Rheumatology/Orthopedic Buzz Terms

Rheumatology. I'm not sure there is a more gray area of medicine... perhaps that's why I don't like it that much. I remember sitting in rheumatology class listening to cases thinking, "it could be any of the rheum diseases that we've talked about!" They all sound the same and there is no ONE test that gives you the answer. I find it immensely frustrating (perhaps why I ended up in a surgical field), but I tip my hats to the providers that work in it. It is so difficult to pin down a diagnosis and successfully treat a patient with rheum issues... so for me, I stick to the basics.

See below for my knowledge extent on these rheum/orthopedic PANCE/PANRE test-able gems:

Osteoarthritis (OA)
Exercise, PT
If knee joints involves - encourage weight loss indicting
Pool activities
NSAIDS

Rheumatoid arthritis (RA)
Aspirin, other NSAIDS
methotrexate for severe cases
benefits take months to see after therapy initiation

Ankylosing Spondylitis
PT
Indomethacin
Bamboo spine on plain films

SLE
NSAIDs for joint symptoms
Benign cases only need supportive care
Systemic corticosteroids for serious complications
Could be a cause of thrombosis in young women (oral contraceptives can also cause this)

Rickets
Vit D deficiency

Osteomyelitis
Aspirate and culture
Immobilize
Generally start with IV antibiotics then follow with PO antibiotics




Source: Medical boards Step 2 Made Ridiculously Simple - A. Carl, MD, PhD
Photo: wiki.cns.org

Postoperative management of temporal lobectomy

Postoperative management of temporal lobectomy:

1.     OR to PACU x 1 day to floor x 1-2 day – aim for D/C on POD3
2. ·      Early rise in body temp post op, think about incentive spirometery
3. ·      Hep lock as soon as patient starts taking PO fluids
4. ·      Encourage sitting and ambulating
5. ·     Patient remains on preop AEDs for 1-2 years post op (managed by Epilepsy folks)

·      Possible complications to look for:

o   Hemiparesis

§  Usually happens after cauterization/tearing of perforating vessels (from posterior communicating vessels or anterior choroidal a.)

§  Paralysis usually occurs immediately – this would be known before post op check

o   Visual field defects

§  Contralateral superior quadrant anopsia from damage of the Meyer loop

§  Always check visual fields

o   Dysphasia

§  Usually transient (1-3 weeks post op)

§  Approx 50% of dominant temp. lobe resections have dysphasia

o   Aseptic meningitis

§  A complication that usually presents 72 hrs – 1 week post op

§  Stiff neck, severe HA, nausea, elevated body temp

§  Diagnosis of exclusion with LP

o   Post operative seizures

§  Sz w/in 1^st 24hrs does not correlate to poor long term outcomes

§  Sz after 48hrs (with adequate AED blood levels) indicate poor long term outcome

Source: Neurosurgical Operative Atlas 2nd Ed- Starr, Barbaro, Larson

Pic source: http://www.neuros.net/en/epilepsy_surgery.php