UWorld - Step 2 CK "Rheum/Ortho & Sports" Flashcards
What causes bursitis?
Excessive frictional forces on the bursa from overuse, trauma, joint crystals, or infection.
Patients with trochanteric bursitis classically complain of ________________.
pain when sleeping on the affected side or with resisted abduction/external rotation
How can you differentiate peripheral vascular disease from bursitis?
Peripheral vascular disease is induced by exercise and activity. Bursitis can be worse at rest if weight is applied to the area.
What lifestyle modifications can prevent future gout attacks?
- Weight loss
- Low-fat diet
- Decreased meat intake (particularly from organs)
- Decreased alcohol intake
- Avoidance of foods high in refined sugar and fructose
- Avoidance of diuretics (and other gout-causing drugs like niacin)
What is severe pain in the first MTP called?
Podagra
Describe mixed cryoglobulinemia syndrome (MCS).
MCS is a small- and medium-vessel vasculitis that is associated with HCV and SLE. It presents with the following symptoms:
•Palpable purpura
•Arthralgias
•Renal disease (proteinuria or glomerulonephritis)
•Peripheral neuropathy
Patients with slipped capital femoral epiphysis (SCFE) typically hold the affected leg in what position?
Mild external rotation
How is SCFE treated?
Immediate screw fixation
What are some risk factors for SCFE?
- Age 10 - 16
- Male sex
- Obesity
- Endocrinopathies
Idiopathic avascular necrosis of the hip is referred to as ______________.
Legg-Calvé-Perthes disease; this usually occurs between age 5 and 7
In those taking methotrexate, the American College of Rheumatology recommends CBCs every ___________.
3 months
If an x-ray of a patient with suspected avascular necrosis is normal, then consider doing _____________.
an MRI
AVN only presents on x-ray in later stages. MRIs can detect early avascular necrosis.
What are some modifiable risk factors for osteoporosis?
- Smoking
- Excess alcohol intake
- Being sedentary
One of the highest risk factors for fragility fracture is ____________.
history of fragility fractures
Patients with a clavicle fracture need to have ______________.
a careful neurovascular exam, because the fractured clavicle can injure the subclavian artery or brachial plexus
Any suspicion for neurovascular injury warrants further evaluation.
__________________ drugs can cause Raynaud’s.
Sympathomimetic
Describe the appearance of the rash found in acute rheumatic fever.
It is pink with a defined border.
Aspiration of the joint fluid of a patient with Lyme arthritis will show an ____________ profile.
inflammatory (WBCs between 2,000 and 50,000; negative Gram stain; no crystals)
What is De Quervain tenosynovitis?
It is a tendonitis of the abductor pollicis longus and extensor pollicis brevis; this pattern is common in new mothers who hold their babies with a wedge-shaped hand.
____________ is a condition in which the thumb gets locked in flexion.
Trigger thumb
How do scaphoid fractures “classically” present?
•Pain in the anatomical snuffbox
Describe the signs of rotator cuff impingement.
- Normal ROM
* Pain with passive motion through special tests (e.g., Neer’s Hawkin’s)
How does biceps tear present?
- Anterior shoulder pain
* Pain with lifting
______________ is often described as equinas and varus positioning of the talus and calcaneus.
Clubfoot
Clubfoot can be corrected by ______________.
serial casting and stretching
List three signs that might be seen in an x-ray of a child with rickets.
- Bowing of the long bones
- Cupping and fraying of the metaphysis
- Enlargement of the costochondral joint
The anterior fontanelle usually closes by ____________.
2 years
Dermatomyositis is associated with malignancy, weakness, heliotrope rash, Gottron’s papules, ____________.
interstitial lung disease, and myocarditis
_____________ can present with exertional arm pain and aortic bruits.
Takayasu arteritis
______________ presents with numbness of the arms, limited neck range of movement, and chronic neck pain.
Cervical spondylosis (caused by osteophytes around the cervical facets)
Pruritus triggered by hot baths is a feature of _______________.
myeloproliferative disorders
Describe Charcot joint.
In those with neuropathy – such as diabetic neuropathy, tabes dorsalis, or syringomyelia –chronic trauma to the foot with loss of proprioception will cause secondary degenerative joint disease (like osteoarthritis).
What pattern of enthesitis is characteristic of ankylosing spondylitis?
Pain at the Achilles tendon, acromioclavicular junction, and tibial tuberosity.
(Enthesitis is inflammation at the insertion site of tendons.)
A person with Down syndrome with recent incontinence, hyperreflexia, and dizziness likely has a weak ____________ ligament.
posterior transverse
This stem describes atlantoaxial instability which is found in ~10% of those with trisomy 21. Fortunately, it is asymptomatic in most. Treatment is surgical fixation.
The two most common causes of fat emboli are fracture of long bones and _____________.
pancreatitis
The classic triad of fat emboli symptoms is _______________.
respiratory distress (tachypnea), petechiae, and neurologic symptoms such as confusion
The symptoms of Sjögren syndrome include xerostomia, dry eyes, _______________.
arthritis, Raynaud’s, and interstitial lung disease
Antibodies to _____________ are often found in Sjögren syndrome.
SSA (Ro) and SSB (La)
What does it mean that something is positively or negatively birefringent?
Both positively and negatively birefringent crystals will appear blue and yellow under the microscope. They do so in different arrangements, though: one turns blue when it’s parallel to the light and the other turns blue when it’s perpendicular to the light. (Essentially, unless you know the direction of the light, the two will look exactly the same under the microscope.)
Because these are so similar, it’s only useful if the stem tells you it’s negative or positive. Otherwise, rely on the shape of the crystal to decide if it’s gout or pseudogout.
Describe patellofemoral pain syndrome (PFPS).
PFPS is caused by overuse of the quadriceps or misalignment of the patella. It is common in adolescents and presents with chronic, aching pain that is worsened by ascending stairs. Compression of the patella usually reproduces the pain.
PFPS is treated with quadricep strengthening exercises and activity modification.
•This is the most common cause of knee pain in young women!
Hinged knee braces are primarily used for ______________.
ligamentous injuries
What are knee immobilizers used for?
- Patellar fractures
* Patellar tendon or quadricep tendon tears
True or false: “insidious onset” means coming on suddenly.
False. Insidious onset means gradual development.
Osgood-Schlatter is most common in which demographic?
- Boys age 13-14
- Girls age 10-11
It is more common in boys overall.
Osgood-Schlatter is most often ___-lateral.
uni
Osgood-Schlatter, also called traction apophysitis, is treated with _______________.
quadricep stretching, activity restriction, and NSAIDs
How can you differentiate patellofemoral stress syndrome, Osgood-Schlatter, and patellar tendonitis?
- Osgood-Schlatter will present with abnormal tibial tubercle on x-rays (usually).
- Patellofemoral stress syndrome presents with pain over the whole patella, while patellar tendonitis presents with pain over the inferior pole of the patella.
Why does osteonecrosis sometimes occur after a fracture to the scaphoid?
Blood flow enters the scaphoid distally and proceeds proximally from there. If the artery is disrupted in the fracture, the bone dies.
Those with ankylosing spondylitis can develop osteopenia from what two causes?
- Chronic inflammation leads to bone destruction (from cytokines such as TNF-alpha)
- Enthesitis and sacroiliac fusion can lead to rigidity that increases risk of fracture
Succinylcholine should be avoided in patients with neuromuscular disorders (because of upregulation of acetylcholine receptors) and _______________.
crush injuries –these can lead to rhabdomyolysis with hyperkalemia; succinylcholine is a depolarizing agent that increases potassium levels and raises the risk of arrhythmia
One of the earliest signs of compartment syndrome is ________________.
paresthesia; paralysis and decreased pulses present later
_____________ can occur after revascularization of an ischemic limb.
Compartment syndrome
Weakness of the hip muscles can present as __________ pain.
knee
Almost all cases of Kawasaki disease present in those younger than ____________.
five years (with a peak incidence before age two!)
Give the diagnosis of Kawasaki disease.
•Fever for 5 days or longer •At least four of the following: - Conjunctivitis - Rash - Adenopathy - Strawberry tongue - Hand and foot edema or desquamation
Nursemaid’s elbow (radial subluxation) can be treated with two maneuvers: _________________.
hyperpronation of the forearm or supination of the forearm with flexion of the elbow
What position does the head take in torticollis?
- Head tilted toward the affected muscle
* Chin pointed away from the affected muscle
What are some risk factors for torticollis?
All things that relate to crowding in the uterus:
•Breech position
•Multiple gestations
•Oligohydramnios
In addition to crystals in the synovial fluid, what knee pathology often presents with pseudogout?
Meniscal calcification
A patient with “erythematous to violaceous papules on the dorsum of the fingers” might have underlying ________________.
cancer
The lead-in describes Gottron’s papules seen in dermatomyositis.
What is sciatica?
Sciatica (also called lumbosacral radiculopathy) is caused by minor disc herniations that lead to pinching of a nerve root. Patients commonly complain of pain radiating to the posterior calf and foot that worsens with the straight leg raise test.
How should sciatica be treated?
Most cases resolve in several days. NSAIDs and moderate movement are encouraged.
Bursa are ___________________.
synovial sacs that alleviate friction along joint movement points
Patellar fractures present with inability to _____________.
extend the knee
What is a good way to distinguish patellar tendonitis from patellofemoral pain syndrome?
Patellar tendonitis presents with pain at the inferior pole of the patella.
ACE inhibitors can cause hyper-___________.
kalemia
Describe the differences between primary and secondary Raynaud phenomenon (RP).
- Primary RP is more common in young people and presents by itself.
- Secondary RP is more common in older people and presents as a complex with other disorders.
To distinguish the two, take a thorough clinical history, perform a good clinical exam, and draw levels of antibodies (which, if positive, will suggest secondary RP).
_______________ causes pain that is relieved by forward bending.
Spinal stenosis
What physical exam maneuver can help diagnose vertebral fracture?
Point tenderness at the midline
A 34-year-old man presents to your clinic with recurrent oral ulcers, conjunctivitis, nodules in the skin, and genital lesions. He is likely at increased risk for ________________.
thrombosis
The vignette describes Behçet syndrome, a medium-vessel vasculitis that causes increased ulceration following mild trauma, oral ulcers, uveitis, nodules in the skin, and genital lesions.
Counterforce braces are often used for ___________________.
tendonitis
In tendonitis, passive motion opposite the direction of muscle flexion causes pain by stretching it (which also aggravates the problem). Preventing this helps heal the tendon.
In addition to medications, meat intake, alcohol intake, and kidney disease, ______________ can also increase risk of gout.
hospitalizations and surgeries
Patients taking hydroxychloroquine should undergo _________________ evaluation.
ophthalmologic
Hydroxychloroquine can cause retinopathy.
Describe osteiod osteomas.
- Present as cyst-like bone lesions
- Pain that responds to NSAIDs and is usually worse at night
- Typically resolve on their own although can be surgically resected in refractory cases
Whipple’s disease presents with this classic triad: _______________.
- Malabsorptive diarrhea
- Migratory polyarthritis
- Fever
- Adenopathy
(Remember the mnemonic PAS: Pas-positive globules, Arthritis, Steatorrhea.)
How should fibromyalgia be treated?
1) . Regular aerobic exercise and good sleep hygiene
2) . TCAs, SNRIs, or gabapentin
What is a Baker cyst?
Extrusion of knee joint fluid into the gastrocnemius bursa
What are the symptoms of a ruptured popliteal cyst?
- Often caused by exercise
- Bruising in a crescent shape around the medial malleolus
- Swelling of the leg similar to DVT
What parts constitute the hindfoot, midfoot, and forefoot?
- Hindfoot: calcaneus and talus
- Midfoot: cuboid, cuneiform
- Forefoot: metatarsals to toes
How can foot positioning help differentiate between clubfoot and metatarsus adductus?
- Metatarsus adductus is a benign condition in which the forefoot medially deviates. The hindfoot is neutrally positioned. It goes away with time.
- Clubfoot is characterized by medial and upward displacement of the forefoot and hindfoot. It requires surgical correction with serial casting.
