Uworld Ortho/Rheum Flashcards
This arthropathy causes destructive arthritis in patients with long-standing diabetes who have peripheral neuropathy
Neuropathic (Charcot) arthropathy
patient with exertional arm pain (likely claudication), systemic symptoms, and pulse deficits has typical features of what?
Takayasu arteritis, a chronic large artery vasculitis that predominantly affects Asian women age < 40
Clinical findings in Behcet disease
- Recurrent, painful oral aphthous ulcers
- Genital ulcers
- Eye lesions (e.g. uveitis)
- Skin lesions (e.g. erythema nodosum, acneiform lesions)
- Thrombosis
Describe the evaluation of Behcet disease
- Pathergy- exaggerated skin ulceration with minor trauma (e.g. needlestick)
- Biopsy-Nonspecific vasculitis of different sized vessels
Lifestyle changes that can prevent future gout attacks
- Weight loss to achieve BMI <25
- Low fat diet
- Decreased seafood and red meat intake
- Protein intake preferably from vegetable and low fat dairy products
- Avoidance of organ-rich foods (e.g. liver and sweetbreads
- Avoidance of beer and distilled spirits
- Avoidance of diuretics when possible
What medications can increase the risk of gouty attacks
- thiazide and loop diuretics
- aspirin
- beta blockers
This is defined as advanced RA associated with splenomegaly and neutropenia
Felty syndrome
De Quervain tenosynovitis is caused by inflammation of what tendons
- Abductor pollicis longus
- Extensor pollicis brevis
Clinical features of Paget disease of bone
- most patients asymptomatic
- Bone pain and deformity
- skull: headache, hearing loss
- Spine: spinal stenosis, radiculopathy
- Long bones: Bowing, fx, arthritis of adjacent joints
- Giant cell tumor, osteosarcoma
Lab values in Paget Disease of bone
- Elevated Alk phos
- Elevated bone turnover markers (e.g. PINP, urine hydoxyproline)
- Calcium and phosphorus are usually normal
Patellofemoral pain syndrome is a common cause of anterior knee pain in young women. It is usually due to chronic overuse or malalignment. The patellofemoral compression test can reproduce the pain. Initial management includes what?
- Activity modification
- NSAIDs
- Stretching and strengthening exercises (quads)
Besides primary idiopathic gout, what are the other causes?
- Increased urate production: Myeloproliferative/lymphoproliferative disorders, Tumor lysis syndrome, Hypoxanthine guanine phosphoriribosyl transferase deficiency
- Decreased urate clearance: Chronic kidney disease, Thiazide/loop diuretics
Adverse effects of hydoxychloroquine
Retinopathy
What is the female athlete triad of risk factors for a stress fracture?
- Low caloric intake
- Hypomenorrhea/amenorrhea
- Low bone density
This is associated with pain between the third and fourth toes on the plantar surface and with a clicking sensation (Mulder sign) that occurs when simultaneously palpating this space and squeezing the metatarsal joints
Morton Neuroma
what labs and tests diagnose dermatomyositis?
- Elevated CPK, aldolase, LDH
- Anti-RNP, anti-Jo-1, Anti-Mi2
- Diagnostic uncertainty: EMG, Biopsy
Describe the management of Dermatomyositis?
- High dose glucocorticoids PLUS glucocorticoid sparing agent
- Screening for malignancy
Wound infections in burn patients are common, and patients with large surface area burns (>20%) are at highest risk. What is the earliest sign?
Change in appearance of the wound (partial thickness injury turns into a full thickness injury)
Burn wound sepsis can develop rapidly and is associated with some or all of the following systemic findings?
- Temp <36.5 (97.7) or >39 (102.2)
- tachy (>90)
- tachypnea (>30)
- Refractory hypotension (systolic blood pressure < 90)
- Oliguria, unexplained hyperglycemia, thrombocytopenia, and mental status changes are also common
Lumbosacral radiculopathy (sciatica) is due to nerve root compression, usually by a herniated disc or lumbar spondylosis. Most patients will experience spontaneous resolution. Initial management is primarily focused on what?
Short term relief of symptoms with NSAIDs or acetaminophen
Patients with RA are at increased risk of developing what?
- Osteopenia
- Osteoporosis
- Bone fractures
Patients with fibromyalgia have a fairly normal physical exam except for trigger point tenderness in areas such as where?
- mid trap
- lateral epicondyle
- costochondral junction
- greater trochanter
correlation of pain in fibromyalgia with exercise and what can improve pain and provide long term benefit?
- patients perceive that their pain and fatigue worsen acutely after exercise
- A regular, incremental, low impact exercise regimen can improve pain and provide long term benefit
rapid onset of hemarthrosis is associated with what knee injury
ACL tear
This is due to a decrease in exocrine output from the lacrimal and salivary glands. Decreased blink rates, oxidative damage, and use of anticholinergic meds can also contribute
Age related sicca syndrome
Like patellofemoral pain syndrome, this disease can cause anterior knee pain that is worse with squatting. However, it would NOT be seen in adult patients?
Osgood-Schlatter disease
A young African American woman with constitutional symptoms (fatigue), thrombocytopenia, probable mitral regurg (holosystolic murmur to the apex), and a + ANA, suggestive of SLE, now likely has a CVA (sudden onset unilateral weakness, negative CSF findings) . . . likely has what?
Antiphospholipid syndrome
Antiphospholipid syndrome is characterized by a thrombotic event or pregnancy morbidity in the setting of a positive autoantibody to 1 of what 3 phospholipids?
- Anticardiolipin antibody
- Anti-beta2-glycoprotein-1 antibody
- Lupus anticoagulant
Erythema nodosum is a condition of painful, red or violaceous, subcutaneous nodules. It can be a sign of a more serious disease process . . what test should be done?
-Even in the absence of respiratory symptoms, chest x-ray should be performed in patients with Erythema nodosum to assess for findings consistent with sarcoidosis
with the elbow held in extension, passive flexion of the wrist reproduces pain . . what is diagnosis?
Lateral epicondylitis
This causes posterolateral elbow pain similar to that in lateral epicondylitis and may occur in conjunction with that condition. Findings include weakness of extension at the wrist and third digit, reproduction of pain on resisted supination of the forearm, and pain at the radial tunnel on resisted hyperextension of the wrist
Radial tunnel syndrome
What anti rheumatoid drug causes macrocytic anemia and why?
Methotrexate: inhibits dihydrofolate reductase
Clinical features of Felty syndrome?
- Rheumatoid arthritis: Severe erosive joint disease and deformity, Rheumatoid nodules, Vasculitis (mononeuritis multiplex, necrotizing skin lesions)
- Neutropenia
- Splenomegaly
Whipple disease is a multisystem disorder with a varied presentation caused by infection with the gram-positive bacillus Tropheryma whippelii. What are the most common presenting symptoms?
- Chronic malabsorptive diarrhea
- weight loss
- Migratory non-deforming arthritis
- lymphadenopathy
- low grade fever
Compression of the median nerve at the wrist causes carpal tunnel syndrome, characterized by pain and paresthesias in the first 3 digits and the radial half of the 4th. The diagnosis is usually made on clinical grounds, what what can confirm the diagnosis?
Nerve conduction studies
Patients with pseudogout should be evaluated for secondary causes such as what?
- hyperparathyroidism
- hypothyroidism
- hemochromatosis
Patients with long-standing ankylosing spondylitis can develop bone loss due to increased osteoclast activity in the setting of chronic inflammation. In addition, spinal rigidity in these patients can increase the risk of what?
vertebral fracture, which often results from minimal trauma
Patients with sarcoidosis who are asymptomatic are often followed without treatment due to a high rate of spontaneous remission. However, patients with symptomatic disease (e.g. cough, dyspnea, fatigue, hypercalcemia) are treated with what?
-Systemic glucocorticoids
Treatment of Paget Disease of Bone
Bisphosphonates
What is a well known complication of Giant cell arteritis and how do you follow this?
- Aortic aneurysms
- Serial chest x-rays
