SM 220a - Approach to Joint Pain Flashcards

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1
Q

What finding is present in this ultrasound of a patient’s foot?

Which joint condition does it indicate?

A

Double-contour sign

Indicative of gout

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2
Q

Which autoantibodies are likely to be elevated in rheumatic disease?

A
  • Rheumatoid factor
  • Anti-Cyclic Citrullinated Peptide (Anti-CCP)

Neither is specific for rheumatic disease, but both are sensitive

If a patient has both autoantibodies + clinical suspicion for rheumatic disease, then the diagnosis is very likely

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3
Q

Which autoanitbody is most likely present in a patinet with lupus?

A

ANA

Sensitive, but not specific for Lupus
(30% of the healthy population is positive for ANA)

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4
Q

Someone with infectious joint pain will usually have ______ WBCs in their synovial fluid

A

Someone with infectious joint pain will usually have
50,000 - 100,000 WBCs in their synovial fluid

Will be turbid to very turbid

Send this patient to the ER!

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5
Q

What factors can increase a patient’s CRP?

A
  • Obesity
  • Heart disease
  • Infection
  • Malignancy
  • Diabetes
  • Smoking
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6
Q

This double-contour sign on ultrasoudn is indicative of which joint condition?

A

Gout

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7
Q

Which autoantibody is most likely present in a patient with systemic or drug-induced vasculitis?

A

ANCA

May also be present in IBD, SLE, and AIH

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8
Q

Someone with non-inflammatory joint pain will usually have ______ WBCs in their synovial fluid

A

Someone with non-inflammaory joint pain will usually have
200-2,000 WBCs in their synovial fluid

Will be clear to slightly turbid

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9
Q

What factors can increase a patient’s Erthroycyte Sedimentation Rate? (ESR)

A
  • Age
  • Diabetes
  • ESRD
  • Pregnancy
  • Females tend to have higher ESR
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10
Q

Someone with inflammatory joint pain will usually have ______ WBCs in their synovial fluid

A

Someone with inflammaory joint pain will usually have
2,000 - 50,000 WBCs in their synovial fluid

Will be slightly turbid

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11
Q

What factors can decrease a patient’s Erthroycyte Sedimentation Rate? (ESR)

A
  • CHF
  • Sickled RBCs
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12
Q

What information can you learn from an Erthroycyte Sedimentation Rate? (ESR)

A

Inflammatory state of the patient

  • Higher ESR implies more inflammation
  • Factors that can increase ESR
    • Age
    • Diabetes
    • ESRD
    • Pregnancy
    • Females tend to have higher ESR
  • Factors that can decrease ESR
    • CHF
    • Sickled RBCs
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13
Q

What information can you learn from an C-Reactive Protein (CRP) test?

A

A patient’s inflammatory state

Higher CRP implies more inflammation

  • Levels change more quickly than ESR = more sensitive
  • Less variable than ESR
  • Can be affected by age and gender
  • Factors that increase CRP
    • Obesity
    • Heart disease
    • Infection
    • Malignancy
    • Diabetes
    • Smoking
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14
Q

Which labs are most useful in measuring control/determining prognosis for rheumatic disease?

A

CRP and ESR

Note: Anti-CCP and ANA are useful for diagnosis, but nor monitoring

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15
Q

What is the Schober test?

In which patients is it useful?

A

Useful in patients with estabilished inflammatory back pain - used to monitor management/progression

  • Mark lumbosacral junction
  • Mark 10 cm above (measure w/tape measure)
  • Ask the patient to bend forward
    • Normal = Space between marks will expand to 15 cm
      • Less expansion = evidence of lost range of motion. May indicate progression of inflammation or possible fusion
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16
Q

What features of a patient’s history are consistent with an inflammatory joint condition?

A
  • Symmetric pain
  • Pain in multiple joints
  • Improvement with activity
  • Response to steroids
  • Systemic and extra-aricular features
    • Rash (lupus)
    • IBD
    • Raynauds (color changes to hands/extremeties in different temperature)
    • Inflammatory eye disease
    • Enthesitis
    • Dactylitis
17
Q

What pathology can be revealed using the straight leg test?

A

Useful when a patient presents wtih lumbar radiculopathy (back pain that radiates down the leg)

  • Straight leg test puts traction on lumbar spinal roots and causes pain
  • This provides evidence of radiculopathy
    • Due to compression of the nerve
    • Helps to diagnose the problem
18
Q

A normal synovial fluid will have ________ WBCs

A

A normal synovial fluid will have 0-200 WBCs

Will be clear, pale yellow

19
Q

What distinguishing features can separate inflammatory joint pain from other joint pain?

A
  • Stiffness
    • Inflammatory: stiffness lasts >1 hour in the morning
    • Other: May be stiff, but usually <30 minutes
  • Response to activity
    • Inflammatory: symptoms improve with activity
    • Other: symptoms are worse with activity
  • Response to rest
    • Inflammatory: symptoms are worse with rest
    • Other: Symptoms are better with rest
  • Response to steroids
    • Inflammatory = yes
    • Other = no