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449 Cards in this Set
- Front
- Back
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Q001. Ankylosing Spondylitis - What is it; Risk factors |
A001. Chronic inflammatory disease of spine and pelvis; sacroilitis => fusion of affected joints; 20's - 30's; seronegative; HLA-B27; risk factors – male, family History |
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Q002. Ankylosing Spondylitis - History/PE
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A002. History - hip and low back pain, worse with inactivity, worse in mornings, better with activity, thru day; PE - hip pain and stiffness; limited chest expansion; loss of lumbar lordosis; positive Schober test - decreased spine flexion; may have anterior uveitis,; 3rd degree heart block; aortic insufficiency => CHF |
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Q003. Ankylosing Spondylitis - Dx
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A003. Dx based on clinical & XR; HLA-B27; ESR - may be elevated; RF & ANA - negative; spine and pelvic XR - "bamboo spine"
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Q004. Ankylosing Spondylitis - Tx
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A004. NSAIDs; exercise; physical therapy
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Q005. Reiter's - What is it
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A005. "Can't see, can't pee, can't climb a tree"; conjunctivitis; uveitis; urethritis; arthritis; may also have - keratoderma blennorrhagicum, circinate balanitis; after infection with – campylobacter, Shigella, salmonella, chlamydia, ureaplasma; seronegative; HLA-B27; young men
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Q006. Psoriatic Arthritis - What is it
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A006. Chronic inflammatory arthritis; psoriasis of skin; psoriatic nail lesions; DIP joints; sausage-shaped digits; "mushroom caps"; HLA-B27; seronegative
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Q007. Rheumatoid Arthritis - What is it
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A007. Chronic autoimmune diseases; peripheral joints - symmetrically inflamed; progressive destruction of articular tissue; erosion of - cartilage, bones, tendons; systemic Sxs; atlanto-axial subluxation; ruptured Baker's cyst; MC females 35-50; HLA-DR4; T cell activation - why HIV improves pre-existing
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Q008. Rheumatoid Arthritis - History/PE
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A008. Insidious onset of morning stiffness > 1 hr; painful, warm swelling of multiple symmetric joints > 6 wks; MC - wrist, MCP, PIP, any joint may be involved; axial rare except upper cervical spine; ulnar deviation; MCP joint hypertrophy, swan-neck, boutonniere; subq, painless Baker's cysts
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Q009. Rheumatoid Arthritis - Dx
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A009. RF (anti-Fc IgG Ab); ESR; XR; synovial fluid aspiration - slightly turbid, decreased viscosity, WBC 3,000-50,000
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Q010. Rheumatoid Arthritis - Tx
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A010. NSAIDs; COX-2 inhib; severe – corticosteroids, methotrexate, hydroxychloroquine sulfate, gold, azathioprine; operative may be necessary.
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Q011. Felty's Triad - What is it
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A011. RA; splenomegaly; neutropenia
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Q012. Juvenile Rheumatoid Arthritis - What is it
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A012. Nonmigratory, nonsuppurative, mono- and poly-arthropathy; bony destruction; < 16 y/o; lasts > 6 wks; 95% - disease resolves by puberty
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Q013. Juvenile Rheumatoid Arthritis - History/PE
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A013. 3 patterns; all patterns may have – fever, nodules, erythematous rashes, pericarditis, fatigue; pauciarticular - MC form, < 4 joints, weight-bearing joints; ANA type - MC subtype, asymm involvement of lg. joint, iridocyclitis – insidious, if not treated => blind; RF type - poor prognosis, HLA-B27 - boys also have spondyloarthropathies,; polyarticular - > 5 joints, similar to adult RA, symmetric, may develop iridocyclitis; Still's disease (systemic) - least common, daily high spiking fever, evanescent salmon-colored rash, hepatosplenomegaly, serositis
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Q014. Juvenile Rheumatoid Arthritis - Dx
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A014. No diag tests; XR; RF - positive in 15%; ANA - may be positive; RBC decreased; elevated – ESR, WBC, platelets; normal ESR doesn't exclude Dx
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Q015. Juvenile Rheumatoid Arthritis - Tx
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A015. NSAIDs; corticosteroids; ROM and strength exercises; methotrexate; monitor iridocyclitis
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Q016. Scleroderma - What is it
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A016. Progressive systemic sclerosis; multisys disease; thickening of skin from; accumulation of connective tissue; MCC of death - pulmonary; CREST - better prognosis; MC - females 30-50
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Q017. Scleroderma - History/PE
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A017. All have thick skin & Raynaud's; Lung - pulmonary fibrosis => restrictive lung disease and cor pulmonale; GI - esophageal dismotility, achalasia, decreased motility of small intestines, dilation of large intestines, large diverticula; renal - malignant HTN => ARF; CREST - limited form
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Q018. CREST - What is it
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A018. Calcinosis; Raynaud's; esoph dysmotility; sclerodactyly; telangiectasias
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Q019. Scleroderma - Dx
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A019. RF; ANA; eosinophilia; anticentromere Ab - CREST; anti-Scl-70 - systemic
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Q020. Scleroderma - Tx
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A020. Systemic glucocorticoids; penicillamine - skin changes; Ca2+ channel blockers - Raynaud's; ACE inhibitor - renal disease, HTN
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Q021. SLE - What is it
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A021. Multisys autoimmune; women - especially Black; Ab-mediated cellular attack; deposits of Ag-Ab complexes; lupus-like syndrome - drug-induced lupus, Hydralazine, penicillamine, Procainamide, INH, methyldopa; rash only, anti-histone Ab, resolves when drug discont.
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Q022. SLE - History/PE
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A022. DOPAMINE RASH; Discoid rash; Oral ulcers; Photosensitivity; Arthritis; Malar rash; Immunologic criteria; Neuro Sxs - lupus cerebritis, seizures; Elevated ESR; Renal disease; ANA positive; Serositis; Hematologic abnormalities; Sxs exacerbated - sun exposure, pregnancy
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Q023. SLE - Dx
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A023. Anemia; leukopenia; TCP; ANA; anti-dsDNA; anti-Sm Ab; active attacks - decreased C3 and C4; antihistone Ab - drug-induced; anti-Ro (SSA) - neonatal lupus, neonatal congenital heart block if pregnant, screen; antiphospholipid Ab – hypercoagulability, thromboembolic disease, recurrent spontan abortions, stillbirths; Tx - LMWH
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Q024. SLE - Tx
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A024. Arthritis - NSAIDs; major organ involvement - steroids; flare-ups - steroids; antimalarials - rash; nephritis – cytotoxics, cyclophosphamide, azathioprine
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Q025. SLE - Complications
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A025. Infections; progressive impairment of – brain, heart, lungs, kidney; increased risk - spontaneous abortion (antiphospholipid Ab); neonates - increased risk of congenital complete heart block (anti-Ro/SSA)
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Q026. Temporal Arteritis - What is it
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A026. Giant cell arteritis; women 2x's > men; > 50 y/o; subacute granulomatous inflamm; large vessels – aorta, external carotid - especially temporal, vertebral a; blindness - occlusion of central retinal; polymyalgia rheumatica - 50%
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Q027. Temporal Arteritis - History/PE
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A027. Headache; temporal tenderness; scalp pain; jaw claudication; fever; monocular blindness - transient or permanent; weight loss; malaise; myalgia; arthralgia
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Q028. Temporal Arteritis - Dx
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A028. ESR; ophthalmologic evaluation; Biopsy - temporal artery
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Q029. Temporal Arteritis - Tx
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A029. If suspect TA - start steroids before Biopsy; hi-dose prednisone - 1-2 mos. before taper; monitor eye exams
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Q030. Henoch-Schönlein Purpura - What is it
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A030. Immune-mediated vasculitis; IgA immune complexes; small arteries - GI tract; skin; joints; kidney; 2-11 y/o; degree of renal involvement; det. prognosis
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Q031. Henoch-Schönlein Purpura - History/PE
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A031. Palpable purpura - buttocks and legs; asymmetric, migratory; periarticular swelling; abdominal pain; preceding URI
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Q032. Henoch-Schönlein Purpura - Tx
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A032. Usually self-limited; Tx supportive; steroids - Sxs
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Q033. Henoch-Schönlein Purpura - Complications
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A033. GI bleeding; intussusception; glomerulonephritis
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Q034. Polymyalgia Rheumatica - What is it
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A034. Elderly females; close association with; temporal arteritis
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Q035. Polymyalgia Rheumatica - History/PE
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A035. Pain and stiffness – shoulder, pelvic girdle; especially severe in morning or after inactivity; minimal joint swelling; fever, malaise, weight loss; hard to - get out of chair, lift arms above head; muscles not weak; pain limits muscle effort
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Q036. Polymyalgia Rheumatica - Dx
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A036. Clinical; anemia; ESR high
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Q037. Polymyalgia Rheumatica - Tx
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A037. Low-dose prednisone
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Q038. Inflammatory Myopathies - What Are They
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A038. Inflammatory muscle diseases; progressive muscle weakness; polymyositis; dermatomyositis; inclusion body myositis
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Q039. Inflammatory Myopathies - History/PE
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A039. Difficulty with proximal muscles - lifting objects, combing hair, getting up from chair; difficulty with distal later - writing; dermatomyositis - heliotrope rash, Grottron's papules
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Q040. Inflammatory Myopathies - Dx
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A040. Most sensitive test - CK - elevated; aldolase - elevated; anti-jo-1 autoAb; EMG; muscle Biopsy - confirms
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Q041. Inflammatory Myopathies - Tx
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A041. Steroids - polymyositis; dermatomyositis; inclusion body myositis - resistant to immunosuppressives
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Q042. Fibromyalgia - What is it
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A042. Connective tissue d/o; myalgia; weakness; fatigue; no inflammation; associated with – depression, anxiety, IBS; MC women > 50
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Q043. Fibromyalgia - History/PE
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A043. Pain when palpate at least 11 of 18 tender points; palpate "trigger point"=> pain, body aches; fatigue; sleep disorders
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Q044. Fibromyalgia - Dx
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A044. Dx of exclusion; myofascial pain syndrome - < 11 tender points or nonfibromyalgia-associated tender points
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Q045. Fibromyalgia - Tx
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A045. Stretching; heat application; hydrotherapy; transcutan electrical; nerve stimulation; patient education; stress reduction; low-dose antidepressants
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Q046. Sjogren's - What is it
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A046. Chronic autoimmune disease; lymphocytes infiltrate exocrine glands; can become progressive => systemic => lymphoproliferative (malignant lymphome)
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Q047. Sjogren's - History/PE
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A047. Xerostomia; dry eyes; keratoconjunctivitis sicca; "sandy feeling under eyes"; dental caries; parotid enlargement
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Q048. Sjogren's - Dx
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A048. Schirmer's test - decreased tear production; rose bengal stain - corneal ulcers; anti-Ro (SSA) & anti-La (SSB); Biopsy - lymphocytes infiltrate salivary gland
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Q049. Sjogren's - Tx
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A049. None; symptomatic Tx - artificial tears
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Q050. What drugs can induce SLE?
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A050. Procainamide; Hydralazine; Isoniazid; Chlorpromazine; Methyldopa; Quinidine
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Q051. What are the features of SLE?
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A051. Fever, anorexia, malaise, weight loss; Butterfly rash; Nail fold infarcts; Splinter hemorrhages; Raynaud's Phenomenon
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Q052. What is the diagnostic criteria for SLE?
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A052. Requires 4 of 11 criteria:; Malar rash; Discoid rash; Photosensitivity; Oral ulcers; Arthritis; Serositis; Renal disorder; Seizures, psychosis; Hematologic; Immunologic; Positive ANA
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Q053. How do you treat SLE?
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A053. Refer to rheumatologist; NSAIDS; Antimalarial drugs; Steroids; Immunosuppressive drugs; Anticoagulation
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Q054. What is antiphospholipid antibody syndrome?
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A054. Recurrent venous or arterial occlusions; Recurrent fetal loss; Thrombocytopenia; Antiphospholipid antibodies; No other features of SLE
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Q055. What is scleroderma?
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A055. diffuse fibrosis of the skin and internal organs
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Q056. What are the two forms of scleroderma?
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A056. Limited - CREST; Diffuse - Renal failure, intersitial lung disease, cardiac disease
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Q057. What is CREST syndrome?
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A057. Calcinosis; Raynaud's syndrome; Esophageal dysmotility; Sclerodactyly; Telangiectasia
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Q058. What are the clinical findings of scleroderma?
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A058. Polyarthralgia, Raynaud's phenomenon; Thickened skin, with loss of normal folds; telangiectasia, pigmentation, depigmentation; Dysphagia; Restrictive lung disease; Pericarditis, heart block; Renal disease
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Q059. What labs do you see with scleroderma?
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A059. mild anemia; normal ESR; positive ANA; SCL-70; Anticentromere antibody (50% w/ CREST)
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Q060. How do you treat scleroderma?
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A060. Severe Raynaud's phenomenon - nifedipine, losartan; Esophageal reflux - H2 blockers, PPI, antacids; Bacterial overgrowth and pseudoobstruction - octreotide; Malabsorption d/t bacterial overgrowth - tetracycline
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Q061. True or False: Prednisone is commonly used in the treatment of scleroderma.
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A061. False
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Q062. What is Sjogren's Syndrome?
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A062. chronic dysfuction of exocrine glands
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Q063. What are the clinical findings of Sjogren's Syndrome?
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A063. keratoconjunctivitis; burning, itching, FB sensation in eye; Dry mouth; Loss of taste and smell; Parotid enlargement; Desiccation of nose, throat, larynx, vagina, skin; Dysphagia; Pancreatitis
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Q064. What labs do you see with Sjogren's syndrome?
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A064. Mild anemia; Leukopenia; Eosinophilia; Polyclonal hypergammaglobulinemia; Positive RF; ANA; Anti-SS-a and Anti-SS-b; Thyroid-associated autoimmunity; Schirmer test; Lip biopsy; Parotid gland biopsy
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Q065. What does a Schirmer test measure?
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A065. quantity of tears secreted
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Q066. How do you treat Sjogren's syndrome?
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A066. Supportive and symptomatic
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Q067. What drug can relieve xerostomia?
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A067. Pilocarpine
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Q068. People with Sjogren's are at risk for developing what?
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A068. lymphoma
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Q069. What is polymyalgia rheumatica?
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A069. pain and stiffness in neck, shoulder, and pelvic girdle
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Q070. What are the characteristics of polymyalgia rheumatica?
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A070. pain and stiffness in neck, shoulder, and pelvic girdle; symmetrical symptoms; more prolonged in the morning; low-grade fever, fatigue, weight loss
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Q071. Does PMR have muscle weakness?
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A071. No
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Q072. What labs do you see with polymyalgia rheumatica?
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A072. ESR and CRP elevated; Anemia and mild thrombocytosis
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Q073. How do you treat polymyalgia rheumatica?
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A073. Prednisone 10-20 mg/day for 6 months-2 years
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Q074. Know about Giant Cell Arteritis.
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A074. Symptoms; Treatment
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Q075. What is polyarteritis nodosa?
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A075. medium-sized necrotizing arteritis
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Q076. What can cause polyarteritis nodosa?
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A076. Idiopathic; Hep B or C; Drugs
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Q077. What drugs can cause polyarteritis nodosa?
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A077. PTU; Hydralazine; Allopurinol; Penicillamine; Sulfasalazine
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Q078. What are the signs and symptoms of polyarteritis nodosa?
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A078. fever, malaise, weight loss; pain in extremities; Foot drop; livedo reticularis; HTN
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Q079. What labs do you see in polyarteritis nodosa?
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A079. anemia; elevated ESR; Leukocytosis; Hep B or C
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Q080. How do you confirm a diagnosis of polyarteritis nodosa?
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A080. tissue biopsy
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Q081. How do you treat polyarteritis nodosa?
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A081. corticosteroids (up to 60mg/day); immunosuppressive agents (cyclophosphamide); refer to rheumatologist
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Q082. What is a complication of polyarteritis nodosa?
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A082. mesenteric vasculitis
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Q083. What is Reiter's syndrome?
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A083. Reactive arthritis
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Q084. What causes Reiter's syndrome?
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A084. dysentery - Shigella, Salmonella, Yersinia, Campylobacter; STD - Chlamydia
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Q085. What are the clinical findings of Reiter's syndrome?
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A085. Urethritis; Conjunctivitis; Mucocutaneous lesions; Aseptic arthritis; Fever, weight loss; Aortic regurgitation
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Q086. With Reiter's syndrome, what do you see on x-ray?
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A086. permanent or progressive joint disease (sacroiliac or peripheral joints)
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Q087. How do you treat Reiter's syndrome?
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A087. NSAIDS; antibiotics at time of infection; tetracycline; sulfasalazine; methotrexate; anti-TNF agents
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Q088. True or False: Once symptoms of Reiter's syndrome develop, antibiotics can reduce the severity of the disease.
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A088. False
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Q089. Sjogren's si/sx
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A089. triad - keratoconjuctivitis sicca, xerostomia, arthritis; also, pancreatitis, fibrinous pericarditis
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Q090. Sjogren's labs
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A090. + ANA, antiRo/antiLa abs, 70% RF +; a/w HLA-DR3
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Q091. Behcet's si/sx
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A091. 20 yo; oral/genital ulcers; uveitis, arthritis, other derm disease
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Q092. Dermatomyositis si/sx
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A092. young kids, old peeps; symmetric weakness of proximal muscles (can see dysphonia/dysphagia) look for trouble getting out of chair. skin involvement = heliotrope rash around eyes + periorbital edema
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Q093. Dermatomyositis labs
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A093. high ESR, high CPK, abnormal EMG, muscle biopsy --> inflammation + ANA
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Q094. Kawasaki's si/sx
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A094. <5 yo; truncal rash, fever >104x(>5d), conjunctival injection, cervical LAD, strawberry tongue, skin desquamation. -> coronary vessel vasculitis, aneurysms, MI
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Q095. Kawasaki Tx
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A095. NOT STEROIDS; aspirin + IVIG
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Q096. Polyarteritis nodosa si/sx
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A096. Associated with hepatitis B + cryoglobulinemia; fever, abdominal pain, weight loss, renal disorder, peripheral neuropathies.
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Q097. Polyarteritis nodosa labs
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A097. high ESR, leukocytosis, anemia, hematuria/proteinuria. Biopsy of medium-sized vessels --> vasculitis
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Q098. Scleroderma si/sx
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A098. C - calcinosis; R - raynaud's; E - esophageal dysmotility; S - sclerodactyly; T- telangectasia; heartburn, mask-like leathery facies.
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Q099. Scleroderma labs
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A099. Positive ANA; positive anticentromere Abs = CREST; positive antitopoisomerase = scleroderma
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Q100. What drugs can cause secondary SLE?
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A100. procainamide; hydralazine; dilantin (phenytoin); sulfanomide; INH
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Q101. What is the dx lab in secondary SLE?
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A101. Positive antihistone Abs
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Q102. What are the dx labs in SLE?
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A102. Positive ANA screen; positive antiSm or anti-ds-DNA
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Q103. What are other lab findings in SLE?
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A103. false positive for VDRL or RPR for syphilis; PTT falsely elevated; (SLE actually thrombogenic)
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Q104. Takayasu's arteritis si/sx
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A104. East Asian women 15-30yo; "pulseless" in 1 or both arms. carotid involve --> neuro sign, stroke; CHF
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Q105. Wegener's granulomatosis si/sx
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A105. old peep; nose bleeds, nasal perforation, hemoptysis, dyspnea, hematuria, ARF
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Q106. What's the diff between Wegener's and Goodpasture?
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A106. Weg = old peep, +ANCA; Goodpasture = young peep, positive antiglomerular antibody
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Q107. Polymyalgia Rheumatica si/sx
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A107. Women >50yo; Pectoral and pelvic girdles, neck involvement; a/w temporal arteritis
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Q108. Polymyalgia Rheumatica labs
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A108. Really high ESR; normal muscle biopsy/EMG
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Q109. Rheumatoid factor
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A109. It is an antibody against the Fc portion of IgG = RF & IgG form immune complexes. which is itself an antibody, IgM or IgA type.
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Q110. RF or RhF positive in:; is often determined in patients suspected in any form of arthritis
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A110. High levels RF: generally > 20 IU/mL; rheumatoid arthritis: present in 80%; Sjögren's syndrome: present in 60%
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Q111. false (+) RF or RhF; Blood test performed in patients with suspected rheumatoid arthritis (RA)
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A111. Chronic hepatitis; Any chronic viral infection; Leukemia; Dermatomyositis; Infectious mononucleosis; Scleroderma; Systemic lupus erythematosus (SLE)
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Q112. Sjögren's syndrome; * antibodies to Ro(SSA) or La(SSB) antigens, or both; * > 40 years old at the time of diagnosis & Woman >> Man
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A112. an autoimmune disorder in which immune cells attack and destroy the exocrine glands that produce tears and saliva with Schirmer test(+); A lip biopsy can reveal lymphocytes clustered around salivary gland
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Q113. Spondyloarthropathies
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A113. Group of related INFLAMMATORY JOINT Ds associated with the MHC class I molecule HLA-B27
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Q114. Seronegative spondylarthropathy
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A114. Spondylarthropathy & (-)rheumatoid factor (RhF)
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Q115. Non-specific spondylarthropathy
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A115. Indicator of other rheumatological disease (in particular rheumatoid arthritis)
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Q116. Subgroups (with increased HLA-B27 frequency)
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A116. ankylosing spondylitis Caucasians (AS, 92%),; ankylosing spondylitis African-Americans (AS, 50%),; reactive arthritis (Reiter's syndrome) (RS, 60-80%),; enteropathic arthritis associated with inflammatory bowel disease (IBD, 60%),; Psoriatic arthritis (60%),; isolated acute anterior uveitis (AAU, iritis or iridocyclitis, 50%), and; undifferentiated SpA (USpA, 20-25%).
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Q117. Buergers
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A117. thromboangiitis obliterans;; idiopathic, segmental, thrombosing vasculitis of intermed/small peripheral arteries and veins; seen in heavy smokers (tx- stop smoking)
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Q118. Buerger's findings
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A118. intermittent claudication, superficial nodular phlebitis, cold sensitivity, pain
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Q119. Takayasu's arteritis
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A119. pulseless disease;; granulomatous thickening of aortic arch and/or proximal great vessels;; associated with elevated ESR; primarily affects Asian females < 40 y/o
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Q120. Takayasu's sxs
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A120. fever,; arthritis,; night sweats,; myalgia,; skin nodules,; ocular disturbances,; weak pulses in upper extremities
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Q121. Temporal arteritis (giant cell)
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A121. most common vasculitis that affects medium and small arteries, usually branches of carotid; focal, granulomatous; unilateral HA, jaw claudication, impaired vision (occlusion of opthalmic artery- blindness); half of patients have systemic involvement and polymyalgia rheumatica; elevated ESR
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Q122. Temporal arteritis treatment
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A122. steroids
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Q123. young male smoker
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A123. buergers
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Q124. young asian female with weak pulses in upper extremities
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A124. takayasus
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Q125. PAN
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A125. necrotizing immune complex inflammation of medium sized muscular arteries typically involving renal and visceral vessels; sxs: weight loss, malaise, fever, abdominal pain, melena, HA, myalgia, HTN, neuro dysfunction, cutaneous eruptions
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Q126. PAN association
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A126. hep B;; multiple aneurysms and constrictions on arteriogram; not associated with ANCA (P maybe)
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Q127. Tx of PAN
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A127. corticosteroids, cyclophosphamide (hemorrhagic cystitis)
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Q128. Wegener's granulomatosis
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A128. traid of focal necrotizing vasculitis,; necrotizing granulomas in the lung and upper airway and necrotizing GN
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Q129. Wegener's sxs
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A129. perforation of nasal septum,; chronic sinusitis,; otitis media,; mastoiditis,; cough,; dyspnea,; hemoptysis,; hematuria; looks like goodpastures but upper respiratory tract is also involved
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Q130. findings in wegeners
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A130. CANCA,; CXR- may reveal large nodular densities,; hematuria and red cell casts; tx: cyclophosphamide, corticosteroids
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Q131. Churg Strauss
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A131. granulamatous vasculitis with eosinophilia;; involves lung, heart, skin, kidneys, and nerves; often seen in atopic pts; tx: steroids
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Q132. Kawasaki's disease
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A132. acute, self limiting disease of infants and kids;; acute necrotizing vasculitis of small/medium sized vessels; fever, congested conjunctiva, changes in lips/oral mucosa,; LAD, may develop coronary aneurysms,; skin rash,; strawberry tongue; tx: high dose aspirin
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Q133. HSP
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A133. most common childhood vasculitis;; skin rash (palpable purpura) below legs,; arthralgia,; intestinal hemorrhage,; abdominal pain,; melena
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Q134. telangiectasia
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A134. AV malformation in small vessels;; looks like dilated capillary; hereditary hemorrhagic telangiectasia-AD inheritance; presents with nosebleeds and skin discolorations
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Q135. What is arthrocentesis?
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A135. Arthrocentesis is a needle aspirate of synovial fluid for microscopic analysis. The cell count is the most accurate way of telling immediately if there is an infection versus inflammation. Counts from 0 to 2,000 are normal; from 2,000 to 20,000 are from inflammatory disorders such as gout. Counts above 50,000 are from infections. Counts between 20,000 and 50,000 are indeterminate.
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Q136. Anti-Scl-70
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A136. Scleroderma
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Q137. Anti- Microsomal; (2)
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A137. 1. Hashimoto's; 2. Autoimmune Hepatitis
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Q138. Anti-b islet cell
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A138. IDDM; type I diabetes
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Q139. Anti-Acetylcholine receptor
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A139. Myasthenia gravis
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Q140. Anti-Adrenal
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A140. Addison's
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Q141. Anti-Basement membrane
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A141. Goodpasture's
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Q142. Anti-Centromere
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A142. CREST
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Q143. Anti-ds DNA
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A143. SLE [specific]
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Q144. Anti-Epithelial
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A144. Pemphigus vulgaris
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Q145. Anti-Gliadin
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A145. Celiac disease
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Q146. Anti-Histone
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A146. Drug induced lupus
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Q147. Anti-IgM
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A147. Rheumatoid arthritis
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Q148. Anti-Intrinsic Factor
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A148. Pernicious anemia
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Q149. Anti-Mitochondrial
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A149. Primary biliary cirrhosis
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Q150. Anti-Neutrophil
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A150. Vasculitis
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Q151. c-ANCA
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A151. Wegener's granulomatosis
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Q152. p-ANCA
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A152. Polyarteritis nodosa
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Q153. Anti-Nuclear
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A153. SLE
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Q154. Anti-Thyroglobulin
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A154. Hashimoto's
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Q155. Anti-Thyroid peroxidase
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A155. Hashimoto's
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Q156. Anti-TSH receptor; (2)
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A156. Graves' or Hashimoto's
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Q157. Anti-Jo-1
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A157. Polymyositis;; dermatomyositis
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Q158. Anti-parietal cell
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A158. Pernicious anemia
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Q159. Anti-platelets
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A159. ITP
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Q160. Anti-smith
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A160. SLE
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Q161. B27
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A161. PAIR; Psoriasis,; Ankylosing spondylitis,; Inflammatory bowel diseas,; Reiter's syndrome
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Q162. B8
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A162. Graves Disease, Celiac Sprue
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Q163. DR2
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A163. Mulitple sclerosis,; hay fever,; SLE,; Goodpastures
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Q164. DR3
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A164. DM Type 1
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Q165. DR4
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A165. Rheumatoid Arthritis, DM Type 1
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Q166. DR5
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A166. Pernicious anemia = B12 deficiency,; Hashimoto's thyroiditis
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Q167. DR7
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A167. Steroid-response nephrotic syndrome
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Q168. Compartment Syndrome - What is it
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A168. Increased pressure in a confined space; compromises nerve, muscle & soft tissue perfusion; MC - ant. compartment of lower leg & forearm; causes – fractures, crush injuries, burns, ischemic- reperfusion after an injury, casts
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Q169. Compartment Syndrome - History/PE
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A169. The 6 P's:; Paresthesias; Palpation - tense compartment; Pallor; Poikilothermia; Pulselessness; Paralysis; Pain - out of proportion with passive motion of fingers & toes; Volkmann's contracture
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Q170. Compartment Syndrome - Dx
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A170. Measure compartment pressure - > 30 mmHg not good; delta pressure - diastolic minus compartment; should be > 30 to be OK
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Q171. Compartment Syndrome - Tx
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A171. Surgical emergency; immediate fasciotomy of all compartments; do in < 6 hrs.
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Q172. Low Back Pain - What is it
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A172. Paraspinous; strains - muscle injury; sprain - ligament injury
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Q173. Low Back Pain - History/PE
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A173. If malignancy - pain worse at night; pain not relieved by rest; pain not relieved by changing positions; if point tenderness over vertebral body – osteomyelitis, fracture, malignancy; cauda equina syndrome - bladder or bowel dysfunction, saddle-area anesthesia, impotence, surgical emergency
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Q174. Low Back Pain - L4 Associated Deficits:; Motor; Reflex; Sensory
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A174. Motor - foot dorsiflexion, tibialis anterior; reflex - patellar; sensory - medial aspect of leg
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Q175. Low Back Pain - L5 Associated Deficits:; Motor; Reflex; Sensory
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A175. Motor - big toe dorsiflexion, extensor hallucis longus; reflex - none; sensory - medial forefoot & lateral aspect of leg
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Q176. Low Back Pain - S1 Associated Deficits:; Motor; Reflex; Sensory
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A176. Motor - foot eversion; peroneus longus/brevis; reflex - achilles; sensory - lateral foot
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Q177. Low Back Pain - Dx
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A177. Mainly clinical; XR; MRI; electrodiagnostic studies - nerve conduction velocity test
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Q178. Low Back Pain - Tx
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A178. Sprains & strains - NSAIDs; physical therapy; continue activities as tolerated; rest > 1-3 days unnecessary. 90% recover spontaneously in 6 weeks; surgery - if correctable spinal disease, cauda equina syndrome - surgical emergency: immediate decompression, laminectomy
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Q179. Herniated Disk - What is it
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A179. Nucleus pulposus herniates posteriorly => nerve root or cord compression; neck/back pain; sensory & motor deficits; causes - degenerative changes, trauma, neck/back strain, neck/back sprain; middle-aged & older men after strenuous activity; L4-L5 & L5-S1
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Q180. Herniated Disk - History/PE
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A180. Several months of aching pain => sudden onset of severe, electricity-like LBP; pain exacerbated by straining; sciatica: tingling - lower extremities, numbness, muscle weakness, atrophy, contractions, spasms, pain increased by - passive straight leg, crossed straight leg raises, large midline herniations => cauda equina syndrome
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Q181. Herniated Disk - Dx
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A181. MRI
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Q182. Herniated Disk - Tx
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A182. Most cases - bed rest; NSAIDs; physical therapy; localized heat; resolved in 2-3 weeks; if no neuro deficit - bed rest not advised, early mobilization; muscle relaxant, NSAIDs; diskectomy - if persistent or disabling Sxs
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Q183. Spinal Stenosis - What is it
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A183. Stenosis of cervical or lumbar spinal canal => compression of nerve roots; usually from degenerative joint disease; middle-aged or elderly
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Q184. Spinal Stenosis - History/PE
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A184. Neck pain; back pain - radiates to butt & legs, leg numbness, leg weakness, "spaghetti legs", "walks like a drunken sailor"; leg cramping - at rest, standing, walking; sitting gives relief; leaning forward gives relief (flexing at hips decreased pain)
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Q185. Spinal Stenosis - Dx
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A185. XR; MRI or CT
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Q186. Spinal Stenosis - Tx
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A186. Mild to moderate - NSAIDs; abdominal muscle strengthening; advanced - epidural steroid injection; surgical laminectomy - short-term, will recur
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Q187. Developmental Dysplasia of Hip; What is it
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A187. Congenital hip dislocation => dislocated femoral heads due to - lax musculature; excessive uterine packing (breech) => poor development of acetabulum, hip; will progress if not corrected; MC - 1st born breech females
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Q188. Developmental Dysplasia of Hip; History/PE
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A188. Barlow's - hip adducted; Ortolani's - thighs abducted; Allis' (Galeazzi's) sign - knees unequal when hip & knees flexed, dislocated side is lower; asymmetrical skin folds; limited abduction of affected hip
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Q189. Developmental Dysplasia of Hip; Dx
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A189. Early detection; evaluate clinical; US - if after 10 weeks old; XR - unreliable until 4 mos. old, neonatal femoral head radiolucent
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Q190. Developmental Dysplasia of Hip; Tx
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A190. Start Tx early; < 6 mos. - Pavlik harness; 6-15 mos. - spica cast; 15-24 mos. - open reduction; if no Tx started by 24 mos. - significant defect
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Q191. Developmental Dysplasia of Hip; Complications
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A191. Complications - joint contractures; AVN of femoral head
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Q192. Limp - What is it
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A192. 1 of the MC musculoskeletal disorder of kids; MC cause - trauma
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Q193. Limp - History/PE
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A193. May be associated with pain or fever; ask about - history of trauma, recent infections, contact with TB- positive patients; young kids & toddlers - infected joint; adolescent & teens – JRA, slipped capital femoral epiphyses (SCFE), Legg-Calve-Perthes (LCP); disruption in normal gait – Trendelenburg, antalgic gait; infection – erythema, edema, limited ROM; trauma or tumor - point tenderness; always evaluate for – fever, signs of systemic infection, neuro involvement – reflexes, muscle atrophy, changes in sensation, bowel & bladder function
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Q194. Limp - Differential Dx
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A194. STARTSS HOTT; Septic joint; Tumor; Avascular necrosis (LCP); RA/JRA; TB; Sickle cell disease; SCFE; HSP; Osteomyelitis; Trauma; Toxic synovitis
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Q195. Limp - Dx
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A195. Thorough H&P; XR; CBC; ESR; CRP; bone scan; nerve conduction studies; joint aspirate & culture - if suspect septic joint
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Q196. Limp - Tx
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A196. Depends on cause
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Q197. Legg-Calve-Perthes - What is it
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A197. AVN of femoral head; UNK etiology; boys 4-10; can be bilateral
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Q198. Legg-Calve-Perthes - History/PE
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A198. Usually asymptomatic at first => painless limp or => pain, referred to knee; limited abduction; limited internal rotation; atrophy
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Q199. Legg-Calve-Perthes - Tx
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A199. Self-limited; observation; if disease extensive or ROM impaired – brace, hip abduction with Petrie cast, osteotomy; prognosis dependent on – age, ROM, extent of involvement, joint stability
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Q200. Slipped Capital; Femoral Epiphysis - What is it
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A200. Separation of proximal femoral epiphysis through growth plate => fem head displaced; medial & posterior to fem neck; can be bilateral; obese Black 11-13 y/o boys; if < 11 y/o, may be associated with endocrinopathies; may be due to imbalance between GH & sex hormones
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Q201. Slipped Capital; Femoral Epiphysis - History/PE
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A201. Thigh or knee pain; painful limp; acute or insidious; acute - restricted ROM, inability to bear weight. limited internal rotation; limited abduction; hip tenderness; flexion => obligatory external rotation
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Q202. Slipped Capital; Femoral Epiphysis - Dx
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A202. TSH; XR both hips – AP, frog-leg lat
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Q203. Slipped Capital; Femoral Epiphysis - Tx
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A203. Start promptly; no weight on limb until; surgical stabilized with screws; acute slip - gentle closed reduction
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Q204. Slipped Capital; Femoral Epiphysis - Complications
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A204. Chondrolysis; AVN of fem head; premature hip OA => hip arthroplasty
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Q205. Shoulder Dislocation - Mechanics
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A205. MC - anterior dislocation, axillary artery & nerve, hold arm in external. rotation; posterior dislocations, radial artery, seizures & electrocutions, hold arm in int. rotation
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Q206. Shoulder Dislocation - Tx
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A206. Closed reduction; followed by sling & swath; recurrent - surgery
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Q207. Hip Dislocation - Mechanics
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A207. MC - posterior dislocation, compress sciatic nerve., can cause AVN, posterior directed force on, internal rotated, flexed, adducted hip, "dashboard injury"; anterior dislocation - obturator nerve compromises.
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Q208. Hip Dislocation - Tx
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A208. Closed reduction followed by abduction; pillow/bracing; CT after reduction
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Q209. Colles' Fracture - Mechanics
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A209. MC wrist fracture; distal radius; fall onto outstretched hand => dorsally displaced/angle Fracture; common in elderly (osteoporosis), kids
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Q210. Colles' Fracture - Tx
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A210. Closed reduction; then long arm cast; intra-articular - open reduction
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Q211. Scaphoid (Carpal Navicular) Fracture; Mechanics
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A211. MC fractured carpal bone; can be 1-2 weeks for XR to show; assume if tenderness in anatomical snuff box; proximal 3rd scaphoid fractures can => AVN
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Q212. Scaphoid (Carpal Navicular) Fracture; Tx
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A212. Thumb spica cast; open reduction - displacement; nonunion common
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Q213. Boxer's Fracture - Mechanics
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A213. Fracture of 5th metacarpal neck; forward trauma of closed fist
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Q214. Boxer's Fracture - Tx
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A214. Closed reduction & ulnar gutter splint; excessive angulation - percutan pinning; skin broken - assume infection by human oral pathogens; "fight bite"; surgical irrigation; debridement; IV Antibiotics to cover Eikenella
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Q215. Humerus Fracture - Mechanics
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A215. Direct trauma; radial nerve. wrist drop; loss of thumb abduction
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Q216. Humerus Fracture - Tx
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A216. Hanging arm cast or coaptation splint & sling; functional bracing
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Q217. Nightstick Fracture - Mechanics
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A217. Ulna shaft fracture; from self-defense - arm against blunt object
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Q218. Nightstick Fracture - Tx
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A218. ORIF; open reduction & int. fixation
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Q219. Monteggia's Fracture - Mechanics
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A219. Diaphyseal Fracture; proximal ulnar; subluxation of radial head
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Q220. Monteggia's Fracture - Tx
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A220. ORIF - shaft fracture; closed reduction - radial head
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Q221. Galeazzi's Fracture - Mechanics
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A221. Diaphyseal Fracture; radius; dislocation of distal radioulnar joint; from direct blow to radius
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Q222. Galeazzi's Fracture - Tx
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A222. ORIF - radius; cast forearm in supination
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Q223. Hip Fracture - Mechanics
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A223. MC in osteoporotic women who fall; shortened, ext rotated leg; at risk for DVTs; displaced fem neck fractures - high risk of AVN, fracture nonunion
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Q224. Hip Fracture - Tx
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A224. ORIF; parallel pinning of femoral neck; anticoagulant; > 80 y/o - may need hip hemiarthroplasty
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Q225. Femur Fracture - Mechanics
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A225. Direct trauma (MVA); fat emboli; fever; scleral & axillary petechiae; confusion; dyspnea; hypoxia
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Q226. Femur Fracture - Tx
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A226. Intramedullary nailing; open fractures - thorough irrigation; debridement
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Q227. Tibial Fracture - Mechanics
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A227. Direct trauma; car bumper & pedestrian injury; compartment syndrome
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Q228. Tibial Fracture - Tx
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A228. Casting vs. intramedullary nailing
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Q229. Open Fracture - Mechanics
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A229. Orthopedic emergency; must go to OR in < 6 hrs. (risk of infection)
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Q230. Open Fracture - Tx
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A230. OR emergently to repair; Antibiotics
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Q231. Achilles Tendon Rupture - Mechanics
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A231. MC in unfit men in sports; hear sudden "pop"; sounds like rifle shot; limited plantar flexion; pos Thompson test - pressure on gastrocnemius; doesn't => ft plantar flexion
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Q232. Achilles Tendon Rupture - Tx
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A232. Long-leg cast for 6 wks
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Q233. ACL Injury - Mechanics
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A233. From forced hyperflexion; positive anterior drawer sign; Lachman's test; rule out meniscal or MCL injury
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Q234. ACL Injury - Tx
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A234. Surgery; graft from patellar or hamstring tendons
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Q235. PCL Injury - Mechanics
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A235. From forced hyperextension; positive posterior drawer test
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Q236. PCL Injury - Tx
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A236. Operative PCL repair - for highly competitive athlete
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Q237. Meniscal Tears - Mechanics
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A237. Clicking or locking; joint line tenderness; positive McMurray's test
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Q238. Meniscal Tears,; MCL/LCL Injuries - Tx
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A238. Conservative; unless associated with Sxs or ligament injuries
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Q239. Clavicular Fracture - What is it
|
A239. MC fractured long bone in kids; birth-related (lg infants); brachial n. palsies; usually middle 3rd of clavicle; proximal end displaced superiorly; from pull of sternocleidomast
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Q240. Clavicular Fracture - Tx
|
A240. Figure-of-8 sling vs. arm sling
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Q241. Greenstick Fracture - What is it
|
A241. Incomplete fracture; cortex of one side of bone
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Q242. Greenstick Fracture - Tx
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A242. Reduction with casting; order films at 7-10 days
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Q243. Nursemaid's Elbow - What is it
|
A243. Radial head subluxation; from being pulled or lifted by hand; kid will not bend elbow
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Q244. Nursemaid's Elbow - Tx
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A244. Manual reduction - gentle supination of elbow; at 90 degrees of flexion; no immobilization necessary.
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Q245. Torus Fracture - What is it
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A245. Buckling of cortex of long bone; secondary to trauma; usually distal radius or ulna
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Q246. Torus Fracture - Tx
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A246. Cast immobilization; 3-5 wks - dep. on age
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Q247. Supracondylar Humerus Fracture - What is it
|
A247. 5-8 y/o; proximal to brachial a. risk of Volkmann's contracture
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Q248. Supracondylar Humerus Fracture - Tx
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A248. Cast immobilization; closed reduction; percutan pinning - if significant displaced
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Q249. Osgood-Schlatter Disease - What is it
|
A249. Overuse apophysitis of tibial tubercle; localized pain; especially with quadriceps Ctx; active young boys
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Q250. Osgood-Schlatter Disease - Tx
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A250. Decreased activity 1-2 yrs; neoprene brace
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Q251. Salter-Harris Fractures - What are they
|
A251. Fractures of growth plate of kids; classified by fracture location; I - physis; II - metaphysis & physis; III - epiphysis & physis; IV - epi-, meta- & physis; V - crush injury of physis
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Q252. Salter-Harris Fractures - Tx
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A252. I & II - nonoperatively; others & unstable fractures-operatively; prevents leg-length inequality
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Q253. Osteosarcoma - What is it
|
A253. 2nd MC primary malignant; bone tumor; metaphyses - distal femur; proximal tibia; proximal humerus; can metas to lungs; men; 20s-30s; Paget's can precede development of secondary osteosarcoma
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Q254. Osteosarcoma - History/PE
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A254. Progressive pain => intractable pain; worse at night; constitutional Sxs; at site of tumor - erythema; enlargement
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Q255. Osteosarcoma - Dx
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A255. MRI; CT; XR - Codman's triangle, sunburst pattern
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Q256. Osteosarcoma - Tx
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A256. Limb-sparing surgical proc; pre- and postop chemo – methotrexate, doxorubicin, cisplatin, ifosfamide; amputation - may be necessary if big
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Q257. Paget's (Osteitis Deformans) - What is it
|
A257. Osteoclasts accelerate bone turnover in local areas => hyper osteoblastic repair => abnorm structure that weakens bone; may be associated with paramyxovirus infection; mainly disease of elderly
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Q258. Paget's (Osteitis Deformans) - History/PE
|
A258. Often asymptomatic; if Sx occur, develop insidiously; deep bone pain; bone softening => tibial bowing, kyphosis, freq fractures; increased in cranial diameter - (frontal bossing); deafness - CN8 compressed
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Q259. Paget's (Osteitis Deformans) - Dx
|
A259. Alkaline phosphatase; increased urinary hydroxyproline; serum Ca2+ & phosphate- normal; XR - bony cortex very expanded, jigsaw/mosaic bone pattern, thick trabeculae
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Q260. Paget's (Osteitis Deformans) - Tx
|
A260. NSAIDs; calcitonin; alendronate
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Q261. Paget's (Osteitis Deformans) - Complications
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A261. Fracture; hi-output cardiac failure; arthritis; deafness; secondary osteosarcoma; vertebral collapse => spinal cord compression
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Q262. Gout - What is it
|
A262. Recurrent attacks - acute monoarticular arthritis; monosodium urate crystals; middle-aged, obese men, Pacific Islanders; hyperuricemia - secondary to uric acid underexcretion; other causes - Lesch-Nyhan, diuretics (furosemide, HCTZ), trauma, surgery, infections, steroid withdrawal, cyclosporine, malignancy, excessive red meat or red wine, hemoglobinopathies
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Q263. Pseudogout - What is it; Dx; Tx
|
A263. MC - elderly or preexisting joint damage; if < 50 y/o - metabolic abnorm, hyperparathyroidism, hypophosphatasia, hypomagnesemia, hemochromatosis; knee - #1, also ankle, wrist, shoulder; Dx - fluid aspiration, Positive birefringent rhomboid crystals; XR - chondrocalcinosis; Tx - same as gout; low dose of colchicine - prevents recurrence
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Q264. Gout - History/PE
|
A264. 1st episode - awakened from sleep; sudden onset of joint pain; podagra; usually 1st MTP joint, knee, ankle, DIP & PIP; joint – erythematous, swollen, tender; as becomes chronic - multiple joints involved; urate crystals deposited in connective tissue (tophi), kidneys
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Q265. Gout - Dx
|
A265. Joint-fluid aspirate - needle-shaped, negative birefringent crystals; yeLLow when paraLLel to condenser; increased WBC; advanced - "rat bite" = punched-out erosions - of long- standing tophus, "overhanging margin"
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Q266. Gout - Tx
|
A266. Acute - decrease inflammation; NSAIDs (indomethacin); IV colchicine or steroids - if elderly maintenance - decrease uric acid level:; probenecid if underexcrete, inhibits reabsorb of uric acid; allopurinol if overproduce or have RF or have kidney stones, can precipitate acute attack
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Q267. Osteoarthritis - What is it; Risk Factors
|
A267. Degen joint disease; deterioration of articular cartilage of moveable, weight- bearing joints; MCC- idiopathic; secondary - any diseases that causes stress or trauma to joint; knee OA - MCC of chronic disability in elderly in West; risk factors – obesity, family History, history of joint trauma; especially intra-articular fractures, repetitive stress
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Q268. Osteoarthritis - History/PE
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A268. History - joint stiffness - insidious onset; pain - insidious onset; worse by activity & weight-bearing; relieved by rest; crepitus; decreased ROM; PE - weight-bearing joint involved; DIP - heberden nodes; PIP - bouchard nodes; MTP joint of 1st toe; cervical spine
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Q269. Osteoarthritis - Dx
|
A269. Based on clinical & XR; XR - irregular joint space narrowing, osteophytes, subchondral sclerosis, subchondral bone cysts; ESR normal; synovial fluid aspiration - straw-colored fluid, normal viscosity, WBC < 3000
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Q270. Osteoarthritis - Tx
|
A270. Weight reduction; physical therapy; NSAIDs; intra-articular corticosteroid injections; elective joint replacement - total hip/knee arthroplasty
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Q271. Duchenne Muscular Dystrophy - What is it; What is Becker's
|
A271. XLR; defect of dystrophin - cytoskeletal protein; MC muscular dystrophy; most lethal; ages 2-6; Becker – milder, XLR, abnormal-sized dystrophin
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Q272. Duchenne Muscular Dystrophy - History/PE
|
A272. History - axial and proximal before distal muscles; progressive clumsiness; fatigability; hard to stand or walk; hard to walk on toes; waddling gait; Gower's maneuver; PE - pseudohypertrophy of gastrocnemius; possible MR
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Q273. Duchenne Muscular Dystrophy - Dx
|
A273. CK - always high; EMG; muscle Biopsy; DNA; diagnostic - immunostain for dystrophin
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Q274. Duchenne Muscular Dystrophy - Tx
|
A274. No cure; Tx supportive; physical therapy; achilles tendon release; wheelchair by 13 y/o; death in 20s
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Q275. what is the defect in Bruton's agammaglobulinemia?
|
A275. X-linked recessive defect in a tyrosine kinase gene associated with low levels of all classes of Igs
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Q276. this disorder occurs in boys and is associated with recurrent bacterial infections after 6 months of age, when levels of maternal IgG antibody decline
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A276. Brutons agammaglobulinemia (B cells)
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Q277. this immune deficiency presents with tetany owing to hypocalcemia and recurrent viral and fungal infections
|
A277. DiGeorge syndrome/thymic aplasia (T cells)
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Q278. this immune deficiency is associated with congenital defects of heart and great vessels
|
A278. DiGeorge syndrome
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Q279. what ist eh chromosomal abnormality associated with DiGeorge syndrome?
|
A279. 22q11 deletion
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Q280. this is a defect in early stem cell differentiation and presents with recurrent viral, bacterial, fungal, and protozoal infections
|
A280. SCID - B and T cell deficiency
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|
|
Q281. failure to synthesize MHC II antigens, defective IL-2 receptors, and adenosine deaminase deficiency can all lead to what immune deficiency?
|
A281. SCID
|
|
|
Q282. what does IL-12 receptor deficiency (decreased activation of T cells) present with?
|
A282. disseminated mycobacterial infections
|
|
|
Q283. defect in CD40 ligand on CD4 T helper cells leads to inability to class switch; presents early in life with severe pyogenic infections
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A283. hyper-IgM syndrome (decreased activation of B cells)
|
|
|
Q284. this disorder is characterized by high levels of IgM and very low levels of IgG, IgA, and IgE
|
A284. hyper-IgM syndrome
|
|
|
Q285. this syndrome is characterized by an X-linked defect in the ability to mount an IgM response to capsular polysaccharides of bacteria
|
A285. Wiskott-Aldrich syndrome (decreased activation of B cells)
|
|
|
Q286. what is the triad of symptoms associated with Wiskott- Aldrich syndrome?
|
A286. infections, thrombocytopenic purpura, eczema (WIPE)
|
|
|
Q287. this syndrome is associated with elevated IgA levels, normal IgE levels, and low IgM levels
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A287. Wiskott-Aldrich syndrome
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|
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Q288. this syndrome presents with recurrent 'cold' (noninflamed) staphylococcal abscesses, eczema, coarse facies, retained primary teeth, and high IgE levels
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A288. Job's syndrome (decreased activation of macrophages)
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|
|
Q289. this syndrome is characterized by failure of gamma- interferon production by helper T cells; neutrophils fail to respond to chemotactic stimuli
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A289. JOb's syndrome
|
|
|
Q290. what is the defect in leukocyte adhesion deficiency syndrome?
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A290. defect in LFA-1 adhesion proteins on phagocytes
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|
|
Q291. this syndrome presents early with severe pyogenic and fungal infections and delayed separation of umbilicus
|
A291. leukocyte adhesion deficiency syndrome
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|
|
Q292. how is Chediak-Higashi inherited?
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A292. autosomal recessive
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|
|
Q293. this disease is marked by a defect in microtubular function and lysosomal emptying of phagocytic cells
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A293. Chediak-Higashi disease
|
|
|
Q294. this disease presents with recurrent pyogenic infections by staph and strep, partial albinism, and peripheral neuropathy
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A294. Chediak-Higashi disease
|
|
|
Q295. defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes
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A295. chronic granulomatous disease
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|
|
Q296. how is the diagnosis of chronic granulomatous disease confirmed?
|
A296. negative nitroblue tetrazolium dye reduction test
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|
|
Q297. this disease presents with marked susceptibility to opportunistic infections with bacteria, especially S. aureus, E. coli, and Aspergillus
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A297. chronic granulomatous disease
|
|
|
Q298. what is the defect in chronic mucocutaneous candidiasis present?
|
A298. idiopathic dysfunction of T cells specifically against candida albicans
|
|
|
Q299. what is the most comon selective immunoglobulin deficiency? how does it present?
|
A299. selective IgA deficiency - presents with sinus and lung infections;; milk allergies and diarrhea are common
|
|
|
Q300. ataxia-telangiectasia is an idiopathic dysfunction of what type of cells?
|
A300. B cells
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|
|
Q301. defect in DNA repair enzymes with associated IgA deficiency; presents with cerebellar problems and spider angiomas
|
A301. ataxia-telangiectasia
|
|
|
Q302. deficiency of what leads to hereditary angioedema?
|
A302. C1 esterase inhibitor
|
|
|
Q303. deficiency of which complement protein leads to severe, recurrent, pyogenic sinus and RT infections?
|
A303. C3
|
|
|
Q304. deficiency of what complement proteins leads to Neisseria bacteremia?
|
A304. C6-C8
|
|
|
Q305. deficiency of what leads to paroxysmal nocturnal hemoglobinuria?
|
A305. decay-accelerating factor
|
|
|
Q306. patients with what deficiency have an increased susceptibility to recurrent bacterial infections, especially with encapsulated bacteria
|
A306. C3 deficiency;; not detected until later in life
|
|
|
Q307. what is the most important immunological protective mechanism against blood-borne encapsulated organisms?
|
A307. IgG-mediated opsonization in the spleen
|
|
|
Q308. Warthin-Finkeldy giant cell is pathognomonic for what?
|
A308. measles or the live attenuated measles vaccine
|
|
|
Q309. Lyme arthritis is associated with what HLA?
|
A309. HLA-DR4
|
|
|
Q310. patients with Wiskott-Aldrich syndrome have a 12% chance of developing what?
|
A310. non-Hodgkin's lymphoma
|
|
|
Q311. test of choice to determine presence of circulating anti-Rh antibody?
|
A311. indirect Coombs test to measure IgG anti-Rh antibody
|
|
|
Q312. low levels of all antibody classes
|
A312. common variable immunodeficiency
|
|
|
Q313. spleen is important for removing what type of organisms? list 3
|
A313. strep pneumo,; H. flu,; Neisseria
|
|
|
Q314. what is defective in leukocyte adhesion deficiency?
|
A314. integrins - function both in adhesion of leukocytes to other cells and in the phagocytosis of complement-coated material
|
|
|
Q315. HLA types associated with SLE?
|
A315. HLA-DR2 and HLA-DR3
|
|
|
Q316. most likely sequelae of rheumatic fever?
|
A316. mitral valve disease
|
|
|
Q317. antitopoisomerase antibodies?
|
A317. scleroderma/systemic fibrosis - likely to develop diffuse systemic fibrosis & death from consequences of systemic disease such as pulmonary fibrosis or malignant hypertension
|
|
|
Q318. what is responsible for strong binding between monocytes, T lymphocytes, macrophages, neutrophils, and dendritic cells, and injured epithelium?
|
A318. LFA-1; interacts with ICAM-1
|
|
|
Q319. an increased level of what cytokine would decrease the likelihood of a delayed-type hypersensitivity reaction?
|
A319. IL-10
|
|
|
Q320. what 2 molecules exert the most powerful chemotactic effect on neutrophils?
|
A320. C5a and C8
|
|
|
Q321. what are the best markers for identification of B cells?
|
A321. CD19, CD20, CD21
|
|
|
Q322. IgG subclass deficiency is associated with a deficiency with what other substrate?
|
A322. IgA
|
|
|
Q323. what is C-reactive protein a marker of?
|
A323. non-specific inflammation - one of the most commonly measured acute-phase reactants
|
|
|
"stuck-on" appearance
|
seborrheic keratosis
|
|
|
red plaques with silvery-white scales and sharp margins
|
psoriasis
|
|
|
the most common type of skin cancer; the lesion is a pearly-coated papule with a translucent surface and teleangiectasias
|
basal cell carcinoma
|
|
|
honey-crusted lesions
|
impetigo
|
|
|
febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity
|
cellulitis
|
|
|
positive Nikolskys sign
|
pemphigus vulgaris
|
|
|
negative Nikolskys sign
|
bullous pephigoid
|
|
|
a 55 year old obese patient presents with dirty, velvety patches on the back of the neck
|
acanthosis nigricans --> check fasting blood sugar to rule out diabetes
|
|
|
dermatomal distribution
|
varicella zoster
|
|
|
flat-topped papules
|
lichen planus
|
|
|
iris-like target lesions
|
erythema multiforme
|
|
|
a lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry
|
contact dermatitis
|
|
|
presents with a herald patch, Christmas-tree like pattern
|
pityriasis rosea
|
|
|
a 16 year old presents with an annular patch of alopecia with broken-off, stubby hairs
|
alopecia areata (autoimmune process)
|
|
|
pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-meatballs" appearance
|
pityriasis versicolor
|
|
|
four characteristics of a nevus suggestive of melanoma
|
asymmetry, border irregularity, color variation, large diameter
|
|
|
premalignant lesion fro sun exposure that can lead to squamous cell carcinoma
|
actinic keratosis
|
|
|
"dew-drop on a rose petal"
|
lesions of 1st degree varicella
|
|
|
"cradle cap"
|
seborrheic dermatitis; treat with antifungals
|
|
|
associated with propionbacterium acnes and changes in androgen levels
|
acne vulgaris
|
|
|
a painful, recurrent, vesicular eruption of mucocutaneous surfaces
|
herpes simplex
|
|
|
inflammatoin and epithelial thinning of anogenital area, predominantly in postmenopausal women
|
lichen sclerosis
|
|
|
exophytic nodules on the skin with varying degrees of scaling ulceration; the second most common type of skin cancer
|
squamous cell carcinoma
|
|
|
what vitamin do you supplement for a measles infection?
|
vitamin A
|
|
|
normal skin at birth that gradually progresses to dry, scaley skin = ??
|
ichthyosis vulgaris, aka lizard skin
|
|
|
dry, rough skin over extensor surfaces + horny plates = ??
|
ichthyosis
|
|
|
what vitamin supplement should be give for measles?
|
vitamin A
|
|
|
normal birth at skin that gradually progresses to dry, scaley skin = ??
|
ichythyosis vulgaris, aka lizard skin
|
|
|
dry, rough skin over extensor surfaces + horny plates = ??
|
ichthyosis
|
|
|
virus that causes measles
|
paramyxovirus
|
|
|
name of red spots with bluish specks over buccal mucosa and what disease it is associated with?
|
Koblik spots, measles
|
|
|
cough + coryza + conjunctivitis = ??
|
measles
|
|
|
well-circumscribed areas of depigmentation over arms/legs
|
vitiligo
|
|
|
autoimmune disease that attacks melanocytes and is associated with other AI diseases?
|
vitiligo
|
|
|
most common metal causing contact dermatitis
|
nickel
|
|
|
how do you rule out melanoma?
|
excisional biopsy
|
|
|
if a melanoma is >1mm deep what else must you do besides excise it?
|
sentinal lymph node study
|
|
|
poison ivy is what type of hypersensitivity exposure and what causes it? does it require prior exposure?
|
type IV hypersensitivity, cell-mediated which means you need prior exposure
|
|
|
what causes molluscum contagiosum?
|
pox virus
|
|
|
best method for photo-protection (avoiding sun burn)
|
sun avoidance
|
|
|
numerous umbilicated vesicles over healing atopic dermatitis = ??
|
eczema herpeticm
|
|
|
name the SIRS criteria
|
1. fever/hypothermia2. tachypnea3. tachycardia4. leukocytosis, leukopenia or bandemia
|
|
|
what is the normal course for impetigo?
|
erythmatous macule --> vesicle --> pustule --> honey-colored, crusted exudates
|
|
|
what causes hereditary angioedema?
|
C-1 inhibitor deficiency
|
|
|
what virus causes rubella?
|
RNA togovirus
|
|
|
what is the chronology for rubella?
|
1. exposure2. fever, malaise3. suboccipital adenitis4. maculopapular rash on face then trunk and extremities
|
|
|
treatment for tinea corporis
|
terbinafine
|
|
|
most common viral infection of hand
|
herpetic whitlow; common in healthcare workers
|
|
|
most common cause of acquired angioedema
|
ACEI use
|
|
|
what dermatological disorder is commonly seen with Parkinsons?
|
seborrheic dermatitis
|
|
|
which types of hypersensitivity are anti-body mediated?
|
types I, II, III
|
|
|
name the different types of hypersensitivity?
|
type I - anaphylactic, atopictype II - cytotoxictype III - immune complex, serum sickness, arthus reactiontype IV - delayed, cell-mediated
|
|
|
polygonal + purples + pruritic + papules = ??
|
lichen planus
|
|
|
what type of hypersensitivity is psoraisis?
|
T-cell mediated
|
|
|
yellow, greasy, erythematous scaling patches/plaques = ??
|
seborrheic dermatitis
|
|
|
young person with severe seborrheic dermatitis --> what must you rule out?
|
HIV
|
|
|
what BSA defines Stevens-Johnsons and what is the treatment?
|
<10% BSA, treat with analgesia and IVIG
|
|
|
what skin disorder is commonly associated with other autoimmune disorders?
|
vitiligo
|
|
|
what is the most common cause of cellulitis and what is the treatment of choice?
|
staph, treat with keflex
|
|
|
what causes hot tub folliculitis?
|
pseudomonas aeruginosa
|
|
|
what is a kerion?
|
inflammatory granulomatous reaction in children to tinea capitus
|
|
|
bullseye rash
|
Lyme disease
|
|
|
treatment for lice
|
permethrin shampoo
|
|
|
dome-shaped with central umbilication
|
molluscum contagiosum
|
|
|
christmas-tree pattern with herald patch
|
pityriasis rosea (HHV-6)
|
|
|
what causes cervical CA?
|
usually HPV 16, 18, 31, 33
|
|
|
Shagreen patches with ashleaf spots
|
tuberous sclerosis
|
|
|
cafe-au-lait spots
|
neurofibromatosis
|
|
|
hemangioma/port-wine stain on face
|
Sturge-Weber syndrome
|
|
|
what are hemangiomas often indicative of?
|
von Hippel-Lindau disease
|
|
|
what is the sign of Leser-Trelat?
|
multiple seborrheic keratoses erupting at once associated with underlying malignancy, often gastric cancer
|
|
|
most common skin CA associated with sun exposure
|
basal cell CA
|
|
|
ABCD of melanoma
|
Asymmetric shapeBorders irregularColor variationDiameter >6mm
|
|
|
what are strawberry hemangiomas and what do they indicate?
|
they are benign vascular tumors of children that usually regress on their own at 5-8 years old
|
|
|
what rash on the body does not appear scaly but will scale with scraping?
|
tinea versicolor
|
|
|
rosey-hue with teleangiectasias over cheeks, nose, chin
|
rosacea
|
|
|
treatment for moderate to severe acne, predominantly nodulocystic and firm
|
oral isotretinoin
|
|
|
what nail problems is psoriasis associated with?
|
onycholysis and nail pitting
|
|
|
what is erysipelis? what bacteria commonly causes it?
|
commonly seen in patients with impaired lymph drainage who develop a rash that looks like "orange peels"; caused by strep pyogenes
|
|
|
what are strong risks for a mole that is maligant?
|
changes in size/shape/color/borders
|
|
|
what anesthestic is used for suturing vessel-rich areas?
|
1% lido with 1:100,000-1:400:000 epi
|
|
|
what rash do you need to look for with warfarin?
|
look for warfarin-induced necrosis that can occur within 1 week of beginning warfarin therapy; well-demarcated erythematous lesion that progresses to necrosis
|
|
|
what is bullous pemphigoid? what do you see on immunoflorescence?
|
it is an autoimmune bullous disorder in patients over 60 that present with wide-spread blistering over flexor and perianal surfaces; immunoflorescence will show epidermal basement membrane antibodies
|
|
|
what is the most important factor in determining the resectable margins with a melanoma?
|
depth of the tumor
|
|
|
what is the most effective means to prevent death from melanoma?
|
early clinical detection
|
|
|
what is the most preventable risk factor for developing melanoma?
|
chronic sun exposure
|
|
|
what condition presents as a macular scaling behind the ears, on the scalp, eyebrow, nasal-labial folds? who commonly gets it?
|
serborrheic dermatitis; common with patients that have neurological disorders or HIV
|
|
|
what presents with erythematous plaques with silvery-white scales on the extensor surfaces?
|
psoriasis
|
|
|
what solution should be given during the first 24 hours following a burn injury?
|
lactated ringers
|
|
|
what is pemphis vulgaris? what do you see on immunoflorescence?
|
it is an autoimmune disease of the skin that presents with painful, fragile blisters of the oropharynx, chest, face and perianal regions; look for antibodies to adhesion desmoglein molecules
|
|
|
this disease results from a deficiency of hepatic uroporphyinogen decarboxylase and presents with chronic blistering of sun exposed regions and skin hyperpigmentation? who is it associated with?
|
porphyria cutanea tarda; seen with alcoholics and hepatitis
|
|
|
this disease presents with vesicular lesions and crusting erythematous plaques over the genital region, chest, neck and axilla with an malodorous discharge
|
familial benign pemphigus
|
|
|
what is Groves disease?
|
it is a transient acantholytic dermatosis in men >50; appears as small red papules on back/chest |
|
|
Where does atopic dermatitis present in infants?
|
Face, scalp, extensor surfaces. Diaper area is spared
|
|
|
What is the treatment for atopic dermatitis?
|
Topical steroids- but not longer than 2-3 weeks
|
|
|
How does seborrheic dermatitis present in an infant?
|
Red diaper rash with yellow scale, erosions, and blisters. A thick crust may be seen on the scalp.
|
|
|
What kind of people can develop severe seborrheic dermatitis?
|
HIV and Parkinson's patients
|
|
|
How do you treat seborrheic dermatitis?
|
Selenium sulfide or zinc pyrithione shampoos for the scalp; Topical antifungals or steroids for other areas in adults
|
|
|
When does a drug eruption occur?
|
7-14 days after exposure
|
|
|
What is erythema multiforme?
|
Targetoid lesions that can be on the palms and soles and associated with systemic symptoms. Can lead to TEN or SJS
|
|
|
What is erythema nodosum?
|
Panniculitis that can be triggered by infection (STREP, histo, cocci, yersinia, TB), drug reactions (sulfonamides, OCPs, abx), and chronic inflammatory disease (IBD, sarcoidosis, Behcet's)
|
|
|
How does erythema nodosum present?
|
Painful, erythematous nodules on the lower legs. Patients may have a false positive VDRL
|
|
|
What is bullous pemphigoid?
|
Antibodies to the BMZ that presents as firm, tense, stable blisters with NO Nikolsky sign or mucosal involvement. Linear immunofluorescence pattern. Treated by steroids
|
|
|
What is pemphigus vulgaris?
|
Antibodies to desmoglein (keratinocyte adhesion), lace-like/fishnet immunofluorescence, flaccid bullae, POSITIVE Nikolsky sign, common mucosal involvement (starts in mouth), treated by high-dose steroids + IVIG
|
|
|
What are triggers for pemphigus vulgaris?
|
ACEIs, penacillamine, phenobarbital, penicillin
|
|
|
What is erysipelas?
|
Starts out as a small red patch on the cheek or extremities that turns into a painful shiny red plaque. patients often have a history of cutaneous ulcers, pharyngitis, or lymphedema
|
|
|
What does scarlet fever look like?
|
Sunburn with goosebumps |
|
|
What does the rash of Salmonella typhi look like?
|
Small pink papules on the trunk (rose spots) in groups of 10-20 plus fever and GI involvement. Treat with Rocephin and possible cholecystectomy for chronic carrier state
|
|
|
What is Ludwig's angina?
|
Bilateral cellulitis of the submental, submaxillary, and sublingual spaces from an infected tooth
|
|
|
How does necrotizing fasciitis present?
|
Sudden onset of pain and swelling at the site of trauma or recent surgery. Erythema spreads quickly over the course of hours to days and the skin becomes dusky and purplish. There is undermining of the skin and subcutaneous layer, bullae, gas production
|
|
|
How is necrotizing fasciitis treated?
|
Early and aggressive surgical debridement followed by Pen G + Flagyl or Rocephin
|
|
|
What monthly blood tests do patients on isotretinoin require?
|
LFTs, TGs, cholesterol, and B-hCGs
|
|
|
What is tinea versicolor?
|
Small, scaly patches of varying color on the chest or back that are hypopigmented. Treat with ketoconazole or selenium sulfide
|
|
|
How does gas gangrene present?
|
Around a site of recent injury or surgery. Swelling around the injury with skin that turns pale and then dark red
|
|
|
How can gas gangrene be treated?
|
Hyperbaric oxygen, surgical debridement, abx
|
|
|
What does lichen planus look like?
|
Violaceous, flat-topped, polygonal papules with prominent Koebner's phenomena (lesions at the site of trauma) with a shiny surface with fine white lines (Wickham's striae). Tx with steroids
|
|
|
How do you treat rosacea?
|
Flagyl
|
|
|
What needs to be ruled out when pityriasis rosea is suspected?
|
Fungal infection (KOH stain)Syphilis (RPR)
|
|
|
How is melanoma treated?
|
Lesions confined to the skin are treated by excision with margins
|
|
|
What is tinea capitis?
|
Infection of the scalp; mainly affects children with scaly patches of hair loss and possible inflamed, boggy granuloma of the scalp. REQURES SYSTEMIC Antifungals
|
|
|
What infection can cause erythema multiforme?
|
Herpes
|
|
|
What is heratoacanthoma?
|
Rapidly growing (grows to full size in 1-2 months) flesh-colored lesion with a central crater that contains keratinous material, usually on the face. Spontaneously involutes but observe in those with a history of it |
|
|
What's the derm term for:Flat spot <1cm (non-palpable, just visible)
|
Maculeexamples: Freckles, tattoos
|
|
|
What are some of the distinguishing characteristics of necrotizing fasciitis?
|
Unexplained, excruciating pain in the absence of or beyond areas of cellulitisErythema with blister and bullae formation & possible crepitusDM patient with foot cellulitis and signs of systemic toxicityPerineal cellulitis with abrupt onset & rapid spread (Fournier’s gangrene)
|
|
|
What is the treatment for a limb with dry gangrene?
|
Autoamputation over time Angiography to evaluate the extent & location of peripheral artery disease → distal bypass of stenotic areas → if circulation improves & healing is adequate, then amputation of the affected region |
|
|
What is the treatment for wet gangrene infection?
|
Emergency debridement or guillotine amputation of the infected portion of the foot then revision to a below or above the knee amputation 72 hours later (antibiotics are indicated if cellulitis or gas gangrene is present) |
