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CPC - Hip Pain in Young Man

7/20/2016

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Case
CC: 39M c/o right hip pain
VS: WNL
...waiting 6 hours ot be seen
HPI: dull, constant aching x 3 months, worse iwth physical activity, acutely worse after basketball today, happening more often
No trauma (remote surgery of right knee), has unprotected intercourse with monogamous partner
Soc/Fam: remote drug history (not IV); active, fit, plays basketball frequently
ROS: sporatic back pain, infrequent night sweats over summer, occasional numbness/tingling in right foot
PE: right hip pain with add/ab, prominent thoracic spine
DDx: traumatic injury/repetititve injury, cauda equina, epidural hematoma, joint infection, ankylosing spondylitis, bony fracture, discitis
Labs: normal
XR hip: erosion at hte femoral head-neck junction, osteopenia, loss of joint space

Picture
Gibbus formation
  • collapse fo vertebral body 2/2 adv skeletal dx
  • causing structural kyphosis
​



Potts Disease
  • spinal tuberculosis
  • 21% of TB cases
  • hematogenous spread
  • cold abscess (little inflammation) w destruction of vertebae
    • constitutional sxs in only 20-30%
  • neuro deficits are subtle
    • TTP, radiation, weakness/numbess
  • Pott's paraplegia
    • can occur at any stag eof vertebral dz
    • minimal or no warning, w/o trauma​
PicturePhemister's Triad: Case courtesy of Dr Matt Skalski, Radiopaedia.org. From the case rID: 25197
  • Phemister's Triad
    • erosion at had-neck junction
    • osteopenia surrounding the joint
    • loss of joint space
  • additional imaging is needed
    • lung XR
      • colsolidation 50%
      • hilar and medistinal LAN 35%
      • cavitation 29%
      • normal 15%
  • RF's
    • imigration from endemic areas
    • time in prison, mental health institutes, shelters, refugee camps
    • employment in health care
    • HIV


Other Extrapulmonary TB
  • lymph nodes
    • chronic, nontender, cervival LAN
    • constintutional sx
  • pleura
    • chronic cough, pleuritic CP, progressive dyspnea
  • skeletal
    •  35% of EPTB cases
    • requires complete MRI of spine and NSGY


Tx Pearls
  • tx varies with suspicious, severity, co-infx
  • EPTB tx for 6 months
    • bone/joint and CNS tx for 9 months
  • tx all pregnant women
  • tx meds have interations with HIV meds
  • Bottom line: call ID

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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map