Ortho/Rheum Flashcards
(128 cards)
1
Q
What is the treatment for dry eyes from Sjögren’s?
A
Cyclosporine
2
Q
What condition is most commonly seen with Raynauds?
A
Scleroderma
3
Q
Anti-Ro and Anti-la antibodies?
A
Sjögren’s
4
Q
What condition does a Schirmer test help diagnose?
A
Sjögren’s
5
Q
What condition is associated with CREST syndrome?
A
Scleroderma
6
Q
Anticentromere antibody?
A
Scleroderma
7
Q
What is the Dx? 20 year old female with pericarditis and rash.
A
Systemic lupus erythematosus (SLE)
8
Q
Anti-smith antibodies?
A
Systemic lupus erythematosus (SLE)
9
Q
List the causes of Reiters syndrome.
A
Chlamydia - Salmonella - Clostridium difficile - Campylobacter jejuni
10
Q
Uveitis urethritis and oligoarthritis?
A
Reiter’s syndrome
11
Q
What disease is associated with polymyalgia rheumatica?
A
Giant cell arteritis
12
Q
What is the Dx? AM Stiffness in shoulders and hip girdle in a 50 year old.
A
Polymyalgia Rheumatica
13
Q
Anti jo1 antibodies?
A
Polymyositis
14
Q
What treatment is used for acute pseudogout?
A
Steroids and aspiration of the joint
15
Q
What medications are used for acute gout?
A
Colchicine and indomethacin
16
Q
What medication is used for chronic gout?
A
Allopurinol
17
Q
Most common part of body to get a pseudogout attack?
A
Knee
18
Q
Most common part of body to get a gout attack?
A
First MTP joint (AKA: Podagra)
19
Q
Positive birefringent crystals?
A
Pseudo gout
20
Q
Negative birefringent crystals?
A
Gout
21
Q
How many fibromyalgia trigger points are needed for diagnosis?
A
Greater than 11 of 18
22
Q
Fibromyalgia treatment?
A
Tricyclics (e.g. amitriptyline) - Patient education
23
Q
Osteoporosis treatment?
A
First line: bisphosphonates consider denosumab - teriparatide
24
Q
Swan neck deformity and ulnar deviationn associated with?
A
Rheumatoid arthritis
25
Boutonniere deformity associated with?
Rheumatoid arthritis
26
Bouchard nodes associated with?
Osteoarthritis
27
Heberden's nodes associated with?
Osteoarthritis
28
What medication is often used to treat the pain and inflammation of Sjögren's syndrome?
Hydroxychloroquine with steroids for the pain and inflammation
29
What antibodies are associated with Sjögren's syndrome?
Anti-Ro and anti-La antibodies also known as SSA and SSB
30
What are two common complications associated with Sjögren's syndrome?
Primary biliary cirrhosis and non-Hodgkin’s lymphoma
31
Which antibody is associated with scleroderma?
Anti-centromere antibody
32
Will a patient with scleroderma develop dysphagia to solids, liquids, or both liquids and solids?
Both liquids and solids
33
Patients with SLE are commonly treated with what two types of medications?
Corticosteroids and immune modulation medications like cyclophosphamide
34
Screening for SLE is performed using the ANA antibody. Which antibody is confirms the diagnosis?
Anti-Smith antibody
35
A 30 year old female presents with erythema over the cheeks and nose and pericarditis. What do you suspect?
Systemic lupus erythematosus
36
Which rheumatologic disorder may follow infection with Chlamydia, Campylobacter Jejuni or Clostridium difficile?
All three infections can lead to Reiter’s syndrome (also known as reactive arthritis)
37
What condition do you suspect in a 54 year old with stiffness specifically in the shoulders and hip girdle?
Polymyalgia rheumatica
38
How does polymyositis differ from myasthenia gravis?
Polymyositis does not cause facial or ocular weakness like that which is seen in myasthenia gravis
39
What is the diagnostic test of choice in a patient with dermatomyositis?
Muscle biopsy
40
A 50 year old man has a purplish mottled discoloration of the torso, muscle pain, extremity weakness, weight loss and HTN. What condition do you suspect?
Polyarteritis nodosa
41
What is the age of onset for psoriatic arthritis?
Between the ages of 30 to 50 (Skin involvement occurs before the joint involvement)
42
What is the age cut off for someone to have juvenile rheumatoid arthritis?
Joint stiffness for more than six weeks in a child 16 or younger
43
Name three deformities seen in rheumatoid arthritis.
Ulnar deviation - Swan neck deformity - Boutonniere deformity
44
Which bone cancer is most likely to start in the spine or pelvis of children?
Ewings sarcoma
45
What age group is osteosarcoma most likely to affect?
Second decade of life
46
What is the Dx? Patient in his 20s with progressive bone pain worse at night and a sunburst appearance on X-ray.
Osteosarcoma
47
What is the most common bone location for metastasis of other (non-ortho) cancers?
Spine
48
Which type of bone cancer is usually seen in patients over 50 years of age?
Chondrosarcoma
49
Name 3 types of Bone cancer.
Osteosarcoma - Chondrosarcoma - Ewings sarcoma
50
What pathogen can cause septic arthritis in healthy sexually active young adults?
Neisseria gonorrhoeae
51
Treatment for osteomyelitis?
Debridement - Blood and wound cultures - Antibiotics based on culture for 6 + weeks - Remove hardware if present
52
Is osteoarthritis or rheumatoid arthritis more likely to be associated with a pleural effusion?
Rheumatoid arthritis because it is a systemic disease process
53
What hypertension medication can cause gout attacks?
Hydrochlorothiazide
54
+ C-ANCA?
Wegner’s Granulomatosis
55
+ Anti-Acetylcholine receptor antibody?
Myasthenia Gravis
56
+ Anti-PM1 antibody, Anti-Jo antibody?
Polymyositis
57
Anti-CCP (cyclic citrullinated peptide) is the most specific test for what disorder?
Rheumatoid Arthritis
58
+ P-ANCA?
Churg-Strauss and ulcerative colitis
59
+ Anti-basement membrane antibody?
Goodpasture’s Syndrome
60
+ ASCA?
Crohn’s disease
61
+ anticentromere antibody and anti-SCL 70 (AKA anti-topoisomerase)?
Scleroderma
62
What type of fracture places patient at risk for fat embolism?
Long bone fracture
63
What exam finding is pathognomonic for fat embolism?
Petechial rash after long bone fracture
64
Treatment for compartment syndrome with high compartment pressure of 35-40 mmHg?
Fasciotomy
65
5 Ps to look for if compartment syndrome is suspected?
Pain - Pallor - Pulselessness - Paresthesias - Paralysis
66
What is the name for a 5th metatarsal diaphysis fracture?
Jones Fracture
67
Treatment for Achilles tendon rupture?
Surgical repair
68
What is the Dx? + Thompson test of the ankle patient can't stand on toes
Achilles tendon rupture
69
Most common type of ankle sprain?
Lateral sprain from inversion of the foot (Anterior talofibular ligament)
70
What is the most likely injury with a + posterior drawer and posterior sag sign?
PCL injury/tear
71
What is the most likely injury with a + anterior drawer test of the knee?
ACL injury/tear
72
What is the most likely injury after a varus stress trauma to the knee?
LCL injury
73
What is the most likely injury with a + McMurrays test of the knee?
Meniscal tear/injury
74
What is the most likely injury with a + Lachman s test of the knee?
ACL injury
75
Treatment for Osgood-Schlatter?
Conservative: Ice - NSAIDs - Protective pad over area
76
Where is pain and swelling located with Osgood-Schlatter disease?
Tibial tubercle/tuberosity (the point of insertion of patellar tendon)
77
Should DVT prophylaxis be provided to all hip FX patients (unless contraindicated) after ORIF of the hip?
Yes
78
What is the Dx? Elderly patient after a fall with an externally rotated and shortened left leg.
Left hip fracture
79
Name 2 common risk factors for developing a hip fracture.
Osteoporosis - Elderly
80
What is the best imaging study for congenital hip dysplasia?
Ultrasound
81
What is the Dx? Obese child with hip pain limp and altered gait.
Slipped capital femoral epiphysis
82
What is the best imaging for avascular necrosis?
MRI of the hip
83
What is the Dx? Persistent hip pain after trauma which is worse with weight bearing starts in groin and radiates to thigh.
Avascular necrosis
84
How do claudication and pseudoclaudication differ?
Claudication occurs from decreased arterial flow - Pseudoclaudication occurs from nerve compression in spinal stenosis
85
What is the Dx? Elderly patient with pain worse with walking and standing better lying down or leaning forward (grocery cart test).
Spinal stenosis with pseudoclaudication
86
What extra articular manifestations can be seen in patients with ankylosing spondylitis?
Uveitis - Cardiac abnormalities - Interstitial lung disease - CAD - IgA nephropathy
87
What is the Dx? Young man with chronic back pain and stiffness and +HLA-B27 and high ESR.
Ankylosing Spondylitis
88
What age group usually presents with scoliosis?
Teenage girls at onset of puberty to the time of cessation of growth
89
What is the Dx? Oblique X-ray of the Lumbar spine shows L5 with a Scottie dog with collar.
Spondylolysis
90
What is the Dx? Back pain after lifting heavy boxes with lower extremity weakness decreased sensation and + straight leg raise.
Lumbar herniated nucleus pulposus (HNP)
91
Name the syndrome. Hemisection of the spinal cord and loss of motor function/vibration/proprioception on same side, and loss of sensation/pain/temperature on opposite side.
Brown-Sequard Syndrome
92
What is it called when a vertebral body slips anteriorly?
Spondylolisthesis
93
What condition does bladder or bowel incontinence with back injury indicate?
Cauda equina syndrome (requires immediate neurosurgical consultation
94
Which nerve root does the ankle reflex test?
S1
95
Motor nerve root for great toe?
L5
96
Is a clay shoveler's fracture stable or unstable?
Stable
97
Are Jefferson and hangman's fractures stable or unstable injuries?
Both are unstable neck fractures
98
What type of fracture consists of an avulsion fracture of the spinous process of C6 or C7?
Clay shoveler's fracture
99
What type of fracture has bilateral fractures in anterior and posterior arches of C1?
Jefferson Fracture
100
What type of trauma is a hangmans fracture associated with?
Hyperextension and compression of the cervical spine
101
What type of fracture occurs through the pedicles of C2 with anterior slip of C2 on C3?
Hangman's fracture
102
Describe a positive Spurling test.
Pain or radiculopathy with axial loading of the cervical spine
103
What does a + Spurling test indicate?
Cervical nerve root compression
104
What is the most likely Dx? Neck pain after MVA with paraspinal muscle tenderness. C-spine X-ray shows reversal of normal lordosis but no fracture.
Cervical Strain (Whiplash)
105
What causes herpetic whitlow?
Herpes Simplex Virus (HSV)
106
What is a felon?
An abscess in the tip of the finger
107
Preferred treatment for Dupuytren's contracture?
Surgical release
108
How do you treat fractures of the fourth and fifth metacarpal?
Ulnar gutter splint
109
Fourth and fifth metacarpal fracture?
Boxer's fracture
110
What complication are scaphoid fractures at risk for?
Avascular necrosis
111
What is the treatment for a scaphoid fracture?
Thumb spica splint
112
What does snuff box tenderness after a fall indicate?
Possible scaphoid fracture (Treat snuff box tenderness as a fracture)
113
Treatment for Gamekeeper's thumb injury?
Thumb spica splint
114
What injury can occur with a fall on an abducted thumb?
Gamekeepers thumb (AKA: Skiers thumb)
115
What bone is involved in both Colles and Smith fractures of the wrist?
Distal radius
116
What is the most likely wrist fracture in a patient who fell with their hand closed or received a blow to the back of the wrist?
Smith fracture (AKA: Reverse Colles)
117
What is the most common wrist fracture in a patient who fell with an out stretched hand?
Colles fracture: Results in a silver fork or dinner fork deformity
118
Describe the symptoms of De Quervain's tenosynovitis.
Pain and swelling at base of thumb may radiate to radial aspect of wrist
119
What does a positive Finkelstein test indicate?
De Quervains tenosynovitis
120
What is the Dx? Patient with numbness and tingling in 4th and 5th fingers (ulnar distribution).
Cubital Tunnel Syndrome
121
What metabolic conditions are often associated with carpal tunnel syndrome?
Diabetes - Thyroid Disease - Pregnancy - EtOH abuse
122
What condition does a positive Tinel's and Phalen's sign suggest?
Carpal tunnel syndrome
123
Describe Phalen's sign.
Phalen's sign: Pain/tingling with maximal wrist flexion for several minutes
124
Describe Tinel's sign.
Tinel's sign: Pain/paresthesias when you tap the volar wrist
125
What is the Dx? Wrist/hand pain worse at night and with repetitive motions but alleviated by shaking hand
Carpal tunnel syndrome
126
What type of subluxation usually occurs from quickly pulling on a childs lower arm?
Radial head subluxation (AKA: Nursemaid's elbow)
127
What does a Fat pad sign on an elbow X-ray indicate?
Elbow fracture
128
What is the Dx? Acute swollen elbow after bumping it on a table.
Olecranon bursitis (AKA: Scholar's elbow)
