Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
113 Cards in this Set
- Front
- Back
|
T/F. In RA, the presence of anti-CCP and Rheumatoid Factor may indicate a greater 1. risk for more severe erosive polyarthritis.
|
TRUE
|
|
|
Name 2 autoantibodies specific for SLE.
|
anti-dsDNA and anti-Smith
|
|
|
What is the most sensitive imaging test to detect soft tissue injuries, intraarticular derangements and marrow abnormalities?
|
MRI
|
|
|
How soon will degradation of cartilage occur in acute bacterial arthritis?
|
48 hours
|
|
|
Name 3 most common sites of septic arthritis among IV drug users.
|
Spine
Sacroiliac Joint Sternoclavicular Joint |
|
|
Why are synovial fluid cultures in gonococcal arthritis consistently negative?
|
Articular manifestation is a consequence of immune reaction to circulating gonococci and immune complex degradation that
happens on immune complex deposition in the synovium. |
|
|
T/F. Most common site for TB arthritis is the thoracic and lumbar spine.
|
FALSE
|
|
|
What do you call the palpable vibratory or crackling sensation elicited with joint motion?
|
Crepitus
|
|
|
Alteration of joint alignment such that articulating surfaces incompletely approximate each other
|
Subluxation
|
|
|
Abnormal displacement of articulating surfaces such that the surfaces are not in contact
|
Dislocation
|
|
|
For diarthrodial joints, the arc of measurable movement through which the joint moves in a single plane
|
Range of motion
|
|
|
Loss of full movement resulting from a fixed resistance caused either by tonic spasm of muscle (reversible) or by fibrosis of periarticular structures (permanent)
|
Contracture
|
|
|
Abnormal shape or size of a structure; may result from bony hypertrophy, malalignment of articulating structures, or damage to periarticular supportive structures
|
Deformity
|
|
|
Inflammation of the entheses (tendinous or ligamentous insertions on bone)
|
Enthesitis
|
|
|
Infection or inflammation involving an epicondyle
|
Epicondylitis
|
|
|
4 Questions for initial rheumatic history and PE to determine
|
1. Is it articular?
2. Is it acute or chronic? 3. Is inflammation present? 4. How many/which joints are involved? |
|
|
If acute, which are some conditions to consider?
|
Infectious arthritis
Gout Pseudogout Reactive arthritis |
|
|
If Chronic, what are some conditions to consider?
|
Psoriatic arthritis
Reactive arthritis |
|
|
Firbomyalgia in less than 60 years , consider
|
Tendinitis, bursitis
|
|
|
Fibromyalgia in more than 60 years, consider
|
osteoarthritis, gout
|
|
|
Drug-Induced Musculoskeletal Conditions
Quinidine, cimetidine, quinolones, chronic acyclovir, interferon, IL-2, nicardipine, vaccines, rifabutin, aromatase and HIVprotease inhibitors |
Arthralgias
|
|
|
Drug-Induced Musculoskeletal Conditions
Glucocorticoids, penicillamine, hydroxychloroquine, AZT, lovastatin, simvastatin, pravastatin, clofibrate, interferon, IL-2, alcohol, cocaine, taxol, docetaxel, colchicine, quinolones, cyclosporine, protease inhibitors |
Myalgias/myopathy
|
|
|
Drug-Induced Musculoskeletal Conditions
Quinolones, glucocorticoids, isotretinoin |
Tendon rupture/tendinitis
|
|
|
Drug-Induced Musculoskeletal Conditions
Diuretics, aspirin, cytotoxics, cyclosporine, alcohol, moonshine, ethambutol |
Gout
|
|
|
Drug-Induced Musculoskeletal Conditions
Hydralazine, procainamide, quinidine, phenytoin, carbamazepine, methyldopa, isoniazid, chlorpromazine, lithium, penicillamine, tetracyclines, TNF inhibitors, ACE inhibitors, ticlopidine |
Drug Induced Lupus
|
|
|
Drug-Induced Musculoskeletal Conditions
Osteonecrosis |
Glucocorticoids, alcohol, radiation, bisphosphonates
|
|
|
Drug-Induced Musculoskeletal Conditions
Osteopenia |
Glucocorticoids, chronic heparin, phenytoin, methotrexate
|
|
|
Drug-Induced Musculoskeletal Conditions
Scleroderma |
Vinyl chloride, bleomycin, pentazocine, organic solvents, carbidopa, tryptophan, grapeseed oil
|
|
|
Drug-Induced Musculoskeletal Conditions
Vasculitis |
Allopurinol, amphetamines, cocaine, thiazides, penicillamine, propylthiouracil, montelukast, TNF inhibitors, hepatitis B vaccine, trimethoprim/sulfamethoxazole
|
|
|
ANA Pattern
Diffuse |
Clinical Correlate
Nonspecific Drug-induced lupus, lupus Antigen Identified Deoxyribonucleoprotein Histones |
|
|
ANA Pattern
Peripheral(rim) |
Clinical Correlate
50% of SLE (specific) Antigen identified ds-DNA |
|
|
Differential diagnosis of gouty arthritis.
|
Septic Arthritis
|
|
|
Inflammation of the tendinous or ligamentous
insertions of bones. |
Enthesitis
|
|
|
Alteration of joint alignment.
|
Subluxation
|
|
|
Patient with unilateral neuropathic pain
extending from the gluteal region down the posterolateral leg most likely has. |
Sciatica
|
|
|
ANA Antigen , give the pattern
dsDNA |
peripheral
|
|
|
ANA Antigen, give the pattern
U1 RNP |
speckled
|
|
|
ANA antigen, give the pattern
RNA Polymerase 1 |
nucleolar
|
|
|
Patient underwent operative replacement one
month ago presenting with septic arthritis now is most likely associated with what etiologic agent. |
Coagulase Negative Staphylococcus
|
|
|
What is the most common presentation of TB
arthritis? |
Chronic granulomatous monoarthritis
|
|
|
Patient presenting with fever, facial rash with
well-defined indurated margin particularly at the nasolabial fold has what and gives the drug of choice. |
Erysipelas, Penicillin
|
|
|
Recommended duration of treatment for osteomyelitis
|
4-6 weeks
|
|
|
DOC for Pseudomonas
|
Ciprofloxacin
|
|
|
Drug causing tendon rupture
|
Quinolones, glucocorticoids, isotretinoin
|
|
|
What is the infectious agent that causes erisypelas?
|
Streptococcus pyogenes
|
|
|
What is the infectious agent that causes gas gangrene?
|
Clostridium sp.
|
|
|
Antibiotic regiment for gas gangrene?
|
Clindamycin + Penicillin
|
|
|
What is the recommended duration of IV antibiotic therapy for osteomyelitis?
|
4-6 weeks
|
|
|
Tx for animal bite (prophylaxis or early infection)
|
Amoxicillin/clavulanate
|
|
|
Tx for animal bite (established infection)
|
Ampicillin/sulbactam
|
|
|
Tx for Bacillary angiomatosis
|
Erythromycin 500mg PO qid
|
|
|
Tx for Cellulitis (staph or strep)
|
Nafcillin or oxacillin, 2g IV q4-6h
|
|
|
MRSA skin infection
|
Vancomycin 1g IV q12h
|
|
|
Necrotizing fasciitis (group A strep)
|
Clindamycin plus Penicillin G
|
|
|
Necrotizing fasciitis (mixed aerobes and anaerobes)
|
Ampicillin, 2g IV plus Clindamycin plus Ciprofloxacin
|
|
|
What is the most common pathogen causing scalded skin syndrome, furunculosis, bullous impetigo, acute bacterial arthritis or pyolomyositis
|
Staphylococcus aureus
|
|
|
What is the drug of choice for MRSA
|
Vancomycin
|
|
|
Differentiate most common site involved in hematogenous osteomyolitis among children versus those in adults
|
children - long bones
adults - spine |
|
|
What is the best diagnostic imaging study for osteomyolitis that is most sensitive and specific
|
MRI
|
|
|
Give the common differential diagnosis is acute monoarthritis in an adult male other than trauma, and bacterial arthritis
|
crystal induced gout
|
|
|
What is the drug of choice for gonococcal arthritis for disseminated gonococcal arthritis
|
Ceftriaxone
|
|
|
What is the most common pathogen responsible seen in patients presenting with chronic monoarticular infection
|
Pott's disease
M. TB |
|
|
What is the most common rheumatic disease that predisposes to non-gococcal arthritis
|
Rheumatoid arthritis and SLE
|
|
|
Increasingly resistant to antibiotics
Frequent successor to other bacteria when initial therapy fails May be related to contamination |
Pseudomonas aeruginosa
|
|
|
Considerable variation in antibiotic susceptibility
Increasing antibiotic resistance with overuse May become resistant to antibiotics during therapy |
Enterobacteriaceae (Escherichia coli, Klebsiella, others)
|
|
|
May spread rapidly through soft tissues
|
Streptococci
|
|
|
Usually associated with foreign material or implants
Biofilm production |
Staphylococci other than S. aureus (coagulase-negative)
|
|
|
Most likely bacterial pathogen
Aggressive, invasive Often metastatic foci with bacteremia Consider surgery early |
Staphylococcus aureus
|
|
|
Usually mixed with aerobic bacteria
May be synergistic Survival dependent on devitalized tissue |
Anaerobic bacteria
|
|
|
Associated with cat scratches and probably with fleas
|
Bartonella hennselae
|
|
|
Prominent in developing countries, especially with unpasteurized milk
|
Brucella species
|
|
|
Candida the most likely genus
Considerable variation in susceptibility, depending on species Surgery may be helpful if infection is invasive |
Fungi
|
|
|
May involve any bone
Vertebral osteomyelitis common in some countries |
Mycobacterium tuberculosis
|
|
|
The foremost bacterial cause of osteomyelitis is
|
Staphylococcus aureus.
|
|
|
Antibiotics for the Treatment of Osteomyelitis
Methicillin-susceptible Staphylococcus aureus |
Oxacillin or nafcillin
Cephalosporins Clindamycin |
|
|
Antibiotics for the Treatment of Osteomyelitis
Methicillin-resistant S. aureus |
Vancomycin
Daptomycin Linezolid |
|
|
Antibiotics for the Treatment of Osteomyelitis
Streptococci |
Penicillin
|
|
|
Antibiotics for the Treatment of Osteomyelitis
Enterococci |
Penicillin plus gentamicin
Vancomycin |
|
|
Antibiotics for the Treatment of Osteomyelitis
Enterobacteriaceae (E. coli, Klebsiella, other) |
Cetriaxone of another cephalosporin
Ciprofloxacin |
|
|
Antibiotics for Treatment of Osteomyelitis
Pseudomonas aeruginosa |
Ciprofloxacin
|
|
|
2 factors that enhance bone susceptibility for osteomyelitis
|
trauma ischemia, foreign bodies
|
|
|
devascularized bone in ischemic necrosis
|
sequestra
|
|
|
complication of deep gonococcal infection in preantibiotic
area |
gonococcal endocarditis or meningitis
|
|
|
most common route of infection for septic arthritis in all
age groups |
hematogenous
|
|
|
pathogen in complicated traumatic injuries w/ extensive
contamination |
polymicrobial
|
|
|
risk factors for non-gonococcal bacterial arthritis
|
DM,
glucocorticoid therapy, hemodialysis, malignancy |
|
|
organism causing septic arthritis in HIV patients
|
Pneumococcal, salmonella, H.influenza
|
|
|
Septic arthritis DDx
|
gout, bursitis, cellulitis
|
|
|
most commone musculoskeletal feature of GC arthritis
|
tenosynovitis of the knees, hands, wrists
|
|
|
initial treatment for GC arthritis
|
Ceftriaxone
|
|
|
treatment for lymphocutaneous sporotrichosis
|
Oral itraconazole 100-200mg/d 3-6mos
|
|
|
what kind of infection sporothrix causes
|
Fungal infection
|
|
|
cause of impetigo contagiosa
|
strep pyogenes
|
|
|
cause of folliculitis
|
Staph aureus
|
|
|
Drug of choice for MRSA
|
Vancomycin
|
|
|
histo finding of chronic osteomyelitis
|
necrotic bone
|
|
|
most common site of osteomyelitis in children
|
long bones
|
|
|
most common site of TB osteomyelitis
|
thoracic spine
|
|
|
most common route of infection of osteomyelitis
|
contiguous foci of infection
|
|
|
route of infection in osteomyelitis that necessitates
surgery |
continuous foci
|
|
|
Synovial cysts Rotator cuff tears Tendon injury
Method of imaging? |
Ultrasound
|
|
|
Method of imaging?
Herniated intervertebral disk Sacroiliitis Spinal stenosis Spinal trauma Osteoid osteoma Stress fracture |
CT Scan
|
|
|
Method of imaging?
MRI |
Avascular necrosis
Osteomyelitis Intraarticular derangement and soft tissue injury Derangements of axial skeleton and spinal cord Herniated intervertebral disk Pigmented villonodular synovitis Inflammatory and metabolic muscle pathology |
|
|
Treatment of Common Infections of the Skin
Animal bite (prophylaxis or early infection) |
Amoxicillin/clavulanate,875/125 mg PO bid
|
|
|
Treatment of Common Infections of the Skin
Animal bite (established infection) |
Ampicillin/sulbactam, 1.5–3 g IV q6h
|
|
|
Treatment of Common Infections of the Skin
Bacillary angiomatosis |
Erythromycin, 500 mg PO qid
|
|
|
Treatment of Common Infections of the Skin
Herpes simplex (primary genital) |
Acyclovir, 400 mg PO tid for 10 days
|
|
|
Treatment of Common Infections of the Skin
Herpes zoster (immunocompetent host >50 years of age) |
Acyclovir, 800 mg PO 5 times daily for 7–10 days
|
|
|
Treatment of Common Infections of the Skin
Cellulitis (staphylococcal or streptococcal) |
Nafcillin or oxacillin, 2 g IV q4–6h
|
|
|
Treatment of Common Infections of the Skin
MRSA skin infection |
Vancomycin, 1 g IV q12h
|
|
|
Treatment of Common Infections of the Skin
Necrotizing fasciitis (group A streptococcal) |
Clindamycin, 600–900 mg IV q6–8h, plus
Penicillin G, 4 million units IV q4h |
|
|
Treatment of Common Infections of the Skin
Necrotizing fasciitis (mixed aerobes and anaerobes) |
Ampicillin, 2 g IV q4h, plus
Clindamycin, 600–900 mg IV q6–8h, plus Ciprofloxacin, 400 mg IV q6–8h |
|
|
Treatment of Common Infections of the Skin
Gas gangrene |
Clindamycin, 600–900 mg IV q6–8h, plus
Penicillin G, 4 million units IV q4–6h |
