Msk/derm: Msk

Front 1

What are five questions to ask when assessing musculoskeletal pain?

Back 1

Articular or not; Inflammatory or not; Acute/chronic; Number of joints involved; Pattern of involvment

Front 2

What are three non-articular categories of MSK pain?

Back 2

Peri-articular; Referred visceral pain; Neuropathic pain

Front 3

What are the four cardinal signs of inflammation?

Back 3

Erythema, warmth, pain, swelling

Front 4

In inflammatory arthritis, is the pain worse at rest or with activity? What about non-inflammatory arthritis?

Back 4

IA: Aggravated at rest, improves with activity; OA: Better at rest, aggravated by activity

Front 5

How does morning stiffness differ between inflammatory and non-inflammatory arthritis?

Back 5

While both typically have morning stiffness, IA is associated with prolonged stiffness, greater than 45 minutes

Front 6

Oligoarthritis is defined as involvement of how many joints?

Back 6

1-4

Front 7

What are three common patterns of joint involvement in arthritis?

Back 7

Additive; Intermittent; Migratory

Front 8

What is the typical pattern of joint involvement in gout? (Additive, intermittent, migratory)

Back 8

Migratory, but possibly intermittent

Front 9

NSAIDs inhibit synthesis of what compounds?

Back 9

Prostaglandins

Front 10

How is misoprostol useful when prescribing long-term NSAID therapy? What other class of agents could alternately be considered?

Back 10

Misoprostol is a gastroprotective agent. You could also consider using a PPI.

Front 11

What class of drugs is useful for dramatically reducing inflammation in arthritis, but likely does not reduce long-term damage to the joint?

Back 11

Glucocorticoids (NSAIDs have anti-inflammatory properties, but are primarily used as analgesics)

Front 12

What might you consider for bridging therapy when starting a DMARD for inflammatory arthritis?

Back 12

Glucocorticoids (i.e. prednisone)

Front 13

Hydroxychloroquine was developed initially as what type of medication? What class of drug is it in relation to MSK issues?

Back 13

Antimalarial medication - currently used as a DMARD

Front 14

What is the major contraindication/toxicity of hydroxychloroquine?

Back 14

Retinopathy

Front 15

What is the first-line pharmacologic therapy for rheumatoid arthritis?

Back 15

Methotrexate

Front 16

What is a common 'toxic' side effect of many DMARDs?

Back 16

Leukopenia (bone marrow suppression)

Front 17

Unlike other DMARDs, what is a common reason for patient discontinuation of Leflunomide?

Back 17

Diarrhea

Front 18

What is classic triple therapy of DMARDs for RA?

Back 18

Methotrexate + Hydroxychloroquine + Sulfasalazine

Front 19

If classic DMARDs fail to work in rheumatoid arthritis, what class of medications should you consider?

Back 19

Biologic agents

Front 20

What are the two primary classifications of biologic agents for RA? (The two original ones)

Back 20

Anti TNF-alpha agents; IL-1 receptor antagonists

Front 21

What class of biologics is counterindicated in patients with CHF?

Back 21

Anti-TNF drugs

Front 22

T-cell costimulation and B-cell depletion are new targets for what class of drugs?

Back 22

Biologics (used in RA)

Front 23

Anti-nuclear antibodies are produced in what connective tissue disease?

Back 23

SLE (Although it can be found in many other autoimmune disorders)

Front 24

What are the four classical skin manifestations of SLE?

Back 24

Malar rash; Photosensitivity; Discoid rash; Oral ulcers

Front 25

What are the three classical organ manifestations of SLE?

Back 25

Arthritis; Serositis; Renal disorder

Front 26

What is peculiar about the inflammatory arthritis seen with SLE?

Back 26

It is non-deforming and non-erosive

Front 27

What are three types of serositis found in SLE?

Back 27

Pleuritis; Pericarditis; Peritonitis

Front 28

What two neurologic symptoms are associated with SLE?

Back 28

Seizures and psychosis (in the absence of any other known cause)

Front 29

Polymyositis and Dermatomyositis fall into which category of autoimmune disorders?

Back 29

Idiopathic inflammatory myositis

Front 30

What is the typical presenting symptom of polymyositis?

Back 30

Muscle weakness (not pain)

Front 31

What is typically present with dermatomyositis which is not found in polymyositis?

Back 31

Skin rash

Front 32

Gottron's papules and Heliotrope rash is associated with which autoimmune disorder?

Back 32

Dermatomyositis

Front 33

In a patient presenting with dermatomyositis or polymyositis, what should we always screen for?

Back 33

Malignancy

Front 34

Digit flexion deformaties can be found in what autoimmune disorder?

Back 34

Systemic sclerosis

Front 35

What autoimmune disease is associated with grouped vascular phenomena, such as Raynaud's; Telangiectasia & Pulmonary hypertension?

Back 35

Systemic sclerosis

Front 36

What are the two categories of scleroderma?

Back 36

Limited cutaneous & Diffuse cutaneous

Front 37

What does CREST syndrome stand for? In what disease is it found?

Back 37

Calcinosis; Raynaud's phenomenon; Esophageal dysfunction; Sclerodactyly; Telangiectasias - Associated with limited cutaneous scleroderma (limited systemic sclerosis)

Front 38

Xeropthalmia and xerostomia are characteristic of which autoimmune disorder?

Back 38

Sjogren's syndrome

Front 39

What is the overlap disorder comprising features of scleroderma, SLE and myositis? What antibody is associated with this disease?

Back 39

Mixed connective tissue disease; anti-RNP antibody

Front 40

Anti-Jo1 antibodies are associated with what autoimmune disorder?

Back 40

Polymyositis/Dermatomyositis

Front 41

What two antibodies are associated with neonatal lupus erythematosus?

Back 41

Anti-Ro and Anti-La (Anti-SSA and SSB)

Front 42

The presence of anti-smith (anti-Sm) antibody has a very high positive predictive value for what autoimmune disease?

Back 42

SLE

Front 43

Low C3/C4 counts and a positive Anti-Ro antibody is most likely due to what condition?

Back 43

SLE

Front 44

What is the only antibody which is correlated with SLE disease severity? What marker is also correlated with disease severity?

Back 44

Anti-dsDNA (increases with severity). C3/C4 counts decrease with severity

Front 45

What are the four primary X-ray findings of arthritis?

Back 45

Joint space narrowing; Osteophytes; Sclerosis; Subchondral cyst formation

Front 46

What is an alternative to joint replacement for a younger patient? What is its primary purpose?

Back 46

Osteotomy; Redistributes mechanical pressure to another part of the joint

Front 47

What is the procedure of joint fusion known as?

Back 47

Arthrodesis

Front 48

What is the five-step process of tendinosis development?

Back 48

Stress; Stress-activated protein kinases; Apoptosis; Tendinopathy; Tendon degeneration

Front 49

What is the main dysfunction in paratenonitis?

Back 49

A tendon rubbing over a bony protuberance

Front 50

What is the best way to classify incidence rates of injury in athletes?

Back 50

Rate per athlete exposure (rather than per season, game or practice)

Front 51

What are some intrinsic risk factors for MSK injury?

Back 51

Malalignment; Limb length discrepancy; Muscle imbalance; Muscle insufficiency

Front 52

What is the biggest determinant of type of MSK injury?

Back 52

Age (older: overuse injuries; younger: tendon insertion injuries)

Front 53

What is the treatment for achilles tendinopathy?

Back 53

Stretching and strengthening physiotherapy; Night splints

Front 54

"Jumper's knee" is also known as what tendinopathy? What are two signs/symptoms?

Back 54

Patellar tendinopathy; Tenderness at insertion point on inferior patella, Tight quadriceps

Front 55

Distance runners are at risk for what overuse syndrome?

Back 55

Iliotibial tract friction syndrome

Front 56

What are the three mainstays of treatment of tendinopathies?

Back 56

Ice; NSAIDs, Stretching

Front 57

What is the medical term for Tennis Elbow? How is it caused?

Back 57

Lateral epicondylitis; Caused by activities that stress the wrist extensor and supinator muscles

Front 58

Which muscle is most commonly involved in lateral epicondylitis?

Back 58

Extensor carpi radialis brevis

Front 59

Medial epicondylitis is caused by activities that stretch which two types of muscles?

Back 59

Flexor and pronator muscles

Front 60

What is the most common symptom in rotator cuff tendinopathy which causes patients to seek medical help?

Back 60

Night pain

Front 61

What is the most common muscle injured in rotator cuff tendinopathy?

Back 61

Supraspinatus

Front 62

Why do children tend to get MSK injuries at apophyseal sites?

Back 62

Growth plates are located at these sites, and thus they can grow quite rapidly

Front 63

What is the most common overuse injury in kids?

Back 63

Osgood-Schlatter disease

Front 64

A 10-year old boy who is active in several sports including soccer and basketball presents with knee pain and swelling over the tibial tubercle with tenderness. His hamstrings are very tight. What is the most likely problem?

Back 64

Osgood-Schlatter Disease

Front 65

Sever's disease is associated with pain over which apophyseal location?

Back 65

Calcaneus

Front 66

Injury associated with insertion of the peroneal tendon at the base of the fifth metatarsal is known as what disease?

Back 66

Iselin's Disease

Front 67

What is the main basis of classification of soft tissue lesions?

Back 67

Cell of origin, or cell differentiation

Front 68

What percentage of sarcomas arise in children?

Back 68

15%

Front 69

How much more common are benign tumors than sarcomas?

Back 69

100:1

Front 70

Which of the following soft tissue tumors is most common in children? (Liposarcoma; Synovial sarcoma; Clear cell sarcoma; Rhabdomyosarcoma)

Back 70

Rhabdomyosarcoma

Front 71

How to soft tissue lesions typically present?

Back 71

Painless; Enlarging mass

Front 72

Where are 40% of soft tissue lesions located?

Back 72

Lower extremity

Front 73

What are four methods of biopsy?

Back 73

Fine needle aspiration; Core; Open; Excisional

Front 74

Benign tumors of fat cells are known as what? What about malignant tumors?

Back 74

Lipoma; Liposarcoma

Front 75

Benign tumors of smooth muscle cells are known as what?

Back 75

Leiomyoma

Front 76

Malignant tumours of skeletal muscle are known as what?

Back 76

Rhabdomyosarcoma

Front 77

Benign vascular tumours are known as what?

Back 77

Hemangioma

Front 78

Schwannomas are benign tumours arising from what tissue?

Back 78

Peripheral nerve sheath

Front 79

Benign cartilaginous tumours are known as what?

Back 79

Chondroma

Front 80

Is a bone tumour in a child more or less likely to be a primary tumour than in an adult?

Back 80

More likely - in adults it is more likely metastasis or hematopoetic

Front 81

What are the four most common ways that bone tumours are picked up/diagnosed?

Back 81

Incidental; Pain; Mass; Fracture

Front 82

What are 3 red flags associated with pain in bone tumours?

Back 82

Nocturnal; Persistent; Increasing intensity

Front 83

In relation to bone tumours, X-Rays have a high incidence of false _______, while bone scans have a high incidence of false ________. (Negatives, positives)

Back 83

X-ray - false negatives; Bone scan - false positives

Front 84

In relation to bone tumours, what type of lesion will form with an increase in osteoclastic activity? What about an increase in osteoblastic activity?

Back 84

Osteoclastic: Lytic lesion; Osteoblastic: Sclerotic lesion

Front 85

A benign, small, bone-forming lesion is known as what?

Back 85

Osteoma

Front 86

Acute phase reactants are produced in which organ?

Back 86

Liver

Front 87

What is the most commonly measured positive acute phase reactant?

Back 87

CRP

Front 88

How are acute phase reactants classified?

Back 88

Positive or Negative

Front 89

What is the most important determinant of ESR?

Back 89

Plasma levels of fibrinogen (in inflammatory states)

Front 90

How do you calculate the upper limit of normal for ESR in a man? In a woman?

Back 90

Man: Age/2 Woman: Age+10/2

Front 91

Compared to ESR, does CRP rise faster or slower with inflammation?

Back 91

Faster

Front 92

Is rheumatoid factor specific to RA?

Back 92

No - not all who have RF will develop RA, and not all with RA have RF

Front 93

RA patients with a high titer rheumatoid factor are more likely to develop which features of the disease?

Back 93

Systemic manifestations and erosive arthritis

Front 94

Citrullination of proteins occurs in what condition?

Back 94

Rheumatoid arthritis

Front 95

Bow-legged is known as a _________ deformity

Back 95

Varus

Front 96

Femoral anteversion in a child results in what sort of gait?

Back 96

In-toe gait

Front 97

What is the primary cause of cerebral palsy?

Back 97

Hypoxia

Front 98

What is the most common type of scoliosis?

Back 98

Idiopathic

Front 99

What are the three types forms of idiopathic scoliosis?

Back 99

Infantile, Juvinile, Adolescent

Front 100

Asymmetry of abdominal reflexes can indicate an abnormality of what bony structure?

Back 100

Spine

Front 101

Developmental dysplasia of the hip can result from a problem during what?

Back 101

Birth (i.e. breach birth)

Front 102

How is club foot treated?

Back 102

Manipulation of the foot with weekly casts from 4-6 weeks, followed by orthoses until age 4

Front 103

What classification scale of injuries around the growth plate in children is used?

Back 103

Salter Harris Classification

Front 104

What is the primary radiographic finding of Ewing's sarcoma

Back 104

Soft tissue swelling without much obvious bone deformity

Front 105

What is unique to bone healing not found in most other tissues?

Back 105

It is healed with new bone, unlike most other tissue which heal with scar tissue

Front 106

What are the four stages of fracture healing?

Back 106

Inflammation; Soft callus; Hard callus; Remodelling

Front 107

What is the gait termed in someone who has one leg shorter than the other?

Back 107

Antalgic gait

Front 108

How is a simple fracture different from a comminuted one?

Back 108

Simple fracture: 2 bits (single break); Comminuted: more than 2 bits

Front 109

How do we classify open fractures?

Back 109

Type 1: Skin wound <1cm; Type 2: 1-10cm; Type 3(a,b,c): >10cm, soft tissue loss, arterial injury

Front 110

There is a significant increase in risk for infection or nonunion in what type of fracture?

Back 110

Open fracture (compound)

Front 111

Is displacement of a fracture defined by the proximal or distal segment?

Back 111

The distal segment

Front 112

5-10% of patients with femoral shaft fractures will also have what type of fracture?

Back 112

Femoral neck fracture

Front 113

How long must arthritis be present for for a diagnosis of JIA?

Back 113

6 weeks

Front 114

Arthritis is defined as a joint effusion or 2 or more of what symptoms?

Back 114

Heat; Loss in range of motion; Tenderness/stress pain

Front 115

What are the 6 subtypes of JIA?

Back 115

Oligoarticular; Polyarticular RF-; Polyarticlar RF+; Systemic; Psoriatic; Enthesitis-related

Front 116

Chronic/asymptomatic uveitis coupled with two episodes of an inflamed knee joint in the past 6 months in a 3 year old girl is most likely what?

Back 116

Oligoarticular JIA (Though possibly psoriatic arthritis, but is less common)

Front 117

Is oligoarticular JIA more common in boys or girls? What is the peak age of onset?

Back 117

More common in girls; aged 2-4

Front 118

Is RF+ or RF- polyarthritis JIA more common?

Back 118

RF- polyarthritis is more common

Front 119

Is a child who has five large inflamed joints, with an asymmetric distribution more likely to be RF+ or RF-?

Back 119

More likely to be RF-. RF+ presentations are typically symmetrical (and may also involve small joints).

Front 120

Is early erosive disease more common in RF+ or RF- polyarthritis JIA?

Back 120

RF+

Front 121

What are some extra-articular findings in systemic arthritis?

Back 121

Spiking fever; Rash; Lymphadenopathy; Hepatosplenomegaly; Serositis; Myocarditis

Front 122

Spiking fevers are a feature of what subtype of JIA?

Back 122

Systemic JIA

Front 123

A 5 year old presents with an evanescent, salmon-coloured rash and joint pain. What MSK condition should you suspect?

Back 123

Systemic JIA

Front 124

In which subtype of JIA is there a male predominance?

Back 124

Enthesitis-related arthritis

Front 125

A family history of spondylarthropathy may predispose a child to what type of JIA?

Back 125

Enthesitis-related arthritis

Front 126

Symptomatic uveitis is found in which subtype of JIA?

Back 126

Enthesitis-related arthritis

Front 127

Tenosynovitis is a feature of what subtype of JIA?

Back 127

Psoriatic arthritis

Front 128

What are the four classes of drugs used to treat JIA?

Back 128

NSAIDs; Steroid injection; DMARDs; Biologics

Front 129

What percentage of children with JIA will not be in remission in adulthood?

Back 129

50%

Front 130

Which subtype of JIA has the best prognosis?

Back 130

Oligoarthritis

Front 131

Fever plus 4 of 5 of what criteria are required for the diagnosis of Kawasaki disease?

Back 131

Bilateral conjunctival injection; Mucous membrane changes; Peripheral extremity changes; Rash; Cervical adenopathy

Front 132

What is the treatment for Kawasaki disease?

Back 132

IVIG + ASA