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Flashcards in MSK Rheumo ortho Step Up Deck (190):
1

where is numbness in carpal tunnel

thumb, index and middle finger

2

most common shoulder dislocation

anterior

3

posterior shoulder dislocations occur with

seizures and electrical shock

4

deltoid malfunction, which nerve

axillary

5

most common hip dislocation

posterior

6

H and P for ligament tear

pain welling that is worse with joint stress
decreased ROM
ligament instability

7

what imaging confirms ligament tear

MRI

8

what is the knee triad injury

medical collateral
lateral meniscus
ACL

9

Tx for Mensical tear

NSAID, PT, arthroscopic repair or debridement

10

signs of compartment syndrome

pain
pallor
poikilothermia
pulselessness
paresthesia
paralysis

11

best screening test for compartment syndrome

pain with passive stretchin

12

colles fracture

fall on outstretched hand
dinner fork appearance

13

what is the most common carpal fracture

scaphoid

14

what is the boxer fracture

5th metacarpal neck

15

fracture humerus puts what nerve at risk

radial

16

management for hip fracture

anticoagulate since at risk for AVN and DVTs

17

which bone fracture puts one at major risk for blood loss

pelvic

18

which back pain is worse at rest and better with activiy

ankylosing spondylitis

19

radiating pain that is worse with standing and walking

pseudoclaudication
relieved when leaning forward or walking uphill

20

deficits with S1 compression

achilles reflex
cannot foot evert or plantarflex
sensory deficit of lateral foot

21

deficits with L5 compression

cannot dorsiflex first toe
sensory deficits- lateral lower leg and first web space

22

deficits with L4 compression

patellar reflex
cannot foot dorsiflex
medial leg sensory loss

23

what is erb duchenne

superior trunk injury
caused from shoulder dystocia usually
will have waiteris tup

24

claw hand injury

ulnar nerve
will have weak finger adduction
poor 4th and 5th finger flexion
lumbrical weakness

25

clinical features of axillary nerve injury

cannot should abduct or elevate

26

klumpke palsy

posterior and medial cord injury from hyperabduction of the arm
will have claw hang, poor wrist and hand function assoc with horner syndrome

27

Tx for osteoporosis

prevention
bisphosphonates decrease osteoclast activity, increase bone densiity and decrease fracture risk
selective Estrogen R modulators like raloxifene help increase bone density
pulsatile teriparatide (recombinanat PTH) stimulates osteoblasts and bone remodeling

28

why is hormone replacement not recommended anymore for osteoporosis

increased risk for breast cancer, DVTs, CAD and stroke

29

signs of osteopetrosis

increased fractures, blindness or deafness, bony compression of nerves, impaired healing

30

labs in osteopetrosis

decreased Hb, decreased Hct
increased acid phosphatase, increased CK

31

Tx for osteopetrosis

transfusion marrow components for osteoclast production, activity restriction

32

signs of paget disease of bone

deep bone pain, increased fractures, tibial bowing, kyphosis, increased cranial diameter, deafness

33

labs in pagets disease of bone

increased alk phos
increased urine hydroxyproline
normal Ca and phosphate

34

my hat no longer fits

paget disease

35

Tx pagets of bone

bisphosphonates and calcitonin

36

osteogenesis imperfecta

defective production collagen
fractures with minimal trauma, blue sclera, skin and teeth deformities, possible deatness, joint hypermobility

37

do not give this for acute attack gout

allopurinol

38

how does allopurinol work

inhibit uric acid formation

39

how does probeneci work

inhibits kidney uric acid resorption

40

what is pseudogout made of

Calcium pyrophosphate dihydrate deposition disease

41

joint aspirate is + birefringent, rhomboid crystals

pseudogout

42

Tx pseudogout

NSAIDs and colchicine

43

msot common cause septic joint

Staph sureus

44

labs in septic joints

increased WBC, inc ESR and CRP
joint aspiration will show numerous WBC with high Neutrophils
decreased glucose
+ cultures

45

Tx gonorrhea septic arthritis

IV ceftriazone and doxy

46

Tx S aureus septic joint

penicillinase R penicillin

47

Tx gram negative septic joint

aminoglycoside

48

msot common cause osteomyelitis in sickle cell patient

salmonella

49

common osteomyelitis in IV drug users

pseudomonas

50

erythema chronicum migrans

bulls eye
lymes

51

what happens in lymes early disseminated state

myocarditis
cardiac arrhythmias
heart block
bells palsy
sensory-motor neuropathies, aseptic meningitis or meningoencephalitis

52

What happens in lymes late disseminated stage

few months to years later, chronic synovitis, monoarthritis or oligoarthritis, subacute encephalopathy or polyneuropathy

53

labs for lymes

ELISA and western blot for Ab

54

Tx lymes

doxycycline, amoxicillin or cefuroxime

55

what causes OA

chronic noninflammatory joint degeneration involving articular cartilage deterioration

56

risk factors for OA

advanced age, FMH, obesity, previous joint trauma, repetitive joint stress

57

joint stiffness and pain that worsens with activity and weight bearing
worse in DIP in hands with heberden nodes and PIPs bouchard nodes

degenerative joint disease

58

XR in degenerative joint disease

osteophyte formation, joint space narrowing, subchondral bone sclerosis and subchondral bone cyst formation

59

RA vs OA

RA affects both sides body in symmetric distribution
DIP joints spared
OA asymmetric may only affect one joint
DIP frequently involved

60

bony protuberances on DIP

heberden nodes

61

bony protuberances on PIP

bouchard nodes

62

Tx OA

activity modification, heat, analgesics, NSAIDs, weight loss, PT, corticosteroid, or hyaluronic acid injections

63

what causes RA

chronic inflammatory disorder. synovial hypertrophy with granulation tissue formation on articular cartialge (pannus)

64

HLA in RA

HLA DR4

65

signs Sx RA

PIP and MCP joints
symmetric polyarthropathy
morning stiffness with pain

66

swan neck deformity

flexed DIP with hyperextended PIP
RA

67

boutonniere deformity

flexed PIP
RA

68

other manifestations RA besides hand joints

subcutaneous nodules, pleuritis, pericarditis, scleritis

69

labs in RA

RF + in 75%
+ anti citrullinated peptide Ab ACPA
+ ANA in 40%
joint aspiration will show 5,000-50,000 luekocytes

70

false + RPR or VDRL

SLE

71

Ab in SLE

ANA
anti dsDNA
Anti-Sm

72

Ab in drug induced lupus

antihistone Ab
ANA

73

Ab in polymyositis or dermatomyositis

ANA
Anti-Jo1

74

Ab in Ankylosing spondylitis

HLA B27

75

Ab in scleroderma

anti Scl 70 ANA

76

Ab in CREST

anti centromere

77

Ab in mixed CT disease

anti TNP ANA

78

Anti Ro and Anti La

sjogren

79

Tx RA

DMARDs like hydroxychloroquine or sulfasalazine
MTX or TNFa inhibitors
leflunomide, anakinra
glucocorticoids and NSAIDs for acute flares

80

if starting TNFa inhibitor, need to check what

PPD for latent TB

81

Risk factors SLE

young women
black asian or hispanic

82

findings in SLE

malar and discoid rash, serositis, oral ulcers, arthritis, phosensitivity, CNS symptoms, cardiac Sx, renal Sx
fever malaise, weight loss, abdominal pain, vomiting, conunctivitis, blindness

83

what drugs can present like SLE

sulfonamides, hydralazine, isoniazid and phenytoin and procainamide

84

C' in SLE

dec C3 and C4

85

Tx SLE

avoid sun
NSAIDs
hydroxychloroquine
corticosteroids
immunosuppresants
anticoag if hypercoagulable

86

complications SLE

lupus anticoagulant and anticardiolipin ab increase miscarriage and fetal death

87

risk factors for polymyositis and dermatomyositis

women blacks and elderly

88

signs Sx for polymyositis and dermatomyositis

symmetric progressive proximal muscle weakness (legs first) and myalgias

89

red heliotropic rash on face, upper extremities, chest back
violet discorloarion of eyelids

dermatomyositis

90

labs in polymyositis and dermatomyositis

increased Cr, aldolase, CK, AST, ALT, LDH
ANA +
Anti jo1 if intersitial lung disease

91

muscle Bx of dermatomyositis

inflammatory cells surrounding muscle fasicles and muscle degeneration

92

muscle Bx polymyositis

inflammatory cells within muscle fasicles and muscle degeneration

93

EMG of polymyositis

spontaneous fibrillations

94

Tx polymyositis

high dose glucocorticoids 4-6 weeks with taper
IV Ig and rituximab for resistant cases

95

complications polymyositis or dermatomyositis

interstitial lung disease, increased risk of malignancies

96

polymyalgia rheumatica is assoc with what

temporal arteritis

97

Sx polymyalgia rheumatica

pain and stiffness in shoulder and pelvic girdle
difficulty getting out of bed or raising arms
unexplained weight loss, fever, minimal joint swelling
strength maintained but movement limited by pain

98

labs in polymyalgia rheumatica

decreased Hct
increased ESR
negative RF

99

MRI in polymyalgia rheumatica

increased signal at tendon sheaths, and synovial tissue outside joints

100

imaging for polymyalgia rheumatica

MRI

101

Tx for polymyalgia rheumatica

low dose corticosteroids and after 1 day already have relief

102

Dx polymyalgia rheumatica, next step?

workup for temporal arteritis

103

presdisposition to what with fibromyalgia

hypothyroid
RA
sleep apnea

104

Tx fibromyalgia

stretching
TCAs
SSRIs
patient education
PT

105

risk factorys of ankylosing spondylitis

20-40 years old
male >female
white >black

106

Sx ankylosing spondylitis

hip and low back pain that worse in morning and improves over course of day
limited ROM
painful kyphosis, relieved when bending forward
can have anterior uveitis

107

labs in ankylosing spondylitis

HLA B27 in 90%
increased ESR
neg RF and ANA

108

radiology of ankylosing spondylitis

bamboo spine- vertebral fusions)
MRI can show increased signal in SI joints

109

Tx for ankylosing spondylitis

PT
NSAIDs
exercise
sulfasalazine
MTX
anti TNF drugs

110

Arthritis in psoriasis

DIP joints and spine

111

Sx psoriatic arthritis

asymmetic joint pain and stiffness, worse in morning gets better throughout day
pain with stress on joints
!! pitting in nails

112

XR in psoriatic arthritis

highly destructive lesions of DIP and PUP joints
pencil in cup

113

Tx psoriatic arthritis

NSAIDs, MTX, sulfasalazine, anti TNF

114

Sx scleroderma

arthralgias, myalgias, hand swelling, raynaud, skin thickening, esophageal dysmotility
intestinal hypomotility, dyspnea, arrhythmias and HF

115

CREST

calcinosis
raynaud
Esophageal dysmotility
sclerdactyly
telangiectasias

116

anticentromere

CREST

117

anti scl 70 Ab

scleroderma

118

Tx for scleroderma

supportive care, ACEI, CCB, avoid caffeine, nicotine
decongestants help with raynaud
MTX or corticosteroids

119

complications scleroderma

pulm fibrosis, heart failure, acute renal failure from malignant renal HTN

120

what helps with raynauds

decongestants

121

mixed connective tissue disease

overlapping SLE scleroderma and polymyositis signs and Sx

122

Ab in mixed connective tissue diseease

anti ribonuceloprotein RNP

123

Tx for mixed CT disease

NSAIDs, corticosteroids, ACEI

124

sjogrens

lymphocytic infiltraiton exocrine glands

125

sjogren assoc with

RA SLE and primary biliary cirrhosis

126

Sx signs sjogren

dry eyes mouth and enelarged parotid glands, purpura on legs, peripheral neuroapthy, symmetric arthritis

127

sicca syndrome

sjogren without autoimmune association

128

most common type of bone tumor in adults

from mets

129

find bone tumor in adult, next step

full workup to look for tumor source

130

osteosarcoma

most common primary malignant bone tumor
adolescents!
male>female

131

where do osteosarcomas occur

distal femur, proximal tibia, proximal humerus

132

risk factors osteosarcoma

paget disease
p53 mutations
familial RB
radiation exposure
bone infarcts

133

labs in osteosarcoma

inc alk phos, inc ESR LDH

134

XR osteosarcoma

sunburst, codman triangle

135

Tx for osteosarcoma

radical excision and chemo

136

what tumors mets to bone

prostate, renal cell, thyroid, lung, lymphoma and breast

137

tumor in diaphysis of long bones

ewing sarcoma

138

Sx of ewing sarcoma

bony pain
tissue swelling
fever fatigue, weight loss, fractures with minor trauma and maybe a palpable mass

139

labs in ewings

increased WBC, dec Hb, inc ESR need Bx

140

Tx ewings

radiation, adjuvant chemo, radical excision

141

survival ewings sarcoma

60% 5 year with both radiation or chemo

142

what is the most benign bone tumor in metaphysis of long bones

osteochondroma

143

where do osteochondromas occur

metaphysis of long bones
lower femur or upper tibia

144

Signs osteochondroma

irritated soft tissues overlying mass, frequently nontender

145

bony growth of long bone, on top of cortical bone and is non continuous with normal cancellous bone

malingant

146

XR of osteochondroma

bony growth off metaphysis of long bone and cancellous portion is continuous with interior of lesion

147

Risk factors for developmental dysplasia of the hip

female>male
firstborn child
babies in breech
oligohydramnios

148

galeazzi sign

knees at unequal heights when hips and knees flexed

149

asymmetric skin folds in infant

check for developmental dysplasia of hip

150

Dx developmental dysplasia of hip

US
XR only helpful after 4 months of age

151

Tx developmental dysplasia of hip

pavlik harness if less than 6 mo
closed or open reduction if > 6 mo

152

risk factors slipped capital femoral epiphysis

adolescent, obese, black, hypothyroid

153

thigh and knee pain, limp, limited internal rotation and abduction of hip
hip flexion causes external hip rotation

slipped capital femoral epiphysis

154

XR slipped capital FE

posterior andmedial displacement femoral head from metaphysis

155

Tx for slipped capital FE

surgical pinning, weight bearing restrictions

156

increased risk for what with Slipped Capital FE

Avascular necrosis femoral head

157

what is legg calve perthes disease

avascular necrosis of capital femoral epiphysis

158

age of legg calve perthes

3-8 years olf

159

Tx legg calve perthes

containment of hip in acetabulum with surgery or bracing

160

osgood schlatter

inglammation of tibial tubercle- osteochondritis

161

age for osgood schlatter

young boys during puberty

162

Tx osgood schlatter

stretching exercises and NSAIDs

163

salter harris physeal fracture I

physeal separation no extension into bone

164

salter harris physeal fracture II

partial physeal separation with proximal extension into metaphysis, rare growth disturbance

165

salter harris physeal fracture III

partial pyseal separation with distal extension into epiphysis

166

salter harris physeal fracture IV

fracture through metaphysis, physis and epiphysis

167

what is salter harris fracture V

crush injury of physis

168

most common fracture in children

clavicular fracture

169

how to correct nursemaids elbow

supination of arm with flexion of elbow from 0 to 90

170

rickets

vit D deficiency

171

what happens to bones in rickets

epiphyseal cartilage becomes hypertrophic without calcification

172

Sx of rickets

bone pain, delayed walking, bowed legs, kyphoscoliosis, proximal leg weakness, decreased height, softened skull bones

173

labs in rickets

inc alk phos
dec phosphorus
dec Ca and vit D with inc PTH in hypocalcemic
inc Vit D if hypophosphatemic

174

XR rickets

transclucent lines in bones, flattening of skull, enlarged costal cartilages

175

Juvenle idiopathic arthritis

nonmigratory affecting 1+ joints for > 3months

176

XR for juvenile idiopathic arthritis

osteopenia and subchondral sclerosis around involved joints

177

Tx for juvenile idiopathic arthritis

NSAIDs, MTX and corticosteroids

178

pauciarticular juvenile arthritis

large joints (not hips)
2-3 years old
will have uveitis or iridiocyclitis
resolve in

179

polyarticular juvenile arthritis

5+ joint
2-5 yrs or 10-14 yrs
symmetric, spin involvement, hand deformities
dactylitis
growth retardation, fever

180

which juvenile arthritis does not have growth retardation

pauciarticular

181

systemic juvenile arthritis

182

Tx for systemic juvenile arthritis

NSAIDs MTX, corticosteroids, cytotoxic drugs

183

Duchenne muscular dystrophy

X linked from deficiency in dystrophin

184

most common lethal muscular dystrophy

duchenne

185

when does duchenne muscular dystrophy start

2-6 years old

186

Sx signs duchenne muscular dystrophy

clumsiness, fatiguability,, difficulty standing up and wlaking, gower maneuver, weakness from proximal mm to distal
pseudohypertophy of calf mm

187

labs in duchenne muscular dystrophy

icnreased CK, muscle Bx shows muscle fiber degeneration and fibrosis with basophilic gibers

188

Dx duchennes

immunostaining for dystrophin (which is absent)

189

Tx duchenne

PT
corticosteroids
pulmonary support
ACEI decrease cardiac afterload

190

complications duchenne

cardiac issues, scoliosis, flexion contractures
death by 20 years old from respiratory issues!!!