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Medicine I > MSK Complaints > Flashcards

MSK Complaints Flashcards

1
Q

what are signs of MSK problem?

A

fever
weight loss
neurologic deficit
pain that awakens the px at night
urinary or bowel incontincence

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2
Q

what are the red flag diagnoses of MSK?

A

fracture
acute crystal-induced arthritis
septic arthritis

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3
Q

what should u find out in the px’s hx?

A

was there trauma experienced by the px?
did the px acquire any illness or infection?

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4
Q

what aer the ROS of rheuma?

A

fever, rash, myalgias, weakness, scalp changes or lesions
nail changes

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5
Q

what are rheumatic complaints?

A
  • Cellulitis = Erythema around the knee
  • swelling of joint in the px’s left knee
  • swollen right knee w/o erythema
  • warmth or effusion upon palpation
  • tophic or uric acid deposits in px w/ chronic tophaceous gout
  • osteoarthritis of the hands
  • bony enlargement of the distal interphalangeal joints
  • classic discoid rashes of lupus = scarring w/ central clearing
  • petechial rashes in. a px w/ vasculitis
  • coalescing vasculitic lesions
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6
Q

upon assessment of MSK complaints, what should u take note in anatomic localization?

A
  • is it articular/non-articular?
  • is the problem in the joint or around the joint?

Articular
1. if pain is deep or diffuse
2. pain or limited ROM (active & passive)
3. swelling
4. crepitation or grafting

Periarticular
1. painful on active but not passive ROM
2. point/focal tenderness in adjacent regions

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7
Q

to determine the chronology, what should u ask?

A
  1. onset (abrupt, indolent)
  2. evolution
    * chronic = osetoarthritis,
    * itnermittent = crystal arthritis
    * migratory = rheumatic fever, gonococcal, or viral arthritis
    * additive = RA, psoriatic arthritis
  3. Duration
    * acute (<6wks)
    * chronic (>6wks)
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8
Q

how do you determie the nature of hte pathologic process?

A
  • cardial signs of inflammation = erythema, swelling, warmth, pain
  • systemic = faitgue (esp afternoon), fever, rash, weight loss
  • lab = EST & CRP INC, Thrombocytosis, anemia/chronic disease, hypoalbuminemia
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9
Q

what phenomenon occurs when joints get stuck but it resolves on its own in 5-10mins

A

gel phenomenon

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10
Q

what should u determine in the extent of involvement of MSK complaints?

A
  1. Articular: monoarticular, oligoarticular (2-3 joints, Polyarticular: 4 or mroe)
  2. non-articular: focal or widespread
  3. Distibution: symmetrical/a, upper & lower ex, axial skeleton involvement (ankylosing spondylitis, sponfyloarthritis)

focal = epicondylitis. widespread = fibromyalgia

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11
Q

what are the most common conditions of MSK?

A

low back pain & trauma/fracture

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12
Q

low back pain can indicate what? how do u confirm its origin?

A

Fibromyalgia

<60 yrs -> repetitive strain (tendinitis, bursitis), gout (males only_, rheumatoid arthritis, psoriatic, reactive arthritis, infectious arthritis

> 60yrs = osteorhtiritis, Gout, pseudogout, polymyalgia rhematica, osetoporotic fractyre, septic arthritis (bacterial) –> Septic arthritis

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13
Q

wat are s/sxof De Quervains tenosynocitis?

A
  • overuse syndrome assoc with pain on thumb & wrist motion
  • swelling/pain for first dorsal movement
  • (+) Finkelstein’s test
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14
Q

what are red flag conditions assoc w/ gout?

A

gout
septic arthritis
fracture
vascular ischemia
carpal tunnel syndrome

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15
Q

what is hte main complaint in acute monoarthritis?

A

acute inflammatory monoarthritis

  1. joint aspiration = best dx test
  2. synovial fluid analysis = infection or crystal yung source
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16
Q

what are clin features of gout?

A
  • male > female
  • extremely painful
  • 1st MPT: Podagra
  • abuse NSAIDs & steroids
17
Q

whta re the 4 stages of gout?

A
  1. asymptomatic hyperuricemiia
  2. acute flares = urate crystals
  3. intercritical gout = intervals betw acute flares
  4. advanced gout
18
Q

whta re the 4 stages of gout?

A
  1. asymptomatic hyperuricemiia
  2. acute flares = urate crystals
  3. intercritical gout = intervals betw acute flares
  4. advanced gout
19
Q

what test is done to analyse synvoial fluid content?

A

arthrocentesis

20
Q

in which cases do u do arthrocentesis?

A
  • trauma with joint effusion
  • monoarthritis in px with chronic polyarthritis
  • trauma with joint effusion
  • joint infection, crystal-induced arthritis, hemarthrosis
21
Q

what should u consider if effusion is hemorrhagic in arthrocentesis?

A
  • trauma/mechanical detanement
  • coagulopathy
  • neuropathic arthropathy
22
Q

what should u consider to determine osteoarthritis?

A

chronicity = if >6 wks

23
Q

what are features of the joint & hands of osteoarthritis?

A

JOINTS
* INC thickness of subchondral bone
* osteophyte formaiton/bony enlargement
* non-uniform loss of cartilage

HANDS
* DIP = Haberden’s nodes
* PIPs = Bouchard’s nodes
* 1st carpometacarpa joints

24
Q

what are clin features of rheumatoid arthritis?

A
  • morning stiffness of hands
  • limping gait, DEC appetite
  • welling of joints around wrists
  • PIPs swollen, droughlwhen plp
  • Mullet finger, Butonniere deformity, swan neck deformity, chronic synovitis
25
Q

what are the classifications of rheumatoid arthritis?

A
  1. joint involvement
    * 0 = 1 large joint
    * 1 = 2-10 large joints
    * 2 = 1-3 smal joints (MCP, PIP, thumb, ,IP, MTP, wrists)
    * 3 = 4-10 small joints
    * 5 = >10 joints (at least 1 small joint)
  2. serology
    * 0= neg RF A& ACPA
    * 2 = low-positive RF or low positive anti-CCP Abs
    * 3 = high positive RF or high positive anti-CCP Abs
  3. acute phase reactants, duraiton of symptoms
    *0 = <6 wks
    * 1 = >6wks

score of > or equal to 6 = definite RA

26
Q

what are extra-auricular manifestations?

A

neurologic
hematologic
GI
skeletal
endo

27
Q

what is the Systemic Lupus International Collaboratoring Clinic (SLICC) criteria for SLE?

A

Clin manifestations:
* acute, subacute cutaneous LE
* chronic cutaneous LE
* oral or nasal ulcers
* nonscarring alopecia
* synovitis
* serositis
* renal
* neurology
* hemolytic anemia
* leukopenia (<4,000/uL)
* Lymphophenia (<1,000/uL)
* thrombocytopenia (<100,000/uL)

Immuno manifestations
* ANA > ref neg value
* Anti-dsDNA > ref
* Anti-Sm
* antiphospholipid
* low serum complement
* positive direct COOmbs test

fullfillment of atleast 4 (4/11) manifestations w/ atleast 1 in each cat

Medicine I (8 decks)

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