Rosh MSK Flashcards by John Goodman

12 year old male presents with complaing of knee pain while running.

PE shows tenderness over the tibial tubercle.

What is the most likely diagnosis?

Osgood-Schlatter Disease

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12 year old male presents with complaing of knee pain while running.

PE shows tenderness over the tibial tubercle.

What is the treatment of choice for this condition?

Ice

NSAIDs

Quad stretching

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What would you expect to see upon PE with Osgood-Schlatter disease?

Tenderness over the tibial tubercle

Pain while running

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Patient presents with fever, monarticular pain, and decreased ROM

What is the most likely diagnosis?

Septic arthritis

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What lab findings are characteristic of septic arthritis?

How do you diagnose it?

WBC > 50,000 with >75% PMNs

Arthrocentesis

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What are the most common causitive agents of septic arthritis in a patient <35 years of age?

What is the treatment?

N. gonorrhea, S. aureus

IV ABX, surgical washout

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A male patient presents with back pain that’s worse in the morning and improves with exercise.

What is the most likely diagnosis?

Ankylosing Spondylitis

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A male patient presents with back pain that’s worse in the morning and improves with exercise.

What gene is associated with this disease?

What is the treatment?

HLA-B27

NSAIDs and PT

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Which diseases are associated with HLA-B27?

PAIR

Psoriatic arthritis

Ankylosing spondylitis

IBD

Reactive arthritis

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What is Anti-SSA/Ro associated with?

Lupus

Sjogren’s

Neonatal heart block

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What is Anti-La/SS-B associated with?

Sjogren’s

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What is Anti-centromere associated with?

CREST syndrome

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What is Anti-dsDNA associated with?

Lupus

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What is Anti-Jo1 associated with?

Inflammatory myopathy

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What is Anti-Smtih associated with?

Lupus

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What is Anti-topoisomerase (Sci-70) associated with?

Systemic sclerosis

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What is Anti-histone associated with?

Lupus

Drug-induced Lupus

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What is c-ANCA associated with?

Granulomatosis

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What is p-ANCA associated with?

Microscopic polyangiitis

Churg-Strauss

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What is Anti-smooth muscle antibody associated with?

Chronic immune hepatitis

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What is Anti-mitochondrial antibody associated with?

Primary biliary cirrhosis

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What are the major Jones critera for acute rhematic fever?

Carditis

Polyarthritis

Chorea

Subcutaneous nodules

Erythema marginatum

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What are the minor Jones critera for acute rheumatic fever?

Fever

Arthralgia

Elevated ESR or CRP

Prolonged PR interval

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An obese male adolescent presents with a progressive limp and knee pain. Upon PE you find loss of internal hip rotation.

What is the most likely diagnosis?

SCFE (Slipped Cap Femoral Epiphysis)

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How is the diagnosis of SCFE made?

AP and frog-lateral X-rays

Ottawa Ankle Rules for ankle: Bone tenderness at posterior edge of distal or tip of _________ and \_\_\_\_\_\_\_\_\_\_ Inability to bear weight both _________ and \_\_\_\_\_\_\_\_\_\_\_

Lateral malleolus and medial malleolus immediate after injury and time of evaluation

Ottawa Ankle Rules for foot: Bone tenderness at the \_\_\_\_\_\_\_\_\_\_ Bone tenderness at the \_\_\_\_\_\_\_\_\_\_\_\_ Inability to bear weight both ___________ and \_\_\_\_\_\_\_\_\_\_\_\_

Navicular bone Base of fifth metatarsal Immediate after injury and time of evaluation

What will labs show with Gout?

needle-shaped crystal with negative birefringence

What medications can trigger gout?

Loop and thiazide diuretics

What is another name for reactive arthritis?

Reiter Syndrome

mnemonic for reactive arthritis

Can't see (uveitis), can't pee (urethritis), can't climb a tree (arthritis)

Older patient presents with low back pain that is releived with leaning forward. What is the most likely diagnosis?

Spinal stenosis

What causes spinal stenosis?

Narrowing of the lumbar spinal canal with compression of the nerve roots

What bug is mostly commonly found in cat bites?

Pasteurella multocia

What is the drug of choice for cat bites?

Augmentin

What complications can arise from cat bites?

Osteomyelitis Tenosynovitis

Which nerve is commonly injured in anterior knee dislocation? Which artery is commonly injured?

Common peroneal nerve Popliteal artery

What is the most common type of knee dislocation?

SALTR types

S-Slipped A-Above growth plate L-Lower than growth plate T-Through the growth plate R-Rammed (crushed)

What do you call any fracture or dislocation of the tarsal-metatarsal joint?

Lisfranc injury

What is the Fleck sign?

Pathognomonic for lisfranc Avulsion fracture of medial aspect of base of second metatarsal

What is the treatment for a Lisfranc injury?

Nondisplaced: non-weight bearing case Displaced: surgery

What is the mechanism of injury in an ACL tear?

Quick stop moving and change in direction while running

Papable purpura

Hypersensitivity vasculitis

Palpable purpura Abdominal pain Hematuria N/V/D

Henoch-Schonlein purpura

Cough Dyspnea Hemoptysis Glomerulonephritis

Goodpasture's syndrome

Small vessel vasculitides

Hypersensitivity vasculitis Henoch-Schonlein purpura Goodpasture's syndrome

Skin ulcers Nephritis Mesenteric ischemia

Polyarteritis nodosa

Sinusitis Pulmonary infiltrates Nephritis

Granulomatosis w/ polyangiitis

Recurrent painful oral & genital ulcers Uveitis, iritis, or optic neuritis

Bechet disease

Pulmonary infiltrates Nephritis

Microscopic polyangiitis

Medium vessel vasculitides

Polyarteritis nodosa Granulomatosis w/ polyangiitis Bechet disease Microscopic polyangiitis

Branches of carotid artery Headache Jaw claudication Vision changes

Giant cell arteritis

Aorta and major branches Finger ischemia Arm claudication

Takayasu's arteritis

Large vessel vasculitides

Giant cell arteritis Takayasu's arteritis

What is the main treatment for all vasculitides?

Prednisone

40-50 year old male patient presents with malaise, fever, sore throat, aches, and pains. Upon PE you find tender lumps under the skin on lower legs. What is the most likely diagnosis?

Polyarteritis nodosa

What is the pathognomonic sign for polyarteritis nodosa?

Starburst livedo (painful violaceous plaques that are surrounded by livedo reticularis)

Risk factors for osteoporosis

Alcohol Steroid use Whites Asians

T-score indicative of osteoporosis

= 2.5

What are the rotator cuff muscles?

SITS Supraspinatus (abduction) Infraspinatus (external rotation) Teres minor (external rotation) Subscapularis (internal rotation)

Young patient presents with Hx of a URI, complaining of abdominal pain, arthralgia, and a rash. The rash began on buttocks and lower extremities. What is the most likely diagnosis?

Henoch-Schonlein purpura

What is the most common cause of Henoch-Scholein purpura?

IgA mediated vasculitis

What are the common complications of Henoch-Scholein purpura?

Nephropathy Intussusception

Gradually increasing multiple myalgias F\>M Proxima \> distal

Polymyositis

Polymyositis symptoms + Dermatologic manifestations Scaly rash Shawl sign Proximal \> distal

Dermatomyositis

Autoimmune & degenerative destuction of muscle cells Pharyngal muscle weakness Distal \> proximal

Inclusion body myositis

Patient presents with muscle pain and progressive weakness of 3 months. PE shows diffuse tenderness of shoulder and pelvic girdle. You draw labs: + Anti-Jo, + Anti-SRP, + Anti-Mi-2 What is the most likely diagnosis?

Polymyositis

What is the name for a high ankle sprain?

Syndesmotic ankle sprain

How does a high ankle sprain occur? What is the managment?

External rotation force Immobilization, non-weightbearing, surgical PRN

What is the first line treatment for scabies?

permethrin 5%

What is the most common cause of erysipelas?

Beta-hemolytic strep (strep pyogenes)

What is the treatment for erysipelas?

Ceftriaxone, cefazolin (systemic symptoms) Amoxicillin, cephalexin (mild to moderate)

Patient presents with erythema migrans and viral-like syndrome after a history of being in the woods. What could they have?

Lyme disease stage I

Arthritis, myocarditis, bilateral Bell's palsy

Symptoms of stage II Lyme disease

What is the cause of Lyme disease?

Borrelia burgdorferi

What is the treatment of Lyme disease in a child or pregnant women?

Amoxicillin

What are the 2 pathognomonic symptoms of Lyme disease?

Erythema migrans Bilateral facial nerve palsy