Treatment - MSK & Rheum

Question 1

acromioclavicular joint dislocation “shoulder separation”

Answer 1

brief sling immobilization
class 3 (AC & CC ligaments ruptured) may need sx

Question 2

clavicle fractures

Answer 2

• mid 1/3 –> arm sling 4-6 wks adults, figure 8 sling kids

- proximal 1/3 –> ortho consult

Question 3

suppurative flexor tenosynovitis

Answer 3

I&D w/ irrigation + IV abx

Question 4

olecranon bursitis

Answer 4

• rest, NSAIDs, local steroid injection

- if septic bursitis - aspirate + abx

Question 5

ulnar shaft / nightstick frx

Answer 5

nondisplaced distal 1/3 –> short arm cast
nondisplaced mid-proximal 1/3 –> long arm
displaced –> ORIF

Question 6

monteggia frx or galeazi frx

Answer 6

UNSTABLE! Needs ORIF

Question 7

gamekeeper’s (skier’s) thumb

Answer 7

thumb spica and referral to hand surgeon (bc affects pincer function)

Question 8

bite wounds (human) abx

Answer 8

augmentin

Question 9

dupuytren contracture

Answer 9

• intralesional corticosteroid injection, PT

- sx correction if contracture >30 deg @ MCP joint of any PIP contracture

Question 10

legg-calve-perthes disease

Answer 10

• idiopathic avascular osteo in kids

- observation bc self-limiting w/ revascularization (2 yr) with activity restriction

Question 11

LCL/MCL grades tx

Answer 11

Grade 1 - sprain
Grade 2 - incomplete tear –> conservative, PT, RICE, knee immobilizer
Grade 3 - compete tear –> +/- surgical repair

Question 12

patellar and quad tendon ruptures

Answer 12

sx repair w/in 7-10 days

Question 13

acute osteomyelitis

Answer 13

abx 4-6 weeks (at least 2 wks IV) +/- debridement

newborn <4mo –> Group B strep –> Nafcillin or Oxacillin + 3rd gen ceph

children –> staph aureus / MSSA –> Nafcillin or Oxacillin or Cefazolin/Ancef (clinda or vanc if allergic)
-vanc or linezolid if MRSA

sickle cell dz –> salmonela, staph –> 3rd gen ceph or FQ

puncture wound –> pseudomonas –> CIPRO or levoflox

Question 14

chronic osteomyelitis

Answer 14

more refractory –> SX debridement + cultures –> ABX (not empiric)

Question 15

septic arthritis

Answer 15

2-4 wk course guided by gram stain (arthrocentesis)

gram pos cocci - nafcillin (vanc if MRSA suspected or PCN allergy)

gram neg cocci or gonococcus - ceftriaxone (cipro if allergy)

gram neg rods - ceftriaxone (3rd gen ceph) + anti-pseudomonal aminoglycoside (gentamicin)

no organism seen - nafcillin or vanc + ceftriaxone (+/- anti-pseudomonas)

Question 16

paget disease

Answer 16

BISPHOSPHONATES or calcitonin

Question 17

raynaud’s phenomenon

Answer 17

CCB, prostacyclin
-vasospasm-induced change of fingers, toes, ears, nose, tongue, worse w/ cold, smoking or emo stress (face, neck and distal elbows/knees)

Question 18

scleroderma

Answer 18

DMARDs, corticosteroids

Question 19

SLE

Answer 19

sun protection, hydroxychloroquine for lesions; NSAIDs/tylenol for arthritis, +/- pulse dose corticosteroids

cytotoxic drugs: methotrexate, cyclophosphamide

Question 20

sjogren’s

Answer 20

-pilocarpine - cholinergic, inc lacrimation and salivation (SE diaphoresis, flush, sweat, bradycardia, D/N/V, incontinence, blurred vision)

Question 21

polymylagia rheumatica

Answer 21

low dose corticosteroids

Question 22

pseudogout

Answer 22

INTRAARTICULAR CORTICO 1ST LINE; colchicine for prophylaxis

Question 23

rhabdo

Answer 23

• IV saline 4-6L/day
• MANNITOL to induce osmotic diuresis
• BICARB to alkalinize urine
• calcium gluconate if hyperK w/ ECG findings

Question 24

RA

Answer 24

• DMARDs - promptly reduces permanent damage
• METHOTREXATE 1st LINE (leflunomide, hydroxychloroquine/plaquenil, sulfasalazine)
• NSAIDs first line for pain control; CORTICO 2nd line if no relief w/ nsaids

Question 25

kawasaki syndrome

Answer 25

IV immune globulin + high dose ASA

-cortico if refractory

Question 26

psoriatic arthritis

Answer 26

NSAIDs 1st LINE –> methotrexate –> TNF-inhib

Question 27

ankylosing spondylitis

Answer 27

NSAIDS + REST/PT 1st LINE –> TNFa inhibitor –> steroids

Question 28

reactive arthritis

Answer 28

NSAIDs –> methotrexate –> sulfasalazine, steroids