Rheumatology Flashcards
“tennis elbow”
lateral epicondylitis; MCC of elbow pain
sx. of tennis elbow
tenderness over lateral epicondyle
pain on resisted wrist extension and hand gripping
“golfers elbow”
medial epicondylitis
sx. of golfers elbow
tenderness over medial epicondyle
pain on wrist flexion
cubital tunnel syndrome
ulnar nerve entrapment
- pain and sensory/motor loss in ulnar region
- paresthesias in ulnar aspect of arm/hand
carpet layers elbow
olecranon bursitis
- extremely tender to palpation but does NOT cause restriction or pain with ROM of elbow
how can you diagnose trochanteric bursitis?
hip pain that pts can point to with one finger on lateral hip; pain worsened with actively resisted abduction
Tx. trochanteric bursitis
corticosteroid injection
what type of pain is consistent with hip joint pathology?
pain localized to groin and restricted ROM in hip
what kind of injury should make you suspect a meniscal tear?
twisting injury of foot in weight bearing position, in which a popping or tearing sensation is felt, followed by severe pain and swelling over several hours
sx. experienced by pts with meniscal tears
clicking or locking of knee secondary to loose cartilage; but usually pain only on walking, esp stairs
sensitive and specific tests to dx. meniscal tears
pain along joint line - sensitive
audible pop or snap in McMurray’s test - specific
pain and tenderness over anteromedial aspect of lower leg just below the joint line of the knee; focal tenderness on the upper, inner tibia about 5 cm distal to medial articular line of the knee
anserine bursitis
young woman complains of pain in knee when going down steps and development of knee stiffness/pain at rest when knee is flexed for prolonged period of time
dx. patellofemoral pain syndrome
pt presents with pain when reaching overhead and when lying on their shoulder - dx?
rotator cuff tendinitis
rotator cuff tendinitis
inflammation of the supraspinatus and/or infraspinatus tendons as well as the subacromial bursa
adhesive capsulitis
frozen shoulder - decrease range of shoulder motion due to stiffness (not pain or weakness)
bicipital tendinitis
anterior shoulder pain is elicited with resisted forearm supination or elbow flexion
pt comes in with arm weakness, esp during abduction and/or external rotation
rotator cuff tear
how can you diagnose a rotator cuff tear?
positive drop-arm test (inability to smoothly lower affected arm from full abduction)
what is the next step in management of someone with referred shoulder pain?
CXR - helps identify underlying intrathoracic process (apical lung tumor, effusion,PTX)
how do you treat a pt with polymyalgia rheumatica who is having flares on steroid tapering?
give min. dose of steroids that prevents symptoms and add steroid-sparing agent such as Methotrexate
empiric therapy of choice for community acquired septic arthritis w/ synovial fluid positive for gram positive cocci
Vancomycin - increase in MRSA strains
- may switch to oxacillin or cefazolin once culture results are present
what is MRI of joints useful for?
detecting avascular necrosis
soft tissue masses
collections of fluid not visualized by other modalities
gold standard for diagnosing prosthetic joint infection
arthrocentesis with culture
CF in prosthetic joint infection
mostly pain
fever, leukocytosis absent
elevated ESR
pt who had arthroplasty many years ago presents with pain in proximal and medial aspect of the thigh that is worse with weight bearing
aseptic loosening
radiograph finding in aseptic loosening
osteolysis
what drugs can you use in an acute gout attack
NSAIDs - first line
corticosteroids
colchicine
when is colchicine most effective in tx. gout
pts with monoarticular involvement
when used w/in first 24 hours of attack can abort the attack
when can you begin uric-acid lowering therapy in gout pts?
when pt has atleast 2 documented cases of gout; never during an acute attack
what is the target serum uric acid level in gout therapy?
< 6.0 mg/dl - at this conc, monosodium urate crystals are resorbed
what else should you give a pt before initiating allopurinol?
prophylactic colchicine OR
low dose steroids OR
NSAIDs
- atleast for 1 week before
chronic apatite deposition disease
large, minimally inflammatory effusions that develop in shoulder or knee; destruction of associated tendon structures and chronic pain
first line management option for pts with OA of the knee
physical therapy - esp. quadriceps muscle training
chronic pain at the base of the thumb suggests..
OA of first carpometacarpal joint
“grind test”
movement of thumb in circular direction elicits pain in OA
finkelstein test
flexing thumb into palm, closing fingers over thumb and bending wrist elicits pain in De Quervain tenosynovitis
pt presents with pain on palpation of the distal aspect of the radial styloid
de Quervain tenosynovitis
which tests can be used to test for Carpal tunnel syndrme?
Tinel sign - tapping flexor retinaculum
Phalen sign - flexing the wrists against each other
next best step in pt with OA that acetaminophen isnt helping?
NSAIDs, ie. ibuprofen
next pharmacologic intervention in pt with OA in whom NSAIDs are not helping
intra-articular corticosteroids or hyaluronan injections
radiograph showing marginal joint erosions would support a diagnosis of..
rheumatoid arthritis
what chronic infection can RF be positive in?
chronic hepatitis C
in which RA patient is methotrexate not warranted as first line DMARD therapy?
those who consume alcohol regularly -> increases risk of hepatotoxicity
what DMARD is warranted in a patient with early, mild and nonerosive RA?
hydroxychloroquine
- esp if pt has contraindications to methotrexate
what should you suspect in pts with explosive onset, widespread psoriasis along with DIP joint involvement, asymmetric joint involvement and symptoms of enthesitis or joint ankylosis?
untreated HIV infection
presence of acute oligoarticular arthritis involving the lower extremities in a patient with inflammatory diarrheal illness suggests…
enteropathic arthritis
patient has pain in the eye, sensitivity to light and blurred vision - dx?
acute anterior uveitis
acute anterior uveitis (unilateral) is strongly associated with..
HLA-B27 arthropathies, esp, ankylosing spondylitis
MC diagnosed systemic illnesses associated with anterior uveitis (3)
ankylosing spondylitis
reactive arthritis
sarcoidosis
definitive test to diagnose ankylosing spondylitis
MRI (with gadolinium enhancement )of sacroiliac joints
young pt presents with persistent pain and morning stiffness involving the lower back that is alleviated with activity; there is accompanying tenderness of the pelvis
consider a diagnosis of ankylosing spondylitis
what tests can be done to confirm presence of SLE?
- anti-dsDNA ab
2. measure complement C3, C4 and CH50 levels
which antibody is associated with development of interstitial lung disease in scleroderma?
anti-Scl70
antihypertensive drugs of choice in SLE?
ACEi - help control proteinuria as well
what is initial tx. when you suspect lupus nephritis in pt?
high dose prednisone
skin condition characterized by central telengiectasias, flushing and acneiform papules/pustules
rosacea
the classic malar rash typically spares what area of the face?
nasolabial folds - relatively protected from the sun
most appropriate tx. for Raynaud’s phenomenon in systemic sclerosis
dihydropyridine CCB i.e. amlodipine
young female presents with diffuse pain on both sides of the body, above and below the waist as well as axial skeletal pain - dx?
fibromyalgia
lab findings frequently present in pts. with Sjogren’s syndrome
Ro/SSA and La/SSB abs
ANA
RF
hypergammaglobulinemia
MC organ involved in PAN
kidney - causes HTN, kidney insufficiency and renal vasculitis
diagnosis of PAN (2)
- sural nerve biopsy
2. kidney angiography
angiographic findings in pts with PAN
microaneurysms or a beaded pattern with areas of arterial narrowing and dilation
Tx. of suspected PAN
immunosuppressive therapy - steroids, cyclophosphamide (if severe)
what should you consider in a pt with upper and lower airway manifestations, renal involvement and inflammatory arthritis
Wegener’s granulomatosis
ab’s that are specific for Wegeners
c-ANCA
anti-proteinase 3 ab
what do you do next if you suspect giant cell temporal arteritis in a patient?
IV steroids (methylprednisone) - initiate treatment before doing any diagnostic test
gold standard for dx. of temporal arteritis
temporal artery biopsy
patient presents with pain in the shoulder and hip girdle accompanied by significant elevation in ESR
suspect polymyalgia rheumatica
