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36 Cards in this Set
- Front
- Back
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Key History -
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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 |
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Key PE -
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VS
HEENT musculoskeletal exam relevant neurovascular exam |
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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 |
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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 |
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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 |
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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
XR - wrist MRI - wrist |
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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 |
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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 ??? |
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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 |
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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 |
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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? |
Psoriatic arthritis
RA SLE |
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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? |
RF, ANA, ESR
CBC XR - hands |
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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 |
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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 - hip, pelvis
CT or MRI - hip CBC |
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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 - traumatic
hip fracture |
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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 - hip
CT or MRI - hip CBC |
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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 or ligament damage |
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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 knee arthrocentesis and synovial fluid analysis - cell count, gram stain, culture, crystals MRI - knee |
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45 y/o M
presents with right knee pain with swelling and redness. What is Differential? |
Septic arthritis
gout pseudogout lyme arthritis trauma reiter's arthritis |
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45 y/o M
presents with right knee pain with swelling and redness. What is Workup? |
CBC
knee arthrocentesis and synovial fluid analysis - cell count, gram stain, culture, crystals BC, UC XR - knee uric acid lyme Ab |
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65 y/o M
presents with right foot pain. He has been training for a marathon. What is Differential? |
Stress fracture
plantar fasciitis foot sprain or strain |
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65 y/o M
presents with right foot pain. He has been training for a marathon. What is Workup? |
XR - foot
bone scan - foot |
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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 |
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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 |
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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 |
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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 - arm
bone scan MRI - elbow |
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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
RA SLE psoriatic arthritis reiter's arthritis |
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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? |
Knee arthrocentesis and
synovial fluid analysis - cell count, gram stain, Cx ANA, anti-dsDNA, ESR, RF, CBC BC, cervical Cx XR - knee |
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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's syndrome lumbar spinal stenosis OA |
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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 |
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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 |
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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 |
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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
fracture of the humerus rotator cuff injury |
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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 |
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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 thyroid disease |
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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 |
