Autoantibodies
What autoantibodies are found in Sjogren' syndrome?
anti-Ro and anti-La
What condition is suggested with a positive shoulder cross-over test?
AC separation
What is the MOI for MCL tear and what PE findings will you have? (include specialized tests)
MOI is sudden valgus force to lateral knee
a pop is reported, with medial joint line pain
there is pain with ambulation, instability, TTP, medial ecchymosis, and effusion
Tests are saphenous nerve exam and valgus stress test at 30 degrees
A patient is diagnosed with fibromyalgia, what medication could you give them to help them sleep?
TCAs (Amitriptyline)
Legg-Calve-Perthes
SCFE is PAINFUL limp
What autoantibodies are found in diagnosis of PM?
anti-SRP and anti-Jo-1
Which epicondylitis is described as "tennis elbow" and which movements will be exacerbate this condition?
Lateral epicondylitis
Supination and wrist extension
Name the four types of knee bursitis, which is most common?
Suprapatellar
Prepatellar (most common)
Infrapatellar
Pes anserine
Systemic manifestations of polymyositis
Interstitial lung disease (5-30%)
Diaphragm and chest-wall muscle weakness
GI: pharyngeal and esophageal involvement (30%)
Cardiovascular (rare)
A 62 year old man presents with back pain that radiates below the knee after helping his son move today. What is his likely diagnosis and what imaging would you like to order?
L5-S1 disc herniation
MRI without contrast
What autoantibody tests follow a positive ANA in systemic sclerosis and what classification does each indicate?
Anti-centromere (limited disease)
Anti-Scl 70 (diffuse disease)
What is the most important clinical predictor of a cervical spinal injury?
Gait changes
What is the recommended time frame from diagnosis of compartment syndrome to emergency fasciotomy?
1 hour
What medications do you give for treatment of secondary Reynaud's?
1. calcium channel blockers (nifedipine or amlodipine)
2. Antibiotics (if ischemic ulcers are present)
A patient present to the ER today with digital ulcerations, pallor, rounded shoulders, and depression of the scapula. What is their likely diagnosis, and what hallmark characteristic are you likely to see upon further inspection?
Thoracic outlet syndrome
GIlliatt-sumner hand
What serological tests are included in the diagnosis of RA and which is most specific?
RF, anti-CCP, and ANA.
anti-CCP is most specific
What is the sail sign, what test do you see it in, and what fractures does it indicate in both child and adult?
Elevation of the anterior fat pad
Seen in elbow radiograph sign
Indicates supracondylar fraction in kids and radial head in adults
Management of a Zone I fifth metatarsal fracture vs a Zone II or III metatarsal fracture?
Zone 1 (without rotational displacement): non-operative, case shoe, WBAT
Zone 2 & 3: NWB cast 6-8 weeks
What disorder are Gottron's papules associated with and where on the body do they occur?
Pathognomonic for DM
Dorsal MCP and PIP joints
A 45 year old woman presents to the clinic today with headaches and hearing loss. She states that the pain is worst at night. You run some labs and see that her S. calcium and S. phosphorus are normal, but her alkaline phosphatase is elevated. What is her likely diagnosis and how would you treat it?
Paget's disease
Start with initial NSAIDs for pain
What are the three most important autoantibodies in SLE following a positive ANA? Which one of these indicates a possible thrombocytic issue?
anti-dsDNA
anti-SM
anti-phospholipid
WHat components must be documented for an extremity fracture?
"Old acid”
Open/closed
Location
Degree (incomplete vs complete)
Articulation involvement
Comminution & pattern
Intrinsic bone quality
Displacement
Describe Ottawa ankle criteria
Inability to bear weight
Medial/lateral malleolus TTP
5th MT base tenderness
navicular tenderness
3 components of rapid referral to rheum for RA?
1. 3 or more joints swollen
2. positive MTP or MCP squeeze test
3. Morning stiffness for 30 mins or more
A 50 year old woman presents to the ER today with generalized fever and fatigue. Upon PE you note that the patient has swan-neck deformity and ulnar drift as well as a maculopapular rash that spares the knuckles. What is your likely diagnosis and what is the first test you would like to run?
SLE
First run an ANA (90% sensitive)