Diagnosis Flashcards
Patient presents with back pain that often improves with exercise. He c/o morning stiffness, enthesitis, and eye problems. Upon PE, you note joints in spine are tender to palpation. There is decreased ROM. Increased occiput to wall distance indicating kyphosis. Posture is poor with flexion deformity of neck. FABER - painful indicating sacrolilitis. CRP, ESR elevated, HLA-B27 positive. Dx?
ankylosing spondylitis
Patient presents with knee, ankle, and foot pain for the past 1 month. (asymmetric). Also has heel pain, swelling, and dactylitis. CM include cystitis, urethritis, conjunctivities, and mouth ulcer and skin rash. ESR, CRP elevated. Had chlamydia infection 6 weeks ago. suspect….what is tx and prognosis?
reactive arthritis. tx preceding infection if ongoing, consider NSAIDS, corticosteroids. should resolve in less than 6 months. 20% will develop more chronic, persistent arthritis
woman presents over 50 years of age with bilateral aching and morning stiffness lasting 45 minutes for the past 2 months in neck, shoulders, and hips. ESR greater than 40. dx and tx?
polymyalgia rheumatica. should have prompt response to glucocorticoids (confirms dx as well)
75 year old appears chronically ill with c/o new onset headache. thickened, tedner cranial aa. fever, fatigue, weight loss. ocular exam shows cotton wool spots. ESR over 50. dx, tx, and prognosis?
get temporal a. biopsy (bilateral)- suspect giant cell artteritis. high dose glucocorticoids immediately. prognosis- 15-20% of patients can have permanent partial or complete visual loss
