MSK Flashcards
osteoporosis
loss of bone matrix and mineral
rf: white, asian, small build, smoking, ETOH hx
primary causes: post menopausal women, senile osteoporosis ( lack of calcium)
secondary : corticosteroid use, hyperthyroidism,
dx: DEXA scan,
compartment syndrome
incr. pressure in limited space
causes: bleeding/ swelling in closed compartment caused by trauma or crush injury ( tibial shaft fx)
s/s: severe pain , paresthesia, paresis, pallor, pain with passive stretch
dx: measure compartment pressure if dx is unclear
tx: urgent fasciotomy
OA- DJD
idiopathic, non-inflammatory
s/s: stiffness in AM - better with rest, crepitus, joint swelling, dec. ROM, Heberdens DIP nodes ( most common)Bouchard PIP
dx: xray- narrow joint place, osteophytes
tx: Tylenol ( 1s), NSAIDS, topical diclofenac, steroid injections, capsaicin, viscosupplemenation, surgery when QOL is diminished
Acute osteomyelitis
hematagenous speed of bacteria ( s. aureus)
often affects long bones of children
adults> 50 y/o
s/s: fever, chills, warmth/ swelling
refuse to use limp in kids
dx: cbc, sed rate, + bc, bone tx
bone scan, MRI
tx: IV abx 4-6 weeks, then oral abx 6-8 weeks
oxacillin, cefazolin
MRSA- vancomycin
debride
chronic osteomyelitis
untreated blood infection or exogenous untreated trauma/ infection > 2 weeks
s/s: mild fever, mild elevated ESR and CRP
persistent drainage,
dx: X-rays show bone destruction
confirm with bone scan,
tx: long-term abx, surgical I and D , possible amputation
septic arthritis
bacteria to joint
N. gonorrhea, s. aureus
MRSA and group b strep
s/s: joint swelling, redness, limited ROM
with gonorrhea - have lesions o palms and fee
dx; confirm with blood, take from synovial
joint fluid-elevated WBC, and decrease glucose
tx: rest, ice, elevation, arthroscopic I and D, IV abx 4-6 weeks
if no better in 48 hours, open I and D
ganglion cysts
being tumor or wrist
fluid-filled mass
dx: clinical
tx: wrist splinting, aspiration with steroid injection, surgical excision
bone tumors on X-ray
bening- asymptomatic, well -defined with sclerotic margins
malignant: pt have pain, X-ray show lesion with lytic destruction and poor margins
bone cysts
s/s: usually asymptomatic
dx: found on X-ray and confirm of b
tx: asp/ ink with steroids or bone marrow
osteoid osteoma
most common being bone tumor, M> F
s/s: aching, night pain relieved with NSAIDS
dx: xray
tx: symptomatic, if fails surgical removal
radio frequency ablation
osteosarcoma
most common malignancy of bone in knee
happe in men 15-25
h/o with retinoblastoma
s/s: persistent night pain and palpable mass
dx: xray- destructive lesions sun ray, sun burst appearance get bone /soft tissue for dx mRI -- used for stating high all phase
tx: chemo and surgicall resection
ewing sarcoma
seen in pelvis, distal femur,
increased LDH
10-20
dx: lytic lesion of bone “onion skin appearance”
bone bx
tx: surgical resection, chemo and rad tx
fibromyalgia
females ( 20-50)
s/s: msk pain around neck, shoulders, low back hips. fatigue,
trigger points
tx: patient ed, mod. exercise, CBT, SSRI, SNRI, lyrics/ neuron tin, ultra, trigger pt injections
gout
under excretion or overproduction of uric acid
RF: thiazide/ loop diuretic, ETOH ( beer), MM, hypothyroid, pacific islanders
s/s: fever and sudden onset of monarticualr joint swelling/ pain
may develop top on ears, hands, elbows, and feet
dx: uric acid> 7.5, incr ESR and WBC, synovial fluid ( + sodium urate crystals)
negative bifringent and needle-like
tx: acute: NSAIDs 7-10 days
chronic: colchicine
chronic management: weight loss, increase dirty, limit ETOH intact, red meats, lentils, oatmeal,
pseudogaout
recurrent arthritis affecting large joints
s/s: similar to gout
dx: normal uric acid levels and synovial fluid
positive for birefringement
tx: saids and intraarticurlar steroids
colchicine
juvenile RA
affects females> males
two peaks 1-3 and then 8-12 years
may develop RA as adults
systemic- severe
polyarticular- 5 or more of joints with fever
oligo articular- 1-4 joints,ritis
dx: fevers, morning stiffness/ rash
elevated WBC and ESR and CRP
50% + ANA, RF negative
tx: NSAIDS, methotrexate, nighttime splinting, exams with slit lamp 2-4 X /yr
polyarteritis nodosa
necrotizing arteritis of medium sized vessels, affects 30 in 1 million
30% cases caused by hep b
s/ss: fever, malaise, wt loss, extremity pain, monneuritis, SQ nodules, skin ulcers, abd pain, n/v
dx: tissue bx or angiogram
tx; high dose corticosteroids, IV steroids,hep B, prednisone,
polymyositis
systemic disorder of unknown cause, peaks in 5-6%
s/s: progressive neck and proximal mm weakness of UE and LE
25% have dysphagia
reddish purple maculopapular rash in shawl distribution
dx: mm bx
increase in CPK, aldolase
tx: steroids, methotrexate
look for malignancy
reactive arthritis
tetrad of conjunctitivey, urethritis, aseptic arthritis and oral lesions
s/s: fever, arthritis in knee/ ankel, conductivity, and much mucocutaneous lesions
dx: X-rays shows joint destruction
tx; NSAiDS, PT
less likely to develop if original infection treated
RA
idiopathic, chronic inflame dz, affects synovial membranes,
s/s: malaise, wt loss, fever, SQ nodules, Sjogren’s syndrome,
late: ulnar deviation, boutonnière and swan neck deformities
dx: elevated ESR and CRP,anemia jt fluid
Anti-Ccl
X-rays show soft issue swelling
prone to C1-2 subluxation ( don’t ignore neck complaints)
RA tx
decrease inflamm/pain and avoid deformity
tx: NSAIDS,DMARDS ( when dx is made)
methotrexate, etanercept, TNF inhibitors, antimalarials
lupus
inflamm/autoimmune affects all organs
caused by meds ( procainima, quinidine, INH
affects females, blacks
s/s: fever, malaise, rash, raynads, arthalgias)
late: pleurite, pneumonititis
must have 4/1 1 criteria to dx
dx: positive ANA, RF, pos anti ds DNA, make sure not drug induced
tx: steroids, NSAIDS
scleroderma
diffuse fibrosis of the skin
affects 3-50 y/o
CREST-calcinosis, raynauds, esophageal motility, sclerdoderma,
s/s: polyarthalgia, fever, malaise, skin folds are abn,
lat: pulmonary fibrosis, pericarditis,
tx: ACE to protect kidneys
dx: anemia, protein in urine, positive ANA, anti topoisomerase and anti-centromere antibody
tx; symptomatic and supportive
CCB for Raynauds
ACE
sjorgen’s syndrome
dry eyes and dry mouth
autoimmune
40-66
F> M
dental caries
dx: anemia, leukopenia, positive for RF, positive anti ss-A, SS-B,
Shcirmer’s test- how much tears
tx: symptomatic an supportive
