PCE Multisystems

Morning stiffness lasting at least 1 hour, swelling in at least 3 joints, at least one area swollen is wrist, MCP or PIP, symmetrical arthritis, rheumatoid nodules, abnormal amounts of RF, erosions or bony decalcification on radiographs of hand and wrist

7 criteria for the classification of acute RA

Piano key sign

May occur in RA patients

Volar subluxation of the wrist and hand on the radius

May cause extensor tendon rupture

DIP flexion, PIP hyperextension, MCP flexion

Swan neck deformity

Brunnel-Littler Test

Passive PIP flexion with MCP held in flexion, repeat with MCP held in extension

Positive = PIP joints limited in flexion when MCP held in extension = intrinsic muscle tightness

Flexor digitorum profundus

Swan neck deformity typically involves...

DIP extension, PIP flexion, MCP extension

Boutonniere deformity

IP hyperextension, MCP flexion

Z-deformity

Knee ballottement, brush tests

Tests to see if there is excess fluid in the knee

Hammer toe

Claw toe

Mallet toe

Rheumatoid cachexia

Loss of body mass (predominantly skeletal muscle) due to RA

Tenosynovitis

Inflammation of a tendon sheath

Wrist flexors, thumb flexors, patella, achilles tendon

Common sites for tenosynovitis in RA

Olecranon bursae, extensor surface of forearms, achilles tendon

Common sites for rheumatoid nodules in RA

Duration of morning stiffness, bilateral grip strength testing, number of active joints, ESR

4 components of SAJI

Vasculitis, peripheral neuropathy, spinal cord compression, cardiovascular disease, episcleritis

Vascular, neurological, CV and ocular complications of RA

Effusion, joint line tenderness, stress pain

1 of the following (3) means a joint is "active"

Subluxation or deformity, bone on bone crepitus, loss of more than 20% of PROM, ligament instability

1 of the following (4) means a joint is "damaged"

Systemic Lupus Erythematosus (SLE)

An autoimmune disorder characterized by the production of autoantibodies

Can affect any organ

Presents with episodes of remission and relapse

Heat, stretching, strengthening

Contraindicated in inflamed, hot or swollen joints

Serositis, oral ulcers, arthritis, photosensitivity, blood disorders, renal disorder, ANA +ve, abnormal immune tests, seizures or psychosis, malar rash, discoid rash

Name as many criteria for the Dx of SLE that you can think of...

Malar rash

Seen in SLE

Erythema over the cheeks, tending to spare the nasolabial folds

Symmetrical, tenderness, effusion, commonly in peripheral joints, spine and hips usually spared

Describe the nonerosive arthritis seen in SLE

Discoid rash

Seen in SLE

Erythematous raised patches, may cause scarring

Ankylosing spondylitis

A chronic inflammatory arthritis of the axial skeleton

May progress to complete spinal fusion

Associated with HLA-B27

Low back and glute pain, loss of ROM, postural abnormalities, tenderness of muscle insertion sites, insidious onset

Signs and symptoms of ankylosing spondylitis

Increased thoracic kyphosis, decreased lumbar lordosis, eye upward gaze, fixed thoracic cage, hip and knee flexion

Postural changes in advanced ankylosing spondylitis

Cervical rotation, tragus to wall, modified Schober, finger to floor side flexion, intermalleolar distance

5 components of the Bath Ankylosing Spondylitis Metrology Index (BASMI)

LBP >3 months, Lsp ROM limitation, chest expansion limitation, sacroilitis on x-ray

Modified New York Criteria for Dx of AS - 4 criteria (3 clinical + 1 radiographical)

Osteoporosis

A metabolic bone disease that presents with decreased bone mass (density) and microarchitectural deterioration (quality)

Osteomalacia

A metabolic bone disease which results in softening of bones due to decalcification of bones

Paget's disease

A metabolic bone disease involving abnormal osteoclast and osteoblast activity followed by disorganized remodeling

Leads to enlarged and misshapen bones

Osteomyelitis

Inflammation within bone caused by an infection

Osteogenesis imperfecta

A genetic bone disorder characterized by fragile bones

Superficial burn (1st degree)

Pink or red, no blisters, dry, mild pain

Damage to epidermis only

Healing takes 2-3 days, no scarring

Superficial partial thickness burn

Bright pink or red, intact blister, moderate edema, very painful

Damage into papillary dermis

Healing takes 7-10 days, minimal scarring

Deep partial thickness burn

Broken blisters, wet surface, insensitive to light touch or light pinprink

Damage into the reticular dermis

3-5 weeks healing time

Scar formation (heterotrophic or keloid)

May require skin grafting

Full thickness burn

White, charred, black or red

Eschar formation, no blanching with pressure

Painless

Damage to dermis, and partially into subcutaneous tissue

Subdermal burn

Subcutaneous tissue visible

Large exit wound and smaller entry wound

Always considered severe

Extensive surgery, debridement and grafting

18

Head and neck % in children

14

Each leg is which % in children

Facial burns, singed eyebrows and nasal hairs, harsh cough, hoarseness in voice, carbonaceous sputum, abnormal breath sounds, respiratory distress, hypoxemia

Signs of inhalation injury

Infection, increase in metabolic activity, inhalation injury, fluid loss, heterotopic ossification, peripheral neuropathy, amputation, scars

Complications of burn injuries

Heterotopic ossification

The presence of bone in soft tissue where bone normally does not exist

Complication of burn injury

Etiology unknown, usually in areas with full thickness burns

Fluid loss, decreased CO

Cardiovascular complications associated with burn injuries

CO poisoning, tracheal damage, upper airway obstruction, pulmonary edema, pneumonia

Inhalation injury complications

Hypertrophic scar

Excessive scar formation that raises above the level of the adjacent skin

Raised, red and rigid

Keloid scar

Scar that extends beyond the boundary of the OG wound

More common in people with dark pigmentation

Autograft

Graft from patient's own skin (taken from unburned area)

Common donor sites = thighs and back

Sheet graft

A skin graft which is applied without alteration

Better cosmetic appearance (face, neck, hands)

Mesh graft

A skin graft processed through a device that makes tiny incisions to allow the skin graft to expand

Used when there is limited donor skin

Greater SA but poorer cosmetic appearance

Allograft

Temporary graft from the same species (usually from a cadaver)

Xenograft

Temporary graft from another species (usually a pig)

Flexion

Anterior neck position of contracture in burn injury

Adduction, IR

Shoulder position of contracture in burn injury

Flexion, pronation

Anterior elbow position of contracture in burn injury

Wrist flexion, thumb adduction, intrinsic minus position (claw hand)

Wrist and hand position of contracture in burn injury

Flexion, adduction

Hip and groin position of contracture in burn injury

Flexion

Knee position of contracture in burn injury

PF

Ankle position of contracture in burn injury

Neutral or extension

Anterior neck suggested positioning in burn injury

Abduction, flexion, ER

Shoulder suggested positioning in burn injury

Extension, supination

Anterior elbow suggested positioning in burn injury

Wrist extension, intrinsic plus position, thumb abduction

Wrist and hand suggested positioning in burn injury

Extension, abduction, neutral rotation

Hip and groin suggested positioning in burn injury

Extension

Knee suggested positioning in burn injury

Neutral

Ankle suggested positioning in burn injury

Sweating, nausea, tremors, warmth, anxiety, palpitations, hunger, headache, blurred vision, confusion, weakness, fatigue, difficulty speaking, seizures, coma

Signs and symptoms of hypoglycemia

Polydipsia, polyphagia, polyuria, fatigue, blurred vision, delayed healing

Signs and symptoms of hyperglycemia

Symmetrical, distal > proximal

Diabetes, HIV, Guillain-Barre peripheral neuropathy distribution

Autonomic neuropathy

Seen in diabetes

Impaired function of the peripheral nerves of the ANS

Blunted HR and BP response to activity

High resting HR

Poor thermoregulation

Increased incidence of orthostatic hypotension, post-exercise hypotension

HIV

A virus which attacks the immune system, specifically T-cells with CD4 receptors

Progressively weakens the hosts immune system

Increased susceptibility to opportunistic infections and cancers

Feces, urine, saliva, sweat and tears

Body fluids not infectious for HIV

Fibromyalgia syndorme (FMS)

A syndrome characterized by widespread chronic pain and increased pain response to pressure with no other cause

Pain, allodynia, headache, fatigue, sleep disturbance, cognitive dysfunction, anxiety and/or depression, IBS

S&S of fibromyalgia syndrome

Pitting, brawny, weeping

3 types of lymphedema from least to most severe

Deep heating agents, electrical stimulation (local), traction, local ultrasound

Contraindicated during pregnancy...

Greater potential for ambulation, decreased energy expenditure

Transtibial amputation advantages

Not a weight bearing end, bony prominences are at increased risk for skin breakdown

Transtibial amputation disadvantages

Greater healing

Transfemoral amputation advantage

Not a weight bearing end, lower potential for ambulation, greater energy expenditure

Transfemoral amputation disadvantages

Rigid dressings

Can be removable (RRDs) or non-removable (IPOP)

Excellent for edema and pain control

Excellent for protection

Enhances healing

May help prevent knee flexion contractures

Disadvantages = expensive

Semi-rigid dressings

i.e. Unna's paste

Good edema control, can remove and reapply easily to inspect incision, superior to soft dressing in enhancing healing

However, may loosen easily, needs frequent changing, and takes time to dry

Soft dressings

i.e. elastic wraps and elastic shrinkers

Easy to remove and apply, inexpensive

But poorer edema control and protection