1. autoimmune

2. secondary to drugs or environmental toxins 

depositions

blockage/ischemia 

1. size of affected blood vessels

2. pattern of organ involvement

3. granulomatous inflammation and eosinophilic infiltrate 

palpable purpura

hemoptysis

glomerulonephritis 

history

physical 

drug allergies

bacterial endocarditis

viral infections 

upper/lower respiratory tracts

eyes

kidneys 

c-ANCA  w/ anti-proteinase 3

Immunosuppressive Therapy (cytoxan replaced by Imuran)

and prednisone

ultimately taper steroids and then dc imuran 

1. atopy allergic rhinitis

2. eosinophilia

3. systemic vasculitis 

corticosteriod therapy

severe cases Cytoxan, Methotrexate, Imurana 

p-ANCA

antimyeloperoxidase specificity supports Dx 60% of MPA 

azotemia

hypertension

fever

asthenia

myalgias 

bacterial or viral infections

(Hep B or C) 

high dose corticosteroids in acute stages

cytoxan or methotrexate in severe cases

abdominal angiography including celiac, renal and mesenteric vessels for microaneruysms 

vessels from venules to aorta

coronary arteritis and/or aneurysm 

fever

nonpurulent conjunctivitis

oral mucosal erythema

dryness and fissuring of lips

desquamation of hands and feet

polymorphous nonvesicular rash

cervical  adenopathy 

IV immunoglobulin

and aspirin 

Temporal or Giant Cell

Takayasu  

fever

scalp tenderness

HA

mastication muscle declaudation

inflammatory aortic aneurysms

retinal ischemia 

unequal extremity pulses, BP

abdominal aneurysms

bruits in neck, abdomen and extremities 

flu-like illness

sxs of limb, cerebral, cardiac or renal ischemia 

corticosteroids

taper them, if relapse occurs you can add cytoxan or methotrexate

low-dose aspirin plus steroid 

painful oral ulcerations

also have genital lesions that cause scarring 

glucocorticoids

cytoxan

infliximab

interferon

thalidomide 

intermittent attacks of vasoconstriction in digits with pallor followed by cyanosis, then redness

triggered by exposure to cold or emotional stress 

limited cutaneous 7 year with Raynaud's = 87%

scleroderma = 81%

Diffuse scleroderma = 72%

presence of visceral involvement decs survival rate significantly  

Avian flu

SARS 

really bad infective enterogastritis

exhaustive diarrhea

rapidly fatal 

irrigate and debride

culture pus 

1. >3 weeks

2. >101 degrees fahrenheit

3. no dx despite best efforts 

Infection

neoplasm

immune mediated dz

miscellaneous 

pain and swelling which slowly subsides

also heat, disability, discoloration and limitation of function 

1: mild - stretching

2: moderate - involves a partial tear of the tendon or ligament

3: severe - total disruption of the ligament

4: severe with avulsion of bone at the insertion 

congential : hip and knee

traumatic : falls, blows, rotational injuries

pathologic : hip, late complication of inf and RA 

fracture

dislocation

rotator cuff tear 

adhesive casulitis

stiff shoulder - pain/progressive but steady loss of active/passive motion

50% dec in motion compared to other side

DM

hypothyroidism

parkinson's

cervical disk disease 

NSAIDs

moist heat

gentle stretch

6 mths - 2 years for full recovery 

rest, cold packs, NSAID

corticosteroids injections

PT

full thickness tears, req surgery including possible joint replacement 

may need sling

subacromial steroid injections

PT 

most often a result of repetitive use and strain injury

may be seen in RA, gout and pseudogout

presents with warmth, redness, tenderness, stiffness and pain 

Aseptic: RICE, NSAIDS, Aspiration, Cortisone

Septic: antibiotics, aspiration, surgical drainage, bursectomy 

what can happen if Little Leaguer's elbow is left untreated?

it can cause osteochondrosis dissecans

it may require surgery in some cases

Txt: stop aggravating activity, rest and ice packs

avulsion of the extensor tendon to the distal phalanx

tip of the finger remains dropped as the other fingers are extended

flexion of the PIP joint and hyperextension of the DIP joint

repair is surgical

acute sprain or tear of ulnar collateral ligament of the thumb

valgus force on the abducted MCP joint

Finkelstein's test

grasp the thumb of the affected hand with the fingers and then ulnar deviate the wrist

sharp pain at radial styloid is positive test

what is the most common mass that develop's in the hand?

location, shape, not adherent to overlying skin

large ganglions will trans-illuminate

a thickening of deep fascia which passes from the palm into the fingers

shortening of this tissue causes bands which pull the fingers into the palm

Dupuytren's contracture in men greater than 50...

the ring finger

treatment is surgical

trochanteric bursitis causes tenderness where?

combinatino of plantar flexion and inversion

lateral stabilizing ligaments are most often damaged

fracture or dislocation

neurovascular compromise

tendon rupture of subluxation

wound that penetrates the joint

mechanical locking of the joint

injury to the syndesmosis

Ankle Sprains management

PRICE

Protect with a splint

rest

ice

compression

elevation

NSAIDS

air-filled or gel-filled ankles braces

SXS of compartment syndrome

severe pain

paresthesia

diminished reflexes

loss of motor function

directed at reducing compression of bv and nn

loosen constrictive dressings and casts

measure intracompartmental pressure w/ catheter

fasciotomy

pain

erythema

swelling

heat

pointing

fluctuance

hot compresses

management of pain

incision and drainage

antibiotic coverage

pressure than ice immediately

followed by rest and elevation of the extremity

drain large ones

drill a hole into a nail

Conditions associated with fibromyaglia may include...

HA

IBS

paresthesia

depression

anxiety

panic attacks

widespread pain of 3 months + in the axial distribution involving both sides of the body above and below the waist

sleep problems, fatigue, stiffness, cold intolerance

pain in 11+ of the 18 trigger pts

adequate sleep

exercise

balanced diet

what are the most common bone sarcomas?

osteosarcomas

ewing sarcomas

chondrosarcomas

severe pain of short duration, often after sports injury

may be palpable as firm-to-hard mass

resistent to chemo and radiation

aggressive resection is a must

ewing sarcomas usually only occur in which race?

white

ewing sarcoma presents with...

fever

wt loss

malaise

poorly localized bone pain

rapidly enlarging mass

leukocytosis

ESR

Xray findings in Ewing Sarcoma

painless, palpable mass on extremities or trunk

low grade tumors push aside contiguous structures

high grade tumors infiltrate adjacent organs

1: <5cm and has not spread to lymph nodes or other organs

2: >5cm, superficial, has not spread

3: >5cm, deep, has not spread

4: a tumor of any size or grade and has spread

classic kaposi sarcoma presents with...

Skin Bx

generally respond to resection, radiation, low dose vinblastine, doxorubicin or interferon

gastrointestinal Stromal Tumors

predominately in middle aged

70% stomach

CD117

most assc with asbestos

85% pleura

dyspnea and CP

NO CURE

survival rate <1 year

bone infection - progressive inflam. bone destruction, bone necrosis, new bone formation

acute or chronic

hematogenous 20%

contiguous focus (trauma) 50%

vascular insufficiency (DM) 30%

contiguous focus osteomyelitis may be Dx...

small bones of feet over weight bearing or pressure bearing areas

debridement, amputation

CBC with diff ESR, CRP

radiography/nuclear medicine tests

"Inadequate surgical _____________ regardless of antibiotic therapy, is the most common cause of treatment failure" for osteomyelitis

complete surgical debridement

with initiation of appropriate ABX per C&S

(2-4 wks or longer)

chronic 4-6 wks IV with mths of oral antibiotics