2 Flashcards
Arthritis involving multiple joints in a sexually active pt is — until proven otherwise
Gonococcal septic arthritis
What’s growing pain? Rx
2-12yr of age, bilateral lower extremity pain which primarily occurs at night and resolves by morning, p/e is normal, activity is also normal
Rx- reassurance, massage n over the counter pain meds
A 23 yr old soccer player presented after an injury to the knee. She experienced a popping sensation during the injury followed by rapid onset of knee swelling n a feeling of instability when bearing wt. joint aspiration shows blood
Dx?
Anterior cruciate ligament injury
A guy who works as an airport baggage handler came with elbow pain. Has tenderness at the elbow; passive flexion at the wrist, resisted extension of wrist reproduce the pain
Dx?
Lateral epicondylitis/tennis elbow
Is due to overuse of the extensor mms
A 6yr old boy presented with left hip n knee pain of 3months duration. He has antalgic gait(short time wt bearing on the affected site. P/E- internal rotation n abduction r limited. Atrophy of the left proximal thigh is seen
Dx? Y?
Legg-perthes disease
Idiopathic avascular necrosis(osteonecrosis) of the femur
The most common cause of an asymptomatic elevation of alkaline phosphatase in an elderly pt is?
Paget disease of the bone
A 65 yr old male presented with rt hip pain; his ALP is 475, other liver enzymes being normal; hydroxyproline is raised. X ray shows cortical thickening and bone scan- increased radiotracer uptake
Dx is?
Rx?
Paget disease of the bone
- Rx
- asymptomatic: observe
- symptomatic: bisphosphonates( alendronate,…)
Differentiating features of inflammatory arthritis from viral(parvovirus B19) arthritis?
In RA, the joint pain and STIFFNESS are more pronounced and ESR IS ELEVATED Unlike viral arthritis.
A 45 yr old woman presented with proximal mm wkness ( difficultly combing her hair and getting in n out of her car. She also has difficulty swallowing. Neurological examination is normal; ESR n creatinine kinase r elevated
What’s the Dx? How’s the definitive dx made?
Rx?
Polymyositis
Muscle biopsy
Prednisone is the initial mx or glucocorticoid sparing agents such as methotrexate, azathioprine
A woman above the age of 50, with a 3month hx of shoulder n hip pain n stiffness lasting for more than one hr, elevated ESR most likely has?
Rx of choice?
Polymyalgia rheumatica
Prednisone
PMR is frequently associated with giant cell artists
A 30 yr old female presented with chronic anterior knee pain especially with squatting, running, prolonged sitting or using stairs. Extending the knee while compressing the patella reproduces the pain
Dx?
Rx?
Patellofemoral syndrome
Stretching n strengthening the thigh mms
A 31 yr old complains of rt knee, rt heel and low back pain. He was recently treated for urethral discharge. He’s currently afebrile . He has oral ulcer on examination. Synovial fluid analysis- WBC 10000, with many pmn leukocyte but negative gramstain
Dx, which clinical features r suggestive?
Rx?
Reactive arthritis ( a type of seronegative spondylo arthropathy)
Knee n back involvement, mucocutaneous lesions r suggestive. No fever and sterile effusion make gonococcal arthritis less likely
NSAIDs r the 1st line therapy
A pt presented with knee pain following a twisting injury. There’s tenderness at the medial knee n valgus stress test is positive
Dx?
Medial collateral ligament tear
Gradually increasing pain n swelling of a knee after trauma, locking n catching with decreased range of motion, hemarthrosis on tapping, popping, locking,pain during internal/external rotation
Dx?
Meniscal tear
Medial deviation of the forefoot with neutral position of the hind foot is? Mx?
Metatarsus adductus- a congenital foot deformity
Mx- reassurance (spontaneously resolves) unlike clubfoot which needs serial manipulation and casting
