Joint pain & inflammation. - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-22-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 508 Times in 232 Posts
Reputation: 518
Default Joint pain & inflammation.

A 48-year-old man presents with history of joints pain. Asymmetric, involving the proximal and distal small joints of the Lt hand, the Rt knee, and right elbow. Pain, swelling, & stiffness. Joints are red & warm to the touch. Morning stiffness is moderate. Physical examination reveals nails pitting & separation from the nail bed. X-rays of the hands show resorption of the distal end of the phalanx. The erythrocyte sedimentation rate (ESR) is elevated to 42 mm/hr, and rheumatoid factor is negative. Which of the following is the most likely diagnosis?
1. Degenerative joint disease (asteoarthritis)

2. Rheumatoid arthritis
3. Pseudogout
4. Psoriatic arthritis

5. Septic arthritis.

Reply With Quote Quick reply to this message
The above post was thanked by:
dryogi (09-23-2011), iron (09-23-2011), step1an (09-23-2011), Usmle16Forall (4 Weeks Ago)



  #2  
Old 09-22-2011
iron's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 229
Threads: 43
Thanked 52 Times in 43 Posts
Reputation: 62
Default

Quote:
Originally Posted by ag2011n View Post
A 48-year-old man presents with history of joints pain. Asymmetric, involving the proximal and distal small joints of the Lt hand, the Rt knee, and right elbow. Pain, swelling, & stiffness. Joints are red & warm to the touch. Morning stiffness is moderate. Physical examination reveals nails pitting & separation from the nail bed. X-rays of the hands show resorption of the distal end of the phalanx. The erythrocyte sedimentation rate (ESR) is elevated to 42 mm/hr, and rheumatoid factor is negative. Which of the following is the most likely diagnosis?
1. Degenerative joint disease (asteoarthritis)

2. Rheumatoid arthritis
3. Pseudogout
4. Psoriatic arthritis

5. Septic arthritis.

It looks like psoriatic arthritis, from the involvement of DIP, nail pitting and onchylosis...but with red, warm and raised ESR, may be septic arthritis. psoriasis is also inflamatory so it may have raised ESR..but septic arthritis is usually monoarthritis.
Reply With Quote Quick reply to this message
The above post was thanked by:
Usmle16Forall (4 Weeks Ago)
  #3  
Old 09-22-2011
dr_mhm's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 100
Thanked 236 Times in 147 Posts
Reputation: 246
Default

Quote:
Originally Posted by ag2011n View Post
A 48-year-old man presents with history of joints pain. Asymmetric, involving the proximal and distal small joints of the Lt hand, the Rt knee, and right elbow. Pain, swelling, & stiffness. Joints are red & warm to the touch. Morning stiffness is moderate. Physical examination reveals nails pitting & separation from the nail bed. X-rays of the hands show resorption of the distal end of the phalanx. The erythrocyte sedimentation rate (ESR) is elevated to 42 mm/hr, and rheumatoid factor is negative. Which of the following is the most likely diagnosis?
1. Degenerative joint disease (asteoarthritis)
2. Rheumatoid arthritis
3. Pseudogout
4. Psoriatic arthritis
5. Septic arthritis.
4. Psoriatric arthritis, fulfills the criteria.

Osteoarthritis - wouldn't produce nail changes, ESR would be normal. Also, it's in weight bearing joints as well as prox and distal IF joints.
RA - Although RF is not necessary, for USMLE purposes it usually is. Would have longer morning stiffness. No nail involvement.
Pseudogout - usually presents in knee, if not, still mono- o pauciarthritis. No nail involvement. ESR could be elevated depending if secondary.
Septic arthritis - it's a monoarthritis, would have more general symptoms, and ESR would be even higher.
Reply With Quote Quick reply to this message
The above post was thanked by:
ag2011n (09-23-2011), step1an (09-24-2011), Usmle16Forall (4 Weeks Ago)
 
  #4  
Old 09-23-2011
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 239
Threads: 3
Thanked 48 Times in 37 Posts
Reputation: 58
Default

4. Psoriatic arthritis
__________________
I'm Predictable In The Unpredictable Future !
Reply With Quote Quick reply to this message
  #5  
Old 09-23-2011
busterbee's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 218
Threads: 16
Thanked 110 Times in 59 Posts
Reputation: 120
Default

psoriatic arthritis
__________________
you are born with wings, don't walk through life
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #6  
Old 09-23-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 508 Times in 232 Posts
Reputation: 518
Default

Guys your correct, it is Psoriatic arthriti.
Reply With Quote Quick reply to this message
  #7  
Old 09-23-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

so do we see reabsorption of distal phalanx and seperation of nails in psoriasis??
Reply With Quote Quick reply to this message
  #8  
Old 09-23-2011
dr_mhm's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 100
Thanked 236 Times in 147 Posts
Reputation: 246
Default

Quote:
Originally Posted by confident View Post
so do we see reabsorption of distal phalanx and seperation of nails in psoriasis??
Remember the "pencil in a cup" deformity!
Nail lesions: the typical one is nail pitting, but also seen: separation of the nail from the nail bed, cracking, loss of the nail, etc.
Reply With Quote Quick reply to this message
The above post was thanked by:
Ace3 (09-24-2011), iron (09-23-2011)
  #9  
Old 09-23-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 508 Times in 232 Posts
Reputation: 518
Default

Nail changes in psoriasis vary from little pits in your nails, loosening of the nail to Crumbling of thenail,severe psoriatic nail disease can lead to functional and social impairments if left untreated.

Erosive disease frequently occurs in patients with either DIP involvement or progressive deforming arthritis and may lead to subluxation and, less commonly, to bony ankylosis of the joint.
Erosion of the tuft of the distal phalanx, and even of the metacarpals or metatarsals, can progress to complete dissolution of the bone. Although this form of acro-osteolysis is not diagnostic, it is highly suggestive of psoriatic arthritis.
Reply With Quote Quick reply to this message
The above post was thanked by:
Ace3 (09-24-2011), iron (09-23-2011), step1an (09-24-2011)
  #10  
Old 09-24-2011
USMLE Forums Guru
 
Steps History: 1 + CK
Posts: 373
Threads: 30
Thanked 375 Times in 160 Posts
Reputation: 385
Default

Quote:
Originally Posted by dr_mhm View Post
Septic arthritis - it's a monoarthritis, would have more general symptoms, and ESR would be even higher.
Agree, but be aware of the gonnococcal septic arthritis, which is a poly articular diseased presenting with a rash.
__________________
Knowing is not enough; we must apply.
Willing is not enough; we must do.
Reply With Quote Quick reply to this message
The above post was thanked by:
Ace3 (09-24-2011), ag2011n (09-24-2011)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Diarrhea Transmural inflammation alindawater USMLE Step 1 Classic Clues 3 02-16-2017 08:59 PM
Bacterial factor involved in a disease that caused sore throat then joint pain! ricko335 USMLE Step 1 Forum 7 09-14-2012 06:35 AM
Q Joint Pain podebrad USMLE Step 2 CK Forum 1 08-03-2011 01:42 PM
55 yo man with monoarthritis of knee joint tkourkou USMLE Step 2 CK Forum 7 03-15-2011 03:26 PM
basic science - protein electrophoresis acute/chronic inflammation schiwei USMLE Step 1 Forum 1 12-01-2010 10:17 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)