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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?

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
What are the drugs used to treat lupus?
- Hydroxychloroquine (base drug) - Steroid (varies) - IV cyclophosphamide (severe)
26
Which lab test indicates inflammation of muscle (polymyositis)?
Creatine kinase levels
27
What is the treatment for polymyositis?
- HIgh dose steroid (weaned) - Immunosuppressive - Watch for lung disease
28
Pts with dermatomyositis >45 years have increased risk of | _____
Malignancy
29
What is an important investigation for patients with suspected scleroderma?
X-rays (to look for calcinosis)
30
What is CREST syndrome?
A limited form of scleroderma
31
What are some features of pain experience in osteoarthritis?
- Occurs in or near the joint - Worsens w/ activity - May be nocturnal
32
What are some pathological changes that occur in osteoarthritis?
- Thickened capsule - Cyst formation - Subchondral sclerosis - Fibrillated cartilage - Synovial hypertrophy - Osteophyte formation
33
What are the causes of osteoarthritis?
1. Genetics 2. Joint overloading 3. Damage
34
What medical therapies are available for osteoarthritis?
1. Topical anti-inflammatories 2. Paracetamol (first line) 3. NSAIDs 4. Opioids 5. steroids
35
What risk factors should be considered before prescribing NSAIDs for osteoarthritis?
1. CVS risk factors - hypertension, diabetes, smoking, arterial disease 2. Thrombotic history 3. Renal impairment
36
What are the red flags for back pain?
- 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
What are the clinical features of fibromyalgia?
- Chronic widespread and constant pain - Poor and unrefreshing sleep - Fatigue - Poor concentration and memory - Somatic complaints
38
Which feature are required for diagnosis of fibromyalgia?
- History of chronic and widespread pain - Poor quality sleep - Neurocognitive effects - Somatic symptoms
39
How do you assess fibromyalgia?
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
What is the cause of fibromyalgia?
Stress resulting in tension in the body that amplifies pain
41
What is the common mode of injury to the medial collateral ligament?
Direct valgus force and internal rotation
42
What is an important symptom that differentiates haemarthrosis and effusion in the knee joint? What injury does haemarthrosis suggest?
- Speed (haemarthrosis comes on early and tends to be painful) - ACL injury until proven otherwise
43
What is the most used clinical investigation for knee ligament injuries?
MRI (beware false + for menisci)
44
What is the second most common cause of haemarthrosis?
Patellar dislocation
45
What are 6 main categories of problem associated with the shoulder joint?
- Instability - Subacromial problems - AC joint problelms - Labral and biceps tendon - Arthritis - Frozen shoulder
46
What is frozen shoulder?
Someone with a relatively minor injury that goes on to get major restriction of motion in the shoulder
47
These history points are typical of which shoulder joint pathology: - Traumatic event, numbness - Something coming in and out - Dead arm after contact event
Instability or subluxation
48
Is pain an ongoing feature of shoulder instability/subluxation?
No - only really a problem at dislocation
49
What is a Bankart lesion? When is it usually seen?
Damage of the glenoid due to an anterior shoulder dislocation
50
What are the abbreviations for management of shoulder dislocations?
TUBS - traumatic, unilateral, bankart lesion, SURGERY AMBRI - atraumatic, multidirectional, multiple family members, bilateral, REHAB (CT disease)
51
What are 4 common sub-acromial pathologies?
- Subacromial bursitis - Subacromial impingement - Rotator cuff tendinosis - Rotator cuff rupture
52
What is painful arc syndrome a symptom of?
Subacromial impingement
53
What are the 3 types of meniscal tears?
- Vertical - Transverse - Radial
54
What is an important thing to be aware of in ankle fractures?
- Talar shift | - Increases joint stress and likelihood of post traumatic arthritis
55
Ankle sprains tend to occur when ___flexed and ____
Plantarflexed and inverted
56
Whats a common history for achilles tendon injuries?
Forced acceleration

MBCHB IV (1 decks)

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