1. Viral causes of polyarticular arthritis
- Rubella (can get with vaccine administration), rash
- Hep B
- HIV
- Parvo (kids don't get the arthritis, just fever and rash - lacy macular lesion ie nonspecific viral exanthem)
2. DDx Monoarticular arthritis 
- Inflammatory: infectious, crystalline, trauma
- Infectious: septic joint (staph/GC), osteomyelitis, lyme
- Crystalline: gout, pseudogout/CPPT
- Non-inflammatory: osteoarthritis, trauma.
3. DDx Inflammatory polyarticular arthritis 
- Rheum: Lupus, Sarcoidosis, Rheumatoid arthritis/JRA, Seronegative spondyloarthropathies (Reactive arthritis/Reiters, Psoriatic, IBD, Ankylosing spondylitis), most of the other autoimmune diseases (Mixed connective tissue disease, dermatomyositis, sjogrens)
- Infectious (bacterial): bacterial endocarditis, lyme disease.
- Infectious (viral): rubella, hep B, HIV, parvo (adults)
- Post-infectious: enteric, urogenital, rheumatic fever.
4. Common causes of joint pain (non-OA) at...
- Neck: cervical radiculopathy, cervical sprain
- Shoulder: rotator cuff injury, impingement
- Elbow: olecranon bursitis, lateral epicondylitis (tennis elbow); overuse injury from extensor tendons... the tendon distal to the insertion is hypovascular and more prone to microtears from overuse. Likely the extensor carpi radialis brevis is implicated, among others. Medial epicondylitis is the same, but at the medial (all of the major wrist/finger flexors and arm pronators attach at one tendon on the ulna); more rare than lateral epicondylitis.

- Hand: carpel tunnel
- Hip: trochanteric bursitis (lateral), meralgia paresthetica (thigh)
- Knee: patellar tendonitis (pain directly on patellar tendon, often inferior), patellofemoral pain syndrome (pain under patella from friction), meniscal/ligamentous injuries
- Foot: achilles' tendonitis, plantar fasciitis
5. Metatarsalgia vs metatarsal stress fx
- Line up their toe with their foot, push in, that really hurts if they have a stress fx
- Tell them to take a week off, come back, if it still hurts then you'll xray-- gives time for metatarsalgia to resolve, also by then you'll actually see the fracture on x-ray
6. Acute, fluctuating confusion- delirum
- (Acute, non-fluctuating confusion - "acute confusional state" - look for another CNS insult: stroke, toxin, infection, hypoglycemia)
- To diagnose delirium, use confusion assessment method: AIDA
- Acute onset, fluctuating course
- Inattention (can't focus, easily distractible)
- Disorganized thinking (illogical, incoherent, rambling, rambling)
- Altered level of consciousness (lethargy, stupor, hypervigilant/climbing walls)
7. Workup of delirium
- H&P
- Basic labs
- CXR
- UA
- EKG
- Review meds
8. When to get further testing for delirium:
- EEG- delirium will show you diffuse slowing c/w toxic encephalopathy every time so there is usually no point. Only get this in someone with a hx of seizures. Non convulsive seizures are rare, usually at least they have eye deviation or something.
- LP- get it if they have a fever, delirium, and no source
- CT- get it if you have reason to believe there may be a subdural. Don't get it to "rule out stroke" if you can get a decent neuro exam; stroke almost always has focal neurological findings.
- Neuro consult
9.  Delirium is persistent-- it tends to go on for months, so if someone is ready for discharge and still delirious, keeping them more days will not help resolve the issue.
10. Preventing onset of delirium in hospitalized patients
- Let them sleep
- Reorientation (family members, make sure they have glasses/hearing aids/etc to prevent sensory deprivation)
- Early ambulation (i.e. get the nasal cannula, foley, IVs out)
- Keep them hydrated.