Mdd Flashcards
What are the types/characteristics of psoriatic arthritis
Asymmetric: This type affects around 70% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves fewer than 3 joints. Symmetric: This type accounts for around 25% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to rheumatoid arthritis and is disabling in around 50% of all cases. Arthritis mutilans (M07.1): Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage. Arthritis mutilans has also been called chronic absorptive arthritis, and may be seen in rheumatoid arthritis as well. Spondylitis (M07.2): This type is characterised by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis. Distal interphalangeal predominant (M07.0): This type of psoriatic arthritis is found in about 5% of patients, and is characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.
Which conditions is vitiligo associated with
Vitiligo is sometimes associated with autoimmune and inflammatory diseases such as Hashimoto’s thyroiditis, rheumatoid arthritis, type 1 diabetes mellitus, psoriasis, Addison’s disease, pernicious anemia, alopecia areata, and systemic lupus erythematosus.[6]
Symptoms lateral/medial epicondylitis
Medial; tenderness around medial epicondyle and pain on wrist flexion, lateral visa versa, minimal signs of inflammation
What are the flexors of the wrist and their innervation
Flexor Carpi ulnaris (ulnar nerve) and flexor carpi radialis (median nerve) and in 90% palmaris longus (median)
What are the extensors of the wrist and their innervation?
Extensor carpi radialis longus and brevis, extensor carpi ulnaris (all radial nerve, ulnaris post inerosseus)
Finger extensors and innervation
Extensor digitorum (extends digits 2-5), extensor digiti minimi (extends 5th), extensor digiti indices (extends index/2nd) All post interosseus nerve
thumb extensors and innervation
Extensor policis longus (extend at MCP) extensor policis brevis (Extend at MCP and IP), abductor policis longus (extend and abduct radially) All Post interosseus
Finger flexors and innervation
Flexor digitorum superficialis (flexes digits 2-5 at PIP), innervation median nerve, flexor digitorum profundus (flexes digits 2-5 at DIP, innervation antereor interosseus of median nerve 2 and 2 ulnar nerve 4 and 5)
Symptoms of PMR
–Age > 65 yrs –ESR > 40mm/hr –Bilateral upper arm tenderness –Bilateral shoulder pain or stiffness –Morning stiffness > 1 hour –Onset of illness within 2 weeks –Depression or weight loss or both
3/more of these indicate pmr
How is schober’s test performed and what does it suggest
A.Patient stands erect with normal Posture
B.Identify level of posterosuperior iliac spine1.Mark midline at 5 cm below iliac spine
2.Mark midline at 10 cm above iliac spine
C.Patient bends at waist to full forward flexion
D.Measure distance between 2 lines (started 15 cm apart)
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III. Interpretation
A.Normal: distance between 2 lines increases to >20 cm
B.Abnormal: distance does not increase to >20 cm1.Suggests decreased Lumbar spine range of motion
2.May suggest Ankylosing Spondylitis
Which movements and reflexes can be tested to test myotome functions
C5; shoulder abduction and biceps reflex
C6;Elbow flexion, wrist extension, brachioradialis reflex
C7; elbow extension and wrist flexion, triceps reflex
C8; thumb ext, wrist ulnar dev
T1; Hand intrinsics
Hip flexion L2/3 Hip extension L4/5 Hip adduction L2/3 Hip abduction L4/5 Knee extension L3/4 Knee flexion L5/S1 Ankle Dorsiflexion L4/5 Great toe extension L5 Ankle plantarflexion/eversion S1/2
L4; foot dorsiflexion and knee jerk
L5; great toe extension
S1; eversion foot
what symptoms will supraspinatous injury cause
Painful arc 70-120, painful catch on lowering, painful resisted abduction, empty can test positive
What rotator cuff muscle(s) will cause painful external rotation
teres minor/infraspinatous
what rotator cuff muscles will cause painful internal rotation
Subscapularis
What is the cause of a winged scapula
seratous anterior, long thoracic nerve
describe the empty can test
The patient is tested at 90° elevation in the scapula plane and full internal rotation (empty can) or 45°external rotation (full can). Patient resists downward pressure exerted by examiner at patients elbow or wrist.
ECT
•Pain
•Muscle weakness Pain/Muscle Weakness/Both
•Pain located to subacromial region and/or weakness.
what areas of the skin does psoriasis typically affect
Psoriasis often affects the tips of the elbows and knees, the scalp, the navel, and around the genital areas or anus
what blood test can be raised in seronegative arthropathies
•HLA-B27
What are the characteristics of reactive arthritis
2-3 weeks after illness, usually salmonella/shigella/campylobacter/chlamydia, mouth ulcers and urethritis, lower limb and asymmetric, acute syndrome will settle after 18/12, analgesia, steroids, sulfasalazine if necessary or other slow acting dmard
what conditions can cause a raised RF
Systemic lupus erythematosus (SLE) Sjögren's syndrome Interstitial pulmonary fibrosis Hepatitis B, Chronic liver disease and chronic hepatitis Primary biliary cirrhosis Infectious mononucleosis and any chronic viral infection Bacterial endocarditis Leprosy Sarcoidosis Tuberculosis Syphilis Visceral leishmaniasis Malaria Leukemia Dermatomyositis Systemic sclerosis
what does seronegativity mean ITO disease course
What does seronegativity mean for your disease course? Is there a difference between seronegative and seropositive patients?
●Generally seronegative patients do not develop Rheumatoid Nodules, but there are always exceptions to this finding. There is also speculation that seronegativity is an indicator of less severe disease and slower progression, but again, there are exceptions
What are the possible symptoms of Wegner’s granulomatosis
- Ulcers, sores and crusting, in and around the nose, with destruction of nasal cartilage.
- Rhinorrhoea, often bloody.
- Haemoptysis.
- Haematuria.
- Subglottic stenosis (20% of patients) - causing hoarseness, stridor, dyspnoea, or cough.
- Rashes (up to 50%) - often small red/purple raised areas or blister-like lesions, ulcers, or nodules.
- Conjunctivitis, scleritis and episcleritis.
- Chronic ear infections.
- Mononeuritis multiplex.
- Peritonitis.
- Unlike polyarteritis nodosa, hypertension and eosinophilia are unusual.
sensory organs, lungs
What blood tests can suggest Wegner’s Granulomatosis
•Blood test for antineutrophil cytoplasmic antibodies (ANCA), of 2 types: C-ANCA and P-ANCA - detectable in nearly all patients with active severe Wegener’s granulomatosis
How is Wegner’s granulomatosis treated
steroids and cyclophosphamides
What are the ranges of movement of the shoulder
Abduction: 150 degrees Forward flexion: 180 degrees Extension: 45-60 degrees Rotation (test with elbow flexed to 90 degrees, see Apley's Scratch Test) External Rotation: 90 degrees Internal rotation: 70-90 degrees
What are the ranges of movement of the hip
Patient supine
Hip flexion: 110 to 120 degrees
Hip abduction: 30 to 50 degrees
Hip adduction: 20-30 degrees
Patient in lateral decubitus position
Hip extension: 10 to 15 degrees
Patient sitting or supine with hip flexed to 90 degrees and knee flexed to 90 degrees
Hip external rotation (lateral): 40 to 60 degrees
Hip internal rotation (medial): 30 to 40 degrees
How is the straight let raise interpreted
Radiating pain into the legs
Suggests radiculopathy
Higher likelihood findings suggesting radiculopathy
Excruciating Sciatica-like pain
Pain occurs at 30 to 40 degrees of leg elevation
Pain radiates into opposite leg (Crossed Straight Leg Raise)
Indicates severe impingement
Almost always due to a large disk Herniation
What are the technical terms for increased plantar angle and decreased
- Pes cavus.
308. Pes planus.
Which tendons run through the carpal tunnel
A total of nine flexor tendons[2] (not the muscles themselves) pass through the carpal tunnel:
flexor digitorum profundus (four tendons)
flexor digitorum superficialis (four tendons)
flexor pollicis longus (one tendon)
