Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Résidence - FM Learner > 57. Joint Disorder (26%) > Flashcards

57. Joint Disorder (26%) Flashcards

(49 cards)

Start Studying
1
Q

Chez un patient qui consulte pour une douleur articulaire, différenciez la pathologie grave de la pathologie bénigne.

Nommez des examples de pathologies graves

A
  • sarcome
  • arthrite septique
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chez le patient qui présente une douleur musculo-squelettique imprécise, posez un diagnostic rhumatologique spécifique en vous appuyant sur l’anamnèse, l’examen physique et les investigations (p. ex., goutte, fibromyalgie, monoarthropathie vs polyarthropathie).

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chez le patient qui présente une monoarthropathie, éliminez quoi?

A

une cause infectieuse (p. ex. infection transmissible sexuellement).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chez les patients souffrant de douleur musculo-squelettique, incluez dans le diagnostic différentiel les sources de douleurs viscérales et référées.

Nommez des examples.

A
  • angine
  • fracture dans la plaque de croissance qui se manifeste sous forme d’arthralgie
  • douleur neurogène
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Décrire l’utilisation des radiographies dans les lésions ligamentaires

A

Diagnostiquez cliniquement les blessures ligamentaires. NE FAITES PAS d’examen radiologique.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chez un patient qui consulte pour une douleur articulaire, incluez dans votre diagnostic différentiel certaines affections systémiques.

Nommez des examples.

A
  • Granulomatose de Wegener
  • Lupus érythémateux
  • Colite ulcéreuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dans votre évaluation des patients avec un diagnostic d’une affection rhumatologique, recherchez les complications reliées à la maladie

Nommez un example.

A

iritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chez les patients atteints de polyarthrite rhumatoïde, initiez rapidement quoi ?

A

rapidement le traitement en incluant à la médication un agent de rémission de la maladie.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nommez catégories DDX : Monoarthrite

A
  • Atraumatic : Inflammatoire, non-inflammatoire
  • Traumatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nommez DDX monoarthrite : Atraumatic - Inflammatoire

A
  • Septique
  • Goutte/pseudogoutte
  • Réactive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nommez DDX monoarthrite : Atraumatic - Non-inflammatoire

A
  • Osteoarthrite
  • Fibromyalgie
  • Nécrose avasculaire
  • Cartilage
  • Néoplasme
  • Épicondylite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nommez DDX monoarthrite : TRAUMATIC

A
  • Fracture
  • Avulsion
  • Hémarthrose
  • Tendon
  • Nécrose avasculaire
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nommez catégories DDX : Polyarthrite

A

Inflammatoire
* Infection
* Crystale
* Rheumatologique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nommez DDX polyarthrite : Infection

A
  • Gonorrhée
  • Endocardite
  • Maladie de Lyme
  • Rhumatisme articulaire aigu
  • Virus (VIH, parvovirus, hépatite)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nommez DDX polyarthrite : Crystale

A
  • Goute
  • Pseudogoute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nommez DDX polyarthrite : Rheumatologique

A
  • Réactionnelle
  • Rhumatoïde
  • Lupus
  • Polymylagie rhumatismale
  • Inflammation intestinale
  • Sarcoïde, vascularite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name ALARM FEATURES of joint pain

A
  • Hot (fever, warm joint)
  • BOG (soft and boggy joint)
  • AM : Stiff > 30 mins
  • PM : Pain (Night pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Differentiate joint vs. soft tissue pain

A
  • Arthritis: Pain on ROM, decreased ROM, swelling, erythema
  • Soft tissue: ROM preserved, tendernes over bursae, tendons, or ligaments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name DDX Monoarthritis (7)

A
  • Trauma
  • Infection (Septic arthritis)
  • Crystal-induced arthritis
  • Osteoarthritis
  • Systemic (Gonoccocal, non-gonococcal, mycobacterial, fungal, lyme)
  • Mechanical derangement
  • Neoplasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hemarthrosis is associated with which conditions ? (3)

Study These Flashcards
A
  • fractures intra-articulaires
  • luxations
  • lésions ligamentaires
21
Q

Gonoccocal joint infx presents how?

Study These Flashcards
A
  • present as purulent arthritis
  • or a triad of tenosynovitis, vesiculopustular skin lesions, and polyarthralgias
22
Q

Non gonococcal bacterial joint infections should be suspected in who? (3)

Study These Flashcards
A

in IV drug users, immunocompromised, prosthetic joint

23
Q

List Crystal-induced arthritis (2)

Study These Flashcards
A

Gout (cristaux d’urate monosodique )
Pseudogout (CPPD)

24
Q

Name causes of Systemic arthritis (4)

Study These Flashcards
A
  • Spondylarthrite séronégative (Arthrite réactive, Arthrite psoriasique, Arthrite associée aux maladies inflammatoires de l’intestin)
  • Polyarthrite sarcoïde
  • Polyarthrite rhumatoïde
  • Troubles myélodysplasiques et leucémiques
25
Name redflags of joint pain (6)
* Articulations chaudes/enflées * SX B * Raideur matinale > 30 minutes * Douleur nocturne * Faiblesse * Neurologique (douleur brûlante, engourdissement ou paresthésie)
26
Describe history : Joint pain
* Red flags * Joint pain (OPQRST) * Prior joint pain/similar episodes * Systemic arthritis (morning stiffness>1h) * Trauma * Travel (Lyme) * Seronegative spondyloarthritis (GI/GU complaints) * Family history * PMH (immunosuppression) * Habits (IVDU, STI risk)
27
When to suspect : Spondylarthrite séronégative (4)
suspect in * enthésite (l'inflammation des sites d'insertion du tendon, du ligament, de la capsule articulaire ou d'un fascia sur l'os) * dactylite (inflammation grave des articulations des doigts et des orteils) * conjonctivite/uvéite * psoriasis
28
Describe physical exam : Joint pain
* Vitals, temperature (high-grade fever) * Soft tissue swelling, warm, effusion * Passive/Active ROM * Extraarticular : Tophi, Skin changes (Psoriasis, Malar rash, Erythema nodosum), Eye involvement
29
Describe investigations : Joint pain (3)
* Imaging (XR, US, CT, MRI). Consider avoiding imaging in absence of trauma or focal bone pain * Joint aspiration * Consider labs
30
Describe joint aspirations
Gross appearance Crystal analysis White cell count and differential * <2,000/mm3 usually non-inflammatory * >20,000 suspect septic arthritis Gram stain and Culture
31
What labs to consider in joint pain : (6)
* CBC * LFT * ESR/CRP * ANA, RF, Anti-CCP * (HLA)-B27 * Coags (in hemarthrosis)
32
Décrire présentation/questionnaire : Fibromyalgie
33
Décrire EP : Fibromylagie
* Neurologique : possible de retrouver allodynie, trouble d’équilibre et sensibilité aux 9 paires de points douloureux (pas obligatoire pour poser diagnostic) * Articulaire : devrait être normal * Tout ce qui est pertinent pour confirmer ou infirmer une autre condition
34
Décrire bilans : Fibromylagie
* Bilan d’exclusion : FSC, CRP, CPK, TSH * Maladies chroniques, syndrome métabolique, obésité peuvent augmenté légèrement la CRP * CRP > 20 considérer investigation supplémentaire * Tout autre investigation doit être justifiée par trouvailles au questionnaire ou à l’examen objectif
35
Décrire tx : Fibromylagie
* Traitement pharmacologique : approche par symptôme (Antidépresseur 3 cycliques, SNRS ou gabapentinoïdes, Éviter les opiacés et les benzo) * Éducation * Psychothérapie PRN * Exercices physiques et autogestion * Référer en ergothérapie, réadaptation interdisciplinaire ou services spécialisés de main d’oeuvre (selon les besoins) PRN * Physiothérapie PRN
36
Name a few Diagnostic Differentiators for Wegener’s granulomatosis, lupus, ulcerative colitis
37
Name signs/symptoms : Gout
* Acute arthritis -> painful, swelling, erythema, usually lower extremity (most common 1st MTP), limited joint mobility * Tophi (monosodium rate crystals) > rate deposit in cartilage / tendon bursa / soft tissue / synovial * Renal > nephropathy, calculi, acidic urine
38
Describe investigations : Gout
* Hyperuricemia is NOT diagnostic of acute attack (normal 15-480). Helpful to determine efficacy of prophylaxis * Consider synovial fluid aspiration for rate crystals (especially if septic arthritis is still on the differential) * Imaging Options (uncertain usefulness in primary care) - when diagnostic testing is necessary, use synovial fluid aspiration especially if septic arthritis is still on the differential (X-rays usually not useful u/s (low quality evidence, Dual energy CT)
39
Describe dx : Gout (4)
New York Criteria : >= 2 of the following: * > or = 2 attack of painful joint swelling with complete resolution within 2 weeks * Unilateral first MT joint attack (podagral) * Response to colchicine (major reduction in inflammation within 48 hrs) * Tophi (proven or suspected)
40
Describe lifestyle tx : Gout (6)
* Limit purine intake + limit high fructose intake * Avoid alcohol * Avoid meats, sardines, shellfish, beans, peas * Consider diet <1600 kcal / day (show to reduce serum uric acid) * Weight loss. Given risk factors include HTN / obesity / CAD / DM / dyslipidemia * Avoid thiazides, consider losartan instead
41
Describe acute gout tx (4)
* use topical ice as an adjunct treatment * NSAID (Naproxen) * Colchicine * Corticosteroids - if NSAID + colchicine contraindicated (ex. On warfarin), avoid in poor diabetes control, infection (ex. prednisone)
42
Describe urate lowering therapy for gout (1)
Allopurinol
43
Which patients should be considered for prophylactic urate lowering therapy ? (5)
* ≥ 1 tophi * radiographic damage from gout * ≥ 2 flares / year * >1 lifetime flare but <2 / year * first flare and CKD stage ≥3, SU >535 umol/L, or urolithiasis * Do NOT Rx for first flare w/ none of the above conditions
44
Describe : Rheumatoid Arthritis (4)
* Chronic autoimmune disorder causing (usually **symmetrical**) erosive synovitis of peripheral joints (small and large), swelling, stiffness, pain * Morning stiffness ≥ 1 hour, improves w/ use, worsens w/ rest * Joint damage > ⬇️ motion, instability, deformity, crepitus * Constitutional symptoms (fatigue, rarely wt loss) * Vasculitis * Lymphocytic Infiltrates - rheumatoid nodules, pulmonary fibrosis, pleural effusion, pulmonary nodules, pericarditis, Hashimoto's thyroiditis, hepatosplenomegaly * Joint Deformities - Boutonniere, Swan neck, claw toe, hammer toe, mallet toe
45
Name dx criteria : Rheumatoid Arthritis
At least 4 of the following: * Moring stiffness around joints for ≥ 1 hour * Arthritis ≥ 3 joint areas (soft tissue swelling) * Arthritis of hand joints (wrist, MCP, PIP) * Symmetric arthritis. Bilateral involvement PIP, MCP or MTP joints * Rheumatoid nodules * Serum rheumatoid factor elevated * Radiographic changes on hand and wrist views (erosions, decalcification)
46
Name investigations : Rheumatoid Arthritis
* Bloodwork : RF, anti-cyclic citrullinated peptide (anti-CCP), CRP/ESR, FSB (elevated platelets) * X-ray (diagnostic erosions rarely seen in disease <3 month, I Consider imaging of hands + feet q6mo in recent onset) * Joint aspiration
47
Name Complications of Untreated Rheumatoid Arthritis (6)
* Anemia * Scleritis * Deformities - hands, frozen shoulders, nodules * Pericarditis * More Infections * ?malignancy (unsure if related to DMARDs)
48
Describe pharmacotx : Rheumatoid Arthritis
* **NSAIDS** - symptom relief but do NOT alter course of illness. Use lowest effective dose for shortest time possible. Offer a PPI * **Disease-modifying anti-rheumatic drug (DMARDs)** - start ASAP - adjust q3-6mo * **Corticosteroids** (adjunct to the above to manage flares, bridge DMARDs, max 3/yr). Can use as short term bridging when starting a new synthetic DMARD but taper rapidly * Gastro protection if >65y/o or history of PUD
49
Name examples DMARDs
* **Methotrexate** * Leflunomide * Sulfasalazine * Hydroxychloroquine * Cyclosporine * Azathioprine

Résidence - FM Learner (95 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions