Diseases Flashcards
“Paget’s”
“<div>Condition of abnormal bone remodeling</div> <ul> <li>Increased osteoclastic bone resorption (primary cellular anomaly), coupled with abnormal new bone formation</li> <li>Possibly due to slow viral infection –> paramyxovirus or respiratory syncytial virus</li> </ul> <ul> <li>CPx: asymp</li> <li>X-rays: coarsened trabeculaewhich give the bone ablastic appearance</li> </ul> <ul> <li>Labs: high ALP, normal Ca</li> </ul> <ul> <li><div> <div> <div><img></img></div> </div></div></li><li>Medical Options:</li> <ul> <li>Calcitonin</li> <ul> <li>Safe and effective</li> <li>Side Effects (20%)</li> <ul> <li>Nausea, facial flushing, polyuria</li> <li>20% have resistance after successful initial period</li> </ul> </ul> <li>Bisphosphonates:</li> <ul> <li>Less common side effects</li> <li>Zolendronate most common per Monument</li> </ul> <li>Teriparatide –> CONTRA-INDICATED DUE TO RISK OF SARCOMA</li> </ul> <li>Surgery:</li> <ul> <li>Arthroplasty and ORIF</li> <ul> <li>Worse outcomes due to abnormal bone</li> <li>High rates of aseptic loosening</li> </ul> <li>Pre-op treatment with calcitonin and/or bisphosphonates decreases bleeding</li> </ul></ul>”
Sickle Cell Disease
“<div> <div> <div> <div>Summary</div> <ul> <li>Genetic disorder of hemoglobin synthesis with 2 phenotypes</li> <ul> <li>sickle cell anemia</li> <ul> <li>sickle cell anemia involves the presence of two abnormal hemoglobin S alleles</li> <li>more severe form</li> </ul> <li>sickle cell trait</li> <ul> <li>sickle cell trait involves a single copy of the abnormal hemoglobin gene</li> <li>usually asymptomatic</li> </ul> </ul> </ul> <ul> <li>X-ray</li> <ul> <li>Bone infarcts, fishtail vertebrae</li> </ul> <li>Bone scan</li> <ul> <li>osteomyelitis: normal marrow uptake, abnormal bone scan</li> <li>infarct: decreased marrow uptake, abnormal bone scan</li> </ul> <li>Ortho Manifestations</li> <ul> <li>Sickle cell crisis/vasc occlusion - bone pain; tx: hydroxyurea, hydration</li> <li>Osteomyelitis: staph aureus most common, but salmonella possible; pts can become asplenic from infarcts (risk of S pneumo, Salmonella, Klebsiella)</li> <ul> <li>Can lead to path # in 10%</li> <li>OM can present similar to bone infacts (RC 2018)</li> </ul> <li>Septic arthritis</li> <li>AVN</li> <li>Dactylitis</li> </ul> <li>THA - increase risk of dislocation, infection (still Staph aureaus), dislocation</li> </ul> <div></div> </div> </div></div>”
Hemophilia
“<ul> <li>Bleeding disorder</li> <ul> <li>X-linked: A (Factor 8), B (Factor 9)</li> <li>AD: C (Factor 11)</li> </ul> <li>Ortho</li> <ul> <li>Hemophilic arthropathy</li> <ul> <li>Coxa valga deformtiy</li> <li>High risk INFECTION (RC EXAM)</li> </ul> <li>Septic Arthritis</li> </ul> <li>Management</li> <ul> <li>factor VIII or IX administration(Orthobullets)</li> <ul> <li>indications</li> <ul> <li>relevant factor is administered for Hemophilia A (Factor VIII) and B (Factor IX)</li> <li>established bleed with decreased factor VIII and IX or increased Bethesda assay (>5 BU)</li> </ul> </ul> <ul> <li>modalities</li> <ul> <li>increase factor levels by risk of potential blood loss and bleeding</li> </ul> <ul> <li>acute hematomas</li> <ul> <li>increase blood factor levels to 30%</li> </ul> <li>acute hemarthrosisand soft tissue surgery</li> <ul> <li>increase blood factor levels to 40-50%</li> </ul> <li>skeletal surgery</li> <ul> <li>increase blood factor levels to 100% for first week following surgery then maintain at > 50% for second week following surgery</li> </ul> </ul> </ul> </ul><li><img></img><br></br></li></ul>”
<div>RC 2018 - What is true with regards to sickle cell anemia? </div>
<div>a.RBC’s can sickle at normal oxygen tension</div>
<div>b.Presentation of bone infarct is similar to osteomyelitis</div>
<div>c.Heterozygous individuals are symptomatic</div>
<div>d.No increased risk of infection</div>
B.
<div>RC 2014 - Give 3 physical findings (besides pain) associated with a trendelenberg gait</div>
<ul> <li>Abduction weakness</li><li>Trendelenburg sign: Inability to maintain level pelvis when lifting contralateral leg of weak abductors</li> <li>Weak EHL</li> <li>? Leg Length Discrepancy</li> <li>LBP</li></ul>
RA
“<ul> <li>T cell mediated immune response</li> <li>RF is an IgM antibody with recognized and attacks native IgG</li><li>leads to cartilage degradation, ligamentous laxity, synovial expansion/erosion</li><li>non-ortho: rheumatoid nodules, artheromatous plaques, lung scar tissue</li><li><div> <div> <div><img></img></div> </div></div></li><li><div>C-spine xrays q2-3 years</div></li><li><div>Holding treatment: biologics, NSAIDs, ASA.</div></li><li><div>May need Stress dose steroids peri-op</div></li></ul>”
RA diagnosis
“<ul> <li>2010 criteria</li> <ul> <li>symptoms: joint involvement, >6weeks</li><li>labs: RF/ACPA, ESR/CRP</li><li><img></img><br></br></li> </ul><li>1987 criteria</li><ul><li>Morning stiffness ≥ 1h</li> <li>Swelling in ≥ 3 joints</li> <li>Rheumatoid nodules</li> <li>Radiographic changes of the hand including bony erosions and decalcification</li> <li>Symmetric arthritis</li> <li>Serum rheumatoid factor</li> <li>Arthritis of the hand (MCP, PIP) and wrist</li> <ul> <li>have ≥4 of 7 criteria for a 6 week period</li> </ul></ul><li><br></br></li><ul> </ul></ul>”
