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Rhumatology

Physical Exam Findings & Pathology

QuestionAnswer
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