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34 Cards in this Set
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What is Sarcoidosis? Clinical Features? How is the Diagnosis made? Treatment? |
Sarcoidosis is a systemic disease where there are abnormal collections of inflammatory cells, specifically noncaseating granulomas. Clinical Features: * Most Common- Lung Involvement, Cough & SOB, Uveitis, Tender Skin Nodules, Affects Salivary ( Dry Mouth, Cavities) and Lacrimal Glands (Dirt in Eye Sensation), Arthritis Less Common--> 7th Cranial Nerve Can be Affected, Liver and Kidney Involvement
* There will be a history where the symptoms resolve on their own. Diagnosis: Best Initial Test is Chest X- Ray, but it is a Diagnosis of Exclusion Confirmatory Diagnosis: Biopsy of the lymph node that is the most accessible. Lung Lymph Node, Lacrimal Gland, Parotid Gland, Superficial Lymph node, NOT The Skin Nodules! Treatment: Symptomatic Patients--> Prednisone |
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What are the two important lab findings in Sarcoidosis to be aware of? |
- Hypercalcemia: The cells in the non-caseating granuloma have 1-alpha hydroxylase activity which converts vitamin to it's active form of 1,25 dihydroxy vitamin D ( Calcitriol) - Elevated serum ACE |
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A young female athlete/runner c/o anterior knee pain. The pain has been present for months with gradual onset. It is worse with going up and down stairs and prolonged sitting. NSAIDs don't help pain. No significant history of trauma. Diagnosis? Diagnostic Test? Treatment? |
Patellofemoral Pain Syndrome: The most common cause of knee pain in young adults. Usually no history of trauma. Clinical Dx: Patellofemoral Compression Test- Pain is brought on when the knee is extended while pressing the patella is compressed. X- Rays and MRI are usually normal. Imaging is only needed if patient fails to improve with treatment. Treatment: Stretching and Strengthening Exercises of the Thigh Muscles |
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An obese woman presents to her doctor with left medial knee pain that has been ongoing for months. Pain is worse with activity and traveling up and down the stairs. There is tenderness over the left side of the medial knee upon palpitation. What is the Diagnosis? |
Anserine Bursitis: There is pain and swelling over the medial aspect of the knee. ( Inferolateral to the knee joint). Most Common in Obese/Overweight, Pts with Osteoarthritis Symptoms can be episodic - No Imaging is Needed if Clinical Presentation is Clear Treatment: Conservative---> NSAIDs and Rest |
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What is Osgood Schlatter Syndrome? Diagnostic Exam? Treatment? |
This is a condition where there is inflammation of the patellar ligament at the tibial tuberosity. It is due to repeated tension of the growth plate of upper tibia. The pain can be unilateral or bilateral. This occurs more commonly in boy ( 12-15 yo) after a rapid growth spurt. This is a clinical diagnosis. No imaging is needed. On Physical Exam, there may be a bump over the knee, but that is due to an enlarged tibial tubercule. Treatment: NSAIDs and Rest |
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Femoral Nerve Injury What movements would be limited? What reflexes are affected? Where is the sensory loss? |
- Femoral Nerve Injury is usually caused by trauma - Decreased Knee Extension - Decreased/Absent Knee Jerk Reflex - Sensory Loss Over The Anterior & Medial Aspect of the Thigh, Loss of Sensation over medial shin and foot arch |
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Sciatic Nerve Injury What movements would be limited? What reflexes are affected? Where is the sensory loss? |
Sciatic Nerve Injury is usually caused s/p Hip Replacement or Hip Dislocation. Weakness is the Lower Leg Muscles Ankle Reflex is Decreased/Absent Sensory Loss is in the Lower Leg Only |
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Obturator Nerve Injury What movements would be limited? What reflexes are affected? Where is the sensory loss? |
The patient would not be able to adduct the leg and there is sensory loss over medial part of the thigh No reflexes affected |
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Common Peroneal Injury What movements would be limited? What reflexes are affected? Where is the sensory loss? |
* Occurs due to damage to the knee. The Common Peroneal Nerve wraps around the Fibula. Weakness in Dorsiflexion ( Foot Bending Towards Body) and Eversion-->" Foot Drop" Sensory loss over Dorum on the Foot ( Top of Foot) |
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A 60 yo man with bilateral shoulder pain and thigh pain/ hip pain for 2-3 months. The pain is associated with morning stiffness that lasts for 1-2 hours. What is the Diagnosis? Management? Treatment? |
Polymyalgia Rheumatica: A condition where there is profound pain and stiffness in at least 2 of the following- the shoulders, pelvis or neck A Laboratory Test will show and Elevated ESR and C Reactive Protein are both elevated, but no joint inflammation Treatment: Low Dose Steroids ( Prednisone) - Rapid Relief is Expected. If no relief consider another DX. * There is an association with Giant Cell Arterits |
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Sjorgen Syndrome What is it? Clinical Presentation? How is it Diagnosed? Treatment? What are condition is it associated with? |
An autoimmune disease where the lacrimal (tear) and salivary glands are destroyed. Clinical Presentation: Dry Eyes ( "Gritty Sensation in the Eye"), Dry Mouth/Xerostomia ( Dental Carries, Candidiasis) Dx: No true test, Antiribonucelic acid--> Anti-Ro/SSA and Anti-LA/SSB are positive Treatment is Symptomatic: Pilocarpine- stimulate secretion of Saliva Cevimeline- Stimulate secretion of Salvia There is an increased risk of B Cell Non-Hodgkin's Lymphoma, which presents as a unilateral involvement of the parotid gland |
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A pt comes into the office with joint pain in hands and knees. There is associated with a reticular rash on the face, arms and legs, which occurred at the same time as the joint pain. About a week prior, the patient had an upper respiratory infection with fever and myalgia that resolved spontaneously. What is the Diagnosis? How is the Diagnosis made? Management? |
Viral Arthritis: Joint pain ( symmetric joint pain, swelling and stiffness) and rash shortly following a non-specific flu like illness. It is typically caused by the Parvovirus B -19. * In Kids, the rash may appear on the face; ie slapped cheek The Diagnosis is Clinical, but if you really want to confirm, get a confirmation via serum serology The Joint Pain is Self Limiting! |
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What are clues that the arthritis is due to Lyme Disease? |
There will be involvement of a tick bite ( bacteria living in tick causes the disease Borrelia Burgdirferi). H/o Travel to PA, NJ, DE, Conneticut, MA, Minnesota, Wisconsin The arthritis is usually is one joint. There will be a rash " bulls eye rash" / erythema migrans. Later on in the disease process there is a migratory arthritis. |
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A pt has joint pain in the fingers, wrists, and ankles. He went on a trip to the Carribean, 2 months ago and during the trip he developed fever for a couple days and shortly after the began having joint pain. The joint pain has persisted for months along with swelling of the joints. No Rash Developed. What is the Diagnosis? Clinical Presentation? Management? |
Chikungunya Fever: common in the Carribean and tropical regions of Africa, South Asia, etc. Spread by a Mosquito Clinical Presentation: Pt will develop a fever and shortly after joint pain appears. The fever will go away, but the joint pain stays around. The joint pain and swelling is bilateral and symmetic.There may be a rash Dx: Polymerase Chain Reaction Tx: Supportive- Usually the joint pain and other symptoms resolve in 7- 10 days. If joint pain becomes Chronic---> Methotrexate. |
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What is Ehrilochosis? Clinical Presentation? Diagnosis? Management? |
A bacterial illness that can be transmitted by a tick . It causes Flu-Like Symptoms and Vague Symptoms like Nausea/Vomiting, Cough, Joint Pain, Body Aches. Patient will have significant lab abnormalities, like Leukopenia, Thrombocytoenia, and Elevated AST/ALT Diagnosis: Peripheral Blood Smears- See Inclusion Bodies in WBCs or PCR Tx: Doxycycline |
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A patient has arthritis is multipe joints, hepatomegaly and personal or family history of Diabetes. What is the Diagnosis? What would the joint aspiration show? |
Hemochromatosis- An overabsorption of Iron that deposits everywhere in the body. Pt will have dark skin, joint pain, new onset diabetes ( damage to pancreas) The Joint Aspiration would show positive bifringent rhomboid crystals ( pseudogout- calcium pyrophosphate deposition). |
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What is the treatment of a Radial Head Subluxation? |
This commonly occurs in kids, when their arm is pulled too hard. No X-Ray is needed when the diagnosis is clinical. Tx: Hyperpronation of the Forearm. ( A "hyper" kid injury needs a hyper fixing Another techqnie is suppination of the child's forearm with the elbow flexed |
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What is Dermatomyositis? Clinical Presentation? Diagnostic Testing? Treatment? |
An autoinflammatory disease that affects the muscles. CP: Musle Weakness in the Hips and Shoulders. Pt will have difficultly rising from chair, climbing stairs. Associated with a rash located over the knuckles or Purplish Rash around the Eyes. Diagnostic Test: Check the level of enzymes found in skeletal muscles-> HIgh CK, Lactate Dehydrogenase and Aldolase. Initial Screening Testing--> ANA ( Antinuclear Antibodies), Anti-Jo-1 Antibodies Only do a muscle biopsy ( confirmation) if negative antibodies but there is still a igh suspiscion Treatment: High Dose Steroids |
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What should you screen for in a patient with Dermatomyositis? |
Initerstial Lung Disease--> Chest X- Ray Always screen for Malignancy |
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What is the best way to preserve a body part that got amputated in an accident/trauma? ( Finger, Toes, Etc) |
Place the body part in Gauze , Moisten with Saline and place in a sterile bag |
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What is the treatment for Raynaud's Phenomena? |
1st Line: Nifedipine Others: Amlodipine, Dilitiazem * If patient doesn;t get better, look for other causes like Scleroderma. Order ANA or RF |
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What is Complex Regional Pain Syndrome? How is it Diagnosed? What is the treatment? |
A long term pain syndrome that gets worse with time. Usually occurs after a surgery or Trauma. The patient will have pain out of proportion to injury and limited movement. The patient's limb will be hypersensitive. There will be temperature changes, edema, muscle wasting and abnormal skin discoloration. Diagnosed with MRI or Autonomic Testing( Measures Sweat Output) Tx: Phenoxybenazime, which is an alpha blocking agent that blocks sympathetic nerve activity or reginal IV anesthesia |
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What is Rheumatoid Arthritis? Clinical Presentation? Best confirmation Test? Treatment? |
RA- an autoimmue arthritis that causes destruction of the joints. CP: Most commonly occurs in women 20s- 40s. The Hand Joints ( PIP and MCP) are affected. Pt might have Baker's Cysts ( swelling of the bursa behind the kneee) Dx: -Best Confimatory Test--> Anti Cyclic Citrullinated Peptide Rheumatoid Factor ( IgM autoantibody against Fc portion of IgG) is Positive and ESR elevated, X- Ray shows Joint Space NArrowing, Loss of Cartilage and Osteopenia Tx: Try NSAIDS or Disease Modifying Agents ( Methotrexate, Sulfasalzine, Hydroxychloroquine) If no improvement after 6 months, add on anticytokine agent---> Infliximab or Etancerp |
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How is Paget's Disease Diagnosed? What is the treatment for Paget's Disease? |
Paget's Disease: Bone Pain in one or more bones or bone fractures. Skull is typically affected. Labs show an elevated Alkaline Phosphatase. Most patients are asymptomatic. Dx: Combination of X- Ray Findings ( Osteolytic Lesions) and Elevated Alkaline Phosphatase Bone Scan can help determine the extent of skeletal involvement. Bisphosphonate- Alendronate x 6 montsh and then two months of Risedronate |
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A child is playing a sport and falls on an outstretched hand. There is immediate elbow pain and swelling with limited range of motion of the arm. An X- Ray shows a posterior dispalcement of elbow fat pad. What is the diagnosis? Management? |
Supracondylar Humerus Fracture- usually occurs in boys when pt falls on an outstretched hand or direct trauma to the lower end of the humerus. Treatment: Bone in place ( nondisplaced fracture): Use a splint and sling Bone out of place ( displaced fracture) Surgical reduction and pinning |
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A young man has pain in his knee and ankle for the past few week. He also has bilateral eye pain, irritation ,blurry vision and painful urination. About two weeks ago he has diarrhea after eating at a restaurant that has now resolved. What is the cause of the arthritis? Management? |
Reactive Arthritis- arthritis that occurs after a GI or GU infection Joint Synovial Fluid Aspiration: Show Elevated WBCs, but no organisms |
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What conditions are associated with HLA- B27? |
There is a HLA- B27 association with Ankylosing Spondyloarthritis, Reactive Arthritis, and Psoriatic Arthritis |
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A patient was involved in a MVA and was not wearing a seatbelt. The knee hit the dashboard. He presents with right knee pain and swelling. What is the diagnosis? |
Posterior Cruciate Ligament Injury known as the Dashboard Injury, Can also be seen in an athelete falls on a flexed knee - It can be diagnosed with the Posterior Drawer Test: Push the Tibia Back with Knee Flexed. If Tibia can be pushed abnormally---> PCL Injury * PCL may not hear a popping sensation. MRI is the confirmatory test |
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What are the clues that a patient's knee pain is due to an Anterior Cruciate Ligament tear? |
ACL injuries are common in athletes. Most patient will report a " popping sensation" Anterior Drawer Test is positive- Knee comes forward too far |
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What maneuver can be done to determine if there is an Achilles Rupture? |
Thompson Test- Squeeze the Patient's Calf Muscle and Observe for Plantar Flexion ( Foot Goes DOwn) If there is no achilles rupture, the squeeze will produce plantar flexion. |
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A pt has been on steroid therapy for months and develops groin pain. What is the diagnosis? What is the best imaging to detect the diagnosis? Management? |
Osteonecrosis of the Femoral Head The best test is an MRI Management: The goal of therapy is to preserve the joint for as long as possible. Early Stages ( Stage 1 and 2)- Positive X- Ray Finding w/o Femoral HEad Collapse---> Core Decompression - Drilling a Hold iNside the bone to release pressure and restore blood flow Late Stages( Stage 4): Total Hip Replacement |
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Treatment for Gout |
1st Line: |
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What is the best diagnostic test to confirm Gout? The Treatment for Gout |
Best Diagnostic Test: Arthrocentesis- Shows Monosodium Urate Crystals ( NOT Serum Uric Acid Levels- Some pts have a low uric acid level 1st Line: NSAIDs ( Indomethacin is the most common). If no response use intraarticular steroids Colchicine- Use in the first 24 hour if contraindication to NSAID ( Renal failure) Prevention: Allopurinol lowers the level of uric acid. Do not use in acute gout attack If a patient has renal failure or transplant--> Intrarticular steroids |
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What reduces the risk of a Fat Embolism? |
Fat Embolism: Multiple Fractures. Triad of Confusion, Respiratory Insufficiency and Neurologic Confusion The best way to prevent this is Early Immobolization and Operative Fixation of Fractires. NOT Low Molecular Weight Heparin! |
