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Musculoskeletal and skin > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Development dysplasia of the hip

  • description
  • dx
  • tx
A
  1. Femoral head doesn’t sit completely inside acetabulum
    - 2ndary to capsular laxity and mechanical factors

2a) Ortolani’s test
- elevate hip and abduct of femur
- hip is reducible

b) Barlow’s test
- adduct and depress femur
- hip is dislocatable out the back

c) Ultrasound

  1. Achieve and maintain early, concentric reduction
    - pavlik harness
    - closed and open reduction
    - osteotomies
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2
Q

Slipped capital femoral fracture

  • description
  • epidemiology
  • clinical presentation
  • tx
A
  1. Slip through the growth plate
    - The femoral head remains in the acetabulum, the neck is displaced anteriorly and externally rotates
  2. Seen most commonly in
    - Adolescent, obese, African American boys
  3. Presentation
    • Limp
    • Externally rotated gait
    • Obligatory external rotation with hip flexion • Decreased hip internal rotation
    • Hip, thigh
    • Knee pain - referred from obturator nerve
  4. Stick a pin going through head and neck until growth plate heals and solidifies
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3
Q

Femoral shaft fracture tx

A
  • Restore limb length
  • Restore alignment
  • Restore rotation
  • use intramedullary nail
  • early stabilization important to reduce blood loss and fat emboli
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4
Q

Which vessels provide blood to head of femur

A

Circumflex femoral vessels and obturator artery

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5
Q

AVN

  • what happens
  • most common non-traumatic causes
  • imaging
  • tx
A
  • occlusion of vessels leading to bone necrosis and cartilage collapse
  • alcoholism and steroid use
  • X-ray + MRI (for earlier stages)

TREATMENT

i. Early stages
1. Bisphosphonates
2. Anticoagulants
ii. Core decompression
1. Unpredictable outcome
iii. Rotational osteotomy
1. Cut and rotate proximal femur towards a better weight bearing area of bone
iv. Vascularized fibular strut grafting
v. Hip arthroplasty
1. Do this if there is an area of collapse

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6
Q

Greater trochanteric bursitis

  • presentation
  • tx
A
  • pain right over the greater trochanter
  • bursitis b/w greater trochanter and IT band

TX

  • activity mods
  • anti-inflammatories
  • physical tx -> stretches to give bursa more room
  • cortisone injection -> to help w/ PT
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7
Q

Wear and tear arthritis =

  • what increases risk
  • presentation in the hip
  • physical exam
  • imaging
  • tx
A

osteoarthritis

-obesity, age, FH

  • Stiffness in the hip
  • Pain “flares”
  • Groin pain - always check hip w/ groin pain
  • Limp

PHYSICAL EXAM
• Decreased range of motion
• Internal rotation most often restricted
• Obligatory external rotation of the hip when flexed
• Limp
• Reproducible groin pain

XRAYS
• Joint height narrowing
• Sclerosis 
• Cystic formation 
• Osteophytes

Tx

  1. Start w/ activity mods and ice
  2. Anti-inflammatory
  3. Cortisone injection
  4. Only “cure” is total hip replacements
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8
Q

Hip fracture

-younger vs older patients

A

i. In younger patients -> preserve bone and cartilage as much as possible

ii. Older -> harder to heal so reduction and fixation on some and total hip replacements on others
iii. In older individuals -> very high (30-50%) 3 month mortality rate

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9
Q

Unique aspect of seronegative spondyloarthropathies

A

Enthesitis -> inflammation of insertion of ligament or tendon into the bone

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10
Q

Key feature to separate mechanic back pain from inflammatory

A

inflammatory gets better w/ exercise

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11
Q

Progression of anklylosing spondylitis

A

Bilat SI inflammation w/ pain in gluteal area -> ossification of spinal ligaments (bamboo spine)

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12
Q

Reactive arthritis presentation

A

asymmetric inflammatory oligoarthritis that develops 1-4 weeks after a nongonococcal urethritis or an infectious diarrhea; usually involves joints in the lower extremities

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13
Q

Triad for Reiter’s syndrome

A
  1. Nongonococcal urethritis
  2. Uveitis/Conjunctivitis
  3. Arthritis of large joints (inflammatory)
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14
Q

Organisms associated with Reactive arthritis

A

U CCSSY

Ureaplasma

Campylobacter
Chlamydia
Salmonella
Shigella
Yersinia
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15
Q

Other key manifestation unique to reactive arthritis

A
  1. Oral ulcers
  2. Keratoderma blenorrhagica—erythematous scaly hyperkeratotic skin lesions on palms and soles
  3. Circinate balanitis—red scaly area on the glans penis with a gray, serpiginous annular edge that spreads outwards in phases

IMAGING
-asymmetric non-marginal jug handle syndesmophytes

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16
Q

Unlike in RA, which phalangeal joints can be involved with psoriatic arthritis?

A

DIP

dactylitis w/ pitting for finger nails

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17
Q

Which type of arthritis with PA?

A
  • most commonly asymmetric oligoarthritis

- can also be poly like RA

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18
Q

Arthritis mutilans

A
  • associated with PA or poorly managed RA

- complete joint erosion

19
Q

Imaging finding with PA

A

Pencil in a cup sign -> central erosion

Followed by ankylosis

Spondyloarthropathy -> comma shaped

20
Q

Key points about paget’s disease

  • most common location
  • number of bones involved
  • uni or bi lateral
A
  • pelvis
  • polyostotic
  • unilateral
21
Q

T1 vs T2 MR imaging

A

T1 -> bone, vessels, nerve (any soft tissue)

T2 -> fat suppression (appears dark)

  • so fluid can show up bright
  • good for looking at edema
22
Q

3 general fractures

A
  1. Traumatic
  2. Stress
    A) Fatigue - abnormal stress across normal bone
    B) Insufficiency - normal stress across abnormal bone
23
Q

1 cause of AVN

A
  • trauma

- most occur at head of femur

24
Q

Radiology signs of quadriceps tendon rupture

A

fat pad displaced anteriorly

->edema in suprapatellar bursa

25
Q

Key radiology signs of ACL tear

A

Acute injury with joint effusion on X-ray

-fat pad displaced anteriorly

26
Q

Anakinra

  • generic
  • MoA
  • side effects
A

o IL-1Ra
o Endogenous antagonist of IL-1
o Binds to receptor but no signaling ensures
o IL-1 is produced by RA synovium
o Drug didn’t work too well
o Receptor antagonist was only occupying receptor for a brief period of time
o Also increased incidence of bacterial infections
o Additional IL-1 antagonists are being studies
• Canakinumab and rilonacept

27
Q

TNF inhibitors

  • categories + drugs
  • side effects
  • contraindications
A
  1. Soluble TNF receptor
    - Etancercept
  2. mAb
    - Adalimumab - fully humanized -> high affinity
    - infliximab - chimeric

SIDE EFFECTS

  • increased risk of infection
  • reactivation of TB

CONTRAINDICATIONS

  • pregnant/nursing women
  • recent live virus vaccine (e.g. HSV for shingles)
  • allergy to mouse/hamster proteins
28
Q

Abatecept (Orencia)

A
  • CTLA4 w/ IgG1

- blocks activation of T-cell

29
Q

Tocilizumab (Actemra)

A

IL-6 inhibitor
• Blocking this will push naïve T-cell towards the T-reg pathway which tones down the immune response

ADVERSE EFFECTS
• Serious infectious adverse events are a concern
o Risk increases w/ time
• Cause neutropenia as well but not progressive but improves over time
• Elevates LFT but not a major issue
• Can raise LDL
• Diverticuli
• Can increase metabolism of some drugs by enhancing CYP450

30
Q

Rituximab (Rituxan)

A 
•	Targeting B-cells 
•	Anti-CD20
o	Not present on the progenitor cells 
•	Rituximab targets this marker 
o	Induces apoptosis of B-cells

Adverse effects
• Inc risk for infections
• Allergic rxns

31
Q

BAFF (BLys)

A

• Target B-lymphocyte stimulating hormones
• BAFF promotes B cell maturation and survival
• BAFF also synergizes w/ IL-6 in TH17 creation
• Anti-BAFF agents are in trial – Benlysta
-Human mAb
-Tested in lupus patients
-Significant improvement over conventional tx

32
Q

Classify the primary lesions

A
  1. Flat
    - macule/patch
  2. Raised
    - papule/plaque
    - nodule
    - tumor
  3. fluid filled
    - vesicles/bulla
    - pustules -> fulled w/ neutrophils/eosinophils
33
Q

Translucent lesions on skin - think?

A
  • BCC

- eccrine neoplasms -> very translucent

34
Q

Distribution of Herpes Zoster lesion

A

Dermatomal

35
Q

Arrangement/pattern of HSV

A

grouped vesicles on an erythematous base

36
Q

linear pattern of lesion due to?

A

external sources such as poison ivy

37
Q

Annular morphology

  • def
  • example
A

-ring with central clearing

Tinea corporis (ringworm)

38
Q

Pityriasis rosea presents with what type of lesion?

A

Oval

39
Q

Round or nummular lesions

  • description
  • cause
A
  • coin shaped lesions

- discoid lupus or nummular dermatitis

40
Q

Hemorrhagic crust

  • which layer of skin
  • risk for
A
  • past the epidermis

- risk for scarring

41
Q

Lab to look at scabies

A

Mineral oil prep of scraping

42
Q

Lab to look at fungal infection

A

KOH prep - margin scaling of lesion

43
Q

Fissure on the lower leg think

A

Eczema craquele

44
Q

Umbilicated lesion

  • description
  • example
A
  • central depression or dell

- Molluscum

Musculoskeletal and skin (11 decks)

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