Inflammatory Flashcards
Signs: ear, neck or head pain
blurred vision
Lab: ESR elevated
Temporal arteritis
What is the treatment for giant cell arteritis?
prednisone immediately
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)
Who is Dupuytren’s disease most common in?
men
50-70s
celtic northern european
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
How is dupuytren’s treated?
- corticosteriod inject pit
- surgical fasciectomy with MCP
- reoccur 25-80% nocure
- post op PT and splint
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
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
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
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)
What organisms are likely to infect a human bite?
saliva transmit
higher bacteria concentration
(especially alpha hemolytic strep, Staph, eikenella)
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
What part of the finger does felon infect?
pulp tissue of tip of finger
usually secondary to puncture
What is the organism infecting felon?
Staph usually
how is felon treated?
x-ray to dx baseline
septate the septae and drain
how does a felon present?
pointed central tip
swelling is deep
secondary to puncture
where does paronychia present?
around the nail: swollen and red
What organism is likely to infect in a paronychia?
staph aureus
chronic nail biting often does this
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?
- ESR and WBC nonspecific
- ELISA lyme specificity increased if done with western protein blot
- 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?
- itchy, painful rash and flu within 1-2w of the bite
- SOB
- heart block
- 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?
- arthrocentesis and aspire
- culture
- gram stain
- WBC count
- 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
- history of overuse
- locally swollen
- red
- pain at end of ROM
What is the work up for diagnosing bursitis?
PE
radio to rule out degenerative joint disease
