Rheum #5 Flashcards
Common drug secondary cause of osteoporosis
corticosteroid prednisone equivalent dose >5.5mg day for at least 3 months
what is the gold standard for dx of osteoperosis
DEXA
DEXA scan values for osteoporosis
t-score less than -2.5 SD
some radiological signs of osteoporosis
vertebral copression fx (wedge fx, requires 20% height loss)
Codfishing sign (biconcave vertebral discs)
Picture frame vetebra
Clinical signs of fractures or osteoporosis (apparently)
weight < 51kg (Low BMI)
Wall-occiput distance > 0cm
Rib-pelvis distance < 2 finger breadth
Per the osteoprosis risk stratification, what must you do with someone who is in the high risk category?
start pharmotherapy
What is low, medium, high risk osteoperosis
low- 10 year fx risk <10%, reassess in 5
Medium- 10 year fx risk 10-20%, reassess in 1-3
high- 10 year fx risk >20%
tx of osteoperosis (2 categories)
- lifestyle
- -Calcium/vit d 1000mg, exercise, stop smoking, lessen caffeine - Drug therapy- Bisphosphonate
treatment specific to post-menopausal women
Raloxifene (1st line) is a selective estrogen receptor modulator –> helps prevent vertebral fractures
Hormone replacement therapy (combined estrogen + progesterone)
what is septic arthritis and what is the biggest risk for it
Joint infection
–with a prosthetic joint
the more abnormal? the more likely
(prosthetic > RA > OA > normal joint
etiology of septic arthritis (gonoccocal vs non-gonococcal)
N. gonorrhea (gonoccocal –> 75% of septic arthritis in young sexually active people)
S. Aureus, SAlmonella Spp(sickle), S pneumonia (children) (non-gonoccocal)
gonococci vs nonconicoccle septic arthritis age
Gonococcal- <40
Non gonococcal- >80
Big 3 investigations for septic arthritis
Arthrocentesis (joint aspirate will be cloudly, yellow incredibly high WBCs)
Plain x-ray (to rule out other stuff)
CRP (c-reactive protein monitors inflam response to therapy)
best and most accurate investigation for septic arthritis
aspiration of the joint
treatment for septic arthritis
empiric antibiotic therapy
ceftriaxone and vancomycin are best initial empiric therapies
most common cause of septic arthritis
s. aureus
in people with prior joint replacement, what should you consider as cause for septic arthritis
coagulase-negative staphylococcus1
Most common route of infection for septic arhtritis
hematogenous
most commonly affected joints (in descending order) for septic arthritis
knee, hip, elbow, ankle, sternoclavicular joint
osteomyelitis (bone infection) most commonly caused by
staph aureus
best diagnosis for osteomyelitis
X-ray, then go do MRI (or bone scan if cant do MRI)
Esr can be useful to follow response to therapy
most accurate test for osteomyelitis
biopsy and culture
how long will it take for osteomyelitis to show up on plain film x-ray
8-10 days after onset of infection
tx for acute and chronic osteomyelitis
acute- IV antibiotics for 4-6w
chronic- surgical debridement, antibiotics
2 aetiologies of compartment syndrome
intracompartamental- fracture
extracompartamental- constrictive dressing, poor position during surgery, circumferential burn
5 P’s of compartment syndrome (these are late, do NOT wait for these to develop to diagnose hopefully)
Pain out of proportion not relieved by analgesics
- Pallor
- Parasthesia
- Paralysis
- Pulselessness
most important sign of compartment syndrome
increased pain w/ passive stretch
do we need investigations fo rcompartment syndrome?
no- clinical dx
Complications of compartment syndrome
volkmann’s ischemic contracture- Ischemic nercrosis of mm folowed by secondary fibrosis
Rhabdomyolysis
