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89 Cards in this Set
- Front
- Back
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What are the signs of axillary nerve damage
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deltoid atrophy
shoulder numbness |
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What is the cause of carpal tunnel syndrome
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median nerve compression at the wrist
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What are the causes of carpal tunnel syndrome
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1) Pregnancy
2) rheumatoid arthritis (RA) 3) diabetes mellitus (DM) 4) acromegaly 5) hypothyroidism 6) obesity 7) overuse |
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Demographics of carpal tunnel syndrome
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1) 30-55 yr of age;
2) female > male |
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What are the signs of carpal tunnel syndrome
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1) Wrist pain that radiates up arm and worsens with hand flexion and grasping,
2) decreased hand strength 3) numbness in thumb, index and middle fingers 4) decreased palmar two-point discrimination (except on the radial side of the palm) 5) Positive Tinel's sign (i.e., tapping over carpal tunnel elicits wrist tingling and pain) 6) Phalen's sign (i.e., placing dorsal side of hands together and flexing wrists 90° causes the onset of symptoms within a minute) 7) Thenar muscle atrophy |
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How is carpal tunnel syndrome diagnosed
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EMG (show impaired conduction)
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How is carpal tunnel syndrome treated
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1) wrist splints activity
2) NSAIDs 3) corticosteroid injections 4) Surgery (release of transverse carpal ligament) |
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What is the most common type of shoulder dislocation?
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anterior
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What are causes of posterior shoulder dislocation
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seizures
electrical shock |
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What is the treatment for shoulder dislocation
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1) urgent closed reduction
2) sling 3) surgery |
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What is the most common type of hip dislocation
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posterior (dashboard injury)
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What are the 12 types of important fractures
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1) Colles
2) Scaphoid 3) Boxer's 4) Humerus 5) Monteggia 6) Galeazzi 7) Hip 8) femur 9) tibial 10) Ankle 11) Rib 12) Pelvic |
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What are common causes of back pain
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MAD BRACING
Muscular strain AAA Degeneration (disc herniation, stenosis) Bone (fracture, scoliosis, spondylolisthesis) Renal stones Ankylosing spondylitis Cauda equina Infection Neoplasm GI (peptic ulcer disease, pancreatitis) |
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What is the treatment for back pain
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1) NSAIDs
2) PT 3) Rest (muscular injuries) |
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What is the most common location of disc herniation
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lumbosacral region (L4-L5, L5-S1 discs)
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What do degenerative disc changes lead to
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herniation and nerve impingement
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What are signs of disc herniation
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pain worsens with straight leg raises or Valsalva maneuver
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How are degenerative disc herniation diagnosed
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MRI (confirms dx)
CT (bone structure) |
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What is the cause of the majority of back pain
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1) 90% of back pain is caused by muscular injury
2) it resolves within 6 wks regardless of treatment |
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What is the treatment of disc herniation
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1) NSAIDs
2) epidural injection 3) Surgical decompression |
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What occurs during spinal stenosis
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narrowing of bony spaces in the spine secondary to arthritic changes causing nerve compression
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What are the signs of spinal stenosis
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radiating pain that is worse with walking and standing
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How is spinal stenosis diagnosed
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1) Ct or x-ray (confirms)
2) MRI (r/o herniation) |
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What is the treatment for spinal stenosis
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1) NSAIDs
2) PT 3) epidural injections 4) Surgical decompression |
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What is the treatment for posterior hip dislocation
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1) closed reduction
2) brace 3) abduction pillow |
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What are signs of ankle or knee sprains
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pain with weight bearing or movement
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What is the treatment for ankle or knee sprain
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RICE:
Rest Icing Compression of swelling Elevation of joint analgesics |
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What is an open fracture
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fracture penetrates skin and is exposed to outside environment
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What is the treatment of open fractures
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irrigation
antibiotics Surgery |
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What are the signs of ligament tears
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pain and swelling that worsens with joint stress, decreased joint range of motion; ligamentous instability on joint stress testing
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What is used to diagnose ligament tears
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MRI (confirm tear)
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What is the treatment for ligament tear
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surgical repair
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What types of structures are CT and MRI useful for diagnosis
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CT- bone pathology
MRI- soft tissues |
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Meniscus tears are associated with what injury
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ACL injury
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What are signs of meniscus tear
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1) vague pain inside knee joint
2) clicking or locking of joint 3) pain along joint line near tear |
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How are Meniscus tears diagnosed
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MRI may detect tear
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What is the treatment for Meniscus tears
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1) NSAIDs
2) physical therapy 3) arthroscopic repair or debridement |
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What is the triad seen with lateral blow to knee
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1) medial meniscus tear
2) MCL tear 3) ACL tear |
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Signs of fibromyalgia
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1) musculoskeletal pain in at least 11 of 18 pts
2) sleep disturbance (lack of phase 4 sleep) 3) easy fatigability 4) muscle stiffness |
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Tx for fibromyalgia
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SSRI (amitriptyline)
cyclobenzaprine |
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Rheumatoid arthritis can only be diagnosed after how many weeks
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6 weeks
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what is a common cause of viral arthritis
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Parvo B19 (contact with children)
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What are the signs of ankylosing sponylitis
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back pain
morning stiffness (greater than 3 mths) sacrolilac tenderness Anterior uveitis (blurring, photophobia) |
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Signs of prostate cancer
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PSA>4
bone pain osteoblastic bone lesions hypercalcemia |
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Causes of reactive arthritis
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Chlamydia
SHigella Salmonella Yersinia Campylobacter C. difficile |
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What questions are important when addressing arthritis
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1) is it inflammatory
2) is it mono or polyarticular 3) is it symmetric or asymmetric 4) What is the duration of symptoms? |
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What is the treatment for viral arthritis
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NSAIDs
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Patients with ankylosing spondylitis have an increased risk of what
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vertebral fracture due to decreased bone density
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Normal wbc count
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4500-11000
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Most common cause of septic arthritis in young sexaully active patients
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N gonorrhea
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How is septic arthritis diagnosed
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gram stain of synovial fluid
blood cultures urethral cultures skin cultures |
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What is the classic ankylosing spondylitis patient presentation
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male <40 with low back pain that is worse in the morning and gradually improves during the day
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Signs of Osteoarthritis
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age>50
crepitus bony enlargement bony tenderness lack of warmth and morning stiffness |
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What is the difference between PVD and lumbar spinal stenosis
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unlike PVD the symptoms for spinal stenosis are positional and remain while standing still
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How is lumbar spinal stenosis pain relieved
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flexion (sitting, walking uphill)
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What is the diagnositic study of choice for Parvo B19
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anti-B19 IgM
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which joints are affected with Parvo B19
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MCP, PIP, ankle joints
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Two most common causes of inflammatory monoarthritis
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septic arthritis
crystal induced arthritis |
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Well known complication in patients with temporal arteritis
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aortic aneurysms (need serial CXR)
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Types of rheumatologic diseases
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Ankylosing Spondylitis
Fibromyalgia Mixed CT dz Polymyalgia rheumatica Polymyositis & dermatomyositis Psoriatric arthritis RA Scleroderma Sjogren SLE |
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Ankylosing sponylitis
Dx |
1) hip & low back pain worse in morning & w/ inactivity
2) Pain improves over course of day 3) Limited ROM 4) Painful kyphosis relieved by bending forward 5) Anterior uveitis 6) +HLA B27 7) neg RF 8) ANA neg 9) X-ray (bamboo spine) 10) MRI |
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Ankylosing spondlyiits
TX |
1) PT and exercise
2) NSAIDs 3) sulfasalazine 4) MTX 5) Anti-TNF 6) Joint replacement |
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Fibromyalgia
DX |
1) myalgia & weakness w/o inflammation
2) trigger pts 3) fatigue 4) depression 5) sleep disturbance 6) dizziness 7) headaches 8) mood disturbance |
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Fibromyalgia
Tx |
1) Stretching & PT
2) antidepressants (TCA, SSRI) |
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Mixed CT dz
Dx |
1) Raynaud's
2) polyarthralgias 3) Swollen hands 4) Proximal mm weakness 5) esophageal hypomotility 6) pulmonary symptoms 7) +RNP |
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Mixed CT dz
Tx |
1) NSAIDs
2) Corticosteroids 3) ACE-I |
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Polymyalgia rheumatica
Dx |
1) Temporal arteritis
2) pain & stiffness in shoulder and pelvic girdle 3) difficulty raising arms & gettting out of bed 4) Unexplained wt loss 5) fever |
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Polymyalgia rheumatica
TX |
corticosteroids
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Polymyositis & dermatomyositis
Dx |
1) proximal mm weakness
2) red heliotropic rash 3) incr aldolase, CK, Cr 4) incr LFTs, ALT, AST, LDH 5) + ANA 6) + Anti-Jo-1 7) mm bx (inflam cells w/in mm-> polymyositis surrounding mm -> dermatomyositis) 8) EMG (spontaneous fibrillation) |
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Polymyositis & dermatomyositis
Tx |
1) corticosteroids, MTX, or azathioprine for 4-6 weeks
2) IVIG can be added |
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Psoriatic arthritis
Dx |
1) asym joint pain & stiffness
2) worse in morning & improve w/ activities 3) anterior uveitis 4) + B27 5) neg RF 6) x ray -> DIP & PIP (pencil cup) 7) MRI (marrow edema) |
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Psoriatic arthritis
Tx |
1) NSAIDs
2) MTX 3) Sulfasalazine 4) anti-TNF |
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Rheumatoid arthritis
Dx |
1) morning stiffness w/ pain
2) decr mobility 3) warm joints, joint swelling, fever 4) swan neck deformity (DIP,PIP) 5) Boutonniere deformity (PIP) 6) pleuritis, pericarditis 7) +RF 8) +ANA 9) incr ESR + IgM 10) joint aspiration 5000-50000 leukocytes 11) xray (stiffness and swelling, joint space narrowing) 12) MRI |
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Rheumatoid arthritis
Tx |
1) PT
2) NSAIDs 3) low dose corticosteroids 4) hydroxychloroquine 5) MTX 6) sulfasalazine |
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Scleroderma
Dx |
1) Raynauds
2) skin thickening 3) Esophageal dysmotility 4) CREST 5) anti-SCL 70 ANA |
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Scleroderma
Tx |
1) ACE-I
2) CCB 3) Nicotine & decongestants 4) MTX 5) corticosteroids |
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Sjogren
Dx |
1) dry eyes
2) dry mouth 3) enlarged parotid gland 4) symmetric arthritis 5) anti Ro (anti SSA) 6) anti La (anti SSB) |
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Sjogren
Tx |
1) Pilocarpine
2) tears 3) NSAIDs 4) corticosteroids |
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SLE
Dx |
MD SOAP CHAIR
1) +ANA 2) anti dsDNA 3) anti Smith 4) anti histone 5) false + test for syphilis |
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SLE
Tx |
1) Avoid sun
2) NSAIDs 3) corticosteroids 4) hydroxychloroquine 5) cyclophosphamide 6) Anticoagulation |
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Osteoarthritis
Dx |
1) Joint crepitus
2) joint stiffness & pain worse w/ activity & relieved by rest 3) decr ROM 4) DIP (Heberden nodes) 5) PIP (Bouchard nodes) 6) normal ESR 7) <2000 leukocytes joint aspiration 8) xray (osteophyte, jt space narrowing, bone cysts, bone sclerosis) |
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Osteoarthritis
Tx |
1) rest
2) heat 3) wt loss 4) PT 5) NSAIDs 6)corticosteroids or hyaluronaninjections 7) joint replacement |
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Types of MS infections
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1) lyme
2) osteomyelitis 3) septic jt and septic arthritis |
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Lyme dz
Dx |
1) early localized: chills, fatigue, HA, erythema chronicum migrans
early disseminated: myocarditis, HB, arrhythmias, Bell's palsy, meningitis Late disseminated: mono or oligoarthritis, encephalopathy, polyneuropathy 2) + ELISA 3) + western blot |
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Lyme dz
Tx |
1) doxycycline
2) amoxicillin 3) cefuroxime 4) erythromycin (pregnant) |
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Osteomyelitis
Dx |
1) bone pain
2) tenderness 3) fever, chills 4) incr WBC, ESR, CRP 5) cultures 6) MRI 7) bone scans |
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Osteomyelitis
Tx |
1) IV antibiotics (oxacillin or cefazolin)
2) Abscess: I & D |
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Septic joint and Septic arthritis
Dx |
1) migratory polyarthralgias
warm, red, tender, swollen 2) incr WBC, ESR, CRP 3) joint aspiration: WBC, high neutrophils, decr glucose |
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Septic joint and Septic arthritis
Tx |
1) surgical irrigation & drainage
2) N. gonorrhea: ceftriaxone 3) Chlamydia: doxycycline 4) S. Aureus: penicillin 5) Gram neg: aminoglycosides |
