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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
Q

Typical pattern of joint involvement in the hand with RA

A

PIP, MCP, intercarpal and CMC

25
Q

Typical pattern of joint involvement in the hand with psoriatic arthritis

A

PIP, DIP

26
Q

Typical pattern of joint involvement in the hand with hemochromatosis

A

2nd and 3rd MCP (with chondrocalcinosis) or episodic, inflammatory wrist arthritis

27
Q

Tendons that form the rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

28
Q

Shoulder pathology suggested by pain on active (but not passive) abduction, pain over the lateral deltoid muscle, night pain, and positive impingement sign

A

Rotator cuff tendinitis

29
Q

Pain that develops before 180 degrees of passive forward flexion of the shoulder while the examiner stabilizes the scapula

A

Impingement sign (rotator cuff tendinitis)

30
Q

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)

A

Complete tear of the rotator cuff

31
Q

Imaging studies to confirm rotator cuff tendinitis or tear

A

MRI or ultrasound

32
Q

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.

A

Small to moderate (<100 mL)

33
Q

Best position of the knee to palpate for popliteal or Baker’s cyst

A

Partial flexion

for inspection, the knees are best viewed posteriorly with the patient standing and knees fully extended

34
Q

Knee pathology associated with pain on the anteromedial proximal tibia at the insertion of the conjoined tendon

A

Anserine bursitis

35
Q

Muscles that form the conjoined tendon

A

Sartorius, gracilis, semitendinosus

36
Q

Bursa in the knee that is superficial and located over the inferior portion of the patella

A

Prepatellar bursa

37
Q

Bursa in the knee located deep beneath the patellar ligament before its insertion on the tibial tubercle

A

Infrapatellar bursa

38
Q

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)

A

Lateral meniscus tear

McMurray test

39
Q

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)

A

Medial meniscus tear

McMurray test

40
Q

Knee pathology associated with significant anterior movement on drawer sign

A

Anterior cruciate ligament damage

41
Q

Knee pathology associated with significant posterior movement on drawer sign

A

Posterior cruciate ligament damage

42
Q

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

A

L4, L5, or S1

43
Q

Location of true hip joint pain

A

Anteriorly, over the inguinal ligament; may radiate medially to the groin

44
Q

Periarticular disease that may mimic true hip joint pain; tends to worsen with hyperextension of the hip

A

Iliopsoas bursitis

45
Q

Target uric acid level in hypouricemic therapy

A

<6 mg/dL

46
Q

Percentage of healthy population with positive RF or ANA

A

4-5%

only 1% and <0.4% will have RA or SLE, respectively

47
Q

Percentage of RA patients with positive IgM RF

A

80%

48
Q

Conditions other than RA associated with positive low titers of RF

A

Tuberculosis, leprosy, hepatitis
SLE, Sjögren’s syndrome
Chronic pulmonary dse, CLD, CKD

49
Q

Conditions other than SLE associated with positive ANA

A

Polymyositis, scleroderma, APS, Sjögren’s syndrome, drug-induced lupus, CLD, CKD, advanced age

50
Q

ANA pattern (related to autoantibodies against ds-DNA) highly specific and suggestive of lupus

A

Peripheral

51
Q

Aside from limited scleroderma, centromeric ANA pattern is also seen in this condition

A

Primary biliary cirrhosis

52
Q

Normal synovial fluid is viscous because of the high levels of this substance

A

Hyaluronate

53
Q

White cell count of noninflammatory synovial fluid

A

<2000/uL with mononuclear cell predominance

54
Q

Typical white cell count of inflammatory synovial fluid

A

2000-50,000/uL with PMN predominance

55
Q

White cell count of septic synovial fluid

A

> 50,000/uL with >75% PMNs

56
Q

Gallium scanning is primarily used in identification of these conditions

A

Occult infection or malignancy

57
Q

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

A

Prosthetic joint infection

58
Q

Gallium scanning utilizes 67Ga, which binds these proteins, and are preferentially taken up by neutrophils, macrophages, bacteria, and tumor tissue (e.g., lymphoma)

A

Serum and cellular transferrin and lactoferrin

59
Q

Reason why lower uric acid levels are seen in women

A

Estrogen has uricosuric effects

60
Q

Preferred imaging technique when evaluating complex musculoskeletal disorders

A

MRI

Rheuma (HPIM 18e) (4 decks)

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