Rheumtology And Sports Medicine Flashcards
1
Q
A
A
A
2
Q
Lumbar canal stenosis occurs mostly after age ——
A
60 years
3
Q
The etiology of low back pain that worsens with flexion
A
Lumar disc herniation
4
Q
Confirmatory test for lumbar canal stenosis
A
MRI spine
5
Q
What is the timeline for development of fat embolism after a major trauma?
A
24-72 hours
6
Q
What is the triad of fat embolism?
A
Respiratory insufficiency
Petechiae
Neurological impairment
7
Q
What causes petechiae in fat embolism?
A
Blockage of dermal capillaries resulting in extravasation of erythrocytes.
8
Q
Studies have shown that smoking cessation —— weeks prior to surgery reduces the risk of post-operative pulmonary complications.
A
4 weeks
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.
10
Q
Indications for pre-operative PFTs
A
- Prior to lung resection
- To optimize COPD status is baseline is unknown
- To evaluate for cause of dyspnea or exercise intolerance
11
Q
Bone marrow elements on synovial fluid analysis
A
Intra-articular fracture
12
Q
Skin lesions in reactive arthritis
A
- Keratoderma blennorhagica
2. Circnate balanitis
13
Q
Which infections are associated with reactive arthritis
A
- GU: Chalmyida
2. GI: Salmonella, shigella, yersinia, campylobacter
14
Q
Timeline for development of reactive arthritis after a GI or GU infection
A
3-6 weeks
15
Q
Reiter’s syndrome triad
A
- Arthritis
- Uveitis
- Urethritis
16
Q
Synovial fluid analysis with reactive arthritis
A
Inflammatory arthritis with negative bacterial gram stain and culture
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
18
Q
Time from URI to development of rheumatic fever
A
2-4 weeks
19
Q
Blood test for diagnosis of parvovirus B19
A
Serum Parvovirus B19 IgM
20
Q
Most common type of JIA
A
Oligoarticular arthritis
21
Q
What is the typical presentation and examination finding of JIA
A
- Limping worse in the morning and improves throughout the day
- Swelling and warmth without erythema
22
Q
Three subtypes of JIA
A
Oligo, polyarticular and systemic
23
Q
What is the most feared complication of JIA
A
Uveitis which may lead to permanent vision loss
24
Q
What is mild JIA? Tx?
A
Single joint involvement, normal ESR/CRP and well-appearing child.
Tx with NSAIDs and glucocorticoids
25
What is severe JIA? Tx?
>1 joint involved, sick appearing child, elevated ESR/CRP
| Tx with DMARDs or biologics
26
Diagnosis of dermatomyositis
Characteristic findings: Clinical + Serology positive for anti-Jo1 and anti-Mi2
Atypical features: Skin and muscle biopsy may be required
27
Which disease has very similar presentation to dermatomyositis?
HIV associated myopathy: proximal myopathy of lower extremities and psoriatic lesions involving hands, feet, palms and soles with extensive scaling.
28
Antibodies in dermatomyositis
Anti-Jo1 and anti-Mi2
29
Systemic complication associated with dermatomyositis
ILD
30
Screening for ILD in symptomatic and asymptomatic patients with dermatomyositis
Symptomatic: CT chest and PFT
Asymptomatic: CXR
31
Difference in myopathy associated with dermatomyositis and HIV
DM: UE=LE
HIV: LE>UE
32
Treatment of dermatomyositis
High dose glucocorticoids + steroid sparing agent
33
Dermatomyositis may occur alone or as a ____ which may occur before, after or with the onset of symptoms.
Paraneoplastic syndrome
34
Which malignancies are associated with dermatomyositis?
Adenocarcinoma of - cervix, ovary, bladder, lung, pancreas and stomach
35
—— is more sensitive and —— is ore specific for SLE
Anti-dsDNA and Anti-Sm
36
Anti-dsDNA antibody is associated with ____ and _____ in SLE
Disease activity and lupus nephritis
37
How to differentiate if symptoms of worsening are related to lupus or infection etc.?
Anti-dsDNA levels
38
Which DMARD is preferred in SLE and why?
HCQS- improves cutaneous manifestations, serositis, and arthralgias.
39
Rituximab in SLE is associated with whihc side effect?
PML
40
What is medical tibial stress syndrome?
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
What is the diagnostic test for medical tibial stress fracture?
Clinical diagnosis. Xray takes 4 weeks to show findings.
| MRI is preferred imaging.
42
What are the x-ray findings of medical tibial fracture?
Fracture line, bone sclerosis, cortical thickening, and periosteal lifiting
43
Relationship between risk of gout and CKD, ESRD on HD, and post-renal transplant?
CKD—> increased risk
HD—> reduces risk
Renal transplant on immunosupression —> Increased risk due to increased uric acid excretion
44
Treatment of acute gout in CKD
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
Kawasaki disease
Systemic vasculitis
46
Diagnosis of Kawasaki disease
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
CVD monitoring in kawasaki disease with coronary aneurysm
Lifelong
48
Lab test in kawasaki disease
ESR and CRP
49
Follow-up duration in kawasaki
Daily to monitor new symptoms
50
Scarlet fever clinical features
1. Pharyngitis
2. Strawberry tongue
3. Circumoral pallor
4. Sandpaper rash
51
Treatment of scarlet fever
Oral amoxicillin
52
Treatment of kawasaki disease
High dose aspirin and Immunoglobulin
53
How long does it take for symptoms of kawasaki to resolve after IVIG
24 hours
54
Skin peeling in kawasaki disease
Resolution
55
Time for development of coronary artery aneurysm in Kawasaki
10 days
56
Echocardiogram in Kawasaki
At baseline and in 2-6 weeks post treatment
57
Vaccinations after IVIG
Defer for 11 months
58
Differential diagnosis is anterior knee pain in young females
1. Patelofemoral pain syndrome
2. Pre-patellar bursitis (Housemaid’s knee)
3. Patellar tendonitis (Jumper’s knee)
4. Osgood-Schlatter syndrome
59
Physical exam in patellofemoral pain syndrome
1. Patellofemoral compression test
| 2. Pain with squatting
60
Treatment of patellofemoral pain syndrome
Stretching exercises of the quadriceps
61
Characteristic feature of PMR
Pain and morning stiffness without weakness.
| P/E with painful active ROM and normal passive ROM
62
Ca and Vit D daily intake for osteoporosis
Ca 1200mg/day and Vit D 800 IU/day
63
Medications which increase risk of gout
1. Diuretics
2. Low dose ASA
3. Immunosupressants
64
Contraindications for NSAID
1. CKD or AKI
2. PUD
3. CHF
4. Current anticoagulant therapy
5. NSAID sensitivity
65
Contraindications for cochicine
1. Severe renal or liver Dx
| 2. Concomitant use of CYP-450 inhibitors
66
Colchicine dose in gout
1.2 mg —-> 0.6 mg an hour later
67
Window for colchicine treatment in gout
Most effective within 24 hours of therapy
68
Allopurinol in acute gout
Worsens gout attack
69
First line treatment for Raynaud’s
A mlodipine
N ifedipine
D iltiazem
70
Pathological features of scoliosis
1. Back pain
2. Neurological symptoms
3. Rapid progression >10/year
4. Vertebral abnormalities on X-ray
71
Imaging in low back pain
1. Age > 50
2. History of malignancy
3. Nocturnal pain
4. H/O IVDU, immune supression or recurrent bacterial infection
72
Initial test for back pain with red flags
Xray and ESR
73
Markers of bone resorption in PDB
N telopeptide and C telopeptide
74
Instructions for bisphosphonate use
Empty stomach with upright posture for 30-60 minutes
75
Trunk rotation angle in scoliosis that warrants imaging
>7 degrees
76
Pulmonary side effect of MTX
Inflammatory pneumonitis
77
Steroid dose for PMR vs GCA
Low dose 10-20
| High dose 50-60
78
5 DDx of shoulder pain
1. Rotator cuff tendinopathy/impingement
2. Rotator cuff tear
3. Biceps tendinopathy
4. Adhesive capsulitis
5. OA
79
5 GCA criteria
1. Age > 50
2. New onset headache, visual disturbance, and fever
3. ESR > 50
4. Temporal artery biopsy positive
5. Scalp tenderness
80
C/F of RMSF
Non specific symptoms like fever, headache, polyarthralgias and myalgia. Rash on hands and feet.
81
Give away C/F of RMSF
Petechial rash on hands and feet
82
Complications of RMSF
Encephalitis, pulmonary edema, bleeding, and shock
83
Dx of RMSF
Rickettsia serology and skin biopsy
84
Antibiotics for sepsis in infants
Ampicillin + Gentamicin/cefotaxime
85
Most common organisms for pediatric sepsis < 28 days
E.Coli and GBS
86
Most common organisms for sepsis in infants >28 days
Pneumococcus and meningococcus
87
Empiric antibiotic for pediatric sepsis > 28 days
CTX/Cefotaxime +- Vancomycin
88
Why avoid CTX and sulfonamides in neonates?
Hyperbilirubinemia
89
Test to establish or exclude the diagnosis of active TB
NAAT and sputum culture
90
Clinical presentation of diptheria
Child <15 years of age with fever, sore throat, pseudomembranous tonsillitis, cervical LN
91
Complications of diphteria
Toxin mediated myocarditis, kidney disease, and nerve involvement
92
Rx of diptheria
Erythromycin or Penicillin G
| Antitoxin if severe
93
2 clinical manifestations of disseminated gonorrhea infection
Purulent monoarthritis or
| migratory polyarthralgia, tenosynovitis, and 2-10 pustules
94
Organisms for CLABSI
CONS
S. Aureus
Candida
Aerobic gram negative bacilli
95
Site with least risk of CLABSI
Subclavian
96
Indications for IV antibiotics for UTI in children
Age < 2 years
Inability to tolerate PO (vomiting)
HD instability
Failed PO meds
97
Organisms in human bite
Staph. Aureus
Step viridans
Ekinella
Anaerobes: fusobacterium and prevotella
98
Rx of human bites
Amoxicillin- clavulinic acid + tetanus booster
99
Anti inflammatory effect of MTX
AICAR trasncarbomylase inhibition
