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PANCE Practice > PANCE Prep- MSK/Rheum > Flashcards

PANCE Prep- MSK/Rheum Flashcards

1
Q

Most common type of shoulder dislocation and its MOI

A

anterior
-arm abducted, externally rotated
“Squared off shoulder”

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2
Q

What is a Hill-Sachs lesion?

A

groove on humeral head (compression fracture from impact against glenoid)

(Hill- in the GROOVE)

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3
Q

What is a Bankart lesion?

A

glenoid inferior rim fracture

BACK on glenoid rim

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4
Q

How do you Dx and Tx an anterior shoulder dislocation?

A

DX: axillary and Y view xray: humeral head inferior/anterior to glenoid fossa

TX: reduction w/ pinprick* sensation over deltoid to r/o axillary nerve injury**

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5
Q

What muscles make up the rotator cuff

A

SITS

  • Supraspinatus—- tear to this is MC
  • Infraspinatus
  • Teres minor
  • Subscapularis
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6
Q

Describe PE findings for rotator cuff tear

A
  1. passive ROM> active ROM
    • empty can tests- supraspinatus strength
      Impingement tests:
  3. Hawkins: anterior pain w/ internal rotation of humerus while shoulder/elbow at 90degrees
  4. Drop arm test
  5. Neer Test: arm fully pronated w/ thumb down and pain w/ forward flexion
  6. suprasinpatus test: pain w/ abduction against resistance
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7
Q

Describe Type 1, 2, and 3 shoulder separations

A

Type 1: ligamental sprain- nl CXR
Type 2: AC ligament ruptured, CC ligament sprained- slightly widening CXR
Type 3: AC and CC ligaments ruptured- significant widening on CXR

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8
Q

TX of shoulder separation

A

brief sling immobilization, ice, pain control and ortho f/u

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9
Q

What nerve injuries must be ruled out in proximal humerus/humeral head fx and humeral shaft fx

A
  • proximal humerus/humeral head fx: brachial plexus or axillary nerve- check deltoid sensation
  • humeral shaft fx: radial nerve injury- may cause wrist drop
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10
Q

MC fractured bone in children, adolescents and newborns during birth

A

clavicle fx

**in children <2 suspect abuse

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11
Q

adhesive capulitis is most common in who

A

40-60s w/ DM or hypothyroidism

**due to inflammation

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12
Q

What is thoracic outlet syndrome?

A

idiopathic compression of brachial plexus (95%), subclavian vein (5%) or subclavian artery (1%)

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13
Q

Clinical manifestations of thoracic outlet syndrome

A
  1. nerve compression: pain/paresthesia to forearm, arm or ULNAR SIDE of hand
  2. vascular compression: swelling/discoloration esp. w/ abduction of arm
  3. PE: + Adson: loss of radial pulse w/ head rotated to affected side
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14
Q

complications of supracondylar humerus frcatures

A
  1. median nerve and brachial artery injury: Vokmann ischemic contracture- claw like deformity from ischemia w/ flexion/contracture of wrist
  2. radial nerve injury
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15
Q

Presentation:

  • MOI: FOOSH
  • lateral (radial) elbow pain, inability to fully extend the elbow w/ a + fat pad sign on XR
A

radial head fx

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16
Q

What is Kanavel’s signs?

A

FLEXor tenosynovitis (infection of the flexor tendon synovial sheath of the finger- MC w/ s. aureus)

  1. Finger held in flexion
  2. Length of tendon sheath is tender
  3. Enlarged finger (fusiform swelling of the finger)
  4. Xtension of the finger causes pain (pain w/ passive extension)**
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17
Q

Presentation:

  • MOI: direct blow to flexed elbow
  • inability to extend the elbow
  • complication: ulnar nerve dysfunction
A

olecranon fracture

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18
Q

Presentation:

abrupt “goose egg” swelling (boggy, red elbow) w/ limited ROM w/ flexion

A

olecranon bursitis

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19
Q

tx of olecranon bursitis

A

rest, NSAIDS, local steroid injection, avoid repetitive motions

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20
Q

an Ulnar shaft fx is also called ___

A

nightstick fracture

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21
Q

What is a Monteggia fracture

A

fx of proximal ulnar shaft fracture w/ an anterior radial head dislocation

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22
Q

What is a Galeazzi fracture

A

fx of mid-distal radial shaft w/ dislocation of distal radioulnar joint

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23
Q

what do Monteggia and Galeazzi fractures have in common?

A

BOTH UNSTABLE and need ORIF

Monteggia: fx of proximal ulnar shaft fracture w/ an anterior radial head dislocation

Galeazzi: fx of mid-distal radial shaft w/ dislocation of distal radioulnar joint

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24
Q

radial nerve injury presents as ___
axillary nerve injury presents as __
peroneal nerve injury presents as ___

A
  • wrist drop
  • loss of pinprick sensation on deltoid
  • foot drop
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25
Q

What is a nursemaid’s elbow?

A

radial head subluxation
MOI: lifting/swinging/pulling a child 2-5y/o while the forearm is pronated and extended–> radial head wedges into the stretched annular ligament*

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26
Q

What is a Hutchinson fracture

A

aka Chauffeur’s fracture

-radial styloid fracture

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27
Q

What is the difference between tennis elbow and golfers elbow

A

Tennis elbow: LATERAL epicondylitis- inflammation of tendon insertion of extensor carpi radialis brevis (ECRB) muscle
**lateral elbow pain w/ wrist EXTENSION against resistance

Golfters elbow: MEDIAL epicondylitis- inflammation of pronator teres-flexor carpi radialis
**medial elbow pain w/ wrist FLEXION against resistance

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28
Q

Presentation:

  • MOI: FOOSH w/ hyperextension
  • presents w/ flexed elbow, marked olecranon prominence, and inability to extend elbow
A

Elbow dislocation (posterior MC)

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29
Q

TX and complications of elbow dislocation

A
  1. EMERGENT reduction
  2. posterior splint

Complications: brachial artery and median/ulnar/radial nerve injury

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30
Q

What is cubital tunnel syndrome and how do you dx

A

ulnar nerve compression at the cubital tunnel along the medial elbow (ulnar neuropathy)

PE:
+ Tinel’s sign at elbow
+ Froment’s sign (holds paper and compensates w/ flexion of thumb IP joint- pinching effect)

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31
Q

DX and TX of a scaphoid fracture

A

“aka navicular fracture”
DX: snuffbox tenderness
TX: tx as fracture bc increase incidence of avascular necrosis–> nonunion
*thumb spica

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32
Q

What is a Colles fracture

A

distal radius fx w/ DORSAL/posterior angulation (wrist fx)

MOI: FOOSH w/ wrist EXTENSION

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33
Q

tx of colles fracture

A

sugar tong splint or volar forearm splint

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34
Q

What is a Smith fracture

A

reverse colles fracture- distal radius fx w/ VENTRAL/anterior angulation

(MOI: FOOSH with wrist FLEXION)

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35
Q
  • Lunate doesn’t articulate w/ both the capitate OR radius= ____
  • “piece of pie sign” of AP and “spilled teacup sign” on lateral view

-Lunate doesn’t articulate with capitate but still articulates with radius

A
  • Lunate dislocation (EMERGENT consult needed)

- Perilunate dislocation

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36
Q

What is complex regional pain syndrome?

A

autonomic dysfunction following bone or soft tissue injuries - MC affects UE

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37
Q

Presentation:

  1. Pain out of proportion to injury following bone or soft tissue injuries
  2. waxy or pale skin, brittle nails, loss of hiar
  3. joint atrophy and contractures
A

complex regional pain syndrome

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38
Q

Management of CRPS

A

NSAIDS, PT, TCA

***Vitamin C prophylaxis after fractures may reduce the incidence of CRPS

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39
Q

What are the following finger injuries:

  1. Mallet (Baseball) finger:
  2. Boutonneire deformity:
  3. Swan Neck deformity:
A
  1. finger flexed at DIP joint and UNABLE to extend at DIP
  2. Finger FLEXED at PIP joint and hyperextended at DIP
  3. finger hyperEXTENDED at PIP and flexed at DIP
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40
Q

avulsion of extensor tendon w/ sudden blow to tip of extended finger w/ forced flexion

A

mallet finger

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41
Q

What is Gamekeeper’s thumb

A

aka skier’s thumb

  • sprain or tear of the ulnar collateral ligament of the thumb–> instability of the MCP joint
  • thumb far away from other digits esp. w/ valgus stress pulling thumb away from hand— forced hyperabduction injury

Skiers thumb: ACUTE
Gamekeepers: CHRONIC hyperabduction injury

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42
Q

TX of Gamekeepers/Skiers thumb

A

Thumb spica and referral to hand surgeon

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43
Q

What is a boxer’s fracture and how do you tx

A

fx of the neck of 5th metacarpal

tx: ulnar gutter splint and always check for bite wounds and tx w/ augmentin if present

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44
Q

What is a Bennett’s and Rolando’s Fracture

A

Bennett’s: intraarticular fx through base of 1st MCP

Rolando’s: Comminuted Bennett’s fracture

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45
Q

Describe Salter-Harris Fractures

A

“SALTR”
Type 1: “Same” isolated growth plate fx
Type 2: “Above” metaphysis fx + growth plate fx (MC)
Type 3: “Lower” epiphysis fx + growth plate fx
Type 4: “Through” metaphysis fx, growth plate fx, and epiphysis fx
Type 5: “Rammed” growth plate compression injury

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46
Q

What is deQuervain tenosynovitis

A

stenosing tenosynovitis of the abductor pollicus longus (APL) and extensor pollicus brevus (EPB)

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47
Q

DX and TX of deQuervain tenosynovitis

A

PE: + Finkelstein test: pain w/ ulnar deviation or thumb extension

TX: thumb spica splint x 3 weeks

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48
Q

Presentation of carpal tunnel syndrome

A

*MEDIAN nerve entrapement/compression at carpal tunnel (common w/ DM)

  1. Paresthesia and pain of palmer 1st 3 and 1/2 of 4th digits especially AT NIGHT
  2. Thenar muscle wasting
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49
Q

DX and TX of carpal tunnel syndrome

A

DX: + Tinels sign: percussion of median nerve produces symptoms
+ phalens sign: flexion of both wrists for 30-60 sec reproduces pain

TX: VOLAR splint and NSAIDS

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50
Q

how do you differentiate carpal tunnel syndrome and pronator syndrome

A

*both median nerve compression

CTS: compression at carpal tunnel so pain in wrist/hands and worst at night

Pronator syndrome: compression in prox. forearm so pain in prox. forearm and NOT worse at night

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51
Q

Presentation:
hip pain w/ leg shortened, INTERNALLY rotated and adducted w/ hip/knee slightly flexed

VS

hip pain w/ leg shortened, EXTERNALLY rotated, and abducted

A

hip dislocation (posterior MC)

hip fracture

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52
Q

Presentation:

  • MC in children 4-10y/o
  • loss of abduction and internal rotation
  • PAINLESS LIMING x weeks (worsen w/ continued activity esp. at the end of the day)
A

Legg-Calve-Perthes disease

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53
Q

what is Legg-Calve-Perthes disease

A

idiopathic avascular osteonecrosis of the femoral head in children due to ISCHEMIA of the FEMORAL epiphysis

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54
Q

DX and TX of Legg-Calve-Perthes disease

A

DX:
Hip XR: increased density of the femoral head, widening of the cartilage space, CRESCENT SIGN

TX: observation bc it is self-limiting w/ revascularization w/in 2 yrs, ortho, NWB

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55
Q

Presentation:

  • MC 7-16y/o during growth spurt
  • hip, thigh, or knee pain w/ limp
  • external rotation of affected leg
A

Slipped capital femoral epiphysis

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56
Q

what is slipped capital femoral epiphysis and what how do you tx

A

femoral head epiphysis slips posterior and inferior at growth plate

TX: NWB–> ORIF

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57
Q

What is a Greenstick fracture and a Torus (Buckle) fracture

A

Greenstick: incomplete fx w/ cortical disruption and periosteal tearing on the convex side of fx “BOWING”

Torus/Buckle: incomplete fx w/ “WRINKLING” or “BUMP” of metaphyseal-diaphyseal junction

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58
Q

What knee injury is associated with the following MOI:

  1. Valgus stress w/ rotation
  2. Varus stress
  3. Noncontact- pivoting jurying, deceleration, hyperextension and internal rotation
  4. squatting, twisting, or trauma w/ femur rotation of the tibia
A
  1. MCL
  2. LCL
  3. ACL
  4. Meniscal tear
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59
Q

PE of ACL tear

A
  1. pop and welling– hemarthrosis
  2. knee buckling and inability to weight bare
    • Lachmans (most sensititve)
    • anterior drawer test
  5. +/- Segond fracture: avulsion of the lateral tibial condyle w/ varus stress to the knee
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60
Q

Segond fracture is pathognomonic for what injury

A

ACL tear

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61
Q

PE of meniscal tears

A
  1. locking, popping, giving way
  2. effusion after activities
    • McMurrays sign
  4. joint line tenderness
  5. Apley test
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62
Q

Best way to dx patellar fracture

A

Sunrise view on xray

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63
Q

Patella baja = ___

Patella alta = ___

A

baja= quadriceps tendon rupture: palpable defect ABOVE knee

alta= patellar tendon rupture: palpable defect BELOW knee

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64
Q

complications and tx of knee (tibial-femoral) dislocation

A

complications:
1. popliteal artery injury in 1/3rd of patients–> NEED arteriography
2. peroneal or tibial nerve injury

TX: immediate ortho consult

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65
Q

A positive apprehension sign (pt exhibits anxiety/forcefully contracts the quad when the examiner pushes laterally on patella) usually means ___

A

patellar dislocation (usually lateral dislocation)

or patellofemoral syndrome (chondromalacia)

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66
Q

What is Osgood-schlatter and how does it present?

A

-osteochondritis of the patellar tendon at tibial tuberosity from overuse or small avulsions (due to quad contraction on the patellar tendon insertion into the tibia)

  • MC in 10-15y/o w/ chronic knee pain during growth spurts
  • activity related knee pain/swelling
  • PROMINENT and TENDERNESS TO ANTERIOR TIBIAL TUBERCLE
67
Q

What is a baker’s cyst and how do you tx

A

synovial fluid effusion (ex. from meniscal tear) that is displaced w/ cyst formation

tx: conservatitve: ice, assisted weight bearing, NSAIDS

68
Q

What is patellofemoral syndrome

A

aka Chondomalacia

  • idiopathic softening/fissuring of patellar articular cartilage
  • MC in runner

-ANTERIOR knee pain “behind” or around the patella worsened w/ knee hyperflexion, prolonged sitting, jumping or climbing

69
Q

MC cause of knee pain in runners

A

iliotibial band syndrome (usually lateral knee pain during onset of running then resolves)

70
Q

+ Ober test: pain or resistance to adduction of the leg parallel to the table in neutral position

+ lateral condyle tenderness

A

ITB sydnrome (iliotibial band)

71
Q

85% of ankle sprains involve what ligaments?

A

collateral (Anterior talofibular MC, calcaneofibular)

72
Q

What ligament is the main stabilizer during inversion and eversion

A

inversion: anterior talofibular ligament (ATFL)
eversion: deltoid ligament

73
Q

What are the Ottawa Rules for imaging?

A

Ankle:

  1. pain along lateral malleolus
  2. pain along medial malleolus
  3. inability to walk >4 steps at the time of injury and in ER

Foot:

  1. Navicular (midfoot) pain
  2. 5th metatarsal pain
  3. inability to walk >4 steps at the time of injury and in ER
74
Q

Presents:

  1. sudden heel pain after push-off movement, pop, sudden sharp calf pain
    • Thompson Test
A

achilles tendon rupture

Thompson test: weak, absent plantar flexion w/ gastrocnemius is squeezed

75
Q

There is an increased risk for achilles tendon rupture with ___ use

A

fluoroquinolone

76
Q

What is a Maisonneueve Fracture

A

spiral proximal fibular fracture (due to rupture of the distal talofibular syndesmosis and interosseus membrane) as a result of a distal medial malleolar fracture and/or deltoid ligament rupture

*get prox. xray view to r/o

77
Q

xray: Clear space: btwn tib and fib and deltoid lig. tenderness

A

Maisonneueve Fracture

78
Q

Presentation:

  • heel pain, tenderness to plantar/medial foot, worse w/ dorsiflexion of toes,
  • pain worse after period of rest (ex. 1st few steps in morning)
  • pain decreases throughout day
A

Plantar fasciitis

79
Q

Presentation:
-pain/numbness at the medial malleolus, heel and sole
-pain worsens at night and with dorisflexion
+ tinel sign

A

Tarsal Tunnel syndrome (posterior tibial nerve compression from overuse, restriction or edema)

**Mimics plantar fasciitis pain but PF decreased throughout the day and TT pain increases throughout the day)

80
Q

What is a bunion

A

Hallux valgus deformity of the bursa over 1st metatarsal

81
Q

What is a hammer toe

A

deformity of PIP joint: flexion of PIP joint and hypertension of MTP and DIP join

82
Q

What is Charcot’s joint

A

aka diabetic foot
-joint damage and destruction as a result of peripheral neuropathy

*Obliteration of joint space on xray

83
Q

What is a Morton’s neuroma and how d you tx

A

degeneration/proliferation of the plantar digital nerve (MC at 3rd metatarsal head)

  • walking on a marble
  • *Positive Squeeze test

TX: wide shoes, glucocorticoid injection, surgery

84
Q

What is a Jone’s Fracture and how do you tx

A

transverse fracture through the diaphysis of 5th metatarsal

tx: NWB x 6-8 weeks then f/u xrya– complicated by nonunion/malunion

85
Q

What is a pseudojones fracture and how do you tx

A

transverse AVULSION tx at base (tuberosity) of 5th metatarsal

tx: walking cast x 2-3 weeks

86
Q

What is a Lisfranc injury

A

disruption btwn the articulation of the medial cuneiform and the base of the 2nd metatarsal

Lisfranc joint: bases of 1st 3 metatarsal heads and their respective cuneiforms

tx: ORIF

87
Q

What is this finding called and what does it mean?

fracture at the base of the 2nd metatarsal

A

Fleck sign

*pathognomonic for disruption of tarsometarsal ligaments in lisfranc injuries

88
Q

Lateral shift of the second metatarsal or widening btwn metatarsals with weight baring x-rays

A

Lisfranc fracture/dislocation

89
Q

Sciatica pain distribution is in what dermatome pattern

A

L5-S1: back pain radiating to the thigh/buttock, lower leg

90
Q

How do Dx herniated disc (nucleus pulposus)

A

+ straight leg test
+ crossover test
+/- stretch, reflex and sensation deficits

91
Q

Where is the herniated disc most likely?

  • ANTERIOR thigh pain
  • Sensory loss to the medial ankle
  • Weak ankle dorsiflexion
  • loss of knee jerk
  • Weak knee extension
A

L4

92
Q

Where is the herniated disc most likely?

  • POSTERIOR leg/calf, gluteus pain
  • Plantar surface of foot
  • Weakness of plantar flexion
  • Walking on toes more difficult than walking on heels
  • LOSS of ANKLE jerk
A

S1

93
Q

Where is the herniated disc most likely?

  • LATERAL thigh/leg, hip, groin paresthesia and pain
  • Dorsum of the foot: esp. btwn 1st and 2nd toes
  • Weakness of big toe extension
  • walking on heels more difficult than walking on toes
  • normal reflexes +/- loss of ankle jerk
A

L5

94
Q

Findings of Cauda Equina syndrome

A
  1. new onset of urinary retention
  2. new onset of bowel incontinence
  3. Saddle anesthesia
  4. Uni/bilateral leg radiation
  5. decreased anal sphincter tone of rectal exam (no anal wink)
95
Q

What is scoliosis and how do you tx

A

lateral curvature of spine >10degrees +/- associated w/ kyphosis or lordosis

dx: Adams forward bending test most sensitive
- Cobb’s angel on AP/lateral films

96
Q

Signs of Neurofibromatosis type I

A
  1. Scoliosis
  2. Cafe au lait spots
  3. skin tags
  4. Axillary freckles
97
Q

What is:
Spondylolysis:

Spondylolithesis:

A

Spondylolysis: Pars interarticularis defect from either failure of fusion or stress fracture (often from repetitive hyperextension trauma)
**MC form of back pain in kids and adolescents

Spondylolithesis: forward slipping of a vertebrae on another

98
Q

MC cause of osteomyelitis: ___

Salmonella osteomyelitis is pathognomonic for ____

A

S. aureus

Sickle cell disease

99
Q

describe lab and xray findings of osteomyelitis

A

labs: increased WBCs, ESR, and CRP

Xray: periosteal reaction, lucent areas of cortical destruction, soft tissue swelling

*MRI is most sensitive test in early disease

**Bone aspiration is GOLD STANDARD

100
Q

single swollen warm painful joint, decrease ROM, tender to palpation, fever

arthrocentesis: WBC >50,000 primarily PMNs,

A

septic arthritis

TX: Abx + arthrotomy w/ joint drainage

  1. Gram + cocci: Nafcillin (vancomycin if MRSA suspected)
  2. Gram - cocci or gonococcus: Ceftriazone
  3. Gram - rods: Cefriazone + anti-pseudomonal aminoglycoside
101
Q
  • Pain out of proportion to injury

- pain on passive stretching earliest indicator* tense extremitites

A

Compartment syndrome

Dx: increased intracompartmental pressure >30-45mmhg

TX: fasciotomy

(muscle/nerve ischemia and decreased perfusion)

102
Q

MC bone malignancy

*it MC has METS to ___

A

Osteosarcoma

Lungs

*MC adolescents

103
Q

XRAY: “hair on end” or “sun-ray/burst” appearance

A

osteosarcoma

TX: resection and chemo as adjuvant therapy

104
Q

bone pain +/- palpable mass +/- fever MC on femur and pelvis

XRAY: lytic lesion, periosteal reaction “onion skin” appearance

A

Ewing Sarcoma

105
Q

XRAY: Punctate or ring and arc appearance pattern of calcification

A

Chondrosarcoma (CA of the cartilage)

106
Q

MC benign bone tumor

A

osteochondroma

seen esp. ages 10-20y/o, MC In males

107
Q

XRAY: pedunculated, grows away from growth plate and involves medullary tissue

A

osteochondroma

108
Q

S/S of Paget Disease of the Bone (Osteitis Deformans)

A
  1. MC asymptomatic or bone pain
  2. high alkaline phosphates
  3. warmth
  4. Deafness if skull involvement

Labs:

  1. increased alkaline phosphate
  2. XRAY: blade of grass/flame shaped lucenecy (lytic phase), Coarsened trabeculae (sclerotic phase), cotton wool appearance (skull)
109
Q

Tx of Paget Disease of the Bone (Osteitis Deformans)

A
  1. Bisphosphonates (inhibits osteoclast activity- decreased bone resorption and turnover) or calcitonin
    ex. Alendronate, Risedronate)
110
Q

causes of drug induced SLE

A

procainamide, hydralazine, INH, quinidine

+ Anti-histone antibodies

111
Q
  1. joint pain, fever, malar butterfly rash
  2. pericarditits, pleuritis
  3. annular erythematous patches on face, annular
  4. glomerulonephritits, retinitits, oral uclers, alopecia
A

SLE

112
Q

How do you dx and tx SLE

A

DX:

    • ANA (best initial but not specific)
    • anti-ds DNA and anti-smith Ab (100% specific for SLE but not sensitive)
  3. 4+ manifestations (malar rash, discoid rash, photosensitivity, oral painless ulcers, polyarthritis, serositis, proteinuria, seizure, anemia, luekopenia, thrombocytopenia, ANA, anti-ab)

TX:

  1. Sun protection: sun screen, hydroxychloroquine (for lesions)
  2. NSAIDS or acetaminophen for arthritis
113
Q

Labs with Antiphospholipid Ab syndrome

A
    • anticardiolipid Ab (associated w/ false + VDRL/RPR)
  2. lupus anticoagulant
  3. B2 glycoprotein I Ab. Women w/ APLS may have frequent miscarriages
114
Q 
Thickened skin (sclerodactyly)
Tight, shiny, thickened skin (localized or generalized)
A

Scleroderma (systemic sclerosis)

AKA CREST syndrome
C-calcinosis cutis
R-aynauds
E-esophageal motility disorder
S-Sclerodactyly
T- Telangiectasia
115
Q

How do you dx and tx Sjogren’s Syndrome

A

DX: ANA, esp antiSS-A and antiSS-B

    • RF
  2. Schirmer test (dry eyes)

TX: artificial tears, Pilocarpine (cholinergic)

116
Q

How do you dx and treat fibromyalgia

A
  1. diffuse pain in 11 out of 18 trigger points >3months* + widespread pain
  2. moth eaten appearance of muscle biopsy

TX: exercise- TCA, SSRIs, pregabalin

117
Q

pain/stiffness of the proximal joints (shoulder, hip, neck).

- bilateral proximal joint aching/stiffness typically in the morning >30 min

A

Polymyalgia rheumatica
*CLOSELY related to giant cell arteritis

DX: clinical, increased ESR

TX: low dose corticosteroids

118
Q
  1. Heliotrope (blue-purple) upper eyelid discoloration
  2. Gottron’s papules: raised violaceous scaly eruptions on the knuckles
  3. Photosensitive poikiloderma “shawl or V sign”
A

Dermatomyositis

119
Q

risk factors for gout

A
  1. purine-rich foods: alcohol, liver, seafood, yeast,
  2. meds: thiazide, loop, ACEI, pyrazinamide, ethambutol, ASA ARBS, allopurinol (wait til flare goes down or away)
  3. men
120
Q

Compare and contrast the synovial fluid crystals and XRAY w/ gout and pseudogout

A

Gout: negatively birefringent; needle shaped
-monosodium urate
XRAY: mouse bite-punched out erosions

Pseudogout: weakly positive; rhomboid shaped
-Calcium pyrophosphate dihydrate
XRAY: chondrocalcinosis

121
Q

Tx for Gout

A
  1. Acute: NSAIDS, colchicine

2. Chronic: uric acid lowering agetns: allopurinol

122
Q

TX for pseudogout

A
  1. intraarticular steroids 1st line
  2. NSAIDS, Colchines

chronic: NSAIDS

123
Q

DX and TX of rhabdomyolysis

A

DX: labs: increased CPK >20,000, LDH and ALT

  1. hyperkalemia
  2. Hypocalcemia
  3. UA dark urine that is + for heme but neg for blood

TX:

  1. IV saline hydratation
  2. Mannitol
  3. bicarbonate to alkalinize the urine
124
Q

What are Heberden nodes and Bouchards nodes

A

Herberden: DIP joints

Bouchards: PIP osteophytes

*w/ OA

125
Q

Common clinical manifestations w/ RA

A
  1. small joint morning stiffness, >60 min after initiating movement, improves later in day
  2. Boggy joints
  3. Boutonnieere deformity (flexion at PIP and hyperextend DIP)
  4. Swan neck deformity (flexion at DIP, hyperextension at PIP)
  5. Ulnar deviation

DX:
RF best initial test

126
Q

RA + splenomegaly + decreased WBC/repeated infections = ____

RA + pneumoconiosis= ___

A

Felty’s Syndrome

Caplan Syndrome

127
Q

tx of RA

A
  1. Prompt initiation of DMARDS (reduces permanent joint damage)- ex. Methotrexate***** (nonbiologic)
  2. biologics
  3. NSAIDs for pain, corticosteroids 2nd line

*all patients on DMARDs should have PPD to rule out TB before initiating therapy

128
Q 
HA
Scalp tenderness
jaw claudication
fever
visual changes
thickened temporal artery
A

Giant cell temporal arteritis

DX: Clinical DX!

  • increased ESR CRP
  • temporal artery biopsy (mononuclear lymphoycte infiltration, multinucleated giant cells, lamina cell degradation

TX: HD corticosteroids

129
Q

s/s of Kawasakis

A

CRASH (4 of 5) and BURN

C-conjunctivitis- bilateral, nonexudative
R-rash, polymorphous
A-adenopathy, cerbical
S-strawberry tongue
H- hands and feet arthritis and swelling/peeling

and
BURN:
fever

130
Q

tx of Kawasakis

A
  1. IVIG + high dose ASA

2. corticosteroids if refractory

131
Q

Describe what HSP is and its symptoms

A

IgA deposition in skin–> immune mediated leukocytoclastic vasculitis
*MC after URI sx

H-Hematuria
S-synovial arthritis
P-Palpable purpura MC on LE (not due to thrombocytopenia or coagulopathy)
A-abdominal pain

HSP affects IgA

132
Q

How do you dx and tx HSP

A

DX: clinical dx

  1. kidney biopsy: mesangial IgA deposits
  2. normal coags

TX: supportive (self limited 1-6wks)

133
Q

Clinical manifestations of Goodpasture’s and how to treat

A

*IgG antibodies against type IV collagen of the alveoli and glomerular basement membrane of the kidney

GP= 1. glomerulonephritits (rapidly progressing) 2. Pulmonary hemorrhage (hemoptysis)

DX: biopsy

TX: Glucocortoicoids + cyclophosphamide
2. Plasmapheresis

134
Q

-Chronic low back pain: morning stiffness w/ decreased ROM
- peripheral arthritis, sacrolitiitis*
-Increased ESR, + HLAB27,
XRAY: bamboo spine

A

Ankylosing sponlytitis

TX: NSAIDs, rest, PT,

135
Q
  1. arthritis: asymmetric inflammation
  2. conjunctivitis/uveitis
  3. Urethritis cervicitis
  4. Keratoderma blennorrhagicum= hyperkeratotic lesions on palms/soles

+HLAB27
synovial fluid- bacterial culture negative (aspetic)

A

Reactive arthritis (Reiter’s Syndrome)

Tx: NSAIDs

*MC post chlamydia infection

136
Q

sausage digits

XRAYS: pencil in cup deformity

A

Psoriatic arthritis

137
Q
  • Morning stiffness for at least 1 hour; gel phenomenon –>improves with activity
  • Chronic, symmetric, systemic disease that primarily targets the synovium
  • Small joints first – MCPs, PIPs, MTPs
A

rheumatoid arthritis

138
Q

other joints involved in RA

A
  1. C-spine: C1-C2 subluxation
  2. Spine: compression fx
  3. Shoulder: bursitis, tendon rupture
  4. Elbow: bursitis, ulnar nerve entrapment (4th and 5th digit numbness)
139
Q

risk factors for pseudogout

A
  1. idiopathic
  2. trauma
  3. hemochromatosis
  4. hyperparathyroidism (excess Ca2+)
140
Q

goal uric acid level when managing gout

A

<6 or <5 if tophi is present

*check uric acid level at baseline and 4-6 weeks after therapy, once <6 recheck annually or for compliance

141
Q

how do you differentiate fibromyalgia vs chronic fatigue syndrome?

A

fibro: fatigue and sleep disturbance
- no PE findings despite pain

chronic fatigue: >6months and <50% reduction of normal activity
-short term memory loss, lymph nodes in axillae or neck, HA (actual PE findings)

142
Q

when treating fibromyalgia its important to treat

A
  1. Pain (NSAIDs, TCA, cymbalta, PT)
  2. sleep
    (trazodone, flexeril)
  3. mood (SSRI, wellbutrin, cymbalta)
  4. PT

*check TSH, fT4, CBC, CMP

143
Q

What is the gold standard for drawing an ANA?

A

ANA by IFA (not direct ANA)

144
Q

What disease do these profiles suggest?

  1. ANA + anti-ds DNA
  2. ANA + anti-RNP
  3. ANA + anti-Smith (Sm)
  4. ANA + anti-SSA (Ro)
  5. ANA + anti-SSB (La)
  6. ANA + anti-centromere (SCI-70)
A
  1. ANA + anti-ds DNA= SLE, lupus nephritis
  2. ANA + anti-RNP= mixed CT disease
  3. ANA + anti-Smith (Sm)= SLE marker
  4. ANA + anti-SSA (Ro) = Sjogrens, subacute cutaneous lupus, neonatal lupus
  5. ANA + anti-SSB (La)= Sjogrens, SLE
  6. ANA + anti-centromere (SCI-70)= scleroderma
145
Q

SLE labs to monitor

A 
CRP, ESR
CBC
UA
Serum creatinine w/ eGFR
anti-dsDNA
C3 and C4
146
Q

SLE has increased risk for what cancer

A

non-hodgkin lymphoma (B cell association)

147
Q

clinical features of APS (anti-phospholipid syndrome)

A 
CLOT:
Clot
Livedo reticuarlis
Obstetrical complications/miscarriages
Thrombocytopenia
148
Q

Enlarged, nontender firm parotid or submandibular glands

  • dry eyes and mouth
  • gritty or FB sensation in eye
A

Sjogren’s syndrome

DX: schirmer test

TX: tx symptoms (eye drops, lozenges, vaginal lubricants)
2. systemic: pilocarpine, hydroxychloroquine

149
Q
  • sacroiliitis
  • Insidious onset of back pain
  • morning and nighttime stiffness that improves w/ activity
  • globe loss of ROM in spine
A

ankylosing spondylitis

dx: crp, HLAB27
Xray: abnormal appearing SI joint/ bamboo spine

TX: PT, stop smoking, NSAIDs

  • sulfasalazine and methotrexate for peripheral arthritis
  • Anti-TNF therapy for axial arthritis
150
Q
  • Sausage digits
  • enthesitis
  • keratoderma blennorragica, circinate balanitits,
  • sores of penis
A

reactive arthritis (reiters syndrome)

TX: Physical therapy
Intraarticular steroids
NSAIDs
Sulfasalazine, methotrexate (used less frequently)
 Anti-TNF alpha agents
151
Q
  • generally polyarticular arthritis, affecting both small and large joints. tenosynovitis
  • The fever pattern is distinctive, occurring daily or twice daily, usually in the afternoon or evening, often accompanied by Still’s rash (salmon-colored/pink migratory rash)
  • iridocyclitis (anterior uveitis)
A

Juvenile idiopathic arthritis

DX: clinical, increased ESR, CRP

TX: NSAIDs and/or corticosteroids
*frequent eye exas todetect iridocyclitis

152
Q

describe the joints affected with oligoarticular JIA and polyarticular

A

Oligoarticular: involves 4 or less joints, usually larger joints and often asymetrically
**increased blood flow to joints cause accelerated growth to affected limb causing leg length discrepancy

Polyarticular: involves 5 or more joints, usually small joints, usually symmetric

153
Q

Type I oligoarticular JIA is associated with ___

Type II oligoarticular JIA is associated with ___

A

iridocyclitiis (anterior uveitis)
* slit lamp q 3 months if ANA+, q3months if 7y/o or less or q6 months if >7

Ankylosing spondylitis

154
Q

When should you screen a child with oligo JIA for uveitis

A
  • slit lamp q 3 months if ANA+,
  • q3months if 7y/o or less
  • q6 months if >7
155
Q

tx of uveitis

A

topical steroids but in severe cases systemic meds are needed to tx eye inflammation

156
Q

___ status is important with oligoarcticular JIA but __ status is important with polyarticular JIA

A

ANA

RF

157
Q

RF+ polyarticular JIA is associated w/

A

rheumatoid nodules,
chronic arthritis
joint destruction

158
Q

____ is inflammation at the insertion of tendons

A

Enthesitis

159
Q

enthesitis-related arthropathies

A

ankylosing spondylitits
IBD associated arthritis
psoriatic arthritis

160
Q

If joint aspiration occurs, joint fluid will have increased polymorphonuclear (PMN) cells and low glucose, in the setting of ___

A

JIA.

161
Q

3-6y/o with an acute onset of difficulty walking/weight bearing, usually holding the affected leg rotated out. The children are well-appearing, but usually have a history of recent URI symptoms with/without fever
-limited internal rotation of the hip

A

Transient synovitis of the hip (aka reactive arthritis)
*Transient synovitis is only of the hip otherwise its considered reactive arthritis

TX: supportive (resolves on its on in 1-4weeks)
-Ibuprofen 40-50mg/kg divided TID

162
Q

the most common joint in a child to develop into septic arthritis is

A

hip

163
Q

describe a malar rash vs roscea

A

Malar: encompasses cheeks and nose, but spares nasolabial folds

Rosecea: involves nasolabial folds

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