Uworld Ortho/Rheum

Question 1

This arthropathy causes destructive arthritis in patients with long-standing diabetes who have peripheral neuropathy

Answer 1

Neuropathic (Charcot) arthropathy

Question 2

patient with exertional arm pain (likely claudication), systemic symptoms, and pulse deficits has typical features of what?

Answer 2

Takayasu arteritis, a chronic large artery vasculitis that predominantly affects Asian women age < 40

Question 3

Clinical findings in Behcet disease

Answer 3

• Recurrent, painful oral aphthous ulcers
• Genital ulcers
• Eye lesions (e.g. uveitis)
• Skin lesions (e.g. erythema nodosum, acneiform lesions)
• Thrombosis

Question 4

Describe the evaluation of Behcet disease

Answer 4

• Pathergy- exaggerated skin ulceration with minor trauma (e.g. needlestick)
• Biopsy-Nonspecific vasculitis of different sized vessels

Question 5

Lifestyle changes that can prevent future gout attacks

Answer 5

• 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

Question 6

What medications can increase the risk of gouty attacks

Answer 6

• thiazide and loop diuretics
• aspirin
• beta blockers

Question 7

This is defined as advanced RA associated with splenomegaly and neutropenia

Answer 7

Felty syndrome

Question 8

De Quervain tenosynovitis is caused by inflammation of what tendons

Answer 8

• Abductor pollicis longus

- Extensor pollicis brevis

Question 9

Clinical features of Paget disease of bone

Answer 9

• 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

Question 10

Lab values in Paget Disease of bone

Answer 10

• Elevated Alk phos
• Elevated bone turnover markers (e.g. PINP, urine hydoxyproline)
• Calcium and phosphorus are usually normal

Question 11

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?

Answer 11

• Activity modification
• NSAIDs
• Stretching and strengthening exercises (quads)

Question 12

Besides primary idiopathic gout, what are the other causes?

Answer 12

• Increased urate production: Myeloproliferative/lymphoproliferative disorders, Tumor lysis syndrome, Hypoxanthine guanine phosphoriribosyl transferase deficiency
• Decreased urate clearance: Chronic kidney disease, Thiazide/loop diuretics

Question 13

Adverse effects of hydoxychloroquine

Answer 13

Retinopathy

Question 14

What is the female athlete triad of risk factors for a stress fracture?

Answer 14

• Low caloric intake
• Hypomenorrhea/amenorrhea
• Low bone density

Question 15

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

Answer 15

Morton Neuroma

Question 16

what labs and tests diagnose dermatomyositis?

Answer 16

• Elevated CPK, aldolase, LDH
• Anti-RNP, anti-Jo-1, Anti-Mi2
• Diagnostic uncertainty: EMG, Biopsy

Question 17

Describe the management of Dermatomyositis?

Answer 17

• High dose glucocorticoids PLUS glucocorticoid sparing agent
• Screening for malignancy

Question 18

Wound infections in burn patients are common, and patients with large surface area burns (>20%) are at highest risk. What is the earliest sign?

Answer 18

Change in appearance of the wound (partial thickness injury turns into a full thickness injury)

Question 19

Burn wound sepsis can develop rapidly and is associated with some or all of the following systemic findings?

Answer 19

• 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

Question 20

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?

Answer 20

Short term relief of symptoms with NSAIDs or acetaminophen

Question 21

Patients with RA are at increased risk of developing what?

Answer 21

• Osteopenia
• Osteoporosis
• Bone fractures

Question 22

Patients with fibromyalgia have a fairly normal physical exam except for trigger point tenderness in areas such as where?

Answer 22

• mid trap
• lateral epicondyle
• costochondral junction
• greater trochanter

Question 23

correlation of pain in fibromyalgia with exercise and what can improve pain and provide long term benefit?

Answer 23

• 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

Question 24

rapid onset of hemarthrosis is associated with what knee injury

Answer 24

ACL tear

Question 25

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

Answer 25

Age related sicca syndrome

Question 26

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?

Answer 26

Osgood-Schlatter disease

Question 27

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?

Answer 27

Antiphospholipid syndrome

Question 28

Antiphospholipid syndrome is characterized by a thrombotic event or pregnancy morbidity in the setting of a positive autoantibody to 1 of what 3 phospholipids?

Answer 28

- Anticardiolipin antibody - Anti-beta2-glycoprotein-1 antibody - Lupus anticoagulant

Question 29

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?

Answer 29

-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

Question 30

with the elbow held in extension, passive flexion of the wrist reproduces pain . . what is diagnosis?

Answer 30

Lateral epicondylitis

Question 31

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

Answer 31

Radial tunnel syndrome

Question 32

What anti rheumatoid drug causes macrocytic anemia and why?

Answer 32

Methotrexate: inhibits dihydrofolate reductase

Question 33

Clinical features of Felty syndrome?

Answer 33

- Rheumatoid arthritis: Severe erosive joint disease and deformity, Rheumatoid nodules, Vasculitis (mononeuritis multiplex, necrotizing skin lesions) - Neutropenia - Splenomegaly

Question 34

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?

Answer 34

- Chronic malabsorptive diarrhea - weight loss - Migratory non-deforming arthritis - lymphadenopathy - low grade fever

Question 35

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?

Answer 35

Nerve conduction studies

Question 36

Patients with pseudogout should be evaluated for secondary causes such as what?

Answer 36

- hyperparathyroidism - hypothyroidism - hemochromatosis

Question 37

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?

Answer 37

vertebral fracture, which often results from minimal trauma

Question 38

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?

Answer 38

-Systemic glucocorticoids

Question 39

Treatment of Paget Disease of Bone

Answer 39

Bisphosphonates

Question 40

What is a well known complication of Giant cell arteritis and how do you follow this?

Answer 40

- Aortic aneurysms | - Serial chest x-rays