LECTURE 2A Flashcards
If someone has joint pain, besides most common cause OA, what else could it be?
ankylosing spondylitis
SLE
gout
psoaritic arthritis
reiter’s syndrome/reactive arth
RA
septic arthritis
A 39 year old male patient has back pain. They also have pain and stiffness in their hips and neck. It gets better when they move, but worse when they rest. They have pain at night too.
They started having IBS and uveitis (inflamed eyes). Recently have been fatigued, losing weight, fever, malaise, SOB, heart palpitations/heart issues.
MOST LIKELY DIFF DX:
ANKYLOSING SPONDYLITIS!
nonjoint symptoms: uveitis, fatigue, weight loss, fever, malaise, cardiac/pulm complications, IBS)
joint symptoms: increase w rest, decrease w activity
more men (3:1), young! below 40 years old. RARE
Patient is 40 year old female with back pain. Joint pain in knuckles, wrist, knee, ankles-bilateral symmetry.
They have morning stiffness lasting over an hour. Pain increases with rest (post-rest stiffness), decreases with mild activity. What could they have?
Rheumatoid Arthritis!
Criteria for Rheumatoid Arthritis
- morning stiffness over 1 hour
- arthritis in more than 3 joints
- hand arthritis
- symmetric!
- rheumatoid nodules
- serum rheumatoid factor
- radiographic changes
Rheumatoid Arthritis could affect what in the body?
eyes! dry
mouth! dry
skin
LUNGS and HEART
MAINLY FATIGUE AND JOINTS
Which joint disorder has the following system findings:
-skin rash
-fever, fatigue
-photosensitivity
-dyspnea, cough
-peripheral neuropathy
LUPUS
which joint disorder has the following system findings?
uveitis (eyes!)
fatigue
weight loss
fever
cardiac/pulm complications
ANKYLOSING SPONDYLITIS
which joint disorder has the following system findings?
fever, malaise
tachycardia
GOUT
Patient comes in and has morning stiffness longer than 30 min. LBP better with exercise, not rest. Back pain keeps them up during 2nd half of night…sometimes butt hurts too.
Patient is young (below 50) and has had 3 months of LBP
WHAT IS DIFF DX
inflammatory back pain!!!!
better with exercise but not rest. Pain at night, YOUNG PERSON, insidious………
Patient is young (33-55), either male or female, with LBP. Pain refers to hip. Pain sometimes gets better with rest/lying down.
Wwhat is most likely DX?
non-specific/mechanical LBP
Patient is female, young (20-50), insidious onset of back pain. She has an autoimmune thyroid disorder.
Pain increases with rest, decreases with mild activity. Back is tender to touch.
Maybe also has pain in other joints.
WHAT IS DIFF DX?
RA
Patient is female, young (15-40). Insidious back pain, tender to touch.
Pain increases with rest, decreases with mild activity.
Moderate stiffness in morning.
Also has had recent infection, photosensitivity
DIFF DX IS….
SLE
-female
-young
-fam hx
-infection, sun, UV
-worse with rest, better with mild activity
-tenderness
-rapid, slow, insidious, mild-severe
Patient is male in 50s.
Suddenly has intense pain, very bad at night. Less bad when resting, but still there.
Takes diuretics and has had chemo. DIFF DX IS
GOUT
-50s men, 60s women (more men)
-fam hx
-renal disorders
-worse w WB, better w rest but UNRELENTING, SEVERE
-NIGHT PAIN
-rapid, sudden onset
Patient is male/female with joint pain. Worse with rest, better with mild activity.
Morning stiffness present. Tender
rapid or slow onset, insidious. Mild or severe symptoms.
Patient also has fever, fatigue, malaise.
DIFF DX IS
Psoriatic arthritis! Could also be Reactive arthritis but this is more acute.
Could be septic, but pain should get better with rest and symptoms are SEVERE, rapid onset.
Psoriatic arthritis looks like….
Hx of psoriasis
-no gender
-could present with fever, fatigue, malaise
-insidious! tender, increase with rest, decrease with mild activity. Can be rapid or slow, mild or severe.
Reactive arthritis commonly affects what?
knee, ankle, SI or LBP joints
eyes, UTI, joints commonly affected
Reactive arthritis usually looks like….
ACUTE, rapid, slow, mild or severe
mod-severe stiffness in morning/with rest, better with mild activity
male, 30s
-usually after infection (venereal or dysenteric disease)
Urethritis
Conjunctivitis (inflammed eye)
Nausea, vomiting, diarrhea
Weight loss
Patient abruptly has pain. Rapid progression, severe pain, even at night.
Increased with WB, decreased with rest.
Hx of infection and uses corticosteroids. Has diabetes.
sepctic arthritis!
limb pain like LE, antalgic gait, difficulty walking, COULD BE….
hypothyroidism
lyme disease
polymyalgia rheumatica (hips, shoulders, grannies)
statin-induced myopathy
impairment in spatial perception and stability is called
dizziness
rare in kids, more common in adults
sensation of spinning is called
vertigo (could be peripheral or central)
If someone says they are dizzy, what neck conditions to look out for?
VBI (5 Ds and 3 Ns)
upper cervical ligamentous instability
cervical myelopathy
neoplastic conditions
inflammatory or systemic disease
vertebral artery insufficiency signs and symptoms
5 Ds:
1. drop attack
2. dizzy/lightheaded with neck mvmt
3. dysphasia
4. dysarthria
5. diplopia
3 Ns:
1. nystagmus
2. nausea
3. numb
ANY POSITIVE CRANIAL NERVE SIGNS
VBI could be leading to
stroke! CVA
F: facial droop
A: arm numbness/weak
S: speech difficulty
T: time is brain!
upper cervical ligament instability looks like….
occipital headache/numb
limited neck AROM
cervical myelopathy signs
dizziness, imbalance, unsteadiness without any vertigo is called
dysequilibrium
caused by degenerative changes in brain or body.
when you have presyncope, this could be caused by
cerebellar vascular issues
cardiovascular disease
hypoglycemia or meds
non-specific dizziness is caused by
cervicogenic headaches
panic/anxiety
headache that is unilateral, provoked by neck movement/sustained postures
cervicogenic
15-20%
headache that is pounding, pulsating
unilateral symptoms but shifting sides
may also have nausea, vomit, photophobia, phonophobia
migraine
SEVERE
10-15%
crushing headache
also has lacrimation, nasal congestion, eyelid edema, forehead sweat, ptosis, restless and agitated
CLUSTER
less than 1%
headache in band/tight distribution
caused by stress, anxiety, depression
bilateral symptoms!
tension-type
40% of all headaches
how much rest is recommended after concussion?
24-48 hours
when can adults/older adolescents return to pre-injury levels after concussion?
2 weeks! 80-90% of people.
younger can take up to 1 month
what scale is used to categorize severity of TBI?
glasgow coma scale
RED FLAGS FOR TBI
diplopia
severe headache
seizure
LOC
deteriorating consciousness
vomiting
agitated, combative
concussion is defined as
energy mismatch injury
decreased blood flow + increased glucose
FUNCTIONAL DISTURBANCE, not anatomical. no Dx tests, just clinical Dx
high risk sites for stress fx
- femoral neck
- anterior tib
- medial mal
- tarsal navicular
- base of 2nd and 5th MET
- talus
- patella
MOST COMMON HEADACHE IS
tension type
