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Pance Prep Pearls > Orthopedics and Rheumatology > Flashcards

Orthopedics and Rheumatology Flashcards

1
Q

Most common cause of hematogenous osteomyelitis spread in adults

A

Vertebral osteomyelitis

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2
Q

Initial treatment of choice for chronic osteomyelitis

A

Surgical debridement + cultures (not empiric treatment which is used in acute)

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3
Q

Most common bones affected by osteomyelitis in children

A

-Long bones of the LE

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4
Q

Most common organism in osteomyelitis

A

Staph aureus

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5
Q

Sickle cell disease and ostteomyelitis, puncture wound thru tennis shoe and osteomyelitis causative organisms

A

Salmonella, pseudomonas

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6
Q

When is pain usually worse in osteoarthritis patients? Is it usually symmetric or asymmetric?

A

The afternoon/evening, asymmetric

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7
Q

Bouchard and heberden nodes

A

PIP and DIP enlargement, respectively

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8
Q

Labs for diagnosis of rheumatoid arthritis (3)

A
  • Rheumatoid factor (best initial)
  • Anti CCP antibodies (most specific)
  • ESR and CRP
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9
Q

All patients on biological DMARDS have to be tested for what condition?

A

PPD to rule out TB as it can reactivate TB

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10
Q

Developmental dysplasia of the hip tests

A

Barlow (dislocation) and ortolani (reduce) in <3 month old

>3 months galeazzi test

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11
Q

Most common type of hip dislocation, most common type of shoulder dislocation

A

Posterior, anterior

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12
Q

Hip fracture complication

A

Avascular necrosis in up to 13%, fractures of femoral head and neck associated with higher incidence of avascular necrosis

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13
Q

Painless limping worsened at end of day in childen 4-10 years think of ___. Painful hip groin thigh or knee pain limp in obese children 8-16 years think ____

A

legg calve perthes, slipped capital femoral epiphysis

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14
Q

Most common knee ligamental injury

A

ACL tear

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15
Q

Most sensitive test for ACL tear

A

Lachman test

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16
Q

Segond fracture definition

A

Avulsion of the lateral tibial condyle with varus stress to the knee, if present it is pathognomonic for a torn ACL

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17
Q

Most common mechanism of a PCL tear

A

Car dashboard collision

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18
Q

Peroneal nerve injury is manifested by

A

Foot drop

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19
Q

Inversion ankle sprain is often due to ___ while eversion is often due to ___

A

talofibular ligament, deltoid ligament

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20
Q

Ottowa ankle rules (5)

A
  • Lateral malleolus pain
  • Medial malleolus pain
  • navicular pain
  • 5th metatarsal pain
  • Inability to walk >4 steps at a time
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21
Q

Maisonneuve fracture definition

A

Spiral fracture of proximal third of fibula associated with distal medial malleolar tibial fracture or rupture of the deep deltoid ligament thru transfer in the interosseous membrane, anyone with a distal ankle fracture should have proximal films to rule out this fracture

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22
Q

1st and 2nd most common bones affected by stress fracture

A

3rd metatarsal, tibia

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23
Q

Neuropathic (charcot) arthropathy definition

A

Joint damage and destruction as result of peripheral neuropathy from DM, PVD, or other diseases, can see joint or foot deformity, alteration of shape of foot, radiographs may show obliteration of joint space

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24
Q

Lab values useful in diagnosis of osteomyelitis, what is the initial imaging test, and what is most sensitive imaging test in early disease? What is the gold standard definitive diagnosis?

A
  • WBC count, CRP***
  • Radiographs
  • MRI
  • Bone aspiration
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25
Q

Interdigital (mortan’s) neuroma definition

A

Compressive neuropathy of the interdigital nerve often in women wearing tight fitting shoes, can cause lancinating or burning pain with weight bearing and some numbness or paresthesia, often worsened with reporducible pain with squeezing of foot

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26
Q

Jones fracture management

A

-Nonweight bearing in short leg cast for 6-8 weeks followed by repeat radiographs as often complicated by non-union or malunion, frequently requries ORIF or pinning

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27
Q

Pseudojones vs jones fracture

A

Pseudojones is more common and less serious and is a fracture thru the base of the 5th metatarsal compared to jones which is the diaphysis of 5th metatarsal and only requires a walking cast for 2-3 weeks to heal well

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28
Q

Most common type of salter harris fracture

A

type 2

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29
Q

Best outcome type of salter harris fracture, worst outcome type

A

Type 1, type 5

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30
Q

Above in the Salter harris classification means in the ____, while below means ___

A

long bone, in the epiphysis

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31
Q

Osteosarcoma definition

A

Most common primary bone malignancy in young adults, 90% occur in the metaphysis of long bones like distal femur or proximal tibia, most commonly mets to lungs, see bone pain that is worse at night, radiographs show hair on end or sunburst appearance or codman’s triangle, biopsy is definitive diagnosis

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32
Q

Chondrosarcoma definition

A

Cancer of cartilage, most commonly seen in adults 40-75 y/o, radiographs demonstrate punctate or ring and arc appearance calcification

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33
Q

Ewing sarcoma definition

A

Second most common primary bone malignancy in children and young adults, femur most common, bone pain and swelling accompanied by systemic symptoms, can see periosteal reaction or codman’s triangle as well

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34
Q

First line medical agents in patients not responsive to conservative lifestyle changes in fibromyalgia patients, what is another option?

A
  • TCA’s like amitryptiline

- pregabalin

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35
Q

How does polymyalgia rheumatica present?

A

Pain and stiffness in proximal joints and muscles worse in the morning x2 weeks, may have difficulty combing hair and rising from a chair, will have normal muscle strength on exam**, closely associated with giant cell arteritis

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36
Q

Polymyalgia rheumatica treatment

A

Low dose corticosteroids

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37
Q

Most important initial test in rhabdomylosis symptoms (muscle pain or weakness or swelling + dark tea colored urine) and what other tests are done?

A
  • EKG to look for signs of life threatening hyperkalemia

- Urine dipstick, creatinine kinase

38
Q

Hyperkalemia treatment steps

A

-Calcium gluconate then insulin administered with D50 saline (glucose)

39
Q

How does polymyositis present?

A

Progressive symmetric proximal to distal muscle weakness, decreased muscle strength on exam**

40
Q

Polymyositis treatment

A

High dose glucocorticoids first line

41
Q

Dermatomyositis presentation

A

Similar to polymyositis but also has gottron’s papules - raised scaly patches on dorsum of PIP and MCP joints, as well as heliotrope rash

42
Q

Dermatomyositis treatment

A

High dose glucocorticoids first line

43
Q

Screening test of choice for lupus (most sensitive), what is specific for SLE?

A

ANA, anti-double stranded DNA and anti Smith

44
Q

How is mild lupus treated vs severe?

A

Mild is hydroxychloroquine with or without NSAIDS and maybe low dose corticosteroids, severe is high dose glucocorticoids or intermittent IV pulse methylprednisolone with other immunosuppressive agents

45
Q

4 common drugs that cause drug induced lupus

A

Hydralazine
Procainamide
Isoniazid
Quinidine

46
Q

Antiphospholipid syndrome definition

A

Idiopathic disorder with increased risk of arterial or venous thromboses (may see recurrent miscarriage)

47
Q

Drug indicated for sjogren syndrome

A

Pilocarpine

48
Q

Scleroderma (systemic sclerosis) is an autoimmune connective tissue disorder that leads to fibrosis of skin and internal organs, what is the classic syndrome associated with this?

A

CREST syndrome, calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasias

49
Q

Takayasu arteritis definition, how is it diagnosed, and what is first line treatment?

A

Chronic large vessel vasculitis affecting the aorta and its primary branches, manifests with constitutional symptoms and vessel ischemia like renal artery stenosis, lower extremity claudication, aneurysm rupture, diagnosed with angiography, treated with high dose corticosteroids

50
Q

Kawasaki disease presentation, what is a complication of it?

A

Children often <5 years with fever x5 days (loooong fever) plus conjunctivits, rash, edema, adenopathy, strawberry tongue, etc.

If left untreated can cause coronary artery aneurysm

51
Q

Kawasaki disease treatment

A

IV immunoglobulin + aspirin (yes, even in kids regardless of risk of reyes)

52
Q

Polyarteritis nodosa definition and treatment

A

Systemic vasculitis of medium sized vessels, sees hypertension (especially in renal artery stenosis), renal or mesenteric angiography will show microaneurysms (beading), treated with glucocorticoids

53
Q

Erythema nodosum

A

Inflammatory disorder characterized by tender nodules found symmetrically on the shins

54
Q

Eosinophilic granulomatosis with polyangitis. Most common organ affected, triad of presentation, lab findings

A

Lungs, asthma + eosinophilia + chronic rhinosinusitis, P-ANCA positivity hallmark

55
Q

Cyclophosphamide drug class

A

Immunosuppressant

56
Q

Goodpasture’s disease 2 manifestations and treatment

A
  • Glomerulonephritis, pulmonary hemoptysis

- Glucocorticoids plus cyclophosamide + plasmapheresis

57
Q

What marker is positive in ank spondy?

A

HLA B27

58
Q

Does ank spondy improve with activity? What are the radiographic findings associated with it?

A

YES, sacriliitis and bamboo spine

59
Q

Ankylosing spondylitis treatment first ine

A

NSAIDs, exercise and physical therapy

60
Q

Tumor marker AFP

A

Increased in hepatocellular carcinoma, decreased in down syndrome during gestatoin

61
Q

Tumor marker CA-125

A

Ovarian cancer

62
Q

Tumor marker CEA

A

Colorectal cancer

63
Q

Arthrocentesis findings in gout

A

Negatively bifringent needle shaped crystals

64
Q

What should be used for gout management in a patient with severe renal disease?

A

Glucocorticoids as nsaids are hard on kidney

65
Q

Arthrocentesis findings in pseudogout

A

Positive bifringent rhomboid shaped calcium crystals

66
Q

Best diagnostic test of osteoporosis

A

DEXA scan

67
Q

Screening guidelines for osteoporosis

A

DEXA scan in 65 years or older or anyone with the risk

68
Q

Most common level of a herniated disk

A

L5-S1

69
Q

What level does the spinal cord terminate

A

L2

70
Q

Causes of cauda equina syndrome

A

Lumbar disc herniation most common, spinal stenosis, trauma, tumors, epidural abscess, vertebral fractures

71
Q

Diagnostic study of choice for cauda equina syndrome

A

MRI

72
Q

Most sensitive finding of cauda equina syndrome

A

New onset urinary retention

73
Q

Lumbar spinal stenosis is worsened with what?

A

Extension (relieved with flexion such as leaning forward)

74
Q

Spinal epidural abscess, spinal cord compression diagnostic test of choice

A

MRI with gadolinium

75
Q

Most sensitive physical exam finding for scoliosis, what is the confirmatory test?

A

Adams forward bend test, radiograph demonstrating cobb’s angle >10 degrees measured on ap and lateral film

76
Q

When does scoliosis require treatment to stop progression such as bracing?

A

Cobb angle >25

77
Q

Adson’s test

A

Loss of radial pulse with head rotated to affected side indicating thoracic outlet syndrome

78
Q

Spondylolysis findings on radiograph

A

Scotty dog has a break in the neck

79
Q

What are posterior glenohumeral shoulder dislocations associated with?

A

Trauma or seizures

80
Q

Posterior fat pad sign

A

ALWAYS abnormal, concerning for supracondylar fracture in children or radial head fracture in adults

81
Q

What nerve is injured in saturday night palsy which causes wrist drop due to weakened extensors in the forearm?

A

Radial nerve

82
Q

Nightstick vs monteggia fracture

A

Night stick is just ulnar shaft without any other fracture wall monteggia aslo includes radial head dislocationa nd can cause radial nerve injury as sequellae

83
Q

Galeazzi fracture definition

A

Mid distal radial shaft fracture with dislocation of distal radioulnar joint often from FOOSH, requires ORIF if unstable fracture, long arm or sugar tong splint temporarily

84
Q

Splint for scaphoid (carpal navicular) fracture

A

Thumb spica, remember to re-image 2 weeks later if any anatomic snuffbox tenderness as may not show up initially but has high risk of nonunion

85
Q

Colle’s and smith fracture treatment

A

Sugar tong splints

86
Q

Complex regional pain syndrome definition

A

Autonomic dysfunction following bone or soft tissue injuries characterized by pain, hyperalgesia out of proportion, motor or trophic changes, edea, or vasomotor changes, clinical diagnosis, no other possible causes is diagnosis, nsaids are initial treatment, as well as physical therapy and and maybe TCA’s, vitamin C prophylaxis may reduce incidence of CRPS after fracture

87
Q

How is mallet finger managed?

A

Splint of DIP joint (buddy tape?) for 6-8 weeks to see if heals, then if still not fixed surgical intervention

88
Q

Gamekeeper’s thumb is a tear of what ligament? What is the management?

A

Ulnar collateral ligament of the thumb, treated with thumb spica splint and referral to hand surgeon because can affect pincer function otherwise

89
Q

Boxer’s fracture initial management

A

Ulnar gutter splint

90
Q

Management of carpal tunnel syndrome

A

Volar splint, nsaids, avoid repetitive wrist movement

91
Q

Difference between carpal tunnel and pronator teres syndrome

A

Pronator terres syndrome is associated more with proximal forearm pain than wrist and hand pain and is not associated with pain at night, tenderness activated by pronation of the forearm is huge for pronator teres syndrome

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