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24 Cards in this Set
- Front
- Back
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A 75 y/o women complains about deep aching pain in her hands, worse with use. She mentions early morning stiffness and demonstrated limited range of motion. On examination, you see Heberden's nodes, Bouchard's nodes.
1. What is the likely diagnose? 2. What would you see on x-ray of her hands? 3. At this stage, how would you manage her? |
1. OA
2. X-ray: - narrowed joint space - Gull wing deformity - osteophytes - sclerosis of subchondral bone 3. Early stage can be treated with acetominophen or NSAIDs |
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Your colleage shows you an X-ray of a patient's spine. You can see disc space narrowing, "bridging" osteophytes, and sclerosis.
1. What is the diagnosis? 2. What are the anatomical changes happened in the intervertebral joints? 3. What symptoms might this patient have related to the film findings? |
1. OA
2. Anatomical changes: - degeneration of articular cartilage -> eburnated surface - subchondral cyst - narrowed joint space - reactive osteophytes perpendicular to the spine 3. neurological deficits, radicular pain, muscle spasm, muscle atrophy. (osteophyte might compress on the nerve roots.) |
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A radiology technician shows you an X-ray of a patient's left hand. You can see the so called Gull winged deformity at the PIP joint.
1. What is the cause of this deformity? 2. What is the diagnose? |
1. causes:
- joint space narrowing - reactive osteophytes at the margins of the joints 2. OA |
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A 65 y/o lady present with a lump on her right elbow. She also complains about painful joints in her hands, feet,and neck region. These joints are stiff especially in the mornings. On examination, affected joints are PIP, MCP in both hands, MTP in both feet. Her hands look severily deformed, look like a swan-neck. You order X-rays for the C-spine and hands.
1. What is the lump on her elbow? 2. What might you see on her x-rays? 3. What's her likely disease? 4. What labs should you order to make the diagnosis? 5. What are some other physical findings? 6. How to treat her? 7. What are some considerations for her future surgeries? |
1. Rheumatoid nodule
2. Hand x-ray: juxta-articular osteopenia C-spine x-ray: C1-C2 subluxation 3. RA 4. Latex agglutination for RF (other 6 criteria already met) 5. eyes, heart, lungs, vessels 6. NSAIDs for immediate relif. DMARD, anti-TNF-alpha, anti-B cell drugs for disease treatment. 7. awake nasal tracheal intubation or endoscopy-guided intubation |
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A 67 y/o man presents with chronic cough and shortness of breath. X-ray showed multiple pulmonary nodules. Also seen on x-ray are bony erosions/juxta-articular. On examiantion, both hands are deformed(flexion of PIP and hyperextension of DIP). Skin ulcers are seen on his toes. He also has visual deficits.
1. What do you suspect he has? 2. What is the hand deformity called? 3. What is the cause of his skin ulcers? 4. What might be the caues of his vision problem? 5. What might his HLA type be? |
1. Caplan's syndrome
2. Boutonniere deformity 3. Skin ulcer: rheumatoid vasculitis 4. scleritis/scleromalacia 5. HLA DRB1 |
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A 62 y/o man presents with fever, anorexia, fatigue, and weight loss. He has painful joints in multiple areas, including both hands and feet. His RF is tested positive. His spleen is enlarged. CBC showed granulocytopenia.
1. What is the disease? 2. What is his HLA type? |
1. Felty's syndrome
2. HLA-DR4 |
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A 12 y/o kid comes in with fever and a skin rash. He also complains about pain in his knees, elbows, and ankles. This has been going on for 2 months.
1. What tests should you order and what might be the results? 2. What do you suspect he has? 3. What is the usual duration for this disease? 4. What is his HLA type? |
1. RF latex agglutination (-) and ANA test (+)
2. juvenile rheumatic arthritis 3. more than 10 yrs 4. HLA DRB1 |
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A 40 y/o lady presents with ulnar deviation involving 2nd to 5th fingers. There is no bony erosions on X-ray. You also notice discoid rash along the hair line on the frontal area. She also has thin hair, anemia. History showed episodes of seizures, raynaud's phenomenon, oral ulcers, pleurisy.
1. What is her joint problem called? 2. What is the disease? 3. What labs should you order and what might be the results? 4. Which other problems should you worry about? |
1. Jaccoud's arthropathy
2. SLE 3. ANA test: anti-dsDNA, anti-Sm, ANA. 4. nephritis: class IV is the worst |
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A 3 day old infant develops skin rash, anemia, hepatomegaly, and heart block.
1. What lab tests should you order? 2. What is the likely diagnose? 3. What is present in this kid's serum? 4. What can you say about the mom's condition? |
1. ANA test
2. neonatal lupus 3. maternal anti-SSA, anti-SSB 4. mom has anti-SSA, anti-SSB. She might have SLE, Sjogren's, subacute cutaneous lupus. |
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A well-controlled HTN patient presents with skin rashes, oral ulcers, and pleurisy. History showed he has been on hydralzine for a long for his HTN.
1. What is likely the cause of his symptoms? 2. What test results confirms your suspision? |
1. drug-induced SLE
2. ANA test: antibodies to histones. |
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A patient complains about dtyness in the eye and mouth. ANA test is negative for anti-SSA and SSB. The patient mentioned trouble dealing with allegy this year, tried many medications for it.
1. Now what do you suspect the cause of her symptoms? |
Side effects of medications such as antihistamines, decongestants she might have tried for her allergy.
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A 30 y/o female complains about dryness in the mouth and eyes. Both her parotid glands are enlarged.
1. What lab test helps the diagnosis? 2. What does she has? |
1. ANA test for anti-SSA, anti-SSB
2. Sjogren's syndrome |
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A patient comes in with oral and occular dryness. ANA test is negative for anti-SSA or SSB. He complains abour fatigue, weakness, and weight gain. You sensed his mood is depressed.
1. What other test may be helpful diagnosing him? 2. What is the cause of oral dryness in his case? |
1. Thyroid level test
2. Hypothyroidism |
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A yong adult presents with hard skin, and a skin rash called "morphea" on the face. He is otherwise healthy.
1. What is the disease? be specific. |
Localized scleroderma
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A 60 y/o lady presents with hardened skin only on her hands, especially at the tip of the fingers. X-ray of the hands showed calcium deposits at DIP. Telangiectasia is present on her face. She also complains about dysphasia. Other finds include pulmonary hypertension and episodes of Raynauds phenomenon.
1. What is the diagosis? be specific. 2. What will ANA test show? |
1. Limites scleroderma. She has the full CREST features.
2. ANA: antibodies to centromere. |
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A 62 y/o lady presents with hardened skin on her hands, extending to her wrists, some areas on her face and trunk. X-ray of the hands showed calcium deposits at DIP. Telangiectasia is present on her face. She also complains about dysphasia. Other finds include pulmonary hypertension, pulmonary fibrosis, nephritis, cardiac arrythmia, and episodes of Raynauds phenomenon.
1. What is the diagosis? be specific. 2. What will ANA test show? |
1. Diffuse scleroderma. She has the full CREST and internal organ involvement.
2. ANA: anti-SCL-70 (topoisomerase) |
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A 30 y/o male has slow onset of low back pain, worse in the morning and with inactivity. X-ray showed boxcar spine.
1. What is the likely disease? 2. Is there a genetic component to it? 3. Which physical exam aids in the diagnosis? 4. What stage of disease is he in? 5. How to treat him? |
1. Ankylosing spondyloarthritis
2. Genetic: HLA B27 3. Schober's test 4. early in the disease process 5. NSAIDs, physical therapy, sulfasalzine |
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A 40 y/o presents with low back pain and pain in his right heal. X-ray showed dense region in sacroiliac junction, and bamboo like spine. Foot X ray showed spurs on the calcaneous bone.
1. What is his disease? 2. What is the cause of his foot problem? 3. What is the technical name for his spine manifestation? 4. What other problems might he have? |
1. Ankylosing spondyloarthritis
2. achilis tendonitis and calcaneal fasciitis 3. syndesmophytes 4. other problems: AAU, AI, cauda equina, C1-C2 subluxation, renal amyloidosis, apical fibrosis |
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A 42 y/o man presents with acute anterior uvieitis, low back pain mostly in the morning. He has a positive Schober's test.
1. What does he have? 2. What is his HLA type? 3. How to treat him? |
1. Ankylosing Spondyloarthritis
2. HLA B27 3. physical therapy, NSAIDs for his back. Pupil dilator or occular steroid for his eye. |
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A 34 y/o women presents with red eye, one knee is swollen, painful, but not red, oral ulcers, brittle nails. Upon further questioning, she had diarrhea a month ago.
1. What is her disease? 2. What are some possible cause of her diarrhea a month ago? 3. How to treat her? |
1. Reiter's syndrome
2. salmonella, shigella, yersinia, campylobacter 3. NSAIDs or intra-articular injection for her knee |
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A middle aged man presents with sausage toes and skin manifestations on the sole of his feet that is hyperkeratotic, vesicular. His eyes are redish and he also has some morning stiffness in his back.
1. What is his disease? 2. What is the skin problem called? 3. What is the cause of the sausage toes? 4. What history of illness might he have 4 wks ago? 5. How to treat him? |
1. Reiter's syndrome
2. Keratoderma blenorrhagia 3. inflammation of tendon insertions and synovium 4. diarrhea or prostatitis 5. NSAIDs or injection for joint, topical steroid for skin problem. |
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A 40 y/o man presents with a sausage looking DIP joint and fungal looking nails. He also mentions low back pain. His ANA test is negative. On examination, there are some skin rashes in the umbilical region.
1. What is likely the diagnosis? be specific. 2. How to treat him? |
1. Psoriatic arthritis, DIP subtype.
2. NSAIDs for the joints, methotrexate for skin. |
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A patient presents with joint problems in his left hand and low back pain worse in the morning. X-ray showed pencil-in-cup MCP and fusion of sacro and iliac bone. Other findings: pulmonary fibrosis, aortic insufficiency.
1. What is the disease? be specific. |
1. Psoriatic arthritis, arthritis mutilan and sacrolitis subtypes
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A 33 y/o lady presents with low back pain worse in the morning, skin rashes that are erythemous nodosum. History showed she has Crohn's disease.
1. What is her diagnosis? 2. What is the cause of her rashes? |
1. arthritis associated with IBD
2. inflammtion of fat cells under the skin |
