Presentations Flashcards by Lily Rendall

Polyarthralgia
Early morning stiffness > 30 minutes, improves with activity
Reduced grip strength
Swollen joints
Bouchard’s nodes

Rheumatoid arthritis

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Spinal / neck pain
Morning stiffness >30 minutes improving with activity
Reduced chest expansion Sometimes ‘question mark’ posture

Ankylosing spondylitis

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Asymmetrical oligoarthritis
Nails involved (pitting, onycholysis)
‘pencil in a cup’ on x-ray

Psoriatic arthritis

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Arthritis in several joints
Loose stools with mucous + blood
Weight loss
Pyoderma gangrenosum
Enthesitis

Enteropathic arthritis

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Post infection
Fever, fatigue, malaise
Asymmetrical monoarthritis
Enthesitis
Mucocutaneous lesions

Reiter’s syndrome

Reactive arthritis

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First MTP joint affected commonly
Severe pain, hot swollen joint
Abrupt onset
Monosodium urate crystals

Acute gout

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Monoarthritis - swollen, painful
Commonly knee affected
Calcium pyrophosphate crystals

Pseudogout

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Fever, fatigue, weight loss
Malar rash
Non-scarring alopecia
Raynaud’s
Arthritis
Arthralgia, myalgia
Other systemic involvement
ANA and anti-dsDNA antibodies

Systemic lupus erythematosus

SLE

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Dry eyes - ‘gritty’
Dry mouth / throat
Vaginal dryness
Joint pains, fatigue
Parotid gland enlargement

Sjogren’s syndrome

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Thickening / hardening of skin
Sclerodactyly
Raynaud’s
Ischaemic digital ulcers
Fatigue, weakness
Calcinosis of fingertips
Telangiectasia
‘beaking’ and ‘puckered lips’

Systemic sclerosis

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DVT / PE
Recurrent pulmonary emboli
Livedo reticularis
Miscarriage
Migraine common

Anti-phospholipid syndrome

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Vague systemic symptoms
Raynaud’s
Arthralgia
Myositis
Sclerodactyly
Pulmonary hypertension

Mixed connective tissue disease

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Joint pain worse with use
Pain at night
Morning stiffness < 30 minutes
Instability
Joint line tenderness
Crepitus
Stiff joints, small ROM
Osteophytes
Heberden’s / Bouchard’s nodes

Osteoarthritis

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Presents young
Joint pains after activity
Joint stiffness
Thin stretchy skin
Frequent sprains / dislocations

Joint hypermobility syndrome

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Acute monoarthropathy
Reduced ROM
Swelling and tenderness
Systemic fever

Septic arthritis

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Gradual onset pain in bone
Point tenderness
Swelling, redness, warmth
Malaise, fever, chills

Osteomyelitis

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Bone pain
Symptoms of hypocalcaemia
Fractures easily
Bone deformities
Proximal myopathy

Osteomalacia / Rickett’s

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Often asymptomatic or pain
Enlarged abnormally shaped bone
‘sabre tibia’
Increased metabolism

Paget’s disease of bone

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Insidious onset of groin pain
Pain exacerbated by impact

Femoral head AVN

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Persistent widespread pain
Fatigue
Headaches
Cognitive / memory impairment
Anxiety / depression
Non-cardiac chest pain

Fibromyalgia

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Insidious onset
Ocular muscles affected
Fatigue
Progressive muscle weakness

Myasthenia Gravis

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Disproportionate muscle pain
Massive oedema
Skin discolouration
Quickly progresses to systemic infection

Myonecrosis

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Trismus - lock jaw
Risus sardonicus
Autonomic instability

Tetanus

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Bilateral leg pain
Loss of bladder / bowel control
Perineal / saddle anaesthesia
Loss of anal sphincter tone

Cauda equina syndrome

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Constant unremitting back pain Paraspinal muscle spasms Spinal tenderness May have fever

Vertebral osteomyelitis

Pain in lumbosacral region Pain in buttocks and thighs Pain varies with time and activity

Mechanical back pain

Back pain worse on coughing

Acute disc tear

Unilateral leg pain Low back pain Sharp, shooting, electric pain Numbness and paraesthesia

Sciatica

Inconsistent claudication Burning pain Spinal extension exacerbates pain Pedal pulses preserved

Spinal stenosis + claudication

Severe shoulder pain Inability to move shoulder Empty glenoid fossa visible

Shoulder dislocation

Shoulder pain radiating down arm Associated weakness Tenderness in subdeltoid region

Rotator cuff tear

Gradual severe shoulder pain Pain at night and at rest Shoulder stiffness Massive restriction in ROM

Adhesive capsulitis

Difficulty reaching up and lifting Pain in anterior superior shoulder Pain exacerbated by abduction

Shoulder impingement

Pain in anterior shoulder radiating to elbow Snap with shoulder movement 'Pop eye' sign Extensive bruising

Biceps tendinopathy

Paraesthesia in little and ring fingers Night symptoms Weakness of hand muscles

Cubital tunnel syndrome

Paraesthesia in thumb and radial 3 1/2 fingers Loss of sensation Weakness of the hand Pain relieved by shaking hand Clumsiness

Carpal tunnel syndrome

Pain and tenderness of lateral epicondyle Pain worse upon opening a jar

Lateral epicondylitis aka Tennis elbow

Pain and tenderness over medial epicondyle Pain worse on wrist flexion and pronation

Medial epicondylitis aka Golfer's elbow

Ulnar fracture Radial displacement Pain and swelling Loss of forearm / hand function

Monteggia fracture

Radial fracture Ulnar displacement Pain and swelling Loss of forearm / hand function

Galeazzi fracture

Repetitive strain injury Wrist swollen, may be red Common in postpartum women

De Quervain's tenosynovitis

Pain and tenderness in anatomical snuffbox

Scaphoid fracture

Flexion contracture of 4th/5th finger(s) Starts as a palmer pit / nodule Painless, gradual progression

Dupuytren's contracture

Pain over A1 pulley 'Sticking' of finger in flexion Triggering present

Trigger finger

Inflammation and redness around fingertip Pus collection may be seen

Paronychia

Extremely painful Limited extension in hand / digits due to pain

Flexor tendon sheath infection

Dorsal hand pain Swelling Affected finger shortened

Boxer's fracture

Acute pain in base of thumb Swelling Ecchymosis Pain with motion

Bennett's fracture

General fullness of popliteal fossa Soft and non-tender

Baker's cyst

Pain and tenderness localised to the joint lines Knee 'about to give way' Catching or locking sensation

Meniscal tears

Fever, malaise, night sweats Weight loss Arthralgia, fatigue Claudication in limbs More common in Asian population and women

Takayasu arteritis

Unilateral acute temporal headache Jaw claudication Tender enlarged temporal arteries Scalp tenderness Visual disturbance / loss

Giant cell arteritis

Arthralgia ENT features - sinusitis Resp features - cough Cutaneous features - purpura Multisystem involvement Granulomas NO asthma NO eosinophilia cANCA present

Granulomatosis with polyangiitis GPA

Arthralgia ENT features - sinusitis Resp features - cough Cutaneous features - purpura Multisystem involvement Granulomas Late onset asthma Eosinophilia pANCA present

Eosinophilic granulomatosis with polyangiitis EGPA

Arthralgia ENT features - sinusitis Resp features - cough Cutaneous features - purpura Necrotising glomerulonephritis Multisystem involvement pANCA present

Microscopic polyangiitis MPA

Purpuric rash over buttocks and lower limbs Colicky abdominal pain Blood diarrhoea Joint pain and swelling Sometimes renal involvement

Henoch-Schonlein purpura

Proximal myalgia of hip / shoulder girdles Morning stiffness > 30 minutes Pain worse with movement Fatigue, anorexia, weight loss Normal muscle strength Pitting oedema Carpal tunnel common

Polymyalgia rheumatica

Start up pain on instep of foot Pain worse after activity Swelling on plantarmedial heel Tenderness

Plantar fasciitis

Burning foot pain Tingling that radiates to toes Loss of sensation in affected webspace Mulder's click test positive

Morton's neuroma

Pain in Achilles tendon Morning stiffness Pain and stiffness eases with walking

Achilles tendonitis

Multiple fractures of childhood Short stature Deformities present Blue sclera Loss of hearing

Osteogenesis imperfecta

Progressive muscle weakness Inability to walk Only seen in males

Duchenne's muscular dystrophy

Hip, groin, thigh or knee pain Limp Antalgic gait Loss of internal rotation of hip

Slipped upper femoral epiphysis SUFE

Asymmetry in hips Loss of knee height Less abduction in flexion Young presentation

Developmental dysplasia

Ankle equinus Supination of forefoot Noticed at birth

Club foot