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38 Cards in this Set

  • Front
  • Back
Key History -
Location
quality
severity (intensity)
duration

pattern -
small vs. large joints
number involved
swelling
redness
warmth

associated Sxs -
constitutional
red eye
oral or genital ulceration
diarrhea
dysuria
rash
focal numbness/weakness

exacerbating and
alleviating factors

trauma -
including vigorous exercise

meds
DVT risk factors
alcohol and drug use
family h/o rheumatic disease
Key PE -
VS
HEENT
musculoskeletal exam
relevant neurovascular exam
30 y/o F
presents with wrist pain and a black eye after tripping, falling and hitting her head on the edge of a table.
She looks anxious and gives and inconsistent story.

What is Differential?
Domestic violence
factitious d/o
substance abuse
30 y/o F
presents with wrist pain and a black eye after tripping, falling and hitting her head on the edge of a table.
She looks anxious and gives and inconsistent story.

What is Workup?
XR - wrist
CT - head
urine tox
30 y/o F secretary
presents with wrist pain and a sensation of numbness and burning in her palm and the 1st, 2nd and 3rd fingers of her right hand.
The pain worsens at night and is relieved by loose shaking of the hand.
There is sensory loss in the same fingers.
Exam reveals positive Tinel's.

What is Differential?
Carpal tunnel syndrome
median nerve compression
in forearm or arm

Radiculopathy C6 C7 in cervical spine


De Qeurvain's Tenosynovitis

30 y/o F secretary
presents with wrist pain and a sensation of numbness and burning in her palm and the 1st, 2nd and 3rd fingers of her right hand.
The pain worsens at night and is relieved by loose shaking of the hand.
There is sensory loss in the same fingers.
Exam reveals positive Tinel's.

What is Workup?
Nerve conduction study
EMG

XR - wrist
MRI - wrist

28 y/o F
presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on the face.

What is Differential?
SLE
RA
psoriatic arthritis
parvovirus B19 infection
28 y/o F
presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on the face.

What is Workup?
ANA, anti-dsDNA, ESR, C3, C4, RF, CBC
XR - hands
UA
Ab titers for Parvovirus B19
28 y/o F
presents with pain in the MCP joints of both hands.
Her left knee is also painful and red.
She has morning joint stiffness that lasts for an hour.
Her mother had RA.

What is Differential?
RA
SLE
disseminated gonorrhea
arthritis associated with IBD
OA
28 y/o F
presents with pain in the MCP joints of both hands.
Her left knee is also painful and red.
She has morning joint stiffness that lasts for an hour.
Her mother had RA.

What is Workup?
ANA, anti-dsDNA, ESR, RF, CBC
XR - hands, left knee
cervical Cx
18 y/o M
presents with pain in the interphalangeal joints of both hands.
He also has scaly salmon-pink lesions on the extensor surface of his elbows and knees.

What is Differential?
Psoriasis

Rheumatoid Arthritis


SLE


Gout

18 y/o M
presents with pain in the interphalangeal joints of both hands.
He also has scaly salmon-pink lesions on the extensor surface of his elbows and knees.

What is Workup?
CBC / ESR /

CCP / Anti-dsDNA / ANA / RF /


Uric Acid


XR Hand


XR pelvis/sacroiliac joints

65 y/o F
presents with inability to use her left leg and bear weight on it after tripping on a carpet.
Onset of menopause was 20 yrs ago and she didn't receive HRT or calcium supplements.
Her left leg is externally rotated, shortened and adducted, and there is tenderness in her left groin.

What is Differential?
Hip fracture

Hip Dislocation


Pelvic Fracture

65 y/o F
presents with inability to use her left leg and bear weight on it after tripping on a carpet.
Onset of menopause was 20 yrs ago and she didn't receive HRT or calcium supplements.
Her left leg is externally rotated, shortened and adducted, and there is tenderness in her left groin.

What is Workup?
XR - Pelvis

CT/MRI-hip


CBC


Serum Ca / Vit D


DEXA scan

40 y/o M
presents with pain in the right groin after a MVA.
His right leg is flexed at the hip, adducted and internally rotated.

What is Differential?

Hip dislocation

Hip fracture
40 y/o M
presents with pain in the right groin after a MVA.
His right leg is flexed at the hip, adducted and internally rotated.

What is Workup?
XR-pelvis

CT/MRI-hip


CBC


PT/PTT


Urine toxicology


Serum Alcohol

56 y/o obese F
presents with right knee stiffness and pain that increases with movement.
Her Sxs have gradually worsened over the past 10 yrs.
She noticed swelling and deformity of the joint and is having difficulty walking.

What is Differential?
OA

Pseudogout


Gout


Meniscal / ligament damage

56 y/o obese F
presents with right knee stiffness and pain that increases with movement.
Her Sxs have gradually worsened over the past 10 yrs.
She noticed swelling and deformity of the joint and is having difficulty walking.

What is Workup?
XR - knee

CBC / ESR


MRI - knee


Arthrocentesis / Synovial F analysis


Uric Acid

45 y/o M
presents with right knee pain with swelling and redness.

What is Differential?
Septic arthritis

Gout


Pseudogout


Lyme arthritis


Reiter's synd

45 y/o M
presents with right knee pain with swelling and redness.

What is Workup?
CBC

Knee arthrocentesis


Synovial fluid analysis (cell count, gram stain, culture, crystal)


XR - knee


Uric acid


Lyme titers IgG IgM

65 y/o M
presents with right foot pain.
He has been training for a marathon.

What is Differential?

Stress fracture

Plantar fasciaitis

Foot sprain or strain

65 y/o M
presents with right foot pain.
He has been training for a marathon.

What is Workup?
XR-foot

bone scan-foot


MRI-foot

65 y/o M
presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking.
He has no known trauma.

What is Differential?

Plantar fasciitis


Heel fracture


Splinter/foreign body

65 y/o M
presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking.
He has no known trauma.

What is Workup?
XR - heel
bone scan-foot
55 y/o M
presents with pain in the elbow when he plays tennis.
His grip is impaired as a result of the pain.
There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion with the elbow in extension.

What is Differential?
Tennis elbow

(lateral epicondylitis)


Stress fracture

55 y/o M
presents with pain in the elbow when he plays tennis.
His grip is impaired as a result of the pain.
There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion with the elbow in extension.

What is Workup?
XR - elbow

Bone scan


MRI - elbow

27 y/o F
presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs and vaginal discharge.
She is sexually active with multiple partners and occasionally uses condoms.

What is Differential?

Disseminated gonorrhea


Rheumatoid arthritis


SLE


Reiter's synd

27 y/o F
presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs and vaginal discharge.
She is sexually active with multiple partners and occasionally uses condoms.

What is Workup?

Arthrocentesis / analysis (cc, gs, cul, crystal)


CBC / ESR / ANA / dsDNA ab / RF / CCP


Blood / cervical cultures


XR - knee

60 y/o F
presents with pain in both legs that is induced by walking and relieved by rest.
She had cardiac bypass surgery
6 mos. ago and continues to smoke heavily.

What is Differential?

Peripheral Vascular disease


Leriche synd


(Aortoiliac occlusive dse)


Lumbar spinal stenosis


(Pseudoclaudication)


Osteoarthrits

60 y/o F
presents with pain in both legs that is induced by walking and relieved by rest.
She had cardiac bypass surgery
6 mos. ago and continues to smoke heavily.

What is Workup?
Doppler US - lower
ankle-brachial index
angiograpy
MRI - lumbar spine
45 y/o F
presents with right calf pain.
Her calf is tender, warm, red and swollen compared to the left side.
She was started on OCPs 2 mos.
ago for dysfunctional uterine bleeding.

What is Differential?
DVT

Baker's cyst rupture


Myositis


Cellulitis


Superficial venous thrombosis



45 y/o F
presents with right calf pain.
Her calf is tender, warm, red and swollen compared to the left side.
She was started on OCPs 2 mos.
ago for dysfunctional uterine bleeding.

What is Workup?
Doppler US - right leg
CBC
CPK
D-dimer
50 y/o M
presents with right shoulder pain after falling onto his outstretched hand while skiing
He noticed deformity of his shoulder and had to hold his right arm.

What is Differential?
Shoulder dislocation

Humeral fracture


Rotator cuff injury

50 y/o M
presents with right shoulder pain after falling onto his outstretched hand while skiing
He noticed deformity of his shoulder and had to hold his right arm.

What is Workup?
XR - shoulder
XR - arm
MRI - shoulder
55 y/o M
presents with crampy b/l thigh
and calf pain, fatigue and dark urine.
He is on simvastatin and clofibrate for hyperlipidemia.

What is Differential?
Rhabdomyolysis due to simvastin or clofibrate
polymyositis
inclusion body myositis
55 y/o M
presents with crampy b/l thigh
and calf pain, fatigue and dark urine.
He is on simvastatin and clofibrate for hyperlipidemia.

What is Workup?
CBC
CPK
aldolase
UA
urine myoglobin
TSH
60 yo F c/o left arm pain that started while she was swimming and was relieved by rest



Differentials?

Angina / MI

Tendonitis


Osteoarthritis

60 yo F c/o left arm pain that started while she was swimming and was relieved by rest



Workups?

ECGCBCXR-shoulderCXREchocardiographyStress test