UW3 (03 Rheum & Ortho) Flashcards
Shoulder pain differential
Lateral? 3
Anterior? 3
Posterior? 3
Rotator Cuff
Impingement
Frozen
AC
GH
Biceps
Cervical nerve impingement
Disc herniation
Spinal stenosis
Knee injury
Common @ athlete
Effusion / Swelling
Cruciate
Knee injury
Rare effusion
Unstable at movement
Collateral
Knee injury
Small effusion Extension Locking Instability Joint line tenderness
Meniscus
Adolescent / Obese Dull hip pain Referred knee pain Altered gait Internal rotation ↓
Diagnosis?
Complication? 2
Treatment? 2
Slipped Capital Femoral Epiphysis
AVN
OsteoArthritis
No weight bear
Surgery
Fever / Malaise / Weight Loss
Pain & Stiffness
Bilateral
Torso / Neck / Shoulder / Hip / Thigh
Diagnosis?
Treatment?
PolyMyalgia Rheumatica
Steroid
Reactive arthritis
Common cause?
MSK symptoms?
Eye symptoms?
GenitoUrinary symptoms?
Skin symptoms?
Test?
Treatment? 4
Common cause: Chlamydia
S/S: onset 1-4w after infection Arthritis: Asymmetric & Multiple Uveitis / Conjunctivitis Urethritis / Cervicitis / Prostatitis Ulcer: Oral / Genital
Test: Chlamydia NAAT Treatment Anti-biotics NSAID Steroids DMARDS
Fall @ outstretched arm
Elbow pain & swelling
Diagnosis?
Test & finding?
Treatment? 2
Complications? 2
SupraCondylar Fracture
X-ray
Posterior fat pad displacement
Fracture line
Humerus displacement
No displacement –> Splint / Sling
Displacement –> Reduction + Pins
NeuroVascular injury
Compartment syndrome
Hip dysplasia
Cause / mechanism?
Other finding?
Gait type? 2
Abnormal acetabular development
Leg length discrepancy
Toe walking
Trendelenburg gait
Scleroderma
Pathology?
What causes htn?
Treatment? 3
Abnormal cellulose deposit
Renal crisis
Captopril PO (ACE-I)
+ NitroPrusside IV
+ CCB IV
Children
Hip: flexed, abducted, ext rotated
Non weight bearing
T > 101
Diagnosis?
Lab? 3
Management? 4
Septic arthritis
ESR > 40, CRP > 2, WBC ↑
Joint aspiration = WBC > 50k
US / MRI = Effusion
Vancomycin
Drainage / Debridement
Osteonecrosis
Risks? 2
Alcohol
Steroid
Sjogren
Complication?
Lab / test? 3
B cell lymphoma
Anti-Ro / SSA
Anti-La / SSB
Schimer (tera) test
what happens to pain @ extension? flexion?
for:
- spinal stenosis
- disc herniation
- Spinal stenosis
Worse @ extension
Improve @ flexion - Disc herniation
Worse @ flexion
Improve @ extension
Adolescent scoliosis
When to reassure with scoliomter?
When to do x-ray with scoliometer?
At what cobb’s angle:
Reassurance?
Brace / PT?
Surgical eval?
Scoliometer
< 7° –> Reassurance
> 7° –> X-ray
Cobb’s Angle
< 10° –> Reassurance
> 10° –> Brace / PT
> 40° –> Surgical eval
DermatoMyositis
Skin manifest? 2
Pulmonary? 1
GI? 1
Cardiac? 1
Disease association?
Labs? (3 elevation, 3 positive)
Diagnostic tests? 3
Grotton’s Papule / Heliotrope rash
Interstitial lung disease
Dysphagia
Myocarditis
Association = cancer
CPK ↑ / Aldolase ↑ / ADH ↑
Anti-RNP ⊕ / Anti Jo-1 ⊕ / Mi-2 ⊕
EMG
Biopsy (skin / muscle)
ANA ⊕ –> CXR / CT chest
Carpal tunnel
When / how long to use wrist splint?
Steroid injection complication?
Diagnostic?
Surgery indication? 3
mild symptom < 10m
Tendon rupture
EMG/NCS
Mod/Severe > 6m
No response
Neurologic deficit
Shoulder pain
Pain @ abd & ext rot
SubAcromial tenderness
ROM = normal
What PE to test? - 2 differential if positive?
Neer / hawkin
impingement
Tendinopathy
Shoulder Pain @ abd & ext rot
SubAcromial tenderness
ROM = normal
Weakness @ abd & ext rot
Diagnosis?
Rotator cuff tear
Shoulder
ROM ↓
Symptom Worse at night
Stiffness ± Pain
Diagnosis?
Adhesive Capsulitis
Pain @
Ant shoulder
Lifting / Carrying
Overhead reach
Diagnosis?
Biceps tendon rupture
Gradual shoulder pain (ant / deep)
Diagnosis?
GH joint OA
Repetitive motion / Heavy lifting
Pain @ abduction
Active ROM ↓ + Passive ROM = N
SubAcromial bursitis
Adhesive Capsulitis (treatment)
Conservative? 2
When & what to consider further treatment?
Self limit 6-18m
Shoulder rest
ROM exercise
If no improvement 2-3m
PT
Steroid injection
PostMenopausal OsteoPorosis
Lab test? 3
Lifestyle changes? 4
BMP
CBC
25-OH VitD
Smoke / Alcohol
Weight bearing exercise
Calcium > 1.2g/d
Vit-D > 800u/d
PostMenopausal OsteoPorosis
If osteopenia?
If low risk?
When to start bisophonate?
10y fracture risk
DEXA until 82yo
High risk
Hip fracture risk > 3%
Combined fracture risk > 20%
Osteoporosis
Stiffness @ shoulder / Hip
Fatigue / Weight ↓
Diagnosis?
Disease association?
Lab?
Treatment?
PolyMyalgia Rheumatica
Temporal Arteritis
ESR ↑ / CRP ↑
GlucoCorticoids
Tibial stress fracture
X-ray can be negative for how long?
X-ray findings? 4
Treatment? 3
X-ray ⊝ for 3-4w
Sclerosis
Cortical thickening
Periosteal elevation
Fracture lines
Splint Weight bear ↓ / Crutches 1-2w Gradual exercise (8-12w)
Thick palm fascia @ D3, D4, D5
Nodules @ flexor tendon
(↓ extension @ digits)
Diagnosis?
Risk factor? 5
Treatment? 4
Dupuytren Contracture
Male > 50 FH DM Tobacco Alcohol
Hand tool modification
Needle ApoNeurotomy
Steroid injection
Surgery
Compartment syndrome
Symptoms? 6
Complications? 4
Pain out of proportion Persistent deep pain Paresthesia Tightness / Weakness Pain @ passive stretch DTR ↓ / Pulse ↓
Muscle contracture
Sensory deficit
Infection
Ulceration / Necrosis
New headache, fever, vision change
Temporal – tender & pulse ↓
Diagnosis?
Disease association?
Lab?
Diagnostic?
Giant Cell Temporal Arteritis
PolyMyalgia Rheumatica
ESR > 50
Biopsy
Necrotizing artery
MonoNuclear cells
Paget's Bone disease Symptoms? 4 Bone consistency? Labs? Diagnostic? Treatment? 2
Hearing loss
Dizziness
Fracture
Osteocarsoma
Thick & Heterogenous
Mixed (lytic + sclerotic)
Ca = N / ALP ↑ / PO4 = N
Radio-Nuclei bone scan
Bisphosphonate
Calcitonin
Gout
Crystal? 3
1st line treatment (avoid at? 5)
2nd line treatment? (avoid at 2)
When to use steroid IA vs PO
MonoSodium Urate
Negative Birefringement
Needle Shape
NASAID (AKI, CKD, PUD, CHF, AntiCoag)
Colchicine (CKD, liver dysfunction)
IA steroid @ <2 joints
PO steroid @ > 2 joints
Hemochromatosis
Endocrine issues? 3
Cardiac issue? 2
Common infection organism? 3
Labs? 3
Joint aspiration crystal?
Initial treatment? Does it improve arthropathy?
DM
HypoThyroid
HypoGonadism
CardioMyopathy
Conduction Abnormality
Listeria
Vibrio
Yersenia
Fe ↑ / Ferritin ↑ / Transferin ↑
Calcium PyroPhosphate Dihydrate
Positive Birefringement
Rhomboid
Phlebotomy – Not improve arthropathy
Flu like symptoms
Rash – Red / Reticular
Arthralgia (after flu symptoms)
Organism?
Complication?
Diagnostic?
Treatment?
ParvoVirus B19
Transient Aplastic anemia
B19 IgM
NSAID / Support
Raynaud
Initial treatment?
Systemic or resistant - next step?
Amlodipine > Nifedipine > CCB
ANA / RF / Complement
Joint pain / burning / swelling ROM ↓ Skin changes / discoloration Pain out of proportion Temp changes
Diagnosis?
Tests? 2
Treatment? 2
Complex Regional Pain Syndrome
Sympathetic / Sweat
MRI
Sympathetic nerve block
Regional anesthesia
Weakness @ quadriceps
Knee extension ↓
Sensory ↓ @ Anterior & Medial
Corresponding nerve?
Femoral
Weakness @ LE + Hamstring
Sensory ↓ @ LE
Corresponding nerve?
Sciatic
Adduction –> Pain + Weakness
Sensory ↓ @ distal thigh
Corresponding nerve?
Obturator
Patellar pain (differential)
Patella compression test ⊕?
Pain @ inferior patella
PatelloFemoral
Patellar Tendonitis
LBP + Stiffness < 3m
Lumbar ROM ↓
Chest Expansion ↓
Diagnosis?
Test?
Management? 2
Life expectancy?
Ankylosing Spondylitis
X-ray (repeat)
NSAID / Aerobic exercise
Normal life expectancy
Normal leg development
6m Genu Varum
2y Straight
4y Genu Valgum
7y+ Straight
Plantar flexed foot fixed
Adducted & Int rot
Diagnosis?
Management?
Talipes Equinovarus / Club feet
Serial casting
Morbid Obesity
Increases what other medical condition risk? to improve?
Surgery consideration? 2
OA risk ↑ (Weight ↓)
BMI > 40
BMI > 35 + comorbidities
SLE
Bone loss prevention? 2
Calcium + Vit-D
Swing by arm
Arm @ extension + pronation
Diagnosis?
Cause/Mechanism?
Treatment?
Radial Head Subluxation
Annular ligament displacement
Forearm adjustment:
Pronation or Supination + Flexion
DMARD side effects
MethoTrexate (3)
Leflunomide (2)
HydroxyChloroquine (1)
Sulfasalazine (3)
Infleximab Golimumab Etanercept Certolizumab Adalimumab (4)
Hepatotoxic
Cytopenia
Stomatitis
Hepatotoxic
Cytopenia
Retinopathy
Hepatotoxic
Stomatitis
Hemolytic Anemia
Infection
Demyelination
CHF
Malignancy
Lab test association:
dsDNA Ab Centromere Ab Mitochondria Ab Smith Ab Ro / SSA
SLE CREST / Scleroderma PBC SLE Sjogren
Pain = chronic + wide
Fatigue
Trigger point tenderness
Diagnosis?
Labs?
FibroMyalgia
Labs = normal
PolyMyositis vs PolyMyalgia
Symptoms?
Labs? 5 vs 2
PolyMyositis Pain = mild / none Weak = Prox Musc CK ↑ Aldolase ↑ AST ↑ ANA ⊕ Jo-1 ⊕
PolyMyalgia
Stiffness»_space; Pain
Shoulder / Hip / Neck
ESR ↑ / CRP ↑
Rheumatoid Arthritis
Cervical spine complications? 2
2 lab test? 2 correlated with activity?
X-ray findings? 3
Initial Treatment? 2
Subluxation
Cord complication
RF + CCP Ab
Activity = ESR / CRP
Soft tissue swelling
Bony erosions
Joint space narrowing
NSAID
Methotrexate + Folic Acid
Chikygunya
Arthralgia character
Multiple joints
Bilateral
Symmetric
Distal
Back pain Red flags (needs imaging) 7
Fever Chills Weight changes Age > 50 IVDU Nocturnal pain History of malignancy
Kawasaki
Complications? 2
Tests? 2
Treatment?
Coronary artery aneurysm
Myocardial ischemia/infarction
ESR / CRP – q24h
Echo: 2-6w after treatment
IVIG + Aspirin
Defer immunization
Cough / Dyspnea / Chest pain
Bilateral hilar Adenopathy
Reticular infiltration
Diagnosis?
Associated presentation? 2
Lab test? 3
Diagnostic & findings? 2
Uveitis
Parotid gland edema
Ca ↑ @ serum + urine
ACE ↑
Hepatic = ALP ↑ + GGT ↑
Biopsy
NonCaseating Granuloma
Negative (fungi / AFB)
