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UW3 (2020) > UW3 (03 Rheum & Ortho) > Flashcards

UW3 (03 Rheum & Ortho) Flashcards

1
Q

Shoulder pain differential
Lateral? 3
Anterior? 3
Posterior? 3

A

Rotator Cuff
Impingement
Frozen

AC
GH
Biceps

Cervical nerve impingement
Disc herniation
Spinal stenosis

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2
Q

Knee injury

Common @ athlete
Effusion / Swelling

A

Cruciate

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3
Q

Knee injury

Rare effusion
Unstable at movement

A

Collateral

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4
Q

Knee injury

Small effusion
Extension
Locking
Instability
Joint line tenderness
A

Meniscus

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5
Q 
Adolescent / Obese
Dull hip pain
Referred knee pain
Altered gait
Internal rotation ↓

Diagnosis?
Complication? 2
Treatment? 2

A

Slipped Capital Femoral Epiphysis

AVN
OsteoArthritis

No weight bear
Surgery

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6
Q

Fever / Malaise / Weight Loss
Pain & Stiffness
Bilateral
Torso / Neck / Shoulder / Hip / Thigh

Diagnosis?
Treatment?

A

PolyMyalgia Rheumatica

Steroid

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7
Q

Reactive arthritis

Common cause?

MSK symptoms?
Eye symptoms?
GenitoUrinary symptoms?
Skin symptoms?

Test?
Treatment? 4

A

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
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8
Q

Fall @ outstretched arm
Elbow pain & swelling

Diagnosis?
Test & finding?
Treatment? 2
Complications? 2

A

SupraCondylar Fracture

X-ray
Posterior fat pad displacement
Fracture line
Humerus displacement

No displacement –> Splint / Sling
Displacement –> Reduction + Pins

NeuroVascular injury
Compartment syndrome

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9
Q

Hip dysplasia

Cause / mechanism?
Other finding?
Gait type? 2

A

Abnormal acetabular development

Leg length discrepancy

Toe walking
Trendelenburg gait

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10
Q

Scleroderma

Pathology?
What causes htn?
Treatment? 3

A

Abnormal cellulose deposit

Renal crisis

Captopril PO (ACE-I)
+ NitroPrusside IV
+ CCB IV

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11
Q

Children
Hip: flexed, abducted, ext rotated
Non weight bearing
T > 101

Diagnosis?
Lab? 3
Management? 4

A

Septic arthritis

ESR > 40, CRP > 2, WBC ↑

Joint aspiration = WBC > 50k
US / MRI = Effusion
Vancomycin
Drainage / Debridement

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12
Q

Osteonecrosis

Risks? 2

A

Alcohol

Steroid

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13
Q

Sjogren

Complication?
Lab / test? 3

A

B cell lymphoma

Anti-Ro / SSA
Anti-La / SSB
Schimer (tera) test

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14
Q

what happens to pain @ extension? flexion?

for:

  1. spinal stenosis
  2. disc herniation
A
  1. Spinal stenosis
    Worse @ extension
    Improve @ flexion
  2. Disc herniation
    Worse @ flexion
    Improve @ extension
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15
Q

Adolescent scoliosis

When to reassure with scoliomter?
When to do x-ray with scoliometer?

At what cobb’s angle:
Reassurance?
Brace / PT?
Surgical eval?

A

Scoliometer
< 7° –> Reassurance
> 7° –> X-ray

Cobb’s Angle
< 10° –> Reassurance
> 10° –> Brace / PT
> 40° –> Surgical eval

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16
Q

DermatoMyositis

Skin manifest? 2
Pulmonary? 1
GI? 1
Cardiac? 1

Disease association?
Labs? (3 elevation, 3 positive)
Diagnostic tests? 3

A

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

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17
Q

Carpal tunnel

When / how long to use wrist splint?
Steroid injection complication?
Diagnostic?
Surgery indication? 3

A

mild symptom < 10m

Tendon rupture

EMG/NCS

Mod/Severe > 6m
No response
Neurologic deficit

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18
Q

Shoulder pain
Pain @ abd & ext rot
SubAcromial tenderness
ROM = normal

What PE to test? - 2 differential if positive?

A

Neer / hawkin

impingement
Tendinopathy

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19
Q

Shoulder Pain @ abd & ext rot
SubAcromial tenderness
ROM = normal
Weakness @ abd & ext rot

Diagnosis?

A

Rotator cuff tear

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20
Q

Shoulder
ROM ↓
Symptom Worse at night
Stiffness ± Pain

Diagnosis?

A

Adhesive Capsulitis

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21
Q

Pain @
Ant shoulder
Lifting / Carrying
Overhead reach

Diagnosis?

A

Biceps tendon rupture

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22
Q

Gradual shoulder pain (ant / deep)

Diagnosis?

A

GH joint OA

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23
Q

Repetitive motion / Heavy lifting
Pain @ abduction
Active ROM ↓ + Passive ROM = N

A

SubAcromial bursitis

24
Q

Adhesive Capsulitis (treatment)

Conservative? 2

When & what to consider further treatment?

A

Self limit 6-18m
Shoulder rest
ROM exercise

If no improvement 2-3m
PT
Steroid injection

25
Q

PostMenopausal OsteoPorosis

Lab test? 3
Lifestyle changes? 4

A

BMP
CBC
25-OH VitD

Smoke / Alcohol
Weight bearing exercise
Calcium > 1.2g/d
Vit-D > 800u/d

26
Q

PostMenopausal OsteoPorosis

If osteopenia?
If low risk?
When to start bisophonate?

A

10y fracture risk

DEXA until 82yo

High risk
Hip fracture risk > 3%
Combined fracture risk > 20%
Osteoporosis

27
Q

Stiffness @ shoulder / Hip
Fatigue / Weight ↓

Diagnosis?
Disease association?
Lab?
Treatment?

A

PolyMyalgia Rheumatica

Temporal Arteritis

ESR ↑ / CRP ↑

GlucoCorticoids

28
Q

Tibial stress fracture

X-ray can be negative for how long?
X-ray findings? 4
Treatment? 3

A

X-ray ⊝ for 3-4w

Sclerosis
Cortical thickening
Periosteal elevation
Fracture lines

Splint
Weight bear ↓ / Crutches 1-2w
Gradual exercise (8-12w)
29
Q

Thick palm fascia @ D3, D4, D5
Nodules @ flexor tendon
(↓ extension @ digits)

Diagnosis?
Risk factor? 5
Treatment? 4

A

Dupuytren Contracture

Male > 50
FH
DM
Tobacco
Alcohol

Hand tool modification
Needle ApoNeurotomy
Steroid injection
Surgery

30
Q

Compartment syndrome
Symptoms? 6
Complications? 4

A 
Pain out of proportion
Persistent deep pain
Paresthesia
Tightness / Weakness
Pain @ passive stretch
DTR ↓ / Pulse ↓

Muscle contracture
Sensory deficit
Infection
Ulceration / Necrosis

31
Q

New headache, fever, vision change
Temporal – tender & pulse ↓

Diagnosis?
Disease association?
Lab?
Diagnostic?

A

Giant Cell Temporal Arteritis

PolyMyalgia Rheumatica

ESR > 50

Biopsy
Necrotizing artery
MonoNuclear cells

32
Q 
Paget's Bone disease
Symptoms? 4
Bone consistency?
Labs?
Diagnostic?
Treatment? 2
A

Hearing loss
Dizziness
Fracture
Osteocarsoma

Thick & Heterogenous
Mixed (lytic + sclerotic)

Ca = N / ALP ↑ / PO4 = N

Radio-Nuclei bone scan

Bisphosphonate
Calcitonin

33
Q

Gout

Crystal? 3
1st line treatment (avoid at? 5)
2nd line treatment? (avoid at 2)
When to use steroid IA vs PO

A

MonoSodium Urate
Negative Birefringement
Needle Shape

NASAID (AKI, CKD, PUD, CHF, AntiCoag)

Colchicine (CKD, liver dysfunction)

IA steroid @ <2 joints
PO steroid @ > 2 joints

34
Q

Hemochromatosis

Endocrine issues? 3
Cardiac issue? 2
Common infection organism? 3

Labs? 3
Joint aspiration crystal?

Initial treatment? Does it improve arthropathy?

A

DM
HypoThyroid
HypoGonadism

CardioMyopathy
Conduction Abnormality

Listeria
Vibrio
Yersenia

Fe ↑ / Ferritin ↑ / Transferin ↑

Calcium PyroPhosphate Dihydrate
Positive Birefringement
Rhomboid

Phlebotomy – Not improve arthropathy

35
Q

Flu like symptoms
Rash – Red / Reticular
Arthralgia (after flu symptoms)

Organism?
Complication?
Diagnostic?
Treatment?

A

ParvoVirus B19

Transient Aplastic anemia

B19 IgM

NSAID / Support

36
Q

Raynaud

Initial treatment?
Systemic or resistant - next step?

A

Amlodipine > Nifedipine > CCB

ANA / RF / Complement

37
Q 
Joint pain / burning / swelling
ROM ↓
Skin changes / discoloration
Pain out of proportion
Temp changes

Diagnosis?
Tests? 2
Treatment? 2

A

Complex Regional Pain Syndrome

Sympathetic / Sweat
MRI

Sympathetic nerve block
Regional anesthesia

38
Q

Weakness @ quadriceps
Knee extension ↓
Sensory ↓ @ Anterior & Medial

Corresponding nerve?

A

Femoral

39
Q

Weakness @ LE + Hamstring
Sensory ↓ @ LE

Corresponding nerve?

A

Sciatic

40
Q

Adduction –> Pain + Weakness
Sensory ↓ @ distal thigh

Corresponding nerve?

A

Obturator

41
Q

Patellar pain (differential)

Patella compression test ⊕?
Pain @ inferior patella

A

PatelloFemoral

Patellar Tendonitis

42
Q

LBP + Stiffness < 3m
Lumbar ROM ↓
Chest Expansion ↓

Diagnosis?
Test?
Management? 2
Life expectancy?

A

Ankylosing Spondylitis

X-ray (repeat)

NSAID / Aerobic exercise

Normal life expectancy

43
Q

Normal leg development

A

6m Genu Varum
2y Straight
4y Genu Valgum
7y+ Straight

44
Q

Plantar flexed foot fixed
Adducted & Int rot

Diagnosis?
Management?

A

Talipes Equinovarus / Club feet

Serial casting

45
Q

Morbid Obesity

Increases what other medical condition risk? to improve?

Surgery consideration? 2

A

OA risk ↑ (Weight ↓)

BMI > 40
BMI > 35 + comorbidities

46
Q

SLE

Bone loss prevention? 2

A

Calcium + Vit-D

47
Q

Swing by arm
Arm @ extension + pronation

Diagnosis?
Cause/Mechanism?
Treatment?

A

Radial Head Subluxation

Annular ligament displacement

Forearm adjustment:
Pronation or Supination + Flexion

48
Q

DMARD side effects

MethoTrexate (3)

Leflunomide (2)

HydroxyChloroquine (1)

Sulfasalazine (3)

Infleximab
Golimumab
Etanercept
Certolizumab
Adalimumab
(4)
A

Hepatotoxic
Cytopenia
Stomatitis

Hepatotoxic
Cytopenia

Retinopathy

Hepatotoxic
Stomatitis
Hemolytic Anemia

Infection
Demyelination
CHF
Malignancy

49
Q

Lab test association:

dsDNA Ab
Centromere Ab
Mitochondria Ab
Smith Ab
Ro / SSA
A 
SLE
CREST / Scleroderma
PBC
SLE
Sjogren
50
Q

Pain = chronic + wide
Fatigue
Trigger point tenderness

Diagnosis?
Labs?

A

FibroMyalgia

Labs = normal

51
Q

PolyMyositis vs PolyMyalgia

Symptoms?

Labs? 5 vs 2

A 
PolyMyositis
Pain = mild / none
Weak = Prox Musc
CK ↑
Aldolase ↑
AST ↑
ANA ⊕
Jo-1 ⊕

PolyMyalgia
Stiffness&raquo_space; Pain
Shoulder / Hip / Neck
ESR ↑ / CRP ↑

52
Q

Rheumatoid Arthritis

Cervical spine complications? 2

2 lab test? 2 correlated with activity?
X-ray findings? 3
Initial Treatment? 2

A

Subluxation
Cord complication

RF + CCP Ab
Activity = ESR / CRP

Soft tissue swelling
Bony erosions
Joint space narrowing

NSAID
Methotrexate + Folic Acid

53
Q

Chikygunya

Arthralgia character

A

Multiple joints
Bilateral
Symmetric
Distal

54
Q 
Back pain
Red flags (needs imaging) 7
A 
Fever
Chills
Weight changes
Age > 50
IVDU
Nocturnal pain
History of malignancy
55
Q

Kawasaki

Complications? 2
Tests? 2
Treatment?

A

Coronary artery aneurysm
Myocardial ischemia/infarction

ESR / CRP – q24h
Echo: 2-6w after treatment

IVIG + Aspirin
Defer immunization

56
Q

Cough / Dyspnea / Chest pain
Bilateral hilar Adenopathy
Reticular infiltration

Diagnosis?
Associated presentation? 2
Lab test? 3
Diagnostic & findings? 2

A

Uveitis
Parotid gland edema

Ca ↑ @ serum + urine
ACE ↑
Hepatic = ALP ↑ + GGT ↑

Biopsy
NonCaseating Granuloma
Negative (fungi / AFB)

UW3 (2020) (19 decks)

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