HISTORY
PHYSICAL
INVESTIGATIONS
MANAGEMENT
DOUBLE JEOPARDY
100
"I'm 63 years old! My right knee pain gets worse when I exercise and better when I rest. And it clicks when I bend it!"
Osteoarthritis
100
Mr. Jones came in complaining of toe pain. He also comes in with these. What are these and what is his most likely diagnosis? http://download.thelancet.com/images/journalimages/0140-6736/PIIS0140673609608837.gr2.lrg.jpg
Tophi, gout
100
What does this person have? http://images.rheumatology.org/image_dir/album75676/md_05-14-0066.jpg
Uric acid crystals; gout
100
Name 3 absolute/relative contraindications of NSAIDs
pre-CABG procedure, CAD/CVD, CHF, HTN, GI bleeding/ulcers, bleeding concerns, renal failure, liver disease, elderly patients
100
What are these? http://ard.bmj.com/content/58/5/261/F2.large.jpg
Pseudogout crystals (calcium pyrophosphate, rhomboid shaped, positive birefringence)
200
"Gee doctor, I think I have rheumatoid arthritis, what are some symptoms I should notice?"
Warm, red, swollen symmetrical joints; Morning stiffness >1 hour; Systemic symptoms like fever and fatigue
200
What does this patient have and why? http://i839.photobucket.com/albums/zz316/fsoey025/1_zps0af70932.jpg
Rheumatoid arthritis: ulnar deviation of fingers, rheumatoid nodule at elbow
200
What tests do you order in someone whom you suspect to have septic arthritis?
Bloodwork (CBC and diff, ESR/CRP); Joint aspiration (cell count with differential, gram stain and culture, crystals); can also do blood culture/STI testing
200
Management of OA vs RA
OA: pain management (tylenol, NSAIDs, intraarticular steroid), PT, joint replacement surgery; RA: pain management, DMARDs, prednisone, surgery
200
A man comes with this rash, oral ulcers, photosensitivity and migratory polyarticular arthritis (knees, carpal joints, and joints of the fingers). What does he likely have? https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcTrXfrs0_VlH7HBIJvEjhXvz1XE6WwwflU9LmCLc7B4O8bnXAAe
SLE (lupus)
300
Septic arthritis vs. gout on history
Joint involvement; Risk factors; Systemic symptoms
300
"Doctor, I'm really worried about this finding because I heard I can get joint pain down the line." http://www.medsci.org/v10/p0915/ijmsv10p0915g01.jpg
Target lesion, lyme disease
300
In someone whom you suspect cauda equina syndrome, what imaging should do and how urgent is it?
URGENT MRI
300
Acute vs chronic management of gout
Acute: NSAIDs, Intraarticular/PO steroids, Colchicine Chronic: Colchicine, Allopurinol, low purine diet
300
A child comes in with this "rash" and polyarthritic joint pain. What is his diagnosis? http://i839.photobucket.com/albums/zz316/fsoey025/2_zpsfa6659f1.jpg
Henoch-Schönlein Purpura
400
"I'm a young guy and I notice my back is getting more and more stiff. I also get a lot of eye and intestine issues."
Ankylosing spondylitis
400
Hand findings in OA vs RA
OA: PIP, DIP, 1st MCP, heberden and bouchard nodules; RA: DIP, 2-5 MCPs, swan neck, boutonneire deformity, ulnar deviation
400
Name 3 of the 7 criteria for diagnosis of RA
Morning stiffness x6w, Arthritis of 3 or more joint x6w, Arthritis of hand joint x6w, Symmetric arthritis x6w, Rheumatoid nodules, serum RF +, radiographic changes
400
Most common bacterial cause of Septic Arthritis and the antibiotic treatment (hint: cephalosporin)
Gonoccocal; Ceftriaxone
400
Do a full knee exam
Inspect, palpate, ROM, anterior/posterior drawer, collateral ligaments, meniscus, gait
500
Red flags for low back pain
Cancer - age >50, B-symptoms, night pain; Cauda equina - urinary retention/stool incontinence, neurological symptoms; Infection - fevers, chills, STIs/IVDU, skin lacerations
500
Do an exam for low back pain
Vitals; Abdo exam; MSK: Inspection, palpation, ROM, Straight leg raise, Faber, Schober; Neurological: inspection, tone, power, sensation, reflexes, gait, DRE
500
Describe the findings on this X-ray and what the likely diagnosis is: http://www.rheumatologynetwork.com/sites/default/files/rm/1443969.png
Joint space narrowing, osteophytes, subchondral sclerosis
500
What should you order immediately IV in someone with Cauda Equina Syndrome?
IV high dose Dexamethasone
500
What do patients need to take before starting Allopurinol and why?
NSAIDs or Colchicine to prevent flare up; Allopurinol decreases serum uric acid level, it therefore can cause release of synovial urate crystal and joint inflammation
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