Week 4 Flashcards
What is the most common cause of acute arthritis in men > 40?
Gout
What forms the crystals of gout? Describe their physical appearance.
Uric Acid; Negatively Birefringent {NOT Non-Birefringent} which makes them yellow with polarized light and Needle Shaped.
What forms the crystals of pseudogout? Describe their physical appearance.
Calcium Pyrophosphate Dihydrate Crystals; Weakly Positively Birefringent {Blue} and Rhomboid Shaped.
Serum uric acid levels are often ______ during an acute flare of gout.
Normal
How does gout present?
EXTREME pain, Red and Swollen, Night Pain, and sometimes a low grade fever. Lasts 3 - 10 days.
Which drug may trigger a gout flare while either starting OR stopping it? What does this drug do, and how does it act?
Allopurinol; Reduces the production of uric acid in the body by inhibiting the biochemical reaction preceding uric acid synthesis. Allopurinol is an antihyperuricemic and can be used for gout prophylaxis. NOT for use with acute flare.
How should gout be diagnosed?
3 C’s: Cell count, culture and gram stain, and crystals. {Good for any joint work up really.}
What are “Tophi”?
Large, visible, collections of uric acid usually presenting on “cooler” surfaces of the body. Take at least 10 years to develop.
What drug should be given for acute gout flare ups?
Colchicine. {Also NSAIDs like Indocid 50mg TID}.
How should pseudogout be treated?
NSAIDs, Corticosteroid Injections, and RICE {Rest, Ice, Compression, Elevation}.
Which ligaments of the knee are extracapsular?
Lateral Colateral Ligaments and Medial Colateral Ligaments.
The MCL is physically attached to the medial meniscus. Tear one and you’ll tear the other!
Which set of ligaments usually result in hemarthrosis when torn? Which will usually heal on their own?
ACL, PCL {Intraarticular!}; MCL and LCL {Extraarticular!}
How much synovial fluid is normally in the knee?
3cc
How is ROM recorded? ie. ____/____/____
Active & Passive
Hyperextension/Extension/Flexion
What does it mean to have your knee “locked”?
Decreased Extension with Full {or close to it} flexion.
What is Osteochondritis Dissecans and where does it most commonly affect?
A segment of bone beginning to separate due to a lack of blood supply. Most commonly affected is the knee, elbow, and ankle of children and adolescents.
What is pathognomonic of an ACL tear?
A Segond Fracture. Chunk off of the lateral aspect of the proximal tibia.
What four muscles does the rotator cuff consist of?
SITS: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
What is the most common muscle of the rotator cuff to tear?
Supraspinatus
What two X-Ray views should be ordered for shoulder investigations?
- AP and Axillary {Lateral of the Shoulder}
- And sometime scapular.
What is the most common vector of Glenohumeral Instability?
Antero-inferior
What is a torn Glenoid Labrum called?
A Bankart Lesion {Anterior Inferior Rim}
What is a dent in the Humeral Head called?
A Hill-Sachs Lesions {Posterior Surface}.
Any shoulder injury > 40 without X-Ray evidence of fracture have a _______ until proven otherwise.
Rotator Cuff Tear; These acute tears are often missed, they retract, atrophy, and become irreparable quickly!
When is a posterior glenohumeral dislocation likely to occur?
Seizure / Electrocution. Associated with a pathognomonic inability to externally rotate.
Superior Clavicular Pain with cross body adduction is seen with?
AC Joint Arthritis; often present in manual labourers.
In general, how is arthritis treated?
- Rest
- NSAIDs
- Corticosteroid Injections
- Resection and Surgery
What is “Frozen Shoulder”?
aka: Adhesive Capsulitis
An idiopathic, gradual, and temporary onset of shoulder stiffness.
Goes through 3 phases: Pain {Freezing}, Stiffness {Frozen}, and Thawing.
How does Adhesive Capsulitis present?
- Lack of Active and Passive ROM.
- Decreased External Rotation.
- Normal X-Ray.
What is Heterotopic Bone?
Bone which forms in response to traumatic injury. It is called Ectopic Bone if it forms in soft tissues.
What is Myositis Ossificans?
Formation of Heterotopic Bone in the muscle.
How are proximal tendon biceps tears treated differently than distal tendon biceps tears?
Proximal can be treated with physio - there is little loss of strength.
Distal must be treated operatively. Great loss of strength.
Which three ligaments form the lateral ligament complex of the ankle?
- Anterior Talofibular {Most likely to tear}.
- Calcaneofibular
- Posterior Talofibular {Strongest}
Luxatio Erecta is a?
Inferior dislocation of the shoulder caused by forced abduction.
An ABI of what may indicate vascular injury following a knee dislocation?
< 0.9
Young men presenting with osteoarthritis should tip you off to look for?
Metabolic Anomalies include: Wilsons, Hemochromatosis, Growth Hormone Issues, Phosphate Issues…
Severe osteoarthritis and destruction without a lot of pain or distress should tip you off to look for?
Neuropathic Arthritis {Charcot Joint} and Diabetes.
Severe Psoriatic Arthritis should tip you off to look for?
HIV
Bad Dermatomyositis should tip you off to look for?
Cancer
Bad acute monoarthritis with negative C/S and a rash should tip you off to look for?
Gonococcal Infection
Hemarthrosis should tip you off to look for?
Coagulopathies
What MSK conditions should you watch out for in patients with Thyroid Disease?
Carpal Tunnel, Proximal Weakness or Myalgias, and Raynaud’s.
What MSK conditions should you watch out for in patients with Diabetes?
Carpal Tunnel, Dupuytren’s Calcific Tendonitis, Charcot, and other Neuropathies.
What MSK conditions should you watch out for in patients with Hep B, Hep C, and HIV?
Vasculitis
What MSK conditions should you watch out for in patients with Lyme Disease?
Monoarthritis
Bad Carpal Tunnel should make you concerned about?
Hypothyroidism, Diabetes, RA, Acromegaly.
What is the prayer sign associated with?
Diabetic Hand Syndrome and Poor Glycemic Control. Patient has flexion contractures of the DIP and PIP due to excess collagen crosslinks.
What is Neuropathic Arthritis?
Aka Charcot Joint, a loss of proprioception and sensation leads to injury. It most commonly involves the feet and presents with swelling, deformity, and mild to moderate pain. Occurs < 1% of diabetics.
What are Dupytren’s Contractures?
A condition which occurs in 33-60% of T1DM. It is NOT associated with glycemic control and usually presents in long standing diabetics.
How will CK levels be changed in Thyroid Disease?
Hyperthyroidism: Normal CK
Hypothyroidism: Increased CK
How inflammatory is blood?
Like, so inflammatory its nuts.
Sickle Cell Anemia may result in _______, as a result of this is predisposes to?
Clotting; Bone Infarction, Osteomyelitis, Joint Effusions, and Gout.
What infectious agent causes Lyme Disease?
Spirochete Borrelia Burgdorferi
How does Arthritis of Hepatitis B and C present?
Symmetrical small joint arthritis in the hands and knees caused by immune complex deposition. Looks like RA but its not!
Polyarteritis Nodosa Vasculitis is associated with? What vessels does this affect?
Hepatitis B, small and medium vessels.
Mixed Cryoglobulinemic Vasculitis is associated with? What vessels does this affect? What factor will usually be positive?
Hepatitis C, small and medium; Rheumatoid Factor.
Cryoglobulins are globulins which reversibly precipitate with temperature drop. Found in immune complexes in this condition.
HIV predisposes to what conditions? What is it protective against?
Predisposes to:
- Reactive Arthritis.
- Psoriatic Arthritis.
- Transient Arthritis.
Protective Against:
- RA Flares.
- Lupus.
What is Diffuse Infiltrative Lymphocytosis Syndrome {DILS}?
Dry mouth and Parotid Enlargement associated with HIV infection which looks like Sjogren’s. CD8 cells infiltrate. DILS may precede HIV diagnosis!
