Unknown 132
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Unknown 132 as PDF for free.
More details
- Words: 321
- Pages: 7
Unknown #132
A 32 year old man is evaluated for low back pain. He states he is an avid basketball player, and began to notice back pain three months ago, most mornings after participating in long basketball games. The pain is not noticeable while he is playing basketball. For the past three weeks, he has had worsening back pain in the morning which lasts approximately 60 minutes. He has tried occasional ibuprofen with some relief. He is otherwise in good health, and takes no other medications. Review of systems is positive for fatigue and mild generalized “joint aches.”
On physical exam, he appears well. Vital signs are normal. Conjunctiva are slightly red bilaterally. Cardiac, pulmonary and abdominal exams are normal. There is no small joins synovitis. You ask him to flex his spine (touch his toes) and note that he has 4 cm of expansion in the lumbar spine when going from an erect posture to flexed.
Which of the following is most likely to confirm your suspected diagnosis? A) Blood cultures for neisseria gonorrhea B) Serum rheumatoid factor levels C) HLA-B27 gene testing D) X-rays of the spine E) Anti nuclear antigen testing
Which of the following is most likely to confirm your suspected diagnosis? A) Blood cultures for neisseria gonorrhea B) Serum rheumatoid factor levels C) HLA-B27 gene testing D) X-rays of the spine E) Anti nuclear antigen testing
Ankylosing spondylitis Seronegative spondyloarthropathy Young men Inflammatory symptoms (morning stiffness), peripheral arthropathy and enthesithis Also associated with systemic symptoms – – – –
Fatigue Fever Weight loss Anorexia
Associated with uveitis, cardiac involvement, and some other extraarticular involvement
Ankylosing spondylitis HLA-B27 associated – But not diagnostic, since B27 positivity is common
Appropriate history plus radiographic findings (sacroiliitis) confirm diagnosis Schöber test may be positive (mark at L5 and 10 cm above, ask patient to flex spine, normal expansion is >5 cm) OBJECTIVE: Confirm a suspected diagnosis of chronic ankylosing spondylitis.
A 32 year old man is evaluated for low back pain. He states he is an avid basketball player, and began to notice back pain three months ago, most mornings after participating in long basketball games. The pain is not noticeable while he is playing basketball. For the past three weeks, he has had worsening back pain in the morning which lasts approximately 60 minutes. He has tried occasional ibuprofen with some relief. He is otherwise in good health, and takes no other medications. Review of systems is positive for fatigue and mild generalized “joint aches.”
On physical exam, he appears well. Vital signs are normal. Conjunctiva are slightly red bilaterally. Cardiac, pulmonary and abdominal exams are normal. There is no small joins synovitis. You ask him to flex his spine (touch his toes) and note that he has 4 cm of expansion in the lumbar spine when going from an erect posture to flexed.
Which of the following is most likely to confirm your suspected diagnosis? A) Blood cultures for neisseria gonorrhea B) Serum rheumatoid factor levels C) HLA-B27 gene testing D) X-rays of the spine E) Anti nuclear antigen testing
Which of the following is most likely to confirm your suspected diagnosis? A) Blood cultures for neisseria gonorrhea B) Serum rheumatoid factor levels C) HLA-B27 gene testing D) X-rays of the spine E) Anti nuclear antigen testing
Ankylosing spondylitis Seronegative spondyloarthropathy Young men Inflammatory symptoms (morning stiffness), peripheral arthropathy and enthesithis Also associated with systemic symptoms – – – –
Fatigue Fever Weight loss Anorexia
Associated with uveitis, cardiac involvement, and some other extraarticular involvement
Ankylosing spondylitis HLA-B27 associated – But not diagnostic, since B27 positivity is common
Appropriate history plus radiographic findings (sacroiliitis) confirm diagnosis Schöber test may be positive (mark at L5 and 10 cm above, ask patient to flex spine, normal expansion is >5 cm) OBJECTIVE: Confirm a suspected diagnosis of chronic ankylosing spondylitis.
