- Acute Hematogenous Osteomyelitis
Diagnosis - ↑ WBC+ESR, ↓ hemoglobin; aspirate joint to get culture; bone scan for early detection (non specific), plain films show ragged patchy bone, ↓ MRI signal
- Acute Hematogenous Osteomyelitis
Presentation - Infant- irritable, tender in affected bone, FTT
Child- fever, malaise, won’t use limb, local warmth, swelling, tender
Adult- fever; usually in spine, so local backache in t/l-spine, tenderness
- Acute Hematogenous Osteomyelitis
Prognosis/Complications - Death associated from septicemia, abscess (makes bone weaker), septic arthritis. Shortened limbs, patho fx, contractures, chronic OM
- Acute Hematogenous Osteomyelitis
Treatment - IV antibiotics, pain Tx, hydration (for fever), splinting to prevent movement, surgical
- Chronic Fatigue Syndrome Diagnosis
- Severe chronic fatigue of >6 months
Unrefreshed sleep, post-exertional malaise >24 hrs, multi-jt pain w/out swelling, muscle pain, tender lymph nodes, sore throat - Chronic fatigue syndrome Differential Diagnosis
- fibromyalgia, depression, thyroid disorders, Epstein barr, chronic mono
- Chronic Fatigue Syndrome Presentation
- Onset usually about 30, flu like symptoms, F>M, Caucasian
- Chronic Fatigue Syndrome Treatment
- NSAID’s, low does antidepress, paced activity
- Chronic osteomyelitis
Diagnosis - ↑ WBC+ESR. Plain films (area of abnormal bone, lucency due to less density); bone scans (↑ activity); MRI/CT (↓ bone signal); ↑ staph antibodies)
- Chronic osteomyelitis
Presentation - Pain, tenderness at site, warmth, redness, may have associated cellulitis
- Chronic osteomyelitis
Prognosis/Complications - Brodie’s Abscess (persistent infect lifts away periosteum), necrosis, bone destruction
- Chronic osteomyelitis
Treatment - IV antibiotics, excise necrotic tissue, drain absess, require bone graft and/ or muscle flap
- Fibromyalgia Diagnosis
- May have abnormal levels of substance P or serotonis (indicates CNS/N-T etiology)
- Fibromyalgia Differential Diagnosis
- Chronic fatigue, thyroid dysfunction
- Fibromyalgia Presntation
- Sleep disturbance, fatigue, cognitive confusion, depression, anxiety
- Fibromyalgia Treatment
- Lyrica, Cymbalta (address N-T); NSAID’s, low level antidep;
Exercise, relaxation, trigger point injections - HIV Related Myopathy Presentation
- Progressive painless weakness in proximal muscle groups, face, neck, usually symmetrical. Bx shows necrosis of fibers.
- HIV Related Myopathy Treatment
- Often improves on corticosteroids
- HIV related Osteonecrosis Presentation
- Disproportionate loss of body mass (muscle tissue, fat >10% of body), pain, muscle atrophy, weakness, chronic diarrhea
- Lyme Disease Presentation
- Early: Unilateral inflammation, swelling of large joints (esp. knee), pain in joints, bursae, tendons, muscle, bone in 1 or more locations lasting hours to days
Late: chronic joint pain, fibromyalgia symptoms - Lyme Disease Treatment
- Early: antibiotics, NSAIDS or ASA for inflammation
Chronic: ASA or NSAIDs, local heat, gentle exercise - Osteomalacia Diagnosis
- Radiograph – widened growth plate, looser zone (looks like Fx); ↓ serum CA and PO, excretion of CA
- Osteomalacia Presentation
- Child: Weakness, delated development, FTT, irritability
Adults: anorexia, weakness, bone pain, deformities - Osteomalacia Treatment
- Vit D in diet, sunlight exposure.
- Osteoporosis Diagnosis
- DEXA -1 to -2.5 SD from average is osteopenia
-2.5 or more SD from avg is osteoporosis - Osteoporosis Presntation
- Senile: dowager’s hump. Exaggerated rib, pubic rami fx
- Osteoporosis Treatment
- >50y/o, 1200mg Ca, 800-1000 D3;
- Paget’s Disease Presentation
- Enlarged, brittle bones, accelerated bone turnover. Kyphotic, bowing of limbs, bone pain, may become deaf
- Paget’s Disease Prognosis/Complications
- Bones are fragile
- Paget’s Disease Treatment
- Suppress turnover of bone with calcitonis an di phospates
- Scoliosis Diagnosis
- School screenings, full spine x ray (cobb angle)
- Scoliosis Presentation
- Classic curve is painless, R thoracic. 11-14 yrs, F>M, 85-90% idiopathic
- Scoliosis Treatment
- >30 brace immediately, 20 and 5 degrees progression in 6 months, brace and exercises,
- TB Diagnosis
- For Pott’s disease, radiographs- vertebral collapse, abscesses, kyphosis
- TB Presentation
- Bad cough lasting 3 or more wks, pain in chest, coughing up blood or sputum. Also weakness or fatigue, wt loss, anorexia, chills, or fever.
Latent has no Sx. - TB Prognosis/Complications
- Pott’s Disease (TB spondylitis): back pain, fever, wt loss, neuro symptoms due to abscesses in spine
- TB Treatment
- Anti- TB drugs, drain abscesses, surgery to stabilize spine
- Transient Synovitis of the Hip Diagnosis
- Plain film- normal, ESR may slightly↑
**Temp less than 99.5 - Transient Synovitis of the Hip Differential Diagnosis
- Septic arthritis has higher fever, Legg-Perthes has no fever
- Transient Synovitis of the Hip Presentation
- 2-10 y/o, M>F, usually unilateral. Pain in hip/ groin, limp, difficulty standing/walking, ↓ROM atjoint, low grade fever
- Transient Synovitis of the Hip Prognosis/Complications
- Usually about 2 weeks recovery
- Transient Synovitis of the Hip Treatment
- NSAID’s, rest
