Rheumatology Flashcards by Magda Kazmierczak

“tennis elbow”

lateral epicondylitis; MCC of elbow pain

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sx. of tennis elbow

tenderness over lateral epicondyle

pain on resisted wrist extension and hand gripping

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“golfers elbow”

medial epicondylitis

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sx. of golfers elbow

tenderness over medial epicondyle

pain on wrist flexion

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cubital tunnel syndrome

ulnar nerve entrapment

pain and sensory/motor loss in ulnar region
paresthesias in ulnar aspect of arm/hand

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carpet layers elbow

olecranon bursitis

- extremely tender to palpation but does NOT cause restriction or pain with ROM of elbow

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how can you diagnose trochanteric bursitis?

hip pain that pts can point to with one finger on lateral hip; pain worsened with actively resisted abduction

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Tx. trochanteric bursitis

corticosteroid injection

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what type of pain is consistent with hip joint pathology?

pain localized to groin and restricted ROM in hip

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what kind of injury should make you suspect a meniscal tear?

twisting injury of foot in weight bearing position, in which a popping or tearing sensation is felt, followed by severe pain and swelling over several hours

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sx. experienced by pts with meniscal tears

clicking or locking of knee secondary to loose cartilage; but usually pain only on walking, esp stairs

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sensitive and specific tests to dx. meniscal tears

pain along joint line - sensitive

audible pop or snap in McMurray’s test - specific

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pain and tenderness over anteromedial aspect of lower leg just below the joint line of the knee; focal tenderness on the upper, inner tibia about 5 cm distal to medial articular line of the knee

anserine bursitis

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young woman complains of pain in knee when going down steps and development of knee stiffness/pain at rest when knee is flexed for prolonged period of time

dx. patellofemoral pain syndrome

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pt presents with pain when reaching overhead and when lying on their shoulder - dx?

rotator cuff tendinitis

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rotator cuff tendinitis

inflammation of the supraspinatus and/or infraspinatus tendons as well as the subacromial bursa

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adhesive capsulitis

frozen shoulder - decrease range of shoulder motion due to stiffness (not pain or weakness)

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bicipital tendinitis

anterior shoulder pain is elicited with resisted forearm supination or elbow flexion

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pt comes in with arm weakness, esp during abduction and/or external rotation

rotator cuff tear

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how can you diagnose a rotator cuff tear?

positive drop-arm test (inability to smoothly lower affected arm from full abduction)

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what is the next step in management of someone with referred shoulder pain?

CXR - helps identify underlying intrathoracic process (apical lung tumor, effusion,PTX)

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how do you treat a pt with polymyalgia rheumatica who is having flares on steroid tapering?

give min. dose of steroids that prevents symptoms and add steroid-sparing agent such as Methotrexate

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empiric therapy of choice for community acquired septic arthritis w/ synovial fluid positive for gram positive cocci

Vancomycin - increase in MRSA strains

- may switch to oxacillin or cefazolin once culture results are present

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what is MRI of joints useful for?

detecting avascular necrosis
soft tissue masses
collections of fluid not visualized by other modalities

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gold standard for diagnosing prosthetic joint infection

arthrocentesis with culture

CF in prosthetic joint infection

mostly pain fever, leukocytosis absent elevated ESR

pt who had arthroplasty many years ago presents with pain in proximal and medial aspect of the thigh that is worse with weight bearing

aseptic loosening

radiograph finding in aseptic loosening

osteolysis

what drugs can you use in an acute gout attack

NSAIDs - first line corticosteroids colchicine

when is colchicine most effective in tx. gout

pts with monoarticular involvement | when used w/in first 24 hours of attack can abort the attack

when can you begin uric-acid lowering therapy in gout pts?

when pt has atleast 2 documented cases of gout; never during an acute attack

what is the target serum uric acid level in gout therapy?

< 6.0 mg/dl - at this conc, monosodium urate crystals are resorbed

what else should you give a pt before initiating allopurinol?

prophylactic colchicine OR low dose steroids OR NSAIDs - atleast for 1 week before

chronic apatite deposition disease

large, minimally inflammatory effusions that develop in shoulder or knee; destruction of associated tendon structures and chronic pain

first line management option for pts with OA of the knee

physical therapy - esp. quadriceps muscle training

chronic pain at the base of the thumb suggests..

OA of first carpometacarpal joint

"grind test"

movement of thumb in circular direction elicits pain in OA

finkelstein test

flexing thumb into palm, closing fingers over thumb and bending wrist elicits pain in De Quervain tenosynovitis

pt presents with pain on palpation of the distal aspect of the radial styloid

de Quervain tenosynovitis

which tests can be used to test for Carpal tunnel syndrme?

Tinel sign - tapping flexor retinaculum | Phalen sign - flexing the wrists against each other

next best step in pt with OA that acetaminophen isnt helping?

NSAIDs, ie. ibuprofen

next pharmacologic intervention in pt with OA in whom NSAIDs are not helping

intra-articular corticosteroids or hyaluronan injections

radiograph showing marginal joint erosions would support a diagnosis of..

rheumatoid arthritis

what chronic infection can RF be positive in?

chronic hepatitis C

in which RA patient is methotrexate not warranted as first line DMARD therapy?

those who consume alcohol regularly -> increases risk of hepatotoxicity

what DMARD is warranted in a patient with early, mild and nonerosive RA?

hydroxychloroquine | - esp if pt has contraindications to methotrexate

what should you suspect in pts with explosive onset, widespread psoriasis along with DIP joint involvement, asymmetric joint involvement and symptoms of enthesitis or joint ankylosis?

untreated HIV infection

presence of acute oligoarticular arthritis involving the lower extremities in a patient with inflammatory diarrheal illness suggests...

enteropathic arthritis

patient has pain in the eye, sensitivity to light and blurred vision - dx?

acute anterior uveitis

acute anterior uveitis (unilateral) is strongly associated with..

HLA-B27 arthropathies, esp, ankylosing spondylitis

MC diagnosed systemic illnesses associated with anterior uveitis (3)

ankylosing spondylitis reactive arthritis sarcoidosis

definitive test to diagnose ankylosing spondylitis

MRI (with gadolinium enhancement )of sacroiliac joints

young pt presents with persistent pain and morning stiffness involving the lower back that is alleviated with activity; there is accompanying tenderness of the pelvis

consider a diagnosis of ankylosing spondylitis

what tests can be done to confirm presence of SLE?

1. anti-dsDNA ab | 2. measure complement C3, C4 and CH50 levels

which antibody is associated with development of interstitial lung disease in scleroderma?

anti-Scl70

antihypertensive drugs of choice in SLE?

ACEi - help control proteinuria as well

what is initial tx. when you suspect lupus nephritis in pt?

high dose prednisone

skin condition characterized by central telengiectasias, flushing and acneiform papules/pustules

rosacea

the classic malar rash typically spares what area of the face?

nasolabial folds - relatively protected from the sun

most appropriate tx. for Raynaud's phenomenon in systemic sclerosis

dihydropyridine CCB i.e. amlodipine

young female presents with diffuse pain on both sides of the body, above and below the waist as well as axial skeletal pain - dx?

fibromyalgia

lab findings frequently present in pts. with Sjogren's syndrome

Ro/SSA and La/SSB abs ANA RF hypergammaglobulinemia

MC organ involved in PAN

kidney - causes HTN, kidney insufficiency and renal vasculitis

diagnosis of PAN (2)

1. sural nerve biopsy | 2. kidney angiography

angiographic findings in pts with PAN

microaneurysms or a beaded pattern with areas of arterial narrowing and dilation

Tx. of suspected PAN

immunosuppressive therapy - steroids, cyclophosphamide (if severe)

what should you consider in a pt with upper and lower airway manifestations, renal involvement and inflammatory arthritis

Wegener's granulomatosis

ab's that are specific for Wegeners

c-ANCA | anti-proteinase 3 ab

what do you do next if you suspect giant cell temporal arteritis in a patient?

IV steroids (methylprednisone) - initiate treatment before doing any diagnostic test

gold standard for dx. of temporal arteritis

temporal artery biopsy

patient presents with pain in the shoulder and hip girdle accompanied by significant elevation in ESR

suspect polymyalgia rheumatica

Rheumatology Flashcards

(71 cards)