Elevated ESR and CRP and proteinuria, as well as positive Hep B surface antigen
presence of ANCA is suggestive but not dx
Tx of polyarteritis nodosa
high dose corticosteroids
cytotoxic drugs and immunotherapy may be used
female > male 4:1; onset b/w 30-50yo
Difference between body involvement of diffuse and limited scleroderma
diffuse: skin, heart, lungs, GI tract, and kidneys
limited: mostly affects the skin of the face, neck, and distal elbows and knees; can cause pulm HTN
calcinosis, raynaud's phenomenon, esophageal dysfunction, sclerodactily, telangiectasias in association with LIMITED scleroderma
Lab findings in scleroderma
ANA positive in 90% of pts
anicentromere Ab in limited scleroderma
Tx of scleroderma
tx the organ-specific disease processes (PPIs for reflux, ACE-Is for renal dz, avoidance of triggers and tx with CCBs for Raynaud's, immunosuppressive drugs for pulm HTN
autoimmune disorder that destroys the salivary and lacrimal glands
What can Sjogren's be a secondary complication to?
RA, SLE, polymyositis, or scleroderma
most common in middle-aged females
Enlarged parotid glands
Lab findings in Sjogrens
RF positive in 70%
ANA positive in 60%
Anti-Ro Abs in 60%
Anti-La Abs in 40%
How can you make the dx?
Bx of lower lip mucosa, to confirm lymphocytic infiltrate and gland fibrosis
Tx of Sjogrens
artifical tears and saliva
increase oral fluid intake
ocular and vaginal lubricants
pilocarbine for saliva flow
What can fibromyalgia be concurrent with?
RA, SLE, and Sjogrens
Tx of fibromyalgia
SSRIs, SSNRIS, and TCAs
Pre-gabalin (Lyrica) only drug that is FDA approved specifically for tx of fibromyaglia
pt education, stress reduction, sleep assistance, and tx of psychological problems
what bones are m/c affected in osteomyelitis?
Who is at risk for salmonella osteomyelitis?
Use of radiography for dx osteomyelitis
xray evidence lags behind sx by 7-10 days, therefore use ultrasound
What are sequestra of osteomyelitis?
dead bone surrounding granulation tissue
involucrum (periosteal new bone)
Abx x 3 weeks (1 week IV, 2 weeks PO)
immobilization and surgical drainage
surgical tx to remove sequestra, sinus tract, infected bone, and scar tissue
What Ca mets to the bone?
BLT with a Kosher Pickle
Breast, Liver, Thyroid, Kidney, Prostate
What is the m/c site of bony metastases?
M/C primary benign bone neoplasm of the hand
m/c types of primary sarcomas of the bone
chondrosarcoma, Ewing's sarcoma, and osteosarcoma
m/c primary malignant bone tumor
Epidemiology of Ewing's Sarcoma
5 and 25 yo
Where are Ewing's sarcomas found?
diaphyses of long bones, ribs, and flat bones
Epidemiology of osteosarcomas
where are osteosarcomas generally found?
metaphyseal area of long bones
M/C source of bone lesions in adults > 60 yo
soft tissue sarcoma tx
radiation therapy followed by local resection
When do xrays show decreased bone density?
When 30% of bone loss is present
Study of choice to dx occult hip fx
Open fx tx
debrided and irrigated within 4-8 hours of injury
IV abx (1-2G cephs, and aminoglycosides) for 48 hours after the fx and for 48 hours after surgical procedures
Tx of greenstick fx
If angulation <15%, may long cast; if >15%, refer to ortho
M/C cause of facial pain
M/C condition affecting cervical spine
What is spondylosis?
a condition where degenerative changes occur in the disk, m/c C5-C6, with the formation of osteophytes and disk narrowing; later on in the dz, facet joints and the joints of Luschka are affected
What happens with compression caused by central disk protrusion or osteophytes in spondylosis?
long-tract signs (clonus, Babinskis sign) and gait disturbance
humeral head deformities d/t recurrent dislocations
tear of glenoid labrum in shoulder dislocation
Tx of dislocations
immobilization by sling and swath
therapy, begin after 1 week if >40 yo; at 3 weeks if < 40 yo
Features of adhesive capsulitis
pain and restricted glenohumeral movement; arthrography may show decreased volume of the joint capsule
Tx of adhesive capsulitis
NSAIDs, passive ROM, and occasionally, manipulation under anesthesia
Tx of clavicle fx
children: figure of eight slin for 4-6 weeks
adults: sling for 6 weeks is generally enough to tx the tx
classification of humeral head fx
Volkmann's ischemic contractures
caused by injury to brachial artery, possible with supracondylar humerus fx
osteonecrosis of the lunate
Dupuytren's Disease affects what parts of the hand?
palmar aponeurosis, ring, little and middle fingers, causing painful nodules, pitting, and contractures
Organism specific to human mouth
silver fork deformity
colles fx (distral radius fx with dorsal angulation)
m/c injury of wrist
What is gamekeeper's thumb?
sprain or tear of the UCL of the thumb
m/c common overuse injury of the elbow
What muscle is involved in lateral epicondylitis?
extensor carpi radialis brevis
m/c organism causing olecranon bursitis
tx of nursemaid's elbow
holding affected arm just above the wrist and just below the elbow, place thumb of proximal hand over the radial head while fully supinating and felxing the forearm and applying posteriorly directed pressure (screws the radial head back within annular ligament)
Presentation of nursemaid's elbow
child will present with extremity fully pronated, with slight flexion and held tightly to side
m/c fx carpal bone
what supplies blood to scaphoid?
radial artery by way of lateral and distal branches
What is DeQuervain's Disease?
stenosis tenosynovitis involving the abductor pollicus longus and extensor pollicis brevis
epidemiology in de quervains
diabetics, females > 30
sx of de quervains
radiation of pain up in the forearm, pain and tenderness occur at the wrist and base of the humb
m/c types of scoliosis
right thoracic curves at the T7 or T8 level
How do you manage scoliosis?
10-15 degree curves: 6-12 month f/u with clinical evaluation and possibly xrays
15-20 degree surves: serial AP radoigraphs q3-4mo for larger curves and q6-8months for smaller curves
20+ degree curves: refer to ortho
M/C extrapulmonary location of TB after the LN
TB of the spine (Pott's disease)
What is spinal stenosis?
nerve compression caused by narrowing of the spinal canal or neural foramina
what is central stenosis?
compression of the thecal sac
What is lateral spinal stenosis?
impingement of the nerve root lateral to the thecal sac
Clinical features of spinal stenosis
neural claudication and exacerbation of pain with walking, pain relieved by leaning forward, variable back and leg pain
What is ankylosing spondylitis?
a seronegative spondyloarthropathy that progresses to fusion of the vertebrae
What are sx of ankylosing spondylitis?
restricted lumbar motion
limited motion int hes houlders and hips, synovitis of the knees, plantar fascitis, and achilles tendinitis, hip contractures and fixed cervical, thoracic, and lumbar kyphosis
extra-articular manifestations of ankylosing spondylitis
uveitis, cardiac abnormalities, and interstitial lung dz
lab findings in ankylosing spondylitis
elevated ESR and CRP
HLA-B27 positive in 90% of whites, 50% of blacks
What is cauda equina syndrome?
rare condition involving a large midline risk herniation that compresses several nerve roots, usually at L4-L5
what are clinical features of cauda equina syndrome?
bowel and bladder function is severely impaired
leg pain, numbness, saddle anesthesia and/or paralysis
What is aseptic necrosis?
results from loss of blood supply to the trabecular bone which causes a collapse of the femoral head
What is aseptic necrosis called in children?
Legg Calves Perthes
When is the peak age for LEgg Calve Perthes
4-8 years old
Imaging of choice for aseptic necrosis of the hip
What is SCFE?
weakening of the epiphyseal plate of the femur, resulting in a displacement of the femoral head
What ligament is m/c involved in an ankle sprain?
anterior talofibular ligmanet
What is hallux valgus?
What causes hallux valgus?
lateral deviation of the proximal phalanx
What is considered abnl with an xray of a bunion?
an angle of greater than 15 degrees
What is a morton's neuroma?
a results of traction of the interdigital nerve against the transverse metatarsal ligament causing degeneration of the nerve and chronic inflammation
Where does a morton's neuroma m/c affect?
third web space
what are sx of morton's neuroma?
pain and localized numbness when walking and standing, which is relieved with rest; pain localized to web space commonly with a palpable mass; squeezing forefoot will often reproduce sx