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Uworld > Rheumtology And Sports Medicine > Flashcards

Rheumtology And Sports Medicine Flashcards

1
Q

A

A

A

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2
Q

Lumbar canal stenosis occurs mostly after age ——

A

60 years

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3
Q

The etiology of low back pain that worsens with flexion

A

Lumar disc herniation

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4
Q

Confirmatory test for lumbar canal stenosis

A

MRI spine

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5
Q

What is the timeline for development of fat embolism after a major trauma?

A

24-72 hours

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6
Q

What is the triad of fat embolism?

A

Respiratory insufficiency
Petechiae
Neurological impairment

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7
Q

What causes petechiae in fat embolism?

A

Blockage of dermal capillaries resulting in extravasation of erythrocytes.

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8
Q

Studies have shown that smoking cessation —— weeks prior to surgery reduces the risk of post-operative pulmonary complications.

A

4 weeks

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9
Q

Which surgeries are considered high risk for pulmonary complications?

A

Any surgery from head and neck to upper abdomen.

The risk of pulmonary complications is inverse proportion the distance from the diaphragm.

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10
Q

Indications for pre-operative PFTs

A
  1. Prior to lung resection
  2. To optimize COPD status is baseline is unknown
  3. To evaluate for cause of dyspnea or exercise intolerance
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11
Q

Bone marrow elements on synovial fluid analysis

A

Intra-articular fracture

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12
Q

Skin lesions in reactive arthritis

A
  1. Keratoderma blennorhagica

2. Circnate balanitis

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13
Q

Which infections are associated with reactive arthritis

A
  1. GU: Chalmyida

2. GI: Salmonella, shigella, yersinia, campylobacter

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14
Q

Timeline for development of reactive arthritis after a GI or GU infection

A

3-6 weeks

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15
Q

Reiter’s syndrome triad

A
  1. Arthritis
  2. Uveitis
  3. Urethritis
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16
Q

Synovial fluid analysis with reactive arthritis

A

Inflammatory arthritis with negative bacterial gram stain and culture

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17
Q

Clinical presentation of Parvovirus B19 infections in adults

A

URI —-> 1-2 weeks—-> Symmetric pain in MCP and PIP joints and ssociated reticular lacy rash

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18
Q

Time from URI to development of rheumatic fever

A

2-4 weeks

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19
Q

Blood test for diagnosis of parvovirus B19

A

Serum Parvovirus B19 IgM

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20
Q

Most common type of JIA

A

Oligoarticular arthritis

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21
Q

What is the typical presentation and examination finding of JIA

A
  1. Limping worse in the morning and improves throughout the day
  2. Swelling and warmth without erythema
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22
Q

Three subtypes of JIA

A

Oligo, polyarticular and systemic

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23
Q

What is the most feared complication of JIA

A

Uveitis which may lead to permanent vision loss

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24
Q

What is mild JIA? Tx?

A

Single joint involvement, normal ESR/CRP and well-appearing child.
Tx with NSAIDs and glucocorticoids

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25
Q

What is severe JIA? Tx?

A

> 1 joint involved, sick appearing child, elevated ESR/CRP

Tx with DMARDs or biologics

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26
Q

Diagnosis of dermatomyositis

A

Characteristic findings: Clinical + Serology positive for anti-Jo1 and anti-Mi2
Atypical features: Skin and muscle biopsy may be required

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27
Q

Which disease has very similar presentation to dermatomyositis?

A

HIV associated myopathy: proximal myopathy of lower extremities and psoriatic lesions involving hands, feet, palms and soles with extensive scaling.

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28
Q

Antibodies in dermatomyositis

A

Anti-Jo1 and anti-Mi2

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29
Q

Systemic complication associated with dermatomyositis

A

ILD

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30
Q

Screening for ILD in symptomatic and asymptomatic patients with dermatomyositis

A

Symptomatic: CT chest and PFT
Asymptomatic: CXR

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31
Q

Difference in myopathy associated with dermatomyositis and HIV

A

DM: UE=LE
HIV: LE>UE

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32
Q

Treatment of dermatomyositis

A

High dose glucocorticoids + steroid sparing agent

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33
Q

Dermatomyositis may occur alone or as a ____ which may occur before, after or with the onset of symptoms.

A

Paraneoplastic syndrome

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34
Q

Which malignancies are associated with dermatomyositis?

A

Adenocarcinoma of - cervix, ovary, bladder, lung, pancreas and stomach

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35
Q

—— is more sensitive and —— is ore specific for SLE

A

Anti-dsDNA and Anti-Sm

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36
Q

Anti-dsDNA antibody is associated with ____ and _____ in SLE

A

Disease activity and lupus nephritis

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37
Q

How to differentiate if symptoms of worsening are related to lupus or infection etc.?

A

Anti-dsDNA levels

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38
Q

Which DMARD is preferred in SLE and why?

A

HCQS- improves cutaneous manifestations, serositis, and arthralgias.

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39
Q

Rituximab in SLE is associated with whihc side effect?

A

PML

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40
Q

What is medical tibial stress syndrome?

A

Seen in athletes, runners, ballet dancers, and military recruits. Occurs due to continued stress without adequate rest resulting in stress fracture.Without tenderness to palpation.

41
Q

What is the diagnostic test for medical tibial stress fracture?

A

Clinical diagnosis. Xray takes 4 weeks to show findings.

MRI is preferred imaging.

42
Q

What are the x-ray findings of medical tibial fracture?

A

Fracture line, bone sclerosis, cortical thickening, and periosteal lifiting

43
Q

Relationship between risk of gout and CKD, ESRD on HD, and post-renal transplant?

A

CKD—> increased risk
HD—> reduces risk
Renal transplant on immunosupression —> Increased risk due to increased uric acid excretion

44
Q

Treatment of acute gout in CKD

A

No NSAIDs
Renally dosed colchicine may be used but should be avoided in concomitant cyclosporine use due to decreased clearance.
Intra-articular steroids can be used.

45
Q

Kawasaki disease

A

Systemic vasculitis

46
Q

Diagnosis of Kawasaki disease

A

Child <5 years + Fever > 5 days with 3/5 features:

  1. Non-purulent conjunctivitis
  2. Mucositis
  3. Hand and feet edema with skin peelin
  4. Truncal, perineal, and inguinal rashes
47
Q

CVD monitoring in kawasaki disease with coronary aneurysm

A

Lifelong

48
Q

Lab test in kawasaki disease

A

ESR and CRP

49
Q

Follow-up duration in kawasaki

A

Daily to monitor new symptoms

50
Q

Scarlet fever clinical features

A
  1. Pharyngitis
  2. Strawberry tongue
  3. Circumoral pallor
  4. Sandpaper rash
51
Q

Treatment of scarlet fever

A

Oral amoxicillin

52
Q

Treatment of kawasaki disease

A

High dose aspirin and Immunoglobulin

53
Q

How long does it take for symptoms of kawasaki to resolve after IVIG

A

24 hours

54
Q

Skin peeling in kawasaki disease

A

Resolution

55
Q

Time for development of coronary artery aneurysm in Kawasaki

A

10 days

56
Q

Echocardiogram in Kawasaki

A

At baseline and in 2-6 weeks post treatment

57
Q

Vaccinations after IVIG

A

Defer for 11 months

58
Q

Differential diagnosis is anterior knee pain in young females

A
  1. Patelofemoral pain syndrome
  2. Pre-patellar bursitis (Housemaid’s knee)
  3. Patellar tendonitis (Jumper’s knee)
  4. Osgood-Schlatter syndrome
59
Q

Physical exam in patellofemoral pain syndrome

A
  1. Patellofemoral compression test

2. Pain with squatting

60
Q

Treatment of patellofemoral pain syndrome

A

Stretching exercises of the quadriceps

61
Q

Characteristic feature of PMR

A

Pain and morning stiffness without weakness.

P/E with painful active ROM and normal passive ROM

62
Q

Ca and Vit D daily intake for osteoporosis

A

Ca 1200mg/day and Vit D 800 IU/day

63
Q

Medications which increase risk of gout

A
  1. Diuretics
  2. Low dose ASA
  3. Immunosupressants
64
Q

Contraindications for NSAID

A
  1. CKD or AKI
  2. PUD
  3. CHF
  4. Current anticoagulant therapy
  5. NSAID sensitivity
65
Q

Contraindications for cochicine

A
  1. Severe renal or liver Dx

2. Concomitant use of CYP-450 inhibitors

66
Q

Colchicine dose in gout

A

1.2 mg —-> 0.6 mg an hour later

67
Q

Window for colchicine treatment in gout

A

Most effective within 24 hours of therapy

68
Q

Allopurinol in acute gout

A

Worsens gout attack

69
Q

First line treatment for Raynaud’s

A

A mlodipine
N ifedipine
D iltiazem

70
Q

Pathological features of scoliosis

A
  1. Back pain
  2. Neurological symptoms
  3. Rapid progression >10/year
  4. Vertebral abnormalities on X-ray
71
Q

Imaging in low back pain

A
  1. Age > 50
  2. History of malignancy
  3. Nocturnal pain
  4. H/O IVDU, immune supression or recurrent bacterial infection
72
Q

Initial test for back pain with red flags

A

Xray and ESR

73
Q

Markers of bone resorption in PDB

A

N telopeptide and C telopeptide

74
Q

Instructions for bisphosphonate use

A

Empty stomach with upright posture for 30-60 minutes

75
Q

Trunk rotation angle in scoliosis that warrants imaging

A

> 7 degrees

76
Q

Pulmonary side effect of MTX

A

Inflammatory pneumonitis

77
Q

Steroid dose for PMR vs GCA

A

Low dose 10-20

High dose 50-60

78
Q

5 DDx of shoulder pain

A
  1. Rotator cuff tendinopathy/impingement
  2. Rotator cuff tear
  3. Biceps tendinopathy
  4. Adhesive capsulitis
  5. OA
79
Q

5 GCA criteria

A
  1. Age > 50
  2. New onset headache, visual disturbance, and fever
  3. ESR > 50
  4. Temporal artery biopsy positive
  5. Scalp tenderness
80
Q

C/F of RMSF

A

Non specific symptoms like fever, headache, polyarthralgias and myalgia. Rash on hands and feet.

81
Q

Give away C/F of RMSF

A

Petechial rash on hands and feet

82
Q

Complications of RMSF

A

Encephalitis, pulmonary edema, bleeding, and shock

83
Q

Dx of RMSF

A

Rickettsia serology and skin biopsy

84
Q

Antibiotics for sepsis in infants

A

Ampicillin + Gentamicin/cefotaxime

85
Q

Most common organisms for pediatric sepsis < 28 days

A

E.Coli and GBS

86
Q

Most common organisms for sepsis in infants >28 days

A

Pneumococcus and meningococcus

87
Q

Empiric antibiotic for pediatric sepsis > 28 days

A

CTX/Cefotaxime +- Vancomycin

88
Q

Why avoid CTX and sulfonamides in neonates?

A

Hyperbilirubinemia

89
Q

Test to establish or exclude the diagnosis of active TB

A

NAAT and sputum culture

90
Q

Clinical presentation of diptheria

A

Child <15 years of age with fever, sore throat, pseudomembranous tonsillitis, cervical LN

91
Q

Complications of diphteria

A

Toxin mediated myocarditis, kidney disease, and nerve involvement

92
Q

Rx of diptheria

A

Erythromycin or Penicillin G

Antitoxin if severe

93
Q

2 clinical manifestations of disseminated gonorrhea infection

A

Purulent monoarthritis or

migratory polyarthralgia, tenosynovitis, and 2-10 pustules

94
Q

Organisms for CLABSI

A

CONS
S. Aureus
Candida
Aerobic gram negative bacilli

95
Q

Site with least risk of CLABSI

A

Subclavian

96
Q

Indications for IV antibiotics for UTI in children

A

Age < 2 years
Inability to tolerate PO (vomiting)
HD instability
Failed PO meds

97
Q

Organisms in human bite

A

Staph. Aureus
Step viridans
Ekinella
Anaerobes: fusobacterium and prevotella

98
Q

Rx of human bites

A

Amoxicillin- clavulinic acid + tetanus booster

99
Q

Anti inflammatory effect of MTX

A

AICAR trasncarbomylase inhibition

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