tommyk
05-20-2006, 03:49 PM
Hy 2228
A 40-year-old woman has an 6-month history of diffuse joint pain and swelling that involves both hands and knees. She states that she cannot get any work done in the morning due to the pain, but it usually subsides as the day progresses. She tires easily and constantly feels a little bit "feverish". Her temperature is 37.8 C (100 F), blood pressure is 100/70 mm Hg, pulse is 60/min, and respirations are 18/min. Physical examination shows tender, swollen, and "boggy" hands and knees. Laboratory studies show:
Hematocrit............34%
Hemoglobin...........10 g/dL
A radiograph of this patient's knee is most likely to show which of the following? Dx please?
1-Osteoporosis
2-Osteoarthritis
3-Rheumatoid arthritis
4-Watching too much television
5-Septic arthritis
a) #3, This patient most likely has rheumatoid arthritis, a chronic inflammatory disorder characterized by symmetrical joint involvement and extraarticular manifestations. It typically affects middle-aged women. Symptoms include joint pain and swelling, low-grade fever, malaise, fatigue, vasculitis, pericarditis, rheumatic nodules, episcleritis, and scleritis. Laboratory findings include normochromic, normocytic anemia, increased erythrocyte sedimentation rate, and serum rheumatoid factors. The proximal interphalangeal joints (PIP), metacarpophalangeal joints (MCP), and the wrist joints are the most commonly involved joints. Distal interphalangeal joints (DIP) are usually spared. Radiographic findings include soft tissue swelling, joint effusions, juxtaarticular osteopenia, loss of articular cartilage, joint space narrowing, and bone erosions. The treatment includes rest, physical therapy, NSAIDs, aspirin, corticosteroids, gold, methotrexate, penicillamine, cyclosporine, sulfasalazine, and hydroxychloroquine. Osteophyte formation, subchondral cyst formation, and subchondral sclerosis are the radiographic findings of osteoarthritis. Osteoarthritis is a noninflammatory joint disease characterized by loss of articular cartilage and the aforementioned findings. The symptoms include a deep, aching joint pain that is aggravated by use and relieved by rest. Physical examination shows joint tenderness, bony crepitus, warmth and deformities (Heberden's nodes-DIP and Bouchard's nodes-PIP). Age, wear and tear, obesity, trauma, and certain chronic conditions are factors that increase the risk of osteoarthritis. The treatment includes weight loss, physical therapy, acetaminophen, and surgery.
A 40-year-old woman has an 6-month history of diffuse joint pain and swelling that involves both hands and knees. She states that she cannot get any work done in the morning due to the pain, but it usually subsides as the day progresses. She tires easily and constantly feels a little bit "feverish". Her temperature is 37.8 C (100 F), blood pressure is 100/70 mm Hg, pulse is 60/min, and respirations are 18/min. Physical examination shows tender, swollen, and "boggy" hands and knees. Laboratory studies show:
Hematocrit............34%
Hemoglobin...........10 g/dL
A radiograph of this patient's knee is most likely to show which of the following? Dx please?
1-Osteoporosis
2-Osteoarthritis
3-Rheumatoid arthritis
4-Watching too much television
5-Septic arthritis
a) #3, This patient most likely has rheumatoid arthritis, a chronic inflammatory disorder characterized by symmetrical joint involvement and extraarticular manifestations. It typically affects middle-aged women. Symptoms include joint pain and swelling, low-grade fever, malaise, fatigue, vasculitis, pericarditis, rheumatic nodules, episcleritis, and scleritis. Laboratory findings include normochromic, normocytic anemia, increased erythrocyte sedimentation rate, and serum rheumatoid factors. The proximal interphalangeal joints (PIP), metacarpophalangeal joints (MCP), and the wrist joints are the most commonly involved joints. Distal interphalangeal joints (DIP) are usually spared. Radiographic findings include soft tissue swelling, joint effusions, juxtaarticular osteopenia, loss of articular cartilage, joint space narrowing, and bone erosions. The treatment includes rest, physical therapy, NSAIDs, aspirin, corticosteroids, gold, methotrexate, penicillamine, cyclosporine, sulfasalazine, and hydroxychloroquine. Osteophyte formation, subchondral cyst formation, and subchondral sclerosis are the radiographic findings of osteoarthritis. Osteoarthritis is a noninflammatory joint disease characterized by loss of articular cartilage and the aforementioned findings. The symptoms include a deep, aching joint pain that is aggravated by use and relieved by rest. Physical examination shows joint tenderness, bony crepitus, warmth and deformities (Heberden's nodes-DIP and Bouchard's nodes-PIP). Age, wear and tear, obesity, trauma, and certain chronic conditions are factors that increase the risk of osteoarthritis. The treatment includes weight loss, physical therapy, acetaminophen, and surgery.