Miscellaneous! (obj 23 - 27, 29)

Question 1

An 80 yo British male patient is complaining of bone pain. You observe that he has kyphosis and bowed tibias. You run some labs and find that his serum alkaline phosphatase is markedly elevated. You obtain radiographs and the radiologist’s report notes “osteoporosis circumscripta.”
Diagnosis? Treatment?

Answer 1

Paget disease of bone

bisphosphonates

Question 2

Congenital cause of osteoporosis; presents as recurring spontaneous fractures in utero and in childhood.
(also the sclera of eye can appear blue)

Answer 2

osteogenesis imperfecta

Question 3

When blood flow to a joint is compromised, this condition can occur. It can be a complication of corticosteroids, alcoholism, trauma, SLE, gout, and other factors. This condition usually affects the femoral head, and the usual outcome is total hip replacement.

Answer 3

osteonecrosis, aka avascular necrosis of bone

Question 4

Another name for neurogenic arthropathy.
Joint destruction resulting from loss of protective sensation (proprioception, pain, temperature) leading to loss of muscle tone…joint becomes enlarged, boggy, and painless, with extensive cartilage and bone erosion.

Answer 4

Charcot joint

Question 5

Chronic widespread musculoskeletal pain with fatigue and HA. No objective signs of inflammation and lab studies normal. Most frequent in women age 20-50.

Answer 5

fibromyalgia

Question 6

Vitamin C after a wrist fracture may prevent this syndrome from developing.

Answer 6

Complex regional pain syndrome

formerly known as reflex sympathetic dystrophy

Question 7

~under 40
~women during pregnancy or menses
~one to four days of migratory polyarthralgias
~followed by either tenosynovitis or purulent monoarthritis
~synovial fluid WBC count 30,000 - 60,000
~responds to azithro + ceftriaxone within 24-48 hours

Answer 7

gonococcal arthritis

Question 8

viral arthritis is common after this and this

Answer 8

parvovirus B19

hepatitis B

Question 9

~fever and chills
~pain and tenderness of specific bone/area of bone
~ESR extremely high
~early xrays are negative; need MRI

Answer 9

osteomyelitis

Question 10

What are the 3 types of origins of osteomyelitis?

Answer 10

1. hematogenous (bacteremia)
2. continguous focus (e.g. trauma, joint replacement)
3. vascular insufficiency (diabetic ulcers)

Question 11

Treatment plan for osteomyelitis

Answer 11

1. debridement of necrotic bone

2. prolonged administration of abx

Question 12

abx for osteomyelitis

Answer 12

cipro, cipro + rifampin

Question 13

treatment for acute compartment syndrome

Answer 13

immediate surgical decompression - fasciotomy

Question 14

What diseases could result in a false positive RPR, VRDL, or FTA-ABS test? (and what are these tests for)

Answer 14

False positives for syphilis could result if patient has SLE, RA, or any other autoimmune or collagen disease.
Pat also says gout can produce a false positive.