Musculoskeletal Flashcards
(81 cards)
1
Q
Anterior Glenohumeral Shoulder Dislocation
Sx
Dx
Tx
A
Sx: Arm is abducted, externally rotated
Shoulder looks squared off
Dx: Axillary and Y-View on Xray
Tx: Reduction, but must rule out axillary nerve injury
2
Q
Posterior Glenohumeral Shoulder Dislocation
Sx
Dx
Tx
A
Usually due to forced adduction with internal rotation
Sx: Arm adducted, internally rotated
Dx: Axillary and Y-View on Xray
Tx: Reduction
3
Q
Acromioclavicular Joint Dislocation
Sx
Dx
Tx
A
Usually due to direct blow to adducted shoulder
See a bump deformity at shoulder
Sx: Pain with lifting arm, unable to lift arm and shoulder
Dx: Xrays with weights to dramatize the the dislocation
Tx: Sling Immobilization, Ice, Analgesia
4
Q
What are the 4 muscles that make up the Rotator Cuff Which muscle is most commonly injuried Sx Dx Tx
A
SITS: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
Sx: Anterior deltois pain with decreased ROM, especially with overhead activities (combing hair, reaching for wallet)
Weakness, atrophy, continuous pain
Dx: Empty Can test (Supraspinatus test)
Passive ROM greater than active ROM
Impingement Test (Hawkins, Drop Arm, Neer)
Tx: Rehab, NSAIDS, intra-articular steroids
5
Q
Humeral Shaft Fracture
Sx
Dx
Tx
A
FOOSH injury Need to rule out radial nerve injury, which will be indicated by wrist drop (remember radial N. allows for wrist flexion) Sx: Wrist Drop Dx: Xray Tx: Sugar Tong Splint
6
Q
What is a Clavicle Fracture
Sx
Dx
Tx
A
Most commonly fractured bone in children
Sx: Pain with ROM, deformity at site
Dx: Xray
Tx: Arm sling
7
Q
Adhesive Capsulitis (Frozen Shoulder)
Sx
Dx
Tx
A
Shoulder stiffness due to inflammation
Sx: Shoulder pain/stiffness that lasts for 18-24 months, pain worse at night
Resistance on passive ROM
Tx: Rehab ROM, Anti-Inflammatories, Intraarticular steroid injections, heat
8
Q
Supracondylar Fractures
Sx
Dx
Tx
A
FOOSH with hyperextended elbow Common in kids 5-10yrs old Sx: Swelling and tenderness at the elbow Dx: Abnormal anterior humeral line, Fat pad sign Tx: If non-displaced treat with splint If displaced, ORIF
9
Q
What is a Monteggia Fracture
A
Proximal ulnar shaft fracture with anterior radial head dislocation
Sx: Elbow pain, Wrist Drop
Tx: ORIF
10
Q
What is a Galeazzi Fracture
A
Mid-Distal radial shaft fracture with dislocation of distal radio-ulnar joint
Sx: Fracture or deformity on radial surface of wrist
Tx: ORIF, long arm splint, Sugar ltong splint
11
Q
What is a Nursemaid’s Elbow (Radial Head Subluxation
Sx
Dx
Tx
A
Seen in kids 2-5 years old
Usually due to lifting, swinging, or pulling child with forearm pronated and extended
Sx: Arm slightly flexed, refusal to use arm, tenderness to palpation of radial head
Tx: Reduction with pressure on radial head with supination and flexion
12
Q
What is Tennis Elbow (Lateral Epicondylitis)
Sx
Dx
Tx
A
Inflammation of tendon insertion of extensor carpi radialis brevis due to repetitive pronation of forearm and excessive wrist extension
Sx: Lateral elbow pain with gripping, forearm pronation and wrist extension against resistance
Tx: RICE, NSAIDS
13
Q
What is Golfer’s Elbow (Medial Epicondylitis)
Sx
Dx
Tx
A
Inflammation of pronator teres-flexor carpi radialis due to repetitive stress at tendon insertion of flexor forearm muscle
Seen in golfers or patients who do houshold chores
Sx: Tenderness over medial epicondyle worse with uppling activities
Tx: RICE, NSAIDS
14
Q
What is Cubital Tunnel Syndrome (Ulnar Neuropathy)
Sx
Dx
Tx
A
Ulnar nerve compression at cubital tunnel along medial elbow
Sx: Parasthesias/pain along ulnar nerve
Positive Tinel’s sign at elbow
Positive Froment’s sign
Tx: Wrist immobilization, NSAIDS, Steroids if chronic
15
Q
Scaphoid Fracture (Navicular)
A
FOOSH
Sx: Pain along radial surface of wrist with anatomical SNUFFBOX TENDERNESS
Dx: Clinical as Xray may not show fracture for 2 weeks
Tx: Thumb Spica
16
Q
What is Colles Fracture
Sx
Dx
Tx
A
Distal radial fracture with DORSAL ANGULATION at wrist
Dx: Dinner Fork Deformity
Tx: Sugar Tong Splint/Cast
17
Q
What is a Smiths Fracture
Sx
Dx
Tx
A
Radial fracture with VENTRAL ANGULATION at wrist
Dx: Garden Spade Deformity
Tx: Sugar Tong Splint/Cast
18
Q
What is Complex Regional Pain Syndrome
Sx
Dx
Tx
A
Autonomic dysfunction following bone or soft tissue injury
Sx: Pain out of proportion to injury
Swelling, extremity color changes, increased nail and hair growth
Waxy, pale skin, brittle nails, loss of hair
Tx: Anesthetic blocks, physical therapy, Oral steroids, NSAIDS, TCA, Vitamin C for prophylaxis
19
Q
Mallet Finger
Sx
Dx
Tx
A
Avulsion of extensor tendon
Usually due to sudden blow to tip of extended finger with forced flexion
Sx: Unable to straighten distal finger (DIP joint)
Tx: Splint with uninterrupted extension for 6 weeks
20
Q
What is Boutonniere Defmority
Sx
Dx
Tx
A
Flexed PIP, Extended DIP
Due to sharp force against tip of partially extended digit
Tx: Splint PIP in extension for 4-6 weeks
21
Q
What is Gamekeeper’s Thumb (Skiers Thumb)
Sx
Dx
Tx
A
Ulnar collateral ligament injury of the thumb Leads to instability of the MCP joint Sx: Thumb is far away from other digits Weakness in pincher grasp Tx: Thumb Spica
22
Q
What is Boxers Fracture
Sx
Dx
Tx
A
Fracture at the neck of the 5th metacarpal
Due to punch with clenched fist (boxer move), drunk guy punching a wall
Tx: Ulnar Gutter Splint
23
Q
Describe the following Salter-Harris Fractures Type I Type II Type II Type IV Type V
A
Metaphysis is the area towards the MIDDLE of the bone (wide part of bone)
Epiphysis is the area towards the joint space
Type I: Growth plate fracture Type II (Above): Growth plate fracture + Metaphysis Type III (Lower): Growth plate + Epiphysis Type IV (Through): Growth plate + Metaphysis + Epiphysis Type V (Crush): Growth plate compression VERY BAD
24
Q
What is Dequervain’s Tenosynovitis
Sx
Dx
Tx
A
Stenosing tenosynovitis of abductor pollicus longus and extensor pollicus brevus
Sx: Pain along radial aspect of wrist radiating to forearm
Dx: Finkelstein Test: Pain with ulnar deviation or thumb extension
Tx: Thumb Spica Splint for 3 weeks
25
What is Carpal Tunnel Syndrome
Sx
Dx
Tx
Median Nerve Entrapment/Compression
Sx: Parasthesias, Pain at palm, and first 3 digits, especially at night
THENAR MUSCLE WASTING
Dx: Tinel Sign (tap medial nerve produces pain)
Phalen Sign (Flex wrist at 90 degrees produces pain)
Tx: Volar Splint, NSAIDS, Corticosteroids
26
What is Dupytren Contracture
Contractures of plamar fascia due to nodules/cords
Sx: Nodules over distal palmar crease or proximal phalynx
Tx: Steroid Injections, Collagenase injection
27
Hip Dislocation
Sx
Dx
Tx
```
Usually due to trauma
Can lead to avascular necrosis
posterior is most common location
Sx: Hip pain with leg shortened, internally rotated and adducted with hip/knee slightly flexed
Tx: Surgery, this is an emergency
```
28
Hip Fracture
Sx
Dx
Tx
In elderly may be result of minor or indirect trauma
Sx: Hip pain with leg shortened, externally rotated, abducted
Tx: ORIF
29
What is Legg-Calve-Perthes Disease
Sx
Dx
Tx
Avascular necrosis of femoral head in kids
4-10 years old, usually boys, AA
Sx: PAINLESS limping, worst with activity and throughout day
Hip pain radiates to thigh, knee, or groin
Loss of abduction and internal rotation
Dx: Xray showed Crescent sign
Tx: NSAIDS, bed rest if less than 5 years
If more than 5 years old, abduction bracing
30
What is Slipped Capital Femoral Epiphysis
Sx
Dx
Tx
Femoral head slips posterior and inferior to growth plate
7-16 years old, boys, OBESE, AA/Latino
Sx: PAINFUL limp, hip, thigh or knee pain
External rotation of affected leg
Dx: Frog-Leg Lateral pelvis or lateral hip view
Tx: ORIF (pinning in situ)
31
What is a Greenstick Fracture
Incomplete fracture
| BOWING fracture
32
What is a Torus/Buckle Fracture
Incomplete fracture with wringling or bump at Metaphyseal-Diaphyseal junction due to axial loading
33
MCL and LCL Tear
MCL: ValGus stress with rotation
LCL: VaRUS stress with rotation
Sx: Localized pain, swelling, ecchymosis, stifffness
Tx: Pain control, PT, RICE, NSAIDS, if complete tear needs surgery
34
ACL Injury
Most common knee ligament injury
Due to noncontact PIVOTING injury during running or jumping
Sx: Heard a pop and swelling, Knee is buckling (insability)
Dx: LACHMANS Test is most sensitive, Anterior Drawer Test
Tx: PT
35
Meniscal Tear
Due to compression or trauma with rotation and axial loading
Sx: Popping, Giving Way, Effusion after activities, locking (inability to fully extend knee), Walking up and down stairs is difficult
Dx: MCMURRAYS Test, MRI is imaging choice but not needed
Tx: NSAIDS
36
What is Osgood Schlatter Disease
Sx
Dx
Tx
Osteochondritis of patellar tendion at tibial tuberosity from overuse
Seen in kids 10-15 years old during growth spurts
Sx: Activity related knee pain/swelling
Painful lump below knee, tenderness to anterior tibial tubercle
Dx: Xray shows prominence at tibial tuberosity
Tx: RICE, NSAIDS, Quadriceps Stretching
37
What is a Baker's Cyst
```
Synovial fluid effusion
Sx: Popliteal mass, aching, knee effusion, clicking, buckling, locking of knee
Not painful
Dx: Ultrasound
Tx: Ice, NSAIDS
```
38
Ankel Sprain vs. Strain
Sprain: Most common sports related injury, usually involve lateral ligaments
ANTERIOR TALOFIBULAR
Sx: Hear pop and present with ecchymosis and tenderness of lateral ankle
Dx: Ottawa Ankle Rules
Tx: RICE, crutches, brace
39
What is Achilles Tendon Rupture
Sx
Dx
Tx
Mechanical overload from eccentric contraction of gastrocsoleus complex
Sx: Sudden heel pain after push off movement
Pop with sudden sharp calf pain
Positive Thompson Test (weak absent plantar flexion)
Tx: Surgery
40
What is a BUnion (Hallux Valgus)
Sx
Dx
Tx
Hallux valgus defmority of bursa over the 1st Metatarsla
Due to poorly fitting shoes, RA
Sx: Medial eminence pain with 1st MEtatarsal defviation
Dx: Xray with weight shows Deviation
Tx: Surgery, comfortable wide shoes
41
What is Morton's Neuroma
Sx
Dx
Tx
Degeneration/proliferation of the plantar digital nerve producing painfull mass near tarsal heads
Seen in young women who wear tight shoes/heels
Sx: Lancinating pain with ambulation particularly at 3rd Metatarsal head (3RD WEBSPACE)
Dx: Squeezing of forefoot will reproduce symptoms
Mass is often palpable at 3rd webspace
Tx: Side shoes, Steroid injections
42
What is Plantar Fasciitis
Sx
Dx
Tx
Inflammation fo the plantar aponeurosis due to overuse
Seen in people who are flat footed or have heel spur
Sx: Heel pain, tenderness of plantar fascia of medial foot
Pain worse after periods of rest and decreases with use
Dx: Xray may show flat feet or heel spur
Tx: RICE, NSAIDS, Heel/arch support
43
Herniated Disc
Sx
Dx
Tx
Pain in a dermatomal pattern
Most common at L5-S1
Sx: Sciatica: back pain radiating through thigh/buttocks
Positive straight leg raise, positive crossover test
PHYSICAL EXAM FINDINGS
L4: Anterior thigh pain, sensory loss at medial ankle. Ankle Dorsiflexion weakness, Loss of knee jerk
L5: Lateral thigh/leg/hip and groin parasthesias and pain, Dorsum of foot sensory deficit. Bit Toe Extension weakness, Walking on heels more difficult than toes. No diminished reflexes
S1: Posterior leg/calf/hip pain, plantar surface of foot sensory deficit. Plantar Flexion weakness, walking on toes more difficult than on heels. Loss of ankle jerk reflex
44
What is Cauda Eequina Syndrome
Sx
Dx
Tx
Complication of herniated lumbar disk
Sx: New onset of urinary or bowel retention/incontinence with saddle anesthesia, uni/bilateral leg radation
Decreased anal sphincter tone on rectal exam
Tx: Emergency surgery
45
Spinal Stenosis
Sx
Dx
Tx
Narrowing of spinal cord
Sx: Back pain with parasthesias in one or both extremtiies
Worse with extension: prolonged standing/walking
Relieved with flexion: sitting/walking uphill
Tx: Lumbar epidural injection of steroids, Decompression laminectomy
46
Scoliosis
Sx
Dx
Tx
Lateral curvature of spine >10 degrees
Usually starts at 8-10 years of age, common in girls with family hx
Dx: Adams forward bending test is most sensitive
Measure Cobb angle with AP/Lateral films
Tx: 10-15 degrees: Observe, f/u in 6-12 months with xray
15-20 degrees: Serial AP xrays every 3-4 months
20-40 degrees needs bracing
Greater than 40 degrees needs surgery
47
What is Spondylolysis
Defect in pars interarticularis from failure of fusion or stress fracture
Sx: Lower back pain, may have sciatica sx
Tx: Sx relief, activity restriction, PT
48
What is Spondylolisthesis
Forward slipping of vertebrae on another
Commonly seen in adolescents
Sx: Lower back pain, may cause bowel or bladder dysfunction
Tx: Low grade treat with sx relief and activity restriction
High grade: Surgery
49
What is Osteomyelitis
Sx
Dx
Tx
Inflammation/infection of bone
Acute: seen in kids, S. Aureus, GABHS
Chronic: Adults usually due to trauma/recent surgery, S. Auerus
Can spread Hematogenous, Direct Inoculation, Contiguous
Sx: Gradual onset of high fevers, chills, malaise, ifnlammation/pain over involved bone
Dx: Increased WBC, Increased ESR
MRI is most sensitive in early
Bone Aspiration is GOLD STANDARD
Tx: Surgical debridement, Cultures, Abx
Group B Strep: Nafcillin + 3rd Gen Cephalosporin
MSSA: Mafcillin
MRSA: Vancomycin
Salmonella: 3rd Gen Cephalosporin or FQ (Cipro)
Pseudomonas: Cipro or Levofloxacin
50
What is Septic Arthritis
Sx
Dx
Tx
Infection in joint cavity
Hematongenous, Direct Inoculation, Contiguous Spread
S. Aureus is most common, but N. Gonorrhea is most common in sexually active young adults
Sx: Single, swollen, warm, painful joint, tender to palpation, Fevers, chills, sweats, myalgias
Dx: Arthrocentesis shows WBC>50,000 primarily PMN's, Gram stain and culture, crystals
Tx:
Gram Positive Cocci: Nafcillin (Vanco if MRSA suspected or PCN allergy)
Gram Negative Cocci: Ceftriaxone
Gram Negative Rods: Ceftriaxone + Gentamicin
51
What is Compartment Syndrome
Sx
Dx
Tx
Muscle/nerve ischemia when closed muscle compartment pressure is greater than perfusion pressure
Usually due to trauma after long bone fracture, crush injury
Sx: Pain out of proportion to injury (persistent deep/burning), Volkman's Contracture
Pain on passive stretching, tense xtremities
Dx: Increased intracompartmental pressure greater than 30-45 mmHg
Tx: Fasciotomy (Decompression of pressure)
52
Osteosarcoma
Sx
Dx
Tx
Most common bone malignancy
Usually in adolescents and 2nd peak at middle age
MC mets to LUNGS
Sx: Bone pain/joint swelling
Dx: Xray shows sun burst pattern, hair on end apperance, lytic lesions, Periosteal bone reactions, Codman's Triangle
Tx: Limb-sparing resection, Radical amputation
Chemo as adjuvant
53
Ewing's Sarcoma
Sx
Dx
Tx
Giant cell tumor common in kids
Femur and Pelvis
Sx: Bone pain, palpable mass, joint swelling, fever
Dx: Lytic lesions with layered periosteal reaction (onion peel)
Tx: Chemo, surgery, radiation
54
Chondrosarcoma
Sx
Dx
Tx
Cancer of Cartilage seen in adults
| Dx: Mineralized chondroid matrix punctate or ring and arc apperance
55
Osteochondroma
Sx
Dx
Tx
Benign bone tumor seen in 10-20 year olds
Dx: Pedunculated, grows away from growth plate, involves medually tissue
Tx: Observation
Resection if painful or located in pelvis
56
Paget's Disease (Osteitis Deformans)
Abnormal bone remodeling and disorganized osteoid formation
Seen in Western European descent
Sx: Usually asymptomatic
Bone pain, increased warmth, bowed tibias, kyphosis, frequent fractures, deafness if skull involvements
Dx: Increased Alkaline Phosphates, Normal Calcium and Phosphate
Xray: Lytic phase shows blade of grass/flame shaped lucency
Sclerotic phase shows coarsened trabeculae
Skull has cottom wool apperance
Tx: Bisophosphoantes (Alendronate, Risedronate) which inhibit osteoclast activity (decreasing bone resorption and turnover)
Calcitonin which decreases osteoclast activity
57
Osteoporosis
Decrease in total bone volume which leads to increased susceptibility to fractures
Risk factors: Loss of estrogen (post-menopausal), Alcoholism, smoking, sedentary lifestyle, low calcium and vitamin D intake, female, advanced age, caucasian, Asian race
Dx: Calcium, Phosphate, DEXA scan
-All women >65 yrs get DEXA scan
-Post-menapualsa women <65 yrs get DEXA scan
-Women with HRT for a long time get DEXA
-Patients with RA or evidence of osteopenia get DEXA
Tx: Bisphosphonates are 1st line
HRT (estrogen alone or in combo with progesterone)
Calcitonin is not first line
DEXA 0 to -1 is normal
DEXA -1 to -2.5 is osteopenia
DEXA
58
What is Systemic Lupus Erythematosus
Sx
Dx
Tx
Chronic systemic, multi orgam autoimmune connective tissue disorder
Seen in young females, 20-40 yrs, AA, Latino, Native Americans
Sx: Joint pain, fever, Malar/Butterfly Rash (spares nasolabial folds)
Serositis: Pericarditis, Pleuritis
Discoid Lupus: Annular, Erythematous patches on face and scalp that heals with scarring
Systemic Lupus involves CNS, CV, Glomerulonephritis, Retinitis, Oral Ulcers, Alopecia
Dx: POSITIVE ANA
POSITIVE ANTI-DOUBLE STRANDED
POSITIVE ANTI-SMITH ANTIBODIES
ANTIPHOSPHOLIPID AB SYNDROME
Tx: Sun protection, hydroxychloroquine, NSAIDS, Acetaminophen for arthritis
59
What is Scleroderma
Sx
Dx
Tx
Systemic connective tissue disorder that involves thickening of the skin (sclerodactyl), lung, heart, kidney, GI tract
Sx: Tight, shiny thickcend skin
CREST syndrome: Calcinosis cutis, Raynaud's Phenomenon, Esophageal Motility disorder, Sclerodactyl (claw hand), Telangectasis
Dx: POSITIVE ANTI-CENTROEMERE ANTIBODIES
POSITIVE ANTI-SCL-70 ANTIBODIES
POSITIVE ANA
Tx: DMARDS, Vasodilators for Raynaud's (CCB, Prostacyclin)
60
What is Sjogren's Syndrome
Sx
Dx
Tx
Autoimmune disorder attacking exocrine glands: Salivary, Lacrimal, Parotid
Sx: Xerostoma (dry mouth), Drye eyes
Dx: ANA (antiSS-A Ro, antiSS-B La)
Positive RF
Shirmer test (decreased tear production
Tx: Artificial tears, Pilocarpine (Cholingergic) for Xerostoma
61
Fibromyalgia
Sx
Dx
Tx
Widespread muscular pain, fatigue, muscle tenderness, headaches, poor sleep/memory, increased pain perception
Sx: Diffuse pain, extreme fatigue, stiffness, painful, tender joints, sleep disturbances
Dx: Diffuse pain in 11/18 trigger points for > 3 months
Biopsy shows moth0eaten appearance in type I muscle fibers, injury to muscle
Tx: TCAs, Cymbalta, SSRI, Pregabalin in the only FDA drug approved for Fibromyalgia
62
```
What is Polymyalgia Rheumatica
Sx
Dx
Tx
What should associate with this
```
Idiopathic inflammatory condition causing synovitis, bursitis and tenosynovitis, aching, stiffness of proximal joints
CLOSELY RATED TO GIANT CELL ARTERITIS
Sx: Bilateral proximal joint pain/stiffness, morning stiffness >30 minuts of the pelvic and shoulder girlde
DIFFICULTLY COMBING HAIR, PUTTING ON COAT, GETTING OUT OF CHAIR. No muscle weakness
Dx: Clinical, Increased ESR
Tx: Corticosteroids, Methotrexate
63
What is Polymositis
Sx
Dx
Tx
Inflammatory muscle disease of proximal limbs, neck, pharynx
Sx: Progressive symmetrical, proximal muscle WEAKNESS, usually painless
Dx: Positive Anti-Jo 1 Ab, Positive Anti-SRP Ab
Tx: Corticosteroids, Methotrxate, IVIG
64
What is Dermatomyositis
Sx
Dx
Tx
Heliotrope (blue-purple) upper eyelid discoloration, Gottron's Papules (raised violaceous scaly eruptions on knuckles)
Dx: Increased aldolase, CK, Increased ESR
Tx: Corticosteroids, Methotrexate, IVIG
65
What is Gout
Sx
Dx
Tx
Uric Acid deposition in soft tissue, joints, and bone
Usually due to purine rich foods (alcohol, liver, oily fish, yeasts), Diruetics can cause it (Thiazides, Loop, Ace-I, ASA, ARBs)
Sx: Acute gouty arthritis with joint erythema, swelling and stiffness
Podagra: 1st MTP joint is most common
Also seen in knee, feet, ankle
Tophi deposition (collection of solid uric acid in soft tissues like ear, eyelids, achilles tendon)
Uric acid nephrolithiasis and nephropathy
Dx: Arthrocentesis shows NEGATIVELY BIREFRINGENET NEEDLE-SHAPED URATE CRYSTALS
Xray: Mouse/Rat bite "punched out" erosions
Increased serum Uric Acid, Increased ESR and WBC during acute attacks
Tx: Acute: NSAIDS (Indomethacin), Colchicine is 2nd line
Chronic: Allopurinoll which reduces uric acid production by inhibiting xanthine oxidase. Colchicine also used for chronic tx
66
What is Pseudogout
Sx
Dx
Tx
Calcium pyrophosphate deposition in joints and soft tissue
Sx: Red, swollen tender joint, usually the knee, Chondrocalcinosis (cartilage calcification)
Dx: Arthrocentesis shows POSITIVELY BIREFRINGENET, RHOMBOID SHAPED CPP CRYSTALS
Tx: Corticosteroids are 1st line, NSAIDS, Colchicine for prophylaxis
67
What is Osteoarthritis
Sx
Dx
Tx
Chronic disease due to articular cargilage damage and degeneration.
Obesity is RF
Found in WEIGHT BEARING joints
Sx: Evening joint stiffness, rest improves symptoms, worsens as day progresses
Heberden's Node (palpable osteophytes at DIP)
Bouchard's Nodes (PIP Osteophytes)
Dx: Xray shows joint space narrowing, osteophyte formation, subchondral bone cysts/sclerosis
Tx: Acetaminophen for elderly in mild cases, NSAIDS for moderate to severe cases, Corticosteroid injections
68
What is Rheumatoid Arthritis
Sx
Dx
Tx
Chronic inflammatory disease with symmetric polyarthritis with bone erosions, cartilage destruction and joint structure loss. T-Cell Medicated
Sx: Small joint stiffness (MCP, wrist, PIP, knee, MTP, shoulder ankle)
Joint stiffness improves with movement/as day progresses
Morning stiffness >60min
Boggy joints
Boutonniere Deformity (flexion at PIP, Hyperextension of DIP)
Swan Neck Deformity (flexion at DIP, Hyperextesion at PIP)
Ulnar Deviation at MCP
Rheumatoid Nodules
Dx: POSITIVE RF
POSITIVE Anti-CCP Antibodies MOST SPECIFIC
Xray shows narrowed joint space, subluxation deformities, ulnar deviation of hand
Tx: DMARDS (Methotrexate, Hydroxychloroquine), NSAIDS for pain control, low dose steroids
69
What is Juvenile Idiopathic Arthritis (Rhematoid)
Autoimmune mono or polyarthritis in children less than 16 years
Pauci-articular: 4 or less joints involved, Iridocyclitis (anterior uveitis)
Systemic: Daily arthritis, salmon-color pink migratory rash
Polyarticular: more than 5 small joints involved, Risk of Iridocyclitis
Dx: Clinical, Positive RF, ANA, ESR, CRP
Tx: NSAIDS, Corticosteroids, Methotrexate
70
What is Rhabdomyolysis
Acute breakdown and necrosis of skeletal muscle
Usually due to immobility (stroke victim, fracture, crush injuries, seizures, burns), Meds (statins, Niacin, Fibrates)
Dx: Increased CPK, Increased LDH, ALT, Hyperkalemia
UA shows dark urine that is positive for heme but negative for blood (myoglobinuria)
EKG: Peaked T waves indicate hyperkalemia
Tx: IV saline hydration, Mannitol to induce osmotic diuresis, Bicarbonate, Calcium Gluconate for hyperkalemia
71
What is Giant Cell Arteritis (Temporal Arteritis)
Idiopathic/Autoimmune
A vasculitis of large and meidum arteries, usually affects cranial arteries
Sx: Headache, usually unilateral, temporal, lancinating
Jaw Claudication with mastication
Acute vision disturbances (amaurosis fugax)
Tender scalp, Aortic Aneurysm
Dx: Increased ESR, Increased CRP
Biopsy is definitive, see mononuclear lymphocyte infiltration, multinucleated giant cells
Tx: High dose corticosteroids (40-60mg/day), Methotrexate
72
What is Kawasaki Syndrome
Seen in kids, usually Asian
Affects medium and small vessels, necrotizing vasculitis including coronary arteries
Sx: WARM CREAM
-Fever
-C: Conjunctivitis (bilateral and nonexudative)
-R: Rash, polymorphous
-E: Extremity Changes (desquamation, edema, erythma of palms and soles)
-A: Adenopathy, Cervical Lymphadenopathy
-M: Mucous Membranes, Pharyngeal erythema, lip swelling and fissures, STRAWBERRY tongue
Complications include CORONARY ARTERY ANEURYSM, MI, Pericarditis
Dx: Increased ESR/CRP, Leukocytosis
Tx: IVIG, HIGH DOSE ASA
73
What is Polyarteritis Nodosa
Systemic vasculitis of medium/small arteries that leads to necrotizing inflammatory lesions
Associated with Hepatitis B and C
Sx: HTN, Fevers, myalgias, arthritis, Neuropathy, LIVEDO RETICULARIS RASH
Dx: Increased ESR, Negative ANCA
Renal or Mesenteric angiography shows microaneurysms with abrupt cut-off of small arteries
Tx: Steroids, Plasmapharesis
74
What is Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)
Systemic small vasculitis of arteries and veins with Asthma, Hypereosinophilia and Chronic Rhinosinusitis
Sx: Prodromal Phase is atopic disease, allergic rhinitis, asthma
Eosinophilic phase is peripheral blood eosinophilia involvement in organs like lungs and GI (Gastritis, Dyspnea, nodular disease, pleural effusion)
Vasculitic Phase is life threatening systemic vasculitiis
Dx: Eosinophilia, P-ANCA Positive
75
What is Granulomatosis with Polyangiitis (Wegener's)
Small vessel vasculitis with granulomatous inflammation and necrosis of NOSE, LUNGS, AND KIDNEYS
Sx: Upper Respiratory Tract (saddle-nose defmority, epistaxis, sinusitis)
Lower Respiratory Tract: Parenchymal invovlemnt, cough, dyspnea
Renal: Glomerulonephritis, Hematuria
Dx: Positive C-ANCA, CXR shows infiltrates, nodules
Tx: Steroids with Cyclophosphamide
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What is Henoch Schonlein Purpura (HSP) IgA Vasculitis
IgA deposition in skin, usually seen post-URI
Most common small vessel vasculitis in kids
Sx: Palpable Purpura (usually lower extremities)
Abdominal pain, Arthritis, Hematuria
Dx: Clinical
Kidney biopsy shows mesangial IgA deposits, Normal coagulations, Normal platelets
Tx: Supportive, self limiting, bed rest, hydration, NSAIDS for joint pain
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What is Goodpasteure's Syndrome
Type II Hypersensitivity reaction
IgG antibodies against Type IV collagen in glomerular basement membrane of kidney and alveoli
Dx: Biopsy shows linear IgG deposits in glomeruli or alveoli on immunofluorescence
Tx: Corticosteroids and Cyclophsphamide, Plasmapheresis
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What are the 4 categories under HLA-B27
Reactive Arthritis (Reiter's Syndrome)
Ankylosing Spondylitis
Psoriatic Arthritis
IBD (Crohn's and UC)
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What is Reactive Arthritis
Can't see, can't pee, can't climb a tree
Autimmune response to infection in another part of the body
Usually due to Chlamydia, Gonoarrhea, Salmonella, Shigella, Campylobacter
Sx: Conjunctivitis, Urethritis, Arthritis, Sausage fingers/toes, Keratoderma Blennorrhagica (hyperkeratotic lesions on palms/soles)
Dx: Positive HLA-B27, Increased WBC, Increased ESR
Synovial fluid shows 1,000-8,000 WBC, negative bacterial culture of synovial fluid (aseptic)
Tx: NSAIDS, Abx to tx triggering infection
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What is Ankylosing Spondylitis
Chronic inflammatory arthropathy of AXIAL SKELETON AND SACROILIAC JOINTS with progressive stiffness
Usually seen in young males 15-30 years old
Sx: Chronic low back pain, morning stiffness with reduced ROM, Activity decreases stiffness
Peripheral arthritis, pulmonary fibrosis, aortitis, colitis
Dx: Increased ESR, Positive HLA-B27
Xray shows bamboo spine: squaring of vertebral bodies
Tx: NSAIDDS, TNF-Alpha Inhibitors (Infliximab)
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What is Psoriatic Arthritis
Sx: Asymmetric Arthritis dactylitis, SAUSAGE DIGITS, Sacroiliac arthritis
Pitting of nails, rash with silvery white scales (psoriasis), Chronic Uveitis
Dx: Xray shows PENCIL IN CUP deforimty, Positive HLA-B27
Tx: NSAIDS (methotrexate pafter NSAIDS), TNF-Alpha Inhibitors
