Spinal disorders

Question 1

<p>Drug for Rheumatoid arthritis</p>

Answer 1

<p>DMARD</p>

<p>Disease Modifying, anti-rheumatic drug (methotrexate most common)</p>

<p>Also can use NSAID, corticosteroids</p>

Question 2

<p>Herberden's node (form of osteoarthritis)</p>

Answer 2

<p>DIP - Distal interphalengial joint is herberden's node HD -</p>

<p>HD high definition</p>

<p>PIP - Proximal interphalengial joint - Bouchard (form of osteoarthritis)</p>

<p>BP - blood pressure</p>

<p>MCP - met-carpal phalengial joint</p>

<p></p>

Question 3

<p>Ulnar deviation of MCP (metacarpophalangeal joints)</p>

Answer 3

<p>Rheumatoid arthritis (RA) is about deformed hands, deviation of MCP toward ulnar side</p>

Question 4

<p>Swan neck and Boutonniere deformity</p>

Answer 4

<p>Hyperextension of PIP joints with flexion of DIP joint</p>

<p></p>

<p>Felxed PIP and extended DIP - Boutonniere Deformity</p>

Question 5

<p>Osteoarthritis</p>

Answer 5

<p>Degenerative disease from overuse</p>

<ol><li>Joint pain with activity that improves with rest. - Herbeden and Bouchard nodes</li></ol>

Question 6

<p>Rheumatoid Arthrits RA symptoms</p>

Answer 6

<ol><li>Symmetric joint swelling, morning stiffness >1hr, paain in wrist, MCP and POP joints, boutonniers and swan neck deformity</li></ol>

Question 7

<p>Gout</p>

Answer 7

<p>Swollen, tender, warm joints with sudden onset, podagra (first mcp joint), tophi</p>

Question 8

<p>Ankylosing spondylitis sx</p>

Answer 8

<p>Hip pain, lower back pain that worsens with inactivity & in the morning, radiography shows fused sacroiliac joint and *bamboo spine</p>

Question 9

Treatment for Gout (needle shaped crystals and pain in first metatrsophalengeal joint)

Answer 9

indomethacin (Nonsteroidal anti-inflammatory drug
) - NSAID first treatment of choice for gout
Colchicine - Not first choice, works slower than NSAID
Allopurinol- used for maintenance therapy (chronic)

Use arthrocentesis to take out fluid.
Risks (middle aged male, obesity, alcohol abuse - especially beer with greasy food, diuretic)

Pseudogout (Calcium- blue rhomboid shape) typically knee

Rheumatoid arthritis - usually symmetrical

Septic arthritis - increased wbc, fever

Ostearthritis - degenerative joint disease - pain in weight bearing joints esp end of day. Improves w/ rest. Chronic and no systemic symptoms.

Chronic gout - rat bite erosion in xray

Question 10

Spinal stenosis
vs
Disc herniation
Which spinal movement relieves?
What symptom confirms peripheral artery disease?

Answer 10

Disc herniation - better with extension
Spinal stenosis - better with flexion (worse w/ walking)

Peripheral artery disease - pedal pulse gone

Question 11

Trigger point vs tender point

Answer 11

Trigger points refer points elsewhere

Myofascial pain syndrome relates to trigger points

Question 12

Ankylosing spondylitis

Answer 12

• abnormally stiffening and immobility of a joint due to fusion of spine (bamboo spine) - normally starts from SI joint
• Commonly in young males
• HLA-B27 positive. History of psoriasis, reactive arthritis, inflammatory disease
• AS patient may benefit from warm shower or light exercise - helps with pain/stiffness. (MS gets worse with warm shower)
• complications: eyes, osteoperosis, irritable bowel

Question 13

Reactive arthritis types

Answer 13

The infection usually occurs days to weeks before the onset of joint pain. In some cases a preceding infection may only be identified with laboratory testing.
Symptoms include joint pain and stiffness, most commonly in the knees, ankles, and feet. In a type of reactive arthritis called Reiter’s syndrome, there may be discomfort during urination as well as eye inflammation.
If needed, treatment includes anti-inflammatory medication or steroids.

Conjunctivitis - can’t see

Urethritis - can’t pee

Arthritis - can’t climb tree

All HLA- B27

Question 14

Sheuermann Kyphosis

Answer 14

Early adolescences and defined as anterior wedging of at least 5 degrees, involving at least 3 vertebral bodies
- forward bending, extension, or lying supine does not respond this rigid kyphosis that usually involves the thoracic or thoracolumbar spine

Question 15

Treatment for pain relief of OA

Answer 15

A thumb spic splint to immobilize joint

Mallet finger - mallet finger splint

Question 16

Juvenile rheumatoid arthritis

Answer 16

most common in childhood. Onset <16yrs

• one or more joints at least 6 weeks
• systemic, pauciarticular (1-4 joints), polyarticular (5+ joints)

Question 17

Onset of RA vs OA

Answer 17

OA develops slowly and w/o additional systemic symptoms - can be lumbar involvement

RA symptoms are rapid and can worsen in weeks. Onset - fatigue, fever, weight loss, loss appetite, malaise - can be Cervical spine involvement

Question 18

Blood test for Rheumatoid Arthritis (RA)

Answer 18

anti CCP antibody = cyclic citrullinated peptide
RF
Abnormal CPR levels or ESR

Question 19

Treatment of OA vs RA

Answer 19

Both OA and RA - NSAIDS

RA- DMARDs - disease modifying anti-rheumatic drugs, corticosteroids

Question 20

<p>Myelograma</p>

Answer 20

<p>Imaging and dye used to find tumor or infection or herniated disk in the spine.</p>

Question 21

cauda equina syndrome

Answer 21

Cauda equina syndrome is a rare disorder that usually is a surgical emergency. In patients with cauda equina syndrome, something compresses on the spinal nerve roots. You may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs.

Sx: severe low back and leg pain around saddle. Later findings include lower extremity weakness. Loss of feeling in the legs (sensory loss) and loss of bowel or bladder control (sphincter dysfunction) are also common.

Question 22

Spina Bifida

Answer 22

Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Spina bifida can happen anywhere along the spine if the neural tube does not close all the way.

Prenatal Folic acid is the way to prevent

Question 23

spinal muscular atrophy

Answer 23

SMA is an autosomal recessive disease. This means that (most of the time) both parents must carry the genetic mutation for a child to have the condition

Sx:
muscle weakness and decreased muscle tone.
limited mobility.
breathing problems.
problems eating and swallowing.
delayed gross motor skills.
spontaneous tongue movements.
scoliosis (curvature of the spine)

Type 1: Don’t sit up
Type 2: 6-18 mos (don’t walk)
Type 3: 18mos-late childhoold: Progressive walking difficulty
Type 4: Adult onset

3 FDA approved medications - Spinraza

Question 24

Spinal Tumor

Answer 24

Tumors from other parts of the body can spread (metastasize) to the vertebrae, the supporting network around the spinal cord or, in rare cases, the spinal cord itself.

Spinal tumors or growths of any kind can lead to pain, neurological problems and sometimes paralysis. A spinal tumor can be life-threatening and cause permanent disability.

Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy or other medications.

Sx:
Pain at the site of the tumor due to tumor growth.
Back pain, often radiating to other parts of your body.
Feeling less sensitive to pain, heat and cold.
Loss of bowel or bladder function.
Difficulty walking, sometimes leading to falls.
Back pain that’s worse at night.
Loss of sensation or muscle weakness, especially in your arms or legs
Muscle weakness , which may be mild or severe, in different parts of your bod