Paper 1 Answers
Hayley Dawson, Anna Trigell in EMQs for the nMRCGP® Applied Knowledge Test, 2018
A rudimentary knowledge of the various rheumatological conditions is necessary, but the clinical presentations in the exam tend to fit quite obvious patterns of disease. The differential for the patient described in Question 15 would be any acute swollen joint. Calcium pyrophosphate deposition tends to be slightly less severe than gout, and affects larger joints acutely (e.g. knees/shoulder/wrist). Osteoarthritis in the hand will often affect the first carpometacarpal joint. Heberden’s nodes affect the distal interphalangeal joints, and Bouchard’s nodes (in rheumatoid arthritis) tend to affect the proximal interphalangeal joints. Osteoarthritis can be managed within general practice, but if rheumatoid arthritis is suspected, early referral to a rheumatologist is indicated, as early treatment with disease-modifying drugs can inhibit progression of the disease.
The Musculoskeletal System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
A dislocation, also known as a luxation (or when incomplete, a subluxation) occurs when two articulating surfaces become separated as a result of injury, associated disease, or a congenital disorder. It occurs most often in the shoulder joint and occasionally in the jaw. A sprain is the tearing of ligaments associated with sudden wrenching of a joint. This occurs most often in the ankle and is associated with loss of mobility and discoloration of the skin caused by hemorrhaging into the surrounding tissue. Carpal tunnel syndrome (CTS) occurs when the wrist ligament compresses the median nerve where it passes (tunnels) between the ligament and bones and tendons of the wrist (carpus). Inflammation of the bursa, or bursitis, results from infection or physical stress related to activity or injury. It occurs most frequently near the shoulder, knee, and elbow. Disorders of the tendons include tendonitis, which is an inflammation of the tendon and tendon sheath, usually from a sports injury or strain. It occurs most often in the shoulder area, hamstring, or calcaneal tendon. Tennis elbow is a term that refers to epicondylitis or inflammation of the tendon fibers or ligaments of the elbow joint. Monarticular rheumatism designates a group of disorders that affect the fascia, tendons, ligaments, bursae, and intervertebral disks. The fibromyalgia syndrome is the most common of these, causing generalized muscle aching, joint pain and stiffness, fatigue, paresthesias, and irritable bowel syndrome. Systemic lupus erythematosus (SLE) is a chronic inflammatory disorder that involves the joints as well as connective tissue—tendons, ligaments, bones, and cartilage. Another rheumatic disease is scleroderma (sclerosis, meaning "hard," plus derma, "skin"), causing sclerosis of the skin and some organs. Diseases of the muscles include infections, muscular dystrophy, myasthenia gravis, tetanus, and hernias (see Table 7.2). Myositis (containing the root myo-, meaning "muscle") denotes inflammation of a muscle. Polymyositis and dermatomyositis are specific inflammatory muscle disorders (myopathies) of unknown cause. Polymyositis causes proximal muscle weakness; this is accompanied by a skin rash in dermatomyositis. Muscular dystrophy is a general term for degeneration of muscles as the result of a group of inherited diseases. This disorder, usually beginning in childhood, is characterized by degeneration and reduction in size of muscle fibers with an increase in connective tissue and fat deposits. The most common form is called Duehenne's dystrophy, where muscles enlarge as fat replaces those that have degenerated or atrophied.
Orthopaedics
Kelvin Yan in Surgical and Anaesthetic Instruments for OSCEs, 2021
The primary indication for a hip replacement is arthritis-related pain. Functional limitation of arthritis is another indication, usually associated with pain. The main cause is osteoarthritis. Other causes include rheumatoid arthritis and any inflammatory joint conditions. Stiffness from conditions such as ankylosing spondylitis is so debilitating that it would warrant a hip replacement even when not associated with pain. Another common indication is hip fracture.
Ultrasonographic evaluation of knee joint synovitis in two patients with palindromic rheumatism
Published in Modern Rheumatology, 2002
R. Kasukawa, I. Takeda, H. Iwadate, T. Kanno, K. Kawasaki, K. Soeda
The aim was to evaluate synovial proliferation ultrasonographically in order to identify the period of conversion from palindromic rheumatism to the early-stage of rheumatoid arthritis. Two patients, a 35-year-old man and a 44-year-old man, had been suffering from episodic attacks and remission of oligoarthralgia for 15 years and 6 years, respectively. Both patients were negative for rheumatoid factors, and exhibited slightly elevated levels of C-reactive protein and erythrocyte sedimentation rate at the times of the attacks. Radiograms of the affected joints showed no erosion of the bones in either patient. Ultrasonographic examination revealed both synovial effusion and synovial proliferation in the 35-year-old patient, suggesting conversion from palindromic rheumatism to rheumatoid arthritis, whereas only synovial effusion was found in the 44-year-old patient, suggesting the persistence of palindromic rheumatism. Ultrasonographic evaluations of synovial proliferation in the knee joints provide data that can be used to identify the period of conversion from palindromic rheumatism to the early-stage of rheumatoid arthritis.
Localized rheumatologic diseases
Published in Postgraduate Medicine, 1983
Preview Dr Waxman's article is a helpful reminder that “rheumatism” may present as—and sometimes remain—a localized disease. In what proportion of patients with so-called palindromic rheumatism will classic rheumatoid arthritis ultimately develop? Which kind of arthritis characteristically affects the base of the thumb? For which kind of localized arthritis is prompt diagnosis most essential? The answers to these and many other important questions will be found in the following discussion.
Nonarticular rheumatism and spondyloarthropathies
Published in Postgraduate Medicine, 1990
Preview Musculoskeletal pain is a common symptom in primary care practice, and patients are naturally concerned that they may have arthritis. In many cases, this is not so; the problem turns out to be nonarticular rheumatism or, less often, spondyloarthropathy. However, the early stages of many rheumatic conditions have common core features that may be misleading. In this article, Dr Bennett describes similarities and dissimilarities between nonarticular rheumatism and the spondyloarthropathies and gives guidelines for diagnosis and treatment.
Related Knowledge Centers
- Rheumatoid Arthritis
- Arthritis
- Connective Tissue
- Joint
- Rheumatology
- Ankylosing Spondylitis