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Rheuma (HPIM 18e) > Approach to Articular and Musculoskeletal Disorders > Flashcards

Approach to Articular and Musculoskeletal Disorders Flashcards

0
Q

Feature that differentiates articular from nonarticular disorders

A

Articular disorders - pain or limited ROM on active and passive movement

Nonarticular - pain on active but not passive ROM; less swelling, crepitus, instability, or deformity of the joint

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1
Q

“Red flag” diagnoses that must be diagnosed promptly to avoid significant morbidity and mortality (3)

A
  1. Septic arthritis
  2. Acute crystal-induced arthritis
  3. Fracture
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2
Q

Intermittent stiffness associated with noninflammatory conditions, precipitated by brief periods of rest, lasts less than 60 minutes, and exacerbated by activity

A

Gel phenomenon

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3
Q

Characteristics of morning stiffness associated with inflammatory disease

A

Precipitated by prolonged rest, described as severe, lasts for hours, may improve with activity or anti-inflammatory conditions

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4
Q

Top 5 differentials for musculoskeletal complaints in patients <60 years

A
  1. Repetitive use/strain dso
  2. Gout (men only)
  3. RA
  4. Spondyloarthritis
  5. Infectious arthritis
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5
Q

Top 5 differentials for musculoskeletal complaints in patients >60 years

A
  1. OA
  2. Crystal arthritis (gout/pseudogout)
  3. Polymyalgia rheumatica
  4. Osteoporotic fracture
  5. Septic arthritis
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6
Q

Most frequent musculoskeletal condition in patients with musculoskeletal complaints and low back pain

A

Fibromyalgia

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7
Q

Diagnoses for MSK complaints more common in the young (2)

A

SLE

Reactive arthritis

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8
Q

Diagnoses for MSK complaints more common in middle aged patients (2)

A

Fibromyalgia

RA

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9
Q

Diagnoses for MSK complaints more common in the elderly (at least 2)

A

OA
Polymyalgia rheumatica

Also: osteoporosis, gout, pseudogout, vasculitis, drug-induced disorders

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10
Q

Diagnoses for MSK complaints more common in whites (3)

A

Polymyalgia rheumatica
Giant cell arteritis
Wegener’s granulomatosis

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11
Q

Diagnoses for MSK complaints more common in African Americans (2)

A

Sarcoidosis

SLE

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12
Q

Diagnoses for MSK complaints that may exhibit familial aggregation (3)

A

Ankylosing spondylitis
Gout
Heberden’s nodes of OA

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13
Q

Arthritides that exhibit a migratory pattern of joint involvement (2)

A

Rheumatic fever

Gonococcal or viral arthritis

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14
Q

Arthritides that exhibit an additive pattern of joint involvement (2)

A

RA

Psoriatic arthritis

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15
Q

Symptom duration of a musculoskeletal disorder to be classified as chronic

A

> 6 weeks

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16
Q

Number of joints involved to be classified as oligoarticular

A

2-3 joints

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17
Q

Arthritides that involve mostly the lower extremities

A

Reactive arthritis

Gout

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18
Q

Arthritides that involve mostly the upper extremities

A

RA

OA

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19
Q

Involvement of the axial skeleton is infrequent in RA, with this notable exception

A

Cervical spine

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20
Q

Arthritides that commonly involve the axial skeleton

A

OA

Ankylosing spondylitis

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21
Q

Patients with chronic inflammatory disorders are at higher risk for these diseases

A

Infection, cardiovascular events, neoplasia

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22
Q

28 easily examined joints

A 
PIPs
MCPs
Wrists
Elbows
Shoulders
Knees
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23
Q

Typical pattern of joint involvement in the hand with OA

A

DIP, PIP, 1st CMC

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24
Typical pattern of joint involvement in the hand with RA
PIP, MCP, intercarpal and CMC
25
Typical pattern of joint involvement in the hand with psoriatic arthritis
PIP, DIP
26
Typical pattern of joint involvement in the hand with hemochromatosis
2nd and 3rd MCP (with chondrocalcinosis) or episodic, inflammatory wrist arthritis
27
Tendons that form the rotator cuff
Supraspinatus Infraspinatus Teres minor Subscapularis
28
Shoulder pathology suggested by pain on active (but not passive) abduction, pain over the lateral deltoid muscle, night pain, and positive impingement sign
Rotator cuff tendinitis
29
Pain that develops before 180 degrees of passive forward flexion of the shoulder while the examiner stabilizes the scapula
Impingement sign (rotator cuff tendinitis)
30
Shoulder pathology suggested by a positive drop arm test (patient is unable to hold the arm up once 90 degrees of passive abduction is reached)
Complete tear of the rotator cuff
31
Imaging studies to confirm rotator cuff tendinitis or tear
MRI or ultrasound
32
Manual pressure lateral to the patella may cause an observable shift in synovial fluid (bulge) to the medial aspect. This maneuver is only effective in detecting this volume of effusion.
Small to moderate (<100 mL)
33
Best position of the knee to palpate for popliteal or Baker's cyst
Partial flexion | for inspection, the knees are best viewed posteriorly with the patient standing and knees fully extended
34
Knee pathology associated with pain on the anteromedial proximal tibia at the insertion of the conjoined tendon
Anserine bursitis
35
Muscles that form the conjoined tendon
Sartorius, gracilis, semitendinosus
36
Bursa in the knee that is superficial and located over the inferior portion of the patella
Prepatellar bursa
37
Bursa in the knee located deep beneath the patellar ligament before its insertion on the tibial tubercle
Infrapatellar bursa
38
Knee pathology associated with a painful click when the knee is first flexed at 90 degrees and the leg is extended while the lower extremity is simultaneously torqued medially (inward rotation)
Lateral meniscus tear | McMurray test
39
Knee pathology associated with a painful click when the knee is first flexed at 90 degrees and the leg is extended while the lower extremity is simultaneously torqued laterally (outward rotation)
Medial meniscus tear | McMurray test
40
Knee pathology associated with significant anterior movement on drawer sign
Anterior cruciate ligament damage
41
Knee pathology associated with significant posterior movement on drawer sign
Posterior cruciate ligament damage
42
Sciatica may be caused by impingement of these nerve roots and manifests as neuropathic pain extending from the gluteal region down the posterolateral leg to the foot
L4, L5, or S1
43
Location of true hip joint pain
Anteriorly, over the inguinal ligament; may radiate medially to the groin
44
Periarticular disease that may mimic true hip joint pain; tends to worsen with hyperextension of the hip
Iliopsoas bursitis
45
Target uric acid level in hypouricemic therapy
<6 mg/dL
46
Percentage of healthy population with positive RF or ANA
4-5% | only 1% and <0.4% will have RA or SLE, respectively
47
Percentage of RA patients with positive IgM RF
80%
48
Conditions other than RA associated with positive low titers of RF
Tuberculosis, leprosy, hepatitis SLE, Sjögren's syndrome Chronic pulmonary dse, CLD, CKD
49
Conditions other than SLE associated with positive ANA
Polymyositis, scleroderma, APS, Sjögren's syndrome, drug-induced lupus, CLD, CKD, advanced age
50
ANA pattern (related to autoantibodies against ds-DNA) highly specific and suggestive of lupus
Peripheral
51
Aside from limited scleroderma, centromeric ANA pattern is also seen in this condition
Primary biliary cirrhosis
52
Normal synovial fluid is viscous because of the high levels of this substance
Hyaluronate
53
White cell count of noninflammatory synovial fluid
<2000/uL with mononuclear cell predominance
54
Typical white cell count of inflammatory synovial fluid
2000-50,000/uL with PMN predominance
55
White cell count of septic synovial fluid
>50,000/uL with >75% PMNs
56
Gallium scanning is primarily used in identification of these conditions
Occult infection or malignancy
57
111In-labeled WBC or 67Ga scanning has largely been replaced by MRI in the detection of osteomyelitis and infectious/inflammatory arthritis except when there is a suspicion of this condition
Prosthetic joint infection
58
Gallium scanning utilizes 67Ga, which binds these proteins, and are preferentially taken up by neutrophils, macrophages, bacteria, and tumor tissue (e.g., lymphoma)
Serum and cellular transferrin and lactoferrin
59
Reason why lower uric acid levels are seen in women
Estrogen has uricosuric effects
60
Preferred imaging technique when evaluating complex musculoskeletal disorders
MRI

Rheuma (HPIM 18e) (4 decks)

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