MSK / Rheum Flashcards
(160 cards)
0
Q
5Ps of compartment syndrome
A
Pain, Paresthesia, Pallor, Paralysis, Pulseless
1
Q
varus vs valgus
A
varus: distal inward
valgus: distal outward
2
Q
blue sclera
Dx, Time of presentation, prognosis/issues, genetics?
A
OI type 1
Fractures in preschoolers
Autosomal Dominant
hearing loss by adult (conductive and sensorineural)
3
Q
type A vs B OI type 1
A
A: good teeth
B: bad teeth
4
Q
most severe type of OI, genetics
A
type 2: born w/ multiple fractures
inherited as new mutation or germinal mosaicism
5
Q
achondroplasia:
- genetics
- cause of sudden death
A
AD, or spontaneous mutation in >80%
cervicomedullary junction compression
6
Q
congenital torticollis can be associated w/ what?
Tx?
When till surgery?
A
hip dysplasia.
PT/stretching, but surgery if still present at 1y
7
Q
head tilt with fusion of cervical vertebrae (congenital synostosis of cervical vertebrae)
Dx, other issues?
A
Klippel-Feil syndrome
issues: short neck, low occipital hairline, scoliosis, myelo, renal issues, sprengel deformity, deafness (assoc GU, cardiopulm, CNS issues)
(Clipper file: clippers giving bad haircut and spine disaster)
8
Q
normal kyphosis
A
20-40, No intervention if < 60.
9
Q
Bad posture, kyphosis, back pain in teen
Dx
Tx
A
Scheuermann dz
NSAID, pt, obs
10
Q
What is sprengel deformity?
A
looks like torticollis, but its due to failure of scapula to descend and affected side is broader and shorter
Congenital elevation of the scapula
11
Q
Barlow vs Ortolani
Which side usu worse?
A
Barlow: adduction w/ downward pressure
Ortolani: attempt to relocate
Left worse
12
Q
migratory arthritis w/ rash?
A
think rheumatic fever, strep
13
Q
one femoral head smaller than other in 4-8 yr old boy?
A
Legg Calve Perthes: avascular necrosis of femoral head
14
Q
when do XR findings of osteomyelintis appear?
A
10-14 days after infx
15
Q
chronic knee pain that locks and swells in adolescent?
Dx and tx?
A
osteochondritis dissecans
adolescent boys: immobilization, eventual removal of fragments if not improved
16
Q
pain just below knee in adolescent athlete?
A
Osgood Schlatter
17
Q
When to observe for scoliosis?
A
if curve < 25degrees
18
Q
When to brace for scoliosis
A
if more than 2 yrs growth expected, and curve is 25-40
19
Q
When surgery is needed for scoliosis
A
curve >40-45
20
Q
Dx w/ swelling of bone shafts only in cortical bone, with progressive cortical thickening. DDX?
A
Caffey Dz.
DDX: NAT, but there is no periosteal involvement
21
Q
internally rotated foot with contracted achilles
Dx?
Tx?
how often both feet?
A
club foot, tx: stretch, cast serially (Ponsetti 4-5 wks), surgical release in late 1st year.
50% bilateral
22
Q
genu varus ok until when, then think what?
A
bow legged okay until age 2 and if bilateral.
If not, think rickets, Blounts disease
23
Q
Blount’s disease
What is it, what are the types
A
pathology of proximal tibial physis/epiphysis
Infantile: African Americans, no tx needed
Adolescent: obese African American: need tx
24
absent radius (thumb issues): name 3
1. TAR: thrombocytopenia, absent radius
2. Fanconi ANEMIA: fan blade cuts it off
3. VATER: R: absent radius
25
two syndromes to think of w/ high arches?
1. Friedreich (Fried arch)
| 2. Hurlers
26
Flat feet, pes planus tx:
usu no intervention
27
Tx for salter 1 frx
2-3 weeks cast
28
Type 2 SH fracture?
| Tx
metaphysis splits w/ some physis (the dogbone part: meta)
| closed reduction 3-6 wk cast
29
Type 3 SH?
| Tx
through growth plate and epiphysis, may need open reduct. WORSE than 2 b/c goes into joint space...
30
the deal with fat pads on XR?
anterior fat pad: all right
| posterior fat pad: poor...fracture?
31
snuff box pain?
scaphoid bone fracture even if negative XR
32
hip extended and externally rotated in obese teen male.
How to dx?
Tx?
SCFE
Frog leg/AP XR
Tx: immobilize, no wt bearing, may need pins/bone grafts
33
CAuses of arthritis in children?
GLOVE: GC/genetic, Lyme, Osteomyelitis, Viral (toxic synovitis), Evasive infx (septic arthritis)
34
ANA and RF and ESR levels in ankylosing spondylitis
Normal ana, RF, mild incr ESR
35
back pain relief by exercise and pain in knees?
Think anklyosing spondylitis
36
Drugs used to treat pain in Ankylosing spondylitis
NSAID
sulfasalazine
methotrexate
37
aphthous stomatitis, genital ulcerations, uveitis, GI ulcers, arthritis. high ESR/CRP, normal ANA/RH
Dx and Tx
Behcet syndrome
| tx: systemic steroids
38
heliotrope rash on face, tight shiny skin on knuckles/elbows (Gottron papules), periungual lesions
dermatomyositis
39
organ issues in dermatomyositis
esoph, lung
40
tx for dermatomyositis
steroids, MTX, IVIG, antimalarials. NO sunlight
41
Lowe syndrome vs ehler's danlos?
Lowe also with blindness, hypotonia, ID (low vision, low tone, low IQ) Lowe also called oculocerebrorenal syndrome
42
median age of HSP
5 yo Boy
43
potential complication acutely of HSP
ileoileal intussusception
44
plts in HSP?
NORMAL
45
salmon colored evanescent rash
JRA
46
Timing criteria for JRA
< 16 yr, at least 6 wks in at least 1 joint
47
Labs abnl in JRA?
high ANA, RF usually neg but can distinguish subtypes
48
When is JRA likely to have RF+
older pts w/ polyarthritis JRA usually with more serious issues and nodules, like adult version
49
Polyarthritic JRA:
| +/- systemic disease?
unlikely
50
Oligo JRA / Pauci
- def
- main complication
- the deal w/ boys?
less than 5 joints, usu ANA pos young female.
Typical to have chronic uveitis
Boys may be HLAB27 pos w/ good prognosis
51
high fever, leukocytosis, small pale red macules w/ central clearing and coalescing, HSM, LAD, pleuritis/pericarditis.
Dx?
Systemic JRA / Stills
52
ANA and RF in systemic JRA?
both normally negative
53
WHat is tolmetin sodium?
an NSAID
54
Tx for JRA if cardiac involvement?
steroids
55
leading cause of acquired heart disease in kids < 5 y
Kawasaki
56
when to do echo in kawasaki?
dx, 2-3 wks, 6-8 wks
57
tx of kawasaki?
IVIG 2g/kg x1-2 doses
hi dose ASA 80mg/kg/day x 1-2d
low dose ASA 5mg/kg/day x 2 mos
58
if fever, rash, and conjunctivitis, which is measles?
exudative conjunctiviits, and rash starting and the top and going down
59
where is the rash in Scarlet fever?
flexural areas of extremities
60
erythema chronicum migrans ECM
bullseye rash in Lyme
61
Bell's palsy in lyme, what time frame?
Months...
62
Lyme dx steps
Ab titer, then western blot confirm
63
False pos for lyme?
SLE, dermatomyositis, rickettsial dz
64
concern if child treated for Lyme gets chills, fever, hypotension, sepsis-like?
Jarisch-Herxheimer: lysis of organism, release of endotoxin
65
Major criteria for Marfan?
1. 4 Skeletal: tall, high arched palate, hyperextensible joints, pectus
2. dilation/dissx asc Ao. Also get mitral regurg/prolapse
3. lumbosacral dural ectasia
4. ectopia lentis (anterior)
66
bugs to worry about for post-infx arthritis and tx?
Salmonella, Yersinia, campylobacter, or viral. No tx. supportive care.
67
post vaccine arthralgia, likely issue?
post MMR live vaccine, with post-infx arthritis from rubella component
68
Seronegative spondyloarthropathy means what
ANA and RF normal
69
can't see, pee, climb tree?
Reiter: urethritis, iritis, arthritis
70
bugs before Reiter?
Yersinia, shigella, salmonella, Chlamydial
71
dysuria, conjunctival injection, swollen foreskin, negative UA
Reiter. reactive arthritis
72
murmur best at apex + arthritis?
MR murmur, most common in RF.
73
most common two murmurs of rheumatic fever?
MR first (apex), AR next (new murmur and mild CHF).
74
Jones criteria for Rheumatic?
Recent GAS infx + 2 major or 1 major + 2 minor!
75
What are the major criteria: JONES / RF?
```
Joints: polyarthritis
Heart: carditis, CHF, new murmurs, cardiomegaly
Nodules: subctaneous on extensors
Erythema marginatum
Sydenham chorea
```
76
Minor JONES / RF?
FEAR: fever, elevated inflamm markers, Arthralgia not arthritis which is major), pRolonged pR interval
or HELP: hot, elevated labs, arthaLgia, Prolonged PR
77
erythema marginatum
RF
78
erythema migrans
lyme
79
Treatment of acute rheumatic fever?
GAS tx, sx, prophylaxis: PCN, ASA for arthritis/fever, steroids for carditis, haldol for chorea, digoxin for heart failure
80
LAb tests they want for ARF?
Strep: ASO titers and positive streptozyme. Need definitive documentation of recent strep infx.
81
noncaseating granulomas, bilateral peribronchial infiltrates?
Sarcoid
82
sarcoid vs TB?
think EKG rhythm issue in Sarcoid
83
easy fatigue in sports, renal and eye disease, hypercalcemia and calciuria?
SArcoid (granulomas secrete vit D)...
84
linear hyperpigmented patch that becomes fibrotic
| Dx and tx? Prognosis?
localized, linear scleroderma. self-limited. Tx w/ topical lubricant or photochemotx. May need steroids, antimalarials, immunosuppressives if progressive (MTX, penicillamine). Does not progress to systemic
85
ANA in scleroderma
positive in systemic form
86
serum sickness
- type of rxn
- tx?
type III hypersensitivity, fever, urticaria, arthralgia, LAD
| tx antihistamine/steroids
87
Shirmer test?
measures tear production from eye for Sjogren syndrome
88
painless parotid swelling?
Sjogren
89
SLE pathophys
Ag-Ab complexes in lots of tissues
90
urine finding in SLE
cellular casts
91
sensitive test for SLE
| specific test for SLE
ANA sens, anti-smith specific
92
Drug induced Lupus? Categories and three most common
D-SLE: drugs for heart, sulfonamides, lithium, epilepsy drugs
three most common: procainamide, hydralazine, quinidine
93
signs of active renal dz in SLE?
incr anti-DNA titers, decr levels of complement C3, C4, CH50
94
neonate w/ lupus
clue?
dx?
heart block / bradycardia, hydrops...
anti-ro SS-A Abs,
anti-la SS-B Abs
95
best indicator of good response to Lupus tx?
normalization of C3 and C4
96
common tx for lupus if NSAIDs don't work, and its main s/e?
hydroxychloroquine, ototox, ocular: blurring, permanent retinal damage
97
sinus, lung, kidney involvement in white child
| lab?
Wegener Granulomatosis
| c-ANCA
98
Tx of Wegener?
cyclophosphamide, steroid
99
cANCA in kids?
Wegener
100
advice for people with benign hypermobility
stretch before sports
101
normal WBC in synovial fluid
<200
102
arthritis from trauma, how many WBC?
200-2000
103
arthritis from SLE? WBC in synovial fluid?
5000
104
RF, WBC in synovial fluid
5000
105
JRA, WBC in synovial fluid
15-20,000
106
Reiter, WBC in synovial fluid
20,000
107
septic arthritis, WBC in synovial fluid
>50,000
108
Define heat stroke
1. temp > 105
2. hot dry skin (no sweating)
3. CNS depression
109
What can lead to end organ damage how?
| What is tx?
release of endotoxins and cytokines
| ice packs neck, groin, axilla. Cool to 101-102, not lower
110
what is a hyphema?
| What is tx?
blood between cornea and iris after eye trauma
| OPHTHO referral, admit w/ bed rest and head at 30degrees to decr intraocular pressure. Shield (not patch) eye.
111
what is a blow out fracture
| what are the sx of blow out fracture
orbital wall or floor fracture
| blunt eye trauma w/ double vision when looking to one side and dysconjugate gaze to one side. normal pupils.
112
eye w/ severe pain, tearing, but NO diplopia / dysconjugate gaze
corneal abrasion
113
blood in anterior eye chamber w/ possible visual impairment, NO diplopia
hyphema
114
pain and severe photophobia but no diplopia
traumatic iritis
115
visual deficit in peripheral field, curtain like.
| no dysconjugate gaze
detached retina
116
pain, tearing and diffuse uptake of fluorescein stain in eye?
refer to ophtho for concer about ulceration of corneal epithelium or GN infection of eye, esp in contact lenses
117
most typical ankle injury
inversion injury w/ lateral ligaments: anterior talofibular ligament
118
% of sports injuries involving the lower extrem
75%
119
acute knee injury with "pop", and knee effusion, and positive drawer sign.
Definitive dx?
ACL tear, definitive diagnosis is MRI
120
pain over dorsum of hand near base of thumb?
snuff box: scaphoid fracture :(
121
Tx of mid shaft clavicular fracture?
sling, no reduction
122
pain in the distal / superior clavicle area and negative XR
acromioclavicular separation
123
type of clavicular fracture that can be complicated, and requires what?
medial: CT scan
124
pulseless, pain, paresthesia, pallor?
compartment syndrome
125
confusion without amnesia or LOC?
| Dx and tx?
grade 1 concussion
| examine q5 min after removal from game. Need 20 min rest, then can return if no amnesia or HA
126
confusion w/ amnesia but NO LOC
Grade 2, remove from game, examine frequently. F/u 24 hrs.
| 1 week off sx free
127
LOC head injury
Grade 3: ER, sx free 2 weeks
128
What is the risk re: growth in females taking anabolic steroid use?
early closure of epiphyseal plates: short
129
do you get arrhythmias and seizures w/ steroid use (anabolic)
no
130
common lab findings in anabolic steroid use?
LFTs high, low HDL, high LDL, oligospermia/azospermia
131
How do you test for anabolic steroid use? What is the timing for detection?
PO steroids remain in urine days-wks
| IM steroids remain in system for 6 mos or more
132
is hyperactivity a sign of steroid withdrawal?
| Depression?
Not hyperactivity
| Depression yes
133
IS GH detected in drug screening?
N
134
hydration for teen athlete?
8oz (240mL) before exercise, then every 20 min unless very intense/high endurance sports for > 1 hr, then solution w/ 6-8% glucose
135
what does weight loss in wrestler imply?
lower muscle endurance (loss of water weight)
136
Rule about amount of weight loss?
3 lbs / week or 1.5% body weight per week.
137
in athletes with modest cardiomegaly (f) or cardiac hypertrophy (m) what are restrictions/
none, normal findings in healthy athletes
138
rigid spine, elbow contracture early, cardiomyopathy, autosomal dom or x-linked disease
Emory Dreifus
139
JRA NOT assoc w/ uveitis
systemic JRA
140
uveitis most common with which JIA?
| Correlates with?
oligoarthritis > polyarthritis. NOT systemic.
| Correlates with ANA
141
Treatment specific for polyarticular RF+ JIA?
cyclic citrullinated peptide
142
JIA, splenomegaly, neutropenia is what?
Felty syndrome
143
HLA B27 assoc arthritis (now called enthesitis-related arthritis (ERA))
1. Juvenile ankylosing spondylitis
2. IBD related
3. Reactive arthritis (Reiter's)
144
dactylitis - what is it, what should you think of?
sausage digit: psoriatic arthritis
145
Discoid lupus rash path?
hyperkeratosis, follicular plugs, atrophic annular lesions
| Dermal Band Test
146
4 lupus skin/rash criteria (of the 11)
malar rash
discoid lesion
photosynthesis
oral/nasal mucosal lesions
147
lab abnormalities that are part of the SLE criteria (3)
cytopenias (anemia, leukopenia, TCP)
Positive ANA
Positive immuno: anti DS DNA, anti smith, antiphospholipid Abs
148
3 ITIS / SLE dx criteria?
nonerosive arthrisis
nephritis
pleuritis/pericarditis
149
The stand alone SLE dx criteria?
Encephalopathy
150
nuclear pattern of ANA assoc with what? The rest?
nuclear: scleroderma
| The rest nonspecific (speckled, rim, homogeneous)
151
Anti Ro and La have what three assoc?
1. photosens
2. neonatal SLE
3. Sjogren's
152
lupus anticoagulant does what to coags?
prolongs aPTT
153
Summary of SLE diagnostic criteria
11:
4 skin - photosens, malar, discoid, mucosal
3 itis - arthritis, nephritis, pericarditis/pleuritis
3 labs- penias, ANA, immuno
1 other - enceph
154
Gottron papules?
Juvenile dermatomyositis
155
what is curative for periodic fever, aphthous stomatitis, pharyngitis and adenopathy syndrome?
T&A
156
sinusitis, pulm hemorrhage, glomerulonephritis, recurrent otitis, UTI?
Lab?
Complication
Consider Wegeners: Granulomatosis Polyangitis
+c ANCA
subglottic stenosis
157
treatment of familial Mediterranean fever?
How many days of fever
Concern if not treated
colchicine
3 d
amyloidosis
158
CAuse of intoeing in those walking less than 1 yr vs those >2y
tibial torsion in early walking
| femoral anteversion in those over 2y
159
Blood test predictive of uveitis in JRA?
ANA +
