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112 Cards in this Set
- Front
- Back
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What does Nonarticular Joint Disease affect?
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Tendons, Ligaments, Bursae
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Nonarticular Joint Disease is also known as?
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Soft Tissue Rheumatism
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Types of Soft Tissue Rheumatism?
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Localized Soft Tissue Disorders
Regional Disorders Generalized Pain Syndromes |
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Who are the Localized Soft Tissue Disorders?
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Tendonitis
Bursitis Carpal Tunnel Syndrome Trigger Fingers |
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Who are the Regional Disorders?
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Neck Pain
Low Back pain Chest wall pain syndrome |
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Who are the Generalized Pain Syndromes?
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Fibromyalgia
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Who are the True CT disorders?
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Cutis Laxa
Marfan's Homocystinuria Erhlers Danlos Pseudoxanthoma elasticum Alkaptonuria (ochronosis) |
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What is true Arthritis?
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A specific joint process involving any or all intra-articular structures defined by the joint capsule w/ the potential for damage and/or deformity of joint
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Sx's of arthritis
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Heat (calor)
Redness (rubor) Swelling (tumor) Pain (dolor) Stiffness (rigor) Loss of Fxn |
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Different Distributions of Arthritis
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Monoarthritis = one joint
Oligoarthritis </= 4 joints Polyarthritis > 4 joints Axial Arthropathy - SI joints, hip, and shoulder |
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Different Clinical Courses for Arthritis?
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Intermittent/episodic
Migratory Additive Progressive |
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Osteoarthritis
Patterns of Disease? |
Mono
Oligo Poly |
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Osteoarthritis
Types? |
Primary
Secondary |
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Osteoarthritis
Primary Disease's Focus? |
Focuses on Hyaline Cartilage w/ Secondary Bone Changes
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Osteoarthritis
Secondary? |
Degenerative Joint Disease
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What must Osteoarthritis be differentiated from?
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Mechanical Injury
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RHEUMATOID ARTHRITIS
is the prototype of what? |
Its the prototypical inflammatory "synovial lining" joint disease
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RHEUMATOID ARTHRITIS
primarily affects what? |
small and large joints in a SYMMETRICAL and BILATERAL fashion
its POLYARTHRITIS |
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RHEUMATOID ARTHRITIS
what ages does it affect? |
All ages
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RHEUMATOID ARTHRITIS
what other ways does it manifest? |
EXTRA ARTICULAR
Eye Lung Blood Vessels Spleen Skin |
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ANKYLOSING SPONDYLITIS
prototype of what? |
Prototypical spondyloarthropathy focused on the ENTHESIS as its target
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ANKYLOSING SPONDYLITIS
type of disorder and what it invovles? |
Inflammatory disoder primarily involving Axial skeleton (SI joints, Lumbar, Thoracic, and Cervical Spine), Hips, and shoulders
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ANKYLOSING SPONDYLITIS
associated with what genetically? |
HLA B27
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ANKYLOSING SPONDYLITIS
Extra-Articular Manifestations |
Eyes
Heart Lungs Cauda Equina Syndrome |
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ANKYLOSING SPONDYLITIS
Appearance of patient? |
Neck Forward Flexion
Stiff Spine "straightening" (fusion) |
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ANKYLOSING SPONDYLITIS
What happens to the SI joints? |
Bony Erosions
Sclerosis Fusion |
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ANKYLOSING SPONDYLITIS
what are the boney bridges called? |
Syndesmophytes
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What do syndesmophytes form from?
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Calcification of the annulus fibrosis
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REITER'S SYNDROME
What's another name for it? |
Reactive Arthritis
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Type of arthritis?
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Oligoarthritis
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REITER'S ARTHRITIS
precipitated by? |
Infectious Event either post-dysentery or post-GU infection
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REITER'S ARTHRITIS
who get's it? |
primarily young folks
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REITER'S ARTHRITIS
typical patient complaint... |
Can't Pee
Can't See Can't Climb a Tree |
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REITER'S ARTHRITIS
Related genetically to? |
HLA B27
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REITER'S ARTHRITIS
DDX? |
Disseminated Gonococcemia and other infectious processes
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REITER'S ARTHRITIS
typical Sx's? |
Soft Tissue Swelling (wrists, knees)
Dactylitis (diffuse digital swelling) |
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What is Podogra?
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Swelling of 1st MTP typically seen with Gout
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GOUTY ARTHRITIS
type of arthritis? |
MONOarthritis
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GOUTY ARTHRITIS
associated with? |
CRYSTALS!
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GOUTY ARTHRITIS
what are the crystals made of? |
uric acid
or calcium pyrophosphate dihydrate (CPPD) |
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GOUTY ARTHRITIS
ddx? |
pseudogout
septic arthritis |
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GOUTY ARTHRITIS
based on the ddx of septic arthritis, what do we do? |
Treat for the worst, hope for the best
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PSORIATIC ARTHRITIS
how do the hands present? |
Dystrophic nail changes (nail pitting)
Dactylitis |
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Types of Arthritis-Dermatitis Syndromes
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#1 = Psoriasis and Psoriatic Arthritis
SLE Dermatomyositis and Scleroderma Infectious Diseases |
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Approach to Dx for arthritis?
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Morning Stiffness +/-
Joint Distribution *** Joint Swelling (bony vs soft) +/- Constitutional Sx's (fatigue, wt loss) |
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What is morning stiffness characteristic of?
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Inflammatory arthritis or other infl conditions
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Who long does morning stiffness have to last to be definitive?
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>30 minutes
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What improves morning stiffness?
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activiity
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What is the key concept of Primary Osteoarthritis?
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NON-INFLAMMATORY joint disorder
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What is the most common type of arthritis?
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Osteoarthritis
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OSTEOARTHRITIS
other sx's? |
NO SYSTEMIC Sx's!
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OSTEOARTHRITIS Pathogenesis
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Primary cartilaginous damage w/ fraying, cracking, and fissuring
Secondary changes in subchondral bone and synovial lining |
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OSTEOARTHRITIS
onset? how and when? |
Asymptomatic onset in 2nd to 3rd decade.
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OSTEOARTHRITIS
when does it become very common? |
by 70 years old
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OSTEOARTHRITIS
gender specificity? |
men and women equally, but men onset earlier
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PRIMARY GENERALIZED OA
involves what? |
DIP's
PIP's 1st MCP Intervertebral Disks and Zygopophyseal Joints (cervical and lumbar vert) 1st MTP Hips Knees |
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what is an osteophyte and when does it form?
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Its a bone spur that forms when the surface area of a joint increases typically due to erosion and grinding due to loss of cartilage.
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what is the third most replaced joint in the U.S?
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The 1st CMC
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on physical exam, what are some signs of OA?
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Bony Thickening
Decreased ROM Crepitus (esp w/ knees) |
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In one particular joint, say the right knee, how is OA present?
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Assymetrically
(often hits medial knee more 70%) |
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where else is it assymetrical?
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vertebral column
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Different neurological complications/involvements of OA of cervical and lumbar vertebrae?
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1. Myelopathy/Radiculopathy
2. @ disk level--> inc thickness of Ant Long Ligament which can encroach on ant. SC 3. Hypertrophy of Ligamentum Flava encroaches on Post. SC 4. |
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Other complications of Vertebral OA?
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Compromise of vertebral arteries-->infarct of SC or esophageal compression
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How can you divide Lower Back Pain?
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Local
Radicular |
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Characteristics of Local Lower Back Pain?
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Deep, Aching Pain from soft tissue and vert body irritation
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Characteristics of Radicular Pain?
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Sharp, Stabbing pain from compression of dorsal nerve roots
Projects in dermatomal distributions |
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Where is the pain located with a herniated intervertebral disk?
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Pain limited to spine w/ radiatoin to lower legs and foot
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how can a herniated disk systemically manifest itself?
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It can't (no fatigue, wt. loss, etc)
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How does a herniated disk change lab reports?
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it doesn't
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How do we confirm a herniated disk?
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Myelography
CT MRI |
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4 Critical Q's for LBP patients?
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1. Numbess or strange sensation around butt or between legs?
2. Bladder working normal? 3. Bowels working normal? 4. Weiner working normal? |
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What is DISH?
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Diffuse Idiopathic Skeletal Hyperostosis
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Who get's DISH?
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Old men >50
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DDX for DISH?
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AS
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DISH genetic connection?
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NOT w/ HLA B27
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what do you see on X-ray of a pt with DISH?
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Large ligamentous ossifications bridging several vertabrae (cervical and lower thoracic)
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What's up with SI and spinal apophyseal joints in DISH?
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not eroded
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What about morning stiffness and DISH?
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not accentuated in the morning
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How are the osteophytes in DISH different?
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They're "flowing" osteophytes.
May only be on one side of column |
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DISH Dx criteria
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1. Flowing calcification/ossification on at least 4 contiguous vertebral bodies w/ or w/o osteophytes
2. Preserved disk height! 3. No bony alkylosis of facet joints, SI erosion, sclerosis, or bony fusion |
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ACUTE POLYARTHRITIS
who? |
RA
Acute Rheumatic Fever SLE Gonococcal A Viral A Serum Sickness Rxn Hep ass. A (B&C) HIV |
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5 abnormalities with hands in RA?
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Ulnar Drift
Ulnar Styloid Prominence Interosseous Muscle Wasting Z-thumb deformity Swan Neck deformities |
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what is the swan neck deformity?
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DIP flexed
MIP hyperextended |
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RA gender breakdown?
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Females:Males
3:1 |
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what does RA swelling feel like?
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squishy, spongy
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what is the source of marginal erosion in RA?
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synovial lining tissue
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What is pannus?
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its the proliferative synovium
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how is the cartilage in RA digested?
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SYMMETRICALLY (in OA its asymmetric)
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what do you get with Arthritis Mutilans?
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telescoping digits
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what is a late sign of CTS?
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thenar atrophy
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what is Caplan's Syndrome?
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Its RA involvement in the lungs producing nodules and fibrosis
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where in the lungs does RA cause fibrosis?
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bilateral upper and lower lobes
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what can RA do to blood vessels?
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RA VACULITIS
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how can RA vasculitis manifest itself?
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Foot Drop
Ulceration (medial ankle thin skin) Palpable Purpura (vascular infl) Nodules (necrosis of elastic lamina) |
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What is the "shoulder pad sign" indicative of?
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Secondary Amyloidosis aka RA amyloidosis
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What is Scleritis?
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Severe Inflammatory Condition w/ Edema and Infl Cell infiltration of Sclera of eye
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Scleritis presents with?
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PAIN
redness |
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Scleritis onset?
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4th to 6th decade (peak 5th)
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How often is scleritis bilateral?
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40% of the time
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differerence between scleritis and episcleritis?
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epi isn't painful, may not even know...and its not as red
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What MUST you rule out if pt presents w/ acute monoarthritis?
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Septic Arthritis...cause it has HIGH STAKES
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What is essential to Dx of monoarthritis?
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joint aspiration
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Three ways to test joint fluid?
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Naked Eye (you should be able to read through it)
Bacteriology Microscopy |
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What is the string sign?
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you should be able to form a 3-4 inch string of synovial fluid between finger tips
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What does the leukocyte level need to be to start worrying?
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50,000+
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Types of synovial effusions?
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Non Inflammatory
Inflammatory Septic Hemorrhagic |
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Uric Acid Crystals look like what under "red compensator?"
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Parallel = yellow
Perpendicular = blue |
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how do uric acid crystals look under polarizing microscopy?
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STRONGLY NEGATIVELY BIRIFRINGENT
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How do CPPD crystals look under polarizing microscopy?
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Blunt
Weakly positively birifringent |
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How do CPPD crystals look under red compensator?
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Parallel - blue
perpendicular - yellow |
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What is Milwaukee shoulder?
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Crystalline-induce shoulder arthritis
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which crystals cause Milwaukee shoulder?
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CPPD
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