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2013-07-12 10:03:18

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  1. Shoulder dislocation
    • ant more common, axillary at risk, arm abduct and ext rot
    • post rare: assoc with seizure/electrocution
  2. Hip dislocation
    • ant can injur obturator
    • post MC, dashboard injury risk of sciatic nn injury and avasc nec
  3. Colles fx
    distal radius, fall on outstretched hand, elederly and kids
  4. Scaphoid fx
    • MC fx carpal bone, may take 2 wks for xray to show
    • anatomical snuff box
    • rx: thumb spica cast, with some may get AVN
  5. Humerus fx
    radial nn palsy leading to wrist drop and loss of thumb extension
  6. Carpal tunnel signs
    tinels and phalens
  7. Ulnar nerve
    • finger abduction, palm and dorsal surface of last 2 fingers
    • damage via elbow dislocation
    • get claw hand
  8. axillary nn
    • abduction, sens to lat shoulder
    • damage via ant humeral disloc
  9. peroneal nn
    • dorsiflexion, lateral leg sensory
    • damage via knee dislocation
    • foot drop
  10. Cauda equina syndrome
    • bowel or bladder dysfunction, impotence and saddle area anesthesia
    • surg emergency
  11. Giant cell tumor of bone
    female 20-40, knee pain and soap bubble mass on epiphyseal/metaphyseal region of long bones
  12. ewings sarc
    10-20 yo, onion skinning femur
  13. Osteosarcoma
    • metaphyseal region of distal femur and proximal tibia, often mets to lungs
    • male 20-30
    • pain at night
    • codmans triangle, sunburst pattern
  14. Septic arthritis
    • infection of joint space, prosthetics inc risk, RA and OA are risk factors, endocarditis and IV drug use
    • BIT and MAT: joint asp
    • MC staph
    • empirically rx with ceftriaxone and vanc
  15. Osteo and rheumatoid arth
    osteo:worsens with use, DIP, PIP, joint space narrowing, osteophytes

    • RA: morning stiffness, improves with use, MCP, symmetrical
    • ANTI CCP Ab
  16. Rx gout
    • NSAID 1st line, colchicine may be used
    • steroids if nsaids fail or CI
    • Maintenance: allopurinol
  17. Ankylosing spondylitis
    • hla b27, males and fhx
    • late teens/20s, fatigue LBP worsens with inactivity and in the morning, dec spine flexion, dec chest expansion
    • can have ant uveitis and heart block
    • Xray with fused SI joint, bamboo spine, -rf, -ana
    • Rx: nsaids, TNF inhib (NOT CST!)
  18. Psoriatic arthritis
    • DIP, skin changes sausage shaped digits
    • pencil in cup deformity
  19. polymyositis
    • progressive systemic connective tissue, symmetric progressive proximal mm weakness, pain, and at advanced stages difficulty breathing or swallowing
    • Anti jo-1 ab, inc CK
    • Rx: CST
  20. dermatomyositis
    • heliotrope rash, shawl sign rash shoulders/chest back and gottrons papules: papular rash with scales on dorsa of hands, can be assoc with underlying breast/lung ca
    • Dx: anti jo-1 ab and serum ck inc
    • biopsy shows inflamm Rx: CST
  21. anticentromere
    crest syndrome
  22. SLE Abs
    • ANA, anti ds-dna
    • anti sm
  23. antihistone ab
    • drug induced sle
    • procainamide, hydralazine carbamaz etc
  24. Scleroderma Ab
    antinuclear, anti scl-70, anti topoisomerase i
  25. antimitochondrial ab
    primary biliary cirrhosis
  26. c-anca
  27. p anca
    microscopic polyangiitis
  28. Feltys syndrome
    rheum arth, splenomegaly, neutropenia
  29. Scleroderma
    • systemic sclerosis, deposition of type i and iii collagen, commonly manifests as crest syndrome
    • females 35-50
    • pulm fibrosis
    • anticentromere ab, anti scl-70 ab=bad prog
    • Rx: cst
  30. SLE
    • aa women, rash, oral ulcers, arthritis, malar rash, elevated esr, ana + etc
    • anti ds dna, anti sm
    • Rx: nsaid for mild, cst for acute
    • hydroxychloroquine: isolate skin and joint involvement
    • cyclophosphamide: for severe cases of lupus nephritis
  31. Fibromyalgia vs polymyalgia rheumatica
    fibromyalgia: 30-50, esr normal, anxiety/stress/point tenderness in 11 points, rx: SSrI, said, rest

    • Polymyalgia: >50, pain of shoulder and pelvic girdle, hard to get out of chair(like polymyositis), incinc ESR, anemia
    • Rx: prednisone
  32. DMD
    • XR, 3-5, def of dystrophin
    • axial and proximal muscles, gowers, pseudohypertrophy of calf, MR
    • mm biopsy, EMG: polyphasic potentials and increased recruitment
    • die from pulm congestion and high output cardiac failure from fibrosis
  33. DMD vs Becker
    • DMD: 3-5, die in teens, dystrophin markedly dec or absent
    • Becker: 5-15, die in 30-40
    • dystrophin levels normal but protein abnormal
  34. Developmental dysplasia of hip
    • congen hip dislocation, lax musculature and excessive uterine packing:breech
    • first born females
    • barlow and ortolani
    • early detect! xray unreliable until >4m
    • rx: <6 m with pavlik harness
    • can have AVN of fem head
  35. Nursemaid elbow
    • radial head sublucation that occurs from being pulled or lifted by hand
    • rx: manual redution
  36. osgood schlatter disease
    • overuse apophysitis of tibial rubercle, cant contract quads
    • rx: dec activity
  37. Legg calve perthes
    avn of femoral head, boys 4-10, limited abd and int rotation, observe usually
  38. Juvenile idiopathic arthritis
    • kids less than 16, fever nodules, rashes, pericarditis, faticue
    • Stills: acute febrile, daily spiking fevers and salmon rash
    • Rx: nsaid or cst