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COMLEX PE > Joint/Limb Pain > Flashcards

Joint/Limb Pain Flashcards

1
Q

What key history would you obtain from a patient that complained of joint or limb pain?

A 
Location
Quality
Intensity
Duration
Pattern (small vs. large joints, number involved, swelling, redness, warmth)
Associated symptoms (constitutional, red eye, oral or genital ulceration, diarrhea, dysuria, rash, focal numbness/weakness)
Exacerbating and alleviating factors
Trauma (including vigorous exercise)
Medications
DVT risk factors
Alcohol and drug use
Family history of rheumatic disease
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2
Q

What key physical exams would you perform on a patient that complained of joint or limb pain?

A

Vital signs
HEENT exam
MSK exam
Relevant neurovascular exam

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3
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. Differentials?

A

Domestic violence
Factitious disorder
Substance abuse

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4
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. Differentials: domestic violence, factitious disorder, substance abuse. Workup?

A

XR - wrist
CT - head
Urine toxicology

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5
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’s sign. Differentials?

A

Carpal tunnel syndrome

Median nerve compression in forearem or arm

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6
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’s sign. Differentials: carpal tunnel syndrome, median nerve compression in forerem or arm. Workup?

A

Nerve conduction study
XR - wrist
MRI - wrist

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7
Q

28 yo F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on her face. Differentials?

A

Systemic lupus erythematous (SLE)
Rheumatoid arthritis
Psoriatic arthritis
Parvovirus B19 infection

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8
Q

28 yo F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on her face. Differentials: SLE, rheumatoid arthritis, psoriatic arthritis, parvovirus B19 infection. Workup?

A 
ANA
Anti-ds DNA
ESR
C3, C4
Rheumatoid factor (RF)
CBC
XR - hands
UA
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9
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. Differentials?

A 
Rheumatoid arthritis
SLE
Disseminated gonorrhea
Arthritis associated with inflammatory bowel disease
Osteoarthritis
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10
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. Differentials: rheumatoid arthritis, SLE, disseminated gonorrhea, arthritis associated with inflammatory bowel disease, osteoarthritis. Workup?

A 
ANA
Anti-ds DNA
ESR
Rheumatoid factor (RF)
CBC
XR - hands, left knee
Cervical culture
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11
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. Differentials?

A

Psoriatic arthritis
Rheumatoid arthritis
SLE

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12
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. Differentials: psoriatic arthritis, rheumatoid arthritis, SLE. Workup?

A 
RF
AND
ESR
CBC
XR - hands
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13
Q

65 yo F presents with inability to use her left leg and 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. There is tenderness in her left groin. Differentials?

A

Hip fracture
Hip dislocation
Pelvic fracture

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14
Q

65 yo F presents with inability to use her left leg and 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. There is tenderness in her left groin. Differentials: hip fracture, hip dislocation, pelvic fracture. Workup?

A

XR - hip, pelvis
CT or MRI - hip
CBC

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15
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. Differentials?

A

Hip dislocation - traumatic

Hip fracture

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16
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. Differentials: hip dislocation, hip fracture. Workup?

A

XR - hip
CT or MRI - hip
CBC

17
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 noticed swelling and deformity of the joint and is having difficulty walking. Differentials?

A

Osteoarthritis
Pseudogout
Gout
Meniscal or ligament damage

18
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 noticed swelling and deformity of the joint and is having difficulty walking. Differentials: osteoarthritis, pseudogout, gout, meniscal or ligament damage. Workup?

A 
XR - knee
CBC
ESR
Knee arthrocentesis and synovial fluid analysis (cell count, Gram stain, culture, crystals)
MRI - knee
19
Q

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

A 
Septic arthritis
Gout
Pseudogout
Lyme arthritis
Trauma
Reiter's arthritis
20
Q

45 yo M presents with right knee pain with swelling and redness. Differentials: septic arthritis, gout, pseudogout, lyme arthritis, trauma, Reiter’s arthritis. Workup?

A 
CBC
Knee artherocentesis and synovial fluid analysis (cell coutn, Gram stain, culture, crystals)
Blood, urethral cultures
XR - knee
Uric acid
Lyme antibody
21
Q

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

A

Stress fracture
Planta fasciitis
Foot sprain or strain

22
Q

65 yo M presents with right foot pain. He has been training for a marathon. Differentials: stress fracture, plantar fasciitis, foot sprain or strain. Workup?

A

XR - foot

Bone scan - foot

23
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. Differentials?

A

Plantar fasciitis
Heel fracture
Splinter/foreign body

24
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. Differentials: plantar fasciitis, heel fracture, splinter/foreign body. Workup?

A

XR - heel

Bone scan

25
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 with the elbow in extension. Differentials?

A 
Lateral epicondylitis (tennis elbow)
Stress fracture
26
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 with the elbow in extension. Differentials: lateral epicondylitis, stress fracture. Workup?

A

XR - arm
Bone scan
MRI - elbow

27
Q

27 yo F presents with a 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. Differentials?

A 
Disseminated gonorrhea
Rheumatoid arthritis
SLE
Psoriatic arthritis
Reiter's arthritis
28
Q

27 yo F presents with a 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. Differentials: disseminated gonorrhea, rheumatoid arthritis, SLE, psoriatic arthritis, Reiter’s arthritis. Workup?

A 
Knee arthrocentesis and synovial fluid analysis (cell count, Gram stain, culture)
ANA
Anti-ds DNA
ESR
RF
CBC
Blood, cervical cultures
XR - knee
29
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 six months ago and continues to smoke heavily. Differentials?

A

Peripheral vascular disease (intermittent claudication)
Leriche’s syndrome (aortoiliac occlusive disease)
Lumbar spinal stenosis (pseudoclaudication)
Osteoarthritis

30
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 six months ago and continues to smoke heavily. Differentials: peripheral vascular disease, Leriche’s syndrome, lumbar spinal stenosis, osteoarthritis. Workup?

A

Doppler U/S - lower extremity
Ankle-brachial index
Angiography
MRI - lumbar spine

31
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 two months ago for dysfunctional uterine bleeding. Differentials?

A 
DVT
Baker's cyst rupture
Myositis
Cellulitis
Superficial venous thrombosis
32
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 two months ago for dysfunctional uterine bleeding. Differentials: DVT, Baker’s cyst rupture, myositis, cellulitis, superficial venous thrombosis. Workup?

A

Doppler U/S - right leg
CBC
CPK
D-dimer

33
Q

60 yo F complains of left arm pain that started while she was swimming and was relieved by rest. Differentials?

A

Angina/MI
Tendonitis
Osteoarthritis
Shoulder dislocation

34
Q

60 yo F complains of left arm pain that started while she was swimming and was relieved by rest. Differentials: angina/MI, tendonitis, osteoarthritis, shoulder dislocation. Workup?

A 
EKG
CPK-MB
Troponin
CBC
ESR
XR - shoulder
CXR
Stress test
35
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. Differentials?

A

Shoulder dislocation
Fracture of the humerus
Rotator cuff injury

36
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. Differentials: shoulder dislocation, fracture of the humerus, rotator cuff injury. Workup?

A

XR - shoulder
XR - arm
MRI - shoulder

37
Q

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

A

Rhabdomyolysis due to simvastatin or clofibrate
Polymyositis
Inclusion body myositis
Thyroid disease

38
Q

55 yo M presents with crampy bilateral thigh and calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia. Differentials: rhabdomyolysis, polymyositis, inclusion body myositis, thyroid disease. Workup?

A 
CBC
CPK
Aldolase
US
Urine myoglobin
TSH

COMLEX PE (34 decks)

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