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Internal Medicine > Orthopedics/Rheumatology Error List > Flashcards

Orthopedics/Rheumatology Error List Flashcards

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1
Q

What is Guillin-Barre Syndrome

A

Ascending Weakness

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

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2
Q

What causes Guillain-Barre Syndrome

A

C. Jejuni
CMV
EBV
Immunizations (Flu)

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3
Q

Sx of Guillain-Barre Syndrome

A

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

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4
Q

Dx of Guillain-Barre Syndrome

A

CSF: High protein, Normal WBC

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5
Q

Tx of Guillain-Barre Syndrome

A

Plasmaphoresis to remove autoantibodies

IVIG to suppress inflammation and induced remyelination

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6
Q

What is Multiple Sclerosis

A

Autoimmune inflammatory demyelinating disease of CNS

Causes plaques and neurologic defeicits

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7
Q

What are the 3 different stages of MS

A

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

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8
Q

Sx of MS

A

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

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9
Q

Dx of MS

A

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

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10
Q

Tx of MS

A

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

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11
Q

What are Generalized Seizures

A

Diffuse brain involvement

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12
Q

What is an Absence Seizure, Sx, Dx, Tx

A

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

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13
Q

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

A

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

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14
Q

What is Myoclonus seizure, Sx, Dx, Tx

A

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

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15
Q

What is Atonic Seizure, Sx, Dx, Tx

A

Drop Attacks, Sudden Loss of Postural Tone

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16
Q

What is Status Epilepticus, Sx, Dx, Tx

A

Repeated, Generalized seizures without recovery >30 min.

Tx: Lorazepam or Diazepam, Phenytoin, Phenobarbital

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17
Q

What is a Subarachnoid Hemorrhage

A

Due to ruptured aneurysms which are usually caused by HTN

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18
Q

Sx of SAH

A

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

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19
Q

Dx of SAH

A

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

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20
Q

Tx of SAH

A

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

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21
Q

What is Friedrich’s Ataxis

A

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

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22
Q

Sx of Friedrich’s Ataxis

A

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

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23
Q

Dx of Friedrich’s Ataxia

A

Clinical

Electromyogram, Nerve Conduction Studies, EKG, Echo

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24
Q

Tx of Friedrich’s Ataxis

A

Ace-I
Digoxin
Physical Therapy

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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

Internal Medicine (16 decks)

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