MSK Exam #2 Flashcards

Question

Diabetes presentation

Answer 1

Increased thirst and urination Blurred vision Numbness

Answer 2

Tachycardia Diarrhea Weight loss Elevated temp

Answer 3

Hyperparathyroidism Vitamin D deficiency Diabetes Hyperthyroidism Celiac disease Alcoholism

Answer 4

DEXA or fragility fx Labs to r/o secondary cause Treat osteoporosis an secondary cause if present

Answer 5

Gives 10 year risk of osteoporotic hip fracture

Answer 6

>25% of major osteoporotic fx in next 10 years OR >3% of hip fx next ten years

Answer 7

Everybody gets! Exercise and weight loss Walking 1 hour per week = 20% reduction in hip fracture Smoking cessation ETOH moderation Fall prevention

Answer 8

For everyone! Ideal Vitamin D - 800 IU daily - treat if under 20 with 50,000 weekly

Answer 9

DEXA scan under -2.5 Frax >3% for hip >20% for any fx Frax>3% with T score<1.5 Initiating bisphosphonate therapy

Answer 10

Calcium citrate can be with or w/o food and may be with PPI Calcium carbonate obstructed by PPI and must be with food 1200mg total per day is the goal

Answer 11

Osteoporosis or Osteopenia with +FRAX

Answer 12

End in -dronate Alen - Weekly Rise - Monthly Iban - Q3 months Zole - Yearly

Answer 13

Need a drug holiday of 1+ year with repeat scores - higher risk means longer time before holiday

Answer 14

Take with 8oz of water and NO food No reclining for 30 minutes - heartburn Osteonecrosis of the jaw related to dental procedures - SE

Answer 15

eGFR under 30-35 Significant GI disorders - be cautious

Answer 16

Becoming first line Q6 months Good for CKD patients for osteoporosis $$$ if not covered No drug holiday

Answer 17

Last resort

Answer 18

Inhibits bone resorption and reduces fx risk Also causes clots and hot flashes Needed for

Answer 19

PTH Protein analog Must correct calcium and vitamin D first Wanes after 12 months Good for bisphosphonate holiday

Answer 20

New DEXA every 2 years - consider changing therapy if not inmproving Double therapy not recommended

Answer 21

Osteoporosis before menopause under 50 Failed tx or continual fx

Answer 22

Brittle bone disease, presents with Blue sclera Hearing loss Weak joints and easy fractures

Answer 23

I - Mild; Accelerated osteoporosis II - Lethal - non compatible with life III - Severe, short stature, etc. IV- Moderate, skoliosis, etc. 19 in all

Answer 24

Bowing of bones

Answer 25

r/o abuse Activity restrictions based on severeity May give bisphosphonate therapy

Answer 26

MC joint disease Mainly d/t aging May have asymptomatic or incidental findings

Answer 27

Recurrent trauma leading to degeneration of cartilage Inflammation or loss of estrogen

Answer 28

Bone spur Trying to strengthen itself d/t trauma

Answer 29

Insidious onset Hx of repeated trauma Limited ROM Pain relieved by rest Knee crepitus Early AM stiffness - under 10 minutes

Answer 30

DIP osteoarthritis nodes

Answer 31

PIP nodes - severe osteoarthritis and rheumatoid arthritis

Answer 32

Non-inflammatory Yellow, transparent fluid with few WBCs

Answer 33

Radigraphic - dx of choice May see bone cysts, osteophytes, lipping

Answer 34

PT Weight loss Acetominophen is first line 3-4g daily NSAID - Voltaren/Pennsaid gel or Mobic daily

Answer 35

Effective for most joints Minimal systemic effects Softens up joint space with decreasing efficacy

Answer 36

Helps to lubricate by increasing synovial fluid viscosity Joint injection

Answer 37

Metabolic disease with abnormal amounts of uric acid - monoarticular involvement

Answer 38

Nodular deposit of monosodium urate crystals with an associated foreign body reaction

Answer 39

Gout of the MTP joint of the great toe

Answer 40

Frequently nocturnal Sudden onset Fasting, alcohol, medication changes Asymmetrical with more than one joint possible Intense pain with little weight

Answer 41

Warm, swollen, and tender Inflammatory!! r/o infection

Answer 42

Uric acid level elevated in 75% CBC may help Definitive dx - Negatively birefringent crystals on fluid aspiration

Answer 43

Asymptomatic - Cut out purines, alcohol NSAID for pain - indomethacin/Naproxen Colchicine

Answer 44

Faster than NSAIDs Prednisone, Methylprednisilone Can give directly in joint

Answer 45

Thiazide and loop diuretics Niacin

Answer 46

Venison Nuts Mussels Avocado Sardines

Answer 47

Cheese Bread Vegetables Butter Eggs

Answer 48

Xanthine oxidase inhibitors Alopurinol and Uloric

Answer 49

Increases uric acid excretion - can be used in gouty arthritis

Answer 50

Severe gout with large trophi May need surgery

Answer 51

Positive birefringence Chondrocalcinosis on XR Asymmetrical

Answer 52

NSAIDs and Steroid injections

Answer 53

Chronic systemic inflammatory disease manifesting in synovitis of multiple joints 3x more common in women

Answer 54

From chronic synovitis, Overgrowth of the synovium erodes cartilage, bone, ligaments and tendons

Answer 55

Symmetrical swelling of multiple joint though may be monarticular first Over 30 minutes of AM stiffness Inflammatory Systemic symptoms

Answer 56

Ulnar deviation of wrist Boutinierre and Swan neck deformity Nodules - may be pulmonary

Answer 57

Anti CCP antibodies in 70-8-% ESR/CRP Rheumatoid factor only sensitive in 50% of cases

Answer 58

Hypochromic, normocytic anemia of chronic disease

Answer 59

Plain films may not show changes early on Swelling, demineralization, erosions

Answer 60

Treat both pain and inflammation Treat early NSAID or DMARD

Answer 61

Decrease inflammation and improve pain Prednisone Intrarticular triamcinolone Superior effect for NSAIDs

Answer 62

Methotrexate Pregnancy test needed GI side effects and pancytopenia - follow labs No ETOH Folic acid needed

Answer 63

DMARD Cardiomyopathy and QT prolongation are concerns Risk of retinal toxicity

Answer 64

Older drug as well DMARD Many side effects

Answer 65

TNF inhibitors: Enbrel, Remicade, Humira, Simponi, Cimzia

Answer 66

Asymmetrical Typically in weight bearing joints Prosthetic joints Staph aureus is MCC

Answer 67

Oligoartucular - few joints involved Polyarticular - many joints involved Systemiv Enthesis

Answer 68

Point where tendon/ligament attaches (enthesis) is inflamed

Answer 69

Four or fewer joints Assymetrical Systemic features not common

Answer 70

5+ joints More symmetrical process May be rheumatoid factor positive or negative May have low grade fever

Answer 71

Multiple joints High fever May have an evervescent salmon pink rash

Answer 72

MC in males over 10 Lower extremity large joint arhtritis, llow back pain, sacroileitis Inflammation of tendinous instertions

Answer 73

No one test - may see elevated inflammatory markers

Answer 74

More red cells than white cells with white cells under 2,000 Normal glucose

Answer 75

3K-10K WBCs - mononuclear Normal glucose

Answer 76

5K-69K WBCs - mostly neutrophils Normal or slightly low glucose

Answer 77

Over 60K WBCs, over 90% neutrophils Low to normal glucose

Answer 78

More inflamed/infected leads to lower glucose and higher WBCs Septic>JIA>Reactive>Trauma

Answer 79

May see soft tissue involvement on XR MRI may be helpful

Answer 80

Goal Relieve pain and keepmjoints smooth NSAIDs first line (naproxen, ibuprofen, meloxicam)

Answer 81

DMARDs (Methotrexate)\Response in 3-4 weeks

Answer 82

Insufficiant response to MTX or cannot tolerate TNF inhibitors (etanercept, infliximab) enbreal and remicade respectively

Answer 83

Negative for rheumatoid factor but autoimmune - covers a variety of arhtritis Often affect spine and SI joint

Answer 84

Chronic inflammatory disease of the axial skeleton joints (SI joints typically, then spine) Teens to 20s onset More common in males

Answer 85

Insidious onset - unilateral to bilateral AM stiffnes lasting for hours and improving with activity Lumbar curvature flattens and thoracic curvature exaggerates SOB from physcal restriction

Answer 86

Anterior Uveitis Sausage swelling of fingers/toes Cauda equina Pulmonary fibrosis AV conduction issues

Answer 87

Elevated ESR in 85% Negative RF and anti-CCP Mild anemia Positive HLA-B27 (more in white patients)

Answer 88

XR: Changes take time! Erosion and sclerosis which is bilateral in later stages Shiny corner sign Bamboo spine - fusion of facet joints MRI will show signs sooner

Answer 89

NSAID is first line with steroids having low impact on disease (may even decrease bone density)

Answer 90

TNF alpha antagonists - Enbrel, Remicade, Humira

Answer 91

Psoriasis followed by arthritis in most but not all cases

Answer 92

Symmetrical arthritis DIP joints are MC affected joints Bright white joint on XR Nail pitting Sausage swelling of digits

Answer 93

Severely deforming joint destruction

Answer 94

Elevated ESR May have high uric acid levels w/o gout attacks Negative rheumatoid factor

Answer 95

Sharpened pencil look on phalanx Fluffy periosteal new bone

Answer 96

NSAID - first line TNF blockers and MTX should also be considered early Antimalarials may make worse

Answer 97

May be precipitated by GI/GU infections Few joints in low extremities Extra-articular manifestations are common HLA-B27 asociated MC in young men

Answer 98

Triad of: Arthritis, Uveitis/Conjunctivitis, and Urethritis 1-4 weeks after infection Culture negative synovial fluid Asymmetric!! Systemic symptoms - mucocutaneous lesions

Answer 99

Skin lesions found on palms and soles associated with reactive arhtritis

Answer 100

Some inflammation indicated by synovial fluid analysis

Answer 101

NSAIDs - first line Sulfasalazine or MTX second line Anti-TNF for refractory cases

Answer 102

One fifth of people with IBF More common with crohns

Answer 103

Joint disease that paralells IBD Onset months to years after IBD dx Can also resent with spondylitis that does not parallell IBD

Answer 104

Be careful with NSAIDs - make IBD worse DMARDs may also be effective Steroids may be beneficial

Answer 105

Abrupt onset - urgent ER visit Chills Fever Swelling May look like gout

Answer 106

Aspirate fluid Significant WBC elevation Gram stain, Crystal ID, Culture

Answer 107

Not very useful May see some swelling

Answer 108

C&S for joint fluid Rocephin or Vanc for empiric

Answer 109

Otherwise healthy individuals MC in women under 40

Answer 110

Migratory polyarthralgias for 1-4 days Tenosynovitis (more common) or purulent monoarthritis (less common May have fever, rash, GU symptoms

Answer 111

Inflammatory joint fluid Looks like gout again! Pay attention to hx

Answer 112

Rochephin IV - quicker healing than septic

Answer 113

Rest makes it WORSE rather than better

Answer 114

Rheumatoid arthritis drug Careful in liver disease CI in pregnancy Inhibits pyrimidine synthesis

Answer 115

For ankylosing spondylitis, psoriatic arthritis, Rheumatoid arthritis Risk of anaphylaxis TNF inhibitor

Answer 116

End in ~dronate Inhibits bone resporption Take on empty stomach Osteonecrosis of the jaw Upright after taking medication

Answer 117

Prevents bone loss Increased thromboembolism risk

Answer 118

Caution in elderly Soma can be an addictive substance Flexeril and Robaxin are common

Answer 119

Related to temporal arteritis Pain stiffness in pelvic and shoulder girdle - proximal

Answer 120

Troubel combing hair, putting on coat standing

Answer 121

Anemia with elevated ESR/CRP

Answer 122

LOW DOSE Prednisone with 2-4 week taper - may take years before you need to taper MTX for flares

Answer 123

MC in women, rare in blacks - often also have polymyalgia rheumatica Older pts

Answer 124

Pan-arteritis of medium and large blood vessels - aorta and it branches Can be an issue for vision

Answer 125

HA Scalp tenderness Amaurosis fujax - fleeting blindiness Jaw claudication Fever

Answer 126

Pulsitile, edematous, tortuous temporal artery Maybe MRI/CT Elevated ESR NO CK elevation!!

Answer 127

Biopsy of temporal artery over 3 cm or 1 inch

Answer 128

Can help dx systemic involvement

Answer 129

Begin high dose prednisone 1 month before tapering Add baby aspirin for stroke prevention

Answer 130

1 Gram methylprednisolone may require 2+ years of tx

Answer 131

Often associated with hepatitis B (10% have it) Multisystem necrotizing arteritis of small and medium vessels

Answer 132

Fibrosis of vessels Spares the lungs

Answer 133

Nonspecific - fever, nausea, abd pain, neuropathy, arthralgias Livedo reticularis Digital gangrene Lower extremity ulcerations

Answer 134

No specific test ANCA negative Hep B test Tissue bx Angiogram if mesenteric ischemia suspected

Answer 135

High dose steroids -methylprednisilone for severe Cyclophasphamide added - dont use for long

Answer 136

CKD GI Ischemia CNS disease Cardiac involvement

Answer 137

MC in whites Can occur at ANY age Lungs and Kidney destruction

Answer 138

Upper airway lesions Lower airway lesions Renal issues

Answer 139

Chronic nasal staph

Answer 140

Severe upper respiratory findings - paranasal pain, drainage, saddle nose deformity Serous OM Tracheal stenosis - cough Skin lesions - purpura

Answer 141

Tissue biopsy - must have Elevated ESR Elevated ANCA

Answer 142

Cyclophosphamide - ANCA does not follow remission May use with steroids Rituximab - Maintainance

Answer 143

MTX replaces cyclophosphomides Steroids - continue

Answer 144

Bactrim for chronic Staph infection

Answer 145

Necrotizing vascuitis of medium and small arteries and VEINS Capillaries in lungs and kidneys

Answer 146

Purpura Splinter hemorrhages Lung fibrosis Pulm hemorrhage in severe cases

Answer 147

Elevated ANCA in 75% of cases Elevated CRP/ESR RBC casts, Protein on UA

Answer 148

Steroids, Cyclophosphamide to MTX Immune suppressive tx required for significant involvement

Answer 149

MC vasculitis in children!! Peak in the spring MC in males

Answer 150

IgA deposition -may be allergy mediated Incited by URI, Drugs, Foods, Insect bites

Answer 151

Palpable purpura - lower extremities and buttocks May see intussussception Arthralgia May look like abuse

Answer 152

Mild leukocytosis May see elevated IgA

Answer 153

Prednisone in children - may still have proteinuria for 1 year after onset

Answer 154

Anti-neutrophil cytoplasmic antibodies - associated with Wegners and Microscopic polyangiitis

Answer 155

C -Cytoplasmic P - Pernuclear Usually test for both

Answer 156

Breakfast - 7 Lunch - 12 Dinner - 5

Answer 157

Under 6 weeks

Answer 158

6-12 weeks

Answer 159

Over 12 weeks

Answer 160

Under 20 or over 50 Nocturnal pain Fever/Weight loss Over 1 month Steroid use

Answer 161

C5 nerve root

Answer 162

Lay down flat with legs extended - worsening radicular pain is positive for disk herniation

Answer 163

More sensetive than specific

Answer 164

Evaluation of the UNAFFECTED leg - lay flat and raise - for radicular pain More specific

Answer 165

Weak gluteal muscles on the contralateral side to hip drop

Answer 166

Perform is achilles tendon reflex is abnormal Involuntary shaking when forced dorsiflexion of foot

Answer 167

For malingering: Superficial tenderness out of proportion Axial loading with pain No pain when pt distracted Non anatomic impairment 3/4 is positive

Answer 168

AP, Lateral, Odontoid

Answer 169

3 views and AP and PA views

Answer 170

Normal - a fracture through the neck indicates a pars interarticularis fx

Answer 171

Injury to paravertebral spinal muscles, ligaments, facets, intervertebral disks

Answer 172

Poor physical fitness Job dissatisfaction Smoking Psychosocial issues

Answer 173

Hx of repetetive movement/vibration Transient relief with frequent change in position Worse with movement Radiates to buttocks and thighs

Answer 174

NO neuro defecits Difficultly standing straight Diffuse tenderness in the region - may palpate muscle spasm

Answer 175

XR usually not useful if no trauma - may see aging over 30

Answer 176

Education and symptomatic relief Heat, PT, NSAID or Acetominophen No bed rest Caution with muscle relaxers

Answer 177

Neuro symptom Not improving with conservative therapy - ensure compliance

Answer 178

Improvement should be seen after 4-6 weeks

Answer 179

Repetetive trauma Infection Heredity Tobacco use

Answer 180

Aching +/- radiation Restricted straight leg raise - limited hip flexion Improvement lying down Neuro is NORMAL

Answer 181

Age related changes on XR May want to rule out cancer

Answer 182

Disk space narrowing and Bone spurs

Answer 183

CBT Biofeedback/Spinal cord stimulator Goal oriented activity

Answer 184

Whiplash -Hyperextension and Hyperflexion

Answer 185

Diffuse, non-radiating pain from base of skull to cervicothoracic junction HA

Answer 186

Paraspinous Tenderness and limited ROM NO neuro defecits

Answer 187

XR looking at EVERY vertebrae in the spine for hx of trauma or old age

Answer 188

Soft cervical collar Muscle relaxant NSAID or MILD narcotic Cervical manipulation CI - may use cervical traction ONLY

Answer 189

4-6 weeks to resolve, may take up to 12 months

Answer 190

High energy trauma Extreme ROM injury Axial compression injury

Answer 191

1-3 - One is just the tip, 3 is the process and some of the vertebra

Answer 192

Severe neck pain Focal numbness, global defecits suggest a spinal injury

Answer 193

Palpate and inspect for bruising and swelling through the C-collar - look for a step of point indicating slippage of vertebrae

Answer 194

Fracture without slippage

Answer 195

Fracture with slippage

Answer 196

IMAGING NOT NEEDED IS ALL FIVE SATISFIED: 1. No posterior midline cervical-spine tenderness 2.No evidence of intoxication 3. Normal level of alertness 4. No local neurologic defecit 5. No painful, distracting injuries

Answer 197

CT scan AP, Lateral and Odontoid MRI for neuro symptoms

Answer 198

Immobilize Steroids controversial Consult ortho and neurosurgery Halo vest - Regina George

Answer 199

d/t high energy trauma or in osteoporotic / cancerous patients C collar and backboard Severe pain - may need narcotic May have neuro symptoms Pain on percussion

Answer 200

XR - order CT with contrast if abnormal

Answer 201

TLSO (corset) brace 8-12 weeks if compression fx under 20 degrees Neuro consult Kyphoplasty for MORE than 20 degrees

Answer 202

Spasm in one side of the neck causing abnormal rotation Trapezius or SCM or any other muscle

Answer 203

Peritonsillar abcess

Answer 204

Haldol and Reglan

Answer 205

NSAIDs, Benzos for conservative, Botox for resistant

Answer 206

Shopping cart sign - need to lean over Neurogenic claudication - pain with activity but radicular Improves with flexion

Answer 207

Negative neuro exam Weakness after May have + SLR sign Normal pulses

Answer 208

PT, Water aerobics, NSAIDs for conservative therapy Reatpeat epidural steroid injections Surgery if severe

Answer 209

Herniated disk - can cause sciatica Ipsilateral pain Abrupt severe onset of pain + SLR sign

Answer 210

XR - not very helpful MRI is of CHOICE (but insurance may want an XR first)

Answer 211

NSAIDs, Steroids, Opiates if severe Rest but not complete rest Improves over time (up to a month

Answer 212

Focal defecit - emergent Lack of improvement in 3-4 weeks Recurrent episodes

Answer 213

Compression of L2-L4, stenosis, mass on spine, accident Low back pain and radiculopathy Saddle anesthesia Bowel/Bladder incontinence Foot drop - trip when walking

Answer 214

Emergent!! - referral to neuro-spine Surgery

Answer 215

Emergent MRI

Answer 216

Presentation like a herniated disc but due to some other underlying condition MRI to workup

Answer 217

Hunchback Dowagers hump - often a cosmetic concern Poor pulm function Fall risk

Answer 218

Angle of kyphosis - should be 20-40

Answer 219

NSAIDs Muscle relaxants Back strengthening or bracing Surgery if elligible

Answer 220

Robaxim CNS depressant - can knock a patient out Muscle spasms or tetanus CI in pregnancy

Answer 221

Muscle spasm and/or MSK pain, spastisity Reduces facilitation of spinal neurons CI with Cipro, Fluvoxamine, pregnancy May cause dry mouth

Answer 222

Muscle spasms, TMJ, Fibromyalgia No use in hyperthyroidism, HF, Arrhythmia, MI Caution in acute angle closure glaucoma Pregnancy B

Answer 223

VERY potent Indicated for acute muscle pain Causes CNS depression - can reduce seizure threshold Controlled

Answer 224

For acute muscle pain CI in anemia, hepatic, renal impairment CNS depressant

Answer 225

Hx PE Imaging Labs Constellation of s/s more important than ever

Answer 226

ANA - Anti-nuclear antibody

Answer 227

Looks for antibodies that attack cells - ratio of amount of saline that is needed to dilute out all the AB's - higher is greater likelihood

Answer 228

High sensitivity, Low specificity

Answer 229

1:160 - Get AUTO license at 16

Answer 230

Look for over 40 patterns Look for what antibodies are for

Answer 231

Anti-dsDNA Anti-Smith - At least remember this one Anti-U1-RNP

Answer 232

Mia and Joe go married because they liked each other's skin - Unfortunately Joe wanted to be polyamourous and kept hooking up with some random person who also had nice skin Anti-Mi - Just Dermatomyositis Anti-Jo and Anti-SRP - Dermatomyositis and Polymyositis

Answer 233

Anti-SSA Anti-SSB Double S for two S diseases

Answer 234

Anti-Centromere - With a C!!

Answer 235

Have history of taking a drug - Anti-Histone

Answer 236

Anti-RNA-polymerase Anti-Scl-70

Answer 237

Extractable nuclear antigen - points towards connective tissue disease

Answer 238

Indicates inflammation - not necessarily rheumatoid arhtritis - not specific/sensitive

Answer 239

Anti CCP - 90.4% have RA

Answer 240

CRP is acute ESR is chronic Think alphabetical order

Answer 241

Wegners and Churg-Strauss syndrome

Answer 242

Comes and goes in flares in variable periods Sun, Stress, Infection make it worse Discoid rash Photosensitivity Oral ulcers Alopecia

Answer 243

Low grade fever Joint pain Butterfly rash

Answer 244

Moving arthritis in 2+ joints

Answer 245

Requires biopsy to dx but guarantees lupus

Answer 246

Have hx of taking a drug: Anti histone Hydralazine, Procainamide Penicillamine, Quinidine

Answer 247

Every 6 months Follow with various labs specialties as needed

Answer 248

Refer appropriately Psych SPF over 55 Smoking cessation!! Immunization, Diet, Exercise

Answer 249

Bactrim and Minocycline

Answer 250

Hydroxychloroquine - 1st line for mild Prednisone for moderate MTX or azathioprine added

Answer 251

Hydroxychloroquine, High dose IV prednisone Cyclosporine or monoclonal ab

Answer 252

Bull's eye retinopathy

Answer 253

Naproxen - can also try a steroid or muscle relaxer Use as an add on for flares

Answer 254

Puffiness that does not respond to diuretics Itching and pigmentation changes Raynauds Cutaneous telangiectasias Constipation Iron deficiency

Answer 255

Things get stiff - in general

Answer 256

Limited cutaneous - everything is distal Diffuse cutaneous scleroderma - All over Systemic sclerosis sine scleroderma Systemic sclerosis with overlap syndrome

Answer 257

MC scleroderma Calcinosis Raynauds Esophageal dysfunction Sclerodactyly Telangiectasias

Answer 258

Thickening and tightening of skin on fingers and hands

Answer 259

Anti DNA topoisomerase Anti-Centromere Anti RNA polymerase III Anemia

Answer 260

Get PFT and CT of chest for lung disease screen

Answer 261

nDHP-CCB for raynauds Stepwise approach to control inflammation - NSAIDs (if kidneys okay), then steroids, the hydroxychloroquine, then MTX, then biologics

Answer 262

Used in skin sclerosis and diffuse organ involvement

Answer 263

Autoimmune dryness due to due to diminished lacrimal and salivary gland function

Answer 264

Attack glands - Dry eyes -burning and itching, mouth, Numbness, nerve problems, Vaginal dryness

Answer 265

ANA is often negative ESR elevated Anti SSA and SSB antibodies Schirmers test - for dry eye

Answer 266

Paper wick placed in eye - over 10mm soak is a negative test

Answer 267

Eye drops Skin lotion Fatty acid dietary increase Pilocarpine -cholinergic

Answer 268

Symmetric progressive, painless proximal weakness Muscle atrophy ILD

Answer 269

Gottrons papules and Heliotrope eruption on skin SHAWL SIGN - rash on back of torso

Answer 270

Anti-Mi Anti-Jo Anti-SRP (Remember Mia and Joe) Elevated ESR

Answer 271

Cancer screening every 2 years - age appropriate Swallow test Prednison +/- a DMARD (MTX/Sulfasalazine)

Answer 272

Usually don't cause constitutional symptoms or pathologic fractures/weaken bone

Answer 273

Onion skinning and Moth eaten appearance

Answer 274

Get an MRI - to see soft tissue CT may be better for mets

Answer 275

Overgrowth of bone tissue Males and Long bones most common Benign

Answer 276

Nidus - secretes prostoglandins causing pain Deep, severe pain worse at night and with vasodilation Better with ASA, NSAID

Answer 277

XR - Nidus under 1.5cm, calcified looking like a bell - may need serial imaging CT w/ contrast post XR if any confusion

Answer 278

We cant do a CT - Double density sign

Answer 279

Serial imaging and OTC therapy for mild presentation Removal, Surgery, or Crytherapy for severe

Answer 280

More slow growing than OO Nidus larger than 2 cm In patient SPINE! - neuro symptoms Pain NOT relieved by NSAIDs Systemic symptoms not common

Answer 281

Over 2 cm well circumscribed lesion Shell of new bone surrounding it More soft tissue involvement

Answer 282

Always indicated because of spinal involvement

Answer 283

Refer to onc for a core needle biopsy

Answer 284

Surgical resection -may need for confirmation Curettage and grafting or marginal resection with radiation

Answer 285

Recurrence rate of 10-20% (more than OO)

Answer 286

Bony projections with cartilage cap coming off of long bone MC in tibia, femur, humerus

Answer 287

Grows as the patient grows Most asymptomatic Painless mass Mechanical symptoms - bursitis, etc. Can get fractured or interfere with growth plate

Answer 288

Watch if asymptomatic Excise if inhibiting function, mechanical issues

Answer 289

Recurrence may happen with hereditary osteochondromas

Answer 290

Cartilage tume on the insode of the bone - hyaline From metaphysis into the diaphysis - roughe chondrocytes in the growth plate Typically 2nd decade of life (think growth spurt time

Answer 291

Asymptomaic - Find an incidental knot May have pain, fractures, widening of bones Painless

Answer 292

Centrally located sclerotic looking lesion Use CT/MRI to r/o other diseases

Answer 293

Monitor for small, low-risk lesions Curettage and bone grafting for more concerning

Answer 294

Weight bearing bone >25mm in diameter Involving >50% of the diameter of the cortex

Answer 295

Usually self limiting - may transform to chondrosarcoma - more likely if they have many

Answer 296

Tumor in the epiphysis or apophysis of the bone - MC on proximal humerus

Answer 297

Chronic pain - not affected by exercise Localized tenderness Muscle atrophy and limp may be present

Answer 298

Small well defined lesions with sclerotic border XR usually enough, bipsy to confirm

Answer 299

Curettage and bone grafting Recurrence of 20% Pulmonary mets possible

Answer 300

Abnormal fibrous tissue and trabecular bone replacing normal bone amrrow Slow growing MC in males

Answer 301

Most asymptomatic Shepherds crook Varus defomity or facial assymetry

Answer 302

fibrous dysplasia that is genetic - cafe au lait spots present

Answer 303

Mass with ground glass opacities Thinning of cortical bone May bone scan for multi bone involvement

Answer 304

Nothing if asymptomatic IV bisphosphonates - Fosfamax, curettage not as helpful Send to endo

Answer 305

Recurrence is high May stabilize with maturity

Answer 306

Slow growing bony lesion Tibia in peds, Jaw in adults Firm swelling, tibial bowing Painless

Answer 307

XR - Intracortical lesion Lytic appearing - chunk out of bone

Answer 308

Monitor if asymptomatic with repeat XR every 6 months Resection, Curettage, and bone grafting AFTER skeletal maturity for symptomatic

Answer 309

Collection of fibrous tissue - in kids Usually asymptomatic without bone weakness Lytic on XR and not centered in bone (eccentric)

Answer 310

None if asymptomatic Surgery for large lesions and lesions in high stress areas

Answer 311

Fluid filled bone tumor common in kids 5-15 Asymptomatic unless pathologic fx

Answer 312

Well defined cystic lesions at the metaphysis or metadiaphysis Fallen leaf or fallen fragment sign

Answer 313

Usually resolve after puberty Aspirate and inject methylprednisolone if concerned for fx (ie. contact sports Curettage and graft for LARGE cysts

Answer 314

Rapidly growing and estructive bengn lesion Lots of blood supply MC in females!

Answer 315

Tibia - MC Femur Posterior vertebral elements Pelvis

Answer 316

Pain tenderness and swelling Edema and pathologic fracture Neuro if in spine Stunted growth

Answer 317

Aggressive Eggshell sclerotic rim Soap bubble appearance Lytic metaphyseal lesion

Answer 318

Excision, curettage, and bone grafting always May cauterize blood vessels Recurrence in 10-50% of cases

Answer 319

MC malignant bone tumor - metaphysis of long bones Early adolescence, Adults of 50 are twin peaks

Answer 320

Pin and swelling without eccymosis or erythema Worsening pain and limited ROM No systemic symptoms early on

Answer 321

Osteolytic lesions Moth eaten appearance Starburst and Codmans triangle Bone scan for mets

Answer 322

Surgery with pre and post op chemo to try and save as much limb as possible Radiation usually not effective

Answer 323

Many types - Malignant May be fast or slow growing Older adults MC in pelvis or shoulder girdle May arise from a benign lesion

Answer 324

Deep, dull, progressive, aching pain Worse at night Neuro symptoms possible Limited ROM

Answer 325

Endosteal scalloping on XR

Answer 326

Surgical excision is primary tx with amputation rarely needed

Answer 327

Rare tumor that can proliferate in bone or soft tissue 11 and 22 chromosome translocation

Answer 328

Pelvis and Femur

Answer 329

Localized pain and swelling Constitutional symptoms

Answer 330

Onion skinning on XR Poorly marginate lesion - no round mass

Answer 331

Multi-drug chemo, surgery and radiation - hard to control Better prognosis if young, appendicular skeleton, no mets

Answer 332

Breast Lung Thyroid Kidney Prostate

Answer 333

Pain, Pathologic fracture Anemia

Answer 334

PET scan and biopsy of lesions

Answer 335

Radiation and pain medication Chemo Bisphosphonates

MSK Exam #2 Flashcards

(390 cards)