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MSK Clerkship 2018 > Rheumatology Lecture > Flashcards

Rheumatology Lecture Flashcards

1
Q

How many Americans have an MSK or rheumatologic disorder?

A

50 million

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2
Q

What proportion of PCP visits are for MSK complaints?

A

1 in 5

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3
Q

The most common joint disorder is ____________.

A

osteoarthritis

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4
Q

List the structures that are considered intraarticular and extraarticular.

A 
Intraarticular: 
•Cartilage
•Subchondral bone
•Synovium
• Synovial fluid
Extraarticular: 
•Tendon
• Muscle 
•Bursa
• Ligament
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5
Q

What are symptoms of inflammatory arthritis?

A
  • Pain with all directions of movement
  • Swelling of the entire joint
  • Limited ROM in all directions of movement
  • Pain equal when active or passive
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6
Q

In inflammatory arthritis, look for these exam signs: ________________.

A

warm, redness, swelling, and pain

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7
Q

Classically, the morning stiffness of RA lasts ______________.

A

greater than an hour

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8
Q

In contrast to inflammatory joint disorders, osteoarthritis usually does not have _____________.

A

warmth, redness, or swelling (and the pain is milder)

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9
Q

Synovium lines the inside of the _______________.

A

joint capsule

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10
Q

Which joints are most commonly affected in OA?

A
  • DIPs
  • PIPs
  • 1st MCP
  • 1st MTP
  • Weight-bearing joints
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11
Q

A synovial fluid aspirate with less than ___________ cells is considered non-inflammatory.

A

2,000 cells/mL

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12
Q

What are Heberden and Bouchard nodes?

A

Found in osteoarthritis, Bouchard and Heberden nodes are nodal swellings of the PIP (Bouchard) and DIP (Heberden) joints.

(Just remember that it goes alphabetically proximal to distal.)

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13
Q

An x-ray of the DIPs and PIPs of someone with osteoarthritis may show the ____________ sign.

A

seagull (osteophytes projecting from the sides of the phalangeal head)

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14
Q

Because of asymmetric weight distribution, osteoarthritis can cause ________________ of the joint.

A

asymmetric narrrowing

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15
Q

Based on the number of joints involved and distribution, list the types of inflammatory arthritis.

A

Monoarticular:
•Gout
•Pseudogout
• Septic joint

Oligoarticular, asymmetric (2-4 joints):
•Spondyloarthropathies

Polyarticular, symmetric (5 or greater):
•RA, SLE,

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16
Q

__________ is more of an indicator of chronic inflammation, while CRP is an indicator of acute inflammation.

A

ESR

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17
Q

Recall (from Step studying) that __________ is specific for RA.

A

anti-cyclic citrullinated protein

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18
Q

What is the upper limit for ESR?

A

20 mm/hr for females and 15 mm/hr for males

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19
Q

Citrulline is formed by _______________.

A

deamination of arginine

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20
Q

What immunofluorescent pattern can differentiate lupus from scleroderma?

A

Lupus presents with a circular halo around the nucleus, while scleroderma presents with a clumpy pattern in the nucleus (described as nucleolar).

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21
Q

Only a small percent of those with high __________ develop gout.

A

uric acid levels in the blood

22
Q

Pseudogout more commonly affects the ______________.

A

wrist and knee (as opposed to the 1st MTP like in regular gout)

23
Q

Nongonococcal septic arthritis is more common in which populations?

A
  • IV drug abusers

* Immunocompromised patients

24
Q

Aspirates of septic joints from a nongonococcal etiology will classically have WBC greater than __________.

A

50,000 (though this is not required for a diagnosis of septic arthritis)

25
Q

What symptoms, other than arthralgia, accompany gonococcal arthritis?

A
  • Skin lesions
  • Fever
  • Tenosynovitis

The above generally precede joint pain in s

26
Q

True or false: PID is usually found concomitant with gonococcal arthritis.

A

False. PID, if it is present, generally occurs before the arthritic symptoms.

27
Q

The only inflammatory arthritis that affects the DIPs is _______________.

A

psoriatic arthritis

RA usually spares the DIPs. OA is a non-inflammatory arthritis.

28
Q

Psoriatic arthritis can present with skin lesions, nail lesions, arthritis, and ________________.

A

dactylitis

29
Q

What causes the dactylitis seen in psoriatic arthritis?

A

Tendon swelling

30
Q

Untreated, psoriatic arthritis can progress to _____________.

A

bone deformity with telescoping of the digits and the “pencil in cup” sign on x-ray

31
Q

There are two classes of disorders that can cause inflammatory polyarthritis: ______________.

A

rheumatoid arthritis and connective tissue disease (including Sjogren’s, SLE, and sclerosis)

32
Q

Palpation of a joint with rheumatoid arthritis will often demonstrate a ___________ feel.

A

spongy

33
Q

Bone erosion from rheumatoid arthritis generally starts in the ____________ area.

A

bare (the area where the synovium connects to the sides of the bone)

34
Q

What demographics are more affected by lupus?

A
  • Females
  • Age 15 - 45
  • Non-white races
35
Q

What is different about the arthritis seen lupus compared to rheumatoid arthritis?

A

SLE arthritis does not lead to erosions in the bone.

36
Q

Ankylosing spondylitis always begins before age ________.

A

45

37
Q

In terms of ROM, osteoarthritis can cause ______________.

A

loss of flexion (whereas ankylosing spondylitis causes global loss of ROM)

38
Q

Impingement of the C5 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Shoulder abduction
  • Deltoid skin area
  • Biceps reflex
39
Q

Impingement of the C6 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Wrist extension
  • Thumb and index finger skin area
  • Brachioradialis reflex
40
Q

Impingement of the C7 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Wrist flexion and finger extension (a movement that conveniently makes your forearm look like the number 7)
  • Numb middle finger
  • Decreased triceps reflex
41
Q

Impingement of the C8 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Finger flexion
  • Number ulnar side of hand and forearm
  • Decreased finger jerks
42
Q

Impingement of the L4 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Week quadriceps and foot inversion
  • Numb inner leg
  • Decreased quad reflex
43
Q

Impingement of the L5 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Weak toe extension
  • Numb dorsum of foot
  • Reflexes intact
44
Q

Impingement of the S1 nerve root causes loss of what motor function, what sensory function, and what reflex?

A
  • Weak gastrocnemius
  • Numb lateral foot
  • Decreased Achilles reflex
45
Q

There are more than 150 bursa in the body. List the most common sites for bursitis.

A
  • Prepatellar bursa
  • Olecranon bursa
  • Subacromial bursa
  • Trochanteric bursa
  • Ischial bursa
  • Pes anserine bursa
  • Retrocalcaneal bursa
46
Q

What maneuver is done to evaluate for bicipital tendonitis?

A

Speed’s test: having the patient hold their arms at roughly 30º angles from midline with their palms up and then tapping downward on their wrists

47
Q

Bicipital tendonitis often presents with _____________ pain.

A

anterior shoulder

48
Q

DeQuervain’s tendonitis presents with ______________ pain.

A

radial wrist

49
Q

What tendons are injured in DeQuervain’s tendonitis?

A

Extensor brevis and abductor longus

50
Q

When the Achilles tendon is inflamed, you need to evaluate the patient for ______________.

A

Reiter’s syndrome (reactive arthritis)

51
Q

What things are needed for a diagnosis of fibromyalgia?

A
  • Pain present for more than 3 months
  • Tenderness in 11 of the 18 common sites for fibromyalgia pain
  • Pain above and below the waist (it’s diffuse)

MSK Clerkship 2018 (28 decks)

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