Mehlman/UW Osteoarthritis 03-07 (3)

Question 1

M. OA = degenerative joint disease.

Answer 1

It is NON-inflammatory disease

Question 2

M. OA. synovial fluid?

Answer 2

Since it is non-inflammatory -> synovial fluid same

low WBC in synovial. in serum low ESR.

Question 3

M. what joints?

Answer 3

Hip, knee, hand findings - distal interphalangeal joints, 1st carpometacarpal joint

Question 4

M. how joints look like?

Answer 4

ASYMETRICAL!!! (Asymmetric joint space narrowing)

contrast to RA - usually symetric

Question 5

M. highest risk factor?

Answer 5

OBESITY

Question 6

M. 3 scenatio risk factor?

Answer 6

Obesity

Big and tall and young (<50 y/o)

Heavy lifting on legs for years

Question 7

M. age?

Answer 7

> 40; prevalence incr with age

if big+tall+ young (<50) = despite age

Question 8

M. HY prevention?

Answer 8

WEIGH LOSS!!!!

Question 9

M. what is Eburnation?

Answer 9

its a term that refers to the ivory-like appearance of bone in OA at sites of cartilage erosion

Question 10

UW. morning stiffness?

Answer 10

none or brief < 30 min

Question 11

UW. Systemic symptoms?

Answer 11

absent

Question 12

UW. examination?

Answer 12

hard, bony enlargement of joints, reduced ROM

Question 13

M. Tx? 2

Answer 13

weight loss –> acetaminophen

acet. is correct before nsaids, because its non-inflammatory, therefore nsaid wont do any better

Question 14

M. what always funckin wrong Tx?

Answer 14

STEROIDS (intra or oral)

Question 15

M. what other 2 also wrong Tx?

Answer 15

injections of glycosaminoglycans

use of capsaicin cream

Question 16

M. most viggnettes on nbme: 40-50 yo + high BMI.

Answer 16

.

Question 17

M. hands DIP?

Answer 17

Heberden nodes

Question 18

M. hands PIP?

Answer 18

Bouchard nodes

Question 19

M. RA does not affect DIPs.

If see xray and everything is fucked up –> check if something is wrong with DIP. if yes –> it is not RA, and likely its OA.

Answer 19

.

Question 20

UW. Tx scheme
weight loss –> acetaminophen –> NSAIDS –> next?

Answer 20

Intraarticular GK
topical capsaicin cream

symptoms persists –> surgery (if possible); chronic pain management

As M said, its always fuckin wrong answers

Question 21

M. case. Older + OA + takes nsaids + peripheral edema, why?

Answer 21

kidney damage –> answer is decr. sodium secretion/incr. Na retention

Question 22

UW. synovial effusion in osteoarthritis.
in what patients?

Answer 22

older patients with OA

Question 23

UW. synovial effusion in osteoarthritis.
Popliteal (Baker) cyst formation?

Answer 23

communication of joint space with gastrocnemius or semimembranous bursa allows the synovial fluid to flow posteriorly into the bursa, forming popliteal cyst (Baker)

Question 24

UW. secondary osteoarthritis.
causes: prior joint injury/surgery
infection
inflammatory disorders, eg RA
congenital or acquired body deformities
neuromuscular weakness
hemochromatosis

Answer 24

.

Question 25

UW. synovial effusion in osteoarthritis. Osteoarthritis develops within 10 years in most patients with anterior cruciate ligament injury, and the risk is increased regardless of whether the tear is surgically required.

Answer 25

.

Question 26

UW. OA table. Joint involvement?

Answer 26

knees hips distal interphalangeal joints 1st carpometacarpal joint

Question 27

UW. hip arthritis CP?

Answer 27

pain in groin, buttock, lateral hip AND can radiate to the lower tight or knee.

Question 28

UW table. risk factors for OA. Modifiable 4?

Answer 28

Sedentary lifestyle Obesity (MCC) Occupational joint loading DM

Question 29

UW table. risk factors for OA. Nonmodifiable 5?

Answer 29

Advanced age female sex family history abnormal joint alignment prior joint trauma

Question 30

UW Q. examination findings suggesting OA?5

Answer 30

Periarticular bony hypertrophy and tenderness Limited range of motion with crepitus and pain Small joint effusion without erythema or warmth Varus or valgus angulation Popliteal (Baker) cyst behind the joint

Question 31

UW table. hand OA. Initial management? 2

Answer 31

Stretching and strengthening exercises topical or oral nsaids topical usually sufficient oral carries a risk for peptic ulcer disease