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Clin Med II > MSK Tx > Flashcards

MSK Tx Flashcards

1
Q

What should be taken with MTX?

A

folic acid

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2
Q

When should MTX be stopped prior to conception?

A

3 mo

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3
Q

MTX SE

A

GI upset, hair loss, oral ulcers, LFTs abnormality,

Increased risk of
infection,

Pancytopenia, allergic rxn, pneumonitis, renal failure, worsening of rheumatoid nodules

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4
Q

What baseline tests does Hydroxychloroquine ( HCQ) require?

A

eye exam and follow up to monitor retinal tox

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5
Q

Sulfasalazine monitoring requirements

A

CBC and CMP 2-4 weeks initially, with stable dose every 3 months

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6
Q

Methotrexate (MTX) monitoring

A

CBC, CMP with starting and adjusting the dose once stable can do q2mo

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7
Q

Leflunomide CI

A

pregnant women because of the potential for fetal harm

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8
Q

TNF inhibitor monitoring

A

CMB, CMP, hep B, C, TB test

get live vacc prior to Rx

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9
Q

TNF inhibitor CI

A

heart failure

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10
Q

TNF inhibitor SE

A

Increased risk of infections

TB reactivation

Demyelinating disorder

Autoimmune disorder (positive ANA ,
lupus like syndrome)

New onset and worsening of heart failure

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11
Q

Rheumatoid Arthritis

A

Early and aggressive tx is impt

NSAIDs

Steroids to ↓ sx rapidly

Daily calcium 1200 mg and vit D 1000-2000 IU

Must get CBC, EST< CRP, Hep B & C serologies and TB testing prior to meds

DMARDs
Methotrexate *MC (take w/ folic acid and avoid alcohol)

Hydroxychloroquine ( HCQ)- can take while pregnant

Biologic DMARDs

Managt HTN, DM, hypercholesterolemia
Smoking cessation

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12
Q

Spondyloarthritis

SpA

A

NSAIDs

Sulfasalazine/ Methotrexate for peripheral arthritis only

Biologics

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13
Q

Osteoarthritis

DJD

A

Mild-mod: Muscle strengthening exercises

Weight loss goal of >7.5% bw

NSAIDS, capsaicin

Mod-Severe: Duloxetine, intraatricular steroid, assisted devices, injection

Joint replacement

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14
Q

Osteosarcome

A

Pre-op chemo

Surgical resection- limb salvage or amputation

Post-op chemo x 1 yr

Blood work and imaging q3mo x 1 yr then q6mo x 2 yrs

Chest CT q6mo x 2 yrs (check for lung mets)

CBC to see effect on bone marrow and RBC prod

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15
Q

Chondrosarcoma

A

Surgical resection

Does not respond well to chemo or radiation

Great prognosis if you catch it early

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16
Q

Ewing Sarcoma

A

Surgery

Radiation

Chemo

70% 5 yr survival if local only 30% if mets

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17
Q

Ganglion Cysts

A

Surgical- open excision to take out entire capsule, requires post-op immobilization x 7 days

Recurrence is common

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18
Q

Septic Arthritis

A

Ortho emergency!

Surgical debridement and irrigation

IV abx (7-10 days)

Complications: osteomyelitis (bone infection)

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19
Q

Osteomyelitis

A

Surgical debridement and irrigation

IV abx (at least 6 wks)

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20
Q

Gonococcal Arthritis

A

Ceftriaxone 1g IM QD until signs and sx improve

Treat pt and partners emperically for Chlamydia (azithromycin or doxy)

Screen for complement deficiency of recurrent disseminated gonococcal infection

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21
Q

Lyme Arthritis

A

IM ceftriaxone 21-28 days if early disseminated

Doxycycline 21-28 days

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22
Q

Viral Arthritis

A

Self-limiting, resolves within 1-2 months

Does not cause destructive arthritis

NSAIDs

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23
Q

Septic Bursitis

A

IV antibiotics

Surgical debridement of bursa

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24
Q

Acute Gout

A

Self limiting but treat w/in first 24 hr bc will resolve quicker

Anti-inflam

Colchicine inhibits polymerization of microtubules inhibiting neutrophil chemotaxis

NSAIDs at antiimflam dose

Steroids

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25
Chronic Gout
Lifestylye mod: weight loss, exercise, diet Low Purine Diet D/c or Δ meds: thiazide ot loop diuretics, niacin, cyclosporin Δ to Losartan, CCB or statins due to protective effect
26
CPPD: Pseudogout
Self limiting Anti-inflammatories Colchicine NSAIDs Steroids No medication for chronic management
27
Osteoporosis
Exercise, fall prevention Calcium (1200-1500 mg/day) Vit D (800 IU/day) Avoid tobacco, limit ETOH Hip protectors Biphosphonates Teriparatide (rhPTH) Abaloparatide Denosumab- can use for CKD pts SERM Calcitonin- max 6 mo
28
Bisphosphonates MOA
inhibit bone RESORPTION
29
Bisphosphonates CI
doNOTuseinpatients with Class IIIb or higher CKD
30
Teriparatide (rhPTH) MOA
increases bone formation by osteoblasts
31
Teriparatide (rhPTH) CI
Pagets Unexplained alk phos elevation Children and teens with open epiphyses Pts with prior radiation therapy Hyperparathyroidism h/o hypercalcemia
32
Abaloparatide CI
Paget disease, Bone metastases Skeletal malignancies Unexplained elevation of alkaline phosphatase Radiation therapy Open epiphyses
33
Abaloparatide MOA
Stimulation of osteoblast function and increased bone mass
34
Denosumab indications
osteoporosis pts w/ CKD
35
Impingement Syndrome | Rotator Cuff Syndrome or Rotator Cuff Disease
NSAIDs, rest, ice, activity modification PT: cuff strengthening, stretching, coordinated motion ``` Subacromial injection(s): lidocaine (Xylocaine) + methylprednisolone (Solu-Medrol) ``` Surgery-rare
36
Rotator Cuff Tears
Partial Tear <50% NSAIDs, subacromial steroid inj, PT >50% → surg Complete Tear→ Surgery
37
Biceps Tendinitis
Conservative measures: rest, NSAIDs, and ROM exercises US guided steroid injections in the bicipital sheath Surgery for failed conservative approach
38
Adhesive Capsulitis "frozen shoulder syndrome"
Conservative therapy- ice, NSAIDs Steroid injections PT is very helpful = GS Surgery if failed
39
Glenohumeral Osteoarthritis
PT NSAIDs- caution in elderly, weight risks/benefits Mod of activities Steroid inj (generally not done due to delay in labral healing) Surgery- joint arthroplasty
40
Lateral Epicondylitis | tennis elbow
Rest and NSAIDs (short term) very successful PT: US, icing, friction massage Steroid inj for immediate relief but no LT benefits Arthroscopic debridement (outcomes are no better than conservative measures)
41
Medial Epicondylitis | golfer's elbow
Rest, NSAIDs, friction massage, ultrasound, icing Splinting- don't want to do LT bc of muscle atrophy Steroid inj Activity mod x 1 mo Surgery: debridement, bone spur shaving, release of flexor muscle
42
Olecranon Bursitis
``` Conservative → compression splinting +/- aspiration +/- steroid injection ``` Surgery→ reserved for failure of conservative tx or in the pt w/ infective bursitis→ debridement/ bursal excision
43
De Quervain Disease/Tenosynovitis | mommy thumb
Activity modification Ice NSAIDs Thumb spica splint Injections along tendon sheath
44
Duuytren's Contracture
Early in the disease→ adjust work environment (wear appropriate gloves, cushion tape, built-up handles, etc.) Persistent symptoms → Intralesional steroid inj or Surgical repair (if contracture present)→ open fasciotomy
45
Polymyositis
Induction- IV steroids then po prednisone 1 mg/kg/day Maintenance Methotrexate or Imuran Mycophenolate Mofetil (esp for ILD) Tacrolumus (esp for ILD) IVIG Rituximab
46
Dermatomyositis
Induction- IV steroids then po prednisone 1 mg/kg/day Maintenance Methotrexate or Imuran Mycophenolate Mofetil (esp for ILD) Tacrolumus (esp for ILD) IVIG Rituximab
47
Inclusion Body Myositis
Low response rate to immunosupp PT
48
Rhabdomyolysis
aggressive IV hydration
49
Polymyalgia Rheumatica
Rapid response to corticosteroids 24 hr imrpovement w/ 10-20 mg po prednisone Slow taper→ prevent relapse Steroid-dependent (if relapse when tapering) → methotrexate to facilitate steroid taper
50
Giant Cell Arteritis | Temporal Arteritis
Induction Prednisone 60 mg po qd If visual loss → Solumedrol 1 g IV qd x 3 d Maintenance wean prednisone slowly (1 mg/kg/day for 2-4 wks) 15-17 mo tx duration If flare → add DMARD (methotrexate or tocilizumab)
51
Fibromyalgia
Pt edu Analgeisa Correct sleep disturb Aerobic exercise*- walking, pool PT CBT Tx of associated d/o Pharm- SNRI (Duloxetine or Minacipran), ACAs, anticonvulsants (Pregablin), muscle relaxant, ace, NSAIDs Avoid opiods or narcotics Most pts will still experience sx despite tx
52
Cervical Radiculopathy
Conservative mgmt NSAIDs and tylenol Muscle relaxers PT once pain controlled Many pts get better w/o tx Refer for surgery → for weakness and persistent sx
53
Cervical Myelopathy
Conservative management (not ideal) Surgical Decompression (anterior or posterior)→ goal is to stop from getting worse (won't cure sx just prevent progression)
54
Radiculopathy or Sciatica
Conservative mgmt Selective nerve inj Surgery Narcotics DON'T do much for neuropathic pain
55
Acute back pain mgmt
Conservative Management Activity modification Bed rest 2-3 days MAX Low stress aerobic exercise to minimize debility caused by inactivity Core strengthening, PT Analgesics NSAIDs and Acetaminophen Opiates may be required in the acute phase (not for > 2 weeks) Muscle relaxers, probably more effective than placebo but have not been shown to be more effective than NSAIDs
56
Lumbar Spinal Stenosis
Conservative mgmt Epidural steroid inj Usually eventually need surgical decompression → elective and usually have sx >1 yr before doing this
57
Spondylolisthesis
surgery→ fusion
58
Cauda Equina Syndrome
Surgical emergency! Immediate surgical decompression w/ lumbar laminectomy
59
SLE
Sunscreen, NSAIDS Glucocorticoids (low dose if not organ threatening) If organ/life threatening → High dose glucocorticoids Immunosuppression Plaquenil
60
Scleroderma
Treat contractures w/ PT Sx benefit from plaquenil ACE-I for renal crisis PPI for esophageal dysfn Cyclophosphamide for ILD Sildenafil for pulm HTN
61
Thromboangiitis Obliterans
Vascular surgery STOP smoking

Clin Med II (19 decks)

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