Podcast
Questions and Answers
When examining joint fluid, it is safe to pass a needle through area of cellulitis or plaque
When examining joint fluid, it is safe to pass a needle through area of cellulitis or plaque
False
What is the most common joint disease, known as "the disease of aging"?
What is the most common joint disease, known as "the disease of aging"?
What is NOT a risk factor for the development of osteoarthritis?
What is NOT a risk factor for the development of osteoarthritis?
A patient presents with cartilage degeneration and increase of bone density/mass at a previous injury site. What is likely?
A patient presents with cartilage degeneration and increase of bone density/mass at a previous injury site. What is likely?
Signup and view all the answers
A patient presents with complaints of gradual onset of stiffness, pain and restricted movement of their finger joints (PIP and DIP). The patient otherwise has a normal ROS and PE. What comment would make you think this is osteoarthritis?
A patient presents with complaints of gradual onset of stiffness, pain and restricted movement of their finger joints (PIP and DIP). The patient otherwise has a normal ROS and PE. What comment would make you think this is osteoarthritis?
Signup and view all the answers
A patient complains of stiffness for the last 3-4 months. You decide to get imaging (xray), and find "joint space narrowing, osteophytes, thickened subchondral bone, cysts." What could this be?
A patient complains of stiffness for the last 3-4 months. You decide to get imaging (xray), and find "joint space narrowing, osteophytes, thickened subchondral bone, cysts." What could this be?
Signup and view all the answers
For osteoarthritis, what what labs are likely?
For osteoarthritis, what what labs are likely?
Signup and view all the answers
What are treatment recommendations for osteoarthritis?
What are treatment recommendations for osteoarthritis?
Signup and view all the answers
A male patient (MC) has labs that show the overproduction (or underexcretion) of uric acid. He reports that his mother had this condition as well. What is being described?
A male patient (MC) has labs that show the overproduction (or underexcretion) of uric acid. He reports that his mother had this condition as well. What is being described?
Signup and view all the answers
A patient presents with complaints of intermittent, acute joint pain in their great toe (MTP joint) that is much worse at night. The patient reports mild fevers, chills and fatigue. The recent episode occurred after a large purine-rich meal. On physical exam, you find the patient's great toe to be red, warm, and swollen. The patient is very tender to palpation. What is likely?
A patient presents with complaints of intermittent, acute joint pain in their great toe (MTP joint) that is much worse at night. The patient reports mild fevers, chills and fatigue. The recent episode occurred after a large purine-rich meal. On physical exam, you find the patient's great toe to be red, warm, and swollen. The patient is very tender to palpation. What is likely?
Signup and view all the answers
Gout is commonly associated with what chronic disease?
Gout is commonly associated with what chronic disease?
Signup and view all the answers
What is the initial diagnosis test that should be ordered for a patient with possible gout?
What is the initial diagnosis test that should be ordered for a patient with possible gout?
Signup and view all the answers
You are not sure if your patient has pseudogout or gout. Their joint fluid analysis shows uric acid crystals (needle- like, - birefringent urate crystals). What did you decide?
You are not sure if your patient has pseudogout or gout. Their joint fluid analysis shows uric acid crystals (needle- like, - birefringent urate crystals). What did you decide?
Signup and view all the answers
Your patient has a diagnosis of ______. You are monitoring their condition with x-ray at today's visit. The patient is later the course of ______ and the x-ray shows "punched-out erosions with overhanging bone."
Your patient has a diagnosis of ______. You are monitoring their condition with x-ray at today's visit. The patient is later the course of ______ and the x-ray shows "punched-out erosions with overhanging bone."
Signup and view all the answers
Asymptomatic hyperuricemia does need treatment, it is gout!!
Asymptomatic hyperuricemia does need treatment, it is gout!!
Signup and view all the answers
What cannot be used for the treatment of GOUT?
What cannot be used for the treatment of GOUT?
Signup and view all the answers
A patient with hemochromatosis presents with sudden severe joint pain. PE shows a red, warm joint with limited range of motion. You decided to order radiographs which shows linear calcifications of the cartilage. What is likely?
A patient with hemochromatosis presents with sudden severe joint pain. PE shows a red, warm joint with limited range of motion. You decided to order radiographs which shows linear calcifications of the cartilage. What is likely?
Signup and view all the answers
A 26 year old woman presents to your office with complains of greater than 3 months of widespread MSK pain and stiffness. The patient reports feeling extremely fatigue and does not sleep well at night. On PE, you find nothing remarkable other than point tenderness at the patient's trapezius, knees, and elbows (see image). What is likely?
A 26 year old woman presents to your office with complains of greater than 3 months of widespread MSK pain and stiffness. The patient reports feeling extremely fatigue and does not sleep well at night. On PE, you find nothing remarkable other than point tenderness at the patient's trapezius, knees, and elbows (see image). What is likely?
Signup and view all the answers
This is a correct scenario: A patient with fibromyalgia asks for opiates to help with their chronic pain. They reports bad sleep and many trigger points. You prescribe it for them.
This is a correct scenario: A patient with fibromyalgia asks for opiates to help with their chronic pain. They reports bad sleep and many trigger points. You prescribe it for them.
Signup and view all the answers
A woman in her 40s presents with insidious onset of pain and stiffness in multiple joints bilaterally. On PE, you notice hot, swollen, tender, red joints bilaterally in the hands, knee and ankle (but spares the DIP in the hand). The patient reports that the pain is worse in the morning, but improves throughout the day with activity. What is the likely autoimmune disease?
A woman in her 40s presents with insidious onset of pain and stiffness in multiple joints bilaterally. On PE, you notice hot, swollen, tender, red joints bilaterally in the hands, knee and ankle (but spares the DIP in the hand). The patient reports that the pain is worse in the morning, but improves throughout the day with activity. What is the likely autoimmune disease?
Signup and view all the answers
Chronic systemic inflammatory disease that presents as synovitis/arthritis of multiple joints.
Chronic systemic inflammatory disease that presents as synovitis/arthritis of multiple joints.
Signup and view all the answers
What systemic finding may presents with Rheumatoid Arthritis (RA)?
What systemic finding may presents with Rheumatoid Arthritis (RA)?
Signup and view all the answers
You have a high index of Rheumatoid Arthritis (RA) due to a patient presents with multi-system complaints and symmetric joint swelling. What is the best initial test?
You have a high index of Rheumatoid Arthritis (RA) due to a patient presents with multi-system complaints and symmetric joint swelling. What is the best initial test?
Signup and view all the answers
What finding in the synovial joint fluid is likely for Rheumatoid Arthritis (RA)?
What finding in the synovial joint fluid is likely for Rheumatoid Arthritis (RA)?
Signup and view all the answers
You diagnosis your patient with ____________. At first, the patient had a normal x-ray (first 6 mo), then you repeat to monitor the condition and find "joint space narrowing and erosions, C1-2 subluxation." What is likely?
You diagnosis your patient with ____________. At first, the patient had a normal x-ray (first 6 mo), then you repeat to monitor the condition and find "joint space narrowing and erosions, C1-2 subluxation." What is likely?
Signup and view all the answers
Chronic deformities such as ulnar deviation, boutonniere and swan- neck deformities of PIP and DIP joints, can be seen in what pathology?
Chronic deformities such as ulnar deviation, boutonniere and swan- neck deformities of PIP and DIP joints, can be seen in what pathology?
Signup and view all the answers
A 26 year old AA female presents to your office and reports feeling "terrible." She c/o fatigue, fever, weight loss, joint pain, facial rash, and hair loss. What is a likely cause?
A 26 year old AA female presents to your office and reports feeling "terrible." She c/o fatigue, fever, weight loss, joint pain, facial rash, and hair loss. What is a likely cause?
Signup and view all the answers
What antibody is VERY sensitive for lupus?
What antibody is VERY sensitive for lupus?
Signup and view all the answers
What are the worst cause of symptoms in Systemic Lupus Erythematosus (SLE)?
What are the worst cause of symptoms in Systemic Lupus Erythematosus (SLE)?
Signup and view all the answers
What specific, but not sensitive labs are used to diagnosis Systemic Lupus Erythematosus (SLE)?
What specific, but not sensitive labs are used to diagnosis Systemic Lupus Erythematosus (SLE)?
Signup and view all the answers
Using the diagnostic criteria in the picture, a patient has at least 4 out of 11 findings and is then diagnosed with:
Using the diagnostic criteria in the picture, a patient has at least 4 out of 11 findings and is then diagnosed with:
Signup and view all the answers
A female patient with a history of 4 spontaneous abortions and 1 premature birth presents to discuss fertility. On PE, you notice a mottled violaceous rash (called livedo reticularis). What are you concerned of?
A female patient with a history of 4 spontaneous abortions and 1 premature birth presents to discuss fertility. On PE, you notice a mottled violaceous rash (called livedo reticularis). What are you concerned of?
Signup and view all the answers
A patient with suspected Antiphospholipid Antibody Syndrome (APLA) had labs drawn, all of the following answer choices were positive. What test is most likely falsely positive due to a antibody associated with false positive tests?
A patient with suspected Antiphospholipid Antibody Syndrome (APLA) had labs drawn, all of the following answer choices were positive. What test is most likely falsely positive due to a antibody associated with false positive tests?
Signup and view all the answers
A young woman presents to your office due to concern about her fingers. She reports that her finger tips get very white and cold whenever she is stressed or cold. What is this likely condition?
A young woman presents to your office due to concern about her fingers. She reports that her finger tips get very white and cold whenever she is stressed or cold. What is this likely condition?
Signup and view all the answers
SH initially presented with Raynaud's phenomenon, experiencing episodes of fingers turning white and numb in response to cold temperatures or stress. She also noticed a progressive tightening and thickening of the skin on her fingers, hands, and face, which has been gradually spreading to other parts of her body. This tightening has led to difficulty with finger dexterity, making it challenging for her to perform tasks that once came easily. Her labs: + ANA, anemia, anticentromere ab. What is likely the cause of this disorder?
SH initially presented with Raynaud's phenomenon, experiencing episodes of fingers turning white and numb in response to cold temperatures or stress. She also noticed a progressive tightening and thickening of the skin on her fingers, hands, and face, which has been gradually spreading to other parts of her body. This tightening has led to difficulty with finger dexterity, making it challenging for her to perform tasks that once came easily. Her labs: + ANA, anemia, anticentromere ab. What is likely the cause of this disorder?
Signup and view all the answers
JH is a 60 year old black female that presents with c/o muscle weakness. She reports that it has been gradual and progressively worsening and is now hard to rise from her chair or get up the stairs. She denies any facial or ocular pain. On PE, you notice a rash that is red and present on the face, neck, shoulders, and upper chest (helitrope rash eyelids, poikiloderma chest). You also notice gottron papules on the fingers. What is the likely cause of this muscle weakness?
JH is a 60 year old black female that presents with c/o muscle weakness. She reports that it has been gradual and progressively worsening and is now hard to rise from her chair or get up the stairs. She denies any facial or ocular pain. On PE, you notice a rash that is red and present on the face, neck, shoulders, and upper chest (helitrope rash eyelids, poikiloderma chest). You also notice gottron papules on the fingers. What is the likely cause of this muscle weakness?
Signup and view all the answers
There is a risk of malignancy with dermatomyositis, but not polymyositis.
There is a risk of malignancy with dermatomyositis, but not polymyositis.
Signup and view all the answers
Study Notes
Joint Diseases and Disorders
- It is not safe to pass a needle through an area of cellulitis or plaque when examining joint fluid.
- Osteoarthritis is the most common joint disease, also known as "the disease of aging".
- A patient presenting with cartilage degeneration and increased bone density/mass at a previous injury site is likely to have osteoarthritis.
- A patient with complaints of gradual onset of stiffness, pain, and restricted movement of their finger joints (PIP and DIP) and a normal ROS and PE is likely to have osteoarthritis.
- Imaging (x-ray) findings of "joint space narrowing, osteophytes, thickened subchondral bone, cysts" are consistent with osteoarthritis.
- Labs are not likely to be helpful in diagnosing osteoarthritis.
- Treatment recommendations for osteoarthritis include physical therapy, weight loss, and medications to reduce pain and inflammation.
Gout
- A patient with labs showing overproduction (or underexcretion) of uric acid and a family history of the condition is likely to have gout.
- A patient presenting with complaints of intermittent, acute joint pain in their great toe (MTP joint) that is worse at night, with mild fevers, chills, and fatigue, and a physical exam showing redness, warmth, and swelling, is likely to have gout.
- Gout is commonly associated with chronic kidney disease.
- The initial diagnosis test for gout is joint fluid analysis, which shows uric acid crystals (needle-like, negative birefringent urate crystals).
- X-ray findings of "punched-out erosions with overhanging bone" are consistent with gout.
- Asymptomatic hyperuricemia does not require treatment.
Pseudogout
- Pseudogout is a condition that is similar to gout, but is caused by calcium pyrophosphate crystals instead of uric acid crystals.
- Joint fluid analysis showing calcium pyrophosphate crystals (rhomboid, positive birefringent crystals) is diagnostic for pseudogout.
Hemochromatosis
- A patient with hemochromatosis presenting with sudden severe joint pain, a red, warm joint with limited range of motion, and radiographs showing linear calcifications of the cartilage, is likely to have hemochromatosis-related arthritis.
Fibromyalgia
- A patient presenting with widespread MSK pain and stiffness, fatigue, and poor sleep, and physical exam findings of point tenderness at multiple points, is likely to have fibromyalgia.
Rheumatoid Arthritis (RA)
- A patient presenting with insidious onset of pain and stiffness in multiple joints bilaterally, with hot, swollen, tender, and red joints, and a pattern of morning stiffness that improves with activity, is likely to have RA.
- RA is a chronic systemic inflammatory disease that presents as synovitis/arthritis of multiple joints.
- Systemic findings may include fatigue, weight loss, and fever.
- The best initial test for RA is a rheumatoid factor (RF) test.
- Synovial joint fluid findings of positive RF and anti-citrullinated protein antibodies (anti-CCP) are likely in RA.
- X-ray findings of "joint space narrowing and erosions, C1-2 subluxation" are consistent with RA.
Systemic Lupus Erythematosus (SLE)
- A patient presenting with fatigue, fever, weight loss, joint pain, facial rash, and hair loss, is likely to have SLE.
- The antibody ANA is very sensitive for SLE.
- The worst causes of symptoms in SLE are kidney disease, central nervous system disease, and hematological disorders.
- Specific, but not sensitive labs for SLE include anti-dsDNA, anti-Smith, and anti-ribonucleoprotein.
Other Conditions
- A patient presenting with a mottled violaceous rash (livedo reticularis) and a history of 4 spontaneous abortions and 1 premature birth, is likely to have Antiphospholipid Antibody Syndrome (APLA).
- A patient presenting with Raynaud's phenomenon, and progressive tightening and thickening of the skin on her fingers, hands, and face, is likely to have scleroderma.
- A patient presenting with muscle weakness, a rash on the face, neck, shoulders, and upper chest (heliotrope rash eyelids, poikiloderma chest), and gottron papules on the fingers, is likely to have dermatomyositis.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on safe practices while examining joint fluid, including whether it is safe to pass a needle through areas of cellulitis or plaque.
