Orthopedics/Rheumatology Error List Flashcards Preview

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Flashcards in Orthopedics/Rheumatology Error List Deck (65):
1

What is Guillin-Barre Syndrome

Ascending Weakness
Acute/Subacute inflammatory demyelinating polyradiculopathy with symmetric LOWER TO UPPER EXTREMITY WEAKNESS

2

What causes Guillain-Barre Syndrome

C. Jejuni
CMV
EBV
Immunizations (Flu)

3

Sx of Guillain-Barre Syndrome

Weakness and Paresthesias, usually symmetric
Decreased DTR
Tachycardia, Hypotension, HTN, Breathing Issues

4

Dx of Guillain-Barre Syndrome

CSF: High protein, Normal WBC

5

Tx of Guillain-Barre Syndrome

Plasmaphoresis to remove autoantibodies
IVIG to suppress inflammation and induced remyelination

6

What is Multiple Sclerosis

Autoimmune inflammatory demyelinating disease of CNS
Causes plaques and neurologic defeicits

7

What are the 3 different stages of MS

Relapsing-Remitting: Episodic Exacerbations
Progressive: Decline without acute exacerbations
Secondary Progressive: Relapse Remitting that becomes progressive

8

Sx of MS

Optic Neuritis: Unilateral eye pain worse with eye movement, Diplopia, Visual loss, color loss, blurry vision
Sensory deficits: Weakness, Parasthesias, Fatigue
Spinal Cord: Bladder or Bowel Dysfunction, Nystagmus, Staccato Speech

9

Dx of MS

MRI with Gadolinium is gold standard: see White Matter Plaques
CSF: See increased IgG

10

Tx of MS

Steroids for acute exacerbations
Beta-Interferon for Relapse-Remitting
Amantadine for fatigue

11

What are Generalized Seizures

Diffuse brain involvement

12

What is an Absence Seizure, Sx, Dx, Tx

Brief impairment of consciousness
Brief staring episodes, Eyelid Twitching
Dx: EEG see bilateral symmetric 3Hz spike and wave action or may be normal
Tx: Ethosuximide, Valproic Acid

13

What is a Tonic-Clonic Seizure, Sx, Dx, Tx

Loss of Consciousness with rigidity and arrest of respiration followed by repeitive jerking
Has post-ictal phase: Flaccid coma/sleep
Dx: EEG see generalized high amplitude rapid spiking
Tx: Valproic Acid, Phenytoin, Carbamazepine

14

What is Myoclonus seizure, Sx, Dx, Tx

Sudden brief sporadic involuntary twitching
No Loss of Consciousness
Tx: Valproic Acid, Clonazepine

15

What is Atonic Seizure, Sx, Dx, Tx

Drop Attacks, Sudden Loss of Postural Tone

16

What is Status Epilepticus, Sx, Dx, Tx

Repeated, Generalized seizures without recovery >30 min.
Tx: Lorazepam or Diazepam, Phenytoin, Phenobarbital

17

What is a Subarachnoid Hemorrhage

Due to ruptured aneurysms which are usually caused by HTN

18

Sx of SAH

Sudden onset, worst headache of my life, brief loss of consciousness, N/V, Meningeal Irritation (nuchal rigidity), seizures

19

Dx of SAH

CT scan without contrast (want to see hte blood)
If negative but still suspicious, do LP
If increased ICP and RBC present it's SAH
Can also do CT angiography

20

Tx of SAH

Bedrest, no exertion, no straining
Anti-anxiety meds, stool softeners
BP control, seizure control

21

What is Friedrich's Ataxis

Autosomal recessive that causes sx in children, teens, and young adults

22

Sx of Friedrich's Ataxis

Starts as gait ataxia, difficulty walking, then worsens and spreads to arms and trunk
Loss of sensation in extremities
Reduced DTR, Scoliosis, Dysarthria, Chest Pain, SOB, heart palpitations, Vision Impairment

23

Dx of Friedrich's Ataxia

Clinical
Electromyogram, Nerve Conduction Studies, EKG, Echo

24

Tx of Friedrich's Ataxis

Ace-I
Digoxin
Physical Therapy

25

What is Fibromyalgia

Central Pain Disorder

26

Sx of Fibromyalgia

Aches, Pains, Fatigue, sleep distrubances, tender points
Anxiety, depression, IBS

27

Dx of Fibromyalgia

No lab test
Exclude thyroid disease
Diffuse pain in 11/18 pressure points for >3 months
Biopsy: Moth eaten appearance type I muscle fibers

28

Tx of Fibromyalgia

TCA (Amitriptyline, Nortriptyline, Amoxapine, Clomipramine)
Pregabalin is the only FDA approved drug for Fibromyalgia

29

What is Osteoarthritis

Chronic disease due to articular cartilage damage and degeneration
Seen in weight bearing joints (knees, hips, cervical/lumbar spine)

30

Sx of Osteoarthritis

Evening joint pain and stiffness relieved with rest
Gets worse as day goes on and changes in weather
Herberden's Nodes: Palpable Osteophytes at DIP
Bouchard's Nodes: PIP Osteophytes

31

Dx of Osteoarthritis

XRay: Assymetric joint space narrowing, osteophyte formation, subchondral cysts, sclerosis

32

Tx of Osteoarthritis

Acetaminophen in elderly due to risk of bleeding
NSAIDS
Corticosteroid injections
Avoid high impact exercises

33

What is Rheumatoid Arthritis

Chronic inflammatory idsease with persistent symmetric polyarthritis with bone erosions, cartilage destruction and joint structure loss

34

Sx of Rheumatoid Arthritis

Prodome: Constitutional sx
Small Joint Stiffness
MCP, Wrist, PIP, KNee, MTP, Shoulder, Ankle
Worse with rest
Morning stiffness >60 minutes after initiating movement but gets better as day goes on
Swollen tender erythematous "boggy" joints
Swan neck deformity
Ulnar deviation at MCP joint
Rheumatoid Nodules: Hard and Bony Joints

35

Dx of Rheumatoid Arthritis

+Anti-CCP (Most specific)
+RF
Arthritis >3 joints, morning stiffness, duration >6wks
Xray: Symmetric joint space narrowing, ulnar deviation of hand, subluxation, deformities

36

Tx of Rheumatoid Arthritis

DMARDS like methotrexate, Azotriapine, Hydroxychloroquine
Anti-TNF
NSAIDS for pain, Low dose steroids

37

What is Systemic Lupus Erythematous

Chronic systemic, multi-organ autoimmune disorder of connective tissue

38

Who gets SLE

Young females, AA, Hispanics

39

Sx of SLE

TRiad of joint pain, malar "butterfly" rash, fever
Rash spares nasolabial folds
Serosities: Pericarditis, Pleuritis
Discoid Lupus: Annular, Erythematous patches on face and scalp
Systemic: CNS, Glomerulonephritis, Retinitis, Oral Ulcers, Alopecia

40

Dx of SLE

+Anti-dsDNA
+Anti-Smith Antibodies
+RF
+ANA

41

Tx of SLE

SUn protection
Hydroxychloroquines for skin
NSAIDS, acetaminophen for arthritis

42

What is Polyarteritis Nodosum

A vasculitis of medium/small vessels that leads to necrotizing inflammatory lesions

43

What is Polyarteritis Nodosum associated with

Hepatitis B, Increased Microaneurysms

44

Sx of Polyarteritis Nodosum

Renal: HTN, Renal Failure
CNS: Neuropathy, Mononeuritis Complex
Derm: Livedo Reticularis Purpura (reticular, lacy rash), ulcers, gangrene, Raynaud's Phenomena

45

Tx of Polyarteritis Nodosum

Steroids
Cyclophosphamide (immune-suppressant)

46

What is Low back strain

Nerve root impingement
Suspected when pain is leg-dominant rather than back-dominant
Cauda Equina often presents with bowel or bladder sx

47

Tx of Low Back Strain

Physical Therapy
NSAIDS, Corticosteroid injections
Surgery for cauda equina

48

What is Spinal Stenosis

Narrowing of spinal canal with impingement of nerve roots and cauda equina
Seen in people >60yrs

49

Sx of Spinal Stenosis

BAck pain with parasthesias on one or both extremities
Worse with extension, prolonged standing/walking
Relieved with flexion, sitting/walking uphill
Pain may radiate to thigh

50

Tx of Spinal Stenosis

Steroid Injections at lumbar region to reduce inflammation
Physical therapy or bending over helps open canal which relieves sx
Definitive: Surgery, Decompression Laminectomy

51

What is Raynaud's Phenomenon

Paroxysmal Digital Ischemia

52

What causes Raynaud's Phenomenon

Cold or Emotional Stress
Excessive vasoconstriction leads to cyanosis of fingers followed by vasodilation leading to hyperemia and rubor

53

What is Raynaud's Phenomenon associated with

Scleroderma

54

Tx of Raynaud's Phenomenon

Keep warm, avoid stress
CCB are 1st line for vasodilation (Nifedepine, Amlodipine, Felodipine)

55

What is Polymyalgia Rheumatica

Idiopathic inflammatory condition causing synovitis, bursitis, and tenosynovitis

56

Who gets Polymalgia Rheumatica

Women >50yrs

57

What is closely associated with Polymyalgia Rheumatica

Giant Cell Arteritis

58

Sx of Polymyalgia Rheumatics

Aching/Stiffness of proximal joints (shoulders, Hip, Neck)
Bilateral proximal joint pain/stiffness, morning stiffness>30 minutes of pelvis and shoulder girdle
Difficultly combing hair, putting on coat, getting out of chair
No severe muscle weakness

59

Dx of Polymyalgia Rheumatica

Clinical
Increased ESR
Anemia

60

Tx of Polymyalgia Rheumatica

Corticosteroids
Methotrexate

61

What is Ankylosing Spondylitis

Chronic inflammatory arthropathy of Axial Skeleton and Sacroiliac Joints with progressive stiffness

62

Who gets Ankylosing Spondylitis

Young Males 15-30yrs

63

Sx of Ankylosing Spondylitis

Chronic Low back pain, morning stiffness with reduced ROM
Back stiffness decreases with exercise/activity
Peripheral ARthritis: Saroilitis (Bilateral), Kyphosis, Large joint arthritis
Extra Skeletal: Pulmonary Fibrosis, Aortitis, Colitis, Amyloidosis, Sarcoidosis

64

Dx of Ankylosing Spondylitis

Increased ESR
+HLA-B27
Negative ANA
Negative RF
Xray: Bamboo spine (squaring of vertebral bodies)

65

Tx of Ankylosing Spondylitis

NSAIDS
Rest, physical therapy 1st line
TNF-alpha inhibitors (Infliximab)
Steroids