Nonarticular Rheumatism

Question 1

Comprehension of functional anatomy of the shoulder allows what?

Answer 1

Diagnosis of most of the causes of shoulder pain on clinical examination

Question 2

History and clinical exam are aided by what to provide what?

Answer 2

Aided by ancillary tests to guide application of the most appropriate treatment of shoulder pain

Question 3

The DDx of shoulder pain includes what 2 things?

Answer 3

1) Common local disorders (tendon and adjacent structures)

2) Etiologies arising from distant anatomic sites arising by referred pain pathways

Question 4

What are there a great disposal of to use for the diagnosis of shoulder pain?

Answer 4

Diagnostic Test (lame question…)

Question 5

What are most causes of shoulder pain treated with?

Answer 5

Structured physical therapy program

Question 6

What does a successful treatment program understand?

Answer 6

Potential surgical candidates including those who fail conservative treatment

Question 7

Systemic arthoopathies occasionally present with what and what is essential for these patients?

Answer 7

Shoulder pain; early assessment

Question 8

Patients with carpel tunnel syndrome generally present how?

Answer 8

With nocturnal paresthesias associated with intermittent pain or paresthesia during the day

Question 9

What are ganglia?

Answer 9

Mucin-filled cysts arising from joint capsules or tendon sheaths

Question 10

What can you treat symptomatic ganglia with?

Answer 10

Corticosteroid injections; surgical excision may be necessary to cure

Question 11

Tendinitis of the extensor pollicis longus tendon can be dangerous because of what?

Answer 11

The risk of tendon rupture

Question 12

DeQuervains Dz is what? and who is it common in?

Answer 12

Inflammation of the extensor pollicis brevis and abductor pollicus longus tendons in first dorsal extensor compartment; common in women + associated with repetitive hand activities (…lol) such as caring for an infant

Question 13

Painful osteoarthritis involving what joint of the thumb can be treated with what?

Answer 13

Carpometacarpal joint of the thumb; treated with splinting

Question 14

What are trigger fingers caused by and how are they treated?

Answer 14

Thickening of the A1 retinacular pulley in the palm; treated by corticosteroid injections and splinting

Question 15

Up to what % of people experiences low back pain, and what is the MCC of that back pain?

Answer 15

80%; degenerative changes of the lumbar spine

Question 16

More than % of patients with LBP are largely pain free within 8 weeks?

Answer 16

90%

Question 17

What does initial evaluation of LBP entail?

Answer 17

Identify the few patients with neurologic involvement or systemic dz (infection, malignancy, spondyloarthritis) because they may need urgent or specific intervention

Question 18

Psychosocial and other risk factors predict what for LBP?

Answer 18

They predict the risk of chronic disabling LBP

Question 19

When is imaging rarely indicated for LBP?

Answer 19

In the absence of significant neurologic involvement or suspicion of systemic dz

Question 20

Why must imaging abnormalities be carefully interpreted for LBP?

Answer 20

They are frequently present in asymptomatic individuals

Question 21

A precise pathanatomic dx with identification of the pain generator may not be seen in up to what % of patients?

Answer 21

85%

Question 22

Persistent LBP should be treated with?

Answer 22

An individually tailored program that includes analgesia, core strengthening, stretching, aerobic conditioning, loss of excess weight, and patient education

Question 23

Intensive interdisciplinary rehab with an emphasis on what should be considered if LBP conservative measures fail?

Answer 23

Cognitive-behavioral therapy

Question 24

What is there no evidence for in terms of the effectiveness in LBP patients without radiculopathy?

Answer 24

Epidural Corticosteroids

Question 25

A large number of what 3 things lack evidence of efficacy for LBP?

Answer 25

1) injection technique
2) physical therapy modalities
3) nonsurgical interventional therapies

Question 26

What is the major indication for back surgery?

Answer 26

Presence of a serious or progressive neurologic deficit.

Question 27

If back surgery is performed in the absence of neurologic defects like spinal fusion or degenerative changes, what is the problem?

Answer 27

It is not clearly effective

Question 28

What are the issues that surround fibromyalgia?

Answer 28

Not scientific ones - it is widely agreed the pain and suffering is real; but the primary issues are often social, political, and financial

Question 29

Fibromyalgia lies at the end of a continuum of what?

Answer 29

Polysumptomatic distress rather than being a discrete disorder

Question 30

Fibromyalgia can be diagnosed using what? Does clinical care require a diagnosis?

Answer 30

The American College of Rheumatology 2010 or 1990 criteria; No it does not

Question 31

What is included in the ACR 2010 criteria for fibromyalgia that wasnt in the 1990? Why?

Answer 31

Changes in the sex ratio if patients because men have a higher tolerance for pain and are less likely to be diagnosed with having fibromyalgia than women when the 1990 criteria including tender points are used

Question 32

Advanced neuroimaging techniques showed dysfunction in what part of the brain? As well as what loss?

Answer 32

Hypocampus dysfunction as well as other cerebral abnormalities; and greater grey matter loss

Question 33

The regions in which objective changes are demonstrated may be functional inked to what in fibromyalgia?

Answer 33

Core features of the disorder including affective disturbances and chronic widespread pain

Question 34

Pharmacologic treatment of fibromyalgia is or is not valuable?

Answer 34

Limited valuable; but it is shown that caring and comprehensive care can make a difference