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20 Cards in this Set
- Front
- Back
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252. General characteristics of fibromyalgia?
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a. Adult women account for 80 to 90% of cases
b. chronic non-progressive course with waxing and waning in severity; many patients improve with time |
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253. What is the key to diagnosis of fibromyalgia?
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a. Multiple trigger points (points that are tender to palpation)
b. Symmetrical c. 18. Characteristic locations have been identified including: 1. Occiput 2. Neck 3. Shoulder 4. Ribs 5. Elbows 6. ASS 7. Knees |
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254. Aetiology of fibromyalgia?
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a. Unknown-somatization is not a proven cause.
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255. Clinical features of fibromyalgia?
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a. Stiffness!!!!
b. Body aches (musculoskeletal), fatigue i. pain is constant in 18, and is aggravated by weather changes, stress, sleep deprivation, and cold temperature. ii. It is worse in the morning c. rest, warmth, and mild exercise improve the pain d. the patterns are disrupted, and sleep is a unrefreshing e. anxiety and depression are common |
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256. Diagnostic criteria for Fibromyalgia?
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a. Widespread pain, including axial pain for at least three months.
b. He at least 11 of 18 possible tender point sites |
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257. Before confirming the diagnosis of fibromyalgia, what 11 condition should you r/o/consider (just overview)?
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1. Myofascial syndromes
2. rheumatoid disease 3. polymyalgia rheumatica 4. ankylosing spondylitis 5. spondyloarthropathy 6. chronic fatigue syndrome 7. Lyme disease 8. Hypothyroidism 9. Polymyositis 10. depression and somatization disorder 11. hypertrophica osteoarthropathy |
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258. treatment and management of fibromyalgia?
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a. Advise the patient to stay active and productive
b. meds are generally not effective c. SSRIs and TCAs have shown some effect and may be beneficial d. avoid narcotics e. Cognitive-behavioral therapy (CBT), exercise, consider psychiatric evaluation |
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259. With what HLA are 90% of patients with ankylosing spondylitis associated?
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a. HLA-B27
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260. In who is ankylosing spondylitis more common, male or female?
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a. Male 3:1
b. before positive family history of ankylosing spondylitis, IBD, or psoriasis. |
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261. What condition is a prerequisite for making the diagnosis of ankylosing spondylitis?
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a. Bilateral sacroiliitis!
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262. What is the typical onset of ankylosing spondylitis?
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a. Adolescence or young adulthood
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263. By what is ankylosing spondylitis characterized physiologically?
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a. Fusion of the spine in a descending manner (from lumbaris cervical spine).
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264. Course and prognosis of ankylosing spondylitis?
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a. There is a slow progression, but the course is highly variable.
b. Acute exacerbations are common. c. Life expectancy is normal. d. The first 10 years of the disease can give an indication of the long term severity. |
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265. Clinical features of ankylosing spondylitis?
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a. Low back pain and stiffness (2° to sacroiliitis) – limited motion in lumbar spine.
b. Neck pain and limited motion in cervical spine- occurs later in course of disease c. Enthesitis. d. With extensive spinal involvement, the spine becomes brittle and is prone to fractures with minimal trauma. Severe spinal cord injury can occur with such trauma. e. Chest pain and diminished chest expansion – due to thoracic spine. Involvement. f. Shoulder pain – most commonly, the peripheral joints are affected. g. Constitutional symptoms –Fatigue, low grade fever, weight loss h. Loss of normal posture as disease advances. |
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266. Extra-articular manifestations of ankylosing spondylitis?
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a. Eye involvement (most common)-acute anterior uveitis or iridocyclitis
b. Other extra-articular features are rare, but may involve the following systems 1. Cardiac 2. Renal 3. Pulmonary 4. Nervous systems |
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267. Diagnosis of ankylosing spondylitis?
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a. Imaging studies of lumbar spine and pelvis (plain film, MRI, CT) reveal sacroiliitis
b. Eventually, vertebral columns use, producing bamboo spine. c. Elevated ESR and 75% of patients (due to inflammation)- nonspecific d. HLA-B27 is not necessary for diagnosis. |
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268. Sacroiliitis?
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a. Sclerotic changes in the sacroiliac area.
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269. Treatment of ankylosing spondylitis?
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a. NSAIDs (indomethacin) for symptomatic relief
b. physical therapy-maintain good posture, extension exercises c. surgery may be necessary in some patients with severe spinal deformity d. patients with ankylosing spondylitis who sustain even minor, any complaint of neck or back pain should be strictly immobilized to prevent spinal cord injury until thorough imaging studies are obtained. |
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270. Ankylosing spondylitis, when are back pain and stiffness characteristically worse?
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a. In the morning and better as the day progresses.
b. They improve with exercise and a hot shower and worsen with rest or inactivity. |
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271. Complications of ankylosing spondylitis?
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a. Restrictive lung disease
b. cauda equina syndrome c. spine fracture with spinal cord injury d. osteoporosis e. spondylodiscitis |
