Ortho & Rheumatology Flashcards
Fibromyalgia
4 body parts( 4 quadrants)
3 month’s SX with 11/18 tender points
Female4:1 onset : 29-37 ∆: 44-53yrs
A/W sleep, fatigue, cognitive
+/- depression
Rx: CBT
amitriptyline
Duloxetine
Red flags (not fibromyalgia)
Fever,night sweats
Wt loss
Older age onset
Neurological involved
Hx of malignancy
Trigger for fibromyalgia
Stress
Buerger Disease (TAO)
Non atherosclerotic,segmental occlusion of medium&small sized arteries
Male,smoker
Ischemia and gangrene due to thrombo occlusion of vessels of extremities
Amputation: prevent 2°infection and pain
Raynaud phenomenon
Episodic arteriolar vasospasm of the fingers and toes
Blue >red>pale colour changes
Trigger: cold,stress, anxiety
No amputation
One sided clavicular #
X-ray AP view of the side(R/L)
CT : if tracheal or thoracic involved
Or lat 3rd displaced with coracoclavicular ligament injury
Polymyalgia rheumatica
Symmetrical involvement of hip/shoulder girdle
Tenderness
Raised ESR, CRP, Normochromic anemia
CK : Normal
Rx : steroid !!!
Flexor tenosynovitis
Kanavel signs: 90%sensitive
By order
1. Pain on passive extension
2. Tender flexor tendon sheath
3. Fusiform swelling
4. Fixed flexion at resting position
Fever suggests systemic involved
Rheumatoid arthritis of large joint
Hx of morning stiffness
Tender, swelling noted
X-ray:
Joint space narrowing
Periarticular osteopenia
Soft tissue swelling
Joint margin erosion
X-ray changes in OA
Joint space narrowing
Subchondral sclerosis
Osteophytes
OA Vs RA
OA: aggravated by activity relieved by rest
Acute Back pain in a history of cancer
Red flag sign of metastatic bone involvement usually a pathological #
Other signs of metastatic bone
•H/o cancer
•Wt loss
•Acute back pain
•Nocturnal pain
•Age>50 or <20
•Pain not alleviated in 1mth
Q58 Ortho table
All the conditions with specific sx
Gouty arthritis
NSAID ( Naproxen & Indomethacin)
Colchicine 2nd line
Steroid use in gout
Oral or injection(preferred if only one joint involved) usually when 1st line contraindicated eg PUD/CKD; given for 10 days in tapering dose
Acute gout
1st line: NSAID if Contraindicated
Then colchicine if Contraindicated then steroid
Colchicine (gfr<30 : avoid , renal impaired: reduced dose)
Neonatal lupus erythematosus
Transplacental maternal autoantibodies
Causing cardiac,hepatic and skin problem
Cardiac : rhythm disorder eg block
Ix: Anti RO
SLE
4/11: SOAP BRAIN MD
1 clinical 1 lab 1 immunology
2or > joints involved
Hydoxychloroquine main long term
Cyclophosphamide for severe cases
Steroids for acute exacerbations
Low back pain (lumbar strain)
Rx option
Reassurance
Continue activity
Analgesia
R/v 4-6weeks time
W/out red 🛑flag signs
Cauda equina syndrome
Signs
Fecal incontinence
Urine retention
Saddle anaesthesia
LL weakness and paraesthesia
Low back pain with SLRT + but NO red flag sign 🛑
Conservative mngt
NSAID
Resume activity
Physiotherapy if severe and debilitating
R/v 4-6 weeks
No need imaging !!!
RA features q 47
Cardiac
Renal
Skin
Neuro
Lung
Hematology
Oral
GIT
*No hepatomegaly
Lateral epicondylitis
Caused by ECRB muscle
Brace, counterforce bracing treatment of choice
Olecranon bursitis
Swelling at posterior elbow
Idiopathic, painless ( aseptic)
Pain due to pressure applied/ need TRO septic bursitis (rare)