Usmle Step 1 Fa Musculoskeletal-Joint Disease

Front 1

Osteoarthritis
"degenerative joint disease"
Cause

Back 1

Wear and tear of joints leading to destruction of articular cartilage

Front 2

Signs of osteoarthritis

Back 2

Subchondral cysts, osteophyts, eburnation, Heberdens nodes, Bouchards nodes

Front 3

Heberden's nodes

Back 3

DIP bony swelling

Front 4

Bouchard's nodes

Back 4

PIP bony swelling

Front 5

Predisposing factors for osteoarthritis

Back 5

Age, obesity, joint deformity

Front 6

Osteoarthritis x ray findings

Back 6

Narrowing of joint space due to loss of cartilage and osteosclerosis

Front 7

Joint fluid in osteoarthritis

Back 7

Few cells and normal mucin

Front 8

Most commonly affected joints in osteoarthritis

Back 8

Vertebra, hips, knees, DIPS

Front 9

Classic presentation of osteoarthritis

Back 9

Pain in weight bearing joints after use (end of day)
Pain improves with rest

Front 10

Rheumatoid arthritis etiology

Back 10

Inflammatory disorder affecting synovial joints w/pannus formation

Front 11

Signs/symptoms of rheumatoid arthritis

Back 11

Starts in small joints of hands/feet but may involve any joint (usually symmetric)
Joint swelling, redness, warmth
Subq rheumatoid nodules, ulnar deviation, subluxation, Baker's cyst

Front 12

Most common affected joints in rheumatoid arthritis

Back 12

MCP, PIP (not DIPS)

Front 13

Classic presentation of rheumatoid arthritis

Back 13

Morning stiffness improving with use
Symmetric joint involvement
Systemic symptoms (fever, fatigue, pleuritis, pericarditis)

Front 14

X ray findings in rheumatoid arthritis

Back 14

Erosions and osteoperosis

Front 15

Synovial fluid in rheumatoid arthritis

Back 15

Increased cells (usually neutrophils), poor mucin

Front 16

Classic triad of sjogren's syndrome

Back 16

(1) xeropthalmia (dry eyes, conjunctivitis, "sand in my eye")
(2) xerostoma (dry mouth, dysphagia)
(3) arthritis

Front 17

Associations of Sjogren's syndrome

Back 17

Assoc w/RA
Incr risk of B cell lymphoma
Parotid enlargement, dental caries

Front 18

Epidemiology of Sjogren's syndrome

Back 18

Mainly F 40-60YO

Front 19

Autoantibodies in Sjogren's

Back 19

SSA (Ro)
SSB (la)

Front 20

Joint symptoms in gout

Back 20

Asymmetric distribution
Joint is swollen, red, and painful
Usually MTP joint (big toe)

Front 21

Associated presentation of gout

Back 21

Tophus formation (often on extrenal ear or achiles tendon)

Front 22

Why is gout attack precipitated by alcohol or after a large meal

Back 22

Alcohol metabolites compete for same excretion site in kidney as uric acid causing buildup of uric acid in blood

Front 23

Etiologies of gout

Back 23

Caused by precipitation of monosodium urate crystals in joint space (hyperuricemia)
-Inborn error of purine metabolism usually from an unknown deficiency
(Except Lesche Nyhan syndrome (HGPRT deficiency))
-incr cell turnover
-Von Gierke's disease

Front 24

Diagnosis of gout

Back 24

Tap joint
Crystals are needle shaped and negatively birefiringent
Yellow when parallel and blue when perpendicular to light

Front 25

Treatment of gout

Back 25

Colchicine
NSAIDs
Probenecid
Allopurinol

Front 26

Pseudogout cause

Back 26

Deposition of calcium pytophosphate crystals in joint space

Front 27

Diagnosis of pseudogout

Back 27

Rhomboid cystals that are weakly positively birifringent
Yellow when perpendicular and blue when parallel

Front 28

Felty Syndrome

Back 28

Polyarticular rheumatoid arthritis associated with HLA B27
Splenomegaly and leukopenia

Front 29

Chronic infectious arthritis: causative microbes

Back 29

TB
Lyme disease

Front 30

Septic arthritis presentation

Back 30

Monoarthritis w/asymmetrical pattern. Pain, redness, low grade fever, tenderness, swelling, reduced joint mobility

Front 31

Septic arthritis: #1 overall (causative agent/mech of pathogenesis and treatment)

Back 31

Staph aureus/coagulase inhibits phagocytosis (nafcillin)

Front 32

Septic arthritis: 15-40YO mono or polyarticular (causative agent/mech of pathogenesis and treatment)

Back 32

Neisseria gonorrhea/pilimediate adherence and inhibit phagocytosis (ceftriaxone)

Front 33

Septic arthritis: prosthetic joint (causative agent/mechanism of pathogenesis)

Back 33

Coag negative staph /biofilm allow adherence to teflon

Front 34

Septic arthritis: viral (causative agents/mechanism of pathogenesis)

Back 34

Rubella, hepB, parvovirus/immune complex mediated