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CPS > Case 2 > Flashcards

Case 2 Flashcards

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
Q

Male>female in this type of arthritiis

A

Reiter’s syndrome aka reactive arthritis

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26
Q

These can cause back pain

A

reactive arthritis, psoriatic arthritis

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27
Q

symmetrical pain

A

rheumatoid

28
Q

urethrtitis

A

reactive arthritis, gonococcal arthritis

29
Q

no dry mucous memranes ruled out?

A

Sjogrens

30
Q

No raynauds ruled out?

A

scleroderma, RA, SLE, poly/dermatomyositis

31
Q

Oral ulcers (lack of) ruled out?

A

SLE, Reiters (ie reactive arthritis)

32
Q

Heberden’s nodes

A

DIP joint osteoarthritis nodes= non tender

33
Q

Bouchard’s Nodes

A

PIP joints osteoarthritis

34
Q

Osteoarthritis labs

A

RF- negative
Anti CCP- negative
normal ESR and CRP

35
Q

Rheumatoid arthritis labs

A

RF+
antiCPP+
elevated ESR, CRP

36
Q

Difference when looking/touching joints of RA and OA

A

OA- hard and boney

RA- soft warm and tender

37
Q

Pitting of nails

A

psoriatic arthritis

38
Q

Reiter’s Syndrome=

A

Reactive arthritis Triad
-can’t see (conjunctivitis>uveitis)
, can’t pee (urethritis, circinate balantitis)
, can’t climb a tree (musculoskeletal sx- oligoarthritisi)

39
Q

weird white lines on penis

A

circinate balantitis

part of reactive arthritis

40
Q

Treatment of reactive arthritis

A

abx ,nsaids, steroid injections

41
Q

RA timeline

A

slow, joints happen one at a time

42
Q

Joints of RA

A

WARM AND SWOLLEN (NOT RED)
stiffnes >1 hr
(if red think infection)
TMJ and cricoaretynoid issues

43
Q

hoarseness can happen with?

A

RA- cricoarytenoid joint

–umm sure, i don’t believe this, hoarse voice def has another cause–

44
Q

OA vs RA nodules

A 
OA= non tender
RA= tender
45
Q

Physical of RA

A 
ulnar deviation, 
swan neck/boutonniere deformity
carpal tunnel
boxing glove edema
decreased grip strength
46
Q

Anemia of chronic disease

A

MCV- microcytic

47
Q

Which APR (acute phase response) protein is more reliable?

A

CRP»»»»ESR

48
Q

ESR can be influenced by

A

changes in RBC morphology, anemia, changes in plasma proteins

49
Q

RF

A

IgM/G/A against Fc of IgG

Increased in RA, sjogrens, scleroderma, SLE, chronic liver disease, granulomatous disease

50
Q

AntiCPP

A

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
Q

if ANA is negative, ____ is pretty unlikely

A

SLE

sensitive not specific

52
Q

Anti Smith/Anti dsDNA

A

95% specific

53
Q

CELEBREX

A

selective COX2–> less acid induction

but he says PPI should have been given

54
Q

look at drug stuff

A

d

55
Q

Non pharm therapy

A

OT, PT, cognitive therapy, nutrition, surgery

56
Q

RA might be assoicated with what nutrition issue?

A

anorexia, i guess?

57
Q

RA extraarticular issues

A

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
Q

Tinel sign

A

TAP on wrist

59
Q

phanel sign

A

weird hand movement and see if it goes numb

60
Q

Flick sign

A

need to wake up and flick hand around

61
Q

conservative treatment

A

no repetitive/virbatory movements

guess vibrators and masturbating are out. This explains why they’re depressed. They never have orgasms anymore.

62
Q

Carpal tunnel syndrome

A

slow nerve conduction, thenar atrophy, motor weakness,

>50 yrs, sx>10 months

63
Q

abnormal nerve conduction

A

1 month for abnormal results once carpal tunne starts

64
Q

osteoporosis risk factors

A

low body weight

65
Q

Can RA patients still get preggers

A

sure, just watch out for drugs and deformed babies.

CPS (1 decks)

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