ortho / Rheum Flashcards
a 35-year-old woman who comes to your office with a 1-year history of “aching and hurting all over.” She also complains of a chronic headache, difficulty sleeping, and generalized fatigue. When questioned carefully, she describes “muscle areas tender to touch.” Although the pain is worse in the back, there really is no place free of pain. She also describes headaches, generalized abdomen pains, and some constipation. What is the likely diagnosis
Fibromyalgia
What is fibromyalgia
Widespread muscular pain, fatigue, muscle tenderness, headaches, poor sleep, and memory problems
Who is fibromyalgia most common in
Middle aged women
What are common symptoms of fibromyalgia
diffuse pain that is worse in the morning, extreme fatigue, stiffness, painful, tender joints, and SLEEP DISTURBANCES. Symptoms often worsened with physical and psychological stress
What are treatment options for fibromyalgia
-stress reduction
-sleep/exercise
-duloxetine (Cymbalta) and -milnacipran (Savella), plus the anti-seizure medicine pregabalin (Lyrica)
Common signs of gout
Usually young, >30 yo, asymmetric; great toe; tophi
How do you diagnose gout and what are the findings
Diagnosis is by arthrocentesis –> rod-shaped negatively birefringent.
*Serum uric acid level >8 (supportive NOT diagnostic)
What is the treatment of choice in an acute gout attack
indomethacin
What is the maintenance treatment for gout
allopurinol (colchicine also an option but bad GI side effects)
What are the common symptoms of pseudo gout
usually >60yo; large joints, lower extremity; no tophi
How is pseudo-gout diagnosed and what are the findings
rhomboid-shaped calcium pyrophosphate crystals – positively birefringent from artherocentesis
What is used in the treatment of pseudo-gout
Acute: NSAIDs
Prophylaxis: Colchicine
What is the polyateritis nodosa
is a blood vessel disease characterized by inflammation of small and medium-sized arteries (vasculitis), which can restrict blood flow and damage vital organs and tissues
a 45-year-old male with a past medical history significant for hepatitis B infection presents with a two-week history of severe, unexplained weight loss and malaise. He reports new-onset, lancinating abdominal pain, especially post-meal, and a painful, erythematous rash on his lower extremities. His blood pressure is elevated, and he has mild kidney impairment. On examination, there is tenderness in the epigastric region without rebound or guarding, and palpable purpura is noted on his legs. His labs show elevated erythrocyte sedimentation rate and C-reactive protein, and an angiogram reveals microaneurysms in the renal and mesenteric arteries. He is ANCA-negative and guaiac-positive. A biopsy of the affected skin confirms fibrinoid necrosis consistent with vasculitis. What is the likely diagnosis
Polyarteritis Nodosa
Who is polyarteritis nodosa seen in
Most common in middle-aged men in their 40s-50s
How do you diagnose polyarteritis nodosa
Biopsy of an affected artery (gold standard) demonstrates necrotizing arteritis ⇒ or arteriography showing the typical aneurysms in medium-sized arteries
How do you treat polyarteritis nodosa
steroids (prednisone) +/- cyclophosphamide if refractory
*Plasmapheresis in patients with Hepatitis B virus
a 62-year-old female complaining of headaches, muscle pain, and weakness. She has no history of headaches but has now started experiencing them every morning for the past two weeks. She reports feeling very weak and tired in the mornings and cannot even raise her arms to brush her hair. On examination, she exhibits bilateral shoulder and hip girdle tenderness with reduced range of motion due to pain. She has difficulty rising out of the exam room chair. Laboratory findings show markedly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. She has a normal creatine kinase (CK) level, and rheumatoid factor is negative. The patient is started on low-dose corticosteroids, resulting in significant improvement in symptoms within 72 hours. What is the likely diagnosis
Polymyalgia rheumatica
