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Case: Fever and Back pain in a patient with lupus nephritis

Case: Fever and Back pain in a patient with lupus nephritis. Group: B3b Facton , Rosabelle to Garcia, Irka Facilitator: Dr. Ong -Mateo. PSOAS SIGN.

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Case: Fever and Back pain in a patient with lupus nephritis

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  1. Case: Fever and Back pain in a patient with lupus nephritis Group: B3b Facton, Rosabelle to Garcia, Irka Facilitator: Dr. Ong-Mateo

  2. PSOAS SIGN The PSOAS SIGNis a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocecal in orientation (as the iliopsoas muscle is retroperitoneal). It is elicited by performing the psoas testby passively extending the thigh of a patient lying on their side with knees extended, or asking the patient to actively flex their thigh at the hip. If abdominal pain results, it is a "positive psoas sign". The pain results because the psoas borders the peritoneal cavity, so stretching (by hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes friction against nearby inflamed tissues. In particular, the right iliopsoas muscle lies under the appendix when the patient is supine, so a positive psoas sign on the right may suggest appendicitis. Bickley, Lynn S.. Bates' Guide to Physical Exam and History Taking (9th ed.). Lippincott, Williams, and Wilkins. pp. 390.

  3. Indications for Surgery in Pott’s • Neurologic deficit (acute neurologic deterioration, paraparesis, paraplegia) • Spinal deformity with instability or pain • No response to medical therapy (continuing progression of kyphosis or instability) • Large paraspinal abscess • Non-diagnostic percutaneous needle biopsy sample Pott Disease (TuberculousSpondylitis): Treatment & Medication Author: Jose A Hidalgo, MD; Aug 29, 2008 http://emedicine.medscape.com/article/226141-treatment

  4. Anti –TB Regimen Harrison's Principles of Internal Medicine 17th edition

  5. False-Negative TST • Incorrect administration of the skin test • Incorrect interpretation of the skin test results • Very young age of life (less than 6 months old): The body's immune system is usually not strong enough to cause a reaction to the injected tuberculin

  6. False-Negative TST • Cutaneousanergy (Anergy is the inability of the body to react to skin tests because of a weakened immune system) • Recent TB infection (within 8-10 weeks of exposure) • Overwhelming TB infection: The body's immune system has been weakened by its fight against the TB bacteria • Very old TB infection: The body loses its ability to react to the skin test due to development of tolerance to tuberculin over the years • Recent live virus immunization (e.g. measles and chickenpox) • Some viral illnesses (e.g. measles and chickenpox)

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