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Block 5 - Pulm and Skeletal > Karp Skeletal > Flashcards

Karp Skeletal Flashcards

0
Q

Inflammatory conditions - men 18-34

A

Spondyloarhtropathies
Gonococcal arthritis
Gout

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1
Q

Non inflammatory conditions - men and women - 18-34

A

Injury, overuse

Low back pain

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2
Q

Inflammatory conditions - women 18-34

A

Gonococcal arthritis
RA
SLE

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3
Q

Non inflammatory conditions - men 35-65

A

Low back pain
Overuse or injury
OA
Entrapment syndromes

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4
Q

Inflammatory conditions - men 35-65

A

Bursitis
Gout
Spondyloarthropathies

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5
Q

Inflammatory conditions - women 35-65

A

Bursitis

RA

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6
Q

Non inflammatory conditions - women 35-65

A 
Osteoporosis
Low back pain
Injury or overuse
Fibromyalgia
Entrapment syndromes
OA
Raynauds
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7
Q

Noninflammatory condition - men >65

A

OA
Low back pain
Osteoporosis
Fracture

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8
Q

Inflammatory conditions - men >65

A 
Bursitis
Gout
RA
Pseudo gout
Poly myalgia rheumatica
Septic arthritis
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9
Q

Non inflammatory conditions - women >65

A 
Osteoporosis 
OA
Fibromyalgia
Low back pain
Fracture
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10
Q

Inflammatory conditions - women >65

A 
Bursitis
RA
Gout
Pseudogout
Poly myalgia rheumatica
Septic arthritis
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11
Q

What is the time line between acute and chronic time course?

A

6 weeks

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12
Q

How does mono/oligo arthritis differ from poly articular?

A

> 3 joints affected

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13
Q

What are inflammatory symptoms?

A 
Joint pain - activity and rest 
Soft tissue swelling in joint
Sometimes erythema and warmth
Prolonged (>60 min) morning stiffness
Systemic symptoms common
ESR and CRP increased
Hemoglobin normal or low
Synovial fluid WBC >2000
Synovial fluid % PMN >75
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14
Q

What are non inflammatory symptoms?

A

Joint pain - activity only
Bony swelling in joint if anything
No erythema and warmth
Variable (<75

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15
Q

What is the most common lab feature of inflammation?

A

Acute phase response
IL-6 made
CRP is a direct measure - more specific than ESR that can be elevated with other things like age

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16
Q

What is a big general difference between Articular and non articular disorders?

A

Non articular characterized by pain on active movement only and can be localized no specific non articular structure

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17
Q

What are pain or tenderness symptoms in articular vs. non Articular disorders?

A

A - localized to joint, deep or poorly localized, specific referral patterns
N - localized to extra articular structure, point tenderness, superficial

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18
Q

What are symptoms of pain on movement in articular vs. non articular disorders?

A

A - active and passive movement, in many planes, localized to joint
N - active movement only, in specific planes, rarely localized

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19
Q

What are the symptoms of swelling in articular vs. non articular diseases?

A

A - common, synovial effusion or thickening, bony enlargement
N - maybe, not limited to articular structure

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20
Q

What are limitation of motion symptoms in articular vs. non articular diseases?

A

A - passive and active range of motion, related to mechanical derangement or joint pain
N - maybe but only with active, related to extra articular mechanical abnormality, diffuse pain or weakness

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21
Q

What may be present in articular disease but is not present in a nonarticular disease?

A

Crepitation
Instability
Locking of joint
Deformity - only in NA if antecedent trauma

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22
Q

What are the local and widespread etiologies of non articular disorders?

A

Local - fracture, septic bursitis, bursitis, tendonitis

Widespread - fibromyalgia, hypothyroidism, osteoporosis

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23
Q

Aching and discomfort in subdeltoid region associated with night pain and aggravated with abduction
Hx of repetitive and strenuous upper limb activity - may be absent in elderly
Onset acute or chronic in any age group

A 
Subacromial bursitis (rotator cuff tendinitis)
Suspect rotator cuff tear when weakness or wasting is present
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24
Q

Pain over anterior aspect of shoulder exacerbated by restricted elbow flexion or supination, occurs at any age, night pain is rare, associated with overuse

A

Bicipital tendinitis

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25
Q

Pain and tenderness poorly localized to lateral epicondyle impairing grip, aggravated by resisted dorsiflexion of wrist, often from overuse in person over 30 years

A

Tennis elbow (lateral epicondylitis)

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26
Q

Pain and tenderness poorly localized to medial epicondyle, aggravated by wrist flexion, associated with overuse

A

Golfers elbow (medial epicondylitis)

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27
Q

Deep aching pain on lateral aspect of hip and thigh, aggravated by activity often present at night related to position, more frequent in women

A

Trochanteric bursitis - movement of hip is usually normal

28
Q

Circumscribed painful swelling anterior to patella

A

Pre patellar bursitis - related to recent trauma, may be infected

29
Q

Pain over the medial aspect of upper tibia

A

Anserine bursitis

30
Q

Pain on under surface of heel on weight bearing, aggravated by dorsiflexion of foot

A

Plantar fasciitis - radiographs may show a plantar spur, related to repetitive trauma

31
Q

When should an arthrocentesis be indicated?

A

Acute monoarthritis
Trauma with effusion
Anytime you suspect infection, blood, or crystals
ONLY get cell count and differential, gram stain and culture, and crystal analysis (chocolate agar if gonorrhea suspected)

32
Q

What do colors of synovial fluids mean?

A

Clear - not inflammatory
Translucent or opaque - inflammatory
White and chalky - gout

33
Q

What are the four types of joint fluid?

A

Normal - clear, viscous, WBC 2000 WBC and >75% neutrophils - septic arthritis, RA, gout spondyloarthritis
Hemorrhagic - indicates trauma with or without fracture or coagulopathy

34
Q

What can a WBC alone not do?

A

Differentiate between inflammatory and septic

35
Q

Chronic oligo articular arthritis of lower extremities, possible knee effusion

A

Lyme arthritis

36
Q

What are the three stages of Lyme disease?

A

1 - 3-4 days after transmission - fever, malaise, myalgias, arthralgias, no true arthritis, hallmark is erythema chronicum migrans (ECM)
2 - weeks to months - myalgias and arthralgias, carditis and AV block, meningitis CN vii palsy, conjunctivitis Ns iritis
3 - 5-7 months - arthritis, chronic CNS symptoms of cognitive and memory dysfunction, radiculopathy

37
Q

How is Lyme disease diagnosed?

A

ElLISA assay for IgG to spirochete confirmed by western blot

38
Q

What causes gout and psuedogout?

A

Gout - monosodium urate

Psuedogout - calcium pyro phosphate dihydrate

39
Q

Acute extremely painful monoarthritis, cutaneous erythema/tendonitis, fever, leukocytosis, spontaneous resolution in 3-5 days usually, mean time to first recurrence - 11 months

A

Early gout

40
Q

Granulomatous urate deposits, finger, wrists, knees, olecranon bursa, ears, pressure points involved

A

Late gout - usually - 10 years after first attack, remissions shorten, chronic inflammation

41
Q

What is the relationship between hyperuricemia and gout?

A

Alone doesn’t imply gout but is always in gout
More likely with elevated uric acid but levels can be normal during acute attack
90% have decreased uric acid secretion - idiopathic, CKD, drugs
10% have overproduction (800mg/24hrs) - idiopathic or overproduction

42
Q

How is gout diagnosed definitively?

A

Demo monosodium urate crystals in joint fluid

Birefringence - yellow urate parallel, blue perpendicular (opposite with CPPD)

43
Q

What are radiographic features of gout?

A

Tissue swelling early with preservation of joint spaces
Erosions with overhanging edge at end of capsule (not in joint) late in disease
Little peri articular osteopenia

44
Q

Elderly male with onset of knee swelling and severe pain over hours to days, can be in wrist, shoulder, or ankle

A

Psuedogout (chondrocalcinosis) - mimics gout

45
Q

Elderly female with symptoms in 2nd and 3rd mcp joints of hand, picture of osteoarthritis with inflammation imposed

A

Chronic CPPD arthropathy - can also have pseudo rheumatoid with synovitis and pseudo neuropathic with destruction of joint

46
Q

Calcification of knee menisci, triangular cartilage of the wrist, and symphysis pubis, degenerative changes similar to osteoarthritis, inflammatory or blood tinged joint fluid

A

Chondrocalcinosis

47
Q

What are features of osteoarthritis?

A 
Pain with use, little morning stiffness
Pain and stiffness with inactivity (churchgoers knee)
Sensation of locking or giving away
Crepitus with passive movement
No useful lab tests
48
Q

What is one of the earliest radiographic feature of OA?

A

Bone marrow edema on MRI

49
Q

What is the most common cause of osteonecrosis?

A

Trauma

Particularly fracture of femoral neck

50
Q

Progressive bone pain, often worse at night or with use and weight bearing, pain on movement of affected joint, no inflammation

A

Osteonecrosis - no lab tests for diagnosis

Early signs on MRI include bone marrow edema

51
Q

What is the boutonnière sign in RA?

A

Flexion of PIP and hyper extension of DIP

52
Q

What is the swan neck sign in RA?

A

Flexion of DIP and hyper extension of PIP

53
Q

What are lab features of RA?

A

Rheumatoid factor (anti IgG)
Anti CCP
Normochromic normocytic anemia
Nothing diagnostic by itself

54
Q

What are common viral infections associated with arthritis?

A

Parvovirus B19
Rubella
Hep b and c
HIV

55
Q

What are extra articular manifestations of RA?

A 
Rheumatoid nodules
Keratoconjunctivitis sicca
Episcleritis/scleritis
Vasculitis
Pulmonary nodules/fibrosis
56
Q

What is the use of anti CCP tests in RA?

A

Same sensitivity for RA as RF

utility in diagnosing early RA or differentiating RA from another condition with RF

57
Q

What are general features of seronegative spondyloarthropathy?

A

Chronic and inflammatory
Oligo articular
Asymmetric, often involves axial skeleton
Strongly associated with HLA B27

58
Q

Axial arthritis, enthesitis, arthritis of hips and shoulder, peripheral arthritis, flexed forward posture

A

Ankylosing spondylitis

59
Q

What are general features of ankylosing spondylitis?

A 
Onset in early adulthood before age 40 
Men affected more than women
Back Pain typically first symptom
Insidious onset
Duration more than three months
Morning stiffness
60
Q

What are the extra articular manifestations of ankylosing spondylitis?

A

Anterior uveitis - tearing, pain, photophobia, blurry vision, corneal inflammation and edema, monocular
Aortitis, aortic insufficiency, heart block
Spinal cord damage - spinal fracture, cauda equina syndrome

61
Q

What are the radiographic features of ankylosing spondylitis?

A

Erosion, sclerosis and fusion of sacroiliac joints
Erosion at sites of tendon attachment
Ossification of annulus fibrosis, apophyseal joints, and intervertebral ligaments = bamboo spine
Bone spurs bridge edges of vertebral bodies

62
Q

Arthritis involving large joints of lower extremities or interphalangeal joints, looks like RA but with DIP involvement, involvement of axial skeleton with or without peripheral joint disease, nail ridging and pitting

A

Psoriatic arthritis

63
Q

What are x ray and lab features of psoriatic arthritis?

A

Sausage digits
Joint space loss
Marginal erosion of DIP and PIP joints
ESR and CRP elevated but autoantibodies negative

64
Q

What is Reiter’s syndrome?

A

Triad of urethritis, conjunctivitis, and arthritis

= reactive arthritis

65
Q

What pathogens are associated with reactive arthritis?

A

Shigella, salmonella, campylobacter, yersinia, chlamydia

66
Q

2-4 weeks after infection, additives asymmetrical, oligo articular, lower more than upper limb involvement, digits of hands and feet diffusely inflamed (dactylis), enthesitis, radiographic sacroiliitis

A

Reactive arthritis

67
Q

What are non articular manifestations of reactive arthritis?

A 
Keratoderma blenorrhagicum 
Circinate balanitis
Oral ulcers
Anterior uveitis
Aortitis
Nail dystrophy without pitting

Block 5 - Pulm and Skeletal (19 decks)

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