older patient with pain

Question 1

5 general parts to approach

Answer 1

1. patient centered - experience
2. does this fit a pattern?
3. timing and progression
4. red flags?
5. priority - emergent vs. routine

Question 2

DDx (5)

Answer 2

1. polymyalgia rheumatica
2. inflammatory arth (eg RA)
3. fibro
4. myositis
5. malignancy/systemic/lupus

Question 3

4 articular causes to consider

Answer 3

1. inflammatory (RA)
2. other seropositive (SLE, vasculitis)
3. seroneg. spondylo
4. OA

Question 4

5 key findings in RA bloodwork

Answer 4

1. RF
2. normocytic anemia
3. cytopenia
4. mildly elevated ESR/CRP
5. pos. anti-CCP

Question 5

features of polymyalgia rheumatica

Answer 5

• stiffness and pain in muscles of neck and shoulder girdle
• failry rapid onset
• unusual before 50

Question 6

best test for polymyalgia

Answer 6

ESR - typically >40

Question 7

what to assess in polymyalgia

Answer 7

check for GCA - 15% also have and can go on to dev. as well

Question 8

featues of myositis

Answer 8

• inflammatory
• PAINLESS muscle weakness - esp proximal
• some may also have general aches and stiffness

Question 9

best test for myositis

Answer 9

CK

Question 10

def. of fibro

Answer 10

chronic widespread pain accompanied by other somatic symptoms

Question 11

best test for fibro

Answer 11

no test

- typically can be done with Hx and ruling out pertinent negatives

Question 12

3 common fibro other Sx

Answer 12

1. fatigue
2. sleep probs
3. cog. changes

Question 13

treatment of polymyalgia rheum

Answer 13

prednisone

- can give rapid releif

Question 14

how to take off

Answer 14

slow taper