2993807
Descripción
Fichas por esther.westwood, actualizado hace más de 1 año
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Creado por esther.westwood
hace alrededor de 9 años
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| Pregunta | Respuesta |
| What are the top 4 rheumatic diseases by prevalence? (With percentages) Can you remember any other rheumatic diseases? | 1. Back pain (30%) 2. Regional 'soft tissue' pain (20%) =4. Knee Osteoarthritis and Osteoporosis (both 10%) Other rheumatic disease: hip osteoarthritis (4%), fibromyalgia (2%), gout (2.5%), rheumatoid arthritis (1.3%), ankylosing spondylitis (0.2%), psoriatic arthritis (0.1%), polymyalgia rheumatica (0.04%), lupus/connective tissue disease/myositis (0.03%) |
| 1. What are the 2 rheumatic diseases with greater male prevalence? 2. What are the 2 rheumatic diseases with equal male:female prevalence? | 1. Gout and Ankylosing spondylitis 2. Hip osteoarthritis and Psoriatic arthritis |
| At what age do people commonly get a) fractures from osteoporosis b) hip fractures from osteoporosis c) rheumatoid arthritis d) ankylosing spondylitis e) polymyalgia rheumatica f) lupus/CTD/myositis | A) >60 B) >85 C) >40 D) 20s-30s E) >60 (and not before) F) 20s-40s |
| A) At what age is knee OA more common? B) At what age is hip OA more common? | A) >40 B) >50 |
| What are the first symptoms and relevant investigation findings in polymyalgia rheumatica? | Gradual onset of shoulder/hip stiffness. Raised CRP/ESR |
| What predisposes someone to knee OA? | Genetics, previous injury, obesity, weight-bearing occupations |
| What predisposes someone to hip OA? | Developmental disorders, occupation |
| What are the symptoms of Juvenile Idiopathic Arthritis and what sort of arthritis is it? | SYMPTOMS: jaw development problems; excess finger growth in 1 finger or asymmetric leg/foot growth due to increased blood supply to the epiphysis It is AUTOIMMUNE. May be RF+ or RF-, may be ANA+ |
| Label the joint | |
| What is the 'bare area' of a joint? | An area within the capsule that is not protected by cartilage. It is prone to damage if the joint becomes swollen. |
| Which joints contain fibrocartilage as well as hyaline cartliage? | Knee, elbow, wrist |
| Which bursae are likely to become inflamed? | Large joints: knee, elbow, ankle |
| What is the enthesis? | The fibrocartilagenous area where the tendon inserts into the periosteum of the bone. Commonly becomes inflamed in psoriatic arthritis and ankylosing spondylitis (enthesitis). This causes the periosteum to produce new bone, which can be seen along the shaft of the bone on x-ray |
| Where does joint pain tend to radiate from a) the hip b) the knee c) the spine? | Generally distally A) Thigh and knee B) Shin C) Radicular pain into the arm/leg if there is pressure on the nerve roots |
| What type of problem is it likely to be if joint pain is worse A) upon use B) at rest C) at night? | A) Mechanical B) Inflammatory C) Infection, cancer or severe destruction of the joint |
| What is the typical pattern of morning stiffness of a) OA b) RA c) AS? | A) Gets better within 20-30 minutes of getting up but recurs on sitting down/inactivity B) Still present over 30-45 minutes after getting up C) Lower back and buttocks are stiff upon waking but improve after 30 minutes of activity. It then returns in the evening, worse. |
| What does swelling in OA indicate? | Production of new bone |
| What are the symptoms of systemic rheumatic illness? | Fatigue, weight loss, night sweats, 'feeling ill' |
| What does the 'attitude' of a joint mean? | How it is held |
| What might splinter haemorrhages indicate in rheumatology? | Vasculitis/SLE |
| If the pain is A) on the joint line B) away from the joint line where is the problem? | A) intra-capsular B) peri-articular, e.g. tendon strain, muscle damage |
| If a joint cannot be moved any further on passive movement than active movement, what type of problem is likely? | Mechanical |
| If a joint can be moved further on passive than active movement, what type of problem is likely? | Extra-articular |
| What condition does A) genu varus B) genu valgus predispose to? | A) Medial OA B) Lateral OA |
| What deformity is this? | Boutonniére's deformity |
| What deformity is this? | Swan neck deformity |
| What deformity is this? | Metacarpo-phalangeal joint subluxation |
| When muscle wasting is a) local b) global what is the likely pathology? | A) Tendinitis, a nerve problem etc B) OA |
| What is lateral DIP instability caused by? | Erosive OA |
| What are the following swellings over the olecranon bursa likely to be? A) Soft and fluid filled B) Soft and not fluid filled C) Hard D) Xanthelasma elsewhere on the body | A) Bursitis B) Lipoma C) Gouty tophi D) Cholesterol deposit |
| Where does swelling most commonly occur in OA and what is it? | In the hand: DIP and PIP joints (not MCP usually) Osteophyte formation - pathological production of extra bone to try and repair damage. The swelling is lateral and posterior on the joint and when it is actively forming, it is red and tender. The redness/tenderness tends to resolve over a few months. |
| What are the major causes of erythema over joints? | Sepsis Crystals (e.g. in gout and calcium pyrophosphate arthritis) |
| What are the typical timings of symptoms in an episode of gout? What happens to the skin? | Abrupt onset of pain. Time to maximum pain is <12 hours. Lasts up to 2 weeks (usually 3-5 days before starting to improve) As the inflammation is settling, the skin tends to peel off |
| What is dactylitis and what disorder is it common in? | Swelling of an entire digit Tends to be autoimmune in origin, commonly psoriatic arthritis |
| A) What is stress pain? B) What condition gives universal stress pain? C) What condition gives selective stress pain? | A) Increasing pain towards extremes of movement B) Synovitis (inflammation of the joint lining) C) A localised lesion in/around a joint |
| A) What is the loose pack position? B) What is the tight pack position? | A) Position at which the capsule is at its loosest B) Position at which the capsule is at its tightest and least able to accommodate a rise in pressure |
| What is a) fine crepitus and b) coarse crepitus a sign of? | A) Localised inflammation in the peri-articular region B) Cartilage damage in the joint - it conducts through bone and air |
| Where is a) hip pain and b) shoulder pain likely to radiate to? | A) Into the groin and down the thigh (thigh more common in OA, it improves on rubbing) B) Down the arm |
| ARTHROPATHY A) Where will tenderness be? B) Will passive or active movement be more restricted? C) Where will swelling be? D) What will be warm? E) What type of crepitus will be present? F) Where will muscle wasting be? | A) In the joint line B) Passive=active C) Capsular D) Diffuse/joint E) Coarse (+/- fine) F) Globalised |
| PERIARTICULAR LESION A) Where will tenderness be? B) Will passive or active movement be more restricted? C) Where will swelling be? D) What will be warm? E) What type of crepitus will be present? F) Where will muscle wasting be? | A) Periarticular B) Active>passive C) Localised periarticular D) Localised E) Fine F) Localised |
| What are the signs/symptoms of synovitis? | First sign = warmth (+) Stiffness (+++) Stress pain (+, specific sign) Soft tissue swelling (+) Effusion (+++) |
| What are the signs/symptoms of joint damage? | Stiffness (+/-) Effusion (+/-) Crepitus (+++) Deformity (+) Instability (+) |
| What is the Beighton score? | A score for hypermobility. Extend little finger >90 = 1 point each Bring thumb to touch forearm = 1 point each Extend elbow >10 = 1 point each Extend knee >10 = 1 point each Touch floor with flats of hands = 1 point Max score = 9 (6 = hypermobile) |
| A) What percentage of the population are hypermobile? B) What is hypermobility a risk factor for? C) Which diseases can it be a sign of? | A) !0% B) Pain and dislocation C) Marfan's, Ehler Danlos |
| Where are the typical tender sites in fibromyalgia? | Low cervical spine (interspinous ligaments) Mid point of trapezius Skin roll tenderness of skin overlying trapezius Mid supraspinatus Pectoralis, maximal lateral to the second costo-chondral junction 1-2cm distal to lateral epicondyle of elbow Upper gluteal area Low lumbar spine (interspinous ligaments) Medial fat pad of knee |
| What is the theory of fibromyalgia aetiology? | A regional pain syndrome/disease or illness/anxiety or life crisis leads to sleep disturbance. Sleep becomes non-restorative, leading to pain, fatigue and functional disturbance. These lead to reduced activity and poor aerobic fitness, which lead back to non-restorative sleep, and the cycle continues. |
| How many joints is A) monoarthritis B) oligo/pauci-arthritis C) polyarthritis? | A) 1 B) 2-4 C) >4 |
| What sort of injury has acute onset, predisposing trauma, a single regional pain syndrome that occurs on one or a few movements and is non-progressive, localised tenderness with no/mild signs of inflammation and no constitutional upset? The pain is reproduced by resisted active movement and stress tests. | Overusage/strain injury |
| Which diseases cause nodules with arthropathy? | Rheumatoid arthritis Gout (gouty tophi) Hyperlipidaemia (xanthomata) Lupus (small) Rheumatic fever Multicentric reticulohistiocytosis Polyarteritis nodosa Sarcoidosis If one large nodule, consider cancer |
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