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***pimp questions- rachel > Crozer Medicine 2 > Flashcards

Crozer Medicine 2 Flashcards

1
Q

Clinical findings of RA

A

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

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2
Q

whats lab finding of RA

A

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

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3
Q

Radiographic findings of RA

A

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)

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4
Q

cause of fibular deviation of digits

A

Erosive changes of medial plantar metatarsal heads compromises the integrity of medial collateral ligaments leading to lateral deviation of digits

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5
Q

pannus

A

Granulation tissue that secretes chondrolytic enzymes which break down articular cartilage

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6
Q

clinical findings of psoriatic arthritis

A

Polyarthritis including DIPJ involvement
Sausage digits
Psoriatic skin changes
Nail lesions

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7
Q

lab findings of Psoriatric arthritis?

A

HLA 27 positive. RF neg

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8
Q

Radiographic findings of PA

A 
erosions w bony proliferation
symmetric narrowing of joint space
increased periosteal activity
pencil in cup appearance 
osteopenic changes
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9
Q

clinical findings of Reiter syn

A 
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
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10
Q

Reiter syn triad

A

can’t see, pee or climb a treeconjunctivitis, urethritis, arthritis, also keratoderma blenorrhagicum

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11
Q

lab findings RS

A

HLA 27 positive, RF ng, ESR elevated,synovial fluid analysis

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12
Q

radiographic findings of RS

A

Fluffy periosteal reactions
Large, bilateral heel spur formation
Inflammation and widening of Achilles tendon insertion
Deossifications

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13
Q

clinical findings of ankylosing spondylitis

A

Mostly males affected
Bilateral sacroiliitis – low back pain and stiffness
Heel pain
Peripheral joint pain

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14
Q

lab findings for ankylosing spondylitis

A

HLA 27 positive

RF neg

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15
Q

Radiographic findings of AS

A 
Irregular joint widening with erosions
Reactive sclerosis
Bony ankylosis
Sacroiliac joint fusion
Bamboo spine
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16
Q

Septic arthritis

A

painful, hot swollen joint, systemic signs of fever, NV, tachycardic, confusion

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17
Q

what are lab findings of SA

A 
WBC – elevated with left shift
ESR – elevated
CRP – elevated
Blood cultures – positive
Synovial fluid analysis – elevated WBC with cloudy white or gray color
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18
Q

radiographic findings of SA

A

normal early on, joint effusion, juxta articular osteopenia

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19
Q

etiologies of SA

A

Contiguous, hematogenous, direct implantation, surgical contamination

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20
Q

most common organism of SA

A

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

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21
Q

Tx for SA

A

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

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22
Q

brachymetatarsia

A

premature closure of epiphyseal plate-> short met

usually the 4th

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23
Q

conditions associated w brachymetatarsia

A 
Downs syndrome
Turners syndrome
Cri du chat
Pseudo- or pseudopseudohypoparathyroidism
May be idiopathic
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24
Q

max length metatarsal may be acutely lengthened

A

1 cm graft- Neurovasc structures. if more needed mini-rail

25
Q

lengthening/day w callus distraction

A

1mm/day

26
Q

whats achondroplasia

A

dwarfism

27
Q

whats fibular hemimelia

A

aplasia or hypoplasia of fibula

28
Q

whats DISH

A

diffuse idiopathic skeletal hyperostosis- characterized by multiple ossifications at tendinous or ligament insertion

29
Q

whats apert syn

A

multiple bony coalitions

30
Q

paget disease

A

osteitis deformans-abnormal bony architecture caused by increased osteoblastic and osteoclastic activity.
common in elderly

31
Q

malignant bone degeneration often seen w pagets disease?

A

osteosarcoma

32
Q

stages of paget?

A
  1. destructive= osteolytic
  2. Mixed- osteolytic and osteoblastic
  3. Sclerotic- osteoblastic
33
Q

stages of charcot

A
  1. destructive
  2. coalescence
  3. remodeling
34
Q

conditions associated with positive HLA B27

A

ankylosing spondylitis, reiter disease, psoriatric arthritis, reactive arthritis, enteropathic arthropathies

35
Q

components of crest syn

A 
Calcinosis
Raynauds phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
36
Q

tx of cutaneous larva migrans

A

promethia under occlusion

37
Q

tx of lyme disease

A

doxycycline 100 mg PO daily or Rocephin 1g IV daily

38
Q

DOC for necrotizing fasciitis

A

primaxin 250-1000 IV q6 -8h

39
Q

whats felty syndrome

A

RA, splenomegaly, leukopenia

40
Q

whats mycosis fungoides

A

cutaneous T cell lymphoma that can resemble eczematoid or psoriasis

41
Q

Whats erythrasma

A

Chronic, superficial infection of intertriginous skin caused by Corynebacterium minutissimum.Interdigital lesions appear as maceration.

42
Q

whats ecthyma

A

ulcerative pyoderma of the skin caused by streptococci. infection extends into dermis, characterized by ulcers w overlying crests

43
Q

whats cellulitis

A

Acute spreading infection of dermal and subcutaneous tissue commonly caused by group A Strepor Staph aureus. Affected area is erythematous, warm, edematous, and tender.

44
Q

whats erysipelas

A

Superficial infection that extends into the lymphatics. Lesions are erythematous, indurated with sharply-demarcated margins, and have erythematous, ascending streaks

45
Q

whats lymphangitis

A

inflame of lymphatics as result of distal infection

46
Q

whats psoriasis

A

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

47
Q

lichen planus

A

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.

48
Q

another name for menopausal lipoma

A

juxtamalleolar lipoma

49
Q

effect of steroids on anti inflame? metabolic?

A

Anti-inflammatory
 Decreases production of prostaglandins, cytokines, and interleukins
 Decreases proliferation and migration of lymphocytes and macrophages
Metabolic
 Decreases osteoblast activity

50
Q

difference btwn phosphate and acetate based steroids

A

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

51
Q

common complication following steroid injection

A

steroid flare-hypersensitivity rxn. apply ice

52
Q

how are glucocorticoids metabolized

A

in the liver. secreted in urine

53
Q

whats diazepam

A

valium, a benzodiazepine- anxiolytic/anticonvulsant, muscle relaxant

54
Q

reverse diazepam

A

flumazenil

55
Q

drugs for insomnia

A

Benadryl, estazolam, halcion, ambien,restoril, dalmane

56
Q

drug that leaves metallic taste in mouth?

A

flagyl, lamisil

57
Q

given for Tylenol OD

A

acetylcysteine

58
Q

what causes grey baby syn

A

chloramphenicol (antimicrobial)

***pimp questions- rachel (12 decks)

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