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LE M-S Disorders


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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 Diagnosis
↑ WBC+ESR, ↓ hemoglobin; aspirate joint to get culture; bone scan for early detection (non specific), plain films show ragged patchy bone, ↓ MRI signal
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)
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 Treatment
IV antibiotics, pain Tx, hydration (for fever), splinting to prevent movement, surgical
Chronic osteomyelitis Presentation
Pain, tenderness at site, warmth, redness, may have associated cellulitis
Chronic osteomyelitis Treatment
IV antibiotics, excise necrotic tissue, drain absess, require bone graft and/ or muscle flap
Chronic osteomyelitis Prognosis/Complications
Brodie’s Abscess (persistent infect lifts away periosteum), necrosis, bone destruction
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 Diagnosis
Plain film- normal, ESR may slightly↑ **Temp less than 99.5
Transient Synovitis of the Hip Treatment
NSAID’s, rest
Transient Synovitis of the Hip Prognosis/Complications
Usually about 2 weeks recovery
HIV related Osteonecrosis Presentation
Disproportionate loss of body mass (muscle tissue, fat >10% of body), pain, muscle atrophy, weakness, chronic diarrhea
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
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
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 Diagnosis
For Pott’s disease, radiographs- vertebral collapse, abscesses, kyphosis
TB Treatment
Anti- TB drugs, drain abscesses, surgery to stabilize spine
TB Prognosis/Complications
Pott’s Disease (TB spondylitis): back pain, fever, wt loss, neuro symptoms due to abscesses in spine
Osteoporosis Presntation
Senile: dowager’s hump. Exaggerated rib, pubic rami fx
Osteoporosis Diagnosis
DEXA -1 to -2.5 SD from average is osteopenia -2.5 or more SD from avg is osteoporosis
Osteoporosis Treatment
>50y/o, 1200mg Ca, 800-1000 D3; <50, 1000mg Ca, 400-800 units D3. physical activity.
Osteomalacia Presentation
Child: Weakness, delated development, FTT, irritability Adults: anorexia, weakness, bone pain, deformities
Osteomalacia Diagnosis
Radiograph – widened growth plate, looser zone (looks like Fx); ↓ serum CA and PO, excretion of CA
Osteomalacia Treatment
Vit D in diet, sunlight exposure.
Paget’s Disease Presentation
Enlarged, brittle bones, accelerated bone turnover. Kyphotic, bowing of limbs, bone pain, may become deaf
Paget’s Disease Treatment
Suppress turnover of bone with calcitonis an di phospates
Paget’s Disease Prognosis/Complications
Bones are fragile
Fibromyalgia Differential Diagnosis
Chronic fatigue, thyroid dysfunction
Fibromyalgia Presntation
Sleep disturbance, fatigue, cognitive confusion, depression, anxiety
Fibromyalgia Diagnosis
May have abnormal levels of substance P or serotonis (indicates CNS/N-T etiology)
Fibromyalgia Treatment
Lyrica, Cymbalta (address N-T); NSAID’s, low level antidep; Exercise, relaxation, trigger point injections
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 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 Treatment
NSAID’s, low does antidepress, paced activity
Scoliosis Presentation
Classic curve is painless, R thoracic. 11-14 yrs, F>M, 85-90% idiopathic
Scoliosis Diagnosis
School screenings, full spine x ray (cobb angle)
Scoliosis Treatment
>30 brace immediately, 20 and 5 degrees progression in 6 months, brace and exercises, <20 observe, exercise, examine q4-6 months. Flexibility of hips, spine, strength for spinal extensors

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