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75 Cards in this Set

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DIP joint involvement (2)
classically OA; also in psoriatic arthritis (red, warm, tender) -- ask abt back pain
what is c1-c2 subluxation?
partial dislocation of C1-C2 (atlantoaxial) joint; a/w neurologic sx including UE weakness, hypertonia, and paresthesias; often a/w RA
what risk a/w joints that have been replaced b/c of RA? What should you do?
INFECTION! (RA flares are relatively rare) --> joint aspiration --> Cx, gram stain, cell count
oligoarticular inflammatory arthritis following enteric infection
reactive (reiter's) arithritis (shigella, salmonella, campylobacter, yersinia, c.dif)
clinical course of chlamydial vs enteric reactive arthritis
chlamydial more likely to have recurrent/chronic dz
usefulness of aspirating synovial fluid from asymptomatic joint in ?gout/pseudogout
very high! Chance of finding crystals > 80%
diagnostic test with joint effusion
aspiration of synovial fluid
causes of bloody synovial fluid (4)
coagulopathy, trauma, tumor, Charcot's joint
first step in mgmt of pt with acute joint pain, physical immobility, and warmth
aspiration of synovial fluid -- must not miss infectious cause (esp in setting of underlying joint pathology, eg RA)
what dz a/w pain in ankles and LE + perisoteal new bone formation on radiograph?
hypertrophic osteoarthropathy
what is charcot joint (aka neuropathic joint)?
progressive joint degeneration caused by loss of proprioception --> gradual destruction by repeated subliminal injury, often seen in diabetcs / tabes dorsalis neuropathy
pathognomonic finding in hypertrophic osteoarthropathy
relief from elevation of extremities above head
what is hypertrophic osteoarthropathy a/w?
neoplasm (pulmonary, GI, lymphoma) and infection; MUST R/O LUNG CANCER (CXR --> ?CT); also a/w chronic hypoxic states (often see clubbing)
indication for total knee replacement in pt with osteoarthritis
pain + limitation of fxn --> interference with enjoyment of life
causes and dx of "locking" knee
mechanical injury, eg torn meniscus; arthroscopy is both diagnostic and therapeutic
role of menstrual cycle in disseminated gonococcal infection
more vulnerable during menses and pregnancy
initial tx of disseminated gonococcal infection, and why?
ceftriaxone until sens/spec known! (PCN-resistance is common)
location of parvovirus b19 rash in adults
macular rash anywhere! (not just slapped cheek as in kids)
other sx a/w parvovirus b19
arthritis (acute, symmetrical) usu improving after 2wks with lingering arthrlagias
what could be the cause of diffuse knee pain without morning stiffness and with a completely normal knee exam?
hip pain! ==> do hip exam (ROM, pain, etc.) followed by radiographs
what rheumatic pathology can mimic a DVT? What diagnostic step?
ruptured Baker's (popliteal) cyst; do u/s of calf
what clinical sx of rotator subacromial bursitis (aka cuff tenodinitis)?
tenderness over supraspinatus tendon, nocturnal pain, pain on abduction > 40degrees
tx of rotator subacromial bursitis
injection of corticosteroids + PT to regain fxn
when are radiographs indicated in shoulder pain?
if history c/w OA
PE in true arthritis vs bursitis
TRUE ARTHRITIS/SYNOVITIS: painful limitation of ROM in active AND passive motion; BURSITIS: no limitation of passive motion
tx of De Quervain's tenosynovitis
corticosteroid injection into tendon sheath
Tinel sign of carpal tunnel syndrome
distally radiating pain or paresthesias caused by tapping over site of superficial nerve
what is deQuervain's tenosynovitis?
inflammation of tendons at base of thumb, caused by stress (lifting heavy items)
what is cubital tunnel syndrome?
compression of ulnar nerve as it passes through cubital tunnel at medial elbow
medial epicondylitis vs cubital tunnel syndrome
medial epicondylitis: pain localized to medial elbow w/o radiation to hand, exacerbated by use of forearm/wrist; cubital tunnel syndrome: nerve compression --> paresthesias, weakness, numbness of 4th and 5th digits
effects of c7 radiculopathy
most common cervical radiculopathy -- sensory changes in digits 2-4, motor weakness of triceps, forearm pronation, wrist flexion/extension
medical conditions a/w carpal tunnel syndrome
DM, thyroid dz, obesity
clinical course of fibromyalgia and treatment options
progressive, no direct treatment, use behavioral therapy and supportive pharamcotherapy
"snapping" of hip with walking
iliotibial band syndrome
hip pain with walking and not at rest suggests
OA
most common non-compressive cause of right upper lumbar radiculopathy
DM
what is diabetic amyotrophy?
a type of diabetic neuropathy seen in elderly: u/l or b/l anterior thigh pain, weakness, atrophy
what is restless leg syndrome?
uncontrollable urge to move limbs to stop uncomfortable/odd sensations (usu also in legs) -- moving affected body part provides temporary relief; 4 criteria: 1) urge to move limbs +/- sensations; 2) worse with rest; 3) improve with activity; 4) worse in evening/night
what medical conditions a/w restless leg syndrome?
fe deficiency (20%), many others
tx of restless leg syndrome
dopanine antagonists or gabapentin
what does joint crepitus suggest?
degenerative or mechanical joint disease
maneuver to dx anserine bursitis
pain on medial aspect of knee, focal tenderness over anserine bursa (2inches below joint line)
tx of anserine bursitis
corticosteroid injection, isometric exercises, weight reduction
screening test for osteoporosis
dual-energy x-ray absorptiometry
sensitivity of standard radiographs for osteoporosis
not good -- only consistently demonstrate significant demineralization once 30-40% bone mineral has been lost
defn of osteoporosis vs osteopenia based on DXA (dual-energy xray absorptiometry) test
>2.5 std devs below "young normal" (t score < -2.5) = OSTEOPOROSIS; t-score in (-1, -2.5) = OSTEOPENIA; t-score > -1.0 = NORMAL (within 1 std dev of nl)
what is teriparatide?
recombinant PTH (stimulates bone deposition --> increased bone mass ==> used to tx osteoporosis)
how do most osteoporosis treatments work?
inhibiting osteoclastic resorption (bisphosphonates, estrogens, raloxifene, calcitonin); teriparatide is unique in stimulating bone deposition (recombinant PTH)
best imaging for suspected renal stones
NONCONTRAST CT -- can detect both radiolucent and radio-opaque stones in ureters or kidneys, as well as hydronephrosis (u/s also good for renal stones, but can't see ureteral stones)
mgmt of recurrent UTIs
symptom-initiated (by patient) fluoroquinolones (more and more organisms becoming resistant to bactrim)
how to treat asymptomatic hyponatremia asociated with SCLC?
chemo! Not fluid restriction / other tx of hyponatremia
most common metabolic complication of malignancy
hypercalcemia
appropriate respiratory compensation in metabolic alkalosis
10mmHg increase for every 14 inc in HCO3-
hypomagnesemia, hypokalemia, hypocalcemia: which one explains the others?
HYPOMAGNESEMIA: if < 1.0, induces renal potassium wasting and suppression of PTH secretion and peripheral effects
risk factors for calcium nephrolithiasis (PO)
low daily fluid intake, high dieteray sodium and oxalate, high animal protein intake
what diet decreases risk of calcium stones?
high dietary calcium intake! (maybe b/c calcium binds oxalate and lessens oxalate reabsorption) ==> mg also useful
winter's formula for resp compensation in metab acidosis
PCO2 = 1.5 * HCO3- + 8 +/- 2
how to use delta-delta in AG metab acidosis
calculate anion gap, calculate drop in HCO3; if equal (or close, ratio 1-2), no concomitant pathology; if >1-2, concomitant metab alkalosis; if < 1, concomitant non-AG metab acidosis
what is hyporeninemic hypoaldosteronism
hyperkalemia seen in 20-30% diabetic pts
what causes decreased anion gap?
unmeasured cation or decreased albumin; cations include Ca, Mg, Lithium, or positively charged paraprotein (eg myeloma --> can cause RTA)
lab findings in SIADH
nl K, low BUN, Cr, and serum Uric Acid
why would you get mixed resp+metab alkalosis with kidney stone?
tachypnea --> resp alkalosis; vomiting --> metab alkalosis
24-hr urinary findings in primary hyperaldosteronism
k > 30meq, serum k < 3.0
ethanol vs isopropyl alcohol vs methanol role in metabolic acidosis
only methanol a/w AG metabolic acidosis
how to calc osmolar gap?
2*Na + BUN/2.8 + gluc/18 - S_osm[measured]; should be < 10, else ?unmeasured osmotic substance active in serum
hypokalemia, metabolic acidosis, and inappropriately alkaline urine suggests what dz? What is a possible complication?
distal renal tubular acidosis -- can result in nephrolithiasis
acid-base disorder in seizure
usu lactic acidosis, reverses with cessation of seizure -- no intervention necessary
cause of hyponatremia in cirrhosis
splanchnic vasodilation --> decreased effective circulating volume --> nonosmotic stimulation of ADH
what is pseudohyponatremia?
LAB ARTIFICAT which looks like low serum sodium [] due to volume displacement by very high protein or lipids (also refers to low sodium seen in high glucose)
MCC mild hypercalcemia + osteoporosis of hip, and mgmt
primary hyperparathyroidism ==> parathyroidectomy
None
what risk with post-menopausal estrogen therapy for osteoporosis?
inc risk of breast cancer and CV dz
labs in pitutary vs adrenal source of adrenal insufficiency (secondary vs primary)
don't see hyperkalemia in pituitary insufficiency
MCC adrenal insufficiency
Addison's (autoimmune adrenalitis)
how to correct calcium for albumin?
add 0.8 to Ca for every 1g/L reduction in albumin below 4
effect of large-volume blood transfusions on calcium
decrease serum calcium (as well as ionized calcium) by complexing with citrate