Академический Документы
Профессиональный Документы
Культура Документы
Paget disease
Osteoporosis
Humoral hypercalcemia of malignancy
Long-term steroid use
Side effects:
Erosive esophagitis
Osteonecrosis of the jaw
Osteoporosis:
Estrogen
Calcitonin nasal spray
Denosumab: RANK-L inhibitor
Osteopetrosis:
Rock-like bones:
Defect of bone resorption
Osteoclasts are deficient in carbonic anhydrase
Prone to fractures because of disorganized bony matrix
Obliterate marrow space resulting in penias
Osteoporosis normal
Osteopetrosis normal
Paget Disease of Bone:
Localized disorder of the bony architecture
Increasing both osteoblastic and osteoclastic activivty
First osteoclasts are working then osteoblasts.
Increased hat size:
No major symptoms
Hearing loss
Bone pain, bone deformities and fractures
Alk phosp: shows turnover of bone
2 types of different alk phosph
Osteomalacia and Rickets
Vit D deficiency
Poor calcium absorption
Therefore poor bone mineraliation
Decrease calcium serum and increase PTH secretion
DIT Video 3:
Joint Space: potential space with a negative hydrostatic pressure
Hip Dislocation:
Posterior dislocation. Motor vehicle accidents
Medial and lateral circumflex arteries.
Femoral vein and nerve.
Use traction to
Close reduction: without surgery
Open reduction: with surgery
ORIF:
Unhappy Triad:
Lateral aspect of the knew force while foot is planted:
MCL and ACL
Medial and Lateral Meniscus
Anterior Drawer Test used to check if ACL is injured.
Patellafemoral syndrome:
Leading cause of pain.
Strengthen quadricepts, stretching exercise
Bursitis:
Characteristic features:
Pain beneath the calcaneus or in the medial arch with the first morning and
after weight bearing.
Local point tenderness at the medial tubercle
Rotator Cuff:
Sits
Supraspinaturs
Infrapsinatus
Teres Minor
Subscapularis:
Muscles of the Rotator Cuff
Abduction: supraspinatus: empty can test
Lateral: infraspinatus and teres minor
Internal : subscapularis
Impingement Syndrome:
When structures in the shoulder get trapped by the acromion process during
abduction
Hamate
Capitate
Trapezoid
Trapezium
Avascular necrosis:
DUputryens contracture:
DIt Video 4:
Osteoarthritis:
Wear and tear disease.
Eburnation of the bone
Osteophytes (PIPs=bouchards nodes) DIPS(aberdeens nodes)
Booo = proooximal
Predisposing factors:
Age, obesity, joint trauma.
Pain in the joints after prolonged use
Non-inflammatory
No systemic symptoms
Treatments
Acetaminophen (4g/day)
NSAIDS and COX-2
Steroids
Hyaluronic Acid
Opiods
Joint Replacement
Acetaminophen: reversible inhibits COX:
Antipyretic and analgesic effects:
Ni anti-inflammator effects
Fewer side effects
Toxic Dose: NAPQI-depletes glutathione. Reacts with hepatocytes
Antidote:: N-acetylcysteine: mucolytic, acetaminophen overdose, prevention
of contrast nephropathy.
NAC: N-Acetyl Cysteine: nephropathy, Acetaminphe,, Cystic Fbros
NSAIDS:
Inhibit COX
Therefore inhibit prostaglandins
Aspirin:
Increase GI bleed
Tinnitus
Hyperventilation
Acute renal failure
RA:
Systemic autoimmune disease:
Synovial joints
Not D IP joints
MCPS and PIPS
Ulnar deviation and subluxation of joints
Baker cysts
Swan neck deformities: extension at the PIP and flexion at the DIP
Bouttoneir deformity: button hole. Extensor tendon splits and PIP joint splits
through making flextion and PIP and extension at the DIP
Type 3 hypersensitivty: formation of immune complexes that get deposited.
Soluble antigens in blood
More common in women
RF: iGM against igG
DIT videos 5:
GOUT:
Hyperuricemia: monosodium urate in joints causing inflammation.
Needle shaped cyrstals:
Hyperuricemia:
Decreased exrection of uric acid
thiazide, loop diuretic,
Increased production of uric acid
production of uric acid too high via purine rich foods, or treatment for
leukemia and lymphoma, Lesch-Nyahn syndrome
Gout presentation:
Assymetric joint inflammation
Monoartciular joints
Inflamed joints are swollen,red and painful
Most common in : First Metatarsal pharlygeal joint: Podagra
Tofi: tendon, ear or olecranon bursa
Gout is cyclical: flares
Gout triggers:
Large meals
Alcohol consumption as alcohol metabolites compete with uric metabolits for
exrection
Gout Drugs:
Misoprostol:
ACUTE
Colchicine: inhibits microtubules: stabilized tubulin causing impaired
leukocyte chemotaxis. GI diarrhea. Low therapetuc dose
NSAIDS: indomethacin
Steroids:
Pseudogout:
Different crystal:
Calcium pyrophosphate crystals
Large Joints: Kneww
Older Patients
Chondrocalcinosis: calficiatoin of the articular cartilage
Seronegative Spondylarthropathies:
Associated with arthritis specifcically with spine :spondy=spine
RF is negative
Strong association with HLA-B27
PAIR:
Psoriatic Arthritis
Ankylosing spondylitis
IBD spondylitis
Reactive Arthritis(reiters)
Psoriatic Arthritis:inflammatory arthritis associated with psoriasis
-assymetric
fingers specifically DIP
spine and sacroiliac joints Dactylitis
bony erosions
Ankylosing spondylitis:
Inflammatory disease of spine and sacroiliac joints
Ankyloses: fusion of joints.
Bamboo spine
Limit spine mobility
Stiffness of spine improves with exercise
Uveitis
Increased risk of CV disease
Aortic regurg and conduction
Polyarticular
Pauciarticular
Systemic-onset
Septic Arthritis:
Stap
Step
N.gonnorhea
Gonococcal Arthritis:
STD that presents with polyarticular, migratory arthritis with an assymetric
pattern
Synivitis and pustules
Arthrocentesis: pus ton of wbc. Septic arthritis can be very destructive. IV
antibiotics and surgical consult.
DIT Video 6:
SLE:
Organ System:
Renal (proteinuria, cellular casts)
Neuro(seizures,pyschosis)
Heme (penieas,
Immune (antiphospholipid antibodies)
SLE:
Immune complex
Wire loops
ENA PANEL:
Sjogren Syndrome
Scleroderma
RA
Mixed Connective Tissue Disorders
Drug
Sulfonamides
Hydralizines
Isonizaid
Phenytoin
Procainamide
Low levels of complement
Treatment
Steroids
NSAIDS
Hydroxychloroquine
Cyclophosphamide
Scleroderma:
Progressive systemic slceroris
Fibris and excess collagen deposition
Skin: tight, no wrinkles
Two types
Diffuse : wide spread sclerosis: anti-SCL-70 andi-DANtopoisomerase
CREST:
Calcinosis: subepithelial calcium deposits
R: Raynauld phenomen
E: esophagus dismotility
S:Sclerodactyly
T:Telangiactasis
Limited Skin involvement
Progress less
Centromere antibody
Sjogren:
Dry Eyes.
Dry Mouth
Sicca Symptoms
Dry eyes
Dry mouth
Chronic bronchitis
Reflux esophagitis
SS-A
SS-B
Paratid Gland enlargement
Cavities
B-cell lymphoma
Autoantibodies against: SSA, SSB
(+) RF
women above 40
Muscular Dystophies
Duchhnee: X-linked dystrophin gene mutation: dystrophin helps anchor
muscle fibers. Therefore without it you have accelerated muscle breakdown.
Therefore you have increased Creatine Kinase (CK) marker for muscle
breakdown.
Presents Early: weakness in pelvic muscles
Becker Muscular Dystrophy: inframe deletion
Polymyalgia Rheumatica:
Joint in shoulders and hips
Joint pain and joint stiffness
Systemic: malaise, weight loss, fever, no muscle weakness
Over 50
Women
Temporal arteritis:
Elevated ESR
Treatment: steroids
Polymyositis:
Muscle inflammation
Proximal muscle weakness:Muscle disease
Distal muscle weakness: neurological disease
Cd8_ t cell-induced injury
Muscle biopsy
Aldolase: enzyme from inflamed muscle
(anti-jo1)
Dermatomyositis:
Skin involvement as well as muscle inflammation.
Fibromyalgia:
Increased sensitivity to pain.
Excess muscular tenderness
Palpate trigger points
Chronic generalized pain, sleep, fatigure,
Treatment:
Pregabalin
Milnacipran
Serotonin-Norepinephrine reuptake inhibitor