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MBCHB IV > 1 MUSCULOSKELETAL > Flashcards

1 MUSCULOSKELETAL Flashcards

1
Q

What are the key presenting complaints for rheumatic disease?

A
  • Pain
  • Joint tenderness
  • Joint swelling
  • Stiffness
  • Weakness
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2
Q

What are two types of joint stiffness?

A
  • Inactivity stiffness

- Generalised early morning stiffness

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3
Q

What are the most important aspects of history of a rheumatic disease

A
  • Pain history
  • Time course
  • Loss of mobility or function
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4
Q

When a pt complains about loss of mobility or function what should you ask about?

A

Stiffness esp generalised early morning stiffness

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5
Q

What are the 4 components of distribution

A
  1. Peripheral/axial
  2. Symmetric/asymmetric
  3. Large/small joint
  4. Mono/oligo/poly
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6
Q

What are the DDx for inflammatory arthritis?

A
  1. Septic arthritis
  2. Connective tissue diseases
  3. Spondyloarthropathies
  4. Vasculitis syndromes
  5. Crystal arthropathies
  6. Post-infectious
  7. Pain syndrome
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7
Q

Describe the typical RA patinet

A

Female age 40-50

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8
Q

What is the most common inflammatory arthritis?

A

Rheumatoid arthritis

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9
Q

Rheumatoid arthritis is usually:

  • Symmetrical/asymmetrical
  • Small/large joint
  • Mono/polyarthritis
A

Symmetrical, small joint polyarthritis

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10
Q

What is the typical progression of RA?

A

Small joints in hands and feet -> all peripheral joints -> axial (cervical spine)

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11
Q

How do you measure the severity of RA?

A
  • Duration of morning stiffness
  • # of inflamed joints
  • Joint tenderness
  • ESR or CRP
  • Extra articular features
  • Functional assessment
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12
Q

What are some extra-articular manifestations of RA

A
  • Skin (vasculitic ulcers)
  • Muscle (wasting)
  • Bone (osteoporosis)
  • Tendons (nodules, tendosynovitis)
  • Eyes (episcleritis)
  • CVS (rare)
  • Resp. (pleuritis, pleural effusions)
  • Haem (anaemia, hypersplenism)
  • Nervous (peripheral nerve entrapments, myelopathy)
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13
Q

What are the DDx for RA?

A
  • SLE
  • Psoriatic arthritis or other spondyloarthropathy
  • Viral infection
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14
Q

What are important histological features of RA?

A
  • Dense lymphocytic infiltrate

- Hypertrophy and hyperplasia of synovium

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15
Q

Which autoantibody is present in 75% of RA patients?

A

Rheumatoid factor

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16
Q

What are some complications of RA?

A
  • Accelerated atherosclerosis
  • Atlantoaxial subluxation
  • Osteoporosis
  • Infections
  • Lymphoma
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17
Q

What are the different types of drug therapy for RA?

A
  • NSAIDs
  • DMARDs
  • Steroids
  • Cytotoxics
  • Biologics
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18
Q

Describe levido reticularis

A
  • ‘Lacy’ rash with cyanotic discolouration surrounding pale skin
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19
Q

What should always be on the ddx for a young woman with joint pain?

A

Fibromyalgia

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20
Q

Why are complement levels an important biomarker for lupus?

A

Indicates the presence of circulating immune complexes that trigger the complement cascade

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21
Q

Which disorder is commonly developed secondary to lupus?

A

Antiphospholipid syndrome

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22
Q

What are the diagnostic criteria for antiphospholipid syndrome?

A
  • Presence of venous, arterial thrombosis or pregnancy loss and repeated positive lab tests
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23
Q

What organ is most commonly damaged in lupus?

A

Kidney

24
Q

Name 4 of the clinical features used to diagnose lupus

A
  • Malar rash
  • Discoid rash
  • Photosensitivity
  • Oral ulcers
  • Arthrtis
  • Serositis
  • Renal disorder
  • Neurologic disorder
  • Haematologic disorder
  • Immunologic disorder
  • Antinuclear abs
25
Q

What are the drugs used to treat lupus?

A
  • Hydroxychloroquine (base drug)
  • Steroid (varies)
  • IV cyclophosphamide (severe)
26
Q

Which lab test indicates inflammation of muscle (polymyositis)?

A

Creatine kinase levels

27
Q

What is the treatment for polymyositis?

A
  • HIgh dose steroid (weaned)
  • Immunosuppressive
  • Watch for lung disease
28
Q

Pts with dermatomyositis >45 years have increased risk of

_____

A

Malignancy

29
Q

What is an important investigation for patients with suspected scleroderma?

A

X-rays (to look for calcinosis)

30
Q

What is CREST syndrome?

A

A limited form of scleroderma

31
Q

What are some features of pain experience in osteoarthritis?

A
  • Occurs in or near the joint
  • Worsens w/ activity
  • May be nocturnal
32
Q

What are some pathological changes that occur in osteoarthritis?

A
  • Thickened capsule
  • Cyst formation
  • Subchondral sclerosis
  • Fibrillated cartilage
  • Synovial hypertrophy
  • Osteophyte formation
33
Q

What are the causes of osteoarthritis?

A
  1. Genetics
  2. Joint overloading
  3. Damage
34
Q

What medical therapies are available for osteoarthritis?

A
  1. Topical anti-inflammatories
  2. Paracetamol (first line)
  3. NSAIDs
  4. Opioids
  5. steroids
35
Q

What risk factors should be considered before prescribing NSAIDs for osteoarthritis?

A
  1. CVS risk factors - hypertension, diabetes, smoking, arterial disease
  2. Thrombotic history
  3. Renal impairment
36
Q

What are the red flags for back pain?

A
  • Symptoms of cauda equina syndrome
  • Pain that is worsening, nocturnal or new onset in an older person
  • Systemic features (fever, weight loss)
  • History of cancer or trauma
37
Q

What are the clinical features of fibromyalgia?

A
  • Chronic widespread and constant pain
  • Poor and unrefreshing sleep
  • Fatigue
  • Poor concentration and memory
  • Somatic complaints
38
Q

Which feature are required for diagnosis of fibromyalgia?

A
  • History of chronic and widespread pain
  • Poor quality sleep
  • Neurocognitive effects
  • Somatic symptoms
39
Q

How do you assess fibromyalgia?

A
  1. 4 point scale (0-3 for fatigue, trouble thinking, waking up tired)
  2. Yes/no to headache, lower abdo pain/cramps, depression in the last 6 months
  3. Widespraed pain index
40
Q

What is the cause of fibromyalgia?

A

Stress resulting in tension in the body that amplifies pain

41
Q

What is the common mode of injury to the medial collateral ligament?

A

Direct valgus force and internal rotation

42
Q

What is an important symptom that differentiates haemarthrosis and effusion in the knee joint? What injury does haemarthrosis suggest?

A
  • Speed (haemarthrosis comes on early and tends to be painful)
  • ACL injury until proven otherwise
43
Q

What is the most used clinical investigation for knee ligament injuries?

A

MRI (beware false + for menisci)

44
Q

What is the second most common cause of haemarthrosis?

A

Patellar dislocation

45
Q

What are 6 main categories of problem associated with the shoulder joint?

A
  • Instability
  • Subacromial problems
  • AC joint problelms
  • Labral and biceps tendon
  • Arthritis
  • Frozen shoulder
46
Q

What is frozen shoulder?

A

Someone with a relatively minor injury that goes on to get major restriction of motion in the shoulder

47
Q

These history points are typical of which shoulder joint pathology:

  • Traumatic event, numbness
  • Something coming in and out
  • Dead arm after contact event
A

Instability or subluxation

48
Q

Is pain an ongoing feature of shoulder instability/subluxation?

A

No - only really a problem at dislocation

49
Q

What is a Bankart lesion? When is it usually seen?

A

Damage of the glenoid due to an anterior shoulder dislocation

50
Q

What are the abbreviations for management of shoulder dislocations?

A

TUBS - traumatic, unilateral, bankart lesion, SURGERY

AMBRI - atraumatic, multidirectional, multiple family members, bilateral, REHAB (CT disease)

51
Q

What are 4 common sub-acromial pathologies?

A
  • Subacromial bursitis
  • Subacromial impingement
  • Rotator cuff tendinosis
  • Rotator cuff rupture
52
Q

What is painful arc syndrome a symptom of?

A

Subacromial impingement

53
Q

What are the 3 types of meniscal tears?

A
  • Vertical
  • Transverse
  • Radial
54
Q

What is an important thing to be aware of in ankle fractures?

A
  • Talar shift

- Increases joint stress and likelihood of post traumatic arthritis

55
Q

Ankle sprains tend to occur when ___flexed and ____

A

Plantarflexed and inverted

56
Q

Whats a common history for achilles tendon injuries?

A

Forced acceleration

MBCHB IV (1 decks)

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