Ortho/Rheum 3 Flashcards
How to you treat hyperCa2+ associated with Sarcoidosis?
Steroids
(same as regular treatment for sarcoid).
Hypercalcemia usually responds fairly quickly to steroids.
What are the two qualifications for bariatric surgery?
- BMI > 40
2. BMI > 35 + obesity related comorbidity.
- How do you diagnose Rheumatoid Arthritis?
- What is the Classic presentation of RA?
- What are the classic radiologic findings of RA?
- It is a CLINICAL dx. RF can be negative in 30%.
(Classic presentation + radiologic finding is enough for dx)
- Classic presentation = symmetric polyarthritis of MCP and proximal PCP joints. Stiffness in morning that lasts > 30min.
- Radiologic findings = erosions, osteopenia/perosis, joint space narrowing.
Besides Rheumatoid factor what other Ab test can you order that has higher specificity for Rheumatoid arthritis?
Anti- Citrulline containing peptide (Anti-CCP)
What type of crystals do you see in:
- Gout?
- Pseudogout
- Hemochromatosis arthritis
- Monosodium Urate (negative birefingent)
- Calcium Pyrophosphate (positive birefringent)
- Calcium Pyrophosphate (positive birefringent)
Colle’s fracture (fracture of distal head of radius) is commonly caused by what action?
50% of individuals who present with Colle’s fracture also have a fracture of?
falling on outstretched hands.
Ulnar styloid fracture and scaphoid fracture.
If you tap a painful joint and you see many WBC but negative culture…What 5 diseases should you think of?
- Rheumatoid Arthritis
- Sarcoidosis
- SLE
- Lyme disease
- Spondyloarthropathy
- What disease classical presents with Oligoarthritis, AFTER Urethritis or Gastroenteritis with Oligoarthritis?
- What infections/bugs are implicated?
- Reactive Arthritis
- Chlamydia urethritis (most classically associated)
Gastroenteritis (Salmonella, shigella, campylobacter ext)
Spondyloarthropathies are a group of disorders characterized by what four symptoms?
What type of Spondyloarthropathy classically occurs after chlamydia urethritis of gastroenteritis?
- Sacroiliitis
- Asymmetric oligoarthritis
- Dactylitis
- Enthesitis (inflammation of connective tissue around ligament or tendon)
REACTIVE ARTHRITIS.
Two early symptoms of comportment syndrome?
Three early Physical exam findings?
How do you diagnose and treat Compartment syndrome?
- Pain out of proportion to injury
- Paresthesia
PE:
- Tightness
- Pain on passive muscle stretch
Dx= measure compartment pressure TRX = Fasciotomy if >20-30mmHg.
What ligament injury is classically associated with pivoting or rapid directional change, and causes a popping sound, followed by rapid onset effusion/hemarthrosis, and joint instability.
How do you diagnose this injury?
ACL
MRI
Lumbar Spinal Stenosis classically causes back pain that worsens with what maneuvers? Improves with?
How do you Dx?
How do you treat Lumbar Spinal Stenosis
Worsens = hyperextension of back
Improves = flexion of back or leaning forward.
Dx = MRI
TRX = usually CONSERVATIVE +/- lumbar epidural block. Can consider surgical decompression with laminectomy if above fails.
How does one contract Chickungunya?
In What area of the world?
What are the two main symptoms (nearly always present)?
What are the three other hallmark symptoms that may be present?
Mosquito vector.
S. America, Africa, Asia
- Transient HIGH fever with subsequent symmetric
- polyarthritis or distal joints (usually hands/wrist)
- Maculopapular rash
- Thrombocytopenia
- Increased LFTs.
Chickungunya is usually self-limiting (7-10 days) and only requires supportive trx. However in 30% will develop persistent chronic arthritis.
What is the trx in these individuals?
MTX
What anti-hypertensive agent should be preferentially used in HTN pts with gout as it has a mild uricouric effect?
ARB
(Avoid thiazides and diuretics as they can increase Uric acid levels).
