Joint/Limb Pain Flashcards
30yo F presents with wrist pain and black eye after tripping, falling and hitting her head not the edge of a table. She looks anxious and gives an inconsistent story.
DOMESTIC VIOLENCE
facticious disorder
substance abuse
XR-wrist
CT head
urine toxicology
30yo 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’s Sign
CARPAL TUNNEL SYNDROME
median nerve compression in the forearm or arm
radiculopathy of nerve roots C6 and C7 in the cervical spine
DeQuverian’s tenosynovitis
Phalen’s maneuver and Tinel’s sign
Finkelstein’s test
Nerve conduction studied
EMG
28yo F presents with pain in the interphalangeal joints of her hands accompanied by hair loss and a rash on her face
SLE
RA
psoriatic arthritis
parvovirus B19 infection
ANA, anti-dsDNA, ESR, C3, C4, RF, CCP CBC XR hands UA antibody titers for parvoB19
28yo 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.
RA
SLE
Disseminated gonorrhea
Arthritis associated with inflammatory bowel disease
XR-hands, left knee ANA, anti-dsDNA, ESR, RF, CCP CBC cervical culture arthocentesis and synovial fluid analysis
18yo M presents with pain in the interphalangeal joints of both hands. He also has scaly, salmon-pink lesions on the exterior surface of his elbows and knees
PSORIATIC ARTHRITIS
rheumatoid arthritis
SLE
gout
ANA, ESR, RF, CCP cbc XR hands XR pelvis/sacroiliac joints uric acid
65yo 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 received HRT or calcium supplements. Hr left leg is externally rotated, shortened and adducted, and there is tenderness in her left groin.
HIP FRACTURE
hip dislocation
pelvic fracture
XR hip/pelvis CT or MRI hip cbc, type and cross serum calcium and vitamin D DEXA scan
40yo 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.
HIP DISLOCATION - TRAUMATIC
hip fracture
XR hip CT or MRI hip cbc, type and cross pt/ptt urine toxicology and blood alcohol level
56yo 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.
OSTEOARTHRITIS
pseudogout
gout
meniscal or ligament damage
XR knee cbc esr knee arthrocentesis and synovial fluid analysis (cell count, gram stain, culture, crystals) uric acid mri knee
45yo M presents with fevers and right knee pain with swelling and redness
SEPTIC ARTHRITIS gout pseudogout lyme arthritis trauma reiter's syndrome (reactive arthritis)
cbc knee arthrocentesis and synovial fluid analysis (cell count, gram stain, culture, crystals) blood, urethral cultures XR knee uric acid lyme titers IgG and IgM
65yo M presents with right foot pain. he has been training for a marathon
STRESS FRACTURE
plantar fasciitis
foot sprain or strain
XR foot
bone scan foot
MRI foot
65yo M presents with pain in the heel of his right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma.
PLANTAR FASCIITIS
heel fracture
splinter/foreign body
XR heel
bone scan foot
55yo M presents with pain in the elbows 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’s test) with elbow in extension.
TENNIS ELBOW (LATERAL EPICONDYLITIS) stress fracture
XR arm
bone scan
MRI elbow
27yo 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.
DISSEMINATED GONORRHEA
rheumatoid arthritis
SLE
reiter’s syndrome (reactive arthritis)
knee arthrocentesis and synovial fluid analysis (cell count, gram stain, culture)
ANA
60yo 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.
PERIPHERAL VASCULAR DISEASE (INTERMITTENT CLAUDICATION)
Leriche syndrome (aortoiliac occlusive disease)
lumbar spinal stenosis (pseudoclaudication)
osteoarthritis
ankle-brachial index
doppler US lower extremity
angiography
MRI Lspine
45yo 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
DVT baker's cyst rupture myositis cellulitis superficial venous thrombosis
doppler US right let
cbc
d-dimer
