MSK Flashcards
(214 cards)
1
Q
List the order of tests in an MSK physical exam
A
Gait assessment Inspection Palpation Range of Motion Power Assessment Neuro & Vascular (esp back & wrists/hands) Special tests
2
Q
Acronym for MSK Inspection
A
SEADS = swelling, erythema, atrophy, deformities, scars/skin
3
Q
Acronym for MSK Palpation
A
TESTCA = tenderness, effusions, swelling, temperature, crepitus, atrophy
4
Q
4 muscles of the quadriceps
A
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
5
Q
3 muscles of the hamstrings
A
Semimembranosus (medial)
Semitendinosus
Biceps femoris (short & long)
6
Q
Innervation of the quadriceps
A
Femoral nerve
7
Q
Innervation of the hamstrings
A
Sciatic nerve
8
Q
Innervation of the gluteus
A
Superior/inferior gluteal nerves
9
Q
Innervation of the adductors
A
Obturator nerve (except tibial for adductor magnus, femoral for pectineus)
10
Q
Hip adductors
A
Adductor brevis, longus, magnus, minimus
Pectineus
Gracilis
Obturator externus
11
Q
What is the only intracapsular ligament of the hip?
A
Ligamentum teres
12
Q
There is less stability ___ to the hip, so hip is most likely to dislocate ____
A
Posteriorly (just the ischiofemoral, anterior has ileofemoral + pubofemoral + ligamentum teres)
13
Q
2 phases of gait
A
Swing phase (40%) (toe off --> heel strike) Stance phase (60%) (heel strike --> toe off)
14
Q
If pelvis drops on the swinging side, this indicates….
A
Weakness of hip abductors on opposite side
15
Q
Antalgic gait
A
Stance phase shortened on affected side (pain on weight-bearing)
16
Q
Bilateral hip abductor weakness –>
A
Waddling/Trendelenburg Gait
17
Q
Exaggerated lumbar lordosis could indicate
A
Flexion contractor of the hip joint
18
Q
Bony prominence on lateral aspect of him =
A
Greater trochanter
19
Q
True leg length is measured from…
A
From ASIS to medial malleolus (crosses leg) (<1cm = normal)
20
Q
Apparent leg length is measured from
A
Umbilicus to medial malleolus
21
Q
Diff between true and apparent leg lengths?
A
Apparent = issues at level of hip True = issue below hip
22
Q
To check internal hip rotation you move the foot which way?
A
Laterally!! and vv
23
Q
Expected internal hip rotation, external hip rotation, abduction, adduction, extension
A
Internal = 30o External = 45 Abduction = 45 Adduction = 30 Extension = 20
24
Q
Name 3 special tests in the hip exam and what they are looking for (not including leg length discrepancy)
A
Thomas test (hip contracture) FABER/Patrick's test (SI joint pathology (pain in lower back/gluts) or hip joint path (anterior/lateral pain)) Ober test (tight iliotibial band)
25
Fibularis longus/brevis AKA? Insertions?
Peroneus
Longus --> under foot to 1st metatarsal
Brevis = 5th metatarsal
26
4 arches of the foot
1) Medial longitudinal
2) Lateral longitudinal
3) Anterior/transverse metatarsal
4) Transverse mid-tarsal arch
27
Muscle compartments in thigh
Anterior: Rectus femoris, vastus muscles, sartorius
Medial: Adductor longus/brevis/magnus, gracilis
Posterior: biceps femoris, semitendinosus, semimembranosus
28
Muscle compartments in leg
Anterior: tib ant, EDL, EHL, fibularis tertius
Lateral: fibularis longus/brevis
Poterior superficial: triceps surae (gastroc/soleus), plantaris
Deep: Tib post, FDL, FHL
29
Define gonarthrosis & coxarthrosis
OA of knee (most common) and hip (2nd most)
30
OA leads to ___ formation of knee in early stage. Why?
Varus, medial cartilage lost first
31
What nodes are caused by osteophyte formation in the hands in OA?
Heberdens (DIPs)
| Bouchards (PIPs)
32
4 possible radiograph findings in OA? Important note for diagnosis?
Subchondral cysts/sclerosis
Joint space narrowing
Osteophytes
OFTEN DON'T CORRELATE TO CLINICAL SYMPTOMS?FINDINGS, clinical features more important
33
Acetaminophen toxic dose
7.5-10 g in adults (boxes now say max 3 grams, docs can recommend up to 4)
150 mg/kg in children
34
Most common nontraumatic causes of osteonecrosis (2)
Chronic corticosteroid use (>20 mg prednisone, >2000 mg cumulative)
Alcohol consumption
35
What is SPONK?
Spontaneous osteonecrosis of the knee (femoral condyle or tibial plateau, usually in older women)
36
Tendon sheath
Synovial membrane layer surrounding tendons
37
Arthritides
Inflammatory joint diseases (does NOT include osteoarthritis which is degenerative)
38
Synovitis
Inflammation of synovial membrane
39
Septic arthritis
Bacterial infection of joint
40
Inflammation of tendon sheath = ?
| Common in what disease?
Tenosynovitis
| RA
41
What is enthesitis
inflammation where tendon inserts into bone
42
Palliation and provocation of pain in OA vs inflammatory arthritis
OA: exertion, evening; heat/rest help
A: rest, morning; movement/cold help
43
4 categories of inflammatory arthritis & demographics
RA (young/mid-age women)
SLE (young women)
Spondyloarthropathies (young men)
Gout (mid-age men, post-menopausal women)
44
2 most acute types of arthritis
```
Gout (hyperacute)
Septic arthritis (acute)
```
45
Can joint distribution of arthritis be symmetrical if DIPs/PIPs are differentially affected?
Yes, as long as symmetrical DIGITS are affected
46
Classification of arthritis based on # of joints affected
```
1 = monoarthritis
2-4 = oligoarthritis
5+ = polyarthritis
```
47
3 common differentials for acute monoarthritis
Gout (usually 1st MTP)
Pseudogout (CPPD deposition, usually knee)
Septic arthritis
48
Oligoarthritis presentation is common in _____
Spondyloarthropathies
49
Common axial spondyloarthritis
Ankylosing spondylitis
50
Common peripheral spondyloarthrites (3)
Enteropathic (IBD! usualy lower extremities)
Reactive (after bact infection GI/urethra, usually lower extrem)
Psoriatic (small joints esp hands)
51
Name 3 common features of spondyloarthritises (since peripheral ones don't actually all impact the spine)
Enthesitis
Extra-articular manifestations (skin, eyes)
Seronegative (e.g. no rheumatoid factor)
52
2 patters of presentation in psoriatic arthritis
```
Ray pattern (asymmetric polyarthritis)
Transverse involvement (across DIPs)
```
53
RA usually impacts what body part first?
Feet (symmetric)
54
Which small joints tend to be spared by RA?
CMC
DIPs
(more likely to be OA)
55
SLE arthritis presentation
Symmetric polyarthritis in small joints of hands (DIP mayyy be affected in addition to others)
56
Crystals that form in gout are what?
Monosodium urate
57
Repeated gout attacks cause aggregation of urate crystals & giant cells =
Tophi (bone or soft tissue)
58
What is inflammation caused by in gout?
crystals precip coated by IgG --> phagocytosis, cytokine release
59
Things that decrease UA excretion
```
Meds (aspirin, loop/thiazide diuretics, etc)
CKD
Ketoacidosis
Post-menopause
Alcohol
```
60
Things that increase UA production
High-fructose corn syrup (pop)
Cell turnover (TLS, chemo, hemolytic anemia, psoriasis, cancers)
Enzyme defects
Obesity, hypercholetersol/TAGs, hypertension
Alcohol
61
Most common type of gout =
Podagra (1st MTP)
| Knee (gonacra), fingers, ankle, wrist also possible
62
Gold standard diagnostic tool for gout
Arthrocentesis + synovial fluid analysis (if diagnosis uncertain or septic likely)
63
3 patient characteristics in gout diagnosis tool
Male
CV risk factors
History of prev attacks
64
4 features of attack in gout diagnostic tool
Onset within 24 hours
Joint erythema
1st MTP
Elevated serum UA (higher range of normal?)
65
Renal manifestations of chronic gout
Uric acid nephrolithiasis
| Nephropathy
66
Gold standard for gout diagnosis (if unsure)
Arthrocentesis + synovial fluid analysis
67
Name 3 meds for acute gout flare
1) NSAIDS
2) Glucocorticoids (avoid giving w/ NSAIDs w/out PPI)
3) Colchicine (inhibits phagocytosis of crystals + neutrophil activation/degranulation)
68
NSAIDs from strongest to weakest
Indomethacin > naproxen (Aleve) > diclofenac (Voltaren) > ibuprofen (motrin/advil)
69
What MUST be done when initiating urate-lowering therapy for gout?
Give anti-inflamm prophylaxis for 1 week first (mobilizing urates increases acute flares) --> GCs, NSAIDs, or colchicine
70
Indications for urate-lowering therapy
Absolute: >2 attacks/year, tophi
Relative: CKD, high serum uric acid, urolithiasis
71
Name top 3 urate-lowering therapies and mechanisms
1) Xanthine oxidase inhibitors (Allopurinol/Febuxostat) - prevent UA formation from purines
2) Uricosurics (probenecid) - prevent UA reabsorption in PCT
3) Recombinant uricase (pegloticase) - breaks UA down to allantoin
72
Difference between rasburicase and pegloticase?
Pegloticase is conjugated to PEG to increase half-life and immunogenicity
Rasburicase used in TLS/pre-chemo
73
Tendinitis vs tendinosis
```
Tendinitis = inflammation due to micro-tears
Tendinosis = collagen restructuring (immature/disorganized) due to chronic overuse & improper healing
```
74
Treatment goals/strategies in tendinitis vs tendinosis
Itis --> reduce inflamm (ice, NSAIDs, steroids)
| Osis --> facilitate proper healing (heat unless inflamm episode, long-term physio)
75
What is adhesive capsulitis and what is a key indicator that this is the issue?
Frozen shoulder = reversible contraction of joint capsule
| Won't move actively OR passively
76
Most common cause of shoulder pain
Rotator cuff tendinopathy (usually supraspinatus tendon)
77
Distal tibiofibular syndesmosis = what type of joint?
Fibrous
78
Synchondroses are ___ joints. Examples?
```
Cartilagenous
Epiphyseal plates (temp hyaline cartilage), b/w first 7 ribs & sternum
```
79
6 types of synovial joints
1) Plane (e.g. intercarpals)
2) Hinge (e.g. elbow, interphalangeal)
3) Pivot (proximal radioulner)
4) Condyloid (MCP joints)
5) Saddle (CMC of thumb)
6) Ball & socket (shoulder, hip)
80
The knee consists of one __ joint and 2 ___ joints
```
1 plane (femoropatellar)
2 hinge (med/lat tibiofemoral)
(these are also the 3 compartments)
```
81
Define juvenile idiopathic arthritis
Rheumatic disease diagnosed <16yo with inflamm lasting >6 weeks
82
What part of the eye is often inflamed in JIA?
```
Anterior uvea (uvea = iris + ciliary body + choroid; anterior = iris + ciliary body)
**often asymptomatic
```
83
Main diagnostic imaging technology in JIA?
Ultrasound (can see synovial hypertrophy, intraarticular fluid collection, bone erosions)
84
Define acute, subacute, and chronic back pain
Acute <6 weeks
Subacute = 6-12 weeks
Chronic > 12 weeks
85
Anterolisthesis
Anterior displacement of vertebral body relative to the one below
86
Anterolisthesis secondary to spondylolysis
Spondylolisthesis
87
Displacement of vertebral body posterior relative to the one below
Retrolisthesis
88
Define spondylosis
Degenerative arthritis of the spine (disc space narrowing, arthritic changes of facet joint)
89
Radiculopathy
Impairment of nerve root --> radiating pain, numbness, tingling, muscle weakness in corresponding area
90
Sciatica
Pain/numbness/tingling in distribution of sciatic nerve (posterior/lateral aspects of leg --> foot)
91
Loss of bowel/bladder control and numbness in groin + weakness of lower extremities = ___ syndrome. Caused by what?
Cauda equina syndrome
| Pressure on bottom of spinal canal and spinal nerve roots (bony stenosis, herniated disk)
92
>90% of radiculopathies involve what nerve roots?
L5 & S1 (-->sciatica)
*L5 goes from glut across front of leg to top of big toe
S1 stays down the back
93
3 main categories of differentials for NONmechanical spine disease
Neoplasia
Infection
Inflammatory (usually HLA-B27 associated) - not usually RA!! (RA rarely affects spine except cervical)
94
The vast majority of low back pain is ____ (97%) and 70% are specifically...
Mechanical
| 70% lumbar strain/sprain
95
Pt presents with low back pain that is better when spine is flex or when seated, aggravated by walking downhill more than uphill, bilateral symptoms. Most likely diagnosis?
Spinal stenosis
96
Pt presents with low back pain but WORSE leg pain, radiating below knee. Most likely diagnosis?
Herniated disk?
97
Viral illness that can cause unilateral dermatomal back pain + rash?
Shingles
98
In a herniation, the affected nerve root is above or below the level of disc herniation?
BELOW (e.g. L4-L5 disc herniation--> L5 radiculopathy)
99
Leading causes of morality in SLE (4)
Heart disease
Malignancy
Infection
(also kidney disease)
100
5 lab markers for SLE?
ANA >1:80 (v sensitive!)
Sm & dsDNA (both v specific!)
Low complement
Anti-phospholipid Ab
101
2 types of rashes with SLE? (nonscarring & scarring)
```
Malar = nonscarring, usually over bridge of nose
Scaring = discoid
```
102
SLE nephritis is characterized by...(3)
Renal insufficiency
RBC casts
Proteinuria
(Full house glomerular deposits = IgG/M/A + complement)
103
3 types of inflammatory myopathy
Polymyositis
Dermatomyositis
Inclusion body myositis
104
Polymyositis & dermatomyositis affect ___ muscles
Proximal
105
Name 4 cutaneous manifestations of DM
```
Gottron papules (dorsum of hands)
Heliotrope rash (upper eyelids)
Mechanics hands (dirty-appearing fingers)
Photosensitive poikiloderma
```
106
Name 5 muscle enzymes that can be elevated in myositis
Creatine kinase, aldolase
| LDH, AST, ALT, myoglobin
107
4 roles of electrophysiological studies (nerve conduction + electromyography) in diagnosis of myopathy
1) Exclude neuromuscular issue
2) Provide EMG evidence of myopathy
3) Characterize it (location, severity)
4) Identify target muscles for biopsy (contralateral!)
108
MRI advantage over EMG for determining biopsy site?
You can biopsy the actual muscle you image not just contralateral
109
Treatment for lupus
```
Induction = oral GCs
Maintenance = hydroxychloroquine (+methotrexate or azathioprine if needed)
```
110
Treatment for giant cell arteritis
Steroids (high dose at first then low)
111
Treatment for inflammatory myositis
Physical therapy
UV light protection in DM
Corticosteroids
112
3 organ complications in inflammatory myopathy
Pneumonia (related to resp muscle failure) --> ILD/resp failure
Myocarditis --> arrhythmia
Esophageal muscle weakness --> aspiration pneumonia
113
4 steps in approach to muscle weakness
1) Determine if true muscle weakness vs lassitude
2) Determine site of lesion
3) Determine cause of lesion
4) Evaluate for resp muscle weakness
114
Objective muscle weakness can be broken down by general localization into...
Generalized (e.g. cachexia)
Localized asymmetric
Localized symmetric (proximal e.g. myopathy, distal, specific pattern)
115
5 possible sites of lesion causing true muscle weakness
```
Upper motor neuron
Anterior horn cell
Peripheral nerve
NMJ
Muscle
```
116
Muscle strength testing scale
```
0 = no contraction
1 = flicker
2 = can move w/out gravity
3 = move against gravity
4 = move against limited resistance
5 = normal
```
117
6 differential diagnostic categories for MSK lesions causing muscle weakness
```
Inflammation
Infection
Toxins/drugs
Metabolic/endocrine
Genetic
Neoplastic
```
118
5 common features of spondyloarthropathies
```
Family history
HLA-B27 association
Enthesitis!!
Extra-articular manifestations (uveitis, psoriasis)
Seronegative (no RF)
```
119
Major extra-articular manifestation of ankylosing spondylitis
Acute, unilateral anterior uveitis
120
Anky Spon affects the spine &
SI joint!!
121
Physical exam tests for ankyspon (5)
```
Bilateral chest expansino
Modified Schober test
FABER test
Gaenslen test
Occiput-wall distance
```
122
What might labs in an akyspon patient show (3)
High CRP/ESR
No auto-antibodies
High HLA-B27
123
Best imaging for EARLY detection of ankyspon?
Pelvic MRI (very sensitive for sacroiliitis)
124
Difference between syndesmophyte and osteophyte?
Syndesmophytes originate from annulus fibrosis & spinal ligaments in AnkySpon (inflammatory). Grow vertically --> bamboo spine
Osteophytes originate from vertebral bodies, usually in OA (degenerative). Grow horizontally
Both are ossifications
125
Most important treatment for ankyspon
Physical therapy
126
Respiratory complications of ankyspon
Breathing difficulties
| Apical fibrosis of lungs (due to aspiration, defective ventilation, etc)
127
Medications for ankyspon (4)
NSAIDs = first line
TNF-a inhibitors to reduce axial progression
DMARDs for associate peripheral arthritis
Temporary intra-articular GCs if severe
128
Diagnostic approach to ankyspon:
Physical exam + history + pelvic x-ray
| If inconslusive --> HLA B27 testing --> pelvic MRI
129
Cardinal symptom of ankyspon
Nocturnal back pain (sacroiliitis) that improves w/ NSAIDs/movement (morning stiffness)
+ pain/stiffness along spine
130
Scoliosis is characterized by ___ curvature (___ > ___) and __ of vertebral bodies
Most common curve?
Lateral curvature (Cobb angle >10)
Rotation
(most commonly R convex thoracic)
131
Most idiopathic scoliosis is what class (by age)? Gender distribution?
80% adolescent (10+ years old)
Mostly females
(*for juveniles 4-9yo mostly males, equal below that)
132
Do kids with scoliosis have pain?
Not usually (though adults may due to degeneration/compression of spinal nerves) - assess all kids as often discovered incidentally
133
4 important things to note on spinal X-ray in scoliosis patient
```
Major curvature
Minor curvatures (compensatory)
Cobb angle (>10)
Risser sign (skeletal maturity on iliac crest, rated 1-5)
```
134
Based on Cobb angle, treatment for scoliosis progresses how?
Monitoring --> bracing (slows/halts progression but doesn't fix underlying) --> surgery
135
Which brace most common for scoliosis
Boston (fits under clothes)
136
Congenital spine issues cause by failures of ___ or ___
Segmentation
| Formation (e.g. hemivertebrae)
137
Discs usually herniate in what direction?
Posterolaterally (posterior longitudinal ligament is thinner)
138
Up to 80% of all disc herniations are ___
self-limiting (usually resolve within 4 weeks)
139
When is imaging indicated for uncomplicated herniated disc or spinal stenosis?
After 6-wk trial conservative management & symptoms severe enough to consider surgery
140
Trick to differentiate muscle/joint vs bone pain?
Give anti inflamm
| If helps --> probably muscle/joint; won't help bone
141
Red flags indicating imaging required (6)
Suspected epidural abscess or hematoma, cancer, infection
Cauda equina syndrome
Severe/progressive neuro deficit
Suspected compression fracture
142
Define cauda equina syndrome
A clinical syndrome caused by compression of nerves in the cauda equina (involving ≥ 2 of the L2–S5 nerve roots).
143
4 symptoms of cauda equina syndrome
Back pain
Variable lower extremity neurological defects
Perianal/saddle anesthesia
Bowel/bladder dysfunction (retention or incontinence)
144
Neurological claudication caused by ___ - when you do things your limbs feel “heavy”. Progresses into ____ (compression).
Spinal stenosis
| Cauda equina syndrome
145
Bloodwork in rickets (5)
Low: Vit D, Ca, Phosphate
High: PTH, ALP
146
What are looser zones? In what disease are these seen
Pseudofractures = bands of low bone density on bone surfaces, look like fractures (e.g. in osteomalacia)
147
name 3 features of rickets (bone deformities)
```
Craniotabes (soft skull) & delayed closure of fontanelles
Knee deformities (genu varum)
Rachitic rosary
```
148
Cupping, stippling, and fraying of growth plates are seen in what disease?
Rickets
149
In case of spontaneous fractures, what neoplasm shoudl be tested for? How?
```
multiple myeloma (plasma cells infiltrate BM)
Serum protein electrophoresis --> monoclonal peak (M spike) = abnormal M protein produced by monoclonal plasma cells
```
150
___ is the primary mediator of bone resorption
___ is the endogenous inhibitor of the action of above
Ratio determines BMB
RANKL
| OPG (decoy receptor)
151
Define fragility fracture
Spontaneously or after minor trauma
- Fall form standing hight or sitting or supine <1m high
Fall missing 1-3 stairs
Coughing, twisting, etc.
152
DIfference between Z-score and T-score in DEXA scan
```
Z = diff from average person your age/sex
T = diff from 30yo same sex (more important!)
```
153
T score cutoffs for osteoporosis & osteopenia
154
Calcium, phosphate, and PTH levels in osteoporosis?
Normal (unless other pathology going on)
155
What blood parameter may be elevated in osteoporosis
ALP
156
Recommended biochemical tests for osteoporosis workup (7)
```
Calcium (corrected for albumin)
CBC
Creatinine
ALP
TSH
Vit D
Serum protein electrophoresis (if vertebral fractures)
```
157
Recommended dietary intake of Ca
1000 mg/d
1200 mg/d for women >50 and men>70
(avoid >2500 or >2000 if >50)
158
Daily recommended Vit D
400-800 IU if <50
| 800-2000 IU if >50
159
Name 6 treatment categories for osteoporosis + examples
1. Exercise (balance + strength)
2. Diet (Ca + vit D)
3. HT (estrogen)
4. SERMs (Raloxifene)
5. PTH (teriparatide)
6. mAbs (denosumab)
7. Bisphosphonates (aldendronate)
160
Why does PTH work as an osteoporosis treatment if it's responsible for bone break down? Drug name example?
Teriparatide
| Opposite affect if given INTERMITTENTLY vs continuously
161
How does denosumab work?
Binds RANKL so it can't bind RANK on osteoclasts
162
What are the rare but serious side effects of bisphosphnoates?
Atypical femoral fracture (subtrochanteric insufficiency fracture)
Avascular necrosis of jaw
163
Advantage of denosumab > bisphosphonates re bone?
Not incorporated iNTO the bone!
164
Bisphosphonates mechanism of action
Bind bone surface --> taken up by osteoclasts --> impair their cellular function --> osteoclast apoptosis
165
Name 2 oral bisphosphonates + 1 IV bisphosphonates
Oral: alendronate, risedronate
IV: zoledronate, pamidronate
166
3 most important tests of synovial fluid
1) Culture + Gram stain
2) Cell count + differential
3) Crystal examination
167
Synovial fluid analysis: %PMN in non-inflammatory, inflammatory, and infectious arthritis
Non-inflamm: <25%
Inflamm: >25%
Infectious: >75%
168
How does infectious arthritis beget destruction of joint?
Inflamm --> effusion --> compress BVs --> necrosis of bones & cartilage
Bacterial proteases digest collagen
169
Septic arthritis key triad
Joint pain + impaired ROM + fever
170
Name 3 pathogens that can commonly cause septic arthritis?
Staphylococcus aureus
Mycobacterium tuberculosis
Borrelia (lyme)
171
What are you looking for on arthrocentesis for septic arthritis?
High WBCs
Positive culture
R/O crystals
172
What is the utility of ultrasound/X-ray/MRI in septic arthritis workup?
Hip/SI joints can't be easily aspirated
R/O differentials (osteomyelitis, other joint diseases)
U/S ---> effusions, soft tissue around
X-ray --> see osteolysis after a few weeks
MRI --> early detection of soft tissue infection
173
What is Reiter syndrome?
Reactive arthritis with the whole triad (arthritis + urethritis + uveitis)
174
Reactive arthritis is a sero___ ___arthritis
```
Seronegative spondyloarthritis (HLA-B27 associated)
AUTOIMMUNE not infectious
```
175
Name 4 common pathogens causing reactive arthritis
Shigella
Chlamydia
Salmonella
Campylobacter
176
Arthrocentesis in reactive arthritis
```
High WBCs (not as high as infectious)
Negative gram stain/culture
```
177
Treatment for reactive arthritis (4 main groups)
```
Self-limiting!
NSAIDs
Intraarticular/oral GCs if refractory
If >6mo (chronic) --> DMARDs, biologics (anti-TNF)
Local cryotherapy, physiotherapy
```
178
4 specific MSK manifestations of reactive arthritis
Asymmetric olifoarthritis
Dactylitis
Enthesitis
Sacroiliitis
179
ANA is a defining features of ____ autoimmune disorders, including (4):
Connective tissue
1) SLE
2) Scleroderma
3) Polymyositis/dermatomyositis
4) Sjogren's syndrome
180
Signs/features of MAS in JIA?
Pancytopenia
Liver insufficiency: high AST/ALT/PT/ferritin, low fibrinogen
UNREMITTING fever
181
Interesting bloodwork sign in MAS
High CRP but LOW ESR because of lack of fibrinogen
182
Steroids important in the case of what 2 JIA complications
```
Anterior uveitis (topical)
Macrophage activation syndrome (parenteral)
```
183
MAS is widespread ____ & ____ caused by activation & overproliferation of what cells?
Hemophagocytosis & cytokine release (macrophages + T cells)
184
Most common JIA subtype = ?
| Complication risk? Which joints most commonly involved? ANA?
Oligoarthritis
Anterior uveitis
Large joints (knee/ankle, wrist/elbow)
ANA+ (70%); RF-
185
What pathogen/infection is associated with RA development? Why?
```
Porphyromonas gingivalis (gingivitis)
PPAD enzyme (like endogenous PAD but not regulated) --> citrullination
```
186
How does RA lead to anemia of chronic disease?
Inflamm cytokines (IL-6) --> hepcidin production in liver --> prevents iron absorption/release (so treating the RA can treat the anemia!)
187
Clue that the diagnosis is RA and probably not reactive arthritis?
>6 week duration
188
4 important things of RA pathogenesis
1) Cirtrullination
2) Synovitis
3) Angiogenesis + pannus formation
4) Osteoclast activation + bone breakdown
189
What are 2 important Abs in RF diagnosis?
RF (IgM against IgG)
| anti-CCP (against citrullinated proteins)
190
Useful imaging modality to monitor RA progression/response to treatment
Doppler U/S
| MRI is good but need to be selective, x-ray can be good for bone dislocations, deformities, erosions
191
4 steps of treatment of RA
1. Non-pharmacological therapy
2. Pain control
3. Conventional synthetic DMARDS
4. Biological and targeted synthetic DMARDS
192
Non-pharm therapy for RA
Stop smoking
Physio, OT
Orthotics/splints
193
name 3 csDMARDS for RA
Hydroxychloroquine
Methotrexate
Sulfasalazine
194
What are tsDMARDS? Advantages?
Jak inhibitors
Small molecule, work better/safer (less infection) than biologics
e.g. Olumiant
195
In OA the joint capsule is...
Thickened
196
6 Ps of compartment syndrome
1) Pain
2) Pallor
3) Paresthesias
(later)
4) Poikilothermia (cold)
5) Pulselessness
6) Paralysis
197
6 components of describing a fracture
1) Location on bone
2) Pattern
3) Displacement
4) Angulation
5) Articular involvement
6) Open or closed
198
Describing fracture location
Epiphysis
Metaphysis
Diaphysis (proximal, mid, distal)
199
Fracture pattern
```
Transverse
Oblique (>30o)
Spiral
Segmented
Comminuted
```
200
Fracture displacement
Describe distal relative to proximal
Shortened (impacted) vs distracted
Lateral/medial, palmar/dorsal, radial/ulnar
201
Fracture angulation
Opposite of apex or say ___ apex
Dorsal vs palmar, varus vs vaLgus (L = lateral)
Radial vs ulnar
202
Fracture articular involvement
Intra- or extra-articular
203
Open fracture AKA
| Requires what intervention?
Compound fracture
| 30 min of surgical lavash
204
AB used for type I-III open fractures? What do you also add for type III?
Cefazolin (gram + coverage) for all
| Gentamicin for type III (severe contamination)
205
What is a salter-harris fracture? 5 types?
```
Fracture through physis
I = transverse through entire physis
II = through physis + metaphysis
III = through physis + epiphysis
IV = through all 3 layers
V = crush fracture of physis
```
206
Primary method for treating clubfoot
Ponseti method (serial casting)
207
Name the 5 deformities associated with clubfoot
Hindfoot: equinus (short achilles), varus
Midfoot: cavus
Forefoot: adductus, supination/inversion
208
Clubfoot detectable prenatally at ___ weeks via ___
12-13 weeks (after physiological shift away from equinovarus adductus position)
Transvaginal U/S
209
Clubfoot AKA
Talipes equinovarus
210
Common shoulder tendinopathy must be distinguished from ___ (reduced ROM), ____ (persistent weakness), and ____ (painful flexion)
Adhesive capsulitis
Rotator cuff tendon tear
Biceps tendinopathy
211
Trick to differentiate tendinopathy from tear (shoulder)
Give lidocaine , if ROM improves it's tendinopathy & vv
212
Empty can test for ___ function
Supraspinatus
213
___ = gold standard imaging for tendon disorders
Ultrasound (dynamic)
214
____ and __ useful for evaluating & treating frozen shoulder respectively
```
Arthrography
Arthroscopy (if conservative measures dont' work)
```
