Inflammatory Flashcards by katie scheidemantel

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

Temporal arteritis

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What is the treatment for giant cell arteritis?

prednisone immediately

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Dupuytren’s Disease is caused by…

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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Who is Dupuytren’s disease most common in?

men
50-70s
celtic northern european

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How does dupuytren’s present?

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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How is dupuytren’s treated?

corticosteriod inject pit
surgical fasciectomy with MCP
reoccur 25-80% nocure
post op PT and splint

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

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

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What is the work up for an animal bite?

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

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What is the treatment for an infected animal bite?

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

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what are the layers penetrated by a bite?

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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What organisms are likely to infect a human bite?

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

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What should a human bite be treated with?

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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What part of the finger does felon infect?

pulp tissue of tip of finger

usually secondary to puncture

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What is the organism infecting felon?

Staph usually

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how is felon treated?

x-ray to dx baseline

septate the septae and drain

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how does a felon present?

pointed central tip
swelling is deep
secondary to puncture

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where does paronychia present?

around the nail: swollen and red

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What organism is likely to infect in a paronychia?

staph aureus

chronic nail biting often does this

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How is paronychia treated?

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

pink vesicular lesions on the hands is…

herpetic willow

where does herpetic willow present?

health care workers its common

in pulp of finger tip or paronychium

HOw is herpetic willow treated?

anti virals

do not incise, it will spread

What is the etiology of flexor tendon sheath infection?

puncture to flexor surface of finger

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

how does a flexor tendon sheath present?

Kanavel’s signs

sausage fusifrom swelling
tender along flexor tendon that doesn’t stop at PIP or DIP goes allow hand
flexed finger
crescendo pain with movement

Septic tensynovitis should be treated how?

urgently because can destroy flexor mechanism completely is untreated - surgical drain - ABX for strep and staph 1-3 weeks oral

how does boutonnier deformity present?

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

what is the etiology of boutonniere deformity?

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

What are the diagnostic tests for Lyme?

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

what is the first line treatment for Lyme disease?

doxycycline for over 8 yo | amox if under

what does early stage lyme present as?

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

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

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

Late stage lyme presents as?

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

what organism causes lyme?

spirochete (Borrelia) carried by deer tic

what diseases present as monoarthritis?

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

What is the etiology of septic arthritis?

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

who is at risk for septic arthritis?

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

What are the most common joints for septic arthritis?

knee>hip>ankle>shoulder>wrist>elbow

What are some complications of septic arthritis?

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

How does septic arthritis present?

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

How is septic arthritis DX?

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

How is septic arthritis treated?

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

What is the etiology of bursitis?

overuse infection trauma chemical

What is the structure of a bursa?

thin walled sac lined with synovial membrane | located between bone and muscle for protection

What is the clinical presentation of bursitis

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

What is the work up for diagnosing bursitis?

PE | radio to rule out degenerative joint disease