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NU734 Acute Care I > 735 Musculoskeletal > Flashcards

735 Musculoskeletal Flashcards

1
Q

**Osteoporosis
Affects **

A
  • Osteoporosis affects >10 million the US
  • S**mall proportion are diagnosed **& treated
    *** 8 million women & 2 million men ( Female Predominantly)
  • Loss of ovarian function in women around age 50
    * Precipitates rapid bone loss (most women meet dx criteria by ago 70 to 80 yrs)
    2 million fractures each year occurs in USA due to Osteroporosis
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2
Q

Osteoporosis
characteristics

A
  • Decreased bone strength
  • Post menopausal women
  • Function of Age: Occurs both M and W as a Function of age due to underlying conditions or major risk factors associate with **bone dimerization **
  • Progressive loss of bone tissue: naturally occurs with age
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3
Q

Manifestations & Complications

A
  • Most Common FX: Vertabra and HIP FX , However
  • Fractures occur at any skeletal site
  • DVT/PE: Fx has high association with DVT/PE
    * Mortality: 5 to 20% 1st year after surgery ( if fx occurs can be life debilitation condition )
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4
Q

Osteoporosis
DX

A

**DX Scan **
* Higly Accurate XRAY
*Measures Bone Mass Measurement
**Bone Mass Measurement **
* All Women by age 65
* Males at age of 70 with absence of risk factors or related fracture
**Vitamin D Leve
*<12 associate with Vit D deficiency (Rickets = Kids and Osteomalacia = in adults
* 12 to 20 - Indadequate
* 21 to 50 Addequate
* 50 potenital adv reaction
* >60 adverse reaction

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5
Q

Osteoprorosis
TX

A
  • **vitamin D3 : **
  • 50 K x 8 wks then 2000 daily
  • take with Ca supplement
    *** PostMenopausal Women ** : Purpose to decrease bone turne over rate and incrase bone mass
    Alendronate 70mg pO/weekly st line
    Fosamax (Alendronate and vitamin D )
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6
Q

Acute Gaut
Overview

A

**Metabolic Disorder
**Affects middle aged to Elderly Men

P**ost -Menopausal women
OA, HTN, CKD

**Purines

  • Play Crucial role essential compnnet DNA and RNA
  • Found in animal and plant products
  • Converted to uric acid
  • lead to gout if not flushed out

**Typical Characterization **
Acute or chronic arthritis
Deposits of crystals the joints and connective tissue
**
Comlications **
Depostition into kidney interstitium
Uric acid neprholitheais **( kidney stones )

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7
Q

Acute Gouty Arthritis
Clinical Findings

A
  • First Episode
  • Evening Hours
  • Join pain and sweling
  • Warm, red, tender joints
  • Early attacks suside 3 to 10 days
    *** Precipitating Factors **
    Dietary access
    trauma
    surgery
    Excessiv ethnol ingestion
    Hyporicemic therapy
    serious medical illnessess
    **Common Early clinical Manifestations **
    Acute arthritis
    Affect one joing
    Polyarticular in subsequent episodes
    Metatasophlangeal joint of 1st toe
    Elderly or advnaced disease
    finger or advanced disease
    Finger joints involvement
    Inflamed Heberden’s or Bouchard’s nodes
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8
Q

Gout :
DX

A

*** Arthrocentesis **
* Neele shaped monosodium urate (MSU ) Crystals
* WBC 2000 to 60, 000
* Cloudy (bacteria) ior Chalky (crystals ) apperace
* Bacterial infections can coexist
* Culture fluids to **r/o Septic Arthritis **
* **Laboratory **
* Serum uric Acid levels : can be normal and lower at the time of acute attack
* UA
* CBC, CMP, LFTs
* All labe to obtain to r/o other dx
* **24 -Hour Urine
For urinc acid
> 800 uric acid (excess of Purring)
> Excess purine

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9
Q

Gout Tx

A
  • NSAIDs
    Naproxen, Ibuprofen, Toradol ( check kidney function and GI disorder )
    * Colchicine
  • 1.2mg stat Then
  • 0.6 in 1 HR
  • **Glucocorticoids **
  • Po or IV
  • 30 to 50 mg/day
  • **Hyouricemic therapy for maintenance
    **Not initiated during acute attack
    Alloprnol 100 mg can be incrae to 800 /dau
    Caution with Thiazide use or PCN allergy

Life trhetenin Reaction :
Toxic epidermal necrolysis
systemic vasculysis
bone marrow supression
Hepatitis
renal failure

Combine wit colchicine until normouricemic x 6 month unti NORmouricemic; or without Gaut attack for 6 mont or as long as Tofi is present

ICe rest

Colcine - Acute attack
Alloprurinol - maintace
Can be combine aloprorino

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10
Q

**Rheumatoid Arthritis
OVerview **

A

**Chronic Inflammatory disease **
Unknow Etiology
Most common chronic inflammatory arthritis
No cure or prevention FOUND
**CHaracterization **
Symmeric Polyarthritis
**Disease Process Lead to **
Articular cartilage and bone destruction
Functional disability
CHances increase with AGe
Acquired b/w 25 to 55 age
Plateaus 75
Chance of getting decline after

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11
Q

RA
characteristic

A

**Presenting symptoms **
* Inflammation of Joints, Tendons, Bursa
* Early morning stiffness
* Eases with Physical Activities
* Earlier Joints Involved
* Hands and feet
*** Pattern of Involvement **
Monoarticular or Polyarticular
Symmetrical distribution
Extraacular manifestation
Fituque
Subcutaneous nodules
Lung involvemenet
Pericarditis
Peripheral Neuropathy
vascultis
Hematologic abnormalties

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12
Q

RA
Work Up and DX

A

Inflammatory and Biomarkers
* ESR and CRP
* Anti-CCPs (Biomarkers )
* Rheumatoid Factors
* CBC
Anemia
Leukocytosis
Thrombocytosis (High Plt)
**Joint Aspitration **
Conirms Inflammatory nature
Synovia WBC >75 to rarely >100K
Negative cultue
Traslucent to Opaque yellow ( if not other problem )

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13
Q

RA TX

A

**Primary Objective **
Reduce Inflammatory pain
Prevention of function
Prevention of deformity
Early pharmacologic intervention

**Nonsteroidal anti inflammatory (NSAID) **
Provide relieve
Do Not prevent Erosion
Do not alter disease progression
**Corticosteroids **
Anti inflammatory effect
slow articular erosion rate
Bridge before DMARD
Prednisoen 5 to 10mg/day

DMARDs( Disease modifying anti rheumatic drugs )

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14
Q

RA
Synthetic DMARDs

A

Synthetic DMARDs
Methotrexate
* 1st choice & well tolerated
* Beneficial effect in 2-3 weeks
* Does have complications
Gastric irritation, stomatitis, cytopenias, hepatotoxicity
Sulfasalazine
* Second line agent
* Does have complications
Hemolysis with G6PD deficiency
Check G6PD level before initiating
* Hydroxychloroquine sulfate
Monotherapy with only mild disease
Combo therapy with conventional DMARDs
Effective combination
Methotrexate + Sulfasalazine + Hydroxychloroquine**

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15
Q

RA TX
Biologic DMARDs

A
  • Tumor necrosis factors Inhibitors (TNF Inhibitor)
  • Etanercept, Infliximab, Adalimumab
  • Golimumab
  • **Most Common Therapy : Methothrexate and TNF factors
  • Folic acid with it
  • Reduce
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16
Q

Fibromyalgia
Overview

A
  • Chronic pain Syndrome
  • Charaterized by Chronic Widespread Masculo- Skeleton pain and Tenderness
  • **Common Charactetistic:
    Diffuse Musculoskeletal pain and tenderness
    Absence of Ojbetive findigns - tend to be obuse
  • Affect: 3 to 10% Population
    Prevelance: more in Women; Age 20 to 50; Similar across socioeconomic classess
  • Cultural role play role in TX
    Cause: unknow; theories of etiology exist , none proven
    ** Peripheral Pain Generators Triggers:
    Arthritis, Bursitis, or tendonitis
    Neuropathies
    Inflammatory/degenerative conditions
17
Q

Fibromyalgia
Clinical Findings

A
  • Typical Presentation
    Pain all over
    Pain above and below waist
    Pain invoving axila skeleton ( neck, back, chest)
  • **Characteristic of the Pain **
  • Poorly localized
  • Difficult to ignore
  • Severe in intesity ( by taking BPcaff, skin tenderness)
  • Reduce functional capacity
  • **Beyond pain
    Fatique
    Anxiety and depression
    Cognitive dysfuntion
18
Q

Fibromyalgia
DX:

A
  • **Laboratory and DX **
    Rule out other disease
    *** Duration of Pain **
    Most of the day, most days of weeks
    Pain : >/= 3 months
  • **Criteria for DX **
    Focus on clinical symptoms
    Widespreat or multi-site pain
    Neurophsycholocial symptoms
19
Q

Fibromyalgia
TX

A
  • Amitriptyline
  • Cymbalta or Celxa
  • Flexerill
  • Lyrica or Gabapentin
20
Q

Septic Arthritis
Most Common Cause

A
  • Most common
    Staphylococcus Aureus
    Neisseria Gonorrhohae
    *** Other: **
    Mycobacteria, Spriochetes, Fingi, viruses
21
Q

Septic Arthritis
Younger Adults and Adolescents

A

Neisseria Gonorrhoeaes
most common

22
Q

Septic Arthritis
Adults of all ages

A

50% Straphylococus aureous

23
Q

Septic Arthritis
Older Adults

A

33% Gram negative Bacilli
Pneumoccoci
Beta Hemolytic Steptococci

24
Q

Septic Arthritis
Gram negative Infection s

A

Account for 10%
Common in Injedti drug users and immunocompromissed
E coli and Pseudomonas aeruginosa

25
Q

Septic Arthritis
RF

A

*Most common Reason: *
Chronic inflata Joints
DM, Dialysis, Malignancy, Immunosupression, Cirrhosis, IVDA
if pt have baceria this infectio can be seen down the line

26
Q

Septic Arthritis
Overview

A

**Most Common Route: **
Hematogenous
Baceria enter via blood steam
** Invoves: **single join or few Joints
Knee most frequently
Rapid desruction of articular cartilage
Nearly all bacteari can cause it
surface associated adhesins
Permit adherece to cartilage
Endotoxins promote chondrocyte medicated brewn cartilage

27
Q

Septic Arthritis
Pathogen Cause

A

Surgery: Staphylococcus auriesu (gm +/-)
Prostetheitic Joint:stphloccus negative
Human bites, decutitus ulcer, Intra abdominal: anarobic organism
Foot penetration” Pseudomonas aeruginosa

28
Q

Septic Arthritis
S/s

A

Pain, swelling, heat effective joints, worsenign over hours
Chills and fever : common but can be absent
**

29
Q

Septic Arthritis
XRAY

A

**Joint effusin and soft tissue swelling **
Not defined dx
**Just indicate advanced infection **

30
Q

Septic Arthritis
US

A

Detect Hip effusio

31
Q

Septic Arthritis
CT and MRI

A

Demonstrate infections of sacroliliac Joint
Sternoclavicular joint and spine
IVDA (inj)

32
Q

Septic Arthritis
Labs

A

CBC
CMP
ESR and CRP
BC

33
Q

Septic Arthritis
Synovial Fluids

A

Synovial fluid analysis: Criticl for DX
Synovial leukocyte count: 50,000 to >100,000 mcl

 ******Gram stain & Culture**
           Positive in 75% of Staphylococcus infections
                Positive 50% of gram-negative infections
               Cultures positive in 70-90% Synovial Fluid Color : Turibid, Serosanquinous, or purulent

Synovial total protein, LDH, glucose
Total protein & LDH, increased
Glucose, decreased

Check for crystals
Rule out gout

Blood cultures
Positive in 50%
**

34
Q

Septic Arthritis
Joint drainage

A

Consult Ortho or IR
Arthrocetesis
Severe effusion
Arthroscopic Lavage and debridement with drain placement
Open surgical drainage: conservative txs failed
Protheti join infections: Dependent oon timing of infection
Removeal of prethetic

NU734 Acute Care I (23 decks)

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