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MSK > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Which joint is commonly affected in OA, but rarely in RA?

A

The Carpal Metacarpal {CMC} of the thumb.

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2
Q

What are Heberden’s Nodes and Bouchard’s Nodes?

A

Both are bony swellings. Heberden’s are on the DIP, Bouchard’s on the PIP; associated with osteoarthritis.

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3
Q

Viscosupplementation involves?

A

Hyaluronic Acid Injections into the joint. Moderately effective and primarily used in the knees or when surgery is not an option.

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4
Q

How is Osteoarthritis treated? What is the only thing which truly improves OA?

A

Tylenol PRN -> Tylenol ATC -> NSAIDs -> Opioids; Weight Loss.

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5
Q

Peroneus means?

A

Fibular; I know it’s stupid. Just live with it.

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6
Q

What, in general terms, is Vasculitis?

A

An auto-immune based inflammation of the blood vessel which causes infiltration and necrosis {especially of the muscular portion} of the vascular wall. It may be Granulomatous {Cell Mediated} or Immune Complex Related {Humoral Mediated}.

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7
Q

Temporal Arteritis is associated with what other condition? What four findings are characteristic of TA?

A

Polymyalgia Rheumatica {PMR}.

  • Swollen Temporal Artery
  • Scalp Tenderness
  • Jaw Claudication
  • Visual Complaints {BLIND}
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8
Q

What do you use to treat things like TA, Vasculitis, PMR…?

A

Prednisone!!! Depending on the dose and patient Bisphosphonates and Vitamin D may need to be given to protect your bones.

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9
Q

Whats the big gun to use for bad Lupus?

A

Cyclophosphamide

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10
Q

What is Scleroderma? What is Morphea? What is Limited Scleroderma?

A

An uncommon connective tissue disease which involves a thickening of the skin; a hardened patch of skin, NO internal organ involvement; CREST syndrome, equally severe - specific features.

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11
Q

What is CREST Syndrome?

A

Limited Scleroderma: Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia.

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12
Q

What often presents with Scleroderma?

A

Raynaud’s Phenomenon

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13
Q

Dermatomyositis presents with?

A

Pruritis, Heliotrope Eruptions, and Gottron’s Papules.

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14
Q

What are each of the 3 COX involved with?

A

COX-1: GI
COX-2: Inflammation
COX-3: Fever and Analgesia

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15
Q

Two fun facts about ASA, how do you know you are taking to much, and what drug do you need to be extra careful with?

A

You get Tinnitus with really high doses, displaces many drugs off of Albumin – Notably Warfarin.

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16
Q

What NSAID is used to close PDA in premature infants and cannot be used in pregnant women?

A

Indomethacin

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17
Q

Methotrexate is an antimetabolite of?

A

Folic Acid

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18
Q

How does Polymyalgia Rheumatica present?

A

People > 50 with bilateral shoulder and/or pelvic pain. Usually affects proximal muscles and joints. PROLONGED morning stiffness and asymmetrical arthritis of the wrists, hands, ankles, and feet as well as systemic features {fever, weight loss, malaise} are also common. ESR and CRP are often elevated in Polymyalgia Rheumatica.

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19
Q

Name some large vessel vasculitis.

A

Temporal and Takayasu’s

AKA Giant Cell Arteritis

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20
Q

Name some medium vessel vasculitis.

A

Polyarteritis Nodosa, Kawasaki’s, and ANCA Associated {Wegner’s granulomatosis, Microscopic polyangiitis, and Churgg Strauss}

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21
Q

Name some small vessel vasculitis.

A

Henoch Schonlein, Cryoglobulinemic, and Anti GBM disease,

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22
Q

Vasculitis is a{n}?

A

Autoimmune based inflammation and necrosis of blood vessels.

Cell mediated is granulomatous and Humoral mediated is via immune complex deposition.

23
Q

What form of vasculitis presents with swelling vessels and may cause blindness?

A

Temporal Arteritis

24
Q

How should vasculitis be treated?

A

How dose steroids, immunosupression, or biologics.

25
Q

Churg-Strauss is a?

A

Eosinophilic Granulomatosis with Polyangiitis presenting with asthma, allergic sinusitis, nasal polyps, and eosinophilia.

26
Q

Henoch Schonlein Purpura presents as?

A

Mainly purpura and malaise; may involve the kidney or bowel. Tissue contains IgA and it may occur post viral or drug reaction.

27
Q

What biologic can be used to treat vasculitis?

What immunosuppressive medications are commonly used for vasculitis?

A

Rituximab {B cell depleting}

Methotrexate and Cyclophosphamide {the BIG GUN}.

28
Q

How long should vasculitis be treated for?

A

6 - 12 months after patients enter remission.

29
Q

What tests are used to diagnose SLE?

A

It is a clinical diagnosis. Anti-nuclear Ab +ve in 99% of SLE and 5% of normal population.
Anti-dsDNA and anti-Smith are more specific to SLE. adsDNA changes with disease activity while asm usually remains constant.
Should also be lab evidence of end organ disease.

30
Q

How is SLE treated?

A
  • Anti-Malarial Medication
  • Topical and Systemic Corticosteroids
  • Immunosuppressive and Cytotoxic Agents
  • Supportive care {ACEi, CCB, Sunscreen}
31
Q

Mortality in Lupus patients is caused by?

A

Infection in the first few years followed by cardiovascular disease > 2 years.

32
Q

What is the pathophysiology of lupus?

A

It is an antibody mediated disease {anti-nuclear or tissue specific} which damage organs either directly or through immune complexes.

33
Q

Who typically gets lupus?

A

Female between 15 - 45. F:M 8:1.

34
Q

What autoantibodies are present in Systemic Sclerosis?

A

Antinuclear, Anti-Tropoisomerase I, and Anti-Centromere.

35
Q

What is the treatment for scleroderma renal crisis?

A

Rapid lowering of blood pressure. Gold Standard is with ACEi. Renal failure will occur within days if not treated.

36
Q

Where does the rash of dermatomyositis present?

A

The hands over small joints, on the face, and the shawl area.

37
Q

Which muscles are spared in DM and PM?

Which muscles are first affected?

A

Facial and ocular.

Proximal skeletal muscle weakness without pain presents early.

38
Q

What is elevated in DM and PM?

A

Creatine Kinase and Aldolase.

39
Q

How are PM and DM treated?

A
  • Moderate to high dose corticosteroids.
  • Immunosuppression with agents like methotrexate may be needed.
  • IVIG
40
Q

What symptoms are related to Fibromyalgia?

A

Chronic, widespread musculoskeletal pain all over the place with multiple tender points.

Often associated with sleep disturbance {waking unrefreshed}, chronic fatigue, headaches, irritable bowel, cognitive disturbances, and other forms of chronic discomfort.

41
Q

What is used to treat Fibromyalgia?

A
  • Pregabalin {Lyrica}

- Duloxetine {Cymbalta}

42
Q

What are the 4 main Spondylo-Arthropathies?

A
  • Ankylosing Spondylitis
  • Reactive Arthritis
  • Psoriatic Arthritis
  • Arthritis of Inflammatory Bowel Disease
43
Q

What gene is associated with many Spondylo-Arthropathies?
What else are these associated with?
What are they NOT associated with?

A
  • HLA B27
  • Previous Infection, inflammatory disease.
  • None are associated with Rheumatoid factor of anti-CCP.
44
Q

What is Enthesitis?

A

Inflammation of the Entheses, the site at which tendons and ligaments attach to bones.

45
Q

How does Ankylosing Spondylitis present?

A

Severe AM stiffness in the lower back, immobility and eventual fusion of the spine, large joint {asymmetrical} enthesopathy.

46
Q

How is Ankylosing Spondylitis treated?

A

Aggressive NSAIDs {indomethacin} and exercise. TNF inhibitors are remarkably effective.

47
Q

How does Reactive Arthritis Present?

A

Multi-system response to infection which presents with urethritis {chlamydia} or dysentery {salmonella, shigella, campylobacter, or yersinia} followed by an arthritis, conjunctivitis, painless oral ulcers, and typical skin lesions.

48
Q

Which joints does Reactive Arthritis generally affect?

A

SI Joints and a few large peripheral joints.

49
Q

Enthesitis is more/less common in children than in adults.

A

More

50
Q

Sacroiliitis is more/less common in children than adults.

A

Less

51
Q

Juvenile Dermatomyositis is/isn’t associated with a higher rate of cancer while Dermatomyositis is/isn’t.

A

Isn’t

Is

52
Q

What is Gower’s Sign?

A

+ve sign is indicative of JDM. Starting prone the child must use their hands braced against their body to “climb” to the standing position.

53
Q

Which sided curves are more concerning for scoliosis? Which gender will generally always get an MRI?

A

LEFt sided are less common and more concerning.

Boy get scoliosis less and are more concerning, usually get an MRI.

54
Q

What do positive Galeazzi, Barlow, and Ortolani tests/signs increase the likelihood of? What are each of these tests?

A

Developmental Dysplasia of the Hip {DDH}
Galeazzi: Knees flexed so ankles hit the butt while child lays on back. If the knees aren’t level the test is +ve.
Barlow: Adduct the hip to see if it will dislocate.
Ortolani: Follows Barlow. Clunk when the hip relocates after hip and knee flexion/

MSK (6 decks)

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