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Medical Junior > Sign & Symptoms of Rheumatological disorders, Monoarthritis, Polyarthritis > Flashcards

Sign & Symptoms of Rheumatological disorders, Monoarthritis, Polyarthritis Flashcards

1
Q

What are the 2 big major subgroup of rheumatology & its components

A
  1. Rheumatic diseases
    - Gout
    - RA
    - OA
    - PsA
  2. Connective tissue disease
    - SLE
    - Scleroderma
    - Sjogren’s syndrome
    - Vasculitis
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2
Q

Symptoms of rheumatic disease

A
  1. Arthralgia - joint pain
  2. Arthritis - joint swelling
  3. Joint stiffness
  4. Joint redness
  5. Joint deformities
  6. Muscle weakness
  7. Extraarticular manifestations
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3
Q

Characteristics of inflammatory joint pain

A
  • Pain worse after rest/ in morning
  • Morning stiffness > 30 minutes
  • Troublesome nightime pain
  • Systemic symptoms present
  • Acute/ Subacute
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4
Q

Characteristics of non-inflammatory joint pain

A
  • Pain after movement/ at end of day
  • Morning stiffness < 30 minutes
  • No nightime pain
  • No systemic symptoms
  • Chronic
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5
Q

Important things to ask in history

A
  1. How many joints involved
    - mono, oligo, poly
  2. Symmetrical/asymmetrical joint affected
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6
Q

Examples of joint problem sources

A
  1. Focal pathology
    - tennis elbow, medial meniscal tear
  2. d/t systemic condition
    - RA, SLE, PsA
  3. Referred pain
  4. Radicular pain
    - pain from spine
    - that radiate to back leg
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7
Q

Gout pain usually located at

A

1st metatarsophalangeal joint

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8
Q

Joint pain characteristics and possible causes

A
  1. Sudden joint pain - Trauma, Gout
  2. Few days joint pain - Septic arthritis
  3. Flitting joint pain - Rheumatic fever
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9
Q

Important enquiry in joint swelling

A
  1. Which joint
  2. Localized/ diffuse
  3. Extent
  4. Time course
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10
Q

Joint swelling that happen very fast indicates

A

Hemathrosis

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11
Q

Muscle weakness types and causes

A
  1. Proximal muscle weakness
    - primary muscle disease
  2. Distal muscle weakness
    - primarily neurological
  3. Intermittent weakness
    - Myasthenia gravis (worsen during activity)
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12
Q

Extraarticular manifestation of Still’s disease

A
  1. High spiking fever
    2, Rash
  • almost daily at exact time at exact hour
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13
Q

Extraarticular manifestation of Temporal arteritis

A
  1. Headache
  2. Claudication
  3. Scalp tenderness
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14
Q

Joint problem obese pt likely to have

A

OA of the knee

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15
Q

General appearance of ankylosing spondylitis

A
  1. Loss of lumbar lordosis
  2. Khyphoscoliosis
  3. Limited neck movement
  4. Question mark posture
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16
Q

Scleroderma physical appearance

A
  1. Very tight skin on the hand and face
  2. Microsomia - limited mouth opening
  3. Raynaud’s phenomenon on finger
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17
Q

Cushing syndrome physical appearance - secondary to steroid immunosuppressor

A
  1. Abdominal striae
  2. Moon face
  3. Truncal obesity
  4. Buffalo hump
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18
Q

Late stage rheumatoid arthritis hand deformities

A
  1. Boutonierre deformity of thumb
  2. Ulnar deviation of metacarpophalangeal joint
  3. Swan-neck deformity of finger
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19
Q

Late stage osteoarthritis nodules affect which hand joint

A
  1. Proximal interphalangeal joints (Fusiform swelling)
  2. Distal interphalangeal joints (Heberden’s nodes)
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20
Q

Gouty arthritis hand nodules characteristics

A
  1. Multilobulated
  2. Hard
  3. Tophaceous chalk coming out when punctured
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21
Q

1 Risk factor of psoriasis & Psoriatic hand skin characteristics

A

Risk factor: Family history of psoriasis

Skin:
- Erythematous
- Scaly
- Well defined borders
- Multiple skin lesions

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22
Q

Other joints examinations & signs of rheumatic disease

A
  1. Elbow - psoriatic plaque, tophi, rheumatoid nodules
  2. Knee - crepitus (OA)
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23
Q

Possible findings on examination of face/head

A
  1. Psoriasis - Psoriatic plaque over hairline
  2. Gout - Tophi over ears
  3. Sjogren’s - Dry eyes or mouth
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24
Q

Monoarthritis disease

A
  1. Septic arthritis
  2. Gonococcal arthritis
    - Arthritis-dermatitis syndrome
  3. Gouty arthritis
  4. Pseudogout (CPPD)
  5. Osteoarthritis
  6. Hemarthrosis
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25
60 year old man Right knee pain 10 days Itchy knee Fever 5 days X improve with painkillers Hx of DM, IHD Rt knee - Erythematous, warm, swollen, tender No other joint affected HIgh glucose, High uric acid, High WBC Provisional diagnosis?
Septic arthritis
26
Investigations for septic arthritis
1. Blood culture 2. Arthrotomy & wash out 3. Synovial fluid analysis - Cell count - Gram stain - Culture 4. IV antibiotic
27
Septic arthritis spread & localization
1. Local / direct inoculation by trauma / surgery 2. Hematogenous spread - m.common 3. Knee - m.common 4. S. Aureus - m.common
28
Risk factors of septic arthritis
1. IVDU 2. In situ catheters 3. DM 4. Extremes of age 5. Immunosuppressed
29
Treatment of septic arthritis
1. IV antibiotic atleast 6w - S. aureus 2. 2nd / 3rd generation cephalosporin - penicillin allergy - gram negative infection 3. Refer to ortho for wash out
30
19 years old female Painful swelling of hand 2 days Small, pustule rash over 3rd finger & palm Fever, chills Insect bite Smoker Provisional diagnosis?
Gonococcal arthritis - Looks like septic arthritis but this is a young female pt - Sexual promiscuity & drug abuse (must ask)
31
How to investigate gonococcal arthritis
1. Synovial fluid culture 2. Blood culture 3. Urethra culture 4. Cervix culture 5. Skin culture
32
2 manifestation of gonococcal arthritis
1. Bacteremia: Arthritis-dermatitis syndrome 2. Localized septic arthritis
33
Clinical feature of arthritis-dermatitis syndrome
Triad of: 1. Dermatitis 2. Tenosynovitis 3. Migratory polyarthritis
34
Treatment for gonococcal arthritis
1. Ceftriaxone 2. Cefotaxime 3. Azithromycin
35
33 year old male Acute onset pain & swelling big toe Pain with movement Hx of recurrent joint pain, relieved by NSAIDs Hx of HPT, Obesity, DM Meds: HCTZ, Diltiazem, Metformin, Aspirin, Ibuprofen Uric acid very high Synovial fluid with WBC & PMN Negative gram stain Negatively birefringent crystal Provisional diagnosis?
Gouty arthritis
36
Name of crystal in gouty arthritis synovial fluid
Monosodium urate crystal
37
Treatment of gouty arthritis
1. NSAIDs 2. COX2 Inhibitor 3. Colchicine 4. Systemic corticosteroids 5. Prophylaxis - Allopurinol 1. Low purine diet
38
Elderly lady Painful joint swelling of knee Gradually worsening pain over 1 week Hypothyroid X ray of Rt knee shows - A streak between joints Provisional diagnosis? What is the streak?
Pseudogout (CPPD) Calcium cyropyrophosphate crystals deposition in joint cartilage - mostly at knee
39
Risk factors of pseudogout
1. Female 2. Old age 3. Osteoarthritis 4. Hypothyroidism
40
Treatment of pseudogout
1. NSAIDs 2. COX2 Inhibitor 3. Colchicine 4. Steroids - no uricosuric agent like allopurinol
41
Calcific tendinitis crystal name
Hydroxyapatite
42
65 year old male Swollen knee 2 weeks Gradually incresing in size Increase pain on walking No fever no trauma NKMI Provisional diagnosis?
Osteoarthritis
43
Characteristics of osteoarthritis joint in Xray
1. Sclerosis 2. Reduced joint space 3. Osteophytes
44
Management of Osteoarthritis
1. Weight reduction 2. NSAIDs, COX2 inhibitors, Steroids 3. Surgery - knee replacement
45
15 year old man Recurrent swelling of knee joint Easy bruising Brother also has recurrent joint swelling Deformed knee Provisional diagnosis?
Hemarthrosis d/t Hemophilia
46
30 year old man Playing rugby injured elbow Pain & swelling 15 minutes No fracture Provisional diagnosis?
Hemarthrosis d/t Trauma
47
Risk factors for hemarthrosis
1. Trauma 2. Anticoagulation - warfarin 3. Clotting disorders - Hemophilia 4. fracture 5. Tumour
48
Normal synovial fluid findings
1. Volume < 3.5 2. High viscosity 3. Transparent 4. Clear color 5. WBC < 200 6. PMN < 25% 7. Total protein = 1-2
49
Non inflammatory synovial fluid findings (4 changes)
1. Volume > 3.5* 2. High viscosity 3. Transparent 4. Yellow color* 5. WBC = 200 - 2000* 6. PMN < 25% 7. Total protein = 1-3*
50
Inflammatory synovial fluid (7 changes)
1. Volume > 3.5* 2. Low viscosity* 3. Translucent - opaque* 4. Yellow - opal* 5. WBC = 2000 - 10,000* 6. PMN > 50%* 7. Total protein = 3-5*
51
Septic synovial fluid (7 changes)
1. Volume > 3.5* 2. Variable viscosity* 3. Opaque* 4. Yellow - green* 5. WBC > 100,000* 6. PMN > 75%* 7. Total protein = 3-5*
52
Hemorrhagic synovial fluid (7 changes)
1. Volume > 3.5* 2. Variable viscosity* 3. Bloody* 4. Red* 5. WBC = 200 - 2000* 6. PMN = 50-75%* 7. Total protein = 4-6*
53
Polyarthritis types
1. Rheumatoid Arthritis 2. Psoriatic Arthritis
54
Differential diagnoses for Polyarthritis
1. Infection 2. Crystal disease - gout, pseudogout 3. Systemic rheumatic diseases - RA, SLE 4. Spondyloarthropathy- AS, PsA 5. Systemic vasculitis
55
Investigations for polyarthritis
Blood 1. Inflammatory markers (ESR, CRP) 2. Serology (Rheumatoid factor, anti-CCP, ANA, C3 & C4) Xray Musculoskeletal ultrasound - detect synovitis, osteophytes
56
Rheumatoid arthritis definition
Autoimmune disease Causing inflamed synovium That erodes the cartilage & bone
57
Joint characteristics in RA
1. Bone erosion 2. Swollen inflamed synovial membrane 3. Cartilage wear away 4. Reduced joint space
58
Criteria to diagnose RA, its components & diagnostic score
2010 ACR-EULAR classification criteria for RA 1. Joint involvement 2. Serology 3. Acute phase reactants 4. Duration of symptoms Score 6/10 and above = RA
59
Joint involvement 2010 ACR-EULAR criteria for RA
(0) 1 large joint (1) 2-10 large joints (2) 1-3 small joints (3) 4-10 small joints (5) > 10 joints
60
Serology for 2010 ACR-EULAR criteria for RA
(0) -ve RF/ ACPA (2) low +ve RF/ ACPA (3) high +ve RF/ ACPA RF - Rheumatoid Factor ACPA - Anti-citrullinated protein antibody
61
Acute phase reactants for 2010 ACR-EULAR criteria for RA
(0) normal CRP/ESR (1) abnormal CRP/ESR
62
Duration of symptoms for 2010 ACR-EULAR criteria for RA
(0) < 6 weeks (1) > 6 weeks
63
Common hand joints involved in RA
1. Distal interphalangeal 2. Metacarpophalangeal
64
Extraarticular manifestations of RA (Neuro, CVS, Respi, Skin, Hemato)
Neuro - Peripheral neuropathy CVS - Pericarditis, Raynaud's Respi - ILD Skin - Rheumatoid Nodules Hemato - Felty's syndrome
65
Non-Pharmacological treatment of RA
- Stop smoking - Physiotherapy
66
Pharmacological treatment of RA
1. Painkillers (NSAIDs) 2. Disease modyfying anti rheumatic drugs (DMARDS) - Hydroxychloroquine - Prednisolone - Methotrexate
67
Criteria to diagnose PsA, its components, diagnostic score
CASPAR criteria 1. Evidence of psoriasis 2. Psoriatic nail dystrophy 3. -ve blood test result for RF 4. Dactylitis 5. Radiological evidence of juxta-articular new bone formation 3 and above = PsA
68
Evidence of psoriasis in CASPAR criteria of PsA
(2) current (1) personal hx (1) family hx
69
Psoriatic nail dystrophy in CASPAR criteria of PsA
(1) Pitting, onycholysis, hyperkeratosis
70
Dactyltis in CASPAR criteria of PsA
(1) Current inflammation of entire digit (1) dactylitis hx
71
Radiological evidence in CASPAR criteria of PsA
(1) - well defined ossification - close to joint margins - on plain radiograph - of hands & feet
72
Types of PsA
1. Symmetrical 2. Asymmetric 3. Distal interphalangeal predominant 4. Spondylitis 5. Arthritis mutilants
73
Types of skin psoriasis
1. Chronic plaque psoriasis (m.common) 2. Guttate psoriasis 3. Flexural psoriasis 4. Pustular psoriasis 5. Erythrodermic psoriasis

Medical Junior (29 decks)

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