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Flashcards in MSK= rheum and ortho Deck (166):
1

absence of inflammation and normal lab tests

osteoarthritis

2

best initial analgesic in OA

acetaminophen

3

efficacy of glucosamine and chrondroitin sulfate

NO more effective than placebo

4

chronic gout

tophi--ANYWHERE in body
uric acid kidney stones
LONG ASYMPTOMATIC periods between attacks

5

most accurate test in gout

aspiration joint: needle shaped negative birefringence

6

what is essential to do in dx of gout

TAP JOINT-- exclusion of infection

7

protein and glucose levels in synovial fluid

NOT HELPFUL in diagnosis of gout

8

acute attack lab findings in podagra

ELEVATED ESR and LEUKOCYTOSIS

9

x-rays in gout

NORMAL early on
EROSIONS of cortical bone occur latter

10

intial tx of gout

1. NSAID's
2.STEROIDS
3. colchicine-- used when cannot use NSAIDs or steroids

11

when to use steroid injections in gout

RENAL INSUFFICIENCY or unrepsonsive to NSAIDs

12

diet change in gout

- decrease beer
- weight loss
- decrease high purine foods: meat and seafood

13

side effects of colchicine

neutropenia
and diarrhea

14

benefit of colchicine in gout

effective in PREVENTING SECOND ATTACK of hout

15

gout drugs contraindicated if have renal insufficiency

probenecid
NSAIDs
sulfinpyrazone

16

gout drugs safe if have renal insufficiency

allopurinol

17

which gout drugs not okay to use in podagra

uricosuric agents-- probenecid and sulfinpyrazone
or allopurinol

18

what drug to use if patient has high bp AND gout

losartan-- since lowers uric acid aswell

19

2 big risk factors for pseudogout

HFE
hyperparathyroidism

20

confirmation dx of pseudogout= calcium pyrophosphate deposition disease= CPPD

MUST HAVE ASPIRATION OF JOINT-- positively birefringent rhomboid crystals

21

initial tx of CPPD

1. NSAIDS
2. IA steroids
3. colchicine-- prevent subsequent attacks

22

lower back pain without neuro deficits etc.

NSAIDs. nothing more.

23

lower back pain with sensory loss, point tenderness over spine, hx of cancer, hyperreflexia

CORD COMPRESSION-- malignancy

24

lower back pain with sensory loss, point tenderness over spine, hx of cancer, hyperreflexia AND FEVER AND INCREASE ESR

epidural abscess

25

MRSA epidural abscess

vancomycin or linezolid

26

acute neuro deficits, epidural abscess

systemic steroids

27

methicillin sensitive s.aureus epidural abscess

oxacillin, naficillin, cefazolin

28

leg pain in sciatica

buttocks and BELOW level of the knee

29

DIAGNOSTIC OF SCIATICA

positive SLR

30

L4

m: dorsiflex foot
s: inner calf
r: knee jerk

31

L5

m: dorsiflex toe
s: inner forefoot
r: -

32

S1

m: eversion foot
s: outer foot
r: ankle jerk

33

best initial test for: cord compression, epidural abscess, ank spon, CES

MRI

34

imaging for simple Lower back pain

NOOOOOO

35

imaging for positive SLR alone

NOOOOOOO

36

tx of cord compression

STEROIDS-- more important to prevent paralysis first, then giving MRI imaging

37

tx CES

surgical decompression

38

tx of sciatica

NSAID's and continue ordinary exercise. NO BED REST.
rapid and dramatic beneficts with steroid injections

39

leg pain worse with leaning backwards/ going down hill

lumbar spinal stenosis

40

leg pain better with leaning forward/cycling

lumbar spinal stenosis

41

only test for dx of spinal stenosis

MRI

42

tx spinal stenosis

surgical-- dilate spinal canal

43

what is normal in spinal stenosis

ABI's

44

labs in fibromyalgia

NORMAL LABS

45

best initial tx of fibromyalgia

1. amtitryptiline
2. milnacipran
3. pregabalin
4. trigger point injections with local anaesthetics

46

tx of fibromyalgia with steroids

NEVER THE RIGHT ANSWER

47

when is carpal tunnel pain worse

AT NIGHT

48

most accurate dx of carpal tunnel syndrome

electromyography
nerve conduction studies

49

MRI for carpal tunnel syndrome

NEVER ENVER NEVER NEVER

50

best initial tx carpal tunnel

1. wrist splints
2. avoid manual activity
3. nsaids etc.
4. steroid injection

51

curative tx carpal tunnel

surgical release

52

duputyrens contacture tx.

1. triamcinolone
2. lidocaine
3. collagenase injection

53

severe tenderness at insertion of supraspinatous

ROTATOR CUFF INJURY

54

most accurate test in rotatory cuff injury

MRI

55

tx of rotatory cuff injury

1. conservative: red, NSAIDs, physical tx
2. surgery-- complete tear, unresponsive to conservative

56

which comes first-- sensory or motor impairment in carpal tunnel syndrome

SENSORY

57

anterior knee pain after trauma to joint or meniscal tear

PATELLOFEMORAL SYNDROME

58

anterior knee pain WORSENS just after starting to walk

patellofemoral syndrome

59

anterior knee pain RELIEF after sitting for a prolonged period of time

patellofemoral syndrome

60

XR in PF syndrome

NORMAL

61

tx of PF syndorme

physical tx

62

surgery in PF syndrome

NOOOOO NEVER- because nothing to fix surgically

63

very severe pain in bottom of foot, near the calcaneus

plantar fasciitis

64

pain with plantar faciitis

WORSE-- morning
RELIEF-- walking few steps/use

65

tx of plantar faciitis

1. stretching, arch supports, NSAIDs
2. steroid injection
3. RARELY surgical release of plantar facia

66

need an abnormal XR to diagnose RA?

NOOOOOOOOO

67

Point system dx of RA, >6 points

1. joint involvement (up to 5 points)
2. ESR or CRP (1 pt)
3. duration > 6 weeks (1 pt)
4. RF or anti-CCP (1 pt)

68

MCC death in RA

CORONARY ARTERY DISEASE

69

any patient with erosive disease in RA, start with at least....

METHOTREXATE

70

erosive disease in RA=

joint space narrowing
physical joint deformities
XR abnormalities

71

mild disease DMARD--

hydroxchloroquine

72

what to do before hydroxychloroquine

DILATED EYE exam-- since its toxic to the retina

73

what RA drugs safe in pregnancy

sulfasalazine and hydroxchloroquine

74

SE's of sulfasalazine

- bone marrow toxicity
- hemolysis with G6PD
- rash

75

non- diagnostic criteria for SLE

- alopecia
- lung: pneumonia, alveolar haemorrhage, restrictive lung disease
- ocular: photophobia, cotton wool spots, blindness

76

acute exacerbation of SLE labs

decrease complement
and increase anti-dsDNA

77

what do you patients with SLE die from

infection

78

what do older patients with SLE die from

atherosclerosis

79

asymptomatic ANA

DO NOT TREAT

80

best initial test for APL

mixing study

81

most specific test for APL

Russell Viper Venom Test: prolonged with APL Abs and does not correct on mixing with normal plasma

82

asymptomatic APL antibody

DO NOT TREAT

83

when to investigate APLS

- two first trimester losses
- one second trimester loss

84

preventing recurrence of spontaneous abortion with APL

heparin and aspirin

85

pencillamine in scleroderma

NOT EFFECTIVE

86

renal crisis tx in scleroderma

ACE inhibitors

87

raynaud tx in scleroderma

CCBs

88

pulmonary fibrosis tx in scleroderma

cyclophosphamide

89

pulmonary HTN tx in scleroderma

- bosentan
- sildenafil
- Prostacyclin analogs: iloprost, treprostinil, epoprostenol

90

which cancers are associated with dermatomyositis

OVARY
LUNG
GI
LYMPHOMA

91

best initial test for dermatomyositis

CPK and aldolase

92

most accurate test for dermatomyositis

muscle biopsy

93

anti-Jo antibodies associated with...

lung fibrosis

94

very bad dental caries and need to constantly drink water

sjogrens syndrome

95

most dangerous complication of sjogrens

lymphoma

96

best initial test for sjogrens

schirmer test-- filter paper placed against eye-- wetness of filter paper

97

most accurate test for sjogrens

lip or parotid gland biopsy

98

intial tx of sjogrens

water the mouth
fluoride
artificial tears

99

medical tx of sjogrens

pilocarpine and cevimeline: increase ACh

100

cure for sjogrens

NOOOOOPE, just evaluate for lymphoma, and lifespan is NOT shortened

101

foot drop ddx

peroneal nerve injury
- lead poisoning
- PAN

102

multiple peripheral neuropathies-- like radial nerve and perennial nerve and ulnar nerve and lateral femoral cutaneous nerve

MONONEURITIC MULTIplex

103

mononeuritis multiplex associated with....

PAN

104

stroke in a young person with vasculitis

PAN

105

most accurate test for PAN

bx of symptomatic site

106

test all patients with PAN for.....

hep B and hep C

107

elevated ESR
normal CPK and aldolase

polymalgia rheumatica

108

tx of polymyalgia rheumatica

LOW DOSE steroids

109

giant cell arteritis complication....

aortic aneurysm

110

blindness in GCA

IRREVERSIBLE

111

c-ANCA

anti-proteinase 3

112

p-ANCA

anti-myeloperoxidase

113

best test for wegner

LUNG bx> renal bx

114

least accurate bx in wegners

sinus biopsy

115

recurrent URTI and LRTI with renal insufficiency -- NOT resolving with antibiotics

wegners

116

most accurate test churg-strauss

biopsy

117

most accurate dx of HSP

bx

118

most common dx of HSP

CLINICAL

119

IgA levels for HSP

NOT RELIABLE for making the HSP diagnosis

120

cryoglobulins are not the same as....

cold agglutinins

121

lab tests in cryoglobulinemia

positive RF
make IC's in the cold

122

cryoglobulinaemia tx

NOT STEROIDS
tx underling-- hep C: IFN and ribavarin

123

complement decrease SLE

C3 decreased
(SLE= 3 letters)

124

complement decrease hep C

C4 decreased
(hep C= 4 letters)

125

oral ulcers, genital ulcers, skin lesions

bechets syndrome

126

non-triad thing with bechets...

OCULAR LESIONS--> blindness

127

pathergy

sterile skin pustules from minor trauma (like needle stick), associated with bechets syndrome

128

HLA-B27

NEVER NEVER NEVER
- most accurate
- best initial
- confirmatory

129

back pain worsened by rest

ANK-SPON

130

2 heart things with ank-spon

aortic insufficiency
AV block

131

best initial test in ank-spon

XR of SI joint

132

most accurate test in ank-spon

MRI-- shows abnormalities years before XR is abnormal

133

bamboo spine

LATE finding in ank-spon

134

tx of ank spon

1. NSAIDs
2. exercise
3. anti-TNF

135

tx of psoriatic arthritis

1. NSAIDs
2. MTX
3. anti-TNF

136

specific test for reactive arthritis

NOOOOO specific test for reactive arthritis

137

keratogerma blenorrhagicum

skin lesion unique to reactive arthritis that looks like pustular psoiasis

138

what should be done for hot swollen joint

JOINT TAP-- exclude septic joint

139

tx of reactive arthritis

1. NSAIDs
2. sulfasalazine

140

antibiotics in reactive arthritis

OF no use if the joint pain has already started

141

most accurate test in osteoporosis

DEXA scan

142

blood tests in osteoporosis

NORMAL

143

best initial tx of osteoporosis

vit D and calcium

144

order of tx options in osteoporosis

1. vit D and Ca
2. bisphosphonates
3. ERT
4. raloxifene-- post-menopausal woman: LESS breast cancer risk and REDUCES LDL
5. teriperatide
6. calcitonin

145

calcitonin use in osteoporosis

reduces the risk of vertebral fractures

146

side effects of teriperatide

hypercalcaemia
OSTEOSARCOMA IN RATS

147

if presented with multiple tx options for osteoporosis

vit D, ca, bisphosphonates

148

septic arthritis most commonly occurs in....

DAMAGED JOINTS

149

empiric tx for septic arthritis

ceftriaxone and vancomycin

150

GN bacilli septic arthritis tx

- quinolones
- aztreonam
- cefotazime
- piperacillin
- aminoglycosides

151

GP coci (sensitive) septic arthritis tx

- oxacillin, naf
- cefazolin
- pip-tazo

152

GP cocci (resistant) septic arthritis tx

- linezolid
- daptomycin
- tigecycline
- ceftaroline

153

tx of prosthetic joint injection

LOOSENING OF joint
1. remove joint
2. 6-8 weeks antibiotics
3. replace joint

154

mcc prosthetic joint infection

staph epidermidis

155

polyarthritis, tenosynovitis, petechial rash

= GONOCOCCAL ARTHRITIS

156

when does gonococcal arthritis most often occur

during menses

157

best initial tx for gonococcal arthritis

CEFTRIAXONE
NOTTTTTTTTTT--- fluoroquinolones -- since >5% are resistant

158

recurrent gonococcal infection

TERMINAL COMPLEMENT DEFICIENCY

159

OSTEOmyelitis kids

haematogenous

160

OSTEOmyelitis adults

contiguous-- ie. from nearby infection-- diabetic ulcer

161

best initial test for osteomyelitis

XR

162

most accurate test for osteomyelitis

bone biopsy

163

most appropriate next mgmt if normal XR and osteomyelitis

MRI or bone scan (bone scan if contraindicated MRI--- pacemaker ex.)

164

ESR use in osteomyelitis

follow response to tx

165

culturing and drainage of osteomyelitis

NEVER NEVER NEVER NEVER NEVER correct answer-- since cannot distinguish between colonization inside bone vs. causing infection

166

E. coli tx osteomyelitis

ciprofloxacin-- MUST CONFIRM SENSITIVITY to chipper before starting