PATHOPHYS Flashcards
1
Q
what is the most sensitive test for ACL injury?
A
Lachman’s test
2
Q
what percent of ACL injuries feel pop?
A
70%
3
Q
The classic bone bruise on the tibial plateau of an MRI is found in what kind of injury?
A
ACL
4
Q
if you wait more than 8 hours to evaluate a knee dislocation what could happen?
A
amputation (lack of vascularization from popliteal artery)
5
Q
how could you test to see if someone had torn their achilles tendon?
A
squeeze the gastrocnemius and if normal you should see plantarflexion, if abnormal then you it shouldn’t move
6
Q
what is the genetic defect in myotonic dystrophy?
A
autosomal dominant pattern
-increased CGT repeats of DNA on chromosome 19 which encodes a protein kinase
7
Q
what is the metabolic problem in mcArdle’s disease
A
lack of muscle phosphorylase, so can’t break glycogen down to make ATP, lactate, & pyruvate
8
Q
what is the main pathogenesis of Eaton-lambert syndrome?
A
abs that bind to the voltage gated Ca2+ channels and thus prevent release of ACh at the presynaptic neuromuscular synapse
9
Q
what is the most common vasculitis in children?
A
HSP
10
Q
what kind of vasculitis is present in HSP?
A
IgA immune complex small vessel vasculitis
11
Q
which vasculitis is associated with asthma and eosinophilia?
A
churg-strauss syndrome
12
Q
Name the 2 large vessel vasculitidies:
A
Temporal arteritis
Takayasu’s ateritis
13
Q
Name the 3 medium vessel vasculitidies:
A
PAN
Buerger’s
Kawasaki’s disease
14
Q
Name the small vessel vasculitidies:
A
Wegener's Churg Strauss Microscopic Polyangiitis HSP Essential Cryoglobulinemia Cutaneous Leukocytoclastic angiitis
15
Q
Name the types of vasculitis that form granulomas:
A
temporal arteritis
Takyasu’s arteritis
Wegener’s
Churg Strauss
16
Q
Name the types of vasculitis that have ANCAs:
A
Wegener’s–>C-ANCA
Churg Strauss–>P-ANCA
Microscopic Polyangiitis–>P-ANCA
17
Q
How do you treat kawasaki’s disease?
A
aspirin & IVIG
18
Q
what do you have to remember about the treatment of bacterial arthritis?
A
it is MEDICAL EMERGENCY
- aspirate fluid
- abx
- aspirate fluid
19
Q
what kind of arthritis is found in rheumatic fever?
A
migratory polyarthritis
20
Q
what is the most common cause of viral arthritis in US?
A
ParvoB19
21
Q
what is the antigen associated with RA?
A
HLADR4
22
Q
which antigen do all the spondyloarthropathies have in common?
A
HLAB27
23
Q
What is the best characterized cytokine involved in cartilage degradation?
A
IL-1
24
Q
what is thought to be the 1st irreversible step in pathogenesis of OA?
A
degradation of collagen (signif. reduces mechanical properties of cartilage)
25
what is the most important MMP in OA?
MMP13, b/c it pref. degrades type II collagen
26
aggrecan is also degraded in OA mostly by what 2 enzymes?
MMP, ADAMTS-4
27
what is the most common form of arthritis?
OA
28
what are some of the etiologies of secondary OA?
trauma: fracture, surgery, charcot joint
29
what is the most common symptoms in OA?
pain
30
what are some non-pharm therapies that should be part of management plan for OA pt?
weight loss & exercise
31
Do hyaluronic acid derivatives work in OA?
nope
32
whats the plan of action when you diagnose a pt with infectious arthritis?
hospitalize the pt, Tap the knee, aspirate for gram stain and culture, blood culture, start IV abx
33
most cases of bacterial arthritis result from what kind of spread?
hematogenous seeding of the synovial membrane
34
why are the joints a common place for bacterial infection?
they have abundant vascular supply to synovium and lack a BM
35
what is the most common overall cause of septic arthritis?
Staph Aureus
36
What are some of the risk factors for developing septic arthritis?
```
DM
prosthetic joint in knee or hip
recent joint surgery
skin infection
previous septic arthritis
recent intra-articular injection
```
37
what is the most common cause of bacterial arthritis in young sexually active women?
gonococcal infection
38
what are some of the risk factors for developing disseminated gonococcal infection?
- recent menstruation
- pregnancy or post-partum state
- congenital or acquired complement def. (C5-C8)
- SLE
39
what are the 2 presenting forms of GC arthritis?
1. fever, chills, skin lesions, tenosynovitis, polyarthralgia, w/ GC being cultured from several sites
2. arthritis MC in knee, wrist, or ankle & more than 1 joint can be infected simultaneously w/ GC freq. cultured from synovial fluid
40
what tests should be performed on all pts presenting w/ an inflamed joint?
arthrocentesis & synovial fluid analysis
41
describe the lab findings in a joint aspiration of bacterial arthritis?
protein conc. 1/3 of plasma
| WBC>50,000 (w/ polys predom.)
42
a definite dx of bacterial arthritis can be made only by what?
visualizing bacteria on a gram stained smear or by culturing bacteria from SF
43
what gives better outcomes daily aspiration or surgical drainage?
daily aspiration
44
what is the antibiotic of choice for gonococcal arthritis?
ceftriaxone (about 1 wk course)
45
describe the type of arthritis in acute rheumatic fever?
migratory polyarthritis
46
what are the major manifestations of acute rheumatic fever?
```
polyarthritis (J)
Carditis (O)
subq nodules (N)
erythema marginatum (E)
sydenham chorea (S)
```
47
what is the mainstay treatment of acute rheumatic fever?
antiinflamm. agents-->aspirin
48
Severe systemic symptoms of lyme disease should alert the clinician to consider what kind of coinfection with another tick-borne pathogen?
Babesia microti or anaplasma phagocytophilum (HGE)
49
how do you diagnose lyme disease?
ELISA followed by western blot for confirmation
50
how would you diagnose tuberculous arthritis?
synovial biopsy (with cultures)
51
how does musculoskeletal TB typically present?
Bone Pain, chronic localized infection, most commonly involving the spine, less often the hip or knee
52
which part of the spine is most commonly involved in HIV pts who have musculoskeletal TB?
lumbar spine
53
why are we seeing more fungal infections in our rheumatology pts?
they are taking DMARDs which are immunosuppressive
54
how would you diagnose a fungal infection of bones and joints?
histologic examination or culture of involved tissues
55
if you got a blastomycosis arthritis it most likely came by exposure to what?
soil, dust containing decomposed wood
56
what are some fungal infections that you might get after taking an anti-TNF agent?
coccidiomycosis, histoplasmosis, aspergillus, candida, pneumocystis
57
describe HIV-associated arthritis?
usually oligoarthritis predom. involving the lower extremities & tends to be self-limited
58
what is Diffuse infiltrative lymphocytosis syndrome?
characterized by salivary gland enlargement & peripheral CD8 lymphocytosis w/ sicca symptoms, massive parotid gland swelling, lymphocytic interstitial pneumonias (seen exclusively in HIV pts)
59
what is Immune reconstitution inflamm. syndrome (IRIS)?
paradoxical clinical deterioration that occurs in pts w/ HIV who receive HAART as a result of improvement in cellular immunity
60
ParvoB19 can be a cause of what in infants?
hydrops fetalis (b/c ParvoB19 replicates in erythroid precursors and may cause anemia)
61
what is the most useful test for ParvoB19 after the onset of joint symptoms?
anti-b19 IgM serology
62
Essential mixed cryoglobulinemia is a triad of what 3 things?
arthritis, palpable purpura, & cryoglobulinemia (associated w/ HCV infection in most cases)
63
which factor has the highest association with pseudogout?
old age like >70 y/o
64
if you diagnose CPPD in a pt younger than 55 y/o then what should you do next?
start ddx of primary metabolic or familial disorder
65
which joint is most commonly affected in pseudogout?
knee
66
what do CPP crystals look like under the microscope?
rhomboid, positively birefringent
67
what is a useful & sensitive alternative to diagnosing CPPD?
high resolution ultrasounds
68
how do you treat CPPD?
alleviate symptoms (NSAIDs) and prophylaxis of acute arthritic attacks (colchicine)
69
does septic arthritis present more often with monoarticular or polyarticular involvement?
monoarticular
70
underexcreters make up what % of primary hyperuricemia & gout pts?
90% , (the other 10% being the overproducers)
71
what is the genetic deficiency in Lesch-Nyhan syndrome?
HGPRT
72
what are some risk factors for nephrolithiasis?
high uric acid excretion, reduce urine volume, low pH of urine
73
which class of BP meds cause hyperuricemia?
thiazide diuretics
74
hyperuricemia is defined as a serum urate level greater than ____________
6.8 mg/dL
75
according to Dr. P. acute gout can be treated w/ 4 types of drugs?
1. NSAIDs (prob. indomethacin)
2. colchicine
3. corticosteroids
4. ACTH
76
before starting a specific urate-lowering agent the pt shoudl be treated w/ low-dose what what drugs?
low dose colchicine or NSAID
77
what is your uric acid target blood level?
less than 6 mg/dL
78
what kind of food and drink make gout worse?
alcohol (has lots of purines), seafood, red meat
79
___________ is associated w/ obesity, hypertriglyceridemia, glucose intolerance & metabolic syndrome, HTN, atherosclerosis, and hypothyroidism.
gout
80
tumor lysis syndrome could cause what renal complication?
urate nephropathy from acute hyperuricemia
81
alcohol use, lead intoxication, & cyclosporine treatment are all associated with ______________
hyperuricemia & gout
82
what would be the indication for using pegloticase?
used in a pt with refractory tophaceous gout
83
what's more common anterior subluxation or posterior subluxation of the glenohumeral joint?
anterior subluxation
84
how much strength do you lose by rupturing the long head of the biceps tendon?
not much (the short head & brachioradialis have 85% of strength of elbow flexion)
85
what is a common chronic disorder often found with frozen shoulder?
diabetes
86
What is complex regional pain syndrome?
generally associated with minor trauma:
Phase 1: sympathetic overflow w/ diffuse swelling, pain, evidence of demineralization
Phase 2: atrophy & extremity may be cold and shiny
Phase 3: refers to prog. of trophic changes w/ irreversible flexion contractures, pale, cold painful extremity
87
what is de Quervain's tenosynovitis?
inflammation of sheaths of thumb
| presents as wrist pain, positive finklestein test on exam
88
what is meralgia peristhetica?
lateral femoral cutaneous nerve (L2-L3) entrapment causing diffuse lateral pain
89
what are the 2 most common sites of compression of lateral femoral cutaneous nerve?
inguinal ligament
| psoas insertion
90
what is prepatellar bursitis?
housemaid's knees
91
what is patellar tendonitis?
patellofemoral pain syndrome (from jumping a lot)
92
what radiographic finding do you commonly see in plantar fasciitis?
heel spurs
93
what is cavus feet?
having an unusually high arch
94
what is morton's neuroma?
fibrotic lesion that can cause nerve entrapment in 3rd & 4th webspace
- chronic irritation may be cause
- aching or burning pain that radiates from webspace distally to affected toes
95
what kind of people might get morton's neuroma?
women wearing high heels or tight-fitting shoes
96
what is hammertoe?
flexion of PIP joint and tip of toe points downward
| most common in 2nd toe
97
what % of pts presenting w/ low back pain will be pain free in 8 wks?
90%
98
what is a major indication for back surgery?
serious neurologic deficit
99
what are 3 mechanical causes of low back pain?
lumbar spondylosis
disk herniation
spinal stenosis
100
how do you alleviate pain in spinal stenosis?
flexion of lumbar spine (gets worse with extension)
101
what is hypertrophic osteoarthropathy?
excessive proliferation of skin & bone at distal parts of the extremities from excessive collagen deposition
- clubbing
- periostitis at ends of long bones
102
hypertrophic osteoarthropathy is commonly associated with what 2 things?
chest malignancies
| chronic lung infection
103
what kind of transporters are involved in excretion of urate?
Organic anion transporters (OAT)
104
___________activate the NLRP3 inflammasome
monosodium urate crystals
105
in gout the inflammasome generates what cytokines?
IL-1beta, IL-18, IL-33
106
what two factors lead to the fact that gout commonly flares at night in the big toe?
big toe is cold, hypoventilation-->acidosis, both lead to precipitation of urate crystals
107
what are the 3 stages of gout?
1. asymptomatic hyperuricemia
2. acute gout
3. chronic gouty arthritis
108
what is a useful alternative diagnostic method used for gout?
ultrasound
109
78% of these vasculitis pts have neuropathy like foot drop
PAN
110
which organ does PAN characteristically spare?
Lungs
111
is PAN more common in men or women?
men
112
HSP has immune complex of what kind of immunoglobulin?
IgA
113
cryoglobulinemic vasculitis is most often associated with what long standing chronic infection?
hepatitis C
114
what is the classic tetrad in HSP?
purpura
arthritis
abdominal pain
GN
115
what are cryoglobulins?
contain immunoglobulins and complement proteins and basically aggregate when they get cold
116
what are cryofibrinogens?
have fibrinogen, fibrin, fibronectin (undetectable in serum)
117
what is type I Cryoglobulinemia?
monoclonal Ig that is most often due to Multiple myeloma or Waldenstrom's macroglonulinemia
118
what is type II cryoglobulinemia?
polyclonal IgG with monoclonal IgM against IgG
119
what is type III cryoglobulinemia?
polyclonal IgG & IgM
120
what is the most common manifestation of cryoglobulinemic vasculitis?
palpable purpura with ulcers
121
is rheumatoid vasculitis a big deal?
yes-devastating complication of medium & small blood vessels and requires aggressive therapeutic interventions
122
what is the most common presentation of rheumatoid vasculitis?
purpuric lesions w/ or w/o evidence of medium vessel vasculitis, & deep cutaneous ulcer over the malleoli are a hallmark of RV
123
how do you diagnose microscopic polyangiitis?
biopsy
124
what is a potentially serious complication of giant cell arteritis that warrants ongoing monitoring?
thoracic aortic aneurysm
125
Why is it important to begin steroids as soon as you diagnose giant cell arteritis?
the pt may go blind permanently (don't wait for biopsy)
126
what is the prognosis of temporal arteritis with treatment?
good with treatment
127
which large vessel vasculitis is not associated with glomerulonephritis?
Takyasu's arteritis
128
what kind of pts get takyasu's arteritis?
young asian women
129
Kawasakis disease can cause necrotizing vasculitis in what arteries that are particularly dangeous?
coronary
130
what is the treatment for kawasaki's disease?
aspirin & IVIG
131
what is primary angiitis of the central nervous system?
vasculitis confined only to brain, meninges, spinal cord
132
which crazy complex multisystem disease causes oral and genital ulcers?
bechet's disease (pts in 20's & 30's)
133
Autosomal dominant familial CPPD has been linked in to mutations in what gene?
ANKH -encodes PPi transporter
134
what is driving the cell responses to CPPD crystals?
NLRP3 (cryopyrin) inflammasome activation & caspase-1 activation & IL-1beta processing and secretion
135
what is a helpful way of diagnosing CPPD?
Ultrasound
136
ANKH is on which chromosome?
5p
137
how do you confirm the presence of CPPD crystals?
positive birefringence on light microscopy
138
acute onset symmetric polyarthritis canbe caused by _______infection especially when accompanied by rash.
viral
139
hepatitis B virus infection presents as _______________________
an arthritis-urticaria syndrome
140
what are some of the genes implicated in RA?
HLA-DR4 (MHC II)
PTPN22
peptidylarginine deiminases
141
presence of what can be present for many years before the onset of clinical arthritis?
RF, anti-CCPs
142
what are two major cytokines involved in the inflammation of RA?
TNF, IL-6
143
bone and cartilage destruction are primarily mediated by what two types of cells?
Osteoclasts, Fibroblast-like synoviocytes
144
what is a major environmental risk factor for developing RA?
smoking (creates citrullinated peptides)
145
autoantibodies in RA can recognize what two joint antigens?
type II collagen
| glucose phosphate isomerase
146
how can autoantibodies contribute to synovial inflammation?
can activate complement
147
describe the inflammation of the synovium in RA?
intimal lining hyperplasia & sublining infiltration w/ CD4 Tcells, mphages, & Bcells
148
what kind of T cells are sublining the synovium in RA?
CD4 memory T cells
149
Are neutrophils found in the RA synovium?
no, but they are found in synovial effusions
150
which type of cells are responsible for most of the IL-1 secretion?
mphages
151
which 2 types of cells produce the chemokines that recruit inflammatory cells into the joint?
mphages, fibroblasts
152
inducing apoptosis of inflammatory cells can have what effect in synovial inflammation?
suppress synovial inflamm & joint destruction
153
what are the 3 angiogenic factors that can enhance BV prolif. in the synovium of RA?
IL-8
FGF
VEGF
154
how long does morning stiffness last in RA?
at least 30 mins
155
how long does morning stiffness last in OA?
5-15 mins
156
is joint involvement in RA symmetrical or asymmetrical?
symmetrical
157
Cervical spine involvement in RA carries what risk?
risk of spinal cord compression ranging from sensory loss to catastrophic neurologic compromise & sudden death
158
where do rheumatoid nodules usually show up?
extensor surfaces such as olecranon process & proximal ulna
159
what are some of the exam findings in ankylosing spondylitis?
1. sacroiliac tenderness
2. limited ROM of spine in all directions
3. Loss of lumbar lordosis, thoracic, & cervical kyphosis
4. reduced chest wall expansion
5. increased wall distance test
160
what are the x-ray findings in ankylosing spondylitis?
squaring of the vertebral bodies
| syndesmophyte formation
161
what is important to remember about treating reactive arthritis?
FOLLOWUP, (2-3 months)
recurrence is common
20-50% of pts have chronic course
162
what should be suspected in a pt with an asymmetric joint distribution pattern who may also have dactylitis, enthesitis, inflammatory-type back pain, & who is negative for RA?
psoriatic arthritis
163
what are markers of poor outcome in psoriatic arthritis?
elevated ESR, polyarticular disease
164
which disease has sausage fingers?
psoriatic arthritis
165
which disease has the classic pencil in cup formation on radiography?
psoriatic arthritis
166
you might find increased levels of IL-18 in the serum and synovial tissue of pts with what disease?
psoriatic arthritis
167
what does IL-18 do?
stimulates angiogenesis (important in psoriatic arthritis)
upregulates chemokine expression on synovial fibroblasts
increases mononuclear cell recruitment
168
this disease is characterized by chronic inflammation w/ variable degrees of collagen accumulation (fibrosis) in affected tissues & obliterative vasculopathy of peripheral and visceral vasculature
systemic sclerosis
169
what is often the first sign of early limited sclerosis?
puffy fingers
170
what is the antibody associated with diffuse scleroderma?
anti-scl70 (anti-DNA topoisomerase I)
171
what is the antibody associated with limited scleroderma?
anti-centromere (remember in CREST syndrome)
172
which is more common and also presents with severe symptoms: scleroderma pts w/ upper GI tract or lower GI tract involvement?
upper GI
173
scleroderma pts w/ dysfunction of lower GI tract are associated with what kind of prognosis?
poor prognosis
174
what is the most common cause of death in scleroderma?
respiratory failure
175
how do you treat scleroderma-related ILD?
immunosuppression
176
what are risk factors for pulmonary artery hypertension in scleroderma?
late onset of scleroderma, limited scleroderma, numerous telangiectasias, anti-centromere abs
177
how would you screen and monitor the status of interstitial lung disease in scleroderma pts?
pulmonary function tests
178
what predicts the outcome of ILD in scleroderma pts?
degree of lung fibrosis on CT
179
which scleroderma pts typically have the worse prognosis?
nonwhite & antitopoisomerase I abs (anti-scl70)
180
what kind of of deficiencies have the highest correlation with the risk of developing lupus?
complement deficiencies
181
mutations in ____________ point to impaired regulation of endogenous nucleic acids as an important pathogenic mechanism of lupus.
TREX1
182
what problems are caused by serositis in lupus?
pleura (pleuritic chest pain, pleural effusion)
Pericardium (chest pain, pericardial effusion)
Peritoneal cavity (abd pain, fluid accum.)
183
what are some of the neuropsychiatric complications of lupus?
depression, psychosis
184
what is libman sacks endocarditis?
In lupus: aseptic vegetations that deposit on both sides of cardiac valves, commonly mitral valve
185
what are some of the obstetrical complications of lupus?
considered high risk for both maternal & fetal complications:
small for gestational age fetuses
recurrent fetal loss (antiphospholipid ab)
neonatal lupus
186
how might you try to minimize the significant morbidity associated with lupus pts that get infections?
education
immunization
minimal GCs
prompt anti-microbial therapy
187
Name the pathology:
this disease has fibrosis associated w/ sustained mesenchymal cell activation by growth factors, cytokines, chemokines, ROS, aberrant reactivation of developmental pathways
systemic scleroderma
188
how do the early limited sclerosis pts present?
raynaud's (1st symptom)
puffy fingers
limited skin thickening
anti-centromere antibody
189
how do the early diffuse scleroderma pts present?
```
lots of constitutional symptoms
Tendon friction rubs
Swollen, puffy HANDS
early diffuse skin
Anti-Scl70 & anti-RNA-polymerase III
```
190
what pts typically get scleroderma?
young black women
191
which disease has a watermelon stomach (gastric antral vascular ectasia-GAVE)?
Systemic sclerosis
192
what is a life-threatening condition that occurs in 5-10% of systemic sclerosis pts?
scleroderma renal crisis
193
what are some risk factors for developing scleroderma renal crisis?
early diffuse skin disease
use of GCs
presence of anti-RNA POL III
194
what is the key to treating scleroderma renal crisis?
early use of ACE inhibitors
195
what is the clinical presentation of scleroderma renal crisis?
aburupt onset of severe systemic HTN, visual alterations, & accelerated oliguric renal failure
196
Myopathies are often accompanied by elevated levels of serum _________ and abnormal EMGs.
muscle enzymes
197
what is Gottron's sign and where is it found?
nodules associated w/ dermatomyositis (commonly seen around MCP, PIP, DIP)
198
what kind of lymphocytes are involved in dermatomyositis?
CD4 T cells
199
what kind of histologic findings are present in dermatomyositis?
perimysial inflammation (think of it as being closer to your skin)
200
what disease has mechanics hands?
dermatomyositis-hyperkeratotic, crackling skin findings on tips of fingers
201
what kind of lymphocytes are involved in polymyositis?
CD8 T cells
202
what kind of histologic findings are present in polymyositis?
endomysial inflammation
203
which antibody is associated with the inflammatory myopathies?
anti-Jo-1 (anti-histidyl-tRNA-synthetase)
204
what is a heliotrope rash and what kinds of pts will have it?
rash around the orbits of the eye, found in dermatomyositis or polymyositis
205
which inflammatory myopathy has an increased risk of occult malignancy?
dermatomyositis
206
antiphospholipid abs are a family of autoantibodies directed against phospholipid binding plasma proteins, most commonly _____________
beta2-glycoprotein I
207
when do pregnancy losses typically occur in antiphospholipid syndrome?
10 wks
208
____________ is the prototypical overlap disease w/ features of lupus, scleroderma, & inflammatory myositis.
mixed connective tissue diseases
209
what is the most common presentation of MCTD?
Raynaud's phenomenon
210
MCTD is most commonly associated with which antibodies?
anti-U1-RNP
211
what is the major cause of death in MCTD?
pulmonary hypertension
212
Nearly all pts with a UCTD have ____________ in combo w/ an unexplained synovitis
raynaud's phenomenon
213
what is a useful way to evaluate the potential diagnosis of UCTD?
nail-fold capillary microscopy
214
what kind of antibodies predict the differentiation of UCTD into MCTD?
anti-U1-RNP
215
what kind of antibodies predict the differentiation of UCTD into SLE?
DNA antibodies
216
What kind of antibodies predict the differentiation of UCTD into Systemic sclerosis?
nucleolar antibodies
217
what kind of antibodies predict the differentiation of UCTD into a myositis overlap syndrome?
Synethetase & PM/Scl antibodies
218
what are the main causes of morbidity & mortality in scleroderma overlaps?
pulmonary fibrosis
| pulmonary hypertension
219
how can you tell the difference between primary raynaud's phenomenon and raynaud's in the context of limited sclerosis?
primary raynaud's will have normal caipillaries on nail-fold microscopy
220
In myositis overlap, antibodies to U1-RNP, PM/Scl, or Ku are associated with _________________
corticosteroid responsiveness
221
what finding is found in almost all pts with MCTD?
raynaud's phenomenon
222
what are the 3 phases of raynaud's?
white-->blue-->red
223
what are the clinical hallmarks of Sjogren's syndrome? (3)
keratoconjunctivitis sicca
xerostomia
parotid gland swelling
224
what is the characteristic histopathologic finding in sjogren's syndrome?
chronic Lymphocyticl infiltration of the lacrimal & salivary glands
225
how would you diagnose sjogren's syndrome?
dry eyes, dry mouth, anti-SSA, anti-SSB, and by lip biopsy
226
sjogren's syndrome has a risk of what kind of malignancy?
44x greater risk of developing non-Hodgkin's lymphoma
227
which connective tissue disease has an increased association with dental caries?
sjogren's syndrome
228
what is spear tackler's spine?
loss of cervical lordosis, cervical stenosis, arthritic changes
229
what is stinger syndrome?
aka dead arm syndrome (happens in a pt walking off the field with a traction/tension injury)
- stinging/burning electric shock sensation
- arm numness or weakness
- sensation of warmth
- C5 most common
230
what is the most common mechanism of C-spine fracture-dislocation?
axial load (C5-6 most common)
231
if you have a pt who was a kid doing squats with heavy loads and crappy technique he might get what kind of injury?
stress fracture of pars
232
most shoulder dislocations happen anterior or posterior?
90% are anterior dislocation
233
what is a bankhart lesion?
tearing of the anterior inferior glenohumeral complex from the labrum
234
what is a SLAP tear?
superior labral anterior posterior tear: lots of overhead athletes like baseball players
235
What is OCD capitellum?
```
osteochondritis dissicans (feels like someone threw a pebble into my elbow gears)
-happens in excessive axial loading like gymnasts, & weight lifters)
```
236
how would you dislocate your elbow?
falling on an extended arm
237
what is more serious a proximal or distal biceps tendon tear?
distal is way worse
238
what are the signs & symptoms of an ulnar collateral ligament injury?
pain, tenderness inner side of elbow, especially when throwing (inability to throw at full speed, loss of control)
239
if you have a scaphoid fracture where will you hurt?
pain and swelling at the anatomical snuffbox (difficult to heal because it has a poor blood supply)
240
what are the most common sites for pelvic avulsion fractures?
ASIS, AIIS, Ischial Tuberosity
241
what is the most common ligament involved in an ankle sprain?
lateral ligament
242
how do you test for cervical radiculopathy?
spurling's maneuver: apply axial load to head that's extended and rotated toward painful shoulder-->this is going to hurt a lot
