Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
266 Cards in this Set
- Front
- Back
|
what is another name for torticollis
|
wry neck
|
|
|
what is torticollis
|
neck twisting which causes asymmetric muscle activity
|
|
|
what causes torticollis
|
URI
trauma cervical lymphadenitis retropharyngeal abscess atlantoaxial subluxation |
|
|
what is a complication of a maniscal tear
|
predisposes to osteoarthritis
|
|
|
what is enthesitis
|
inflammation and pain at the site where tendons and ligaments attach
|
|
|
what is another name for osteoarthritis
|
degenerative joint disease
|
|
|
what is osteoarthritis
|
cartilage degradation
|
|
|
what causes osteoarthritis
|
obesity
age trauma |
|
|
how can osteoarthritis present
|
pain in wight bearing bones
stiffness in morning for less than 15 minutes crepitus in joints |
|
|
different joins affected by osteoarthritis and RA
|
osteoarthritis = DIP
RA = spares DIP |
|
|
what is seen in lumbar osteoarthritis
|
lumbar disk degeneration
|
|
|
what are the diagnostic criteria for osteoarthritis
|
>50 yo
morning stiffness < 15 minutes or none at all bone tenderness bone enlargement crepitus no warmth |
|
|
most accurate test for osteoarthritis
|
x ray
|
|
|
what is seen on x ray of osteoarthritis
|
joint space narrowing
osteophytes subchondral cysts and sclerosis |
|
|
initial Rx for osteoarthritis
|
weight loss and moderate exercise
|
|
|
best initial Rx for osteoarthritis
|
acetomenophen
if not NSAIDs if not intraarticular steroids if not colchicine |
|
|
what kind of crystals does gout have
|
sodium urate
|
|
|
what is seen on x ray of hemochromatosis associated arthropathy
|
squared off bone ends
hook like osteophytes in MCP |
|
|
most accurate test for gout
|
joint aspiration
|
|
|
what is seen in joint aspirate of gout
|
needle shaped crystals with negative birefringence
|
|
|
what is the best initial Rx for gout
|
NSAIDS
if not use steroids |
|
|
SE of colchicine
|
diarrhea
BM supression (neutropenia) |
|
|
what is used to prevent a second gout attack
|
colchicine
|
|
|
what do you do if patient is on allopurinol and develops an acute gout attack
|
continue allopurinol and give NSAIDS
|
|
|
SE of allopurinol
|
SJS or TEN
hypersensitivity Rxn |
|
|
SE of which chronic gout Rx can be used with renal injury
|
allopurinol
|
|
|
what kind of crystals does pseudogout have
|
calcium pyrophosphate
|
|
|
MC risk factors for pseudogout
|
hemochromatosis
hyper PTH |
|
|
most accurate test for pseudogout
|
joint aspiration
|
|
|
what is seen on joint aspiration of pseudogout
|
romboid crystals with positive birefringence
|
|
|
virus a/w pagets disease
|
RSV
paramyxo |
|
|
what is increased in pagets disease
|
alk phosph
urine hydroxyproline deoxypyridinoline N-telopeptide |
|
|
Dx
bone scan shows diffuse hot spots |
pagets disease
|
|
|
Rx for pagets
|
bisphosphonates and calcitonin
|
|
|
what is pagets disease
|
osteoclast hyperfunctioning
|
|
|
a/w mosaic patten of lamellar bone
|
pagets disease
|
|
|
a/w abnormal bone remodeling
|
pagets disease
|
|
|
what is the initial goal in a px with pagets disease
|
establish which bones are being effected
|
|
|
when is Rx indicated in pagets disease
|
bone pain
hypercalcemia of immobilization neuro defect high output HF orthopedic surgery weight bearing bones are involved |
|
|
a/w synovial fluid analysis shows <200 WBC
|
osteoarthritis
|
|
|
a/w synovial fluid analysis shows 2,000-50,000 WBC
|
gout and pseudogout
|
|
|
a/w synovial fluid analysis shows >50,000 WBC
|
septic arthritis
|
|
|
best initial Rx for pseudogout
|
NSAIDs
if not give steroids |
|
|
what helps prevent subsequent attacks of pseudogout
|
colchicine
|
|
|
MCC of lower back pain
|
lumbosacral strain
|
|
|
Rx for lumbosacral strain
|
NSAIDS
early mobilization |
|
|
what is done when degenerative joint disease is found on MRI of spine of 60 yo male
|
nothing
common finding in that age |
|
|
Dx
px has history of cancer with the sudden onset of neurologic deficit |
compression of spinal cord
|
|
|
how does the pain of spinal cord compression present
|
dermatologic distribution
|
|
|
what is leriche syndrome
|
aortoiliac occlusion
|
|
|
Dx
px presents with low back pain, claudications of the hip, butt and thigh with weak femoral pulses or bruit |
aortoiliac occlusion
|
|
|
what is another name for disk herniation
|
sciatica
acute disk prolapse |
|
|
a/w positive straight leg raise test
|
disk herniation
|
|
|
what is the best initial test for cord compression
|
x ray
|
|
|
what is the most accurate test for cord compression
|
MRI
if CI, CT with intrathecal contrast |
|
|
when should a px with lower back pain be referred to neurosurgeon or orthopedic surgeon
|
cauda equina
spinal cord compression neurologic problems persistant despite therapy |
|
|
Dx
px has chronic neck pain with limited rotation and bending |
cervical spondylosis
|
|
|
what is seen on radiology of cervical spondylosis
|
boney spurs and sclerotic facet joints
|
|
|
what is the next best step in a patient you think has cord compression
|
glucocorticoids
|
|
|
symptoms a/w cauda equina syndrome
|
bowel and bladder incontinence
erectile disfunction saddle area anesthesia |
|
|
why are the nerves in cauda equina prone to damage
|
poorly developed epineurium
|
|
|
Dx
back pain a/w cancer |
cord compression
|
|
|
Dx
back pain a/w fever and high ESR |
epidural abscess
|
|
|
Dx
back pain a/w worsens with rest and improves with activity |
ankylosing spondylitis
|
|
|
Dx
back pain a/w worse with activity and relieved by rest |
disk herniation
|
|
|
Dx
back pain a/w px remembers the event |
disk herniation
|
|
|
Rx in px with cord compression that doesnt get better with steorids
|
surgical decompression
|
|
|
Rx for epidural abscess
|
steroids and antibiotics
|
|
|
when is surgery indicated in epidural abscess
|
large abscess
neurologic problems unresponsive to antibiotics |
|
|
Rx for cauda equina
|
steroids and surgical decompression
|
|
|
Rx for disk herniation
|
NSAIDS
steroids for those who dont improve |
|
|
when are imaging studies indicated in back pain
|
focal neurologic abnormalities
|
|
|
MCC of spinal stenosis
|
degenerative joint disease (osteoarthritis)
|
|
|
Dx
px has back pain that gets worse with leaning back |
spinal stenosis
|
|
|
what causes spinal stenosis
|
enlarging osteophytes
hypertrophy of the ligamentum flavum |
|
|
best test for spinal stenosis
|
MRI
|
|
|
Rx for spinal stenosis
|
weight loss and steroid injections
surgical correction (laminectomy) |
|
|
Rx for sleep disorder a/w fibromyalgia
|
TCA
|
|
|
best initial therapy for fibromyalgia
|
amitriptyline
can also use milnacipran and pregabalin |
|
|
what causes carpel tunnel syndrome in pregnancy
|
estrogen mediated depolymerization leading to edema
|
|
|
what causes carpel tunnel syndrome in RA
|
tenosynovial inflammation
|
|
|
what causes carpel tunnel syndrome in hypothyroidism
|
deposits of mucopolysaccharides
|
|
|
most accurate diagnostic test for carpel tunnel syndrome
|
electromyography and nerve conduction studies
|
|
|
best initial Rx for carpel tunnel syndrome
|
wrist splints
if not NSAIDS if not steroid injection |
|
|
symptoms of carpel tunnel syndrome
|
pain in thumb, palm, index, and radial half of ring finger
atrophy of thenar eminence worse pain at night |
|
|
what causes dupuytren contracture
|
hyperplasia of the palmar fascia
|
|
|
Rx for dupuytren contracture
|
steroids
surgery for functionally impaired |
|
|
Dx
px has shoulder pain that improves with lidocaine |
rotator cuff tear
|
|
|
Dx
px has shoulder pain that doesnt improve with lidocaine |
rotator cuff tendonitis (subacromial bursitis)
|
|
|
Dx
px has pain with passively moving arm over head |
rotator cuff tendonitis (subacromial bursitis)
|
|
|
what causes rotator cuff tendonitis
|
repeated overhead activity
|
|
|
most accurate test for rotatio cuff injury
|
MRI
|
|
|
best initial Rx for rotator cuff injury
|
NSAIDs, rest and physical therapy
if not steroids |
|
|
when is surgery indicated in rotator cuff injury
|
complete tears
those resistant to NSAIDS and steroids |
|
|
Dx
px has pain with passive wrist flexion and resisted wrist extension |
tennis elbow
|
|
|
Dx
px develops pain after falling backward on outstretched arms |
posterior elbow dislocation
|
|
|
Dx
child develops pain after he is lifted or pulled by the arm |
nursemaids elbow
|
|
|
Rx for nursemaids elbow
|
supinating arm, placing pressure on radial head, and reducing until audible click
|
|
|
virus a/w viral arthritis
|
parvo B19
HIV rubella |
|
|
Dx
day care teacher develops symmetric arthritis |
viral arthritis
|
|
|
Dx
px has pain and swelling directly over the patella |
prepatellar bursitis
|
|
|
Dx
px with pain in the anterior medial tibia just below the knee joint |
anserine bursitis
|
|
|
what causes anserine bursitis
|
abnormal gait
overuse trauma |
|
|
Dx
px has pain extending fingers while you flex then |
radial tunnel syndrome
|
|
|
Dx
px has pain when walking after sitting for a long time in front of the knee or just below the patella however, it gets better with use |
patellofemoral syndrome
|
|
|
Dx
px complains of crepitus with motion of the patella |
patellofemoral syndrome
|
|
|
Rx for patellofemoral syndrome
|
physical therapy and strength training with cycling
|
|
|
Dx
px has severe point tenderness on bottom of foot near the calcaneus that is worst in the morning and improves with walking |
plantar fasciitis
|
|
|
Rx for plantar fasciitis
|
stretching arch support and NSAIDS
surgery for those who dont resolve |
|
|
MC area of axial skeleton damaged by RA
|
cervical
|
|
|
how long must arthritis be present to Dx RA
|
6 months
|
|
|
px with RA are at increased risk for
|
osteopenia and osteoporosis
|
|
|
what causes baker cyst in RA
|
excess fluid production by inflamed synovium
|
|
|
bone cancer a/w:
soap bubble appearance |
giant cell (osteoclastoma)
|
|
|
bone cancer a/w:
small round blue cells |
ewings
|
|
|
bone cancer a/w:
onion skin appearance |
ewings
|
|
|
bone cancer a/w:
usually begins after trauma |
osteosarcoma
|
|
|
bone cancer a/w:
periosteal new bone formation with periosteal elevation |
osteosarcoma
|
|
|
bone cancer a/w:
sunburst pattern |
osteosarcoma
|
|
|
what is felty syndrome
|
RA (for 10 years)
splenomegaly neutropenia |
|
|
what is caplan syndrome
|
RA
pneumoconiosis lung nodules |
|
|
what must be given to a px with erosive RA
|
MTX
|
|
|
what is considered erosive arthritis
|
joint space narrowing
physical deformity of the joint x ray abnormalities |
|
|
MCC of death in RA
|
CAD
|
|
|
best initial Rx for pain in RA
|
NSAIDS
|
|
|
SE of MTX
|
lung
liver BM oral ulcers (somatitis) |
|
|
what is given to a px with RA that is unresponsive to MTX
|
TNF -
|
|
|
SE of TNF -
|
infection
reactivation of TB |
|
|
what is given to a px with RA that is not responsive to MTX and TNF -
|
rituximab
|
|
|
MOA of retuximab
|
removes CD20 lymphocytes
|
|
|
Rx for px with RA that you wish to avoid MTX SE
|
hydroxychloroquine
|
|
|
what must be done when giving hydroxychloroquine
|
dilated eye exam
|
|
|
SE of hydroxychloroquine
|
retinal toxicity
GI upset hemolysis in G6PD def |
|
|
when are steroids used in RA
|
when NSAIDS dont work
as a bridge when waiting for DMARDs to take effect |
|
|
what is another name for juvenile rheumatoid arthritis
|
adult still disease
|
|
|
Dx
high spiking fever in a young person with rash and arthritis |
juvenile rheumatoid arthritis
|
|
|
SE of sulfasalazine
|
rash
hemolysis in G6PD def oligospermia |
|
|
SE of rituximab
|
infection
|
|
|
SE of gold salts
|
nephrotic syndrome
|
|
|
feature of juvenile rheumatoid arthritis rash
|
a/w spiking fever
salmon colored found on chest and back |
|
|
Rx for juvenile rheumatoid arthritis
|
aspirin or NSAIDS
if no response give steroids |
|
|
what complement is decreased in SLE
|
C3
|
|
|
what is seen on x ray of arthritis a/w lupus
|
normal
|
|
|
what complement deficiency is a/w familial lupus
|
C1q
|
|
|
what is the first symptom to bring a lupus px to the hospital
|
arthritis
|
|
|
a/w blue toe syndrome
|
cholesterol emboli
|
|
|
what happens in an acute lupus flare
|
complement levels drop and anti DS DNA rises
|
|
|
Rx for acute lupus flare
|
high dose bolus steroids
|
|
|
Rx for mild lupus limited to skin and joint
|
hydroxychloroquine
|
|
|
Rx for lupus nephritis
|
steroids with cyclophosphamide or mycophenolate
|
|
|
Rx for lupus that best decreases symptoms overall
|
belimumab
|
|
|
presentation of antiphospholipid syndrome
|
thromboses
recurrent spontaneous abortion elevated PTT |
|
|
what antibodies give spontaneous abortion
|
anticardiolipin
|
|
|
what antibodies give elevated PTT
|
lupus anticoagulant
|
|
|
what is the best initial test for antiphospholipid syndrome
|
mixing study
-PTT will remain elevated |
|
|
what the most specific test for antiphospholipid syndrome
|
russell viper venom test
-prolonged |
|
|
when should antiphospholipid syndrome start being investigated
|
2 or more first trimester events
single second trimester event |
|
|
Rx to prevent spotaneous abortion in antiphospholipid syndrome
|
heparin and aspirin
|
|
|
most specific test for scleroderma
|
scl 70 Ab
|
|
|
Rx for renal crisis in scleroderma
|
ACEI
|
|
|
Rx for esophageal dysmotility and GERD in scleroderma
|
PPIs
|
|
|
Rx for reynauds in scleroderma
|
CCB
|
|
|
Rx for pulmonary fibrosis in scleroderma
|
cyclophosphamide
|
|
|
Rx for pulmonary HTN in scleroderma
|
bosenten
sildenafil |
|
|
how is duchennes muscular dystrophy confirmed
|
muscle biopsy
|
|
|
Dx
px has delayed muscle relaxation |
myotonic dystrophy
|
|
|
Dx
px has proximal muscle weakness |
polymyositis
|
|
|
Dx
px has difficulty getting up from seated position or walking up stairs |
polymyositis
|
|
|
labs a/w polymyositis
|
increased CKMB and aldolase
|
|
|
Rx for skin lesions a/w dermatomyositis
|
hydroxychloroquine
|
|
|
best initial test for polymyositis
|
CPK and aldolase
|
|
|
most accurate test for polymyositis
|
muscle biopsy
|
|
|
what is seen on muscle biopsy of polymyositis
|
inflammatory cells and muscle degeneration and regeneration
|
|
|
Dx
EMG shows myopathic pattern |
duchenne muscluar dystrophy
|
|
|
Dx
EMG shows spontaneous fibrillations |
polymyositis
|
|
|
best initial treatment for polymyositis
|
steroids
|
|
|
Rx for polymyositis when steroids dont work or px is intolerant
|
MTX
azathioprine mycophenolate immunoglobulins |
|
|
cancers a/w dermatomyositis
|
ovary
breast lung |
|
|
what other pathologies is sjogrens a/w
|
RA
SLE primary biliary cirrhosis polymyositis hashimoto |
|
|
what is the most dangerous complication of sjogrens
|
lymphoma
|
|
|
best initial test for sjogrens
|
schirmer test
|
|
|
most accurate test for sjogrens
|
lip or parotid gland biopsy
|
|
|
best initial Rx for sjogrens
|
water the mouth
|
|
|
what pathology is PAN a/w
|
hep B
|
|
|
what is spared in PAN
|
lungs
|
|
|
what causes the neurologic symptoms in PAN
|
mononeuritis multiplex
|
|
|
what causes the GI symptoms in PAN
|
vasculitis of mesenteric artery
|
|
|
what skin findings are a/w PAN
|
livedo reticularis
purpura nodules gangrene |
|
|
most accurate test for PAN
|
biopsy of symptomatic site
|
|
|
what is seen in angiography in PAN
|
beading in the
-renal -mesenteric -hepatic |
|
|
what should all patients with PAN be tested for
|
hep B
|
|
|
Rx for PAN
|
prednisone
cyclophosphamide |
|
|
what should be worked up once polymyalgia rheumatica is diagnosed
|
temporal arteritis
|
|
|
Dx
px presents with pain and stiffness in the shoulders and pelvic girdle |
polymyalgia rheumatica
|
|
|
what is seen in labs in polymyalgia rheumatica
|
anemia
normal aldolase and CPK increased ESR |
|
|
Rx for polymyalgia rheumatica
|
steroids
|
|
|
what may be a complication in the aorta a/w temporal arteritis
|
may involve branches and cause aneurysms
|
|
|
what is the best initial test for wegeners granulomatosis
|
c-ANCA
|
|
|
what is the most accurate test for wegeners granulomatosis
|
biopsy
1)lung 2)renal 3)sinus |
|
|
what antibodies are a/w wegeners
|
c-ANCA
|
|
|
what antibodies are a/w churg strauss
|
P-ANCA
|
|
|
what antibodies are a/w microscopic polyangitis
|
P-ANCA
|
|
|
what kind of antibody is C-ANCA
|
anti proteinase 3
|
|
|
what kind of antibody is P-ANCA
|
anti myeloperoxidase
|
|
|
Rx for wegeners granulomatosis
|
prednisone
cyclophosphamide |
|
|
Dx
px with unresolving pneumonia that doesnt get better with antibiotics |
wegeners
|
|
|
Dx
asthmatic patient with vasculitis and eosinophilia |
churg strauss
|
|
|
most accurate test for churg strauss
|
biopsy
|
|
|
Rx for churg strauss
|
prednisone and cyclophosphamide
|
|
|
most frequent vasculitis in children
|
henoch schonlien purpura
|
|
|
tetrad of HSP
|
GI problems
purpura arthralgia hematuria |
|
|
most accurate test for HSP
|
biopsy
|
|
|
what will be seen on biopsy of HSP
|
deposition in skin and kidney of IgA
|
|
|
what is the painless, palpable purpura on butt and legs called in HSP
|
leukocytoclastic reaction
|
|
|
Rx for HSP
|
nothing
only give steroids if extra-renal manifestation |
|
|
what pathology is cryoglobulinemia a/w
|
hep C
|
|
|
manifestation of cryoglobulinemia
|
arthralgia
glomerulonephritis purpura neuropathy |
|
|
what complement is decreased in hep C
|
C4
|
|
|
Dx
Asian with painful oral and genital ulcers and erythema nodosum like nodules |
behcet syndrome
|
|
|
what is pathergy
|
sterile skin pustules from minor trauma like needle sticks
|
|
|
Rx for behcet syndrome
|
steroids
then wean off with -azathioprine -cyclophosphamide -colchicine -thalidomide |
|
|
what is enthesopathy
|
inflammation where tendons and ligaments attach to bones
|
|
|
what additional findings are found in ankylosing spondylitis
|
uveitis
amyloidosis IgA nephropathy apophyseal joint disease inflammatory bowel disease |
|
|
most common extraarticular manifestation of ankylosing spondylitis
|
anterior uveitis
|
|
|
best initial test for ankylosing spondylitis
|
x ray of sacroiliac joint
|
|
|
most accurate test for ankylosing spondylitis
|
MRI
|
|
|
what causes the fusing of vertebral bodies in ankylosing spondylitis
|
bridging syndesmophytes
|
|
|
symptoms of mix connective tissue disease
|
reynauds
Fatigue Arthralgia Myalgia Esophageal dysmotility |
|
|
antibodies a/w mixed connective tissue disease
|
anti U1 RNP
|
|
|
initial Rx for ankylosing spondylitis
|
exercise and NSAIDS
if not used TNF - |
|
|
a/w distal phalangeal resorption
|
psoriatic arthritis
|
|
|
what is the best initial test for psoriatic arthritis
|
x ray
|
|
|
what is seen on x ray for psoriatic arthritis
|
pencil in a cup deformity
|
|
|
best initial Rx for psoriatic arthritis
|
NSAIDs
if not MTX if not TNF - |
|
|
what cutaneous findings are a/w reiters
|
keratoderma blennorhagicum
balanitis circinata |
|
|
Rx for reiters
|
NSAIDS
if not sulfasalazine |
|
|
a/w bone demineralization
|
osteoporosis
|
|
|
most accurate test for osteoporosis
|
DEXA scan
|
|
|
T-score for osteopenia
|
1-2.5 SD below normal
|
|
|
T score for osteoporosis
|
>2.5 SD below normal
|
|
|
best initial Rx for osteoporosis
|
vit D and Calcium
bisphosphonates if T-score >2.5 |
|
|
Rx that decreases the risk for vertebral fractures in osteoporosis px
|
calcitonin
|
|
|
SE of bisphosphonates
|
esophagitis
|
|
|
SE of teriparatide
|
osteosarcoma
hypercalcemia |
|
|
what causes osteitis fibrosa cystica
|
increase PTH
|
|
|
a/w brown tumors
|
osteitis fibrosa cystica
|
|
|
what has the greatest risk for septic arthritis
|
prosthetic joint
|
|
|
what is seen on radiology of septic arthritis
|
normal joint space
|
|
|
criteria for septic arthritis
|
WBC >12,000
>102 fever ESR > 40 refusal to bear weight |
|
|
best step in suspected septic arthritis
|
joint aspiration
|
|
|
bets initial empiric therapy in septic arthritis
|
ceftriaxone and vancomycin
|
|
|
how will an affected prosthetic joint look on radiology
|
surrounded by lucency
|
|
|
Rx for septic arthritis of prosthetic joint
|
remove joint
antibiotics for 6-8 weeks and replace joint again |
|
|
MC organism to cause septic arthritis in prosthetic joint
|
S epidermitis
|
|
|
Triad for gonococcal arthritis
|
polyarteritis
tenosynovitis patechial rash |
|
|
when is gonococcal arthritis more frequent
|
menses
|
|
|
what should be done to reach maximum sensitivity in suspected gonococcal arthritis
|
multiple diffuse sites should be cultured
|
|
|
best empiric therapy for gonococcal arthritis
|
cephalosporine
|
|
|
what should be done in a px with recurrent gonorrhea infection
|
test for terminal complement deficiency
|
|
|
how do children get osteomyelitis
|
hematogenous spred
|
|
|
how do adults get osteomyelitis
|
contiguous spread
|
|
|
best initial test for osteomyelitis
|
x ray
if normal, next step is an MRI |
|
|
most accurate test for osteomyelitis
|
biopsy
|
|
|
what is seen on x ray of osteomyelitis
|
periosteal elevations and necrotic areas
|
|
|
what is used to follow response to therapy in osteomyelitis
|
ESR
|
|
|
what are some findings of mccune albright syndrome
|
precocious puberty
cafe au lait spots polyostotic fibrous dysplasia |
