Transcript שקופית 1
CASE PRESENTATION RHEUMATOLOGY UNIT Gur Chamutal MD CASE 1 A 55 y.o woman, presents with a swollen finger (DIP)-began abruptly-3 days ago. Other finger joints have swollen like this in the past and subsided over a few weeks, but the joints had developed a funny appearance afterwards. The patients is otherwise healthy and takes no medications. Is it arthritis? If yes-acute or chronic? Inflammatory or non-inflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis? Treatment? CASE 2 A 30 y.o woman, pain in her hands, wrists, elbows, shoulders, and feet, present continuously for the past 3m. Her joints feel hard to move after she arises in the morning, and it takes two hours for her to “loosen up”. She has noticed a low grade fever and easy fatigability. No other constitutional symptoms. Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? D.D rheumatoid nodules: Fibroma (chronic trauma) Sarcoidosis RF Gout (tophi) vasculitis MTX?? (exacerbation) CASE 3 A 25 year old man presents due to abrupt onset of pain in his ankles and knees, which began 2 days ago. He has had fever to 38.5, rash on his feet, decreased left eye vision and profuse sweats. He notes recent treatment (3w) for gonorrhea which reduced but did not eliminate his dysuria and his urethral discharge changed from yellow to slightly Iscloudy. it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? CASE 4 60 y.o man presents due to severe foot pain, which awoke him from sleep. He has had a similar attack in his great toe a year ago. The episodes subsided without treatment over one week. The patient takes dizothiaside, aspirin. He admits to drinking alcohol. Physical examination: Obese man with red, hot tender 1MTP, Temp 38.0. Firm nodules on the ear. Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? CASE 5 A 30 y.o male, presents with low back pain- for 5 years, stiff back in the morning and after sitting more than 30 min, limited mobility-hip. His knees have swelled in the past. Other anamnestic details? Physical examination? Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? Schober test- 12/10 cm Positive faber Chest expansion 3 cm CASE 6 A 23 y.o woman presents due to patchy hair loss, low grade fever, fatigue, and diffuse muscle and joint pain. She has had severe pain in her left chest for 2 days with worsening of this pain with deep breath or cough. Physical examination: macular erythema-face, alopecia, dullness to percussion in the left lung base, all joints are tender. Swelling in the wrist and ankle. (pregnancy-hydralazine). Is it arthritis? If yes-acute or chronic? Inflammatory or non.inflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? CASE 7 A 50 y.o woman presents because of hand and knee pain-5 years, but now limiting her hobbies. She notes that the “bumps” on her knuckles first developed-5 years ago. She is having difficulty ascending steps and getting out of low chairs. She notes that her mother had similar appearing hands. Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? CASE 8 A 80 y.o woman presents because of severe bitemporal headache-began 1 week ago. Fleeting obscuration of vision, jaw pain when chews her food. 3m-low grade fever, aching and stiffness in her shoulders, neck and buttocks, 3-4 kg weight loss. Physical examination: Proximal Muscles and TA tenderness, intact pulses. Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? CASE 9 70 y.o man, previous history of “old age arthritis” Affecting his knees, presents with one day of sudden swelling and severe pain in his L knee. He is unable to stand or walk. He has no fever. He had been taking Ibuprufen 400 mg four times a day without any relief. Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment? CASE 10 25 y.o man, previously healthy presents to the E.R with waist pain, macrohematuria, rash, low grade fever and severe weakness. Physical examination: B.P 190/100, pulse 120, pallor. Waist percussion sensetivity. Blood test: Hb-7.0 mg%, Creatinine high-1.2, CRP and ESR- elevated. Is it arthritis? If yes-acute or chronic? Inflammatory or noninflammatory? What company does it keep? What tests if any are appropriate? Most likely diagnosis?Treatment?