MSS/Rheum

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bigfootedbertha
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165226
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MSS/Rheum
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2012-08-07 16:11:22
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MSS Rheum
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MSS/Rheum for PANCE
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  1. Heberden's nodes affect what joints in what disease?
    DIPs in OA
  2. Bouchard's nodes affect what joint in what disease?
    PIP, OA
  3. What is found on OA xrays?
    Asymmetric narrowing, subchondral sclerosis, cysts, and marginal osteophytes
  4. Onset of RA
    40-60 yo
  5. Pathophysiology of RA
    Hyperplastic synovial tissue may erode cartilage, subchondral bone, articular capsule, tendons, and ligaments
  6. Dx criteria for RA
    • Morning stiffness > 1 hour
    • Radiologic changes suggestive of jt erosion or bony decalcification
    • Symmetric arthritis, present for at least 6 weeks
    • Hand arthritis
    • Arthritis in > 3 joints
    • RF > 95%
    • Nodules on bony prominences, extensor surfaces, or juxta-articular regions
  7. Extra-articular manifestations of RA
    Kidneys, blood, eyes, liver, lungs
  8. RA lab findings
    • elevated RF and anti-CCP in 70-80% of pts (but levels low in early disease)
    • Elevated ESR and CRP
  9. RA radiography findings
    soft-tissue swelling and juxta-articular demineralization
  10. RA initial tx
    NSAIDs + DMARD (methotrexate) initially
  11. Other DMARDS than methotrexate
    corticosteroids, sulfasalazine, antimalarials, leflunomide
  12. New biologic tx for RA
    etanercept, abatacept, rituximab, infliximab, and adalimumab
  13. Still's Disease presentation
    Spiking fevers, myalgias, polyarthralgias, and salmon-pink maculopapular rash appearing in the evening with fever
  14. Koebner's phenomenon
    A process in Still's disease where the rash can be elicited by scratching skin in susceptible areas
  15. Extra-articular manifestations of Still's disease
    HSM, lymphadenopathy, leukocytosis, pericarditis, or myocarditis
  16. WBC count in septic arthritis
    >50k
  17. PMN % in septic arthritis
    75%
  18. PMN % in RA
    25-50
  19. WBC count in RA
    3-50k
  20. When are Still's disease pts at risk for uveitis?
    When they have a postive ANA
  21. lab findings in Stills
    • 10-15% have positive RF
    • ESR and CRP increased or nl
  22. Treatment of JRA
    • First line: NSAIDS, PT/OT
    • Second line: methotrexate or leflunomide
  23. Prognosis of JRA
    • 75-80% remit without serious disability
    • Pts who are RF positive are at a greater risk of progressing to disabling arthritis as adults
  24. m/c pathogen in septic arthitis
    staph
  25. Diff b/w osteomyelitis and septic arthritis
    osteomyelitis has systemic sx
  26. What % of septic arthritis pts have pos blood culture?
    40%
  27. distribution of psoriatic arthritis
    few joints, may involve hands and feet
  28. sausage finger appearance
    psoriatic arthritis
  29. Lab findings in psoriatic arthritis
    • Elevated ESR
    • normochromic, normocytic anemia
    • RF is nl
  30. Psoriatic arthritis tx
    • NSAIDs for mild cases
    • Methotrexate for skin inflammation and arthritis
    • Avoid corticosteroids and antimalarials
  31. What is the tetrad of Reiter's
    urethritis, conjunctivitis, oligoarthritis, and mucosal ulcers
  32. Reiter's is a common sequalae to what conditions?
    STDs and gasteroenteritis
  33. Clinical features of Reiter's arthritis
    asymmetric arthritis that involves large joints below the waist; mucocutaneous lesions, urethritis, and conjunctivitis
  34. Leading cause of nontraumatic monoarthritis
    Reiter's
  35. Lab findings in Reiter's
    • Positive HLA-B27 in 50-80% of pts
    • Negative synovial fluid
  36. Treatment of Reiter's
    • PT and NSAIDs are the mainstay
    • ABX given at tiem of infection will reduce the chance of developing the disorder, but do not alleviate the sx of the reactive arthritis
  37. Podagra
    initial gout attack of the great toe
  38. Joint fluid analysis in gout
    rod-shaped, negatively birefringent urate crystals
  39. Uric acid level in gout
    >7.5 (CMDT)
  40. Gout tx
    • Indomethacin 25-50mg TID until sx resolve
    • Corticosteroid injections for accessible jts, PO prednisone if other medicines are not tolerated and septic arthritis has been ruled out
  41. Management of gout between attacks
    allopurinol, colchicine, probenacid, sulfapyrazone, or febuxostat
  42. Pseudogout m/c joints
    knee, wrist, and elbow
  43. Joint aspiration results in CPPD
    positively birefringent rhomboid shaped crystals
  44. SLE epidemiology
    women of child-bearing age; AA>C
  45. Dx criteria for SLE
    • MS. PARANOID
    • Malar rash
    • Serositis

    • Photosensitivity
    • ANA
    • Renal dz (proteinuria, cellular casts)
    • Arthritis
    • Neurologic disorders (seizures or psychosis in absence of any other cause)
    • Oral ulcers
    • Immunologic disorders (LE cell, anti-DNA, anti-Sm, false-positive RPR)
    • Discoid rash
  46. What labs should be ordered in SLE?
    CBC, BUN/Cr, UA, ESR, and serum complement (C3 or C4)
  47. SLE tx
    • Regular exercise and sun protection
    • NSAIDs for MS complaints
    • Anatimalarials for MS and cutaneous manifestations)
    • Corticosteroids for skin and disease flares
    • Methotrexate (low dose) for arthritis, rashes, serositis, and constitutional sx
  48. What is polymyositis?
    inflammatory dz of striated muscle affecting the proximal limbs, neck, and pharynx
  49. Other organ involvement in polymyositis
    joints, lungs, heart, and GI tract
  50. disease with a strong association with occult malignancy
    polymyositis
  51. Clinical features of polymyositis
    insious, painless, proximal muscle weakness; dysphagia, skin rash (malar or heliotrope), polyarthralgias, and muscle atrophy
  52. Lab findings in polymyositis
    elevated CPK and aldolase
  53. Polymyositis tx
    high dose steroids, methtrexate, or azathioprine until sx resolve
  54. Pain and stiffness in the neck, shoulder, and pelvic girdles; accompanied by constitutional sx
    PMR
  55. PMR epidemiology
    women twice as much as men, usually in pts > 50
  56. What % of PMR pts develop GCA?
    ~30%
  57. clinical features of PMR
    • Stiffness, primarily after rest and in the morning
    • MS sx are B/L, proximal, and symmetrical
  58. Lab results in PMR
    ESR > 50 mm/hr
  59. Tx of PMR
    low dose cortocosteroids, unless GCA is present, then it's high dose
  60. What is polyarteritis nodosa?
    Small and medium artery inflammation involving the skin, kidney, peripheral nerves, muscle, and gut
  61. polyarteritis nodosa epidemiology
    male > female 3:1, onset between 40-60 yrs, although it can occur in any age group
  62. Rheum dz with strong association with Hep B
    polyarteritis nodosa
  63. Clinical characteristics of polyarteritis nodosa
    fever, anorexia, weightloss, abdominal pain, peripheral neuropathy, arthralgias, arthritsi
  64. Skin manifestations of polyarteritis nodosa
    palpable purpura and livedo reticularis
  65. Kidney involvement of polyarteritis nodosa
    htn, edema, oliguria, uremia
  66. Lab findings in polyarteritis nodosa
    • Dx with vessel bx or angiography
    • Elevated ESR and CRP and proteinuria, as well as positive Hep B surface antigen
    • presence of ANCA is suggestive but not dx
  67. Tx of polyarteritis nodosa
    • high dose corticosteroids
    • cytotoxic drugs and immunotherapy may be used
  68. scleroderma epidemiology
    female > male 4:1; onset b/w 30-50yo
  69. 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
  70. CREST syndrome
    calcinosis, raynaud's phenomenon, esophageal dysfunction, sclerodactily, telangiectasias in association with LIMITED scleroderma
  71. Lab findings in scleroderma
    • ANA positive in 90% of pts
    • anicentromere Ab in limited scleroderma
  72. Tx of scleroderma
    • no cure
    • 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
  73. autoimmune disorder that destroys the salivary and lacrimal glands
    sjogrens
  74. What can Sjogren's be a secondary complication to?
    RA, SLE, polymyositis, or scleroderma
  75. Sjogren's epidemiology
    most common in middle-aged females
  76. Enlarged parotid glands
    Sjogrens
  77. Lab findings in Sjogrens
    • RF positive in 70%
    • ANA positive in 60%
    • Anti-Ro Abs in 60%
    • Anti-La Abs in 40%
  78. How can you make the dx?
    Bx of lower lip mucosa, to confirm lymphocytic infiltrate and gland fibrosis
  79. Tx of Sjogrens
    • artifical tears and saliva
    • increase oral fluid intake
    • ocular and vaginal lubricants
    • pilocarbine for saliva flow
  80. What can fibromyalgia be concurrent with?
    RA, SLE, and Sjogrens
  81. Tx of fibromyalgia
    • SSRIs, SSNRIS, and TCAs
    • Pre-gabalin (Lyrica) only drug that is FDA approved specifically for tx of fibromyaglia
    • Aerobic exercise
    • pt education, stress reduction, sleep assistance, and tx of psychological problems
  82. what bones are m/c affected in osteomyelitis?
    long bones
  83. Who is at risk for salmonella osteomyelitis?
    SCA
  84. Use of radiography for dx osteomyelitis
    xray evidence lags behind sx by 7-10 days, therefore use ultrasound
  85. What are sequestra of osteomyelitis?
    • dead bone surrounding granulation tissue
    • involucrum (periosteal new bone)
  86. Osteomyelitis tx
    • 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
  87. What Ca mets to the bone?
    • BLT with a Kosher Pickle
    • Breast, Liver, Thyroid, Kidney, Prostate
  88. What is the m/c site of bony metastases?
    spine``
  89. M/C primary benign bone neoplasm of the hand
    endochondroma
  90. m/c types of primary sarcomas of the bone
    chondrosarcoma, Ewing's sarcoma, and osteosarcoma
  91. m/c primary malignant bone tumor
    multiple myeloma
  92. Epidemiology of Ewing's Sarcoma
    5 and 25 yo
  93. Where are Ewing's sarcomas found?
    diaphyses of long bones, ribs, and flat bones
  94. Epidemiology of osteosarcomas
    10-20 yo
  95. where are osteosarcomas generally found?
    metaphyseal area of long bones
  96. M/C source of bone lesions in adults > 60 yo
    metastatic carcinoma
  97. soft tissue sarcoma tx
    radiation therapy followed by local resection
  98. When do xrays show decreased bone density?
    When 30% of bone loss is present
  99. Study of choice to dx occult hip fx
    MRI
  100. 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
  101. Tx of greenstick fx
    If angulation <15%, may long cast; if >15%, refer to ortho
  102. M/C cause of facial pain
    TMJ
  103. M/C condition affecting cervical spine
    spondylosis
  104. 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
  105. What happens with compression caused by central disk protrusion or osteophytes in spondylosis?
    long-tract signs (clonus, Babinskis sign) and gait disturbance
  106. Hill-sachs lesion
    humeral head deformities d/t recurrent dislocations
  107. Bankart's lesion
    tear of glenoid labrum in shoulder dislocation
  108. Tx of dislocations
    • immobilization by sling and swath
    • therapy, begin after 1 week if >40 yo; at 3 weeks if < 40 yo
  109. Features of adhesive capsulitis
    pain and restricted glenohumeral movement; arthrography may show decreased volume of the joint capsule
  110. Tx of adhesive capsulitis
    NSAIDs, passive ROM, and occasionally, manipulation under anesthesia
  111. 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
  112. Neer classification
    classification of humeral head fx
  113. Volkmann's ischemic contractures
    caused by injury to brachial artery, possible with supracondylar humerus fx
  114. Kienbock's disease
    osteonecrosis of the lunate
  115. Dupuytren's Disease affects what parts of the hand?
    palmar aponeurosis, ring, little and middle fingers, causing painful nodules, pitting, and contractures
  116. M/C mononeuropathy
    Carpal tunnel
  117. Organism specific to human mouth
    Eikenella corrodens
  118. silver fork deformity
    colles fx (distral radius fx with dorsal angulation)
  119. m/c injury of wrist
    colles' fx
  120. What is gamekeeper's thumb?
    sprain or tear of the UCL of the thumb
  121. m/c common overuse injury of the elbow
    lateral epicondylitis
  122. What muscle is involved in lateral epicondylitis?
    extensor carpi radialis brevis
  123. m/c organism causing olecranon bursitis
    staph aureus
  124. 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)
  125. Presentation of nursemaid's elbow
    child will present with extremity fully pronated, with slight flexion and held tightly to side
  126. m/c fx carpal bone
    scaphoid
  127. what supplies blood to scaphoid?
    radial artery by way of lateral and distal branches
  128. What is DeQuervain's Disease?
    stenosis tenosynovitis involving the abductor pollicus longus and extensor pollicis brevis
  129. epidemiology in de quervains
    diabetics, females > 30
  130. sx of de quervains
    radiation of pain up in the forearm, pain and tenderness occur at the wrist and base of the humb
  131. m/c types of scoliosis
    right thoracic curves at the T7 or T8 level
  132. 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
  133. Scheurmann's disease
    Juvenile kyphosis
  134. M/C extrapulmonary location of TB after the LN
    TB of the spine (Pott's disease)
  135. What is spinal stenosis?
    nerve compression caused by narrowing of the spinal canal or neural foramina
  136. what is central stenosis?
    compression of the thecal sac
  137. What is lateral spinal stenosis?
    impingement of the nerve root lateral to the thecal sac
  138. Clinical features of spinal stenosis
    neural claudication and exacerbation of pain with walking, pain relieved by leaning forward, variable back and leg pain
  139. What is ankylosing spondylitis?
    a seronegative spondyloarthropathy that progresses to fusion of the vertebrae
  140. 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
  141. extra-articular manifestations of ankylosing spondylitis
    uveitis, cardiac abnormalities, and interstitial lung dz
  142. lab findings in ankylosing spondylitis
    • elevated ESR and CRP
    • HLA-B27 positive in 90% of whites, 50% of blacks
  143. What is cauda equina syndrome?
    rare condition involving a large midline risk herniation that compresses several nerve roots, usually at L4-L5
  144. what are clinical features of cauda equina syndrome?
    • bowel and bladder function is severely impaired
    • leg pain, numbness, saddle anesthesia and/or paralysis
  145. What is aseptic necrosis?
    results from loss of blood supply to the trabecular bone which causes a collapse of the femoral head
  146. What is aseptic necrosis called in children?
    Legg Calves Perthes
  147. When is the peak age for LEgg Calve Perthes
    4-8 years old
  148. Imaging of choice for aseptic necrosis of the hip
    MRI
  149. What is SCFE?
    weakening of the epiphyseal plate of the femur, resulting in a displacement of the femoral head
  150. What ligament is m/c involved in an ankle sprain?
    anterior talofibular ligmanet
  151. What is hallux valgus?
    Bunions
  152. What causes hallux valgus?
    lateral deviation of the proximal phalanx
  153. What is considered abnl with an xray of a bunion?
    an angle of greater than 15 degrees
  154. 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
  155. Where does a morton's neuroma m/c affect?
    third web space
  156. 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

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