Crozer Medicine 2 Flashcards
Clinical findings of RA
Symmetric, progressive, polyarticular, and degenerative inflammatory arthritis
Age of onset between 3-4th decades
Females > males
Pain first thing in morning
Stiffness after rest and reduced with activity
Rheumatoid nodules (25%)
Nail fold infarcts, splinter hemorrhages
Swan neck deformities – flexed DIPJ and extended PIPJ
Boutonniere deformities – extended DIPJ and flexed PIPJ
Other – bullous dermatosis, Raynaud phenomenon, vasculitis
whats lab finding of RA
Rheumatoid factor – positive
RBC – slight to moderate anemia
WBC – elevated in acute cases and normal to decreased in chronic
ESR & CRP – moderate to marked elevation
Synovial fluid analysis – elevated WBCs with cloudy fluid
Radiographic findings of RA
Clinical symptoms may present several years prior to radiographic findings
Peri-articular edema
Periosteal elevation and ossification
Marginal erosions
Subluxation and contractures (Swan neck deformities)
Fibular deviation of digits
Osteoporosis
Symmetric joint space narrowing and destruction (late stage finding)
cause of fibular deviation of digits
Erosive changes of medial plantar metatarsal heads compromises the integrity of medial collateral ligaments leading to lateral deviation of digits
pannus
Granulation tissue that secretes chondrolytic enzymes which break down articular cartilage
clinical findings of psoriatic arthritis
Polyarthritis including DIPJ involvement
Sausage digits
Psoriatic skin changes
Nail lesions
lab findings of Psoriatric arthritis?
HLA 27 positive. RF neg
Radiographic findings of PA
erosions w bony proliferation symmetric narrowing of joint space increased periosteal activity pencil in cup appearance osteopenic changes
clinical findings of Reiter syn
Polyarticular, asymmetric arthritis of lower extremity (mostly affects small bones of feet, ankle, knee, SI joint) Most affects males Capsulitis with digital edema Bony erosions
Reiter syn triad
can’t see, pee or climb a treeconjunctivitis, urethritis, arthritis, also keratoderma blenorrhagicum
lab findings RS
HLA 27 positive, RF ng, ESR elevated,synovial fluid analysis
radiographic findings of RS
Fluffy periosteal reactions
Large, bilateral heel spur formation
Inflammation and widening of Achilles tendon insertion
Deossifications
clinical findings of ankylosing spondylitis
Mostly males affected
Bilateral sacroiliitis – low back pain and stiffness
Heel pain
Peripheral joint pain
lab findings for ankylosing spondylitis
HLA 27 positive
RF neg
Radiographic findings of AS
Irregular joint widening with erosions Reactive sclerosis Bony ankylosis Sacroiliac joint fusion Bamboo spine
Septic arthritis
painful, hot swollen joint, systemic signs of fever, NV, tachycardic, confusion
what are lab findings of SA
WBC – elevated with left shift ESR – elevated CRP – elevated Blood cultures – positive Synovial fluid analysis – elevated WBC with cloudy white or gray color
radiographic findings of SA
normal early on, joint effusion, juxta articular osteopenia
etiologies of SA
Contiguous, hematogenous, direct implantation, surgical contamination
most common organism of SA
What is the most common offending organism of SA?
All ages – Staphylococcus aureus
Neonates – Streptococcus and Gram negatives
Children – H. influenza
Teenagers – Neisseria gonorrhea
Puncture wounds – Pseudomonas aeruginosa
Adults with sickle-cell – Salmonella
Tx for SA
Needle drainage of joint
Open arthrotomy if osteomyelitis, joint implant, or chronic infection
Initial joint immobilization followed by passive ROM
Appropriate IV antibiotics for 2 weeks followed by 2-4 weeks of oral antibiotics
brachymetatarsia
premature closure of epiphyseal plate-> short met
usually the 4th
conditions associated w brachymetatarsia
Downs syndrome Turners syndrome Cri du chat Pseudo- or pseudopseudohypoparathyroidism May be idiopathic
max length metatarsal may be acutely lengthened
1 cm graft- Neurovasc structures. if more needed mini-rail
lengthening/day w callus distraction
1mm/day
whats achondroplasia
dwarfism
whats fibular hemimelia
aplasia or hypoplasia of fibula
whats DISH
diffuse idiopathic skeletal hyperostosis- characterized by multiple ossifications at tendinous or ligament insertion
whats apert syn
multiple bony coalitions
paget disease
osteitis deformans-abnormal bony architecture caused by increased osteoblastic and osteoclastic activity.
common in elderly
malignant bone degeneration often seen w pagets disease?
osteosarcoma
stages of paget?
- destructive= osteolytic
- Mixed- osteolytic and osteoblastic
- Sclerotic- osteoblastic
stages of charcot
- destructive
- coalescence
- remodeling
conditions associated with positive HLA B27
ankylosing spondylitis, reiter disease, psoriatric arthritis, reactive arthritis, enteropathic arthropathies
components of crest syn
Calcinosis Raynauds phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias
tx of cutaneous larva migrans
promethia under occlusion
tx of lyme disease
doxycycline 100 mg PO daily or Rocephin 1g IV daily
DOC for necrotizing fasciitis
primaxin 250-1000 IV q6 -8h
whats felty syndrome
RA, splenomegaly, leukopenia
whats mycosis fungoides
cutaneous T cell lymphoma that can resemble eczematoid or psoriasis
Whats erythrasma
Chronic, superficial infection of intertriginous skin caused by Corynebacterium minutissimum.Interdigital lesions appear as maceration.
whats ecthyma
ulcerative pyoderma of the skin caused by streptococci. infection extends into dermis, characterized by ulcers w overlying crests
whats cellulitis
Acute spreading infection of dermal and subcutaneous tissue commonly caused by group A Strepor Staph aureus. Affected area is erythematous, warm, edematous, and tender.
whats erysipelas
Superficial infection that extends into the lymphatics. Lesions are erythematous, indurated with sharply-demarcated margins, and have erythematous, ascending streaks
whats lymphangitis
inflame of lymphatics as result of distal infection
whats psoriasis
Hereditary disorder with chronic scaling papules and plaques in areas of body related to repeated
minor trauma. Positive Koebner phenomenon and Auspitz sign. Also present are joint pain and
nail changes including pitting, beau lines, oil spot, subungual hyperkeratosis, and discoloration
lichen planus
Inflammatory dermatosis involving skin or mucous membranes with pruritic, violaceous papules
clustered into large, flat-topped lesions with distinct borders. Lesions possibly covered with
Wickham striae (white streaks). Ridges, onycholysis, subungual hyperkeratosis, and
discoloration.
another name for menopausal lipoma
juxtamalleolar lipoma
effect of steroids on anti inflame? metabolic?
Anti-inflammatory
Decreases production of prostaglandins, cytokines, and interleukins
Decreases proliferation and migration of lymphocytes and macrophages
Metabolic
Decreases osteoblast activity
difference btwn phosphate and acetate based steroids
Phosphate-based – soluble with shorter half-life
Minimize inflammatory reaction and edema
Acetate-based – insoluble with longer half-life
May delay inflammatory process or healing and can mask infection
common complication following steroid injection
steroid flare-hypersensitivity rxn. apply ice
how are glucocorticoids metabolized
in the liver. secreted in urine
whats diazepam
valium, a benzodiazepine- anxiolytic/anticonvulsant, muscle relaxant
reverse diazepam
flumazenil
drugs for insomnia
Benadryl, estazolam, halcion, ambien,restoril, dalmane
drug that leaves metallic taste in mouth?
flagyl, lamisil
given for Tylenol OD
acetylcysteine
what causes grey baby syn
chloramphenicol (antimicrobial)
