Approach to Articular and Musculoskeletal Disorders Flashcards Preview

Rheuma (HPIM 18e) > Approach to Articular and Musculoskeletal Disorders > Flashcards

Flashcards in Approach to Articular and Musculoskeletal Disorders Deck (61):
0

"Red flag" diagnoses that must be diagnosed promptly to avoid significant morbidity and mortality (3)

1. Septic arthritis
2. Acute crystal-induced arthritis
3. Fracture

1

Feature that differentiates articular from nonarticular disorders

Articular disorders - pain or limited ROM on active and passive movement

Nonarticular - pain on active but not passive ROM; less swelling, crepitus, instability, or deformity of the joint

2

Intermittent stiffness associated with noninflammatory conditions, precipitated by brief periods of rest, lasts less than 60 minutes, and exacerbated by activity

Gel phenomenon

3

Characteristics of morning stiffness associated with inflammatory disease

Precipitated by prolonged rest, described as severe, lasts for hours, may improve with activity or anti-inflammatory conditions

4

Top 5 differentials for musculoskeletal complaints in patients <60 years

1. Repetitive use/strain dso
2. Gout (men only)
3. RA
4. Spondyloarthritis
5. Infectious arthritis

5

Top 5 differentials for musculoskeletal complaints in patients >60 years

1. OA
2. Crystal arthritis (gout/pseudogout)
3. Polymyalgia rheumatica
4. Osteoporotic fracture
5. Septic arthritis

6

Most frequent musculoskeletal condition in patients with musculoskeletal complaints and low back pain

Fibromyalgia

7

Diagnoses for MSK complaints more common in the young (2)

SLE
Reactive arthritis

8

Diagnoses for MSK complaints more common in middle aged patients (2)

Fibromyalgia
RA

9

Diagnoses for MSK complaints more common in the elderly (at least 2)

OA
Polymyalgia rheumatica

Also: osteoporosis, gout, pseudogout, vasculitis, drug-induced disorders

10

Diagnoses for MSK complaints more common in whites (3)

Polymyalgia rheumatica
Giant cell arteritis
Wegener's granulomatosis

11

Diagnoses for MSK complaints more common in African Americans (2)

Sarcoidosis
SLE

12

Diagnoses for MSK complaints that may exhibit familial aggregation (3)

Ankylosing spondylitis
Gout
Heberden's nodes of OA

13

Arthritides that exhibit a migratory pattern of joint involvement (2)

Rheumatic fever
Gonococcal or viral arthritis

14

Arthritides that exhibit an additive pattern of joint involvement (2)

RA
Psoriatic arthritis

15

Symptom duration of a musculoskeletal disorder to be classified as chronic

>6 weeks

16

Number of joints involved to be classified as oligoarticular

2-3 joints

17

Arthritides that involve mostly the lower extremities

Reactive arthritis
Gout

18

Arthritides that involve mostly the upper extremities

RA
OA

19

Involvement of the axial skeleton is infrequent in RA, with this notable exception

Cervical spine

20

Arthritides that commonly involve the axial skeleton

OA
Ankylosing spondylitis

21

Patients with chronic inflammatory disorders are at higher risk for these diseases

Infection, cardiovascular events, neoplasia

22

28 easily examined joints

PIPs
MCPs
Wrists
Elbows
Shoulders
Knees

23

Typical pattern of joint involvement in the hand with OA

DIP, PIP, 1st CMC

24

Typical pattern of joint involvement in the hand with RA

PIP, MCP, intercarpal and CMC

25

Typical pattern of joint involvement in the hand with psoriatic arthritis

PIP, DIP

26

Typical pattern of joint involvement in the hand with hemochromatosis

2nd and 3rd MCP (with chondrocalcinosis) or episodic, inflammatory wrist arthritis

27

Tendons that form the rotator cuff

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

28

Shoulder pathology suggested by pain on active (but not passive) abduction, pain over the lateral deltoid muscle, night pain, and positive impingement sign

Rotator cuff tendinitis

29

Pain that develops before 180 degrees of passive forward flexion of the shoulder while the examiner stabilizes the scapula

Impingement sign (rotator cuff tendinitis)

30

Shoulder pathology suggested by a positive drop arm test (patient is unable to hold the arm up once 90 degrees of passive abduction is reached)

Complete tear of the rotator cuff

31

Imaging studies to confirm rotator cuff tendinitis or tear

MRI or ultrasound

32

Manual pressure lateral to the patella may cause an observable shift in synovial fluid (bulge) to the medial aspect. This maneuver is only effective in detecting this volume of effusion.

Small to moderate (<100 mL)

33

Best position of the knee to palpate for popliteal or Baker's cyst

Partial flexion

(for inspection, the knees are best viewed posteriorly with the patient standing and knees fully extended)

34

Knee pathology associated with pain on the anteromedial proximal tibia at the insertion of the conjoined tendon

Anserine bursitis

35

Muscles that form the conjoined tendon

Sartorius, gracilis, semitendinosus

36

Bursa in the knee that is superficial and located over the inferior portion of the patella

Prepatellar bursa

37

Bursa in the knee located deep beneath the patellar ligament before its insertion on the tibial tubercle

Infrapatellar bursa

38

Knee pathology associated with a painful click when the knee is first flexed at 90 degrees and the leg is extended while the lower extremity is simultaneously torqued medially (inward rotation)

Lateral meniscus tear
(McMurray test)

39

Knee pathology associated with a painful click when the knee is first flexed at 90 degrees and the leg is extended while the lower extremity is simultaneously torqued laterally (outward rotation)

Medial meniscus tear
(McMurray test)

40

Knee pathology associated with significant anterior movement on drawer sign

Anterior cruciate ligament damage

41

Knee pathology associated with significant posterior movement on drawer sign

Posterior cruciate ligament damage

42

Sciatica may be caused by impingement of these nerve roots and manifests as neuropathic pain extending from the gluteal region down the posterolateral leg to the foot

L4, L5, or S1

43

Location of true hip joint pain

Anteriorly, over the inguinal ligament; may radiate medially to the groin

44

Periarticular disease that may mimic true hip joint pain; tends to worsen with hyperextension of the hip

Iliopsoas bursitis

45

Target uric acid level in hypouricemic therapy

<6 mg/dL

46

Percentage of healthy population with positive RF or ANA

4-5%
(only 1% and <0.4% will have RA or SLE, respectively)

47

Percentage of RA patients with positive IgM RF

80%

48

Conditions other than RA associated with positive low titers of RF

Tuberculosis, leprosy, hepatitis
SLE, Sjögren's syndrome
Chronic pulmonary dse, CLD, CKD

49

Conditions other than SLE associated with positive ANA

Polymyositis, scleroderma, APS, Sjögren's syndrome, drug-induced lupus, CLD, CKD, advanced age

50

ANA pattern (related to autoantibodies against ds-DNA) highly specific and suggestive of lupus

Peripheral

51

Aside from limited scleroderma, centromeric ANA pattern is also seen in this condition

Primary biliary cirrhosis

52

Normal synovial fluid is viscous because of the high levels of this substance

Hyaluronate

53

White cell count of noninflammatory synovial fluid

<2000/uL with mononuclear cell predominance

54

Typical white cell count of inflammatory synovial fluid

2000-50,000/uL with PMN predominance

55

White cell count of septic synovial fluid

>50,000/uL with >75% PMNs

56

Gallium scanning is primarily used in identification of these conditions

Occult infection or malignancy

57

111In-labeled WBC or 67Ga scanning has largely been replaced by MRI in the detection of osteomyelitis and infectious/inflammatory arthritis except when there is a suspicion of this condition

Prosthetic joint infection

58

Gallium scanning utilizes 67Ga, which binds these proteins, and are preferentially taken up by neutrophils, macrophages, bacteria, and tumor tissue (e.g., lymphoma)

Serum and cellular transferrin and lactoferrin

59

Reason why lower uric acid levels are seen in women

Estrogen has uricosuric effects

60

Preferred imaging technique when evaluating complex musculoskeletal disorders

MRI