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Rheumatology > approach to articular / MSK disorders > Flashcards

approach to articular / MSK disorders Flashcards

1
Q

important factors to consider in primary complaint

A
  1. articular or nonarticular
  2. inflammatory or noninflammatory
  3. acute or chronic
  4. localized (monoarticular) or widespread (polyarticular)
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2
Q

physical exam signs that pain is articular

A

deep or diffuse pain, pain or limited ROM on active and passive movement, swelling (caused by synovial proliferation, effusion, or bony enlargement), crepitation, instability, ‘locking’ or deformity

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3
Q

signs of inflammation

A

4 cardinal signs (erythema, warmth, pain or swelling)
systemic symptoms (fatigure, fever, rash, weight loss)
labs (ESR, CRP, thrombocytosis, anemia of chroni disease, or hypoalbuminemia)

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4
Q

quick differential for acute articular complaint

A
  • acute arthritis: infectious arthritis, gout, pseudogout, reactive arthritis
  • initial presentation of chronic arthritis
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5
Q

quick differential for acute nonarticular complaint

A

trauma/fracture, fibromyalgia, polymyalgia rheumatica, bursitis, tendinitis

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6
Q

types of inflammatory disorders

A

infectious (gonorrhea, tb), crystal-induced, immune-related (RA, SLE), reactive (rheumatic fever, reactive arthritis), or idiopathic

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7
Q

morning stiffness

A

related to inflammatory condition

  • precipitated by prolonged rest
  • severe
  • lasts for hours
  • may improve with activity or anti-inflammatory agents
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8
Q

important things to elicit from clinical history

A

onset (abrupt, indolent)
evolution (chronic, intermittent, migratory, additive)
duration
distribution (mono,, oligo, poly)
precipitating events (trauma, drugs, recent illness)

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9
Q

DM can lead to?

A

carpal tunnel syndrome

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10
Q

renal insufficiency can lead to?

A

gout

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11
Q

rheumatic review of systems

A

fever, chills, sweats, weight loss, fatigue anorexia
recent URI/GI illness, urethritis/dysuria
alopecia, rash, photosensitivity
eye pain or redness, visual changes
hearing loss
nasal discharge, sinus tenderness
sicca symptoms
oral or genital ulcers
raynouds
headache, jaw claudication, scalp tenderness
dyspnea, cough, hemoptysis, pleuritic or other chest pain
dysphagia, naausea, emesis, GERD, abdominal pain, change in bowel habits
testicular pain
joint pain, myalgias, morning stiffness
back pain, night pain, morning stiffness
extremity weakness or numbness
epistaxis or other bleeeding
seizures or psychosis
miscarriages

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12
Q

red flag diagnoses

A

septic arthritis, gout, or fracture

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13
Q

DIP pain differential

A

OAA, psoriatic, reactive

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14
Q

PIP pain differential

A

OA, SLE, RA, psoriatic

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15
Q

MCP pain differential

A

RA, pseudogout, hemochromatosis

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16
Q

1st CMC pain differential

A

OA

17
Q

wrist pain differential

A

RA, pseudogout, gonococcal arthritis, juvenile arthritis, carpal tunnel syndrome

18
Q

Heberden’s

A

DIP

19
Q

Bouchard’s

A

PIP

20
Q

labs to look for evidence of inflammation

A

CBC w/ diff, ESR, CRP

21
Q

examples of diseases that cause extreme elevation of ESR/CRP

A

sepsis, pleuropericarditis, polymyalgia rheumatica, giant cell arteritis, adult Still’s disease

22
Q

utility of measuring serum uric acid level

A
  • diagnosis of gout, monitoring response to urate-lowering therapy
  • hyperuricemia is associated w/ increased incidence of gout and nephrolithiasis, but levels may not correlate with severity of disease
  • 5% have nl levels in acute gouty attach (presumably from acute inflammation augmented excretion of uric acid)
23
Q

what can cause an increase in uric acid?

A

inborn errors of metabolism (Lesch-Nyhan syndrome)
disease states (renal insufficiency, myeloproliferative disease, psoriasis)
drugs (alcohol, cytotoxic therapy, thiazides)

24
Q

drugs that can induce lupus

A

hydralazine, procainamide, quiniide, tetracyclines, tumor necrosis factor inhibitors

25
Q

sensitivity / specificity of RF

A

note IgM RF = autoantibodies against Fc portion of IgG
found in 80% of pts with RA and seen in low titers in chronic infections
4-5% of a healthy population will test positive

26
Q

specificity / sensitivity of ANA

A

found in 5% of adults, 14% of elderly / chronically sick people
very sensitivity, but poorly specific for lupus

27
Q

when to consider synovial fluid aspiration

A
  1. monoarthritis (acute or chronic)
  2. trauma with joint effusion
  3. monoarthritis in a pt w/ chronic polyarthritis
  4. suspicion of joint infection, crystal-induced arthritis, hemarthrosis
28
Q

how to analyze synovial fluid

A
  1. appearance, viscosity
  2. WBC count, differential
  3. gram stain, culture and sensitivity
  4. crystal identification by polarized microscopy
29
Q

what to consider if effusion is hemorrhagic

A

trauma or mechanical derangement
coagulopathy
neuropathic arthropathy

30
Q

characteristics of noninflammatory synovial fluid

A

clear, viscous, amber-colored

WBC

31
Q

characteristics of inflammatory synovial fluid

A

turbid, yellow
WBC 2,000-5,000, PMN predominance
eg: RA, gout

32
Q

characteristics of septic synovial fluid

A

opaque, purulent

WBC >50,000, w/ >75% PMNs

33
Q

difference in gout and pseudogout crystals

A

monosodium urate crystals: long, needle-shaped, negatively birefringent, usually intracellular
calcium pyrophosphate dihydrate crystals: short, rhomboid-shaped, positively birefringent

34
Q

examples of use of U/S

A

synovial cysts, rotator cuff tears, tendon injury

35
Q

examples of use of CT

A

herniated intervertebral disk, sacroiliitis, spinal stenosis, spinal trauma, osteoid osteoma, stress fracture

36
Q

examples of use of MRI

A

avascular necrosis, osteomyelitis, intraarticular derangement and soft tissue injury, derangements of axial skeleton and spinal cord, herniated intervertebral disk, pigmented villonodular synovitis, inflammatory and metabolic muscle pathology

Rheumatology (10 decks)

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