525. Rheumatic Diseases – Rheumatology

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525. Rheumatic Diseases – Rheumatology

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 526

FEES: 555/- INR only

CERTIFICATE VALIDITY: Lifetime

CERTIFICATES DELIVERY: In 48 hours

BOOKS/ MANUALS: Pages

Syllabus

Series editor foreword . . . . . . . . . . . . . . . v
Preface . . . . . . . . . . . . . . . . . . . . . . . vi
Acknowledgements . . . . . . . . . . . . . . . . . vii
Dedications . . . . . . . . . . . . . . . . . . . . viii
1. Taking a history . . . . . . . . . . . . . . 1
Presenting complaint . . . . . . . . . . . . 1
History of the presenting complaint . . . . . 1
Past medical history . . . . . . . . . . . . 2
Drug history . . . . . . . . . . . . . . . . 2
Social history . . . . . . . . . . . . . . . 2
Family history . . . . . . . . . . . . . . . 2
Systemic enquiry . . . . . . . . . . . . . . 2
2. Examining joints. . . . . . . . . . . . . . 3
General principles . . . . . . . . . . . . . 3
Clinical examining . . . . . . . . . . . . . 3
Examination of the hip . . . . . . . . . . . 4
Examination of the knee . . . . . . . . . . 6
Examination of the ankle and foot. . . . . . 8
Examination of the spine . . . . . . . . . 10
Examination of the shoulder . . . . . . . 11
Examination of the elbow. . . . . . . . . 13
Examination of the wrist and hand . . . . 14
3. Investigations . . . . . . . . . . . . . . 17
Blood tests . . . . . . . . . . . . . . . 17
Synovial fluid analysis . . . . . . . . . . 19
Nerve conduction studies (NCS) and
electromyography (EMG) . . . . . . . . 19
Biopsy. . . . . . . . . . . . . . . . . . 19
Imaging . . . . . . . . . . . . . . . . . 19
4. Regional pain . . . . . . . . . . . . . . 23
Back, hip and leg pain . . . . . . . . . . 23
Knee pain . . . . . . . . . . . . . . . . 26
Ankle and foot pain . . . . . . . . . . . 27
Neck and/or upper-limb pain . . . . . . . 30
5. Widespread musculoskeletal pain. . . . . 35
Differential diagnosis . . . . . . . . . . . 35
Paraneoplastic rheumatic syndrome . . . . 35
Fibromyalgia. . . . . . . . . . . . . . . 36

6. An acute hot swollen joint . . . . . . . . 41
Differential diagnosis . . . . . . . . . . . 41
History focusing on the acute hot swollen
joint . . . . . . . . . . . . . . . . . . 41
Examination of a patient with an acute hot
swollen joint . . . . . . . . . . . . . . 43
Investigation of a patient with an acute
swollen joint . . . . . . . . . . . . . . 43
7. A child with a limp . . . . . . . . . . . 45
Differential diagnosis . . . . . . . . . . . 45
History focusing on the child
with a limp . . . . . . . . . . . . . . . 45
Examining a child with a limp . . . . . . . 46
Investigating a child with a limp. . . . . . 47
8. A swelling. . . . . . . . . . . . . . . . 49
Differential diagnosis . . . . . . . . . . . 49
History focusing on a swelling . . . . . . 49
Examination focusing on a swelling . . . . 50
Investigation of a patient with a
swelling . . . . . . . . . . . . . . . . 50
9. Back pain . . . . . . . . . . . . . . . . 53
Differential diagnosis . . . . . . . . . . . 53
Examination focusing on back and
leg pain . . . . . . . . . . . . . . . . 53
Investigation of a patient with
back pain . . . . . . . . . . . . . . . 54
Mechanical low back pain . . . . . . . . 54
Prolapsed intervertebral disc . . . . . . . 57
Spondylolisthesis . . . . . . . . . . . . . 59
Spinal stenosis . . . . . . . . . . . . . . 60
Discitis/vertebral osteomyelitis . . . . . . 61
Scoliosis . . . . . . . . . . . . . . . . . 62
10. Altered sensation and weakness . . . . . 65
Differential diagnosis . . . . . . . . . . . 65
History . . . . . . . . . . . . . . . . . 65
Carpal tunnel syndrome . . . . . . . . . 66
Ulnar nerve entrapment . . . . . . . . . 67
Radial nerve injuries . . . . . . . . . . . 68
Common peroneal nerve injuries . . . . . 68

11. Osteoarthritis . . . . . . . . . . . . . . 69
Definition . . . . . . . . . . . . . . . . 69
Incidence . . . . . . . . . . . . . . . . 69
Pathology and aetiology . . . . . . . . . 69
Clinical features . . . . . . . . . . . . . 69
Diagnosis and investigation . . . . . . . . 71
Management . . . . . . . . . . . . . . 71
12. Rheumatoid arthritis . . . . . . . . . . . 75
Definition . . . . . . . . . . . . . . . . 75
Incidence and prevalence . . . . . . . . . 75
Aetiology . . . . . . . . . . . . . . . . 75
Genetic factors. . . . . . . . . . . . . . 75
Environmental factors . . . . . . . . . . 75
Immunological abnormalities . . . . . . . 75
Pathology . . . . . . . . . . . . . . . . 76
Clinical features . . . . . . . . . . . . . 77
Articular features of RA. . . . . . . . . . 77
Extra-articular features of RA . . . . . . . 79
Systemic features of RA . . . . . . . . . 79
The effects of RA on distant organs . . . . 79
Investigations . . . . . . . . . . . . . . 80
Radiological investigations . . . . . . . . 81
Management . . . . . . . . . . . . . . 81
Drug treatment . . . . . . . . . . . . . 81
13. Spondyloarthropathies . . . . . . . . . . 85
Ankylosing spondylitis . . . . . . . . . . 85
Psoriatic arthropathy . . . . . . . . . . . 88
Reactive arthritis . . . . . . . . . . . . . 90
Enteropathic arthritis . . . . . . . . . . . 91
14. Connective tissue diseases . . . . . . . . 93
Systemic lupus erythematosus. . . . . . . 93
The antiphospholipid syndrome . . . . . . 96
Sjo ̈ gren syndrome . . . . . . . . . . . . 97
Polymyositis and dermatomyositis . . . . . 99
Systemic sclerosis . . . . . . . . . . . . 101
The vasculitides . . . . . . . . . . . . . 103
15. Metabolic bone disease . . . . . . . . . 107
Osteoporosis . . . . . . . . . . . . . . 107
Paget disease . . . . . . . . . . . . . . 110
Rickets and osteomalacia . . . . . . . . . 111
16. Gout and pseudogout . . . . . . . . . . 113
Gout . . . . . . . . . . . . . . . . . . 113
Calcium pyrophosphate dihydrate disease . 116

17. Paediatric joint disease. . . . . . . . . . 119
Normal variants . . . . . . . . . . . . . 119
Paediatric hip disorders . . . . . . . . . . 120
Congenital talipes equinovarus (clubfoot) . . 123
Osteogenesis imperfecta . . . . . . . . . 123
Cerebral palsy . . . . . . . . . . . . . . 124
Non-accidental injury. . . . . . . . . . . 124
Paediatric knee conditions . . . . . . . . 125
Juvenile idiopathic arthritis . . . . . . . . 126
18. Fractures . . . . . . . . . . . . . . . . 129
Incidence . . . . . . . . . . . . . . . . 129
Definitions. . . . . . . . . . . . . . . . 129
Clinical features . . . . . . . . . . . . . 129
Diagnosis and investigation . . . . . . . . 130
Management . . . . . . . . . . . . . . 131
Complications of fractures . . . . . . . . 133
Common fractures . . . . . . . . . . . . 135
19. Trauma . . . . . . . . . . . . . . . . . 139
Definition . . . . . . . . . . . . . . . . 139
Incidence . . . . . . . . . . . . . . . . 139
Clinical features . . . . . . . . . . . . . 139
Investigations . . . . . . . . . . . . . . 140
Treatment . . . . . . . . . . . . . . . . 141
Open fractures. . . . . . . . . . . . . . 141
Spinal injuries . . . . . . . . . . . . . . 141
Pelvic fractures. . . . . . . . . . . . . . 142
20. Infection of bones and joints . . . . . . . 145
Osteomyelitis . . . . . . . . . . . . . . 145
Septic arthritis . . . . . . . . . . . . . . 148
Tuberculosis . . . . . . . . . . . . . . . 149
21. Principles of orthopaedic surgery . . . . . 151
Preoperative assessment . . . . . . . . . 151
Immediate preoperative care . . . . . . . 152
Surgery . . . . . . . . . . . . . . . . . 152
Postoperative care . . . . . . . . . . . . 154
Complications . . . . . . . . . . . . . . 154
Infection . . . . . . . . . . . . . . . . 156
Shock . . . . . . . . . . . . . . . . . . 158
22. Malignancy . . . . . . . . . . . . . . . 161
History . . . . . . . . . . . . . . . . . 161
Examination . . . . . . . . . . . . . . . 162
Investigation. . . . . . . . . . . . . . . 162
Primary bone tumours . . . . . . . . . . 165

Secondary bone tumours . . . . . . . . . 168
Haemopoietic diseases . . . . . . . . . . 171
Leukaemia. . . . . . . . . . . . . . . . 171
23. Sports injuries . . . . . . . . . . . . . . 173
Knee injuries. . . . . . . . . . . . . . . 173
Shoulder dislocation . . . . . . . . . . . 178
Ankle sprain . . . . . . . . . . . . . . . 179
24. Soft-tissue disorders . . . . . . . . . . . 181
Introduction . . . . . . . . . . . . . . . 181
Tendon lesions. . . . . . . . . . . . . . 181

Bursitis . . . . . . . . . . . . . . . . . 182
Dupuytren contracture . . . . . . . . . . 183
Self-assessment . . . . . . . . . . . . . . . 185
Single best answer questions (SBAs) . . . . . 187
Extended matching questions (EMQs) . . . . . 195
SBA answers. . . . . . . . . . . . . . . . . 207
EMQ answers . . . . . . . . . . . . . . . . 211
Glossary . . . . . . . . . . . . . . . . . . . 219
Index . . . . . . . . . . . . . . . . . . . . 221

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