Term
What is the most common cause of spinal cord compression?
other causes?
What are the emergencies? |
|
Definition
Most common are due to wear and tear of ostioarthritis
other include abnorm allignment, lumbar rediculopathy, injury, RA
Tumor, Infection |
|
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Term
what are the main S&S of Spinal cord compression?
What is the organism ass with Epidural abscess |
|
Definition
Point tenderness on the spine, a Sensory level, percussion of the vertebra
Epidural Abscess is mostly due to Staph Aureus |
|
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Term
Where are 95% of all lumbar rediculopathies?
A negative ???? excludes Disk herniation with a sensitivity of 95% |
|
Definition
L4/L5 and L5/S3
Straight leg raise test - pain going into the buttock and below the knee when the leg is raised about 60 degrees |
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Term
What is the BITest for Spinal cord compression?
MATest?
When should MATest be used in disk herniation be used? |
|
Definition
Xray
MRI
when there is neurological deficits |
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Term
In spinal cord suppression what is the treatment for:
Lymphoma
tumors
epidural abscess
Cauda equina syndrome |
|
Definition
L: glucocorticoicds,chemo, Surgical decompression
T: radiation, Surgical decompression
CES: surgical decompression |
|
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Term
What is the Treatment for Lumbar reticulopathy?
what if worse
when is surgery an option? |
|
Definition
Conservative management: NDAIDS and continuation of ordinary activities
(yoga is effective)
Steroid injection into epidural space for rapid and dramatic benifit
Surgery is rarly need: only answer if focal neuro defecs develop or progreass |
|
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Term
| if obvious spinal cord suppression with signs what is the Next best step? |
|
Definition
| epidural Cortical steroids |
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Term
What is the cause of spinal cord stenosis?
What are the ass S&S? x4 |
|
Definition
Narrowing of the spinal canal leading to pressure on the cord is idopathic
1. Pain on back extension due to cord presses backward against ligamentum flavum
2. Back pain radiating to buttocks
3. worse when walking downhill better when sitting
4. Pain much less when leaning forward |
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Term
What is the BITest for lumbar Sacral Stenosis?
MATest
What is the treatment? |
|
Definition
MRI for both
Weight loss and Pain meds (NASAIDs, opiates, aspirin)
Steroid injections into lumbar epidural space
PT and exersise
surgical correction is needed in 75% of pts. |
|
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Term
What is the dx test for Fibromyalgia?
What is the best initial therapy?
Other treatments x2 |
|
Definition
amitriptyline ( a TCA)
milnacipran and pregabalin
Trigger point injections sometimes used |
|
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Term
What area is affected in Carpal tunnel syndrome?
what 2 signs are ass with CarpTS? |
|
Definition
pain in hand affecting palm thumb index finger and radial half of ring finger
Tinel sign- pain on tapping or percussion of medial nerve
Phalen sign- pain on flexion of the wrists to 90 degrees |
|
|
Term
What is the BIT for Carpal tunnel syndrome?
MAT? |
|
Definition
Should be obvious from symptoms?
MAT is electromyography and nerve conductoin testing |
|
|
Term
What is the first treatment for Carpal tunnel syndrome
then
then? |
|
Definition
wrist splints , avoid manual activity, NSAIDS
Steroid injections
Surgery can be curative |
|
|
Term
describe a Dupuytren Contracture?
What is the treatment? |
|
Definition
hyperplasia of palmar fascia leading to nodule formation and contracture of fourth and fifth fingers
Triamcinolone, lidocain, or collagenase injection may help
surgery when funtion is impaired |
|
|
Term
what is the MATest for Rotator cuff injury?
What is the Initial therapy?
When is surgery used? |
|
Definition
MRI
NSAIDS, rest and PT
steroids are used to decrease pain
Surgery is used with complete tears |
|
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Term
What are the causes of Patellofemoral syndrome?
What are the S&S x2
What is the tx? |
|
Definition
trauma, meniscal tear, quadricepts stength imbalance
Worse just after starting to walk after having been seated for prolonged time
creptius, joint locking
PT and Strength training with cycling ,
knee braces dont help, or nothing to fix surgically |
|
|
Term
What is the presentation of plantar fascitis?
Where?
Provocation/Allieviation
What is the treatment? |
|
Definition
Very severe pain in the bottom of the foot near the calcaneus where the fascia inserts, unclear etieolgy
worse in the morning and improves with walking a few steps.
Point tenderness at bottom of foot
improves with use
exercises, arch support, and NSAIDs
Steroids injection if those dont solve the problem
surgery rarely needed |
|
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Term
What is the key diagnostic feature for RA?
What is the main dx test for RA? |
|
Definition
Morning stiffness of multiple small, inflamed joints
RF (+) in 70%
Anti Cyclic citrulinated peptide (anti CCP)
80% sens; 95% specific |
|
|
Term
What is Felty syndrome?
what is Caplan syndrome? |
|
Definition
RA, Splenomegaly, Neurtropenia
RA, Pneumoconiosis, Lung nodules |
|
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Term
What spine problems happen in RA?
what does an "erosive" disease mean |
|
Definition
no spine problems exept C1/C2 subluxation
Joint space narrowing
Physical defority of joints
Xray abnormalities |
|
|
Term
What is the Best initial treatment for RA?
not responding/ intolerant |
|
Definition
Methotrexate
TNF inhibitors (infiximab, adalimumab, entanercept) |
|
|
Term
When is Rituximab used?
What is the Toxicities of TNFi's
name them. |
|
Definition
long term control of RA; used in combo with methotrexate
Reactivation of TB screen with a PPD prior to their use
Infection |
|
|
Term
What when is Hydroxychlorquine used?
What are the AEs? |
|
Definition
used in mild disease
Retnal toxicity |
|
|
Term
What are the AE's of Methotrexate?
what are the AE of Sulfasalazine, Leflunomide, Abatacept |
|
Definition
Liver toxicity, BMS, Pulmonary toxicity
BMS, Hemolysis with G6DP, Rash |
|
|
Term
What drugs are used for symptom control of RA?
what is a AE of Rituximab? |
|
Definition
NSAIDs best initial therapy
Steroids if NSAIDS dont work
Infection |
|
|
Term
what is the Presentation of Juvenile Rheumatoid?
other features? |
|
Definition
Often only with fever spikes
JRA rash: Salmon colored on chest and abd
Splenomegally, pericaridal effusion, mild Joint symtoms |
|
|
Term
what is the dx test for JRA?
What is the Treatment? |
|
Definition
no clear dx test, however hypoalbuminemia and leukocytiosos are often present
Aspirin or NSAIDS no response steroids
no responce then TNF drugs |
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