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Musculoskeletal and Connective Tissue > UW 1 > Flashcards

UW 1 Flashcards

1
Q

osteoarthritis - RF

A
  • older than 50
  • obesity
  • prior joint injury
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2
Q

suspected 2ry Raynaud syndrome - next step

A

Autoantibodies + infl markers

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3
Q

Raynaud - treatment

A

1ry –> avoid aggravating factos, CCB if persistent

2ry: evaluate and treat underlying, CCB if persistent, aspirin if risk for ulceration

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4
Q

hemochromatosis - infections?

A

Listeria, Vibrio vulnificus, yersinia enterocolitica

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5
Q

hemochromatosis - musculosckeletal

A

arthralgia, arthropathym chondrocalcinosis

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6
Q

pseudogout - treatment

A
  • intra-articular glucocorticoids
  • NSAID
  • cochicine
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7
Q

pseudogout - diagnosis

A
  • inflammatory effusion; 15-30 wbc
  • CPPD crystals (Rhomboid shape, (+) birefringence
  • chondrocalcinosis on imaging
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8
Q

attacks of pseudogout often occurs in the setting of

A
  • overuse
  • trauma
  • surgery
  • medical illness
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9
Q

Ankylosing spondilitis - inflammatory back pain (characteristics)

A

insdious onset atyounger than 40

  • symptoms for more than 3 months
  • releved with exercise but not rest
  • nocturnal pain
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10
Q

Ankylosing spondilitis - complications

A
  • osteoporosis / vert fractures
  • cauda equine
  • hyperkyphosis
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11
Q

scleroderma - treatment if renal involvement

A

ACEi

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12
Q

low back pain - physical therapy?

A

if 6-12 wks pain or longer

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13
Q

low back pain - treatment

A

acute (less than 6 wks): moderate activity. NSAID or acetaminophen
chronic: consider TCA, duloxetine

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14
Q

Antiphospholipid antibody syndrome - labs

A

Lupus anticoagulant effect: prolonation of aPTT not reversed on plasma mixing studies

  • anticardiolipin antibody
  • antibeta2-gp1 antbody
  • FP VDRL/PRP
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15
Q

Whipple disease?

A

infection with gram (+) Trophyrema whippelii)
chronic malabsortive diarrhea, weight loss, migratory, non deforming arthritis, lymphadenopathy ad a low grade fever
PAS (+) Macrophage on small bowel biopsy

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16
Q

smoking - gout

A

slightly decreases risk

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17
Q

extra symptom of fibromyalgia

A

muscle tenderness in areas such as the mid trapezius, lateral epincondyle, costochondral junction in the chest etc

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18
Q

a very well known complication of giant cell angitiits

A

aortic aneurysms –> due to involvement of the branches of the aorta –> serial chest x-rays

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19
Q

cervical spondylolsis

A

10 % of people older than 50

  • history of chronic neck pain
  • limited neck rotation lateral bending due to osteoarthritis and 2ry muscle spasm
  • sensory deficit due to osteophyte induced radiculopathy
  • bony spurs + sclerotic facet joint
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20
Q

Schirmer test

A

sterile strip of filter paper is placed under lower eyelid –> evidence of dry eyes

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21
Q

2ry amyloidosis (amyloid A) can be 2ry to

A
  1. inflammatory arthritis (RA)
  2. chronic infections
  3. IBD
  4. Malignancy
  5. Vascultisis
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22
Q

2ry amyloidosis - diagnosis

A

abdominal fat pad aspiration biopsy

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23
Q

2ry amyloidosis - treatment

A

treat underlying

colchicine for prevention + treatment

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24
Q

gout - xray

A

punch out erosios with a rim of cortical bone

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25
Q

joint fluid characteristics - normal

A

clear, less than 200 wbc, less than 25% PMNs

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26
Q

joint fluid characteristics - noninflammatory (eg. Osteoarthtitis)

A

clear, 200-2000 WBCs, 25% PMNs

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27
Q

joint fluid characteristics - inflammatory (eg. crystals, RA)

A

translucent or opaque
2000-100.00 WBCs
often more than 50% PMNs

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28
Q

joint fluid characteristics - septic joint

A

opaque
50000-150000
more than 80% PMNs

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29
Q

Parvovirus B19 infection - signs and symptoms

A
  • most asymptomatic or flulike
  • morbiliform rash in adults
  • erythema infectiosume: fever, nauseas + slapped cheek rash
  • acute symmetric artrhalgias/arthritis: resembles RA)
    transient pure red aplasia
    (risis if underlying)
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30
Q

parvo B19 - diagnosis

A

acute: IgM or NAAT for B19
- previous: IgG
- Reactivation: NAAT

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31
Q

possible septic arthrirtis –> … (next step)

A

obtain synovial fluid

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32
Q

a preexisting factor that increase the risk for 2ry infection of the joint

A

preexisting joint disorder

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33
Q

septic arthritis vs gout flare (which also can have fever

A

septic arthritis –> in 3 days

gout –> 12-24 h

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34
Q

lateral epicondylitis - diagnosis

A
  1. tederness at epicondyle + proximal extensor muscle
  2. pain with resisted wrist extension
  3. pain with passive wrist flexion
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35
Q

rheumatoid nodules

A

firm, flesh colored and nontender –> typically occur over pressure points (elvbow and extensor surface of the proximal ulna

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36
Q

erythema nodosum in the absence of resp symptoms - next step

A

chest - x-ray

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37
Q

heel pain - what to think

A

enthesitis

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38
Q

reactive arthritis - treatment

A

NSAID

39
Q

gout - causes

A
  1. increased production: 1ry, Myeloproliferative, tumor lysis, HGPT def
  2. decreaed urate clearance: CKD, thizide/loop diuretics
40
Q

long term use of cyclophosphamide

A

hemorrhagic cystitis + Bladder cancer

41
Q

hydroxychloroquine - SE

A

optic neuritis

eye examination before initiation

42
Q

suspicion of SLE - best initial test

A

ANA (very sensitive: 95-100%)

43
Q

pyoderma gangrenosum

A

rapidly progressive and painful ulcer with a purulent base and vilaceous borders

  • more than 50% have associated systemic disease (IBD)
  • cliically diagnosis after excluding other etioogies (usually with skin biopsY)
  • treatment: local or systemic steroids
44
Q

ecthyma gangrenosum?

A

hemorhagic pustules with surrounding erythema that evolve into necrotic ulcers
- often due to Pseudomonas and occur MC in neutrpenia and Pseudomonas bacteremia

45
Q

causes of chronic low back pain

A
  1. mechanical
  2. radiculopathy
  3. spinal stenosis
  4. inflammatory
  5. metastatic
  6. infectious
46
Q

back pain and suspicion of cancer or infection - management

A

x-ray and ESR –> if abnormal MRI

- if not able to do MRI –> radionuclide bone

47
Q

amount of WBC in synovial fluid in septic arthritis

A

more than 50.000

48
Q

meniscal vs ACL injury regarding effusion

A

ACL: immediate, large, and bloody
Meniscal: later, mild, nonbloody

49
Q

carpal tunnel - RF

A
  1. obesity
  2. Pregnancy
  3. DM
  4. Hypothyroidism
  5. RA
50
Q

Carpal tunnel syndrome - clinical presentation

A

pain + paresthesia in median nerve distrubution

  1. (+) Phalen + Tinel tests
  2. severe disease: weakness of thumb abduction + opposition, atrophy of thenar eminenece
51
Q

Carpal tunnel syndrome - confirmatory test

A

nerve conduction studies

52
Q

carpal tunnel syndrome - treatment

A
  1. wrist splinting (1st choice)
  2. glucocorticoid injection (significant weakness or refractory to first choice
  3. surgery for severe refracory symptoms
    NSAID are note effective
53
Q

carpal tunnel syndrome - sensation in proximal palm?

A

intact because palmar branch does not pass through the canal

54
Q

gout - RF

A
  1. medications
  2. surgery, trauma, recent hospitalization
  3. volume depletion
  4. diet: high protein, high fat, fructose or sweetened beverages
  5. heavy alcohol consumption
  6. underlying medical conditions (HTN, Obesity, CKD, organ transplantation)
55
Q

factors that decrease risk for gout

A
  1. dairy product intake
  2. Vitamin C
  3. Coffee
56
Q

Prevention of future gout attacks

A

g

57
Q

causes of lumbar spinal stenosis

A
  1. degenerative arthritis (spondylosis)
  2. degenerative disk disease
  3. thickening of the ligamentum flavum
58
Q

osteoarthritis - joint involvement

A
  1. knees
  2. hips
  3. DIP
  4. 1st carpometacarpal joint
59
Q

osteoarthitis - examination findings

A
  1. hard body enlargement of joints
  2. reduced range or motion
  3. CREPITUS
60
Q

hip osteoarthritis - pain exacerbated by

A

internal rotation

deep pain

61
Q

meralgia paresthitica

A

caused by compression of the lateral femoral cutaneous nerve at the waist –> burning pain and paresthesias at the lateral thight –> unaffectd by motion

62
Q

impingement of the lumbar nerve roots - hip mobility?

A

normal

63
Q

How to confirm diagnosis of ankylosing spondylitis

A

x-ray of sacroiliax joints (or MRI)

- HLA-B27 is VERY sensitive but not specific (only 5% of HLA-B27 (+) have AS –> not necessary for diagnosis

64
Q

RA - treatment

A

all patients should be started on disease modifying antirheumatic agents as soon as possible as joint damage begins early –> NSAID are adjunctive therapies for symptomatic releif but do not reduce disease progression

  • Glucocorticid can alo releve symptoms and short term radiographic progression but not preventive eventual joint destruction
  • Methotrexate is the best initial choice
65
Q

RA - do not respond after 6 months

A

additional DMARD such as TNF as step up

66
Q

dermatomyositis - management

A

high dose glucocorticoids PLUS glucocorticoid sparing agent

- screening for malignnacy

67
Q

shawl sign

A

dermatomyositis

rash on the chest and lateral neck

68
Q

MCC of nontraumatic vertebral compression fracture

A

osteoporosis and osteomalacia

69
Q

causes of vertebral comprssion fracture

A
  1. trauma
  2. osteoporosis, osteomalacia
  3. infection
  4. bone metastasis
  5. metabolic
  6. Paget
70
Q

vertebral compression fracture - clinical presentation

A

chronic gradual: painless, progressive kyphosis, loss of stature
acute: low back pain + decreased spinal mobility, lying on back, tenderness

71
Q

avascular necroris - clinical

A

groin pain on weight bearng

pain on hip abduction + internal rotation- no erythema, swelling or point tenderrnes

72
Q

avascular necrosis - labs

A
  • no infl markers

- images: crescent sign in advanced stage, MRI is most sensitive

73
Q

DEXA - when for screening

A

all women 65 or older and for younger women who have an equivalent risk osteoporotic fracture

74
Q

DEXA - meaning

A

dual energy x-ray absorptiometry

75
Q

lumbar disc herniation - presentation

A

acute back pain with unilateral radiation down the sciatic nerve to the foot (sciatica) –> usually follows an inciting event and LuMbar flexion makes the pain worse

76
Q

lumbar stenosis - presentation

A

back pain in patietns older than 60 –> back pain radiating to the thighs that is worse with lumbar extension and persists while standing still

77
Q

age related sicca syndrome

A

exocrine output from lacrimal and salivary glands declines with age, associated with atrophy, fibrosis and ductal dilation of the glunds –> decreased blink rates, oxidative damage, excessive evaporation of teras and use of anticholinergic medication in older individuals can also contribute (think about it if shogren syndrome like but older than 65 and ANA (-))

78
Q

giant cell arteritis - biopsy vs steroids first

A

STEROIDS

79
Q

giant cell arteritis - localized symptoms

A
  1. headaches in temporal areas
  2. jaw claudication (MOST SPECIFIC SYMPTOM)
  3. polymyalgia rheumatica
  4. arm claudication: associated bruits in subclavian or axillary areas
  5. aortic wall thickening or aneurysm
  6. CNS: TIAs, strokes, vertigo, hearing loss
  7. visual: amaurosis fugax, anterior ischemic optic neuropathy
80
Q

most specific symptom of giant cell arteritis

A

jaw claudication

81
Q

MC visual manifestation of giant cell arteritis

A

anterior ischemic optic neuropathy

82
Q

giant cell arteritis

A
  1. polymyalgia only: low dose oral steroids
  2. giant cell arteritis: intermidiate to high dose oral glucocorticoids
  3. visual loss: pulse high dose IV glucocorticoid for 3 days follwed by intermediate to high dose oral glucocorticoids
83
Q

RA - infl markers

A

increased CRP and ESR during disease activity

84
Q

IBD arthritis - NSAID

A

relief arthritis but exacerbate the underlying disease

85
Q

characteristic of mechanical chronic low back pain

A

paraspinal tenderness

86
Q

chronic lower back pain that releif with activity

A

inflammatory (eg. spondyloarthropathy)

87
Q

metastatic - characteristic of chronic low back pain

A

worse at night

88
Q

extraglandular manifestation of Sjogren syndrome

A
  1. Raynaud
  2. cutaneous vasculitis
  3. arthralgia/arthritis
  4. interstitial lung disease
89
Q

back pain and suspicion of cancer or infection - management

A

x-ray and ESR –> if abnormal MRI

- if not able to do MRI –> radionuclide bone

90
Q

paget - labs

A
  1. high ALP
  2. elevated bone turnover markers (urine hydroxyproline)
  3. normal Ca2+ + P
  4. x-ray: osteolytic or myxed lytic sclerotic lesions
  5. bone scan: focal increase in uptake
91
Q

paget - treatment

A

biphosphonates

92
Q

suspicion of hearniated disc or lumbar spondyloysis - best initial step

A

NSAID (most patients experience spontaneous resolution)

–>MRI if progressive sensory motor deficits, signs of cauda syndrome, concern of abscess

93
Q

fluoroquinolone mediated tnedinopathy (or rupture)

A
  • most common in Achilles
  • within 24 h with a median of 8 days
  • stop the drug, avoid exercise, seek medical care
94
Q

RFs for fluoroquinolone mediated tendinopathy

A
  1. older than 60
  2. female
  3. normal BMI
  4. concurrent oral corticosteroid use
  5. history of organ transplant

Musculoskeletal and Connective Tissue (19 decks)

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