Ortho/Rheum 1 Flashcards
Which joints are most commonly affected by hemochromatosis arthropathy?
Joint Aspiration reveals what in 50% of cases?
Phlebotomy is the treatment for Hereditary Hemochromatosis. Is it helpful for the arthritis symptoms?
- 2nd and 3rd MCP joints, knees, ankles and shoulders (but can effect ANY joint)
- Calcium pyrophosphate dihydrate crystals (rhomboid shaped, positive bifringens, like pseudogout)
- NO
Dashboard injury in car accidents (where posterior force is placed on the proximal Tibia in a seated position) causes injury to what ligament?
POSTERIOR CRUCIATE LIGAMENT.
Injuries that causes hyperextension of the knee causes injury to what ligament?
What physical exam maneuver can you do to dx?
ANTERIOR CRUCIATE LIGAMENT.
Lachman’s test= knee flexed 20 degrees. then pull proximal tibia towards you while stabilizing femur.
What PE maneuver test for COMPLETE rupture of Achilles Tendon?
Thompson squeeze test = squeeze calf - should normally cause plantar flexion. NO plantar flexion = +ve test = complete Achilles tendon rupture.
NERVE ROOT PAIN presents as shooting pain often down back of leg.
What aggravated and alleviates the pain?
What PE maneuver can you do?
Aggravated = bending forward, coughing, straining. Alleviated = lying down
Straight leg raise test 60 degrees.
Sjogrens syndrome presents with dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia).
What are 4 common complications due to chronic dry mouth?
- Dental carries
- Oral candidiasis (70%)
- Chronic esophagitis
- Loss of taste and smell
What are the serologic findings in Sjogrens Syndrome?
- +ve ANA (Sensitive but not specific)
- Rheumatoid Factor (70% sensitive)
- Anti-Ro (SSA)and Anti-La (SSA) (about 50% sensitive but very specific)
Other than keeping eyes and mouth moist, what two drugs can you use in Sjogrens Syndrome?
Pilocarpine and Cevimeline
increases Ach and therefore increases secretions
What is flail chest?
usually occurs due to blunt force trauma to chest where you have rib fractures on both sides of sternum. You get paradoxical movement of chest wall during inspiration.
Sarcoidosis is a systemic disease. What common finding do you see in:
- Lungs?
- Eyes?
- Skin/Joints?
- Heart?
- Renal,Liver, Spleen?
- Electrolytes?
- CNS
- Hilar lymphadenopathy, mediastinal widening(90%), infiltrates, dyspnea, SOB. (most present only with pulmonary finding and fatigue)
- Uveitis
- Erythema Nodosum, Lupus pernio (violaceous patches on face), Arthritis.
- Restrictive or dilative cardiomyopathy, conduction defects.
- Hepatosplenomegaly, Non-specific renal dysfunction
- Hyper Ca2+ (granulomatous production of Vit D)
- Seventh Nerve palsy (Facial N, Bells Palsy)
If you suspect Sarcoidosis, what is the best initial screening test?
How do you make a DEFINITIVE diagnosis of Sarcoidosis?
Best initial screen = CXR –> look for hilar lymphadenopathy.
Definitive dx = Biopsy showing non-caseating granola of EASILY accessible lesion (symptomatic area):
- skin ( not erythema nodosum)
- Enlarged parotids
- Tender LYMPH NODES
- Lacrimal glands
IF above not available
- Lungs BX via fiberoptic bronchoscopy.
TRX of Sarcoidosis
Steroids.
what are the following disease association?
- anti- centromere abs
- SSA/SSB “anti-Ro/La”
- Antitopoisomerase (anti-scl 70)
- Anti- DS DNA?
- Anti- Histone Ab
- Anti-Smith
- Anti-Mitochondrial Ab
- CREST
- Sjogrens
- Scleroderma (Systemic Sclerosis)
- Lupus/SLE (DS DNA more sensitive than anti-smith)
- Drug induced Lupus
- Lupus (SLE)
- Primary Biliary Cirrhosis.
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) is a multi system disease. What are the following symptoms in the following?
Skin? Joints? Blood? Renal? CNS? Heart and Lungs?
Skin: Malar rash, photosensitivity rash, oral ulcer rash, discoid rash.
Joints: Arthralgia
Blood: Leukopenia, thrombocytopenia, hemolysis .
Renal - varies from proteinuria to ESRD.
CNS - stroke, seizure, meningitis.
Heart and Lungs: Serositis (pericarditis, pleuritis) pulmonary htn, myocarditis.
In SLE what serum marker can you follow as a proxy for disease severity?
Anti- DS DNA
