Musculoskeletal

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Author:
anders
ID:
243599
Filename:
Musculoskeletal
Updated:
2013-11-07 01:06:26
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Step3
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Description:
Musculoskeletal
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  1. Achilles Tendinopathy pathophysiology:
    Runners, neovascularization & innervation???
  2. Achilles Tendinopathy treatment:
    • Initial:
    • - cryotherapy
    • - heel lift
    • - extracorporeal shock wave therapy
    • - deep friction massage
    • - eccentric strength training

    Surgery if pt fails 3-6 months of conservative therapy
  3. Osteoporosis risk factors:
    • Family history
    • Slender body build
    • Fair skin
    • Early menopause
    • Sedentary lifestyle
    • Cigarette smoking
    • Meds (corticosteroids, L-thyroxine)
    • >2 drinks of alcohol/caffeine per day
    • Low calcium intake
  4. Osteoporosis diagnosis:
    DEXA scan

    T score < -2 is diagnostic
  5. Osteoporosis treatment:
    Bisphosphonates

    Selective estrogen receptor modulator (SERM) - effective for prevention of bone loss in early postmenopausal women and treatment of established osteoporosis but increases risk of DVT 

    Calcitonin is reserved for cases unresponsive to other therapies
  6. Causes of Reactive arthritis (Reiter Syndrome):
    • Genitourinary: Chlamydia, Ureaplasma
    • GI: Salmonella, Shigella, Yersinia, Klebsiella, Camphylobacter

    May be the first manifesetation of HIV infection
  7. Reactive arthritis treatment:
    Initial: NSAIDS

    • Refractory: DMARD (methotrexate, azathioprine, sulfasalazine)
    • BUT, check HIV status first!
  8. Gout diagnosis (gold standard):
    Detection of urate crystals within the synovial fluid of affected joints

    needle-shaped, negatively birefringent crystals
  9. Acute Gout treatment:
    Indomethacin - inhibits prostaglandin synthesis that facilitates the inflammation of acute gout and inhibits phagocytosis of urate crystals by leukocytes which inhibits cell lysis and release of cytotoxic factors that initiate the inflammatory cascade
  10. Gout prevention:
    • Allopurinol - inhibits urate synthesis by irreversibly inhibiting xanthine oxidase
    • Colchicine - anti-inflammatory, used with allopurinol
    • Probenecid - promote urate excretion
    • Sulfinpyrazone - promotes urate excretion
  11. Teriparatide
    • recombinant parathyroid hormone
    • MOA: stimulates bone formation

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