Rheumatological/Degenerative Spinal conditions

Question 1

Degenerative disc disease ss

Answer 1

pain w motion, relieved by rest
morning stiff <1/2hr
Joint instability
locking
bony enlargement

Question 2

Degenerative joint disease ss, px

Answer 2

ss- joint pain w motion and relieved w rest, short duration stiffness<30mins, joint instability/locking

px- joint line tenderness, bony enlargement, malalignment, limitation of ROM

Question 3

Where is DJD seen in hand

Answer 3

dip
pip
cmc
1st mcp

Question 4

Osteoporosis ss/ px

Answer 4

ss- asymptomatic, height loss due to collapsed vertebrae (>6cm from peak height)

px- DEXA scan <2.5

Question 5

Fibromyalgia px, pom

Answer 5

11/18 specific points on a persons body to see how many of them were painful when pressed. Easy fatiguability, sleep disturbance, associated with IBS

pom: pain relievers and antidepressants

Question 6

Rheumatoid Arthritis ss

Answer 6

S/s- morning stiffness >1hr, improves with use /worsens with rest . Affects many joints and impacts other systems. Symetric

Question 7

RA- areas it affects and joint deformities

Answer 7

PIP, MCP, NOT 1st CMC, elbow, shoulder, knee, ankle, c spine

Boutounniere, swan neck, claw toe, hammer toe

Question 8

RA- blood tests

Answer 8

Rheumatoid factor
Anti-CCP

Question 9

Chronic fatigue syndrome

Answer 9

ss- post-exertional malaise, unrefreshing sleep, impaired cognitive, orthostatic intolerance

Question 10

Gout- SS, px

Answer 10

ss- single episode progressing to recurrent episodes of acute arthritis

px- severe pain, redness, joint swelling, reduced ROM

Question 11

Precipitating factors to Gout

Answer 11

Drugs (FACT)
-Furosemide
-Asprine
-Cyclosporine
-Thizide diuretics

Foods (SALT)
-Seasfood
-Alcohol
-Liver/Kidney
-Turkey

Question 12

Raynauds Phenomenon- ss, px (tests)

Answer 12

ss- cold fingers and toes, color changes in skin in response to stress/temo

px- ANA and ESR elevated

Question 13

Anklylosing Spondylitis- ss

Answer 13

mid and lower back staff, morning stiffness >1h, night pain, SI joint, M:F 3:1, <40yold

Question 14

AS physical

Answer 14

Decreased ROM, decreased Schober, decreased chest to wall (normal >5cm). Increased occiput to wall distance >5cm

Question 15

Polymyalgia Rheumatica- ss/px

Answer 15

ss- muscle pain/stuffness in shoulders/hips (prox mm), morning stiffness >1hr, no mm weakness

Question 16

Polymyalgia Rheymatica- Px

Answer 16

Elevated ESR and C-reactive protein
Tender mm but no weakness/atrophy

Question 17

Psoriatic Arthritis- ss (physical manifestations)

Answer 17

Morning stiff >30mins, dactylics, well-demarcated erythematous plaques with silvery scales, Nails (pitting, transverse or longitudinal ridging)

Question 18

psoriatic arthritis px (xray findings)

Answer 18

pencil in cup deformity, mouse ear erosions, sausage digits

Question 19

Sjogren Syndrome- ss

Answer 19

dry eyes and mouth, arthralgia, sinusitis, renal disease, neuropathies

Question 20

Scleroderma- ss

Answer 20

rare autoimmune disorder, CREST
-calcinosis
-Raynauds
-Esophageal dysmotility
-Sclerodactyly
-Telangiectasia

Question 21

Scleroderma lab work (3)

Answer 21

ANA
Scl-70
Anti-cenromere

Question 22

Idiopathic inflammatory myopathy def, SS

Answer 22

autoimmune disease characterized by proximal mm weakness + pain

ss- pt can’t get up from seated pos w/o using arms/mm pain , prox mm weakness progressive

Question 23

Idiopathic inflammatory myopathy px (+ 3 blood markers)

Answer 23

Gottons papules
Gottrons sign (erythematous smooth patches)
Heliotrope rash (rash over eyelids)
Shawl sign

CPK and aldolase, Anti-jo-1, ANA

Question 24

SLE- ss/def

Answer 24

MC: F, 13-40, african americans

ss- photosensitivity, molar rash, discoid rash, oral ulcers, polyaralgia

Question 25

SLE- lab (4)

Answer 25

ESR ANA anti-dsDNA anti- SM

Question 26

DISH ss (MC loc), px

Answer 26

ALL ossification mc in diabetics and asians mc power t/s, C/s ss- stiffness, pain, ROM loss, difficulty swallowing px-thick flowing ossification of the ALL at least 4 contagious segments

Question 27

Juvenile idiopathic arthritis- def, ss, mc type

Answer 27

<16yold M=F stills disease- one/two daily fever slides, arthritis may occur weeks/months later, Oligo (large joints mc), Symmetrical

Question 28

Juvenile idiopathic arthritis lab (stills/oligo/poly)

Answer 28

Stills-elevated ESR, CRP, WBC, platelet Oligo- ANA pos, RF neg Poly- RF pos`

Question 29

Osteochondritis dissecans- ss

Answer 29

jt condition in which bone under cartilage dies due to lack of blood flow ss- pain w activity, swelling and tenderness, joint poping/locking, decreased ROM

Question 30

Osteochondritis dissecans- px, Mc loc

Answer 30

xray shows fragments in joint Reduced ROM (locking in extension) -85% involve medial femoral condyle (lat aspect)

Question 31

Osteomalacia cause, px signs

Answer 31

softening of bones in adults due to vit D def, probs w calcium, phosphorus metabolism px- pseudo fractures on Xray (loosers line) and potentially softening (protrusio acetabuli/bowing), loss of cortical def

Question 32

Reiters syndrome ss, mc cause

Answer 32

peripheral arthritis and one or more extra articular manifistations that occur after infections of the GI or GU (mc chlamydia) ss- Asymetric arthritis, dactylics, iritis, urethritis/cystitis

Question 33

Reuters syndrome lab

Answer 33

HLA B27 +, elevated ESR/CRP sacroilitis unilateral or asymmetrical, non marginal syndesmophytes

Question 34

Osteomalaciagenesis imperfecta- ss (4), px (xray)

Answer 34

ss- osteoperosis, blue sclerae, dentinogenisis imperfecta (peg teeth), hearing issues px- diffuse osteopenia, pencil thin cortices, multiple fx, bowing