifestations
- Diagnosis
- Management
White individuals 30-50
Pyoderma gangrenosum
Cutaneous manifestation of granulomatosis with polyangiitis
Henoch-Schonlein Purpura (HSP)
Half of cases are preceded by an upper respiratory infection
Ileo-ilial intussusception
Granulomatous vasculitities in children
Takayasu arteritis
Granulomatosis with polyangiitis (Wegener)
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
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
Rocky Mountain Spotted Fever
- Symptoms
- Treatment
Symptoms
Headaches
GI symptoms
Non-pruritic petechial rash that begins on extremitis (including palms/soles) and spreads centripetally
Fever
Conjunctival injection
Treatment
Doxycycline
Koplik spots (small white spots on bucal mucosa)
Classic in measles
Forscheimer spots (petechiae on soft palate)
Rubella
Tinel sign
Phalen test
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
Risk factors for carpel tunnel syndrome
Obesity
Diabetes
Hypothyroidism
3rd trimester of pregnancy
De Quervain tenosynovitis
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
Ulnar nerve compression at the elbow
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.
Roseola infantum
- Microbiology
- Epidemiology
- Clinical features
- Treatment
Kocksackie virus
Measles (darker red spots)
Rubella (pink spots)
Reynaud phenomenon
- Associations
- Treatment
- Associations: connective tissue disorders such as scleroderms
- Treatment: Avoiding situations in which the fingers become cold; Pharmalogic treatment with calcium channel blockers, e.g., nifedipine
Growing pains
- Clinical features
- Treatment
Occur in 10-30% of children age 2-12 years
Osteoid osteoma
Benign bone tumor
Causes bone pain in the second decade of life
Respond to NSAIDs
Osteosarcoma
Malignant bone tumor
Systemic sclerosis
- Pathogenesis
- Clinical Features
3. Serology
- Complications
Antiocardiolipin
Anti-phospholipid syndrome
Anti-cyclic citrullinated peptide antibodies
Specific marker for Rheumatoid arthritis
Antimitochondrial antibodies
Primary biliary cholangitis (primary biliary cirrhosis)
Fatigue, puritis, right upper quadrant discomfort
Elevated serum Alkaline phosphatase
Anti-neutrophil cytoplastmic antibodies
Granulomatosis with polyangiitis
Microscopic polyangitis
Anti-smooth muscle antibodies
Autoimmune hepatitis
Achalasia
Risk factors for osteoperosis
- Nonmodifiable
- Modifiable
Stress fracture
- Risk factors
- Clinical presentation
- Management
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
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.
Intussesception
(“Target sign” on ultrasound)
Drooping of the contralateral pelvis
Caused by weakness of the gluteus minimus and gluteus medius, innervated by the superior gluteal nerve
Dentinogenesis imperfecta
Common complication of osteogenesis imperfecta
Osteogenesis imprefecta is associated with: blue sclerae, hearing loss, recurrent fractures, and opalescent teeth.
Radial head subluxation (nursemaid’s elbow)
- Mechanism
- Physical findings
- Treatment
Chronic tophaceous gout
Calcinosis cutis
Severe osteoarthritis
Heberden nodes over distal interphalangeal joints
Bouchard nodes over proximal interphalangeal joints
Psoriatic arthritis
Nail changes common
Rheumatoid nodules
Firm, flesh-colored, nontender
Occur over pressure points such as elbow
Management of low back pain
- Acute pain
- Chronic pain
- Secondary prevention
Fat embolism syndrome
- Etiology
- Clinical presentation
- Diagnosis
- Prevention and treatment
Juvenile idopathic arthritis
Clinical features
Laboratory findings: Anemia results from chronic inflammation and iron deficiency (anemia of chronic disease)
Erythema marginatum
Characteristic of acute rheumatic fever
Parvovirus B19 infection
- Signs and symptoms
- Diagnosis
Causes arthritis resembling RA in adults
Piaget disease of bone
- Clinical featres
- Pathogenesis
- Laboratory testing
- Imaging
- Treatment
Risk factors for gout
- Increased risk
- 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.
Reactive arthritis
- Definition
- Clinical features
- Therapy
Definition: Seronegative spondyloarthropathy resulting from enteric or genitourinary infection
Clinical features: Urethritis, conjunctivitis, mucocutaneous lesions, enthesitis, asymmetric oligoarthritis
Therapy: NSAIDs
Common causes of shoulder pain (Diagnosis, Features)
- Rotator cuff impingement/tendinopathy
- Rotator cuff tear
- Adhesive capsulitis: Frozen shoulder
- Biceps tendinopathy/rupture
- Glenohumoral osteoarthritis
Rotator cuff tear
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.
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.
Screening for osteoperosis
Dual-energy x-ray absorpiometry in all women >=65 and younger women who have an equivalent risk of osteoperotic fracture
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
Joint fluid characteristics (Appearance, WBC count in mm^3, PMNs)
- Normal
- Noninflammatory (e.g., OA)
- Inflammatory (e.g., crystals, RA)
- Septic joint
Osteoarthritis
Chondrocalcinosis
Calcification of joint cartilate, seenin calcium pyrophosphate dihydrate deposition (pseudogout).
Punched out erosions with a rim of cortical bone
Characteristic of gout
X ray findings in septic arthritis
Normal joint space with swelling of adjacent soft tissues
X ray findings in rheumatoid arthritis
Periarticular osteopenia with erosions of the joint margin
- Mechanism
- Complications
Most common complication is entrapment of the brachial artery or median nerve
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
Osteoarthritis
Proximal and distal interphalangeal joints
Avascular necrosis
- Etiology
- Clinical manifestations
- Laboratory findings
- Radiologic imaging
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.
Vitamin D deficiency rickets
- Risk factors
- Clinical manifestations
- X-ray features
- Serum laboratory findings
Vitamin D supplementation of 400 IU daily for babies who do not ingest fortified formula or baby food.
Popliteal (Baker) cyst
- Etiology
- Risk factors
- Clinical presentation
- Complications
Systemic sclerosis subtype characteristics
- Limited cutaneous
- Diffuse cutaneous
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
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
Clinical features of dermatomyositis
- Muscle weakness
- Skin findings
- Extramuscular findings
- Diagnosis
5. Managment
Heliotrope sign
Characteristic of dermatomyositis
Pathognomonic for dermatomyositis
Causes of gout
- Increased urate production
- Decreased urate clearance
Hypoxanthine guanine phosphoribosyl transferase deficiency is Lesch-Nyhan syndrome
Complication of anterior shoulder dislocation
Damage to the axillary nerve causing shoulder abduction weakness
Ulnar nerve damage
- Mechanism
- Deficit
- Mechanism: Fracture of the medial epicondyle of the humerus or deep lacerations of the anterior wrist
- Deficit: Claw hand, resulting from paralysis of the intrinsic muscles of the hand and sensory loss of medial hand
Langerhans cell histiocytosis
Neoplastic process causing a solitary, painful, lytic long bone lesion with overlying swelling and hypercalcemia in a child
Ankylosing spondylitis
- Inflammatory back pain
- Examination findings
- Complications
- Laboratory
- Imaging
Bamboo spine
Fusion of vertebral bodies with ossification of intervertebral discs suggests ankylosing spondylitis
Pathergy: An exaggerated ulcerating skin response following minor injuries (e.g., needlestick)
Behcet disease
- Epidemiology
- Clinical findings
- Evaluation
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
Side effects of long-term cyclophosphamide
Acute hemorrhagic cystitis
Bladder carcinoma
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
