Term
| 3. Description of Basal Cell Cancers |
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Definition
| Most common form of skin cancer. Excessive sun/UV exposure in fair-skinned ppl. Presentation: papule/nodule w/poss central scab or lesion that grow slowly. Have waxy/pearly appearance with telangiectasic vessels. Rolled border. Dx: Waxy/Pearly feature when skin is stretched. See plate 27 Current or p. 1531 Cecil. |
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Term
| 6a. Etiology of Herpes Simplex 1 Current: 113 |
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Definition
| Most often acquired asymptomatically in childhood. Over 85% of adults have serologic evidence of HSV-1. |
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Term
| 2. Common Locations of Skin Cancers |
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Definition
| Basal cell: sun-exposed areas: face, trunk, hands, legs, scalp. Usu in fair-skinned ppl. Waxy, pearly lesion w/rolled borders and central dell. Squamous cell can also occur in above locations + lips, oral cavity, tongue, genitalia. Remember: these are not Melanoma but risk factors and locations are the same for fair-skinned ppl with excessive sun/uv exposure. |
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Term
| 6b. Pathophysiology of Herpes Simplex 1 Current: 113 |
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Definition
| Primary infections may manifest as severe gingivostomatitis. Thereafter, pnt may have recurrent self-limited attacks, provoked by sun exposure, orofacial surgery, fever or a viral infection. |
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Term
| 4a. S/Sx of Herpes Simplex 1 Current: 113-114 |
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Definition
| Principal sx are burning and stinging. Neuralgia may precede or accompany attacks. Lesions: small, grouped vesicles that can occur anywhere but most often on vermillion border of the lips, penile shaft, labia, perianal skin, buttocks. Any erosion in genital region can be due to HSV-2. Regional lymph nodes may be swollen and tender. Lesions usu crust and heal in 1 week. HSV is most common cause of painful genital ulcerations in HIV pnts. |
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Term
| 4b. S/Sx Herpes Zoster Current 115 |
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Definition
| Pain usu precedes the eruption by 48º or more. May persist or actually increase in intensity after the lesions have disappeared. Lesions consist of grouped, tense, deep-seated vesicles distributed unilaterally along a dermatome. (Plate 20) The most common distributions are on the trunk or face. Upto 20 lesions may be found outside the affected dermatomes. Regional lymph nodes may be tender and swollen |
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Term
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Definition
| • Generalized, v. severe itching. • Generalize excoriations w/small pruritic vesicles, pustules and runs or burrows • Usu on finger webs, heels of palms, wrists, elbows and around axillae • Red papules or nodules on the scrotum and on the penile glans and shaft are pathognomonic. (a S/Sx of a dz that is so characteristic of that dz that it is diagnostic) |
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Term
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Definition
| Ringworm ITCHING with CLASSIC lesions of ERYTHEMA have advancing SCALY border and central clearing; DISTINCT border located on EXPOSED skin surfaces or on the TRUNK – pg 103 or PLATES 7/8 |
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Term
| 4e. S/Sx Impetigo Current 118 |
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Definition
| Superficial blisters filled with purulent material that rupture easily. Crusted superficial erosions Macules, vesicles, bullae, pustules and honey-colored gummy crusts which, when removed, leave denuded red areas (plate 23) Face and other exposed parts most often involved. Positive Gm stain and bacterial culture (usu S. aureus in temperate climates, Streptococcus in tropical) |
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Term
| 5a Tx for Herpes Simplex 1 |
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Definition
| • Acyclovir 200 mg x5 daily or 800 mg TID • Valcyclovir 1000 mg BID; • Famciclovir 250 mg TID • Tx x7-10d • Recurrent herpes is usu mild; don’t really need tx. • Can add a potent topical steroid also TID to reduce pain, size, duration of outbreak |
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Term
|
Definition
| • Oral acyclovir 800 mg x5 daily or famicliclovir 500 mg TID or valacyclovir 1 g TID (all are for 7 days) • Keep hydrated. • Adjust for renal function • Initial severe pain: nerve blocks can be used. • Systemic corticosteroids: reduces acute pain: tapering 3 week course prednisone: 60 mg/d. • Local tx: calamine or starch shake lotions. • Severity and duration reduced if tx's w/i 72º after onset with acyclovir |
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Term
|
Definition
| • Kill scabies mites. • Control dermatitis (can last for months after mites gone) • Bedding, towels, clothing laundered or dry cleaned or closed in plastic bags for up to 14 d. • If there is a secondary pyoderma (bacterial infection of the skin): systemic antibiotics • Entire household must be tx'd. •Permethrin 5% cream: very effective and safe • One application for 8-12 hours, repeat in 1 week if needed. • tx pregnant women only if scabies confirmed • Itch will continue for a few wks after tx • Triamcinolone 0.1% cream resolves dermatitis. |
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Term
| 5d. Tx for Tinea corporis |
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Definition
| • Topicals: Miconazole 2%, Clotrimazole 1% solution, cream, lotion, Betenafine, terbinafine. • These are all sold OTC • Tx until 1-2 weeks s/p clearing. • Systemics: Griseofulvin 250-500 mg BID x4-6 wks. OR Itranconazole 200 mg qd x 1 wk. • Either topicals or systemics work in about 4 wks. |
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Term
|
Definition
| 1) Soaks and scrubs to "unroof" crust and clear away pus. 2) Topical bacitracin, mupirocin, or retapamulin. However, systemic abx are usually indicated (cephalexin or doxycycline). 3) Bleach baths help prevent infection of other family members. |
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Term
| 7a S/Sx of Basal Cell Carcinoma |
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Definition
| IN SUN-EXPOSED AREAS. Five Possible Presentations: - A non-healing open sore. May get bleeding. - A reddish or irritated patch, usually on chest, shoulders or arms. - A shiny, pearly nodule/papule -A pink growth, elevated with a rolled border -A scar-like area of waxy, taught skin. (Current plate 38). Lesions may have telangiectasia. |
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Term
| 7b S/Sx of Squamous Cell Carcinoma |
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Definition
| IN SUN-EXPOSED AREAS. Most commonly on head, neck, back, arms, hands. Higher rates in lip, oral cavity, tongue and genitals. Lesion appears as a small, red, warty nodule. May become a non-healing ulcer. |
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Term
| 7c S/Sx Actinic keratosis |
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Definition
| Small (0.2-0.6 cm) macules or papules-flesh-colored, pink or slightly hyperpigmented • Feel like sandpaper • Tender when a finger are drawn over them • Occur on sun-exposed areas of light-skinned ppl • Premalignant but only 1:1000/ yr become squamous cell |
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Term
|
Definition
| A pigmented lesion of: Asymmetry (of border, color, and topography) Border irregularity Color variation Diameter > 6mm Evolving over time "Ugly Duckling Sign" - a mole that stands out compared to pts other moles. Pigment may appear to leak into surroundings. |
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Term
| 8. Risk factors for skin cancer |
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Definition
| Risk factors for non-melanoma and melanoma skin cancers include: Unprotected and/or excessive exposure to ultraviolet (UV) radiation Fair complexion Occupational exposures to coal tar, pitch, creosote, arsenic compounds, or radium Family history Multiple or atypical moles Severe sunburns as a child |
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Term
| Comorbidities for Seborrheic dermatitis |
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Definition
| Often presents secondary to Parkinsons, HIV and acute illness. |
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Term
| 11a. Retin A (Katzung p. 1056) |
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Definition
| • Topical tx for acne vulgaris.(may exacerbate it initially) • use lentil-sized amount • Vitamin A alcohol is the physiologic form of Vit A • Increases epithelial turnover • Used to diminish fine lines and wrinkles • ADRx: erythema and dryness |
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Term
| 11b Benzoyl peroxide (Katzung p. 1056) |
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Definition
| •Topical tx for acne vulgaris. •MOA: antimicrobial activity against P acnes and to its peeling and comedolytic effects. |
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Term
| 11c. Mycostatin Katzung p. 842, 844, 1052 |
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Definition
| Trade name: Nystatin • Antifungal• Oral or topical (cream, ointment, powder, suppositories) • Active against Candida • Used topically for oropharyngeal thrush, vaginal candidiasis, candidal diaper rash and intertriginous candidal infections |
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Term
| 11d. Atarax (generic: Hydroxyzine) |
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Definition
| Relieve itching caused by allergies and to control N/V 2º various conditions, inc. motion sickness. Also, anxiety 2º ETOH withdrawal. |
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Term
| 13. Conditions that favor external genital warts Current 678 |
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Definition
| Sexually transmitted. • Pregnancy and immunosuppression favor growth |
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Term
| 14. Tx of bleeding skin lesions |
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Definition
| Highly suspect for malignancy. Biopsy. |
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Term
| 15a. S/Sx of Pityriasis Rosea |
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Definition
| • Oval, fawn colored plaques up to 2 cm. • Herald patch (usu larger than subsequent ones) seen 1-2 weeks before eruption • Center: crinkled "cigarette paper" • Scale attached at periphery and free at center • Scaly eruption along body folds/cleavage lines. (Christmas tree pattern) • Often on proximal extremities • Occasionally itchy. • Lasts 6-8 wks and heals fine |
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Term
| 15b. S/Sx of Tinea versicolor |
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Definition
| Tinea versicolor (pityriasis versicolor) is superficial skin infection with Malassezia furfur of trunk (usu central upper) that manifests as multiple asymptomatic scaly patches varying in color from white to brown. •Tinea versicolor usu is asymptomatic. •Multiple tan, brown, salmon, or white scaling lesions on the trunk, neck, abdomen, and occ face. The lesions coalesce. In whites, condition is often dx'd in summer months b/c lesions do not tan & become more obvious against tanned skin. There is also a hyperpigmentation type. |
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Term
| 15c. S/Sx Congenital Syphylis |
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Definition
| Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses. |
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Term
| 15e. S/sx Varicella (chicken pox) Current 1239 |
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Definition
| Fever & malaise • pruritic rash begins prominently on face, scalp, trunk and later involves extremities. • maculopapules change in a few hours to vesicles that become pustular and eventually form crusts • New lesions erupt for 1-5 d. • Crusts slough in 7-14 days. • Vesicles and pustules are superficial and elliptical, with slightly serrated borders.• Pitted scars are frequent sequelae.• Virus then remains dormant in cranial nerves and spinal dorsal root ganglia. |
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Term
| 15e. S/sx Varicella (zoster) |
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Definition
| • Pain starts 48º before eruption • May persist and increase after the lesions are gone (post-herpetic neuralgia) • Lesions: grouped, dense, deep-seated vesicles, distributed unilaterally along a dermatome •Usu trunk or face • Regional lymphadenopathy. |
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Term
|
Definition
| • Isotretinoin (Vit A analog, Accutane) is used for tx of severe cystic acne that has not responded to conventional tx. Rx before pnt has significant scarring if not responding to antibiotics. • Absolutely contraindicated in pregnancy • Suicide risk • Strict monitoring and informed consent req'd• Also: intralesional injections of corticosteroids, laser dermabrasion |
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Term
| 17. Cancers caused by sun exposure |
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Definition
| Atinic keratosis • Basal Cell carcinoma • Squamous Cell carcinoma • Melanoma |
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Term
| 18. Management and dx of head lice Current 138, Cecil 2441 |
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Definition
| LOOK for head lice above ears and nape of neck; FLOURESCE under WOOD’s light for easy screening. Tx: dispose of infested clothing. • Pubic lice: permethrin rinse 1% x10 m, permethrin cream 5% x 8º • Sexual contacts should be tx'd also. • Bedding washed and dried @ high temp. • Head lice: Permethrin 1% cream rinse (Nix) is applied and left on x8º. Permethrin resistance is common in head lice. • Malathion lotion 1% but v. volatile: must be done outdoors or in well-ventilated room. • Eyelashes: petrolatum bid x 8 d. |
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Term
| 19a. S/Sx of stasis dermatitis |
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Definition
| Hyperpigmentation, red-brown discoloration from RBC extravasation appear. Later, eczematous changes develop & manifest as erythema, scaling, weeping, & crusting, all of which can be made worse by bacterial superinfection or by contact dermatitis caused by the many topical tx often applied. When chronic venous insufficiency & stasis dermatitis are both inadequately tx'd, stasis dermatitis progresses to frank skin ulceration, chronic edema, thickened fibrotic skin, or lipodermatosclerosis (a painful induration resulting from panniculitis, which, if severe, gives the lower leg an inverted “coke-bottle” shape w/enlargement of the calf & narrowing at the ankle). |
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Term
|
Definition
| Silvery scales on red, well-demarcated plaques on knees, elbows, scalp. Also examine nails, palms and soles • Nail findings: pitting and onycholysis: separation of nail plate from bed. • Mild itching • Might be associated with psoriatic arthritis. • Histology is inconclusive |
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Term
| 19c. S/Sx Dermatophyte Infection |
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Definition
| Asymptomatic Scaling, progress to fissures or maceration in toe web spaces.• Itching, burning, stinging • Comorbidity: lower leg cellulitis • Interdigital webs: itching burning, stinging • Scaling palms and soles • Inflammatory: vesicles of soles • Pain: might be secondary infection w/cellulitis. • Sole and heel: chronic noninflammatory scaling; thickened, fissured • Moccasin distribution (over sides of feet) • Bacteria take over: vesicles may appear. • Nail involvement: discoloration, thickening, crumbling of nail plate |
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Term
| 19d. S/Sx Seborrheic keratosis |
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Definition
| Benign Plaques: beige, brown or black. 3-20 mm diameter. Velvety or warty surface. Look like they're pasted on the skin. Common in elderly |
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Term
|
Definition
| Treatment entails antipruritics, topical corticosteroids, and avoidance of causes. Oral prednisone taper in severe cases. (prednisolone is not enough initially to be effective and not slow enough taper to avoid rebound) |
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Term
| 21. Skin conditions in AIDS populations |
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Definition
| Seborrheic dermatitis (oily scurf/dandruff); Psoriasis; Stevens-Johnson syndrome; Herpes Simplex; Mucocutaneous candidiasis; Molluscum Contagiosum; Herpes Zoster; |
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Term
| 22. Tx of scabies patients |
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Definition
| • Kill scabies mites. • Control dermatitis (can last for months after mites gone) • Bedding, towels, clothing laundered or dry cleaned or closed in plastic bags for up to 14 d. • If there is a secondary pyoderma (bacterial infection of the skin): systemic antibiotics • Entire household must be tx'd. •Permethrin 5% cream: very effective and safe • One application for 8-12 hours, repeat in 1 week if needed. • tx pregnant women only if scabies confirmed • Itch will continue for a few wks after tx • Triamcinolone 0.1% cream resolves dermatitis. |
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Term
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Definition
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Term
| 24. S/Sx of rheumatoid arthritis Current 747 |
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Definition
MORNING STIFFNESS >30 minutes – 1h and is a USEFUL indicator of RA; INSIDIOUS onset; SYMMETRICAL POLYarthritis most likely in SMALL joints of HANDS/FEET and is DEFORMING with progressive disease pathology; CAN occur in NECK, but does NOT affect SPINE/SACROILIAC
JOINTS = most common SS @ PIP of fingers; MCP joints, wrists, knees, ankles and MTP joints
NODULES = 20% pts most likely over BONEY prominences (occasionally seen in BURSAE/ TENDON, LUNGS, SCLERA) and indicates SEROPOSITIVE for RA FACTOR
OTHER Stuff with RA = palmar erythema; dry eyes/mouth/Sjogren; small vessel vasculitis with hemorrhagic infarcts in nail bed; pulmonary fibrosis; pleural effusions; pericarditis; lymphadenopathy; FELTY SYNDROME = splenomegaly/neutropenia with severe/destructive RA- |
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Term
|
Definition
| Chronic, systemic inflammatory dx • Synovitis of multiple joints • women>men=3:1) Peak onset: 4th to 5th decade for women/6th to 8th for men• Inheritance of class II HLA molecules w/distinctive 5-amino-acid sequence known as "shared epitope"• Unk etiology • joint destruction w/disability and shortened life expectancy. |
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Term
| 26. Steps in initial fx care Ortho book p 10 |
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Definition
| Splint before transport • Correct any significant rotational or angular misalignment b4 splinting (gentle traction in long axis of limb-NOT in open fx) • splinting is only temporary • Robert Jones splint if definitive care delayed • Elevate above level of heart • Ck neuro/circulatory status • |
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Term
| 27. Define Tietze's syndrome |
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Definition
| Anterior chest wall syndrome = sharply localized tenderness @ intercostals muscles/ inflammation of CHONDROCOSTAL junctions that is warm; red; swollen and is reproducible by local pressure; most common in 2nd -3rd ribs; younger pt; pain increased with movement |
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Term
| 28. Post cast care and follow-up |
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Definition
| Elevate above heart • Ice x 48-72º • Observe closely for circulatory or compartment syndrome • If telescoping occurs: replace • Itching is common: antihistamines |
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Term
|
Definition
SS = FEVER, anorexia, malaise and WL; 49% of pts have characteristic MALAR/BUTTERFLY rash; DISCOID lupus; fingertip lesions; periungual erythema; nail fold infarcts; splinter hemorrhages with ALOPECIA being common; with ANTECEDENT of Raynaud; EARLIEST manifestations are joint SS in 90% of pts with NON-DEFORMING arthritis and NO EROSIVE damage noted on X-ray;
OCULAR = conjunctivitis; photophobia; MONOcular blindness and blurred vision; COTTON-WOOL spots from retinal artery hemorrhages/occlusions
OTHER = pleural effusion; PN; RESTRICTIVE lung dx; PERICARDITIS/MYOCARDITIS/MITRAL regurg; ABD pain post-prandial d/t mesenteric vasculitis; phychosis; SZ; GLOMERULARNEPHRITIS |
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Term
| 30. S/Sx of systemic sclerosis (scleroderma) |
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Definition
RAYNAUDS is early presentation usually associated with LIMITED
SS = polyarthragia; malaise; WL could be DIFFUSE presentation
SS = cutaneous usually presents before organ with NON-pitting subcutaneous edema/pruritis; HIDEBOUND thickening of skin and reduction in folds/wrinkles may make pt look younger initially
OTHER stuff = dysphagia, GERD, HYPOmotility of GI tract, large mouth diverticuli @ jejunum, ileum, colon, pulmonary HTN, pericarditis, renal crisis all d/t fibrosis of small vasculature and OVERproduction of collagen/matrix proteins |
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Term
| 31a. Patho of cervical sprain Ortho 37 |
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Definition
| Hyperextension force, much of which is absorbed by the ligaments, muscles, discs • later serial x-rays show degenerative changes • Sympathetic nerve chains may be stretched: sx inc: nausea, tinnitus, blurred vision and dizziness. |
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Term
| 31b. S/Sx of cervical sprain |
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Definition
| May have v. few immed post trauma • few hrs later: stiffness followed by pain and decreased ROM • Pain generalized to neck and may radiate to occiput, shoulder, interscapular area, ant chest wall. Clinical findings non-specific |
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Term
| 32a. Lab analysis important in RA |
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Definition
| Anti CCP: 95%; RA factor; RF = IgM in serum directed at Fc fragment of IgG produced by synovial fluid; elevated ESR and levels of C-reactive proteins; leukopenia in presence of FELTY; elevated ALK PHOS |
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Term
| 32b. Lab analysis important in Streptococcal arthritis |
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Definition
| Streptococcus pyogenes causes Rheumatic Fever & according to Current's pg. 731 that is a Group II (Inflammatory) dx (some septic arthritis can present w/group II if it is of low virulence). But usu streptococcal species present as a purulent/septic joint: Volume: >3.5, Clarity: Opaque, Color: ylw - grn, WBC:>100K, PMNs: 75% or more & Culture: usu (+). Labs for Nongonococcal Acute Bacterial (Septic) Arthritis: Synovial fluid (+) 75-90%, bld cultures (+) 50%. Xrays: joint effusion only. |
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Term
| 32c. Lab analysis important in Gonococcal arthritis |
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Definition
Peripheral blood leukocyte count: avg. 10K cells/mcL. Neisseria gonorrhoeae: Sexually active young adults are at risk for septic arthritis caused by this infection. Patients usually present with acute swelling, fever, joint warmth and effusion, tenderness to palpation, and increased pain with minimal ROM in the involved joint.
Synovial fluid WBC: 30K-60K w/(+) in 25%
Blood cultures are (+) in 40% in pts w/tenosynovitis.
XRAY: usu NL or show only soft-tissue swelling. |
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Term
| 32d. Lab analysis important in sporotrichosis |
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Definition
| Chronic fungal infections caused by Sporothrix schenckii. Most pts have contact w/soil, moss or decaying wood. Cultures are needed to establish dx. Antibody test may be useful. In species other than cats, Sporothrix organisms are often sparse in exudate and infected tissue so that diagnosis usu requires culturing the organism. In cultures, a true mycelium is produced, with fine, branching, septate hyphae bearing pear-shaped conidia on slender conidiophores. |
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Term
| 32e. Lab analysis important in osteoarthitis |
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Definition
Xrays more important than labs: characterized by degeneration of cartilage & hypertrophy of bone at articular margins.
• Inflammation minimal (no ↑esr)
• Xray: narrowing of joint space, osteophyte formation, sharpened "lipping" of marginal bone & thick, dense subchondral none. Bone cysts are possible.
•Synovial fluid: clear, straw/yellow colored w/high viscosity. WBC 200-300, PMN<25%, evidence of cartilage debris |
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Term
| 33a. S/Sx of gouty arthritis |
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Definition
| • Initial attack: SUDDEN ONSET • Single joint of lower extremity • classic 1st site: MP joint big toe (podagra) • also: extensor synovium on dorsum of midfoot • Pain/inflammation severe • Pain ppt by exercise, dietary causes, physical/emotional stress, • common after illness/surgery • Typically begin at NIGHT P/E: swelling, Heat, Redness, tender to touch, fever, tachycardia; 1st episode: may be followed w/polyarticular involvement; Eventually urate crystal deposits(tophi) form in subq tissue; Xray: Nl in early dx, puched-out in late dx; LABS: Mild leukocytosis, ↑esr, Hyperuricemia (>5 mg/dL) Synovial aspirate: cloudy, mildly inflamm. Nature w/ Urate crystals |
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Term
|
Definition
• Insidious onset
• Articular stiffness (<15mins) initially then pain on motion
• Pain made worse by activity or weight bearing; relieved by rest
• Heberden nodes (dip), bouchard nodes (pip), flexion contracture, varus deformity of knee
• Limitation of motion, crepitus,of the affected joint
• No systemic manifestations
• mild joint effusion possible |
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Term
| 33c. S/Sx of Ankylosing spondylitis |
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Definition
| Seroneg spondyloarthropathy that progresses to fusion of the vertebrae. This condition involves onset of back pain, stiffness and hip pain during 3rd and 4th decades. Men>Women. Affects SI joint symmetrically and the spine in a progressively ascending manner. Restricts lumbar ROM. Ltd ROM in shoulders and hips, synovitis of the knees, plantar fasciitis and Achilles tendinitis. Hip contractures and fixed cervical, thoracic & lumbar hyperkyphosis. Fx of fused osteopenic spine may occur (usu Cervical) as may sciatica. Extra articular Sx: uveitis, cardiac abn, interstitial lung dz. |
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Term
| 33d. S/Sx of Felty's Syndrome |
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Definition
| Associated with RA. Recurrent infections (esp. skin and respiratory), fever, WL, fatigue, hyper pigmentation (brown skin), ulcers and purpura on skin (esp. legs) from vasculitis, left upper quadrant pain, hepatomegaly, lymphadenopathy, anemia, thrombocytopenia. |
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Term
| 33e. S/Sx of Reiter's Syndrome |
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Definition
-pts are young & joint sxs appear w/in 3-4wks of infection (usu GI or GU infections d/t salmonella & chlamydia respectively)
-asymmetric sterile oligoarthritis, usu of lower extremities (knees & ankles)
-low back pain is common
-enthesis & scaroiliitis are common
-synovial fluid is culture (-)
-fever & weight loss at onset
-extra-articular sxs: urethritis, conjunctivitis & mucotaneous lesions: balanitis, stomatitis, keratoderma blennorrhagicum (indistinguishable from pustular psoriasis), pitting & onchylosis (as in PA) are seen.
-HLA-b27 antigen is present as well as elevated ESR |
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Term
| 34a S/Sx of subacute bacterial endocarditis |
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Definition
| Present w/fever & nonspecific sx (ex: cough, dyspnea, arthralgias, back or flank pain, GI complaints). 25% of pnts have palatal, conjunctival or subungual petechiae/splinter hemorrhages. Osler nodes (painful, violaceous, raised lesions of the fingers, toes or feet), Janesway lesions (painless, red lesions of the palms or soles) and Roth spots (exudative lesions in the retina). Pallor and splenomegaly are common. Strokes and emboli may occur. |
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Term
| 35a. Synovial fluid results expected in septic arthritis |
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Definition
Volume >3.5 ml
Clarity: Opaque
Color: Yellow to Green
WBC >100k
PMNs: ≥75%
Culture: usu + |
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Term
| 35b. Synovial fluid results expected in normal joint |
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Definition
Volume <3.5 ml
Clarity: Clear
Color: Colorless
WBC <200
PMNs: ≤25%
Culture: - |
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Term
| 35c Synovial fluid results expected in acute gout |
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Definition
Volume: Usu >3.5 ml
Clarity: Clear to Opaque
Color: Yellow to Opalescent
WBC: 2000-75,000
PMNs: ≥50%
Culture: - |
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Term
| 35d. Synovial fluid results expected in RA |
|
Definition
Volume: Usu >3.5 ml
Clarity: Clear to Opaque
Color: Yellow to Opalescent
WBC: 2000-75,000
PMNs: ≥50%
Culture: - |
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Term
| 35e. Synovial fluid results expected in OA |
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Definition
Clarity: Clear
Color: Yellow
WBC: 200-300
PMNs: <25%
Culture: - |
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Term
|
Definition
| = ANTI-CCP (Anti-cylic citrullinate) are most specific for RA 95%; RA factor seropositive but can occur in other AI/chronic infections like HCV, Syphillis, endocarditis, TB; RF = IgM in serum directed at Fc fragment of IgG produced by synovial fluid; elevated ESR and levels of C-reactive proteins; leukopenia in presence of FELTY; elevated platelets out of proportion with inflammation |
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Term
| 37a. S/Sx of bicipital tendonitis |
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Definition
Pain in the front of the shoulder when you move your arm and shoulder. This pain will especially be felt when you extend your arm out in front of you or raise your arm above your shoulder.
1. You feel pain when the front of the shoulder is touched.
2. The area may be red and swollen. In some cases you may feel a burning sensation around the area in the front of the shoulder.
3. The pain is often worse at night or first thing in the morning.
4. You may feel or hear a snapping sound when you move the arm or shoulder in certain directions. |
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Term
| 37b. S/Sx of osteochondral fracture |
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Definition
| Usually of the knee or ankle. Pain with weight bearing activities. Swelling, Instability of the joint, Occasional catching and locking of the joint, Tenderness to touch over injured area, Decreased motion. |
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Term
| 37c. S/Sx of impingement syndrome |
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Definition
| difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles. |
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Term
| 37d. S/Sx of rotator cuff damage |
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Definition
Recurrent, constant pain, particularly with overhead activities.
Pain at night that prevents you from sleeping on the affected side. Muscle weakness, especially when attempting to lift the arm. Catching and grating or cracking sounds when the arm is moved. Limited motion. |
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Term
| 37e. S/Sx of biceps rupture |
|
Definition
A sudden sharp pain during activity.
An audible pop or a perceived snapping sensation may be felt.
Recurrent pain while performing overhead or repetitive activities.
Shoulder soreness that may worsen at night.
Bruising, or a visible and palpable mass (bulge) may appear between the shoulder and elbow. The bulge is due to the torn tendon fibers pulling off the shoulder and slipping down into the upper arm, where they come to rest as a balled up mass. Weakness in the arm. |
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Term
|
Definition
MORNING STIFFNESS >30 minutes – 1h and is a USEFUL indicator of RA; INSIDIOUS onset; SYMMETRICAL POLYarthritis most likely in SMALL joints of HANDS/FEET and is DEFORMING with progressive disease pathology; CAN occur in NECK/SPINE, but does NOT affect SACROILIAC
JOINTS = most common SS @ PIP of fingers; MCP joints, wrists, knees, ankles and MTP joints
NODULES = 20% pts most likely over BONEY prominences (occasionally seen in BURSAE/ TENDON, LUNGS, SCLERA) and indicates SEROPOSITIVE for RA FACTOR |
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Term
| 39. Total management of pelvic fx |
|
Definition
Stable = pelvic ring broken only at one point; usually from minor fall in osteoporotic/elderly women; TX symptomatically for 1-2 days of rest and follow with ambulation/weight bearing with a walker
Unstable = pelvic ring broken in more 2 or more place are more serious and life threatening; GU or visceral injury with posterior fx damaging venous/arterial sites = massive RETROperitoneal bleed; TX = prolonged IMMOBILIZATION and surgical repair
Acetabulum fx = involve main weight-bearing surface of hip; TX = reduction (manual or surgical) or traction on femur to restore smooth surface of acetabulum
Stress fx = may be overlooked in OSTEOPOROTIC pts d/t no hx of trauma (pubic bones, ilium and sacrum) |
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Term
| 40a. Skin manifestations/abnormalities in RA |
|
Definition
bruising, athlete’s foot, scars, rheumatoid nodules and vasculitic lesions. NODULES seen in LUNGS, SCLERAE and other tissues correlate with SEROPOSITIVITY for RA factor; DRY eyes/mouth/ mucosa = Sjogrens;
PALMAR erythema; small vessel vasculitis with tiny hemorrhagic infarcts in nail folds/finger pulp; PERICARDITIS; PLEURAL dx; PULOMARY FIBROSIS; skeletal muscle infiltration; HYPERplasia of LYMPH nodes; FELTY syndrome; AORITIS and regurg/vasculitis systemic and pervasive is rare |
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Term
| 40b. Skin manifestations/abnormalities in Reiter syndrome |
|
Definition
| inflammation of the urethra, with painful urination and a discharge from the penis. mouth ulcers, inflammation of the eye, keratoderma blennorrhagica, these are patches of scaly skin on the palms, soles, trunk, or scalp of RS patients |
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Term
| 40c. Skin manifestations/abnormalities in tophaceous gout |
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Definition
| erupting through the skin, exposing its gross histological chalky white appearance is not uncommon. More atypical dermatological manifestations in the form of pustules, ulcerations, and panniculitis have occurred. |
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Term
| 40d. Skin manifestations/abnormalities in ankylosing spondylitis |
|
Definition
| Psoriasis (also can have uveitis and IBD with AS) |
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Term
| 40e. Skin manifestations/abnormalities in OA |
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Definition
| NODULES = boney enlargements of DIP called HERBERDEN nodes and PIP called BOUCHARD nodes which are prominent. No skin involvement. |
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Term
| 41a. S/Sx of gonococcal arthritis |
|
Definition
Fever
Lower abdominal pain
Migrating joint pain for 1 to 4 days
Pain in the hands or wrists due to tendon inflammation
Pain or burning on urination
Single joint pain
Skin rash (lesions are slightly raised, pink to red, may later contain pus or appear purple) |
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Term
|
Definition
| Decreased range of motion (ROM),joint crepitus,and pain gradually worsening throughout the day arefeatures of OA. Common sites of involvement are the distal interphalangeal (DIP) joint (Heberden’s nodes),proximalinterphalangeal (PIP) joint (Bouchard’s nodules),wrist,hip,knee,and spine.The metacarpophalangeal(MCP) joints (except the thumb),ankle,and elbow are usually spared. Joints can become unstable during the late stages of OA |
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Term
| 41c S/Sx of gouty arthritis |
|
Definition
| The most common feature is initial attack of the metatarsal phalangeal joint of the great toe (podagra);it isthe presenting manifestation in 70% of cases. Other joints of the feet,ankles,and knees are commonly affected. Pain,swelling,redness,and exquisite tenderness develop suddenly at and surrounding the joint.In chronic gout,tophi (chalky deposits of urate crystals) may form adjacent to the joint and are considered diagnostic. |
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Term
|
Definition
RA is a chronic disease with synovitis affecting multiple joints and other systemic extra-articular manifestations. Females are affected more often than males (3:1 ratio),with onset typically occurring between 40 and 60 yearsof age.The juvenile form occurs in patients younger than 16. A cascade of events leads to joint destruction.Hyperplastic synovial tissue (pannus) may erode cartilage,subchondral bone,articular capsule,tendons,and ligaments.
For diagnostic criteria of RA.To make the diagnosis,four of the criteria must be present. The DIP joints are usually spared. Extra-articular manifestations of RA include changes in the skin,lungs,kidneys,eyes,liver,blood system,andheart. Osteoporosis is frequently diagnosed. |
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Term
| 41e. S/Sx of polymyalgia rheumatica |
|
Definition
| Polymyalgia rheumatica is characterized by pain and stiffness in the neck, shoulder ,and pelvic girdles and is accompanied by constitutional symptoms (e.g., fever, fatigue, weight loss, depression). It affects women twice as often as men and usually presents in patients older than 50 years. Cause is unknown. It is associated with temporal arteritis in up to 30% of cases. Stiffness usually is the predominant feature, being severe after rest and in the morning. Musculoskeletal symptoms usually are bilateral, proximal, and symmetrical. Giant cell (temporal) arteritis must be ruled out. It characteristically presents with scalp tenderness, jawclaudication, headache, and temporal artery tenderness and may lead to vision loss |
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Term
| 42. Skin involvement associated with joint pain dzs; Felty’s syndrome |
|
Definition
| S/S: Recurrent infections (esp. skin and respiratory), fever, WL, fatigue, hyperpigmentation (brown skin), ulcers and purpura on skin (esp. legs) from vasculitis |
|
|
Term
|
Definition
| subcutaneous abscess (pus) of the distal fingertip. These lesions typically occur after injury to the finger, such as a puncture wound or in response to a retained foreign body in the finger. Patients with Diabetes or autoimmune disorders are more susceptible to this type of infection. Symptoms include pain, swelling, and possibly discharge (pus) from the wound. Treatment options for a felon, or any abscess, include surgical drainage of the abscess, antibiotics and elevation of the extremity. |
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Term
| 43b. S/Sx of dupuytren's contracture |
|
Definition
| HYPERplasia of palmar fascia with NODULAR formation and contraction of PALMAR FASCIA; THINK ETOH white men >50yo with chronic dx like cirrhosis, and is associated with PEYRONIE or other systemic fibrosing syndromes; 4th/5th fingers being most affected with inability to extend fingers; normally well-tolerated d/t normal position/function of hand being exaggerated |
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Term
| 43c. S/Sx of mallet finger |
|
Definition
| loss of extensor tendon at DIP(distal interphalangeal joint) d/t injury which causes the finger to rest in an abnormally flexed position |
|
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Term
| 43d. S/Sx of flexor tendon tear |
|
Definition
| Inability to bend your finger, pain when you bend your fingers or mild swelling near your joints. |
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Term
| 43e. S/Sx of Volkmann's contracture |
|
Definition
| ET = prolonged ischemia usually from compartment syndrome/trauma of forearm resulting in permanent FLEXOR contracture of hand/wrist creating a CLAW-LIKE deformity. |
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Term
| 44a. S/Sx osteochondritis dissecans |
|
Definition
Pain. The most common symptom; pain may be triggered by physical activity — walking up stairs, climbing a hill or playing sports.
Joint popping or locking. Your joint may pop or get stuck in one position if a loose fragment gets caught between the bones during movement.
Joint weakness. You may feel that your joint is "giving way" or weakening.
Decreased range of motion. You may be unable to straighten your leg or arm completely.
Swelling and tenderness. The skin around your joint may become swollen and tender. |
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Term
| 44b. S/Sx chronic medial collateral ligament laxity |
|
Definition
Grade 1 symptoms:
• Mild tenderness on the inside of the knee over the ligament.
• Usually no swelling.
• When the knee is bent to 30 degrees and an outward force applied to the lower leg to stress the medial ligament, pain is felt but there is no joint laxity (looseness) (see assessment).
Grade 2 symptoms:
• Significant tenderness on the inside of the knee on the medial ligament.
• Some swelling seen over the ligament.
• When the knee is stressed as for grade 1 symptoms, there is pain and mild to moderate laxity in the joint, although there is a definite end point (the knee cannot be bent sideways completely).
Grade 3 symptoms:
• This is a complete tear of the ligament.
• Pain can vary and is sometimes not as bad as that of a grade 2 sprain.
• When stressing the knee as described above there is significant joint laxity.
• Athlete may c/o very wobbly/unstable knee. |
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Term
| 44c. S/Sx of chondromalacia of the patella |
|
Definition
Patellofemoral pain syndrome usually causes a dull, aching pain in the front of your knee. This pain can be aggravated when you:
• Walk up or down stairs
• Kneel or squat
• Sit with a bent knee for long periods of time
You may also experience a grating or grinding sensation when you extend your knee. |
|
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Term
| 44d. S/Sx of torn medial meniscus |
|
Definition
The most common symptoms of a meniscus tear are:
• Knee pain
• Swelling of the knee
• Tenderness when pressing on the meniscus
• Popping or clicking within the knee
• Limited motion of the knee joint |
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|
Term
|
Definition
| This is a small piece of calcified cartilage that becomes caught in between the bones of the knee causing sudden, sharp pain and occasional giving away. There is usually moderate to severe swelling of the knee and sometimes the swelling reduces within 48 hours of the sharp pain. Occasionally, the knee actually becomes locked and you are unable to straighten the knee. |
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Term
| 45. Description of talipes equinovarus |
|
Definition
CONGENITAL clubfoot = foot turns inward and downward; may affect one/both feet
Frequently bilateral with unknown ET; 3 major deformities = equines of ankle and forefoot; varus of heel and adduction of forefoot; medial border of foot is concave and lateral border is convex
TX = soft tissue manipulation and progressive casting changed weekly for 6-8 weeks until complete correction is achieved; will NOT correct passively; 50% require corrective surgery – practical ortho |
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Term
| 46. Lab and x-ray findings in OA |
|
Definition
LABS = NO elevated ESR or signs of inflammation – WBC @ synovial fluid <2000 Synovial fluid: volume > 3.5, WBCs 200 - 300/ mcL, PMNs < 25%, glucose = serum, transparent, yellow, culture negative
RADIO = narrowing of joint space; sharpened articular margins; OSTEOPHYTE formation and lipping of marginal bone with thickened/dense SUBCHONDRAL bone; BONE cysts may be present |
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Term
| 47. S/Sx of lumbar strain |
|
Definition
lumbar strain: cause symptoms isolated to the low back, usually they do not cause problems in the legs like some other spine conditions. The most common symptoms are:
o Pain around the low back and upper buttocks
o Low back muscle spasm
o Pain associated with activities, and generally relieved with rest |
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Term
| 47. S/Sx of OA of the lumbar spine |
|
Definition
The facet joints become inflamed and there is more progressive joint degeneration. The surface of the facet joints are covered with articular cartilage. The symptoms which result include:
• pain in the back or spine
• stiffness of the spine
• loss of flexibility in the spine |
|
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Term
| 47. S/Sx of herniated disc with pressure on L5 nerve root |
|
Definition
| LBP (low back pain) radiating down posterolateral aspect of thigh, anterolateral aspect of lower leg, dorsum of foot including great toe and two adjacent toes. Dorsiflexion compromised. |
|
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Term
| 47. S/Sx of herniated disc with pressure on S1 nerve root |
|
Definition
| LBP (low back pain) radiating down posterolateral aspect of thigh, lower leg and heel. Plantar flexion compromised. |
|
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Term
|
Definition
Insidious onset. Starts with joint stiffness lasting ~15 minutes. Later, pain on motion develops. Pain is relieved by rest. Limitation of motion develops. Heberden nodes enlarge the DIP joints; Bouchard nodes the PIP joints.
Joint enlargement is bony, hard and cool (not soft and warm like in RA)
Inflammation NOT present!
Joints affected:
- DIP - Distal interphalangeal
- PIP - Proximal interphalangeal
- 1st metatarsal-phalangeal -MTP
- Knee
- Hip
- NOT wrist and metacarpophalangeal like RA. |
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Term
| 48. S/Sx of torn rotator cuff |
|
Definition
Shoulder pain, esp. at night
Muscle weakness
Catching, grating, cracking sounds
Limited arm motion |
|
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Term
| 48. S/Sx of tendonitis of biceps tendon |
|
Definition
Pain located in the bicipital groove and down anterior arm.
Tender bicipital groove.
Pain with shoulder extension
Positive resistance test
No sx below elbow
No pain w/ neck motion
No neuro sx |
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Term
| 48. S/Sx of fx of proximal humerus |
|
Definition
Pain
Swelling and bruising
Inability to move the shoulder
A grinding sensation when the shoulder is moved
Deformity -- "It does not look right"
Affected arm may appear longer than unaffected arm when extended |
|
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Term
| 48. S/Sx of torn distal biceps tendon |
|
Definition
There is often a "pop" at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two. Other symptoms include:
* Swelling in the front of the elbow
* Visible bruising in the elbow and forearm
* Weakness in bending of the elbow
* Weakness in twisting the forearm (supination)
* A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
* A gap in the front of the elbow created by the absence of the tendon |
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Term
| 48. S/Sx of shoulder bursitis |
|
Definition
Can cause impingement syndrome (like rotator cuff tendinitis)
Etiology: usu trauma which triggers inflammatory process
Sx include: Pain when working overhead or repetitive injuries involving shoulder such as pitching a baseball, throwing a football, etc.
Pain in area of shoulder joint and outside of upper arm
Special tests: + Hawkins; + Neer |
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Term
| 49. S/Sx of Volkmann's ischemic contracture |
|
Definition
The main symptom is pain that does not improve with rest or pain medications, and continues to get worse with time. If the pressure is allowed to continue, there will be:
Decreased sensation
Paleness of the skin
Weakness |
|
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Term
| 49. Patho of Volkmann's ischemic contracture |
|
Definition
Volkmann's contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This usually occurs when there is increased pressure due to swelling, a condition called compartment syndrome.
Compartment syndrome may be caused post trauma due to extreme swelling or from a cast that is either applied too tightly or becomes too tight 2º swelling. |
|
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Term
| 50. Compromised nerve in carpal tunnel syndrome |
|
Definition
Median nerve
Compression b/t carpal ligament and other carpal tunnel structures. Tenosynovitis, malhealed fx, tumor, congenital abnormalities that narrow the carpal tunnel and compress median nerve as it comes through. Pain may extend back into arm or up into shoulder. |
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Term
| 51. Physical findings in L5 radiculopathy |
|
Definition
| Great Toe extension weakness, Weak in heel walking (L5 does dorsiflexion), Footdrop. |
|
|
Term
52. Dx of Paget's dz
CMDT: 1044-1046 |
|
Definition
| One or more bony lesions having high bone turnover and disorganized osteoid formation. Involved bones become vascular, weak and deformed. Dx: often mild and asymptomatic. Only 27% of pnts @ time of dx have sx. Can involve just one bone or multiple. Affected bones usu involved right away: additional ones will not be affected later. Usu: skull, femur, tibia, pelvis, humerus. Pain in involved bone or adjacent joint is usu 1st sx that will present. If in skull: pnt may have HA, deafness. |
|
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Term
| 53. Muscles in rotator cuff |
|
Definition
| Supraspinatus, Infraspinatus, Teres Minor, Subscapularis |
|
|
Term
|
Definition
| Acute angle kyphosis, "humpback" usu 2º spinal TB |
|
|
Term
| 54. Definition of kyphosis |
|
Definition
| Outward (from the body) curving of the thoracic spine. |
|
|
Term
| 54 Definition of lordosis |
|
Definition
| Inward (into the body) curving of the cervical and lumbar spines |
|
|
Term
| 54. Definition of scoliosis |
|
Definition
| Lateral curvature of the vertebral column. Will usu have an asymmetric rib humping in forward flexion. |
|
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Term
| 55. Complications post total knee arthroplasty |
|
Definition
Asymptomatic DVT has been reported in up to 50-70% of patients who receive total knee arthroplasty.
Infection is rare following total knee arthroplasty. It occurs in 1-2.5% of cases
Neurovascular complications are rare. The lateral popliteal nerve may be injured in severe valgus deformity. Tourniquet paralysis may also occur as a rare problem. Major vessel injury may occur in revision procedures or in the rare case in which anatomy is abnormal. |
|
|
Term
| 56. Etiology of Horner's Syndrome |
|
Definition
| Horner syndrome is a rare disorder that occurs when the nerves that travel from your brain to your eyes & face are damaged. It is d/t damage to the sympathetic nerves of your face & eyes, typically affecting only 1 side. Horner syndrome isn't a dz itself. Rather, it's a sign of another medical problem — such as a stroke, tumor or spinal cord injury — that damages the nerves to your face. In some cases, however, no underlying cause can be found. Hallmark findings: drooping eyelid, decreased eye pupil size & decreased sweating on the affected side of face. |
|
|
Term
| 56. Etiology of Sjogren's syndrom |
|
Definition
Sjogren's can occur in isolation (primary) or w/ another rheumatic dz, most commonly w/ RA. Can also occur with SLE, 1° biliary cirrhosis, scleroderma, polymyosisis, Hashimoto thyroiditis, polyarthritis, and idiopathic pulmonary fibrosis (interstitial lung dz)
Exact etiology of Sjögren syndrome is unknown, but is likely multifactorial. A combination of viral, genetic, neural, and environmental factors is thought to be involved.
Marker commonly found: ANA |
|
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Term
|
Definition
| The etiology of Lupus (SLE) remains unknown. A genetic predisposition, sex hormones, and environmental trigger(s) likely result in the disordered immune response that typifies the disease. |
|
|
Term
| 57. Etiology of Felty's Syndrome |
|
Definition
| Unknown etiology. It is sometimes comorbid with RA. |
|
|
Term
| 58. S/Sx of plantar fasciitis |
|
Definition
| Pain on underside of foot, particularly in the first few steps in the morning. As it progresses, it will be the first few steps everytime the pnt gets up from sitting. |
|
|
Term
58. S/Sx Achilles tendonitis
Ortho: 256 |
|
Definition
| Pain, local tenderness, swelling, possibly dry crepitus. Passive dorsiflexion will elicit pain. If chronic: tendon may be thickened. |
|
|
Term
58. S/Sx of Olecranon bursitis
Ortho: 96-97 |
|
Definition
| Acute: contusion, tender, painful swelling may develop over tip of olecranon, elbow ROM is normal. Chronic: thickened, rubbery bursa that is usu not painful. Palpation: multiple small, hard nodules that feel like loose bodies but are villous thickenings or tissue debris in the bursa. |
|
|
Term
| 58. S/Sx of calcaneal apophysitis |
|
Definition
-Low-grade inflammatory rxn @ insertion of the Achilles tendon, often b/l
- common in boys 8-14 yo due to irregular ossification and sclerosis of calcaneal apophysis
S/S: local pain, tenderness. and swelling aggravated by activity and passive stretching of the heel
Xray: may reveal sclerosis of of the apophysis, but this can also be seen on normal feet |
|
|
Term
| 58. S/Sx of Morton's neuroma |
|
Definition
- Commonly involves the 3rd webspace
-Insidious onset
- Burning pain in affected toes
Worse w/ narrow toe box or elevated heels
Pts remove shoes and massage foot to alleviate pain and paresthesias
digital numbness seen late in dz
- pain on plantar web space of involved digits
- direct P between metatarsal heads just distal reproduces pain and paresthesias
Compression test will illicit pain |
|
|
Term
59. Autoimmune dzs with eye involvement
http://www.aafp.org/afp/2002/0915/p991.html |
|
Definition
RA: episcleral nodules, keratoconjunctivitis sicca, scleritis, keratitis, ulcerative keratitis, retinal detachments, macular edema
Juvenile RA: Uveitis
Sjogren's: keratoconjunctivitis sicca.
SLE: conjunctivitis, photophobia, monocular blindness (often transient), blurred vision, keratoconjunctiitis sicca, uveitis, keratitis, retinal hemorrhages, ischemic optic neruopathy, oculomotor abnormalities, visual hallucinations
Giant Cell Arteritis: amaurosis fugax, diplopia, permanent blindness from anterior ischemic optic neuropathy (often no fundoscopic findings for the 1st 24-48 hrs after onset of blindness.
Alkylosig spondylitis: Uveitis
Psoriatic arthritis: Uveitis, conjunctivitis, keratitis
MS: optic neuritis, retrobulbar neuritis, visual field defects
Graves Dz: proptosis, lid lag, keratitis, decreased visual field, loss of color vision |
|
|
Term
| 60. S/Sx of 1st degree sprains |
|
Definition
| Stretched ligament. Swelling. Mild pain. |
|
|
Term
| 60. S/Sx of 2nd degree sprains |
|
Definition
| Stretched ligament with some fibers torn. Swelling. Pain. Likely not to be able to weight bear. Ecchymosis. |
|
|
Term
| 60. S/Sx of 3rd degree sprains |
|
Definition
| Complete severing of ligament. Ecchymosis. Swelling. If nerve is also severed, will not have pain. |
|
|
Term
|
Definition
Incomplete/partial dislocation of a joint
S/S: may include local joint pain, swelling, bruising, difficulty moving the joint crepitus, popping, cracking, feeling that the joint will give out, laxity, pain weakness or numbness
- in the Back: may cause a pinched nerve with associated pain, numbness, tingling, weakness |
|
|
Term
| 61. S/Sx of Behcet's syndrome |
|
Definition
-common in persons of Asian, Turkish or Middle Eastern descent
-HALLMARK: recurrent, painful apthous ulcers of the mouth & genitals
-erythema nodosum-like lesions, follicular rash, "pathergy" phenomenon (sterile pustule formation at the site of needle stick)
-nonerosice arthritis (66%) affecting knees/ankles
-anterior (photophobia, red eye - can lead to hypopyon)/post uveitis
-neuro lesions that mimic MS: sterile meningitis (headaches), cranial nerve palsies, seizures, encephalitis, mental disturbances, spinal cord lesions.
-hypercoaguable tendencies leading to DVT, PE
-clinical course may be chronic w/remissions & exacerbations |
|
|
Term
| 61. S/Sx of Ankylosing Spondylitis |
|
Definition
| Bilat sacroiliac tenderness and limited motion of the lumbar spine. Loss of chest expansion to < 2.5 cm 2º costochondral involvement. • Ant. uveitis occurs in 25% of pnts • usu no urethritis which distinguishes it from Reiters syndrome. |
|
|
Term
| 61. S/Sx of psoriatic arthritis |
|
Definition
-30-55 yo
-peripheral arthritis is very common & is usu symmetric polyarthritis that resemble RA w/fewer small joints (hands, feet)
-oligoarticluar form: may lead to considerable destruction
-DIP joint are primarliy affected (may be monarticlar early in dx w/asymmetric joint involvement & pitting of nails/onycholysis
-severe for (arthritis mutilans) w/marked osteolytis (usu hand)
-spondylitic form: sacroiliitis & spinal involvement (pts usu HLA-B27 +)
-assoc w/skin dx
-"sausage swelling" (enthesopathy) is common clue. |
|
|
Term
61. S/Sx of HIV associated arthritis
CMDT: 1212-1213 |
|
Definition
| Involves single or multiple joints, with or w/o effusion. Involvement of large joints is most common. If joint is warm/erythematous, should tap joint to culture fluid. |
|
|
Term
|
Definition
| Acute fracture usu presents w/ h/o trauma & pain, swelling and tenderness. Deformity may not be present if the fracture is not diplaced. |
|
|
Term
|
Definition
Bone: usu mild & asymptomatic: Bone pain is 1st sxs. It can involve one or many bones (usu skull, femur, tibia, pelvis & humerus). The bones become soft, leading to bowed tibias, kyphosis, and "chalkstick" fractures w/slight trauma. 1/2 pts have hip/pelvic involvement. Bones become highly vascularized leading to limb warmth & possible heart failure d/t "steal syndrome". Characteristic bone hypertrophy leads to skull enlargement & bony overgrowth of the spine causing neuro issues (vision, hearing loss, radicular pain, cord compression. Labs: Alk phos level is up; inc. urinary excretion of hydroxyproline (pyridinoline), XRAY: initial lesions are osteolytic w/dense expanding bones & characteristic radiolucency/opacity.
Derm: extramammary paget dx is a manifestation of intraepidermal ca or underlying gu/gi ca - it resembles chronic eczema & usu involves apocrine areas (genitalia). Mammary dx of the nipple (unilateral red scaling, oozing plaque) is assoc. w/intraductal mammary ca. |
|
|
Term
|
Definition
| Injury to muscle or tendon. Pain, increases with motion. May have swelling, ecchymosis. |
|
|
Term
62. S/Sx of bone tumor
Ortho: 448 |
|
Definition
| Pain and swelling. Possibly increased local heat. May also have constitutional sx of weight loss, fever, lethargy. |
|
|
Term
62. S/Sx of osteomyelitis
CMDT: 780 |
|
Definition
| Fever and chills associated with pain and tenderness of involved bone. |
|
|
Term
| 63. Mechanism of action of NSAIDs |
|
Definition
Work on the CYCLOoxygenase pathway of ARACHIDONIC acid blocking the production of:
Prostaglandins
• PGE2 (which NORMALLY increase gastric mucosal protection and decrease gastric acid production; bronchodilation)
• PGF2 alpha (which NORMALLY causes uterine contraction and bronchoCONSTRICTION) ,
Thromboxane A2 (which NORMALLY promotes platelet aggregation)
Prostacyclin –PGI2 (which NORMALLY causes vasodilation and inhibits PLATELET aggregation -reversible)
NON-SELECTIVE COX INHIBITORS = increased risk for GI bleed; hepatoxicity; bronchspasm/asthma; renal toxicity
SELECTIVE COX -2 INHIBITORS = blocks PROSTACYCLIN (an anti-thrombotic/inhibits platelet aggregation) but leaves THROMBOXANE 2 (a prothombotic/promotes platelet aggregation)
Celebrex: an NSAID that does not inhibit platelet aggregation
UNAFFECTED = meaning an increased risk for MI/STROKE
ACTION of NSAIDS = anti-inflammatory, analgesic, antipyretic |
|
|
Term
| 64. Sequelae of dislocated hip |
|
Definition
| Avascular necrosis and osteoarthritis |
|
|
Term
65. S/Sx of polymyositis
CMDT: 759-760 |
|
Definition
| May begin abruptly: usu presentation is one of gradual and progressive proximal m. weakness of extremities plus the neck • leg weakness (climbing stairs, rising from chair) usu precede arm sx • No facial or ocular m. weakness • May have pain/tenderness but these are not usu chief complaints • 25% have dysphagia usu in upper pharynx (scleroderma is in lower esophagus) • M atrophy and contractures: late findings • If bed bound, screen for weakness of respiratory mm. |
|
|
Term
65. S/Sx of giant cell arteritis
CMDT: 765 |
|
Definition
| Systemic panarteritis affecting medium-sized and large vessels in patients over the age of 50. HA, scalp tenderness, visual sx, jaw claudication. Temporal artery is usu normal but may be nodular, enlarged, tender or pulseless. Asymmetry of pulses, aortic regurg murmur, bruits near clavicles. May have fever of unknown origin. Vague pain in tongue, nose, ears. |
|
|
Term
| 65. S/Sx of polymyalgia rheumatica |
|
Definition
| Pain and stiffness of shoulder and pelvic girdle areas, frequently in association with fever, malaise and weight loss. Does not cause m. weakness. There may be joint swelling in knees, wrists, sternoclavicular joints. Anemia and elevated acute phase reactants (esp ESR). |
|
|
Term
|
Definition
Morning pain and stiffness that improves with activity.
Symmetrical polyarthritis - Especially small joints of hands, feet, wrists and ankles.
Warm, swollen, inflammed joints
Palpable, hypertrophic synovium
Fever
Fatigue
Anemia
Myalgia
May have edema
Rheumatoid nodules (elbows, sclera, lungs, heart)
Sicca
Symptoms WAX AND WANE but progress over time
Deformities: Ulnar dev. and volar sublux. at MCP; PIP extension and DIP flexion = "Swan neck"; "Boutinniere": PIP flexion and DIP extension; Ulnar styloid erosion; Synovitis >>>carpel tunnel synd.
May affect shoulders, elbows, hips, knees, and cervical spine. Thoracic and Lumbar spine NEVER affected. |
|
|
Term
| 66. S/Sx of stenosing tenosynovitis |
|
Definition
| Progressive restriction of a sheath surrounding a tendon, causing inflammation. Pain. Tenderness to palpation. Decreased ROM 2º pain. Resisted ROM reproduces pain. Xrays usu normal. |
|
|
Term
66. S/Sx of fibromyalgia
CMDT 741-742 |
|
Definition
| Women: 20-50 • Chronic widespread M/S pain syndrome w/multiple tender points. • Fatigue, HA, numbness are all common • Objective signs of inflammation absent: lab studies are normal • Partially responsive to exercise, TCAs.• Chronic aching pain and stiffness: prominence in neck, shoulders, low back, hips • Fatigue, sleep disorders, subjective numbness, chronic HAs, IBS • Minor exertion increases pain and fatigue • 3 classic trigger points: trapezius, lateral epicondyle, medial fat pad of knee |
|
|
Term
66. S/Sx of gouty arthritis
CMDT: 732-735 |
|
Definition
| Sudden onset, freq nocturnal • May follow rapid increases or decreases in serum urate levels • |
|
|
Term
66. S/Sx of Dupuytren's contracture
CMDT: 742-743 |
|
Definition
| Hyperplasia of the palmar fascia with nodule formation and contracture of the palmar fascia.• Genetic predisp • occurs primarily in white men over 50 • Higher incidence among alcoholics and those w/chronic systemic disorders (esp cirrhosis) • Nodular or cord-like thickening of one or both hands, w/4th & 5th fingers most commonly affected. |
|
|
Term
67. S/Sx of rheumatoid
CMDT: 747 |
|
Definition
| Usu insidious onset w/morning stiffness and pain in affected joints • Symmetric polyarthritis w/predilection for small joints of the hands and feet; deformities common w/progressive dz • Radiographic findings: juxta-articular osteoporosis, joint erosions and joint space narrowing. •RF and antibodies to cyclic citrullinated peptides (anti-CCP) are present in 70-80% • Extra-articular: sub q nodules, pleural effusion, pericarditis, lymphadenopathy, splenomegaly w/leukopenia, & vasculitis • Dryness of eyes, mouth, other mucous membranes, esp in adv dz (sjogrens) |
|
|
Term
67. S/Sx of systemic sclerosis [AKA Scleroderma]
CMDT: 758-759 |
|
Definition
| 2 types: Limited and Diffuse LTD: (80%) thickening of skin of face, neck, distal extremities CREST (calcinosis cutis, raynaud's, esophageal motility disorder, sclerodactyly and telangiectasia.) DIFFUSE: (20%) widespread thickening of skin, inc truncal involvement, w/ areas of increased pigmentation and depigmentation. Raynauds, antinuclear antibodies in nearly all pnts. Systemic features of gastroesophageal reflux, hypomotility of GI tract, pulmonary fibrosis, pulmonary HTN, renal involvement. |
|
|
Term
67. S/Sx of of Felty's Syndrome
CMDT: 748 |
|
Definition
| Splenomegaly and neutropenia in the setting of severe, destructive RA |
|
|
Term
67. S/Sx of Raynaud's phenomenon
CMDT: 756 |
|
Definition
| Syndrome of paroxysmal digital ischemia. Red, White, Blue. Excessive vasoconstriction w/well demarcated digital pallor or cyanosis; recovery phase: vasodilation leads to intense hyperemia and rubor. Usu fingers, sometimes toes. Primary (Dz) is benign. Secondary (Phenomenon) is less common, related to rheumatoid dz (esp RA) and can cause digital ulceration or gangrene. |
|
|
Term
69. Etiology of osteoporosis
CMDT-1038-1042 |
|
Definition
| Characterized by decrease in amount of bone present to a level below which it is capable of maintaining structural integrity of skeleton. Bone production is normal, bone resorption is increased. Risk factors: long term use of SSRI, Estrogen/Androgen deficiency, Cushing, corticosteroid administration, thyrotoxicosis, hyperparathyroidism, immobilization microgravity, tobacco, ETOH-ism, Malignancy: esp mult melanoma, Medications: excessive Vit D or A, Heparin, others. Marfan, Celiac, DM, RA, Protein-calorie malnutrition, Anorexia Nervosa, Vit C defic. |
|
|
Term
70. Clinical manifestations of rickets
CMDT-1042 |
|
Definition
| Defective mineralization of growing skeleton causes permanent bone deformities (rickets). In adults it is known as osteomalacia. • Clinical manifestations depend on age at onset and severity. • More prone to bone fx with little/no trauma. • Defects in tooth structure, increased risk of caries, poor enamel, delayed tooth formation. • Bone pain: dull, aching, tenderness in spine, pelvis, legs. • Decreased m tone may make movement uncomfortable. |
|
|
Term
71. Conservative tx of tennis elbow
Ortho: 93 |
|
Definition
| Rest, Ice, Exercise program of gentle stretching & strengthening, NSAIDs, steroid/lidocaine injection, counterforce strap, |
|
|
Term
72. Etiology of sarcoidosis
CMDT: 265-266 |
|
Definition
| Systemic dz of unknown etiology with malaise, fever, dyspnea of insidious onset. Symptoms referable to skin, eyes, peripheral nerves, liver, kidney, heart. Characterized by granulomatous inflammation of the lung. |
|
|
Term
| 72. Etiology of sarcoidosis |
|
Definition
|
|
Term
73. Fluid analysis findings in gout
CMDT: 733 Table 20-2 on p. 730 |
|
Definition
| During acute attack (serial measurements): Serum uric acid elevated (>7.5 mg/dL); ESR and WBC are also elevated. Sodium urate crystals in joint fluid or material aspirated from a tophus establishes dx. Crystals are needle like and negatively birefringent when examined by polarized light microscopy. Gout is Group II (Inflammatory): Translucent to opaque, color: Yellow to opalescent; WBC: 2000-75,000; PMNs: 50% or more; Culture: neg. |
|
|
Term
73. Fluid analysis findings in Pseudogout
CMDT:735-736 Table 20-2 on p. 730 |
|
Definition
| Calcium pyrophosphate crystals in joint aspirates. These are rhomboid-shaped. Normal serum urate levels. |
|
|
Term
| 73. Fluid analysis findings in Apatite Dz (aka calcium-hydroxyapatite crystal-deposition disease) |
|
Definition
| Couldn't find any info beyond one article, published in British Lancet. Apatite crystals in joints are sometimes found in OA, not in RA, and a suggestion that a third type of crystal deposition dz be named for Ca+ hydroxyapatite. In animal studies these crystals were found to be inflammatory. |
|
|
Term
73. Fluid analysis findings in RA
CMDT: 748/ Table 20-2 on p. 730 |
|
Definition
| Anti-CCP antibodies and RF, an IgM antibody directed against the Fc fragment of IgG are found in 70-80% of pnts. Anti-CCP antibodies are the most specific blood test for RA (specificity ~95%) ESR and C-reactive protein are typically elevated in proportion to dz activity. |
|
|
Term
| 74. Tx of disc dz in cervical region Ortho: p. 35 |
|
Definition
| Tx is always conservative unless major neurological deficit is present. Fewer than 5% req surgery, which only helps with radicular arm pain. • Rest: cornerstone of tmt. Acute dz: permits healing of soft parts. Chronic dz: allows inflammatory rxn to subside. If not possible, soft collars restrict motion and give support. • PT: moist heat, massage, home cervical traction: usefulness is uncertain. • NSAIDs: particularly for degenerative disc dz. may not relieve pain when nerve compression is present and Narcotics may be indicated. Muscle relaxers only useful as sedatives. |
|
|
Term
|
Definition
-pain at site of tendon insertion
-pain w/grasping, squeezing (shaking hands, opening jars)
-P/E: elicitation of point tenderness over the involved site
-characteristic pain reproduced by clenching the fist & extending the wrist against the pressure of the examiner's palm |
|
|
Term
|
Definition
| Secondary to trauma, metabolic conditions (hyperparathryroidism, hemochromatosis, ochronosis), RA, gout. Obesity is a risk factor. |
|
|
Term
| 77. Sequelae after pelvic fx |
|
Definition
Per emedicine.com & PO: Sequelae d/t unstable fractures:
-The incidence of deep venous thrombosis is increased.
-Post fractures esp. may produce or injury to pelvic vasculature causing massive retroperitoneal bleeding
-GU problems (bladder, urethral, prostate or vaginal injuries)
-Sexual dysfunction may develop.
-Infections from disruption of bowel or urinary system may develop
-Chronic pelvic pain or traumatic arthritis |
|
|
Term
| 78. Confirmation of Tinea Versicolor |
|
Definition
Diagnosed via: fine scales only seen by scraping & viewing under microscope. KOH yeilds lrg, blunt hyphae & thick-walled budding spores ("sketti & meatballs").
P/E: Velvety tan, pink or white macules (4-5mm to lrg confluent areas) that do not tan resulting in hypopigmentationon trunk/back, upper arms, neck & groin. Some itching may be present.on trunk, upper arms, neck & groin. |
|
|
Term
| 79. S/Sx of contact dermatitis |
|
Definition
Contact Dermatitis - Allergic:
• Acute: tiny vesicles & weepy, crusted lesions
• Chronic: scaling, erythema, thickened skin
• severe itching w/erythematous macules, papules & vesicles
• Hot, swollen area w/crusting & oozing: infection
• Poison oak or ivy: linear streaked vesicles on extremities
Irritant:
red & scaly but not vesicular & not weepy or crusty |
|
|
Term
| 79. S/Sx of brown recluse spider bite |
|
Definition
| Brown recluse bite (many of the lesions misdiagnosed are d/t ca-mrsa not brown spiders): causes progressive local necrosis as well as hemolytic reactions (rare). This venom is a collection of enzymes. One of the specific enzymes, once released into the victim's skin, causes destruction of local cell membranes, which disrupts the integrity of tissues leading to local breakdown of skin, fat, and blood vessels. This process leads to eventual tissue death called necrosis in areas immediately surrounding the bite site. |
|
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Term
|
Definition
flea bites sxs: saliva of tick produces rxn of papular urticaria in sensitized pts. Also: hives, itching (can be severe, and may be all over or just where the rash is located) & rash w/small bumps that itch. When pressed the area turns white (blanches to touch)
Note: Symptoms often begin suddenly (within hours) |
|
|
Term
|
Definition
| Sxs of tick bites: Generally painless, local redness, itching, burning, occasional muscle weakness/paralysis. The majority of tick bites result in few, if any, immediate symptoms. |
|
|
Term
|
Definition
| Usu no sxs but plantar warts can elicit tenderness w/pressure & anogential can be itchy. P/E: Verrucous (cauliflower-like) papules on skin or mucous membranes,< 1 cm w/prolonged incubation period 2-18 mths. • Flat warts: most evident w/oblique lighting • Periungual: dry, fissured and hyperkeratotic – resembling hangnails or other non-specific changes • Plantar: look like corns or calluses |
|
|
Term
| 80. S/Sx of dermatofibroma |
|
Definition
| S/S of dermatofibroma: A common idiopathic cutaneous nodule (more in women). It frequently develops on the extremities (mostly the lower legs) & w/usu no sxs but, pruritus & tenderness are seen. The prevalence of the latter makes dermatofibroma the most prevalent of all painful skin tumors. Clinical appearance: solitary, 0.5- to 1-cm nodule (pt can have up to 15) The overlying skin ranges from flesh - gray, yellow, orange, pink, red, purple, blue, brown or black, or a combo. Palpation: hard (feels like frozen pea/small pebble fixed to skin surface) & is freely movable. Tenderness elicited w/manipulation of the lesion. There is characteristic tethering of the overlying epidermis to the underlying lesion w/lateral compression, called the dimple sign. |
|
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Term
| 80. S/Sx of Cherry hemangioma |
|
Definition
| Cherry hemangiomas are the most common cutaneous vascular proliferations. They are often widespread and appear as tiny cherry red papules or macules. These benign lesions are formed by a proliferation of dilated venules. |
|
|
Term
| 80. S/Sx of Basal Cell Carcinoma |
|
Definition
| IN SUN-EXPOSED AREAS. Five Possible Presentations: - A non-healing open sore. May get bleeding. - A reddish or irritated patch, usually on chest, shoulders or arms. - A shiny, pearly nodule/papule -A pink growth, elevated with a rolled border -A scar-like area of waxy, taught skin. (Current plate 38). Lesions may have telangiectasia. |
|
|
Term
|
Definition
| SS = ITCHING confined to groin/gluteal cleft; LESIONS may have SHARP margins, cleared centers and spreading scaly peripheries; may be HYPERpigmented; USUALLY spares scrotum, but CLINICALLY speaking scrotal involvement is more candidiasis!!!!); may have associated tinea on feet/nails |
|
|
Term
| 81. S/Sx of Tinea Corporis CMDT: 107 |
|
Definition
| Ring shaped erythema with scaly border and central clearing. • On exposed surfaces (face and arms) or trunk |
|
|
Term
|
Definition
| Ring shaped erythema with scaly border and central clearing. • On exposed surfaces (face and arms) or trunk |
|
|
Term
| 81. S/Sx of Pityriasis Alba |
|
Definition
| Pityriasis alba (PA):common skin disorder in childrens. Characterized by presence of ill-defined, scaly, faintly erythematous patches that subside to leave areas of hypopigmentation. Lesions may progress through 3 clinical stages: Papular (scaling) erythematous, Papular (scaling) hypochromic, Smooth hypochromic. Lesions subside, leaving areas of hypopigmentation that slowly repigment to normal. The duration of pityriasis alba varies from 1mth - 10 yrs (most cases resolve over several mths to 1yr). Dx is made clinically. It is a nonspecific finding that is commonly assoc. w/atopic dermatitis. |
|
|
Term
|
Definition
Macerated stage: Tx with aluminum subacetate soaks for 20 mins bid. Broad-spectrum antifungal creams and solutions (containing imidazoles or ciclopirox)
Dry and Scaly stage: Use of any of the agents listed in Table 6-2 (clotrimazole, ketoconazole, miconazole, etc.). Addition of urea 10-20% lotion or cream may increase the efficacy of topical txs in thick 'moccasin' tinea of soles.
Systemic: Griseofulvin may be used for severe cases or those recalcitrant to tx. Maintenance with topicals. |
|
|
Term
|
Definition
Prevention: condoms or vaccine (genital warts)
Genital warts: Imiquimod cream (better in women); 20% podophyllin antimitotic soln; 0.5% podofilox soln; 5% 5-fluorouracil cream or snip biopsy
Common warts: - snip off + trichloroacetic acid
-Freezing w/Liquid nitrogen
-Burning (electrocautery)
-Laser therapy -40% salicylic acid plaster -bleomycin dilute injection -warm h2o soak (10-30mins x6wks) |
|
|
Term
| 84. Scabicides associated with neurotoxicity in infants |
|
Definition
Most of the information I found had to do w/the med lindane causing seizures in kids. Family Practice Notebook.com states:
Effects: Neurotoxicity
seizures
headache
paresthias
Incoordination
tremor |
|
|
Term
| 85. Tx for infants with thrush |
|
Definition
Nystatin cream for the bottom,
Nystatin suspension applied w/cotton swab (wiped on cheeks) for thrush. |
|
|
Term
| 85. Tx for infants with diaper rash |
|
Definition
| Frequent diaper changes, exposure to air, ointment for barrier (desitin, zinc oxide, A&D, etc) If bright red, may also have fungal infection. Any OTC antifungal used in genital area OK. 0.1% hydrocortisone cream if needed. |
|
|
Term
| 86. Description of malignant melanoma |
|
Definition
| Flat, raised or both - any pigmented lesion that has just changed appearance is suspect. May have multiple colors (red, white, black, blue) & irregular borders in which pigment appears to be leaking into the normal surrounding skin. |
|
|
Term
86. Description of squamous cell carcinoma
CMDT: 134 |
|
Definition
| Small, red, conical, hard nodules that occasionally ulcerate. Usu occurs subsequent to prolonged sun esposure on exposed parts in fair-skinned ppl who sunburn easily and tan poorly. May arise from actinic keratosis. |
|
|
Term
86. Description of basal cell carcinoma
CMDT: 133 |
|
Definition
| Pearly or waxy papule (more obvious when stretched), rolled borders, may have central scab, erosion or dell. May have telangiectatic vessels. In sun exposed areas (face, trunk, lower legs). History of bleeding. |
|
|
Term
| 87. First line tx for acne vulgaris CMDT: 120-122 |
|
Definition
| • Comedonal: topical retinoids (tretinoin) lentil sized amount. Contra-ind in pregnancy. Also Benzoyl peroxide and topical abx. Comedo extractor. • Papular inflammatory acne: ABX are mainstay of tx. Mild: topical erythro or clinda w/benzoyl peroxide. Moderate: Oral abx: Tetracycline, doxycycline, minocycline (Counsel on birth control pill failure w/abx) • Severe (cystic): Vitamin A analog: Accutane (isotretonin) |
|
|
Term
| 88. Rash description of atopic dermatitis |
|
Definition
| Pruritic, exudative or lichenified eruption on face, neck, upper trunk, wrists, hands and in the antecubital and popliteal folds. • xerosis ichthyosis: dry, thickened, scaly, flaky • Itching may be severe and prolonged. • Rough red plaques. • Fissures under earlobes |
|
|
Term
| 89. Description of cellulitis |
|
Definition
| Edematous, expanding, erythematous, warm plaque with or without vesicles or bullae. Pain, chills, fever are commonly present. Septicemia may develop and can progress to septicemia and shock. From onset of small patch to full presentation is usu 6-36º. |
|
|
Term
|
Definition
| Diffuse spreading infection of dermis and sub q tissue, usu on lower leg and most commonly 2º gram + cocci, esp GABHS and Staph a. Venous insufficiency can predispose. |
|
|
Term
| 91. Best skin cancer screening test |
|
Definition
| Visual inspection by self and by doctor |
|
|
Term
| 92. Description and prognosis of cherry hemangiomas |
|
Definition
| Raised PAPULES <5mm in diameter that appear on trunk of ELDERLY and may be numerous; tiny bright RUBY-red round papules that may become brown with time; EVERYONE has them >30yo and increase numerically with age |
|
|
Term
| 93. Skin lesions and descriptions associated with HIV infection |
|
Definition
| • Herpes Simplex infection: tx w/Acyclocir; Herpes Zoster: tx w/Acyclovir; Molluscum Contagiosum (umbilicated fleshy papule) tx w/liquid nitrogen; Staphylococcus (most common bacterial cause of skin disease in HIV): folliculitis: Clindamycin or Mupirocin, superficial abscesses (follicles): , bullous impetigo; Bacillary angiomatosis (zoonotic transmission from domestic cat fleas); Xerosis: tx w/ emollients; Psoriasis: Phototherapy and tertinate po in retratctable cases. |
|
|
Term
| 94. Pain and symptoms in OA |
|
Definition
Insidious onset. Starts with joint stiffness lasting ~15 minutes. Later, pain on motion develops. Pain is relieved by rest. Limitation of motion develops. Heberden nodes enlarge the DIP joints; Bouchard nodes the PIP joints.
Joint enlargement is bony, hard and cool (not soft and warm like in RA)
Inflammation NOT present!
Joints affected:
- DIP - Distal interphalangeal
- PIP - Proximal interphalangeal
- 1st metatarsal-phalangeal -MTP
- Knee
- Hip
- NOT wrist and metacarpophalangeal like RA. |
|
|
Term
| 95. Patho of nursemaid's elbow |
|
Definition
| Head of the radius becomes subluxed beneath the orbicular ligament. Happens 2º to longitudinal traction on the hand w/elbow extended and forearm pronated. (Happens when child is lifted by wrist or hand) |
|
|
Term
| 95. Tx of nursemaid's elbow Ortho p. 96 |
|
Definition
| Reduction by supinating and flexing the forearm while applying manual pressure over the radial head. Palpable click is heard and pain immed relieved. • Sling x 5-7 d. |
|
|
Term
| 96. S/Sx of L4 nerve root deficit Ortho p. 148 |
|
Definition
| Pain: Low back, posterolateral aspect of thigh, across patella, anteromedial aspect of leg. Sensory change: anterior aspect of knee, anteromedial aspect of leg. Weakness: quads. Reflex change: knee jerk. |
|
|
Term
| Acute Compartment Syndrome p. 19 Ortho |
|
Definition
| Perfusion of the nerve and muscle decreases to the point where it is unable to sustain viability. • Pressure inside the natural fascial compartments of the arm or leg may rise, usu 2º fx bleeding which obstructs venous outflow. • Tissue pressure and necrosis. • Suspect: pain on passive stretching of mm of affected compartment; parasthesias or sensory loss; tenseness of involved compartment. Paralysis may also occur. • Can lead to Volkmann's ishemic contracture if untx'd• Pain will subside once necrosis has occurred. |
|
|
Term
|
Definition
Caused by hyperextension force.
4 treatment modalities:
1) Short period of rest. Soft protective collar may be useful.
2) Analgesics in amts sufficient to relieve any acute pain. Anti-inflammatories esp good if pnt has degenerative joint dz.
3) Cold initially. Heat later in course.
4) Isometric and ROM exercises. Formal PT if sx persists >4-6 wks. |
|
|
Term
|
Definition
| Chronic disc deterioration |
|
|
Term
|
Definition
| POTTS: "Angular kyphosis of the spine from tuberculous spondylitis." TB invasion into two adjoining vertebrae cuts off blood to discs, causing their breakdown and subsequent spinal collapse. Most commonly localized in the thoracic portion of the spine. Results in a gibbus deformity (i.e. hunchback). S/S: Severe kyphosis. |
|
|
Term
|
Definition
| In gout, a nodular deposit of urate crystals and associated fibrous tissue that results from a foreign-body reaction. They are common in cartilage, tendon, bone, subsutaneous tissues, periarticular tissues, and around nail beds |
|
|
Term
| 68b. Definition of Bouchard's Nodes |
|
Definition
| In OA, bony enlargement of the PIP joint due to joint degeneration. |
|
|
Term
| 68c. Definition of Heberden's |
|
Definition
| In OA, bony enlargement of the DIP joint due to joint degeneration. |
|
|
Term
| 42. Skin involvement associated with joint pain diseases: SLE CMDT: 752-753 |
|
Definition
| Red/dusky rash that may have malar distribution in <50% of pnts. Rash over areas exposed to sunlight. Others cutaneous manifestations are: discoid lupus, typical fingertip lesions, periungual erythema, nail fold infarcts, splinter hemorrhages. Alopecia is common. Mucous membrane lesions during flares. 20% have Raynaud phenomenon. |
|
|
Term
| 42. Skin involvement in Sarcoidosis |
|
Definition
| Can result in rashes or various types of skin lesions. One type of lesion is called erythema nodosum which causes raised, red, and tender bumps to form on the skin, usually on the front of your legs. |
|
|
Term
| 42. Skin involvement in Psoriatic arthritis |
|
Definition
| Psoriasis is a common skin condition affecting 2% of the Caucasian population in the United States. It features patchy, raised, red areas of skin inflammation with scaling. Psoriasis often affects the tips of the elbows and knees, the scalp, the navel. |
|
|
Term
| 42. Skin involvement in RA. |
|
Definition
| Bruising, athlete’s foot, scars, rheumatoid nodules and vasculitic lesions |
|
|
Term
| 42. Skin involvement in Reiter Syndrome |
|
Definition
| Keratoderma blennorrhagica, these are patches of scaly skin on the palms, soles, trunk, or scalp of RS patients. |
|
|
Term
| 42. Skin involvement in tophaceous gout. |
|
Definition
| erupting through the skin, exposing its gross histological chalky white appearance is not uncommon. More atypical dermatological manifestations in the form of pustules, ulcerations, and panniculitis have occurred. |
|
|
Term
| Fluid values in a normal joint |
|
Definition
| Volume <3.5 ml
Clarity Clear
Color Colorless
WBC <200
PMNs <25%
Leukocytes Neg
Culture |
|
|
Term
| Fluid values in Noninflammatory joint (ex: OA) |
|
Definition
Volume Usu >3.5 ml
Clarity Clear
Color: Yellow
WBC: 200-300
PMNs <25
Leukocytes Neg |
|
|
Term
| Fluid values in an inflammatory joint (ex RA, acute gout) |
|
Definition
Volume Usu >3.5 ml
Clarity Clear to opaque
Color Yellow to opalescent
WBC 2000-75,000
PMNs ≥ 50%
Leukocytes Neg |
|
|
Term
| Fluid values in a septic joint |
|
Definition
Volume Usu >3.5 ml
Clarity Opaque
Color Yellow to Green
PMNs ≥ 75%
Leukocytes Usu + |
|
|
Term
| Which kind of skin cancer does this describe: “a small, red, conical nodule that ulcerates and bleeds” |
|
Definition
|
|
Term
| Which fractures require no immobilization (i.e. casting or hardware)? |
|
Definition
|
|
Term
| Fractures which do not require immobilization |
|
Definition
| Impacted surgical neck of humerus; radial head; olecranon; patella; shaft of fibula; base of 5th metatarsal; stress fracture; phalanges (except great toe); calcaneus |
|
|
Term
| What is the most common Salter Harris Fx? |
|
Definition
|
|
Term
| Different types of Salter Harris fxs |
|
Definition
- I - S = Same (or Straight across). Fracture of the cartilage of the physis (growth plate)
- II - A = Above. The fracture lies above the physis.
- III - L = Lower. The fracture is below the physis in the epiphysis.
- IV - T = Through. The fracture is through the metaphysis, physis, and epiphysis.
- V - R = Rammed (crushed). The physis has been crushed.
|
|
|
Term
| What 2 types of arthritis affect the DIP joint? |
|
Definition
1 OA and psoriatic arthritis affect DIP. RA never does.
|
|
|
Term
|
Definition
| “Degradation of cartilage and hypertrophy of bone at the articular margins” |
|
|
Term
1. In gout, what are your first three recommendations to your patient?
|
|
Definition
1 ↓ ETOH (especially beer), stop diuretic use, lose weight
|
|
|
Term
| Use of colchicine in gout |
|
Definition
| Stabilize serum urate levels |
|
|
Term
|
Definition
| Helps body eliminate uric acid (PRO=for; enecid think end: put it to it's end point by getting rid of it) |
|
|
Term
|
Definition
| Reduces production of uric acid |
|
|
Term
|
Definition
Thinning of the vertebral discs and the presence of osteophytes
|
|
|
Term
|
Definition
|
DMARDs. They are used as early as possible to stop or minimize cartilage damage and bony erosions.
Steroids are only used for acute flares and then tapered.
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Term
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Definition
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The 10-year probability of hip fracture or of osteoporotic fracture at one of four sites: hip, wrist, proximal humerus, verterbrae
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Term
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osteoporosis treatments for “bone building”
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Definition
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Term
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1. A post-menopausal woman should take _____ mg calcium and _____ IU vit. D daily.
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Definition
| 1500 mg Ca++ and 1000 mg Vit D |
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Term
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What organism is the usual infectious agent in cellulitis?
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Definition
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Term
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1. _______ (organism) causes “typical” folliculitis, while _______ (organism) causes “hot tub” folliculitis.
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Definition
| Staph aureus and P. aeruginosa |
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Term
| The three cardinal findings in lichen planus |
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Definition
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a. Lacy lesions on buchal mucosa
b. Histological findings of lymphocytes in dermis
c. Violaceous, flat-topped papules
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Term
| Drug of choice in moderate papular inflammatory acne. |
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Definition
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Term
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Definition
| Insidious onset. Common in middle and late years. Trauma, congenital hip dysplasia, avascular nexrosis of femoral head and slipped capital femoral epiphysis can be factors in onset. • Articular cartilage becomes progressively thinned and worn away. New bone proliferation around the femoral head and acetabulum occurs, & synovium becomes chronically thickened and congested. |
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