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First Aid: Step 2 CS > Differential & Work-up: Joint/Limb Pain > Flashcards

Differential & Work-up: Joint/Limb Pain Flashcards

1
Q

30 yo F presents with wrist pain and a black eye after tripping, falling, and hitting her head on the edge of a table. She looks anxious and gives an inconsistent story.

A
  1. Domestic violence
  2. Factitious disorder
  3. Substance abuse
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2
Q

WORK UP FOR:

  1. Domestic violence
  2. Factitious disorder
  3. Substance abuse
A
  1. XR-wrist
  2. CT-head
  3. Urine toxicology
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3
Q

30 yo F secretary presents with wrist pain and a sensation of numbness and burning in her palm and the first, second, and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals a positive Tinel sign.

A
  1. Carpal tunnel syndrome
  2. Median nerve compression (forearm or arm)
  3. Radiculopathy of nerve roots C6 & C7 in cervical spine
  4. De Quervain tenosynovitis
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4
Q

WORK UP FOR:

  1. Carpal tunnel syndrome
  2. Median nerve compression (forearm or arm)
  3. Radiculopathy of nerve roots C6 & C7 in cervical spine
  4. De Quervain tenosynovitis
A
  1. Nerve conduction studies
  2. EMG
  3. U/S-wrist
  4. MRI-spine
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5
Q

28 yo F presents with pain in the interphalangeal joints of her hands accompanied by hair loss and a rash on her face.

A
  1. Systemic lupus erythematosus (SLE)
  2. Rheumatoid arthritis
  3. Psoriatic arthritis
  4. Parvovirus B19 infection
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6
Q

WORK UP FOR:

  1. Systemic lupus erythematosus (SLE)
  2. Rheumatoid arthritis
  3. Psoriatic arthritis
  4. Parvovirus B19 infection
A
  1. ANA, anti-dsDNA, anti-Sm, ESR, C3,C4, antiphospholipid antibodies
  2. RF, anti-CCP
  3. ESR, CRP
  4. CBC
  5. XR-hands
  6. UA, urine sediment
  7. Antibody titers for parvovirus B 19
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7
Q

28 yo F presents with pain in the metacarpophalangeal joints of both hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis.

A
  1. Rheumatoid arthritis
  2. SLE
  3. Disseminated gonorrhea
  4. Arthritis associated with inflammatory bowel disease
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8
Q

WORK UP FOR:

  1. Rheumatoid arthritis
  2. SLE
  3. Disseminated gonorrhea
  4. Arthritis associated with inflammatory bowel disease
A
  1. XR-hands, left knee
  2. ANA, anti-dsDNA, ESR, RF, anti-CCP
  3. CBC
  4. Cervical culture
  5. Arthrocentesis and synovial fluid analysis
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9
Q

18 yo M presents with pain in the interphalangeal joints of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees.

A
  1. Psoriatic arthritis
  2. Rheumatoid arthritis
  3. SLE
  4. Gout
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10
Q

WORK UP FOR:

  1. Psoriatic arthritis
  2. Rheumatoid arthritis
  3. SLE
  4. Gout
A
  1. ESR, CRP, RF, anti-CCP, ANA
  2. CBC
  3. XR-hands
  4. XR-pelvis/sacroiliac joints
  5. Uric acid
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11
Q

65 yo F presents with inability to use her left leg or bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago, and she did not receive HRT or calcium supplements. Her left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin.

A
  1. Hip fracture
  2. Hip dislocation
  3. Pelvic fracture
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12
Q

WORK UP FOR:

  1. Hip fracture
  2. Hip dislocation
  3. Pelvic fracture
A
  1. XR-hip/pelvis
  2. CT or MRI-hip
  3. CBC, type & cross
  4. Serum calcium and vitamin D
  5. Bone density scan (DEXA)
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13
Q

40 yo M presents with pain in the right groin after a motor vehicle accident. His right leg is flexed at the hip, adducted, and internally rotated.

A
  1. Hip dislocation-Traumatic
  2. Hip fracture
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14
Q

WORK UP FOR:

  1. Hip dislocation-Traumatic
  2. Hip fracture
A
  1. XR-hip
  2. CT or MRI-hip
  3. CBC, type & cross
  4. PT/PTT
  5. Urine toxicology and blood alcohol level
  6. U/S-abdomen (FAST exam)
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15
Q

56 yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She has noticed swelling and deformity of the joint and is having difficulty walking.

A
  1. Osteoarthritis
  2. Pseudogout
  3. Gout
  4. Meniscal or ligament damage
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16
Q

WORK UP FOR:

  1. Osteoarthritis
  2. Pseudogout
  3. Gout
  4. Meniscal or ligament damage
A
  1. XR-knee
  2. CBC
  3. ESR
  4. Knee arthrocentesis & synovial fluid analysis: cell count, Gram stain, culture, crystals
  5. Uric acid
  6. MRI-knee
17
Q

45 yo M presents with fevers and right knee pain with swelling and redness.

A
  1. Septic arthritis
  2. Gout
  3. Pseudogout
  4. Lyme arthritis
  5. Trauma
  6. Reiter syndrome (reactive arthritis)
18
Q

WORK UP FOR:

  1. Septic arthritis
  2. Gout
  3. Pseudogout
  4. Lyme arthritis
  5. Trauma
  6. Reiter syndrome (reactive arthritis)
A
  1. CBC
  2. Knee arthrocentesis & synovial fluid analysis: cell count, Gram stain, culture, crystals
  3. Blood, urethral cultures
  4. XR-knee
  5. Uric acid
  6. Lyme titers-IgG and IgM
19
Q

65 yo M presents with right foot pain. He has been training for a marathon.

A
  1. Stress fracture
  2. Plantar fasciitis
  3. Foot sprain or strain
20
Q

WORK UP FOR:

  1. Stress fracture
  2. Plantar fasciitis
  3. Foot sprain or strain
A
  1. XR-foot
  2. Bone scan-foot
  3. MRI-foot
21
Q

65 yo M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma.

A
  1. Plantar fasciitis
  2. Hell Fracture
  3. Splinter/Foreign Body
22
Q

WORK UP FOR:

  1. Plantar fasciitis
  2. Heel Fracture
  3. Splinter/Foreign Body
A
  1. XR-heel
  2. Bone scan-foot
23
Q

55 yo M presents with pain in the elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion (Cozen test) with the elbow in extension.

A
  1. Tennis elbow (lateral epicondylitis)
  2. Stress fracture
24
Q

WORK UP FOR:

  1. Tennis elbow (lateral epicondylitis)
  2. Stress fracture
A
  1. XR-arm
  2. Bone scan
  3. MRI-elbow
25
Q

27 yo F presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms.

A
  1. Disseminated gonorrhea
  2. Rheumatoid arthritis
  3. SLE
  4. Reiter syndrome (reactive arthritis)
26
Q

WORK UP FOR:

  1. Disseminated gonorrhea
  2. Rheumatoid arthritis
  3. SLE
  4. Reiter syndrome (reactive arthritis)
A
  1. Knee arthrocentesis and synovial fluid analysis: cell count, Gram stain, culture
  2. Blood, cervical cultures
  3. RF, anti-CCP, ESR
  4. ANA, anti-dsDNA, CBC
  5. XR-knee
27
Q

60 yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery 6 months ago and continues to smoke heavily.

A
  1. Peripheral vascular disease (intermittent claudication)
  2. Leriche syndrome (aortoiliac occlusive disease)
  3. Lumbar spinal stenosis (pseudoclaudication)
  4. Osteoarthritis
28
Q

WORK UP FOR:

  1. Peripheral vascular disease (intermittent claudication)
  2. Leriche syndrome (aortoiliac occlusive disease)
  3. Lumbar spinal stenosis (pseudoclaudication)
  4. Osteoarthritis
A
  1. Ankle-brachial index
  2. Doppler U/S-lower extremity
  3. Angiography
  4. MRI-L spine
29
Q

45 yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs 2 months ago for dysfunctional uterine bleeding.

A
  1. DVT
  2. Baker cyst rupture
  3. Myositis
  4. Cellulitis
  5. Superficial venous thrombosis
30
Q

WORK UP FOR:

  1. DVT
  2. Baker cyst rupture
  3. Myositis
  4. Cellulitis
  5. Superficial venous thrombosis
A
  1. Doppler U/S-right leg
  2. CBC
  3. CPK
  4. D-dimer
31
Q

60 yo F c/o left arm pain that started while she was swimming and was relieved by rest.

A
  1. Angina/MI
  2. Tendinitis
  3. Osteoarthritis
32
Q

WORK UP FOR:

  1. Angina/MI
  2. Tendinitis
  3. Osteoarthritis
A
  1. ECG, troponin, CK-MB
  2. CBC
  3. XR-shoulder
  4. CXR
  5. Echocardiography
  6. Stress test
33
Q

50 yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm.

A
  1. Shoulder dislocation
  2. Fracture of the humerus
  3. Rotator cuff injury
34
Q

WORK UP FOR:

  1. Shoulder dislocation
  2. Fracture of the humerus
  3. Rotator cuff injury
A
  1. XR-shoulder
  2. XR-arm
  3. MRI-shoulder
35
Q

55 yo M presents with crampy bilateral thigh and calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia.

A
  1. Rhabdomyolysis due to statins
  2. Polymyositis
  3. Inclusion body myositis
36
Q

WORK UP FOR:

  1. Rhabdomyolysis due to statins
  2. Polymyositis
  3. Inclusion body myositis
A
  1. CPK
  2. CBC
  3. CMP, calcium, phosphate, uric acid
  4. Aldolase
  5. UA
  6. Urine myoglobin

First Aid: Step 2 CS (23 decks)

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