Arthritis Australia

By W. Yasmin. Wayne State University. 2018.

A 60-year-old male complains of pain in both knees coming on grad- ually over the past 2 years discount 40 mg pantoprazole amex. There are no other findings except for bony enlargement at the distal interphalangeal joint effective pantoprazole 40 mg. A 22-year-old male develops the insidious onset of low back pain improved with exercise and worsened by rest. There is no history of diar- rhea, conjunctivitis, urethritis, eye problems, or nail changes. On exam the patient has loss of mobility with respect to lumbar flexion and extension. The patient is likely to die from pulmonary fibrosis and extrathoracic restrictive lung disease d. A 20-year-old woman has developed low-grade fever, a malar rash, and arthralgias of the hands over several months. If glomerulonephritis, severe thrombocytopenia, or hemolytic anemia devel- ops, high-dose glucocorticoid therapy would be indicated b. The patient can be expected to develop Raynaud’s phenomenon when exposed to cold d. A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, and difficulty swallowing solid food. On exam, there is a joint effusion of the right knee and a dermatitis of the glans penis. Schedule biopsy and begin corticosteroids based on biopsy results and clinical course c. Physical exam shows multiple points of tenderness over the neck, shoul- ders, elbows, and wrists. There is no tenderness over the median third of the clav- icle, the medial malleolus, or the forehead. For each numbered item select the one lettered option with which it is most closely associated. A young male presents with leg swelling and recurrent aphthous ulcers of his lips and tongue. A 19-year-old male complains of low back morning stiffness, pain, and limitation of motion of shoulders. A 65-year-old woman who has a 12-year history of symmetrical polyarthritis is admitted to the hospital. Physical examination reveals splenomegaly, ulcerations over the lateral malleoli, and synovitis of the wrists, shoulders, and knees. Laboratory values demon- strate a white blood cell count of 2500/µL and a rheumatoid factor titer of 1:4096. Basophilia Items 92–96 For each side effect, select the drug with which it is closely associated. A 50-year-old white female presents with aching and stiffness in the trunk, hip, and shoulders. On exam, joints are normal but there are mul- tiple points of tenderness over the occiput, neck, lateral epicondyle, and medial fat pad of the knee. A 35-year-old construction worker presents with complaints of noc- turnal parasthesias of the thumb and the index and middle fingers. Rheumatoid factor, an immunoglobulin directed against the Fc portion of IgG, is positive in about two-thirds of cases and is present early in the disease. Subcutaneous nodules are a poor prognostic sign for the activity of the dis- ease, and disease-modifying drugs (gold, penicillamine, antimalarials, or methotrexate) should be instituted. Oral corticosteroids are generally withheld unless absolutely neces- sary and after disease-modifying drugs are instituted. However, low-dose corticosteroids have recently been shown to reduce the progression of bony erosions. There is no value to using both aspirin and nonsteroidals together, as simultaneous usage will increase side effects. The disease is caused by lymphocytic infiltration and destruction of lacrimal and salivary glands. Dry eyes can be measured objectively by the Schirmer test, which measures the amount of wetness of a piece of filter paper when exposed to the lower eyelid for 5 minutes. Lip biopsy is needed only to evaluate 38 Copyright © 2004 by The McGraw-Hill Companies, Inc. Rheumatology Answers 39 uncertain cases, such as when dry mouth occurs without dry eye symptoms. Mumps can cause bilateral parotitis, but would not explain the patient’s dry eye syndrome.

Rib fractures become more serious if the fracture punctures a lung pantoprazole 20mg generic, causing a condition known as a “pneumothorax” buy generic pantoprazole 20 mg on-line. Air from the puncture enters the chest cavity, which compresses the lung and collapses the organ. Although a person with a rib fracture will complain of pain with breathing, a person with a pneumothorax will have signs of bluish skin coloration (this is called “cyanosis”), distended neck veins, and signs of shock. If you use a stethoscope, you will hear the sounds familiarly associated with Rice Krispies cereal when you listen to the lungs, or perhaps no breath sounds at all from the affected area. If, and only if, the pneumothorax has become life-threatening (known as a “tension pneumothorax”), should you act. Lung decompression can’t be taken lightly, and should only be attempted if it’s clear the patient will die without action taken on their behalf. This is what you do: Clean the area of the chest above the third rib midway between the top of the shoulder and the nipple. A large gauge (14g or larger) spinal needle will be large and long enough to do the job, so consider purchasing this from a medical supply store. You goal is to provide a way for the air to continue to escape from the incision you made, but not to go back in. Take a square of saran wrap or a plastic bag and firmly tape it above the skin incision on three sides only. This will serve as a valve, and allow air to escape, while allowing the lung to re- inflate. It should be noted that there are lung decompression kits that are available commercially. You will have to rig a drainage system to prevent too much fluid from preventing adequate air passage. A rubber tube connected to a jar placed below the patient may perform this duty by using gravity. It will not, however, be as efficient as the electric suction systems available at your local hospital. It’s important to realize that this type of wound will be difficult to recover from. In rare circumstances, damage to a limb may be so extensive that it cannot be saved. At least 25% of American civil war soldiers undergoing the procedure lost their lives due to complications. The closer to the body that the amputation was performed, the higher the death rate will be. It’s unlikely there will be much improvement in survival in future times of trouble. Below are some reasons that an amputation may be indicated: Extensive injury from trauma or burns. Cancerous tumors Serious infection that does not get better with antibiotics Severe frostbite Gangrene Several methods are used to identify where to cut and how much to remove: Checking where an extremity loses a pulse. Looking for areas of reddened skin (infection) or blackened skin (gangrene) Checking where the extremity is no longer sensitive to touch. Basic measures to increase the chances of a successful amputation are: Sedate the patient as much as possible. Preserve an adequate amount of living tissue to cover the exposed end of the bone. Shorten and smooth the bone enough to decrease irritation to the covering soft tissue. Before closing completely, place a drain (discussed earlier in this book) to allow blood and inflammatory fluid to leave the surgical site. As a caregiver in a long-term survival scenario, you cannot expect that everyone under your care will start off in perfect health. It is likely that one or more members of your family or group will have a longstanding medical issue that cannot be ignored. The amount and diversity of chronic medical issues may test the medic’s fund of knowledge. You will be challenged to formulate strategies for power-down situations that you know are inferior to those available in modern times. Despite this, you must take action to be ready for difficult times or your patient may suffer the consequences. You would probably be surprised at how many of your friends have chronic illnesses or conditions that you are unaware of. Even those you may have known for decades may not make it a habit of discussing their medical issues with you. As the person responsible for their medical wellbeing in a collapse, however, it is your duty to obtain full histories from everyone in your party. Thyroid malfunction, diabetes, and heart disease are just some of the issues; these illnesses require medications that will not be manufactured in times of trouble. We must, therefore, think “outside the box” to formulate a medical strategy for these patients that does not include modern technology.

Since his Jeremic1 right hemiparesis was mild discount 40 mg pantoprazole amex, he could roll over order pantoprazole 20mg without prescription, sit, and stand up with 1Clinic for Rehabilitation Dr M. There eral muscle weakness, more noticeable on the right limbs and anal was signifcant decrease in average value of walking speed before incontinence. Therefore, we may suggest that prim- were the positivity to botulinum toxin type B in the blood sample. He also did physical therapy exercises for stimulation, multiplex sclerosis, spasticity. Dis- Functional Outcome in Patient with Simultaneous Bilat- cussion: Wound botulism is a rare disorder, usually associated with eral Thalamic Hemorrhage: a Case Report traumatic injuries, surgical wound infections and infections due to *Y. Mur- Introduction: Spinal cord injuries have as chronic result tetraple- 9 10 11 12 13 gia (affecting both arms and legs) or a paraplegia (affecting legs gia , M. One of the most important rehabili- tation problem for the paraplegic patients is to get independence 1Maggiore della Carità University Hospital, Novara, 2Valduce of movement, in hospital and at home, from the wheel chair to Hospital - Villa Beretta, Costamasnaga, 3University of Foggia, daily living activities. Simple device for this type of mobility, wich Foggia, 4University of Verona, Verona, 5Ospedale di Circolo - induces good psychological effect must be introduced in current Fondazione Macchi University Hospital, Varese, 6MultiMedica rehabilitation activities. Results: Using this type of transfer device – sim- studies able to identify its correlation with disability, but different ple, low-cost and easy to use by the paraplegic patients with good papers demonstrated the effcacy of spasticity treatment in func- psychological impact is more effective that the high-tech devices tional improvements. Conclussions: One of the goals in rehabilitation tions of the patient, perhaps affecting body ownership. In this case, of paraplegis patients is to achieve mobility in wheelchair and to its impact might be better highlighted by patient-reported outcome realize easy transfer from the wheelchair to daily living activities. This type of immune-mediated response is classical- diagnosis of brachial plexus lesion. Conclusions: This shoulder, isolated paralysis with atrophy of ipsilateral trapezius immune-mediated monofocal motor neuropathy broadens previ- muscles and weakness of ipsilateral sternocleidomastoid muscles. They are a consequence of non pro- gressive alterations produced in an immature brain. Main outcome measures were in a slowly, progressive fashion with asymmetric weakness involv- performed before and after treatment: the joint range of motion ing 2 or more motor nerves. Patient 2: 40 year old right handed female The Effects of Stroke Rehabilitation Provided by Inter- presented with isolated left thumb weakness exacerbated by cold disciplinary Team in Mongolia weather. It suggests these monofocal neuropathies are guideline of the stroke rehabilitation in Mongolia. By implement- immune mediated and thus likely a less-appreciated variant spec- ing this project we have started to work by interdisciplinary team. A PubMed literature search Objective: To assess the effectiveness of the stroke rehabilitation J Rehabil Med Suppl 54 E-Posters 191 provided by interdisciplinary team in stroke unit. Materials and ment is benefcial for them and helps them improve the functional Methods: Sixty patients were recruited following Modifed Rankin abilities and the quality of their lives. Experimental groups receive comprehen- Calcifying Pseudoneoplasm of the Neuraxis: a Rare Dif- sive rehabilitation services providedby interdisciplinary team in ferential Diagnosis of Tetraplegia the stroke unit based on the clinical guideline, whereas control group were treated by physical therapy mainly passive which was *C. Case Description: A 49-year-old male presented with male and 27 female patients are recruited and average age were a 4-year history of cervical pain and progressive tetraplegia. Craniotomy and C1-C2 laminectomy revealed no was no statistical signifcance between two groups. This lesion occupied the proved in experimental group when compared with control group occipito-vertebral and C1-C2 transition and was highly adherent to after 3 and 6 months. The patient was referred to a rehabilitation program with signifcant functional improvement. The patient presented with good recovery and good Preservation and Evolution of Functionality of Stroke adaptation to all the daily living activities. Little is known about the natural course of the disease, but the prognosis is usually benign. Introduction: The aim of an inpatient stroke rehabilitation program In spite of its benign prognosis, it is important to distinguish these is to achieve the best functional status of the patient and prepare lesions from the more common calcifed vascular, neoplastic or the discharge into a supporting environment that will develop the non-neoplastic differential diagnosis. The preservation of the functionality of a patient patient with an early lesionectomy, since it allowed us to estab- in the daily life is a major component determining the quality of lish the defnitive diagnosis and to stop the compressive/irratating life of the patient and its family. Then a comparison followed between the functional abilities of the patients at the discharge and at the time Etiology of the interview. Methods: a retrospective re- ing (20% discharge-46% interview), bathing (3% discharge-26% view of all the patients with spinal cord injury above T6 admitted interview) and comprehension(26% discharge-69% interview). The autonomic dysrefexia discharge-40,5% interview), walking(25,5% discharge-66% inter- episodes, the demographic information, the patient’s characteris- view). Only 4 patients were characterized at the same status or tics, the triggering factors and the need of pharmacological treat- deteriorating because of dementia, new stroke or abdication.

Chapter 3: Respiratory infections 107 r The neuraminidase inhibitors zanamivir and os- emboli generic pantoprazole 40mg amex, e buy pantoprazole 40mg visa. Clinical features They are particularly indicated in the elderly, those Patients present with worsening features of pneumonia, with underlying respiratory disease such as chronic usually with a swinging pyrexia, and can be severely ill. Some are manufactured in strates one or more round opacities often with a fluid chickembryosandtheseshouldnotbegiventoanyone level. Routine vaccination is reserved for bronchoscopy may be necessary to exclude obstruction, susceptible people with chronic heart, lung or renal to look for underlying carcinoma, and to obtain biopsies disease,diabetes,immunosuppressionandtheelderly. Echocardiogram should be considered to look for infec- These predications depend on global surveillance or- tive endocarditis. This surveillance depends on viruses being cultured Complication and therefore on nose/throat swabs being taken and Breach of the pleura results in an empyema. Management Lung abscess Posturaldrainage,physiotherapyandaprolongedcourse of appropriate antibiotics to cover both aerobic and Definition anaerobic organisms will resolve most smaller ab- Localisedinfectionanddestructionoflungtissueleading scesses. Largerabscessesmayrequirerepeatedaspiration, to acollection of pus within the lung. Organismswhichcausecav- Definition itation and hence lung abscess include Staphylococcus Thereareessentiallythreepatternsof lungdiseasecaused and Klebsiella. Pathophysiology Aetiology The abscess may form during the course of an acute It is a filamentous fungus, the spores (5 µmindiame- pneumonia, or chronically in partially treated pneu- ter) are ubiquitously present in the atmosphere. The pattern of disease that arises depends 108 Chapter 3: Respiratory system on the degree of tissue invasiveness, the dose inhaled and Aspergilloma the level of the host’s defence. This results from Aspergillus growing within an area of previously damaged lung such as an old tuberculous Allergic bronchopulmonary aspergillosis cavity (sometimes called a mycetoma). Seen on X-ray as a round lesion with an air ‘halo’ above i Initially it causes bronchospasm which commonly it. In immunosuppressed individuals with a low granulo- iii Chronic infection and inflammation leads to irre- cyte count, the organism may proliferate causing a severe versible dilatation of the bronchi (classically proximal pneumonia, causing necrosis and infarction of the lung. The organisms are present as masses of hyphae invad- iv If left untreated progressive pulmonary fibrosis may ing lung tissue and often involving vessel walls. Investigation Theperipheralbloodeosinophilcountisraised,andspu- Management tum may show eosinophilia and mycelia. Eosinophilic Invasive aspergillosis is treated with intravenous am- pneumonia causes transient lung shadows on chest X- photericin B (often requiring liposomal preparations ray. Itraconazole and voriconazole have been used more re- Lung function testing confirms reversible obstruction in cently but current studies comparing efficacy with am- all cases, and may show reduced lung volumes in cases photericin B have yet to prove definitive. Management Obstructive lung disorders Generally it is not possible to eradicate the fungus. Itra- conazole has been shown to modify the immunologic Asthma activation and improves clinical outcome, at least over the period of 16 weeks. Oral corticosteroids are used to Definition suppress inflammation until clinically and radiograph- A disease with airways obstruction (which is reversible ically returned to normal. Maintenance steroid therapy spontaneously or with treatment), airway inflammation may be required subsequently. The asthmatic compo- and increased airway responsiveness to a number of nent is treated as per asthma guidelines. Chapter 3: Obstructive lung disorders 109 Incidence Pathophysiology 20% of children, 5–14% of adults, increasing in preva- The clinical picture of asthma results from mixed acute lence. With time this repeated stimula- Can present at any age, predominantly in children. They secrete mediators of acute and 2 Intrinsic asthma tends to present later in life. There is chronic inflammation including enzymes and oxygen no identifiable allergic precipitant. Patients with occupational asthma from the listed causes are entitled to compensation under in- inflammation recruiting and activating fibroblasts dustrial injuries legislation in the United Kingdom. They also lead, through r Forall patients, non-specific irritant trigger fac- mechanisms which are not yet clearly defined, to tors include viral infections, cold air, exercise, bronchialhyperresponsiveness–anexaggeratedbron- emotion, atmospheric pollution, dust, vapours, choconstrictor response to non-specific insults to the fumes and drugs particularly nonsteroidal anti- airways. The pattern of airway reaction following inhalation of an allergen: i An acute reaction occurring within minutes, peaking Table3. Non IgE related Isocyanates, colophony fumes (from ii A late reaction occurring 4–8 hours after inhalation solder), hardwood dust, complex (the chronic inflammatory response). If there is diagnostic difficulty in patients with mild symp- Mild–moderate Life-threatening attack Severe attack attack toms or just cough, exercise tests or peak flow diary card r r r recordings as above. Occasionally, a trial of oral corti- Speech normal Unable to Silent chest costeroids for 2 weeks can be used. Skin tests are used complete sentences to identify specific allergens and serum can be taken for r Pulse <110 r Pulse ≥110 r Cyanosis total and specific IgEs.