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\author{bee.f (bee.f)}
\pdfinfo{
  /Title (5002-case-13-mrs-joan-lockley.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 13 - Mrs Joan Lockley Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 13 - Mrs Joan Lockley Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38708/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 15th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- 65 y.o., university administrator (P/T)\{\{nl\}\}- Shoulder pain \& stiffness\{\{nl\}\}- Entire shoulder girdle (bilateral)\{\{nl\}\}- Sx started about 4-5 weeks ago\{\{nl\}\}- She cannot recall any specific injury leading Sx\{\{nl\}\}- Feels generally less well\{\{nl\}\}- Noticed some pain in her fingers\{\{nl\}\}- Developed jaw pain \& left sided headaches (over last 2 days, not normally headache sufferer)} \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Shoulder girdle}}\{\{nl\}\}- Stiff \& achy\{\{nl\}\}- 8/10\{\{nl\}\}- Worse in the morning\{\{nl\}\}- Needs approx 1hr before she can shower \& dress herself} \tn 
% Row Count 11 (+ 3)
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Fingers:}} achy pain\{\{nl\}\}- {\bf{Headache:}} 8-9/10\{\{nl\}\}- {\bf{Jaw pain:}} comes on when chewing} \tn 
% Row Count 13 (+ 2)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{AA:}} Getting up \& dressed; combing hair (difficulty to lift hand), sleeping (turning in bed painful)} \tn 
% Row Count 16 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Extras}}\{\{nl\}\}- Paracetamol \& ibuprofen last two weeks (didn't help)\{\{nl\}\}- Headache doesn't ease w/ medication\{\{nl\}\}- Discectomy L4-5 @ 35 y.o.\{\{nl\}\}- Full hysterectomy @ 42 y.o. due to fibroids\{\{nl\}\}- Getting more tired \& Sx affect her mood\{\{nl\}\}- Very concerned shimmy have toggle up job\{\{nl\}\}- Husband passed 2 years ago from MI\{\{nl\}\}- Mother: RA; died @ 65 y.o. from stroke\{\{nl\}\}- Father: passed from aortic aneurysm @ 64 y.o.\{\{nl\}\}- Lost 2.5kg over last 2 months for no specific reason\{\{nl\}\}- Recently more night sweating which wakes her up} \tn 
% Row Count 27 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Examination Findings}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{General observations}}\{\{nl\}\}- Mild kyphosis} \tn 
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% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Head, eyes, ears, nose}}\{\{nl\}\}- Very tender to palpation over the temporal area on L} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical tests}}\{\{nl\}\}- {\bf{Full AROM \& PROM shoulders:}} w/ moderate pain \& stiffness in the shoulder girdle\{\{nl\}\}- {\bf{AROM Cx:}} some tenderness \& stiffness on R rotation\{\{nl\}\}- {\bf{Full AROM \& PROM fingers:}} although some pain in all directions} \tn 
% Row Count 8 (+ 5)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Working diagnosis}}\{\{nl\}\}- Polymyalgia Rheumatica (PMR) - fits well w/ presentation including red flag features} \tn 
% Row Count 3 (+ 3)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{- Bilateral shoulder pain \& stiffness: appears MSK \& inflammatory\{\{nl\}\}{\bf{{\emph{Differentials}}}} (based on age):\{\{nl\}\}- {\bf{Polymyalgia rheumatica (PMR):}} fits well w/ presentation, including red flag features\{\{nl\}\}- {\bf{Rheumatoid arthritis (RA):}} doesn't normally present in the shoulders} \tn 
% Row Count 9 (+ 6)
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{- Temporal pain presentations: pathognomonic of temporal arteritis\{\{nl\}\}{\bf{{\emph{Differentials:}}}}\{\{nl\}\}- {\bf{Giant cell arteritis (GCA) affecting temporal arteries:}} pain location, pain severity, very tender scalp \& presence of jaw claudication\{\{nl\}\}→ {\bf{Urgent}} referral needed due to risk of blindness} \tn 
% Row Count 15 (+ 6)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical guidance}}\{\{nl\}\}- Specialised (normally rheumatologist) evaluation take place {\bf{same day}} (but in all cases within 3 days)\{\{nl\}\}- GP will refer to secondary care via the local fast track GCA pathway\{\{nl\}\}- We need to get the pt to see their GP (or nurse practitioner) urgently on the same day} \tn 
% Row Count 22 (+ 7)
% Row 4
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\mymulticolumn{1}{x{17.67cm}}{{\bf{PMR \& GCA are related conditions:}} around 10\% of PMR pts have HCA \& about 50\% of those w/ GCA have PMR\{\{nl\}\}- {\bf{PMR-like Sx:}} been linked to cancer related to a paraneoplasic syndrome leading some to suggest that pts w/ PMR-like Sx should be screened for {\emph{occult cancer}}} \tn 
% Row Count 28 (+ 6)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentials for inflammatory shoulder pain}}\{\{nl\}\}- {\bf{Rotator cuff tendinitis or tear:}} inflammation or tear of rotator cuff tendons that attach the muscles of the shoulder to the bone\{\{nl\}\}- {\bf{Adhesive capsulitis (frozen shoulder):}} condition in which the shoulder joint becomes stiff \& painful, often following a period of immobility\{\{nl\}\}- {\bf{Bursitis:}} inflammation of bursa, commonly seen in the subacromial bursa\{\{nl\}\}- {\bf{Shoulder arthritis:}} inflammation of the shoulder joint, commonly due to OA or RA\{\{nl\}\}- {\bf{Polymyalgia rheumatica (PMR):}} systemic inflammatory disorder that causes muscle pain \& stiffness, commonly affecting the shoulders, hips, \& neck\{\{nl\}\}- {\bf{Gout:}} type of arthritis caused by the build-up of uric acid crystals in the joints, which can cause sudden \& severe pain in the shoulder\{\{nl\}\}- {\bf{Lupus:}} chronic autoimmune disorder that can cause joint pain \& inflammation, including in the shoulders} \tn 
% Row Count 19 (+ 19)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Causes of referred pain in the shoulder}}\{\{nl\}\}- {\bf{Pancreatitis:}} upper abdomen, radiating to back \& {\bf{L}} shoulder\{\{nl\}\}- {\bf{Angina, heart attack, pericarditis:}} {\bf{L}} shoulder or arm pain\{\{nl\}\}- {\bf{Gallbladder disease:}} {\bf{R}} shoulder blade\{\{nl\}\}- {\bf{Liver disease:}} {\bf{R}} shoulder\{\{nl\}\}- {\bf{Cx disc herniation:}} sharp/shock-like pain\{\{nl\}\}- {\bf{Pneumonia or pleurisy:}} sharp/stabbing pain\{\{nl\}\}- {\bf{Cx/upper Tx musculature}}} \tn 
% Row Count 28 (+ 9)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Causes of jaw claudication}} (Jaw pian, often when chewing)\{\{nl\}\}- Giant cell arteritis (temporal arteritis)\{\{nl\}\}- Atherosclerosis in jaw vasculature: affecting blood flow\{\{nl\}\}- Fibromuscular dysplasia: artery walls thicken, narrowing lumen\{\{nl\}\}- TMJ disorders: dysfunction or inflammation that can be mistake for claudication pain\{\{nl\}\}- Tx outlet syndrome} \tn 
% Row Count 36 (+ 8)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{PMR \& temporal arteritis}}\{\{nl\}\}- Related inflammatory conditions: can both present w/ fever, fatigue, depressed effect, malaise, weight loss\{\{nl\}\}⏺ {\bf{{\emph{Polymyalgia rheumatica (PMR):}}}}\{\{nl\}\}- Non-specific pain, stiffness in shoulder \& pelvic girdles\{\{nl\}\}- Increased ESR rate\{\{nl\}\}- Morning stiffness lasts 30-60 min\{\{nl\}\}- Stiffnessafter prolonged sitting\{\{nl\}\}- Severe pain in neck, shoulders \& buttocks\{\{nl\}\}- Can find it difficult to do ADL, overhead work, brush hair, walk stairs, etc\{\{nl\}\}- Muscle tender to palpate\{\{nl\}\}- NO weakness (unless muscles are atrophying)\{\{nl\}\}⏺ {\bf{{\emph{Temporal arteritis (giant cell arteritis):}}}}\{\{nl\}\}- Can lead to sudden blindness if left untreated\{\{nl\}\}- Unilateral eye Sx: double vision, vision loss\{\{nl\}\}- PMR Sx + headaches, tenderness of affected area of scalp\{\{nl\}\}- Burning, stabbing sensation of Ha\{\{nl\}\}- Jaw claudication is associated Sx, pain when chewing} \tn 
% Row Count 19 (+ 19)
% Row 4
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Myofascial trigger points}}\{\{nl\}\}- Nodules in muscle tissue associated w/ localised pain, tenderness, referred pain\{\{nl\}\}- Can be caused by injury, overuse, stress, or poor posture\{\{nl\}\}{\bf{2 types:}}\{\{nl\}\}- {\bf{Active:}} TTP, causing pain \& discomfort locally or referred\{\{nl\}\}- {\bf{Latent:}} nodules present but not painful/uncomfortable unless pressure is applied} \tn 
% Row Count 27 (+ 8)
% Row 5
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Which muscles can refer pain to temporal area?}}\{\{nl\}\}⏺ {\bf{{\emph{Primary:}}}}\{\{nl\}\}- Trapezius\{\{nl\}\}- Sternocleidomastoid (SCM)\{\{nl\}\}⏺ {\bf{{\emph{Secondary:}}}}\{\{nl\}\}- Temporalis\{\{nl\}\}- Splenius cervicis\{\{nl\}\}- Suboccipital group\{\{nl\}\}- Semispinalis capitis} \tn 
% Row Count 32 (+ 5)
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Health implications for a pt who's had a full hysterectomy}}\{\{nl\}\}- {\bf{Menopause:}} if ovaries removed too, pts will go into menopause if they have not already done so; can lead to Sx: hot flashes, mood changes, \& vaginal dryness\{\{nl\}\}- {\bf{Infertility:}} no longer fertile\{\{nl\}\}- {\bf{Sexual function:}} decreased sex drive; vaginal dryness \&/or discomfort during intercouse\{\{nl\}\}- {\bf{Urinary problems:}} incontinence; UTIs\{\{nl\}\}- {\bf{Increased risk of heart CV disease:}} due to change in hormone levels\{\{nl\}\}- {\bf{Increased risk of certain cancers:}} (e.g. ovarian cancer) due to the removal of the ovaries} \tn 
% Row Count 12 (+ 12)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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