Rheumatology Flashcards
Name the muscles involved in Shoulder rotation
SITS S= Supra spinatus I= Infra spinatus T= Teres minor S= Subscapularis
Name the MC rotator cuff injury
Supra spinatus (Tendinopathy / Tear)
Important information
Rotator cuff tendinopathy/tendinitis May present with pain but weakness won’t be present in tendinitis without tear
In both conditions there is no restriction of passive ROM
What is impingement syndrome in rotator cuff?
Flexion Or Abduction decreases space b/w humeral head and acromion
Pressure on supra spinatus tendon and subacromial bursa result compression of these soft tissues
Name the test to assess rotator cuff impingement
Neer test
Empty/full can test
Treatment of Rotator Cuff tear
Acute tear is surgery with best result obtained if performed within 6wks of injury
Name the muscle which abduct upper arm upto 15 degrees
Supra spinatus innervated by supra scapular nerve
Name the muscle which abduct upper arm upto 100 degrees (Starr after 15 degrees)
Deltoid
Name the muscle which abduct upper arm more than 90 degree
Trapeziums
Name the muscle which abduct upper arm more than 100 degree
Serratus anterior
Name the condition which restrict movement of shoulder both actively and passively
Adhesive capsulitis/ frozen shoulder MCC is rotator cuff tendinopathy
Difference b/w posterior and anterior shoulder dislocation
In POSTERIOR shoulder is held in adducted and internally rotated with visible flattening of anterior aspect of the shoulder and prominence of the coracoid process
In ANTERIOR shoulder is held slightly abducted and externally rotated
Radiographic findings of Posterior shoulder dislocation
Light Bulb sign
Rim sign
Trough line sign
Name the risk factor for Carpal tunnel syndrome
Remember DROP H
D diabetes
R RA
O obesity
P Pregnancy
H Hypothyroidism
How to confirm carpal tunnel syndrome ?
Nerve conduction studies
Name the carpal bone which cause acute carpal tunnel syndrome
Lunate
How De Quervain Tenosynovitis presents?
Pain occur by direct palpation of radial side of wrist at the base of the hand
What is Finkelstein test?
Used to De Quervain Tenosynovitis
- Passive stretching of affected tendon by grasping flexed thumb in palm with fingers result pain
How Trigger thumb present?
Pain over palmar aspect of 1st MCP and locking of thumb in flexion
How flexor carpi radialis tenosynovitis presents?
Pain with radial flexion of wrist and point tenderness of trapezium
How to elicited medial and lateral epicondylitis?
If pain occur by resisted wrist flexion and passive wrist extension then MEDIAL epicondylitis
If pain occur by passive wrist flexion and resisted wrist extension and supination then LATERAL epicondylitis
Name the nerve which hurt in anterior dislocation of humerus
Axillary nerve
What is the cause of injury of musculocutaneous nerve (C5-C7)?
Upper trunk compression
How to d/f proximal and distal median nerve injury?
If palmar sensation lost then mean proximal injury
How to d/f proximal and distal ulnar nerve injury?
Radial deviation of wrist upon flexion in proximal injury
Name the conditions causes pain in foot
Remember STAMP
S Stress fracture T Tarsal tunnel syndrome A Achilles tendinopathy M Morton Neuroma P Plantar fasciitis
Triad of Plantar fasciitis
- Burning pain on PLANTAR surface of foot with 1st step in the morning
- Prolong runners
- Point tenderness at plantar surface of heel on examination
Triad of Morton Neuroma
- Pain b/w 3rd & 4th toes on PLANTAR surface
- Clicking sensation and pain that occurs when palpating this space and squeezing metatarsal joints at same time
- Mechanically induced neuropathic degeneration of interdigital nerves
Triad of Tarsal Tunnel syndrome
- Occur due to fracture of ankle bones
- Compression of tibial nerves
- Burning, numbness and aching of the distal plantar surface of the foot/toes
Name the tendons which make PES anserinus
Gracilis
sartorius
AND semitendinosus
Triad of ANSERINE BURSITIS/PES ANSERINUS PAIN SYNDROME (PAPS)
- localized Pain at medial knee just below the knee line
- Exacerbated by pressure from opposite knee while lying on side
- Negative valgus test
Name the bursitis which is due to infection
Prepatellar bursitis (Housemaid knee) Due to S aureus
DIFFERENTIAL DIAGNOSIS OF ANTERIOR KNEE PAIN IN YOUNG PATIENTS
Remember POP
P Patellofemoral Syndrome
O Osgood Schlatter disease
P Patellar tendonitis
Triad of Patellofemoral Pain Syndrome
- Anterior Knee pain increase on prolonged sitting (Due to flexion)
- pain elicited by extending the knee while compressing patella into trochlear groove and reproduction of pain with squatting are highly suggestive
- exercises to stretch and strengthen thigh muscles/quadriceps, knee extensors and hip abductors (Treatment)
Name the cause of anterior knee pain which occurs due to repeated knee extension Or jumping and kicking
Patellar tendonitis
- pt has point tenderness over inferior pole of patella and patellar tendon
Triad of OSGOOD SCHLATTER DISEASE
- Seen in adolescent athletes
- Pain reproducible by extending knee against resistance
- . Edema and tenderness over tibial tubercle
How Patellar dislocation occurs?
Occur after quick lateral movements around flexed knee
O/E flexed knee with patella displaced laterally
What is Unhappy triad?
Damage of ACL, MCL and Medial meniscus
But lateral meniscus more involved
Occur in contact sports due to lateral force applied to a planted foot
Triad of Meniscal Tear
- Joint Line tenderness
- Acute Popping Sensation with catching, locking and Reduced ROM
- MRI best test to dx
Causes of Avascular Necrosis
D-HAIRS
D Decompression sickness
H Hemoglobinopathies A Alcohol/ APLA I infection like bone / HIV R Renal Transplant S steroid / SLE
Triad of Avascular Necrosis of Hip
- Pain on hip abduction and Internal rotation
- No signs of Inflammation
- Normal Lab tests
Imaging of choice to dx Hip Avascular Necrosis
MRI visualize boundary between normal and ischemic bone, as well as zone of hypervascula
Why children are less prone to develop hip Avascular necrosis?
Due to presence of foveal artery
Name the nerve compress in MERALGIA PARESTHETICA
Lateral femoral Cutaneous nerve at Waist
- burning pain and paresthesia at lateral thigh
Causes of Lower Back Pain
Mnemonic IMM
I inflammatory / Infectious
M musculoskeletal
M malignancy
What are Red flags of Lower back pain?
Age more than 50 yrs
Constitutional symptoms
Trauma
Infectious risk
Nighttime risk
Hx of malignancy
IV drug abusers
LBP more than 1 month
LBP which improves with activity but worst at rest
Sero negative spondylitis
LBP which worse with extension but improves with flexion
Spinal stenosis
What is the characteristic thing of herniated disc?
Pain below knee
How to manage acute LBP? Less than 6 wks
Maintain moderate activity
NSAIDS Or Acetaminophen
Consider opioids, spinal manipulation or muscle relaxants
How to manage chronic LBP?
Exercise therapy (aerobic/ stretching and strengthening)
Intermittent use of NSAIDS or Acetaminophen
Consider TCA / SSRI
Basic d/f b/w neurogenic and vascular claudication
Neurogenic.C improves with activity but worse at rest
Lumber flexion improves pain but extension increases pain
………,…………….
Vascular.C worse with activity but improves at rest
Lumber flexion worse pain but extension decreases pain
Important information
loss of DTRs is common in elderly esp. above 70yrs and not related to Vertebral compression trauma.
Causes of Vertebrate compression fractures
TOP IBM
T trauma
O osteoporosis/osteomalacia
P Paget disease
I infection
B. Bone Mets
M metabolic like hyperparathyroidism
Name the nerve damage in posterior hip dislocation
Inferior gluteal nerve
Pt complains of difficulty climbing stairs or rising from seated position
Also loss of hip extension
Impairment of which nerve causes fecal and urine incontinence
Pudendal nerve
Also decreases sensation of genital area and perineum
Name the nerve which gives sensory sensation to supra Pubic region and motor innervation to transverse abdominis and internal oblique
Iliohypogastric
Name the nerve responsible for cremasteric reflex
Gentiofemoral nerve
Which lower extremity nerve get damaged if wear tight clothing?
Lateral femoral cutaneous nerve
Name the nerve responsible for hip adduction
Obturator nerve
How sciatic nerve gets damaged?
Via Herniation Of disc Or Posterior Hip dislocation
Why Disc herniation always occur posteriorly?
Due to thin posterior longitudinal ligament
What Neurovascular structure hurts if axilla/lateral thorax involve?
Long thoracic nerve
And lateral thoracic artery
What Neurovascular structure hurts if surgical neck of humerus involve?
Axillary nerve
And posterior circumflex artery
What Neurovascular structure hurts if Midshaft of Humerus involve?
Radial nerve
And Deep brachial artery
What Neurovascular structure hurts if Distal humerus/cubital fossa involve?
Median nerve
And brachial artery
What Neurovascular structure hurts if popliteal fossa involve?
Tibial nerve
And Popliteal artery
What Neurovascular structure hurts if posterior to medial malleolus involve?
Tibial nerve
And Posterior tibial artery
What are the consequences of Anti SSA positive Ab in pregnant women?
Neonatal lupus could occur
Manifestations are ;
Congenital heart block
Periorbital/diffuse Rash
Transaminitis
And Cytopenias at birth
Name the antibodies formed in APS
Anti cardiolipin Ab
Anti beta 2 glycoprotein Ab
Specific test to dx APS
Diluted Russell viper venom test
Kaolin clotting time
Triad of Primary Raynaud phenomenon
No underlying cause
Usually occur in women under 30 yrs
With no tissue injury with Negative ANA and ESR
Triad of Secondary Raynaud Phenomenon
Presence of Underlying cause
Usually occur in men over 40 yrs
Tissue injury Or digital Ulcer
Triad of Systematic sclerosis
Autoimmune
Non inflammatory vasculopathy
Collagen deposition with fibrosis
Name the antibody associated with diffuse scleroderma
Anti SCL 70 Ab (Anti DNA Topi 1 Ab)
Anti RNA Polymerase 3
Name the antibody associated with limited scleroderma
Anti centromere Ab
Important information of Sjogren Syndrome
Female of 40-60 yrs
Name the antibody associated with Sjogren Syndrome
Anti Ro and Anti La Ab
What will be seen in biopsy of Sjogren Syndrome?
Focal lymphocytic sialadenitis on labial salivary gland
Sx S of myasthenia gravis
Remember D
Diplopia with ptosis
Dysphagia
Dyspnea
Triad of Lambert Eaton Syndrome
Proximal muscle weakness
ANS Dysfunction
Absence of Deep tendon reflexes
Triad of POLYMYALGIA RHEUMATICA
Proximal muscle pain and stiffness in females over 50 yrs
Increase ESR & CRP but normal CK
Associated with GCA
Triad of Steroid Induced myopathy
Proximal muscle weakness & atrophy w/o pain and tenderness
Normal ESR & CK
Muscle power ↑ after discontinuation but recovery takes weeks to months
Triad of Inflammatory myopathy
Proximal muscle weakness,pain and tenderness
Skin rash and Inflammatory arthritis
Increase in both CK and ESR
Name the antibodies present in Inflammatory myopathy
Anti Jo Ab (histidyl trna synthetase)
Anti SRP Ab
Anti Mi 2 (Helicase) Ab
Triad of Statin induced myopathy
Prominent muscle pain/tenderness with Or without weakness
Normal ESR and increase CK
Rare Rhabdomyolysis
Important information
Both statin induced and Hypothyroid induced myopathy have normal ESR but increase in CK
Condition associated with Charcot Joint
Vitamin B12 Deficiency
DM
Peripheral nerve damage
Spinal cord Injury
Syingomyrelia
Tabes dorsalis
Triad of Charcot Joint
Arthritis with deformed joint
Lacking sensation with loss of neurologic input
Degenerative joint disease and loose bodies on joint imaging
Name the factors which decrease the risk of gout
Dairy product intake
Vitamin C (≥1500mg/day)
Coffee intake more than 6 cups per day
What will be seen in x-ray of chronic gout ?
Punched out erosions with an over-hanging rim of cortical bone known as a “rat bite lesion”
Triad of Whipple disease
Cause by Trophyrema whippelii
Migratory Arthritis non deforming
Malabsorptive Diarrhea
Lymphadenopathy
How Paget disease present?
Seen in old age with complains of headache, deafness and bone pain
Sometimes neurological Sx if involved spinal cord
How Paget diseases increase the chances of heart failure?
Due to formation of AV shunt
Laboratory values in Paget disease
Increase ALP and Increase born turnover markers like PINP and urine hydroxyproline
Whereas Sr calcium and Sr Phosphate are in normal range
MCC of isolated, asymptomatic elevation of alkaline phosphatase in an elderly patient?
Most common cause of isolated, asymptomatic elevation of alkaline phosphatase in an elderly patient is Paget Disease Of Bone(osteitis deformans)
What’s the pattern of bone in Paget disease?
Mosaic pattern of woven and lamellar bone
osteocytes within lacunae in chaotic juxtaposition
Triad of Systematic juvenile idiopathic arthritis
Arthritis
Salmon shaped pink colour macular rash
Daily spiking fever
CBC picture in Systematic juvenile idiopathic arthritis
Increase in WBC and platelets count
And anemia
Triad of Gonococcal arthritis
Pain in multiple Migratory joints without purulent
Dermatitis
Tenosynovitis
…………………….
But stimes purulent arthritis occur
Triad of Osteoid osteoma
Bone pain worse esp at night
Decreases with NSAIDs and no association with physical activity
X rays shows typical small, round, lucency with sclerotic margins and sometimes central ossification.
Bone tumor associated with Gardner syndrome
Osteoma
How to d/f osteoblastoma from Osteoid osteoma?
In osteoblastoma, the size is more than 2cm and pain doesn’t decrease with NSAIDs.
Imaging findings of Giant cell tumor
X rays shows Soap bubble appearance/ Expansile and eccentric lytic areas
MRI shows both hemorrhagic and cystic regions
Predisposing risk factors for osteosarcoma
Paget disease of bone
Bone infarct
Radiation
Familial retinoblastoma
Li fraumeni syndrome
Triad of Ewing sarcoma
Bony pain in children with constitutional symptoms
Imaging shows lamellated appearance or “onion skin” periosteal reaction—usually lytic, central and accompanied by endosteal scalloping followed with moth-eaten or mottled appearance and extension into soft tissue
±lymphadenopathy
Name the bony conditions which have normal lab values Viz Serum(Calcium, ALP, Phosphate and PTH)
Remember triple O
O osteoporosis
O osteopetrosis
O osteitis deformans
Important information
1-2.5 SD below mean (ie T-score -1 to -2.5) Osteopenia
Define Mixed CT disease?
Autoimmune disease with a features of SLE, systematic sclerosis and polymyositis
Name the antibody detected in Mixed CT disease
Anti U1-Ribonucleoprotein
D/F b/w X ray findings of RA and OA
RA—-> Periarticular erosion
OA—> Narrow joint space with Osteophytes
How to t/m Ankylosing spondylitis?
1) Non Pharma
2) if Pharma give NASIDs Or Celecoxib
3) if fail or disease prgress give TNF alpha inhibitor / Anti IL17 Ab viz secukinumab
What is the pathognomonic feature of DUPUYTREN contracture?
Thickening of palm fascia and Decrease extension of digit
Discrete Nodules along flexor tendon near the distal plamar crease
Name the condition showed this–>Discrete Nodules along flexor tendon near the distal plamar crease
DUPUYTREN contracture which dx clinically
Name the Reflex and movement impaired if L2-L4 affected
Patellar reflex
Hip adduction and flexion
Knee extension
Name the movement and sensation impaired if L5 affected
Foot DIE
Foot dorsiflexion, Inversion and Eversion
Toe extension
Loss of sensation of lateral shin and dorsum of foot
Name the Reflex and movement impaired if S1 affected
Think of ankle and plantar
Loss of ankle reflex
Hip extension
Foot plantar flexion
What weakness occur due to S2-S4 lesion?
Incontinence of fecal and urine
Sexual dysfunction
Loss of perineum sensation
How to d/f Sjogren syndrome and
Age related sicca syndrome ?
Both have somehow same sxs but sjogren occur in middle age and SICCA occurs in very old age
SICCA due to decrease exocrine output from salivary and lacrimal gland
How to dx and manage planter fasciitis?
Dx clinically unless secondary pathology
Activity modification and soft heel insert
Stretching exercises
Heat pads / orthotics
Surgery in refractory cases.
What are the risk Factors of Achilles tendinopathy?
Meds like Steroid or Quinolones
Athletic activity
Sys disorder like psoriasis or ankylosing spondylitis
What are the examination findings of Achilles tendinopathy?
Swelling and tenderness 2-6cm proximal to tendon rupture
And
Positive Thompson test means no planter flexion
How to manage Achilles tendinopathy?
In Acute give NASIDS or activity modification ± icing
In chronic Eccentric resistance exercise
How to manage Pes Anesrine
Bursitis
NASIDS
Quadriceps and Hamstring muscles exercise
What are the risk Factors of Osteoarthritis?
Non modifiable:: Being female with advance age Fx hx Prior joint trauma Abnormal joint alignment
Modifiable
Obesity with DM
Occupational joint loading
Sedentary lifestyle
How to Approach Scoliosis?
1)) If it is idiopathic—-> X ray to determine the degree of curvature and assess skeletal maturity Or if show neurological sxs DO MRI
How to manage Scoliosis?
If it is mild (10-30 degree) monitor and reassess after every 6 months
If above 30 degree—> apply thoracolumbarsacral spine brace
If ≥40 degree —->Spinal fixation
What are the complications of shoulder dislocation?
Recurrence of condition
Fracture
Rotator cuff injury
When to take X ray in ankle injury?
Ottawa ankle rules 1
If pain in either malleolus zone esp posterior or tip of it
If unable to walk or bear weight
When to take X ray in foot injury?
Ottawa ankle rules part 2
Pain at the mid zone of foot with::
1) tender at the navicular zone or
2) tender at the base of the 5th meta tarsal or
3) unable to unable to walk or bear weight
Important point of Burst vertebral fracture
Typically occur at L1 with positive finding on imaging
How facet dislocation present?
Typically occur in cervical region due to forward flexion
Affects C5/C6 and C6/C7 region
It shows U/L sxs of radiculopathy
How to prevent future attacks of Gout?
Drop Weight with BMI less than 25
Consume low fat, Red meat and sea food
Avoid alcohol, diuretics and organic rich food
Get protein from vegetables or low fat dairy food
Important point of Gout
Smoking and coffee both lower the risk of Gout
Name the cause of foot pain occur if foot is dorsiflex-eversion and planterflex-inversion
Or
Percussing at the posterior medial malleolus area
Tarsal tunnel syndrome t/m via steroids
How to d/f Ewing sarcoma and fibrosarcoma on the basis of age and image ?
Both show lytic bone lesion and moth eaten margin
But in Ewing sarcoma—>lytic lesion surrounded by concentric layers ±Codman triangle
Fibrosarcoma occur after 30 yrs and Ewing occur in adolescence
Triad of TAKAYASU Arteritis
Mid age Female with BP discrepancies due to aterio occulsive in upper extremity
Pain in muscle and joint
Pulse deficit with arterial bruit on examination
What are the lab and image findings of Takayasu Arteritis?
Elevate inflammatory markers
CT / MRI shows narrow lumen with wall thickening
CXR shows aortic dilation with wide mediastinum
How to treat GONOCOCCAL ARTHRITIS?
1g IV ceftriaxone for 7-14 days followed by PO cefixime when stable
Azomax or doxycycline for Concomitant chlamydia infection
Treat sexual partner too!
How
How toe deformity occurs?
Due to imbalance in strength and flexibility b/w the flexor and extensor muscle group
Seen in DM patient
Name the type of toe deformity which shows this dorsiflexion at MTP joint and planter flexion at PIP and DIP joint
Claw toe
Name the type of toe deformity which shows this dorsiflexion at MTP DIP joint and Planter flexion at PIP joint
Hammer toe
How osteoarthritis present at foot?
It involves mid foot and the first MTP joint
No involvement of lesser toes
Name the condition which shows Pain occur by direct palpation of radial side of wrist at the base of the hand
De Quervain Tenosynovitis
Passive stretching of affected tendon by grasping flexed thumb in palm with fingers result pain
Name the condition and test
Finkelstein test and De Quervain Tenosynovitis
Name the condition which shows Pain over palmar aspect of 1st MCP and locking of thumb in flexion
Trigger thumb
Which condition show this; Pain with radial flexion of wrist and point tenderness of trapezium
flexor carpi radialis tenosynovitis
Name the condition which pain on flexing pt’s long finger while pt actively extends fingers and wrist (elbow pain)
RADIALTUNEL SYNDROME
How to approach Shoulder pain?
If Movement restrict Both on active and passive—-> ADHESIVE CAPSULITIS and Glenohumeral arthritis
If movement restrict only active—->rotator cuff
How to d/f ADHESIVE CAPSULITIS and Glenohumeral arthritis as both condition show disruption active and passive
All shoulder movements disrupt—-> ADHESIVE CAPSULITIS
Only abduction and ext-rotation only—> Glenohumeral arthritis
Triad of Panner diseases
Osteochondrosis of capitellum
Occurs in sports sports that involve throwing
crepitation with loss of supination and pronation in elbow
What are the risk factors of Septic arthritis?
Age above 80
Pre existing joint like OA, RA, Gout and Prosthetic joint
DM, IV drug abuser Or alcohol
Steroid injection in joint
Name the Abx for septic arthritis
Vanco—> Gram positive cocci
3rd generation cephalosporins—>Gram -ve rod
Vanco + cephalosporins -> if negative microscopy and in immunocompromised
How to approach acute lower back pain if patient shows cord compression SxS?
Stat MRI
How to approach acute lower back pain if patient shows sciatica Or red flag?
X Ray And ESR—> normal—>conservative t/m—->no improvement-» MRI
If not normal—>MRI
Name the complications of ANKYLOSING SPONDYLITIS
Osteoporosis
Vertebral fractures
Cauda equina
Aortic regurgitation
Uveitis
Important point
Episcleritis—most strongly associated with RA and IBD
How to manage RHEUMATOID ARTHRITIS ?
Start with methotrexate
If SxS persists after 6 months—->add non biological or Biological therapy
Still persist—> switch to alternate biological therapy
Triad of Felty syndrome
RA
Neutropenia (less than 1500 ANC)
With or without splenomegaly
How to manage OA?
NI—-> No improvement
Non pharma—> NI —>NASID—>NI
Topical NASIDS/Capsaicin or IA steroid/hyaluronic acid —->NI—>surgery Or palliative management
How thrombocytopenia and leukopenia Occur in SLE?
thrombocytopenia due to Immune mediated destruction
leukopenia due to autoimmune mediated destruction
What are the mechanisms of anemia in SLE?
Anemia of chronic diseases
Iron deficiency anemia due to GIT loss
Autoimmune hemolytic anemia
SLE nephritis
Important point of pancytopenia due to SLE
Due to immune mediated destruction (Not due to bone marrow suppression)
What is the MOA and S.E of TNF inhibitors?
MOA is anti cytokines agent
S.E are Infection and Malignancy
CHF and demyelination
What is the MOA and S.E of hydroxchloroquine and sulfasalazine?
Both inhibit TNF and IL-1
hydroxchloroquine cause retinopathy
sulfasalazine causes hepatotoxcity, stomatitis and hemolytic anemia
What are the s.e of MTX and leflunomide?
Both cause hepatotoxicity and cytopenias
MTX also causes stomatitis
How
How to manage FIBROMYALGIA?
Conservative managed like exercise —->NI—>TCA—-> NI—->SSRI/SNRI
Still NI—-> combination drug therapy, referral for supervised rehabilitation, pain management consultation or cognitive behavioral therapy.
Name the condition associated with POLYMYOSITIS /DERMATOMYOSITIS
Malignancy
Myocarditis
Interstitial Lung disease
Dysphagia
What is the bx finding of POLYMYOSITIS?
Patchy necrosis
Endomysial mono nuclear infiltrate
How to manage SECONDARY AMYLOIDOSIS ?
T/m underlying causes
Colchicine for prevention and treatment
Important point of HEREDITARY HEMOCHROMATOSIS and AUTOIMMUNE HEPATITIS
AUTOIMMUNE HEPATITIS
Associated with type 1 DM and (not type 2)
HEMOCHROMATOSIS
Associated with type 2 DM and (not type 1)
Triad of OSTEITIS FIBROSA CYSTICA (Von Recklinghausen disease of bone)
Bone pain due to excessive osteoclastic resorption of bone
fibrous tissue (brown tumors)
Seen in primary and secondary/tertiary (advanced renal disease) hyperparathyroidism.
Define Brodie abscess
central lytic bone defect with surrounding sclerosis termed as Brodie’s abscess
How to treat GIANT CELL ARTERITIS ?
GCA with vision loss—-> High dose steroid that’s pulse therapy for 3 days
GCA only —-> I/m to high oral steroid 40-60mg
PMR only —-> low dose oral steroid 10-20mg
Triad of FIBROSARCOMA
Malignant spindle cell neoplasm
Seen in 30-60yrs
Image shows osteolytic lesion whose margins are well-defined or ragged and moth-eaten
Triad of CHONDROSARCOMA
Occurs in fifth or sixth decade of life
multiple endochondromas and hemangiomas at high risk to develop this
X Ray shows fusiform defect with scalloping
Name the organism causing EARLY ONSET PROSTHETIC JOINT INFECTION (less than 3 months)
S.aureus
Gram negative rod
Anaerobes
Name the organism causing DELAYED ONSET PROSTHETIC JOINT INFECTION (3-12 months)
Coagulase negative staphylococci (epidermis)
Enterococci
Propionibacterium species
Typical sxs like No fever or increase WBC but implant loosening or sinus tract formation
Name the organism causing LATE ONSET PROSTHETIC JOINT INFECTION ( >12 months)
Patient had Infection at distant site then bacteria infects joints via blood
S.aureus
Gram negative rod
B-Hemolytic strep
How to d/f Femoral neck fracture and posterior hip dislocation?
Remember fracture disown leg whereas dislocation still own leg
In Neck fracture, leg is short, abducted and Ext-rotated
Whereas post- Hip dislocation, leg is adducted and Internal rotate
Difference b/w Osteosarcoma and Unicameral Bone cyst
Both have lytic bone lesion
Unincameral has well define borders Whereas Osteosarcoma has irregular borders
Difference between Langerhans cell histiocytosis and Osteosarcoma
Both have lytic lesions
but osteosarcoma Occur in adult and elderly patient whereas other diseases occur in less than 4 years kids
What are the causes of Cervical Radiculopathy and How does it present?
(Sxs depend on nerve involvement)
Causes are disk herniation Or spondylosis
Sxs are loss of upper limb reflexes with pain and paresthesia
Name the test which is Dx and therapeutic for cervical Radiculopathy
Shoulder abduction relief test
Abduction relief the tension on impinged nerve root and improve radicular pain when hand is placed on the top of hand
What are the CNS, CVS and Pulmonary complications of RA?
CNS:
Depression and neuropathy
CVS viz Atherosclerosis and Vasculitis
Pulmonary
Pleural effusion and Pul-HTN
Fibrotic lung disease and lung nodules
What are the Blood, skin, MSK, eye and other complications of RA?
Blood—>anemia
Skin—->RA nodules
MSK—-> Osteoporosis and Osteopenia
Eye—-> Scleritis and epiScleritis
Other—> Sjogren syndrome, Raynaud phenomenon
Triad of Osler weber rendu syndrome
Autosomal dominant
Recurrent nasal bleeding and clubbing
Ruby colored papules blanch with pressure (telangiectasia)
AV malformation with reactive polycythemia
D/f b/w Type 1 and Mixed (type 2 and 3) cryoglobulinemia
> > Type 1:
• Associated with lymphoproliferative or hematologic like Mulitple myeloma
• Normal complement level
> > Mixed
• Associated with HCV, HIV and SLE
• low C4
