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Rhumatology
Physical Exam Findings & Pathology
| Question | Answer |
|---|---|
| Articular disease involves swelling of the entire joint and limits what type of motion? | Both active and passive motion |
| Inflammation involving the tendon, ligament, busae, muscle, fascia, bone, nerve and overlying skin is generally called what? | Extra-articular disease |
| About 85% of people have back pain due to what? | Idiopathic, distinctive from a 'sprain or strain' |
| Musculoligamentous injury disc injury, veretebral collapse, spinal cord metastases and epidural abscess localize back pain where? | Midline back pain |
| Sacroiliitis, trochanteric bursitis, sciatica or hip arthritis is generally localized where? | Pain off the midline |
| What type of pain increases with cough? | Radicular gluteal or posterior leg pain in the S1 distribution |
| Leg pain that resolves with rest and lumbar forward flexion is due to what? | Spinal Stenosis |
| Pain with urinary retention/overflow incontinence, bowel dysfunction | Cauda equina syndrome from S2-4 midline disc or tumor |
| Low back pain + a patient older than 50, history of cancer, unexplained weight loss, pain lasting more than one month, pain at night or IVDU is serious what percent of the time? | 10% probability of serious systemic disease associated with back pain |
| Radicular pain at C6-C7 is most often due to what? | Foraminal impingement from degenerative joint changes |
| Lateral hip pain near the greater trochanter suggests what? | Trochanteric bursitis |
| Migratory pattern of joint pain in what two conditions? | Rhumatic Fever or gonococcal arthritis |
| When are aches and pains considered arthralgias? | when there is no evidence of arthritis |
| inflammation of tendinous sheaths is called | tenosynovitis |
| Sprains are defined as | stretching or tearing of ligaments |
| Severe pain of rapid onset in a red swollen joint | Septic arthritis or gout |
| Severe pain of rapid onset in a red swollen joint in a child? | Osteomyelitis |
| Fever, chills, warmth and redness in what 3 conditions? | Septic arthritis, gout, rheumatic fever |
| Pain, swelling, loss of active and passive motion as well as locking of the joint in what type of joint pain? | Articular joint pain |
| When there is loss of active but not passive motion, tenderness outside the joint and absence of deformity in what kind of pain? | non-articular joint pain |
| Degenerative joint disease is characterized by | degenerative joint disease |
| Stiffness and limited motion after inactivity lasting 30 min or more is indicative of what? | Rhumatoid arthritis |
| Fibromyalgia and polymyalgia rhumatica can be associated with | stiffness after inactivity |
| Consititutional symptoms are often present with | inflammatory arthritis |
| how do you distinguish inflammatory arthritis from septic arthritis? | high fever and faster onset in septic arthritis |
| Butterfly rash on the face | SLE |
| Scaly rash and pitted nails | Psoriatic arthritis |
| papules/pustules/vesicles with reddened bases in distal extremities + joint pain | Gonococcal arthritis |
| Expanding red plaque | Lyme disease |
| Hives | Serum sickness, drug reaction |
| Erosions on penis, scaling papules on soles and palms, arthritis, urethritis, uveitis | Reactive Arthritis (formerly Reiter's) |
| maculopapular rash of rubella | arthritis of rubella |
| Clubbing of fingernails | hypertrophic osteoarthropathy |
| Recent past history of sore throat + arthritis | Acute rheumatic fever and gonococcal arthritis |
| Conjunctivitis | Reiter's, gonococcal arthritis, Behcet's |
| Mental Status change, facial weakness, stiff neck | Lyme disease with CNS involvement |
| Bone strength reflects both | bone density and bone quality |
| Acute involvement of one joint suggests | trauma, septic arthritis, gout |
| What disease is several joints symmetrically distributed? | Rheumatoid arthritis |
| Subcutaneous nodules are seen in | rheumatoid arthritis or rheumatic fever |
| Crepitus over inflammed joints in | Osteoarthritis or inflammed tendon sheets |
| Decreased range of motion in | arthritis |
| inflammation of tissues around a joint and fibrosis or bony fixation around joint | ankylosis |
| Ligamentous laxity of what ligament in knee trauma | ACL |
| Muscle atrophy or weakness | rheumatoid arthritis |
| Palpable bogginess or doughiness and effusion of the synovial membrane indicates | synovitis |
| Palpable joint fluid in | effusion |
| Tenderness over tendinous sheaths in | tendinitis |
| What is the timeline to assess an acute vs chronic joint problem | 6 weeks |
| Greater than 3 joints, chronic, and non-symmetrical | Psoriatic arthritis, Reactive arthritis |
| Greater than 3 joints involved, chronic, symmetrical, involves PIP, MCP is | rheumatoid arthritis |
| Rheumatoid arthritis involves what joints in the hand? | PIP and MCP |
| Chronic, more than 3 joints NOT PIP and MCP | SLE, scleroderma, polymyositis |
| No constitutional symptoms but chronic arthritis involving DIP, carpometacarpal, hip or knee in | Osteoarthritis |
| Facial asymmetry | TMJ |
| Pain with chewing in what 3 main conditions? | Trigeminal Neuralgia, Temporal arteritis, and TMJ |
| what could cause elevation of one shoulder? | Scoliosis |
| When the shoulder is dislocated anteriorly, the rounded lateral end looks | flattened |
| When do you notice atrophy of supraspinatus and infraspinatus over scapular spine? | 2-3 weeks after rotator cuff tear |
| subacromial and subdeltoid bursitis has what type of pain pattern? | localized tenderness |
| Swelling of the shoulder over the rotator cuff suggests | bursal tear that communicates with articular cavity |
| What is the most common rotator cuff muscle to be torn? | Supraspinatus |
| Swelling of the capsule and shoulder is best detected by | looking down on the shoulder from above. |
| Restricted range of motion of the shoulder occurs with | bursitis, capsulitis, rotator cuff tears, sprains, tendinitis |
| A person over age 60 with a positive drop arm test is usually what? | rotator cuff tear |
| Localized tenderness or pain with ADDuction of the arm is usually what? | inflammation of the AC joint |
| Apley's scratch test is used to diagnose what? | rotator cuff tears |
| Pain when the patient supinates their forearm against resistance indicates | inflammation of the long head of the biceps |
| Where does the ulnar nerve traverse through the elbow? | posteriorly in the ulnar groove between the medial epicondyle and olecranon process |
| In a supracondylar fracture, how is the olecranon displaced? | posteriorly in a posterior dislocation of elbow and supracondylar fracture |
| What can you rule out if it is possible to fully extend the elbow? | intra-articular effusion and hemarthrosis |
| Poor finger alignment is seen in what? | flexor tendon damage |
| Local swelling in the hand can be from | cystic ganglion: variation in normal joint or tendon sheath function. Cysts near joints are connected to the joint. The cyst contains clear fluid similar to, but thicker than, normal synovial fluid. Found around the wrist joint. |
| Symmetric deformity in PIP, MCP and wrist with ulnar deviation? | Rheumatoid arthritis |
| Herberden's nodes | osteoarthritis at DIP |
| Bouchard's nodes | osteoarthritis at PIP |
| Thenar atrophy | median nerve compression (CTS) |
| Hypothenar atrophy | ulnar nerve compression |
| Flexion contractures in the ring, 5th and 3rd fingers are | Dupuytren's contractures, from thickening of palmer fascia |
| Tenderness over distal radius | Colle's fracture |
| Tendinous or bony step-offs are suspicious for what? | fracture |
| Tenderness over extensor and ABDuctor tendons of the thumb at radial styloid in what? | de Quervain's tenosynovitis and gonococcal tenosynovitis |
| Tenderness over anatomical snuff-box is | scaphoid bone |
| Why is scaphoid fracture dangerous? | Avascular necrosis |
| MCPs are boggy in | Rheumatoid arthritis |
| Pain is at the base of the thumb in what type of arthritis? | carpometacarpal arthritis |
| Hard dorsolateral nodules on DIP are called | Heberden's nodes (osteoarthritis) |
| DIP joint (type of arthritis) | Psoriatic arthritis |
| Three conditions that limit range of motion of the hand? | arthritis, tenosynovitis and Dupuytren's contracture |
| Name 4 systemic things that can trigger onset of carpal tunnel syndrome? | Pregnancy, Rheumatoid arthritis, diabetes, hypothyroidism |
| What is one way to test weakness of finger flexors and intrinsic muscles of the hand? | Decreased Grip Strength |
| Arthritis, carpal tunnel, epicondylitis and cervical radiculopathy all have what symptom in common? | Decreased Grip Strength |
| Finkelstein's test assess for what? | de Quervain's tenosynovitis |
Created by:
tessah10
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