Rheumatology/Musculoskeletal Flashcards
(174 cards)
1
Q
Low back pain with paraspinal tenderness + normal neuro exam
A
Mechanical
- Muscle strain
- Disc degeneration
2
Q
Low back pain w/ radiation below knee, +straight leg raise test, neurologic deficits
A
Radiculopathy
(Herniated disc)
3
Q
Low back pain w/ pseudoclaudication, relieved by leaning forward
A
Spinal stenosis
4
Q
Low back pain worse w/ rest, improved with activity, with pain in the SI joints
A
Inflammatory
(spondyloarthropathies):
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
5
Q
Low back pain, worsens w/ activity, relieved with rest
A
Lumbar osteoarthritis
6
Q
Low back pain >50yo, worse at night, not relieved with rest
A
Metastatic cancer
(spinal mets)
7
Q
Low back pain + IVDU or recent infection, fever, focal spine tenderness
A
Infectious
- Osteomyelitis
- Discitis
8
Q
Low back pain + midline tenderness
A
Vertebral fracture
9
Q
Enthesitis
(inflammation/tenderness at tendon insertion sites)
A
Spondyloarthropathies:
- Ankylosing Spondylitis
- Psoriatic Arthritis
- Reactive Arthritis
10
Q
Dry mouth, dry eyes, dysphagia, thrush, dental caries
A
Sjögren Syndrome
- Anti-Ro, Anti-La; SSA, SSB respectively
- Inflammation of exocrine salivary glands
- Decreased lacrimation
11
Q
Cochlear dysfunction is a side effect of
A
- Cisplatin/Carboplatin
- Aminoglycosides
12
Q
Optic neuritis is a side effect of
A
- Ethambutol (RIPE)
- Hydroxychloroquine
13
Q
Thyroid dysfunction is a side effect of
A
- Amiodarone
- Lithium
14
Q
Gout is a side effect of this drug
A
Cyclosporine
15
Q
Patients with suspected secondary Raynaud’s Phenomenon (>40yo) should be tested for ____
A
Autoimmune disorders
(ANA, Rf, Antitopoisomerase)
16
Q
Localized pain on anteromedial tibia just below the knee
A
Pes Anserinus Pain Syndrome
17
Q
Woman with anterior knee pain worsened by activity or prolonged sitting
A
Patellofemoral Syndrome
18
Q
Painful swelling directly over patella, usually following trauma
A
Prepatellar bursitis
19
Q
Painful LE ulcer with purulent base and violaceous borders, seen in IBD, RA, or AML pts
A
Pyoderma Gangrenosum
20
Q
Painful subcutaneous nodules on anterior LE
A
Erythema Nodosum
(ASO Abs, TB test, CXR)
- Benign
- Streptococcal infection
- Sarcoidosis
- TB
- Coccidiodomycosis
- IBD
- Behçet disease
21
Q
Inhibits osteoclastic bone resorption
A
- Bisphosphonates
- Calcitonin
22
Q
Tx of Paget disease of bone
A
Bisphosphonates
(inhibits osteoclasts and suppresses bone turnover)
23
Q
Sensitive marker for SLE vs. Specific marker for SLE
A
ANA vs. Anti-dsDNA
24
Q
Painless vesiculopustular skin lesions + Tenosynovitis + Polyarthralgias
A
DGI
(Disseminated Gonococcal Infection)
- +/- Fevers
25
Charcot joint
**Neurogenic arthropathy** 2/2 nerve damage from long-standing diabetes, B12 deficiency, peripheral nerve damage, or SCI
26
Young female w/ exertional arm pain + BP difference in R and L arm
**Takayasu Arteritis**
* Tx: Systemic glucocorticoids
27
Numbness, aching, or burning in the metatarsal heads of the third and fourth toes
**Morton Neuroma**
(mechanically-induced neuropathic degeneration of the interdigital nerves)
* Tx: Metatarsal support: Bar or padded shoe inserts; Surgery if refractory
28
Methotrexate Side-effects in RA Tx
* **Macrocytic anemia**
* **Stomatitis**
* **Hepatotoxicity**
* **ILD**
29
Isolated elevated alk phos, ASx
**Paget disease of bone**
| (osteoclast dysfunction)
30
Suspicion of MM
**Skeletal survey**
31
Tx for Polymyalgia Rheumatica vs. GCA
**Low-dose vs. High-dose Prednisone**
| (respectively)
32
Drug-induced Achilles tendinopathy/tendon rupture
**Fluoroquinolone use**
33
1. Thrombotic event OR adverse pregnancy outcome + 2. Positive anticardiolipin, anti-beta2-glycoprotein-I, or lupus anticoagulant
**Antiphospholipid Syndrome**
34
Oligoarthritis + urethritis
* **+ fever = Gonococcal septic arthritis (abx)**
* **+ mouth sores = Reactive arthritis (NSAIDs)**
35
Trigger point tenderness in trapezius, lateral epicondyles, or greater trochanters
**FM**
| (Fibromyalgia)
36
Acute-onset monoarticular arthritis
| (12-24 hours)
**Gout**
37
Acute-onset monoarticular arthritis
| (24-72 hours)
Septic arthritis
38
Bony spurs in cervical spine x-ray
**Cervical spondylosis**
(usually presents w/ osteophyte-induced radiculopathy)
39
Elevated urine hydroxyproline
**Paget disease of bone**
| (marker for breakdown of collagen)
40
**Gout PPX**
* Alcohol cessation
* Weight loss
* Diet (low red meat, seafood, & added sugars)
41
Low back pain that increases w/ standing, walking, or lying on back
**Vertebral Compression Fracture**
| (usually 2/2 osteoporosis)
42
\>15% of dermatomyositis pts will develop
**Malignancy**
43
Anti-Jo-1
**Dermatomyositis**
44
Anti-Mi-2
**Dermatomyositis**
| (against helicase)
45
\>40yo w/ bone pain + HA + unilateral hearing loss
**Paget disease of bone**
(Osteoclast dysfunction)
* +Elevated alk phos
* +Increasing hat size
* +Bowing
46
Migratory non-deforming arthritis + chronic malabsorptive diarrhea + low-grade fever + PAS+ macrophages
**Whipple’s disease**
* **Tropheryma whippelii** (gram positive bacillus)
47
Nephrotic syndrome + hepatomegaly + S4 + recurrent pulmonary infections + palpable kidneys
**Secondary amyloidosis** (**AA)**
* Tx/PPX: Colchicine
48
Low back pain worse at night, improves with rest
**Spinal osteomyelitis**
49
Low back pain worse in the morning, improves with activity, + diarrhea/abd pain
**IBD-associated arthritis**
50
Acute inflammatory arthritis in setting of surgery or medical illness
**Likely pseudogout (CPPD)**
51
Recurrent oral and genital ulcers + uveitis + non-vesicular rash
**Behçet Disease**
(Turkish, Middle-Eastern, Asian descent)
* +venous/arterial thrombosis (small-medium vasculitis)
52
Primary Raynaud Phenomenon Tx
**CCBs**
**(**nifedipine, amlodipine) + stress or cold avoidance
53
Baker cyst is commonly concurrently seen with
**OA**
54
Female athlete triad of stress fractures
* **Oligo-/amenorrhea**
* **Decreased caloric intake (anorexia/low BMI)**
* **Osteoporosis**
55
Knee popping sensation followed by pain and rapid-onset hemarthrosis
**ACL injury**
(meniscal tear would not have rapid-onset swelling/hemarthrosis)
56
20-30yo w/ chronic lower back pain & stiffness that is relieved w/ activity and worse at night
**Ankylosing spondylitis**
(HLA-B27)
* +sacroiliitis on x-ray
* +Reduced chest expansion
* +Dactylitis (sausage digits)
* +Uveitis
* Dx: X-ray of sacroiliac joints
57
Older pt w/ cortical thickening of bone 2/2 osteoclast dysfunction
**Paget disease of bone**
**(**+elevated alk phos)
* Can lead to hearing loss (skull/temporal bone enlargement)
* Tx: Bisphosphonates
58
Acute knee pain + hypercalcemia
**Pseudogout**
| (CPPD)
59
Evidence of cartilage calcification in setting of acute arthritis episode
**CPPD**
(Pseudogout: Calcium pyrophosphate dihydrate crystal arthritis)
* Also a complication of **chronic hypercalcemia** in setting of **hyperparathyroidism**
60
Achalasia causes ___ LES pressure; Systemic Sclerosis causes ___ LES pressure
**Increased; Decreased**
61
Progressive groin, thigh, or buttock pain on weight bearing in setting of chronic glucocorticoid use that is worsened by activity, relieved by rest, and has reduced ROM
**Avascular Necrosis**
(Osteonecrosis of the femoral head)
* Dx: **MRI**
* **SLE** is also a strong risk factor for **AVN**
62
Exertion-dependent claudication
**Vascular claudication**
| (2/2 aortoiliac atherosclerosis)
63
Postural-dependent claudication
**Neurogenic claudication**
(2/2 nerve root compression from degenerative arthritis)
64
Claudication seen in obstructive atherosclerotic arterial disease (e.g. 2/2 aortoiliac atherosclerosis)
**Vascular claudication**
* Improves with rest
* Abnormal ABI
65
Claudication due to lumbar spinal stenosis
**Neurogenic claudication**
**(**2/2 nerve root compression from noninflammatory degenerative arthritis, such as spondylosis)
* Improves with position (shopping cart sign: pain lessens w/ spine flexion)
* Does not improve immediately with rest (~10 min)
66
Preexisting joint disorders (e.g. gout, pseudogout, osteoarthritis) increase the risk for
**Secondary joint infection**
(**septic arthritis)**
67
Pain on resisted supination of forum + weakness of wrist extension & 3rd digit
**Radial tunnel syndrome**
68
Pain w/ passive wrist flexion or resisted wrist extension
**Lateral epicondylitis**
(Tennis elbow)
* +tenderness at lateral epicondyle
69
Noninflammatory angiofibroblastic tendinitis at common wrist extensor origin from repetitive, forceful wrist extension
**Lateral epicondylitis**
| (Tennis elbow)
70
Tx of Tendonitis
**Rest** \> Immobilization
(Splinting) \> Steroid injection
71
Signs of Tendonitis
* **Focal Tenderness**
* **Pain on Activation**
* **Pain on Stretch**
72
Wrist extension + radial nerve
**Lateral epicondyle**
73
Wrist flexors + Pronator teres; Median nerve
**Medial epicondyle**
74
Best test for biceps tear
**Supination**
75
Deltoid nerve innervation
**Axillary nerve**
76
Burning hand pain that is worst when sleeping, driving, or holding a magazine
**CTS**
| (Carpal Tunnel Syndrome)
77
Bowing of knees (varus deformity), asymmetric joint space narrowing, DIPs swelling
**Primary OA**
78
PIN, dorsal hand (sensory), extrinsic extension
**Radial nerve**
79
AIN, sensory of thumb to half of ring; extrinsic flexion
**Median nerve**
80
Forceful hyperextension of wrist in FOOSH
**Scaphoid fracture**
| (pain at anatomic snuffbox)
81
Pain w/ radial flexion of wrist and point tenderness over trapezium
**Flexor carpi radialis tenosynovitis**
82
Positive Finkelstein test
**De Quervain tenosynovitis**
(grasping of flexed thumb into palm w/ fingers during wrist flexion)
83
Mother w/ radial wrist pain
**De Quervain tenosynovitis**
* Inflammation of abductor pollicis longus & extensor pollicis brevis tendons within fibrous sheath at radial styloid process
84
Chronic low C4 (hypocomplementemia) + HCV +/- SLE
**Cryoglobulinemia**
85
Fibromyalgia Tx
* 1st Line: Regular exercise + Good sleep hygiene
* 2nd Line: **Amitriptyline**
* 3rd Line: Duloxetine (SSRI), Pregabalin, or Milnacipran
86
Anti-topoisomerase
**Systemic Sclerosi**s
| (Anti-Scl-70)
87
Anti-smooth muscle antibodies
**Autoimmune hepatitis,**
88
Young to middle-aged woman w/ widespread pain, fatigue, cognitive/mood disturbances, and point muscle tenderness
???
89
Stiffness in neck, shoulders, & hips + elevated ESR
**Polymyalgia Rheumatica**
(PMR)
* Tx: Low-dose prednisone
* Associated w/ GCA
90
Stiffness in neck, shoulders, & hips + point tenderness
**Fibromyalgia**
(FM)
* Tx: Aerobic exercise + Good Sleep Hygiene
* 2nd Line: Amitriptyline
91
Pain w/ exertion, Relief w/ rest
(Neurogenic vs. Vascular claudication?)
**Vascular Claudication**
92
Relieved w/ walking, persists w/ rest or standing still (Neurogenic vs. Vascular claudication?)
**Neurogenic Claudication**
93
Narrowed joint space on x-ray
**OA**
94
OA Tx
**Exercise/wt loss** —\> NSAIDs —\> Steroid injections/Hyaluronic acid injections —\> Surgery vs. Chronic Pain Management
(non-surgical candidates)
95
Needle-shaped, negatively birefringent crystals
**Gout**
| (YeLLow under ParaLLel light)
96
Rhomboid-shaped crystals, weakly positively birefringent crystals
**Pseudogout**
| (CPPD)
97
Tophus deposits in external ear, olecranon bursa, or achilles tendon
**Gout**
98
GCA Tx
**High-dose methylprednisolone**
99
Sudden loss of vision + HA, abnormal fundoscopic exam, Elevated ESR
**GCA**
(Giant Cell Arteritis) [+/- jaw claudication]
100
Extrusion of synovial fluid from knee joint into gastrocnemius or semimembranous bursa
**Popliteal**
(**Baker) Cyst**
101
Twisting force on a fixed foot
**Medial meniscus tear**
* Popping sound followed by pain
* Crepitus, locking, or catching on exam +/- small effusion
102
**Anserine bursitis**
Well-defined area of subacute medial knee pain and tenderness
(**Pes anserinus pain syndrome)**
103
Crescent-shaped ecchymosis distal to medial malleolus
**Popliteal**
**(Baker) cyst rupture** (Crescent sign)
104
Anterior knee pain that worsens w/ climbing or descending stairs
**Patellofemoral Syndrome**
(PFS)
* Young female athletes
* Dx: Patellofemoral compression test
* Tx: Quadriceps strengthening exercises
105
Tenderness at tibial tubercle
**Osgood-Schlatter disease**
(common during pre-adolescent/adolescent growth spurts
106
Localized back pain worse at night, not relieved w/ rest
**Spinal metastasis**
| (hx of lung/breast/prostate cancer)
107
Positive straight leg test
**Disc herniation**
108
Low back pain radiating down below knee
**Spinal stenosis vs. Disc herniation**
109
Morning stiffness + Dactylitis
**Psoriatic arthritis**
110
Dactylitis + Esophageal dysmotility + ILD + HTN + Anti-topoisomerase Abs (Anti-Scl-70)
**Systemic Sclerosis (SSc)**
111
Joint pain that improves with activity vs. worsens with activity
**Inflammatory vs. Noninflammatory Arthritis respectively**
(**RA vs. OA)**
112
Violaceous plaques, slightly scaly
**Dermatomyositis**
**(**Gottron’s Papules)
113
Red plaques w/ silvery scaling
**Psoriatic Arthritis**
114
Psoriatic Arthritis Tx
**NSAIDs, MTX, & TNF-inhibitors**
115
Monosodium urate
**Gout deposition crystal that creates tophi**
116
Swollen hands + Dactylitis (sausage digits) + Arthritis of DIPs + Nail changes
**Psoriatic arthritis**
| (+red plaques w/ silvery scaling)
117
\>50 w/ shoulder & hip stiffness + can have GCA (Giant Cell Arteritis)
**Polymyalgia Rheumatica**
| (elevated ESR/CRP)
118
Polymyositis Tx
**Prednisone +/- MTX or azathioprine**
119
Weakness that worsens w/ activity
**Myasthenia Gravis**
120
Caplan syndrome
**RA associated with pneumoconiosis**
121
Still’s disease = Juvenile RA w/ predominantly extraarticular manifestations
J**uvenile RA w/ predominantly extraarticular manifestations**
122
TNF-alpha Inhibitor side-effects
* **Infection**
* **Demyelination**
* **CHF**
* **Malignancy**
123
Hydroxychloroquine side-effects
**Retinopathy**
(requires baseline & periodic ophthalmologic assessments)
124
RA patient + oral ulcers
**MTX Toxicity**
125
RA patient w/ neutropenia & splenomegaly
**Felty Syndrome**
126
MTX Toxicity side-effects
* **Oral ulcers/Stomatitis**
* **Hepatotoxicity**
* **Alopecia**
* **BM suppression (cytopenias)**
* **Pulmonary toxicity (**ABB**M**NR**)**
* **Rash**
127
Folate antimetabolite
**MTX**
(first line Tx for RA)
* Folic acid supplementation w/ chronic MTX Tx
* Drugs that induce folate deficiency: "**TMP**"
* **T**MP-SMX
* **M**TX
* **P**henytoin
128
Tenosynovitis + dermatitis + migratory polyarthralgias
**DGI**
| (Disseminated Gonococcal Infection)
129
Peeling of feet
**Keratoderma blennorrhagicum**
(Reactive arthritis 2/2 Chlamydia trachomatis or GI infection)
130
Chrondrocalcinosis on joint x-ray
**CPPD**
(Calcium pyrophosphate dehydrate crystal deposition: **Pseudogout**), Causes:
* Hyperparathyroidism
* Hypothyroidism
* Hemochromatosis (bronze diabetes)
131
Anticitrullinated peptide Abs
**Rheumatoid Arthritis**
| (Anti-CCP)
132
Shoulder pain w/ active ROM but normal passive ROM
* **Rotator Cuff Tendinopathy**
* **Rotator Cuff Tear (\>40)**
* **Biceps Tendinopathy**
133
Decreased active and passive ROM:
* Adhesive capsulitis
* Glenohumeral Osteoarthritis
134
Decreased active ROM but normal passive ROM, \>40
**Rotator cuff tear**
135
Decreased active and passive shoulder ROM w/ hx of shoulder injury/trauma
**Glenohumeral Osteoarthritis**
136
Chronic inflammation, fibrosis, and contracture of the shoulder joint
**Adhesive Capsulitis**
| (Frozen Shoulder)
137
Anterior shoulder pain w/ lifting/carrying/overhead reaching
**Biceps tendinopathy/rupture**
138
Middle-aged w/ shoulder stiffness
**Adhesive capsulitis**
(frozen shoulder) vs. Polymyalgia Rheumatica (elevated ESR/CRP)
139
Frozen Shoulder
**Adhesive Capsulitis**
140
Neer/Hawkins positive + weakness w/ external rotation
**Rotator cuff tear**
141
Normal ROM + positive Neer, Hawkins
**Rotator Cuff Impingement or Tendinopathy**
142
Malignancy + symmetrical proximal muscle weakness
**Dermatomyositis**
| (immune-mediated muscle injury)
143
Erythematous rash over dorsum of fingers
**Gottron’s sign**
**(**Dermatomyositis)
144
Erythematous rash over upper eyelids
**Heliotrope eruption**
| (Dermatomyositis)
145
Antibodies against presynaptic membrane
**Lambert-Eaton** myasthenic syndrome
(presents w/ proximal muscle weakness, dry mouth, ED, absent/diminished DTRs)
146
Proximal muscle weakness + Raynaud phenomenon + polyarthritis + esophageal dysmotility
**Dermatomyositis/Polymyositis**
(+Gottron papules, heliotrope rash in dermatomyositis)
147
Carpal tunnel syndrome structures
**Transverse Carpal Ligament**
* Median nerve
* Flexor digitorum profundus
* Flexor digitorum superficialis
* Flexor pollicis longus
148
Thenar atrophy + weakness of thumb abduction/opposition
**CTS**
| (Carpal Tunnel Syndrome)
149
Sudden “grabbing” pain in lower back w/ lifting
**Lumbar Strain**
(Tx: NSAIDs + Continue moderate activity)
150
First line Tx for RA
**Methotrexate**
**(**DMARDs: Disease-Modifying AntiRheumatic Agents)
* **Test for HBV, HCV, TB, and Pregnancy before beginning MTX therapy**
**Next level:**
* **TNF-alpha inhibitors (etanercept, infliximab, adalimumab, rituximab, tocilizumab)**
* **Non-biologic DMARDs (Hydroxychloroquine, sulfasalazine, azathioprine, leflunomide)**
151
Positive straight leg raise test
**Sciatica**
* 2/2 irritation to sciatic nerve that travels down leg
* Tx: Treat symptoms (pts experience spontaneous resolution)--**NSAIDs** or **APAP**; Maintain moderate activity
* ****Cyclobenzoprine only if refractory
152
Raynaud's + Sausage digits + Fine crackles BL
**_Systemic_ Sclerosis** (Scleroderma/CREST syndrome)
* **+Anti-topoisomerase I Abs (anti-Scl-70)**, Anticentromere+ (**antiCRESTomere**), ANA+ (nonspecific)
* Path: Progressive tissue fibrosis & CT thickening from collagen deposition 2/2 fibroblast dysfunction & increased collagen + ground substance production
* Can progress to obliteration of skin appendages (e.g. hair, follicles, sweat glands)
* Raynaud component = vascular dysfunction
* Extradermal complications: **CREST**
* **C**alcinosis (CCBs)
* **R**aynaud's phenomenon (CCBs)
* **E**sophageal dysmotility (PPI)
* **S**clerodactyly (penicillamine)
* **T**elangiectasias
* **+**Interstitial lung disease (fine crackles)
* +HTN (renal involvement)
* +Scleroderma renal crisis (oliguria, thrombocytopenia, MAHA)
* _+Myocardial fibrosis_, _pericarditis_, pericardial effusion
153
Dry eyes, dry mouth, dysphagia w/ solids only
**Sjögren Syndrome (SS)**
* Autoimmune inflammation of exocrine glands seen in middle-aged women
* **+Schirmer test** (strip of filter paper placed under lower eyelid & measured after 5 min for absorbed fluid
* **+histologic e/o lymphocytic infiltration** of salivary gland
* **+Anti-SSA (Ro)** and/or **Anti-SSB (La)**
* Can also be seen w/ Raynaud, cutaneous vasculitis, arthralgia/arthritis, & ILD
154
Nontender nodules on the elbow
**RA**
(Rheumatoid nodules--firm, nontender, subcutaneous, close to pressure points)
155
Part of spine affected in RA
**Cervical spine**
(Cervical spine subluxation can lead to spinal cord compression)
* Sacroiliac joints = seronegative PAIR spondylarthropathies
* Thoracic = Disc herniation or other spinal d/o
* Lumbar = Disc hernation, spinal stenosis
156
Pain w/ extending the knee while compressing the patella
Patellofemoral syndrome
(young female athlete w/ chronic knee overuse)
* P/w anterior knee pain
157
Popliteal cyst (Baker cyst; posterior knee) is associated w/
**Osteoarthritis**
* Thus, seen in older pts
158
Rhomboid-shaped crystals on arthrocentesis
Pseudogout (CPPD)
* Calcium pyrophosphate dihydrate deposition
* +Chondrocalcinosis on XR
* Can be 2/2:
* **Hyperparathyroidism** (e.g. pt w/ chronic hypercalcemia)
* **Hemochromatosis** (BDAC--bronze DM, arthritis, cardiomyopathy)
159
The pes anserinus in the medial knee is formed by the joining of these 3 tendons
1. Gracilis
2. Sartorius
3. Semitendinosus
160
Male in 20s or 30s w/ LBP
Classically **PAIR** (seronegative spondylarthropathy)
* LBP DDx: "**MRS. C-Mii has LBP**"
* **M**echanical (strain, spasm, paraspinal TTP)
* **R**adiculopathy (+straight leg raise if sciatica)
* **S**tenosis (worse w/ extension)
* **C**ompression fx
* **M**etastasis (lung \> breast \> prostate \> thyroid \> kidney)
* **I**nflammatory (PAIR)
* **I**nfection (osteo, discitis, abscess [IVDU])
161
Testosterone type specific to adrenals
**DHEAS**
* Ovarian T:
* Testosterone
* Androstenedione
* DHEA
* Elevated T + normal DHEAS suggests ovarian tumor \> adrenal tumor (both p/w rapidly progressive hyperandrogenic symptoms)
162
Extrusion of synovial fluid from knee joint into the gastrocnemius or semimembranosus bursa
**Popliteal cyst (Baker cyst)**
(chronic, painless bulge behind the knee)
* Triggered by increased synovial fluid from **RA** or **OA**
* Rupture of Baker's cyst can extend into calf or form a **"crescent sign"** on calf or at ankle
163
Tx & PPX of Amyloidosis
**Colchicine**
(also treats acute gout)
* Gout PPX: Allopurinol
164
Inhibits xanthine oxidase
**Allopurinol**
(Tx of hyperuricemia and gout PPX)
* Acute gout: Colchicine
165
Reactive arthritis usually follows ____ infections
**GI** or **GU**
(Tx: NSAIDs)
* Salmonella
* Shigella
* Campylobacter
* Chlamydia
* Yersinia
Note: Reiter syndrome = Reactive arthritis w/ triad of arthritis, uveitis, & urethritis
166
A mostly LE arthritis that can include
* Assymmetric oligoarthritis
* Urethritis (nongonococcal)
* Conjunctivitis
* Mucucutaneous lesions
* Enthesitis (achilles tendon pain)
**Reactive Arthritis**
* Usually follows GI or GU infection (1-4 weeks post)
* PAIR arthritis, thus suspect when _young male_
* Tx: NSAIDs
167
LBP. MRI or XR?
**MRI** if:
* Neuro deficits
* Cauda equina syndrome features
* Suspected epidural abscess
**XR** if:
* Elevated risk of malignancy (e.g. nocturnal pain, progressive, hx of smoking or cancer, older, weight loss or other B symptoms)
**Skeletal Survey** if:
* Suspect Multiple Myeloma (Bone pain + anemia + hypercalcemia + AKI)
_Uncomplicated_ → NSAIDs
_Persistent_ → PT
CT scan only if needs MRI but cannot tolerate it
168
Achy pain in the shoulders & hips
**PMR**
(Polymyalgia rheumatica)
* +Elevated ESR
* \>50yo
* Often progresses to **GCA**
169
* BP discrepancies between R & LUE
* Pulse deficits
* Bruits
* Fever, arthralgias, weight loss
* Exertional arm pain
**Takayasu Arteritis**
(large-vessel vasculitis)
* **Asian Female \<40**
* Mononuclear infiltrates & granulomatous inflammation
* Arterial wall thickening w/ aneurysmal dilation or narrowing & occlusion
* Elevated ESR/CRP
* Tx: **Systemic glucocorticoids**
Note: if \>50, suspect GCA, especially if more shoulders/hips (like PMR)
170
Male heavy smoker w/ gangrenous digits
**Thromboangiitis obliterans**
| (Buerger disease)
171
Scalp tenderness + Jaw claudication
**GCA**
(Giant Cell Arteritis)
* Temporal HA
* Older
* Elevated ESR
* Shoulder & Hip pain (think of it like advanced PMR)
172
Ankylosing Spondylitis pts have an increased risk of:
* **Aortic Regurgitation** (early diastolic murmur)
* **Vertebral Fracture** (2/2 bone loss from chronic inflammation & rigidity)
* **Anterior Uveitis**
* **Dactylitis** (swelling of fingers & toes)
* **Enthesitis** (tenderness at tendon insertion sites)
173
Are NSAIDs effective in treating CTS?
**No**
Tx:
**S**plinting → **S**teroids → **S**urgery (surgical decompression)
174
Tx of Paget disease of bone
**Bisphosphonates**
(osteoclast inhibitors; like calcitonin but stronger)
