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Skeletal > Inflammatory > Flashcards

Inflammatory Flashcards

1
Q

Signs: ear, neck or head pain
blurred vision
Lab: ESR elevated

A

Temporal arteritis

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2
Q

What is the treatment for giant cell arteritis?

A

prednisone immediately

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3
Q

Dupuytren’s Disease is caused by…

A

proliferation of palmar fascia myofibroblasts
causes contracture of MCP and PIP joint capsule (not tendon)
10% have family history (auto dom)

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4
Q

Who is Dupuytren’s disease most common in?

A

men
50-70s
celtic northern european

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5
Q

How does dupuytren’s present?

A

comorbidities: epilepsy, alcoholism, COPD, diabetes, youth diastasis, trauma accelerate it
1. BL in 45%
2. pitting
3. palmar nodules
4. ring or pinky common
5. MCP and PIP contracture
6. difficulty grasping
7. active flexion normal

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6
Q

How is dupuytren’s treated?

A
  1. corticosteriod inject pit
  2. surgical fasciectomy with MCP
  3. reoccur 25-80% nocure
  4. post op PT and splint
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7
Q

Infection of the hand from a bite is more likely from…

A

a cat vs a dog
Pastuerella, alpha hemolytic step(pneumo and viridans)
staph, bacteriodes, fusobacterium
Rabies

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8
Q

What is the work up for an animal bite?

A

inspect closed fist nerve, tendon, joint
x-ray: look for fracture, foreign body, gas
culture any purulent material

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9
Q

What is the treatment for an infected animal bite?

A 
debride any revitalized tissue and cleanse
usually no suture
Augmentin prophylaxis
Unasyn if infection already established
TB and rabies prophylaxis
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10
Q

what are the layers penetrated by a bite?

A 
dorsal skin usually
tenosynovium
tendon
capsule of joint
(make sure cleanse each layer and that if human bite fist is clenched)
(don't close wound primarily)
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11
Q

What organisms are likely to infect a human bite?

A

saliva transmit
higher bacteria concentration
(especially alpha hemolytic strep, Staph, eikenella)

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12
Q

What should a human bite be treated with?

A

clean each layer
x-ray to rule out fracture or foriegn body
culture
immbolize with MCP flexed to 70 degrees and PIP and DIP extended (prevent contracture)
IV cephalosporin

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13
Q

What part of the finger does felon infect?

A

pulp tissue of tip of finger

usually secondary to puncture

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14
Q

What is the organism infecting felon?

A

Staph usually

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15
Q

how is felon treated?

A

x-ray to dx baseline

septate the septae and drain

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16
Q

how does a felon present?

A

pointed central tip
swelling is deep
secondary to puncture

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17
Q

where does paronychia present?

A

around the nail: swollen and red

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18
Q

What organism is likely to infect in a paronychia?

A

staph aureus

chronic nail biting often does this

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19
Q

How is paronychia treated?

A

warm soaks to seperate nail plate from paronychia tissue
take oral antbiotic daily
partial nail removal if in later stage

20
Q

pink vesicular lesions on the hands is…

A

herpetic willow

21
Q

where does herpetic willow present?

A

health care workers its common

in pulp of finger tip or paronychium

22
Q

HOw is herpetic willow treated?

A

anti virals

do not incise, it will spread

23
Q

What is the etiology of flexor tendon sheath infection?

A

puncture to flexor surface of finger

sliding membrane throughout length of flexor tendon-potential closed space for infeciton

24
Q

how does a flexor tendon sheath present?

A

Kanavel’s signs

  1. sausage fusifrom swelling
  2. tender along flexor tendon that doesn’t stop at PIP or DIP goes allow hand
  3. flexed finger
  4. crescendo pain with movement
25
Q

Septic tensynovitis should be treated how?

A

urgently because can destroy flexor mechanism completely is untreated

  • surgical drain
  • ABX for strep and staph 1-3 weeks oral
26
Q

how does boutonnier deformity present?

A

flexed PIP and extended DIP

unable to keep PIP and DIP in extension while flex MCP and wrist

27
Q

what is the etiology of boutonniere deformity?

A

central slip from extensor of middle phalanx and lateral bands
unopposed flexor tendon and volar drift
attritional
trauma possible

28
Q

What are the diagnostic tests for Lyme?

A
  1. ESR and WBC nonspecific
  2. ELISA lyme specificity increased if done with western protein blot
  3. immunoflourescnce antibody of leading edge or erythema migraines
29
Q

what is the first line treatment for Lyme disease?

A

doxycycline for over 8 yo

amox if under

30
Q

what does early stage lyme present as?

A
  1. itchy, painful rash and flu within 1-2w of the bite
  2. SOB
  3. heart block
  4. mypopericarditis(susternal chest pain)
31
Q

What does lyme present as 3-10w post bite?

A 
secondary skin lesions
lymphandopathy
conjunctivitis
CN facial palsy and motor and sensory neuropathy
myocarditis
pericarditis(friction rub)
endocarditis(murmur)
32
Q

Late stage lyme presents as?

A

scleroderma like lesions
CNS-confusion, sleep disturbance
swelling of one joint(knee common)

33
Q

what organism causes lyme?

A

spirochete (Borrelia) carried by deer tic

34
Q

what diseases present as monoarthritis?

A

gout, gonococcal(or migratory), lyme, septic arthritis, TB

35
Q

What is the etiology of septic arthritis?

A

organism seeds into the joint via hemotogenous, puncture or underlying epiphyseal osteomyelitis

Staph aurea 61% of time, then beta hemolytic strep, then gram (-) baceteia, then strep pneumo

36
Q

who is at risk for septic arthritis?

A 
very young
very old
immune compromised
IV drug users
diabetics
skin or joint surgery
trauma
pre-existing arthritis or prosthetic
37
Q

What are the most common joints for septic arthritis?

A

knee>hip>ankle>shoulder>wrist>elbow

38
Q

What are some complications of septic arthritis?

A

ankylosing and chronic pain
reoccur in 40%
UnTX: cartilage and bone damage and epiphyseal damage in kids

39
Q

How does septic arthritis present?

A 
acute onset
swelling
fever in some
rigors in some
MONOarthritis=septic until proven otherwise
comorbid with other forms of arthritis
40
Q

How is septic arthritis DX?

A
  1. arthrocentesis and aspire
  2. culture
  3. gram stain
  4. WBC count
  5. ESR and CRP
    Radio-takes days to weeks to show anything
41
Q

How is septic arthritis treated?

A

empiric antibiotics and hospitalization
drain
analgesics and follow up to prevent reoccur

42
Q

What is the etiology of bursitis?

A

overuse
infection
trauma
chemical

43
Q

What is the structure of a bursa?

A

thin walled sac lined with synovial membrane

located between bone and muscle for protection

44
Q

What is the clinical presentation of bursitis

A
  1. history of overuse
  2. locally swollen
  3. red
  4. pain at end of ROM
45
Q

What is the work up for diagnosing bursitis?

A

PE

radio to rule out degenerative joint disease

Skeletal (4 decks)

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