Orthopedics/Rheumatology Error List Flashcards
What is Guillin-Barre Syndrome
Ascending Weakness
Acute/Subacute inflammatory demyelinating polyradiculopathy with symmetric LOWER TO UPPER EXTREMITY WEAKNESS
What causes Guillain-Barre Syndrome
C. Jejuni
CMV
EBV
Immunizations (Flu)
Sx of Guillain-Barre Syndrome
Weakness and Paresthesias, usually symmetric
Decreased DTR
Tachycardia, Hypotension, HTN, Breathing Issues
Dx of Guillain-Barre Syndrome
CSF: High protein, Normal WBC
Tx of Guillain-Barre Syndrome
Plasmaphoresis to remove autoantibodies
IVIG to suppress inflammation and induced remyelination
What is Multiple Sclerosis
Autoimmune inflammatory demyelinating disease of CNS
Causes plaques and neurologic defeicits
What are the 3 different stages of MS
Relapsing-Remitting: Episodic Exacerbations
Progressive: Decline without acute exacerbations
Secondary Progressive: Relapse Remitting that becomes progressive
Sx of MS
Optic Neuritis: Unilateral eye pain worse with eye movement, Diplopia, Visual loss, color loss, blurry vision
Sensory deficits: Weakness, Parasthesias, Fatigue
Spinal Cord: Bladder or Bowel Dysfunction, Nystagmus, Staccato Speech
Dx of MS
MRI with Gadolinium is gold standard: see White Matter Plaques
CSF: See increased IgG
Tx of MS
Steroids for acute exacerbations
Beta-Interferon for Relapse-Remitting
Amantadine for fatigue
What are Generalized Seizures
Diffuse brain involvement
What is an Absence Seizure, Sx, Dx, Tx
Brief impairment of consciousness
Brief staring episodes, Eyelid Twitching
Dx: EEG see bilateral symmetric 3Hz spike and wave action or may be normal
Tx: Ethosuximide, Valproic Acid
What is a Tonic-Clonic Seizure, Sx, Dx, Tx
Loss of Consciousness with rigidity and arrest of respiration followed by repeitive jerking
Has post-ictal phase: Flaccid coma/sleep
Dx: EEG see generalized high amplitude rapid spiking
Tx: Valproic Acid, Phenytoin, Carbamazepine
What is Myoclonus seizure, Sx, Dx, Tx
Sudden brief sporadic involuntary twitching
No Loss of Consciousness
Tx: Valproic Acid, Clonazepine
What is Atonic Seizure, Sx, Dx, Tx
Drop Attacks, Sudden Loss of Postural Tone
What is Status Epilepticus, Sx, Dx, Tx
Repeated, Generalized seizures without recovery >30 min.
Tx: Lorazepam or Diazepam, Phenytoin, Phenobarbital
What is a Subarachnoid Hemorrhage
Due to ruptured aneurysms which are usually caused by HTN
Sx of SAH
Sudden onset, worst headache of my life, brief loss of consciousness, N/V, Meningeal Irritation (nuchal rigidity), seizures
Dx of SAH
CT scan without contrast (want to see hte blood)
If negative but still suspicious, do LP
If increased ICP and RBC present it’s SAH
Can also do CT angiography
Tx of SAH
Bedrest, no exertion, no straining
Anti-anxiety meds, stool softeners
BP control, seizure control
What is Friedrich’s Ataxis
Autosomal recessive that causes sx in children, teens, and young adults
Sx of Friedrich’s Ataxis
Starts as gait ataxia, difficulty walking, then worsens and spreads to arms and trunk
Loss of sensation in extremities
Reduced DTR, Scoliosis, Dysarthria, Chest Pain, SOB, heart palpitations, Vision Impairment
Dx of Friedrich’s Ataxia
Clinical
Electromyogram, Nerve Conduction Studies, EKG, Echo
Tx of Friedrich’s Ataxis
Ace-I
Digoxin
Physical Therapy
What is Fibromyalgia
Central Pain Disorder
Sx of Fibromyalgia
Aches, Pains, Fatigue, sleep distrubances, tender points
Anxiety, depression, IBS
Dx of Fibromyalgia
No lab test
Exclude thyroid disease
Diffuse pain in 11/18 pressure points for >3 months
Biopsy: Moth eaten appearance type I muscle fibers
Tx of Fibromyalgia
TCA (Amitriptyline, Nortriptyline, Amoxapine, Clomipramine)
Pregabalin is the only FDA approved drug for Fibromyalgia
What is Osteoarthritis
Chronic disease due to articular cartilage damage and degeneration
Seen in weight bearing joints (knees, hips, cervical/lumbar spine)
Sx of Osteoarthritis
Evening joint pain and stiffness relieved with rest
Gets worse as day goes on and changes in weather
Herberden’s Nodes: Palpable Osteophytes at DIP
Bouchard’s Nodes: PIP Osteophytes
Dx of Osteoarthritis
XRay: Assymetric joint space narrowing, osteophyte formation, subchondral cysts, sclerosis
Tx of Osteoarthritis
Acetaminophen in elderly due to risk of bleeding
NSAIDS
Corticosteroid injections
Avoid high impact exercises
What is Rheumatoid Arthritis
Chronic inflammatory idsease with persistent symmetric polyarthritis with bone erosions, cartilage destruction and joint structure loss
Sx of Rheumatoid Arthritis
Prodome: Constitutional sx
Small Joint Stiffness
MCP, Wrist, PIP, KNee, MTP, Shoulder, Ankle
Worse with rest
Morning stiffness >60 minutes after initiating movement but gets better as day goes on
Swollen tender erythematous “boggy” joints
Swan neck deformity
Ulnar deviation at MCP joint
Rheumatoid Nodules: Hard and Bony Joints
Dx of Rheumatoid Arthritis
+Anti-CCP (Most specific)
+RF
Arthritis >3 joints, morning stiffness, duration >6wks
Xray: Symmetric joint space narrowing, ulnar deviation of hand, subluxation, deformities
Tx of Rheumatoid Arthritis
DMARDS like methotrexate, Azotriapine, Hydroxychloroquine
Anti-TNF
NSAIDS for pain, Low dose steroids
What is Systemic Lupus Erythematous
Chronic systemic, multi-organ autoimmune disorder of connective tissue
Who gets SLE
Young females, AA, Hispanics
Sx of SLE
TRiad of joint pain, malar “butterfly” rash, fever
Rash spares nasolabial folds
Serosities: Pericarditis, Pleuritis
Discoid Lupus: Annular, Erythematous patches on face and scalp
Systemic: CNS, Glomerulonephritis, Retinitis, Oral Ulcers, Alopecia
Dx of SLE
+Anti-dsDNA
+Anti-Smith Antibodies
+RF
+ANA
Tx of SLE
SUn protection
Hydroxychloroquines for skin
NSAIDS, acetaminophen for arthritis
What is Polyarteritis Nodosum
A vasculitis of medium/small vessels that leads to necrotizing inflammatory lesions
What is Polyarteritis Nodosum associated with
Hepatitis B, Increased Microaneurysms
Sx of Polyarteritis Nodosum
Renal: HTN, Renal Failure
CNS: Neuropathy, Mononeuritis Complex
Derm: Livedo Reticularis Purpura (reticular, lacy rash), ulcers, gangrene, Raynaud’s Phenomena
Tx of Polyarteritis Nodosum
Steroids
Cyclophosphamide (immune-suppressant)
What is Low back strain
Nerve root impingement
Suspected when pain is leg-dominant rather than back-dominant
Cauda Equina often presents with bowel or bladder sx
Tx of Low Back Strain
Physical Therapy
NSAIDS, Corticosteroid injections
Surgery for cauda equina
What is Spinal Stenosis
Narrowing of spinal canal with impingement of nerve roots and cauda equina
Seen in people >60yrs
Sx of Spinal Stenosis
BAck pain with parasthesias on one or both extremities
Worse with extension, prolonged standing/walking
Relieved with flexion, sitting/walking uphill
Pain may radiate to thigh
Tx of Spinal Stenosis
Steroid Injections at lumbar region to reduce inflammation
Physical therapy or bending over helps open canal which relieves sx
Definitive: Surgery, Decompression Laminectomy
What is Raynaud’s Phenomenon
Paroxysmal Digital Ischemia
What causes Raynaud’s Phenomenon
Cold or Emotional Stress
Excessive vasoconstriction leads to cyanosis of fingers followed by vasodilation leading to hyperemia and rubor
What is Raynaud’s Phenomenon associated with
Scleroderma
Tx of Raynaud’s Phenomenon
Keep warm, avoid stress
CCB are 1st line for vasodilation (Nifedepine, Amlodipine, Felodipine)
What is Polymyalgia Rheumatica
Idiopathic inflammatory condition causing synovitis, bursitis, and tenosynovitis
Who gets Polymalgia Rheumatica
Women >50yrs
What is closely associated with Polymyalgia Rheumatica
Giant Cell Arteritis
Sx of Polymyalgia Rheumatics
Aching/Stiffness of proximal joints (shoulders, Hip, Neck)
Bilateral proximal joint pain/stiffness, morning stiffness>30 minutes of pelvis and shoulder girdle
Difficultly combing hair, putting on coat, getting out of chair
No severe muscle weakness
Dx of Polymyalgia Rheumatica
Clinical
Increased ESR
Anemia
Tx of Polymyalgia Rheumatica
Corticosteroids
Methotrexate
What is Ankylosing Spondylitis
Chronic inflammatory arthropathy of Axial Skeleton and Sacroiliac Joints with progressive stiffness
Who gets Ankylosing Spondylitis
Young Males 15-30yrs
Sx of Ankylosing Spondylitis
Chronic Low back pain, morning stiffness with reduced ROM
Back stiffness decreases with exercise/activity
Peripheral ARthritis: Saroilitis (Bilateral), Kyphosis, Large joint arthritis
Extra Skeletal: Pulmonary Fibrosis, Aortitis, Colitis, Amyloidosis, Sarcoidosis
Dx of Ankylosing Spondylitis
Increased ESR \+HLA-B27 Negative ANA Negative RF Xray: Bamboo spine (squaring of vertebral bodies)
Tx of Ankylosing Spondylitis
NSAIDS
Rest, physical therapy 1st line
TNF-alpha inhibitors (Infliximab)
Steroids
