Flashcards in Rheumatology Deck (24):
What joint conditions are associated with diffuse joint pain and early morning stiffness?
What joint conditions are associated with localised joint pain and not with early morning stiffness and no joint swelling?
What joint conditions are associated with early morning stiffness and diffuse pain?
What joint conditions are associated with monoarticular joint swelling, localised pain and early morning stiffness?
What joint conditions are associated with polyarticular joint swelling, localised pain and early morning stiffness?
Which bacteria normally causes cellulitis?
What kind of joint conditions are associated with early morning stiffness?
Ones of immunological origin
eg polymyalgia rheumatica, inflammatory myositis, septic arthritis, crystal arthritis, reactive arthritis, spondyloarthritis, viral arthritis, SLE and rheumatoid arthritis
What joint conditions are associated with diffuse pain and DO NOT have early morning stiffness
Chronic pain syndrome
What are the five key questions which need to be asked in a joint pain history?
Does the problem arise from the joint, tendon or muscle?
Is the condition acute or chronic?
Is the condition inflammatory or non-inflammatory?
What is the pattern of affected areas/joints?
What is the impact of the condition on the patient's life?
What are the main symptoms of musculoskeletal conditions?
Pain, stiffness and joint swelling
What are the common patterns of joint involvement in MSK conditions?
Monoarticular - One joint
Pauciarticular - Less than four joints affected
Polyarticular - A number of joints affected
Axial - The spine is predominantly affected
What is the usual distribution of rheumatoid arthritis?
Polyarticular and symmetrical
(but early RA can affect any pattern)
What is the timeframe of gout characterised by?
Acute attack - these often start in the middle of the night, become excruciatingly painful within a few hours, and respond well to NSAIDs
What is the general definition of a chronic MSK condition?
One lasting more than 6 weeks
What additional symptoms are important to ask about?
Fatigue and depression?
What are the main things you are looking for in the gait part of a GALS exam?
Is the gait smooth and symmetrical?
Can the patient turn?
With the patient standing observe bulk and symmetry of gluteals, quads, calfs and shoulders
Equal level of iliac crests?
What are the main components of the spine aspect of a GALS exam?
Scoliosis, kyphosis or lordosis?
Assess lateral flexion of the neck
Ask the patient to bend to touch their toes whilst palpating the movement of the vertebra
What are the main components of the arms aspect of the GALS exam?
Ask the patient to put their hand behind the head
With patients hands held out, palms down, finger outstretched, observe for swelling/deformities
Ask patient to turn their hands and observe muscle bulk and any abnormalities
Assess power grip, pincer grip and precision pinch
Squeeze MCP joint to check for tenderness
What are the main components of the legs aspect of the GALS exam?
Assess full flexion and extension of both knees, feeling for crepitus
With the hip and knee flexed at 90*, assess internal rotation
Perform a patellar tap
Inspect feet for swelling, deformity and callosites on the soles
Squeeze across MTP
What are the three questions you ask at the beginning of a GALS examination?
Do you have any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?
What are the radiographic features of osteoarthritis?
Narrowing of the joint space
What are the main radiographic features of rheumatoid arthritis?
Soft tissue swelling
Ill-defined, marginal erosions
Loss of joint space
What are the main radiographic features of gout?
Asymmetrical soft-tissue swelling
Well-defined periarticular erosions