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