Rheumatology 1

Question 1

Name some types of fracture

Answer 1

Stable fracture. The broken ends of the bone line up and are barely out of place.
Open, compound fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.
Transverse fracture. This type of fracture has a horizontal fracture line.
Oblique fracture. This type of fracture has an angled pattern.
Comminuted fracture. In this type of fracture, the bone shatters into three or more pieces.

Question 2

In addition to the application of a cast/splinting, identify a management/treatment aim for ONE of these two fracture types with a brief rationale

Answer 2

Traction may also be used to stabilize and realign fractures before surgery. Traction uses a system of pulleys and weights to stretch the muscles and tendons around the broken bone.

Regain normal length and alignment of involved bone
Lessen or eliminate muscle spasms
Relieve pressure on nerves, especially spinal nerves
Prevent or reduce skeletal deformities or muscle contractures
To provide a fusiform tamponade around a bleeding vessel

Question 3

2. Ms J complains of widespread muscular aches/pains, morning stiffness, weight gain, a constant feeling of fatigue and symptoms similar to a low grade infection.
   a) List THREE conditions that could cause this combination of symptoms.
   b) For TWO of these identified conditions note the questions you would ask together with responses that will enable you to differentiate between them. (80%)
   c) Choose one of these two conditions and note one management/treatment aim, with a brief rationale. (10%)

Answer 3

A)Polymyalgia Rheumatica
Rhematoid Arthritis
Systemic lupus erythematosus

b) PMR as an inflammatory condition of multifactorial aetiology is generally characterized at least at the beginning by aching and stiffness in the shoulder and in the pelvic girdle

Symmetrical peripheral involvement, RF seropositivity, development of joint erosions and extra-articular manifestations differentiate adult RA from PMR.

About 15% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis, and about 50% of people with temporal arteritis have polymyalgia rheumatica. Some symptoms of temporal arteritis include headaches, scalp tenderness, jaw or facial soreness, distorted vision, or aching in the limbs caused by decreased blood flow, and fatigue

Fatigue and lack of appetite (possibly leading to weight loss) are also indicative of polymyalgia rheumatica.

RA is highly genetic

The rheumatoid nodule, which is sometimes in the skin, is the most common non-joint feature and occurs in 30% of people who have RA.[

Specific deformities, which also occur in osteoarthritis, include ulnar deviation, boutonniere deformity (also “buttonhole deformity”, flexion of proximal interphalangeal joint and extension of distal interphalangeal joint of the hand)

c) Excercise and movement

Question 4

uring the case history a new patient mentions that their previous osteopath said they have a spinal curvature but no leg length discrepancy.

a)	List THREE orthopaedic/rheumatological conditions that could be 			causing this patient’s symptoms.

Answer 4

a)Ankylosing Spondylitis
Rhematoid arthiritis
Scheuermann’s disease

Question 5

b) For TWO of these identified conditions note the questions you would ask together with responses that will enable you to differentiate between them. (80%)
Spinal Curves*

Answer 5

B) AS generally only spine
nkylosing spondylitis usually produces symptoms in the low back, hips, and/or shoulders first. In contrast, rheumatoid arthritis usually first affects smaller joints, such as those in the hands and feet (occasionally the knees are the first affected). Some people with ankylosing spondylitis experience eye symptoms, including redness, light sensitivity, and blurred vision.

Both diseases can affect anyone; however, RA is most frequently diagnosed in women ages 30 to 60 and ankylosing spondylitis is more frequently diagnosed in males under the age of 40.

Question 6

c) Identify ONE of these two conditions and note one management/treatment aim, with a brief rationale. (10%)

Answer 6

Same as movmement, reduce inflmamtion

Question 7

List THREE rheumatological conditions that can develop such ‘subcutaneous lumps’.

Answer 7

Rheumatoid Arthiritis
Sarcoidosis
Gout Tophi

Question 8

b) For TWO of these identified rheumatological conditions (subcutaneous lumps), note the questions you would ask together with responses that will enable you to differentiate between them Include the common sites for these subcutaneous lumps in each condition. (80%)

Answer 8

RA - They are usually subcutaneous especially over bony prominences such as the olecranon (tip of the elbow) or the interphalangeal joints (finger knuckles)

Criteria:
two or more swollen joints
morning stiffness lasting more than one hour for at least six weeks
the detection of rheumatoid factors or autoantibodies against ACPA such as autoantibodies to mutated citrullinated vimentin can confirm the suspicion of RA. A negative autoantibody result does not exclude a diagnosis of RA.

Gout - Tophi - The most common sites are the fingers and the helix / anti-helix of the ears

Alternatively a large blister may form, which ruptures leaving a continuously draining ulcer

Tophi appear on average 12 years after the initial attack of gout. They tend to develop earlier in women, particularly those receiving diuretics
Rarely, tophi can develop without previous acute gouty arthritis
Lesions are normally painless, unless they affect the joint where they can be painful and if untreated cause permanent damage