Case II

Question 1

How can you differentiate articular from periarticular pain?

Answer 1

• Articular: Painful passive ROM

* Periarticular: Painless passive ROM

Question 2

Time from for “chronic” complaint

Answer 2

> 6 weeks

Question 3

Most common cause of septic arthritis?

Answer 3

N. Gonorrhea (70% in PTs < 40)

Question 4

How would blood in a tube differ between hemarthrosis and aspirate trauma?

Answer 4

In trauma from the procedure, the blood may remain unmixed with the synovial fluid, appearing as red streaks in an otherwise yellow fluid

In the case of hemarthroses, the synovial fluid is generally homogeneously bloody and does not form a clot.

Question 5

Crystallography of pseudogout?

Answer 5

Rhomboid crystal Weakly positive birefringence

Question 6

X-ray diagnosis of Pseudogout?

Answer 6

Chondrocalcinosis

Question 7

Crystallography of gout?

Answer 7

Needle shaped, negative birefringence

Question 8

Effects of exercise on inflammatory arthritis?

Answer 8

Improves symptoms

Question 9

Effects of exercise on noninflammatory arthritis?

Answer 9

Worsens symptoms

Question 10

Stiffness duration in inflammatory arthritis?

Answer 10

> 1 hour

Question 11

Stiffness duration in noninflammatory arthritis?

Answer 11

< 30 minutes

Question 12

Common presentation of fibromyalgia?

Answer 12

• Middle aged women
• Widespread achiness and fatigue
• > 11 / 18 tender trigger points

Question 13

What can rheumatic fever cause down the road?

Answer 13

Can cause arthritis and carditis

Question 14

How can bacterial endocarditis affect musculoskeletal system?

Answer 14

• Bacterial endocarditis can cause septic emboli of small vessels with joint pain and small infarcts of fingers
– Fever and heart murmur are typically present

Question 15

What percentage of adult onset back pain is ankylosing spondylitis?

Answer 15

5%

Question 16

How does rest and exercise effect ankylosing spondylitis?

Answer 16

• Improves with exercise (suggests inflammation)

* Worsens with rest (worse at night)

Question 17

What symptoms are associated with ankylosing spondylitis?

Answer 17

• Peripheral arthritis
• TMJ involvement
• Dactylitis
• Constitutional features

Question 18

What are Heberden’s nodes?

Answer 18

DIP joint osteoarthritis (non-tender)

Question 19

What are Bouchard’s nodes?

Answer 19

PIP joint osteoarthritis

Question 20

What hand involvement can be see with SLE?

Answer 20

Reynaud’s phenomenon

Question 21

Name for the rash associated with SLE?

Answer 21

Malar rash

Question 22

What is acronym for SLE?

Answer 22

• Renal involvement
• ANA
• Serositis (pleuritis/pericarditis)
• Hematologic abnormalities
• Oral ulcers
• Neurologic (seizures/psychosis)
• Malar rash
• Arthritis
• Immunologic (Anti Sm or DS DNA)
• Discoid lesions
• Sun sensitivitiy

Question 23

What would be seen on a plain film for psoriatic arthritis?

Answer 23

Juxtarticular bone formation that is distinct from an osteophyte

Question 24

Rheumatoid factor for psoriatic arthritis?

Answer 24

Negative

Question 25

Time of onset for Reiters syndrome?

Answer 25

Musculoskeletal symptoms develop 1 to 4 weeks following an acute infection with the triggering organisms (lots of things EXCEPT gonococcal disease)

Question 26

What is the fun saying for Reiter's syndrome?

Answer 26

* Can't see * Can't pee * Can't climb a tree

Question 27

What will be characteristically lacking in joints affected by RA?

Answer 27

Joints will be tender and swollen but NOT red

Question 28

What joint is involved which accounts for the hoarsness associated with RA?

Answer 28

Cricoarytenoid joint

Question 29

What type of anemia is associated with RA?

Answer 29

Normocytic (this is associated with chronic diseases)

Question 30

Formula for MCHC (concentration of hemoglobin in an RBC)

Answer 30

MCHC = Hemoglobin (g/dL)× 100 ÷ Hematocrit (%)

Question 31

MCV formula?

Answer 31

MCV = Hematocrit (%) × 10 ÷ RBC (million/μL)

Question 32

C-reactive protein (CRP) binds to?

Answer 32

phosphocholine of damaged cells and foreign pathogens

Question 33

Why is ESR not as good of a test as CRP?

Answer 33

ESR may be influenced by abnormal red blood cell morphology, anemia or changes in plasma proteins

Question 34

What level of CRP indicates inflammation?

Answer 34

* >1 mg/dL reflects clinically significant inflammation | * markedly elevated levels >10 mg/dL are strongly associated with infection

Question 35

What is RF factor?

Answer 35

Immunoglobulins of IgM, IgG and IgA directed against Fc | portion of IgG (Commercial test detects only IgM)

Question 36

What other conditions is RF elevated in?

Answer 36

Sjögren’s, scleroderma, SLE, chronic liver disease & granulomatous disease

Question 37

What does elevated Anti-Cyclic Citrullinated Peptide Antibodies (Anti-CCP Ab) indicate?

Answer 37

* May be detected years before onset of RA clinically * A marker of erosive disease * Sensitivity 80%, specificity >95% * Rare false +: hepatitis, autoimmune thyroid disease

Question 38

What would a negative ANA tell you about a PT with possible SLE?

Answer 38

It is very unlikely that they have the disease. This is a very sensitive, although very unspecific test.

Question 39

What antibodies are incredibly specific for SLE?

Answer 39

Anti Smith (Anti Sm)