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CPS > Case 2 > Flashcards

Case 2 Flashcards

(65 cards)

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1
Q

Branch points for “joint pain”

A

localization
inflammatory vs not
number of joints
acute vs chronic (timeline)

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2
Q

periarticular pain

A

painful, limited ROM- with active movement

no pain, unlimited ROM -when PASSIVE

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3
Q

articular pain

A

limited ROM and painful with ACTIVE and PASSIVE movements

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4
Q

Symmetrical

A

RA and SLE

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5
Q

Asymmetrical

A

OA, Reiters syndrome

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6
Q

Psoriatic arthritis

A

symmetrical or asymmetrical

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7
Q

migratory large joints

A

rheumatic fever

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8
Q

DIP pain

A

OA, psoriatic, gout, reiter’s

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9
Q

PIP pain

A

RA, OA, SLE

NOT in reiter’s or psoriatic

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10
Q

MCP

A

rheumatoid arthritis, pseudogout, hemochromatosis

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11
Q

Wrist

A

RA»pseudogut, gonococcal

rare in OA

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12
Q

Sxs that make it and emergency

A
  • want to rule out septic arthritis and other infections

- acute onset, red/hot/swollen, fever/weight loss, weakness, claudication (pain in periphery), burning/paresthesia pain

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13
Q

Infectious arthritis

A

gonorrhea!!!!!!!!!!!
also chlamydia,
want joint aspiration

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14
Q

Crystalline arthritis

A

gout or pseudogout

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15
Q

Hemarthrosis

A

trauma, hemophilia

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16
Q

joint aspiration- checking for?

A

cell count, gram stain/culture, crystals

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17
Q

Aspiration of normal fluid-

Viscosity, clarity, color, protein, glucose, WBC, PMNs

A

high viscosity,
clear,
1-2 protein,
glucose=blood glucose

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18
Q

Aspiration: Non inflammatory

Viscosity, clarity, color, protein, glucose, WBC, PMNs

A

clear yellow,
high viscosity,
3-5 proteins
200-2k WBC,

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19
Q

Inflammatory aspriate

Viscosity, clarity, color, protein, glucose, WBC, PMNs

A 
opaque yellow
Low viscosity,
3-5 proteins 
2k-100k WBC, 
>50% PMNs
>25--lower than blood glucose
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20
Q

Septic arthritis aspirate

A 
opaque yellow/green
variable viscosity
15k-100k WBCs
>75% PMNs
positive cultures
3-5 protein
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21
Q

hemorrhagic aspirate

A 
BLoody, red
variable viscosity
200-2K wbc
50-75% PMNs
4-6 protein
glucose= blood glucose
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22
Q

Add infor about crystals

A

d

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23
Q

Inflammatory vs non inflammatory jt distribution

A

Inflammatory= symmetric

Non inflammatory= non symmetric

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24
Q

Inflammatory vs non inflammatory changes in pain

A

Inflammatory- stiff>1 hr, other complaints (fever, malaise), improves with exerceise
Non inflammatory- stiff

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25
Male>female in this type of arthritiis
Reiter's syndrome aka reactive arthritis
26
These can cause back pain
reactive arthritis, psoriatic arthritis
27
symmetrical pain
rheumatoid
28
urethrtitis
reactive arthritis, gonococcal arthritis
29
no dry mucous memranes ruled out?
Sjogrens
30
No raynauds ruled out?
scleroderma, RA, SLE, poly/dermatomyositis
31
Oral ulcers (lack of) ruled out?
SLE, Reiters (ie reactive arthritis)
32
Heberden's nodes
DIP joint osteoarthritis nodes= non tender
33
Bouchard's Nodes
PIP joints osteoarthritis
34
Osteoarthritis labs
RF- negative Anti CCP- negative normal ESR and CRP
35
Rheumatoid arthritis labs
RF+ antiCPP+ elevated ESR, CRP
36
Difference when looking/touching joints of RA and OA
OA- hard and boney | RA- soft warm and tender
37
Pitting of nails
psoriatic arthritis
38
Reiter's Syndrome=
Reactive arthritis Triad -can't see (conjunctivitis>uveitis) , can't pee (urethritis, circinate balantitis) , can't climb a tree (musculoskeletal sx- oligoarthritisi)
39
weird white lines on penis
circinate balantitis | part of reactive arthritis
40
Treatment of reactive arthritis
abx ,nsaids, steroid injections
41
RA timeline
slow, joints happen one at a time
42
Joints of RA
WARM AND SWOLLEN (NOT RED) stiffnes >1 hr (if red think infection) TMJ and cricoaretynoid issues
43
hoarseness can happen with?
RA- cricoarytenoid joint | --umm sure, i don't believe this, hoarse voice def has another cause--
44
OA vs RA nodules
``` OA= non tender RA= tender ```
45
Physical of RA
``` ulnar deviation, swan neck/boutonniere deformity carpal tunnel boxing glove edema decreased grip strength ```
46
Anemia of chronic disease
MCV- microcytic
47
Which APR (acute phase response) protein is more reliable?
CRP>>>>>>>>ESR
48
ESR can be influenced by
changes in RBC morphology, anemia, changes in plasma proteins
49
RF
IgM/G/A against Fc of IgG | Increased in RA, sjogrens, scleroderma, SLE, chronic liver disease, granulomatous disease
50
AntiCPP
made when there is a post-translational amino acid change from arginine to cirtuilline marker for erosive (severity) disease false positive with hep and **** finish slide
51
if ANA is negative, ____ is pretty unlikely
SLE | sensitive not specific
52
Anti Smith/Anti dsDNA
95% specific
53
CELEBREX
selective COX2--> less acid induction | but he says PPI should have been given
54
look at drug stuff
d
55
Non pharm therapy
OT, PT, cognitive therapy, nutrition, surgery
56
RA might be assoicated with what nutrition issue?
anorexia, i guess?
57
RA extraarticular issues
Neuro, eyes, oral, GI vasculitis, osteoporosis, hypoandrogenism, nodules, puprupro, pyderma gangrenosum, membranous nephropathy or secondary amyloidosis heart stuff i really want to die right now....
58
Tinel sign
TAP on wrist
59
phanel sign
weird hand movement and see if it goes numb
60
Flick sign
need to wake up and flick hand around
61
conservative treatment
no repetitive/virbatory movements | guess vibrators and masturbating are out. This explains why they're depressed. They never have orgasms anymore.
62
Carpal tunnel syndrome
slow nerve conduction, thenar atrophy, motor weakness, | >50 yrs, sx>10 months
63
abnormal nerve conduction
1 month for abnormal results once carpal tunne starts
64
osteoporosis risk factors
low body weight
65
Can RA patients still get preggers
sure, just watch out for drugs and deformed babies.

CPS (1 decks)

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