Ortho/Rheum 5 Flashcards
What is the most serious complication of Dermatomyositis/Polymyositis?
CANCER (for unclear reasons DM > PM increased incidence of cancer).
Requires surveillance when diagnosed…trx of underlying cancer may cause disease regression.
In Polymyositis, other than MSK, what other organ system can be affected?
What initial test should be ordered if lung symptoms present?
Lungs - interstitial lung disease and respiratory muscle weakness.
PFT - to differentiate between interstitial lung disease vs muscular weakness.
Polymyalgia Rheumatica classically presents with what symptoms in what age group and what classically elevated lab values?
DX?
TRX?
- Constitutional symptoms (malaise, fever, weight loss)
- Stiffness > pain of PROXIMAL muscles (shoulders and pelvic girdle)
- NO joint pain
- +/- Decreased Active ROM, but OK passive ROM.
- in >50 yo
- increased ESR (normal CPK)
DX- Clinical, but get ESR (highly sensitive)
TRX = low dose prednisone - amazingly quick response usually.
When someone presents with dry eyes and mouth (Sicca syndrome) what is the first step in work up?
- Confirm decreased secretion by Schirmer test (place strip in eye, and see if secretions soak it)
- ANA, RF and Anti-Ro/La (auto ab screen) - for Sjogrens.
Reactive Arthritis classically presents with polyarthritis 1-4 weeks AFTER either Chlamydia Urethritis OR Infectious Gastroenteritis infections starts…
What other other manifestations do you see:
Skin?
Mucosa?
Eyes?
Genitals?
SKIN –> Circinate Balanitis (shallow ulcers on glans penis), Keratoderma Blennorrhagicum (Psoriasis like lesions on palms/soles.
Mucos –> Ulcers
EYES –> Uveitis
Genitals –> Urethritis, Cervicitis, Prostatitis
Treatment of Reactive Arthritis?
ABX to treat Chlamydia (if present) and NSAID for arthritis.
IF not responsive to NSAID, do Steroids (systemic or intra-articular)
How do Auricular Hematomas occur and what do they look like?
How do you best treat Auricular Hematoma?
Blunt trauma to ear; presenting as a fluctuant mass over anterior pinaa.
TRX = I/D –> to prevent cauliflower ear deformity.
Rotator cuff tendonitis causes pain where in the shoulder?
Aggrevated by what maneuvers?
What physical exam finding would suggest a Rotator cuff tear instead of tendonitis?
Lateral shoulder pain.
Abduction and external rotation.
Think Tear if–Weakness on Abduction/ext rotation.
What is the TRX for pages disease of the bone?
Bisphosphonates.
lower back pain with “RED FLAG” symptoms should undergo evaluation with XR and ESR (otherwise can undergo conservative therapy). What are the 7 “red flag” symptoms of back pain?
What symptoms would prompt urgent MRI?
RED FLAGS:
- Age > 50 yo
- Night time pain
- Constitutional symptoms
- Hx of malignancy
- Trauma
- IV drug use
- > 1 month conservative therapy without improvement.
Urgent MRI to look for CORD COMPRESSION (Bowel/bladder dsf, sensory deficit, saddle anesthesia, motor deficits)
Where does pain usually get referred to in Slipped Capital femoral epiphysis?
DX?
TRX?
Knees
DX = posteriorly displaced femoral head on XR.
TRX = surgical pinning and non-weight bearing.
What is the classic scenario in which you see a supracondylar humorous fracture?
XR is diagnostic. What are the possible findings?
TRX?
Falling onto outstretched arm.
XR:
- Fracture
- Displaced Posterior fat pad (fracture not seen but this is suggestive of fracture)
- Displaced bone
TRX
Non-displaced - long arm splinting and sling
Displaced- ORIF
What is the clinical triad seen in fat embolism, which can occur after traumatic injury to long bones?
How can you DECREASE RISK of fat embolism?
- Respiratory impairment
- Neurological impairment
- Petechial rash
Early immobilization and surgical fixation of fracture?
- What is the most common cause of knee pain in young adults?
- In what group of people do you classically see it in?
- What is the classic presentation?
- What PE maneuver is helpful in dx?
- Patellofemoral Pain syndrome.
- Young female athletes
- Presentation: knee pain that worsens with quadriceps contraction (squatting, going up and down stairs)
- Patellofemoral compression test (extend knee and press on patella –> causes pain)
What is the treatment for Patellofemoral Pain syndrome?
Exercise and stretching to strengthen thigh muscles.
NSAIDS for pain.
