11. MSK Flashcards
1
Q
what is the most common type of arthritis
A
osteoarthritis
2
Q
what is osteoarthritis 1 and what happens 1
A
degenerative disease of joint due to mechanical erosion of the cartilage in the joint
3
Q
risk factors of osteoarthritis 4
A
women, obesity, age, occupation
4
Q
symptoms of osteoarthritis 2
A
- painful, hard joints
- morning stiffness for less than 30 mins
5
Q
state and explain two clinical signs of osteoarthritis
A
- Bouchards nodes (bony growths on PIP joints)
- Heberdens nodes (bony growths on DIP joints)
6
Q
what joints does osteoarthritis affect 1 and 3 examples
A
typically affects the most stressed joints in the body eg base of thumb, hip or knee
7
Q
2 investigations into osteoarthritis and results
A
- bloods= normal
- x-ray of joint (LOSS- los of joint space, osteophytes, subchondral sclerosis, sunchondral cysts)
8
Q
what are osteophytes
A
bony growths on joint
9
Q
what is subchondral sclerosis and sunchondral cysts
A
sclerosis- increased density of bone along the joint line
cyst- fluid filled holes in bone
10
Q
what is the treatment of osteoarthritis 3
A
- lifestyle changes: physio, weight bearing
- pain relief: NSAIDs
- last resort: joint replacement
11
Q
complications of osteoarthritis 2
A
- destruction of joint
- loss of function
12
Q
what is rheumatoid arthritis and what happens
A
inflammatory disease
autoimmune destruction of synovium (soft tissue of the joints)
13
Q
compare the symmetry and number of joints affected for rheumatoid arthritis and osteoarthritis
A
osteoarthritis= asymmetrical, affects few joints
rheumatoid= symmetrical, affects many joints
14
Q
risk factors of rheumatoid arthritis 2
A
HLADR4/1
women
15
Q
symptoms of rheumatoid arthritis 2
A
- painful swollen joints
- morning stiffness lasting more than 30 mins
16
Q
state and explain the 3 clinical signs of rheumatoid arthritis
A
- rheumatoid skin nodules
- boutinniere deformity
- swan neck thumb
17
Q
investigations for R arthritis 4 and results
A
- bloods: high ESR/CRP
- serology: positive rheumatoid factor, positive anti-CCP antibodies
- genetic test for HLA DR1/4
- X-ray (LESS- lost joint spaces, bony erosion, soft tissue swelling, periarticular osteopenia)
18
Q
treatment for R arthritis 3
A
- Disease modifying anti rheumatic drugs- methotrexate/ hydroxychloroquine/ sulfsalazine
- analgesia- NSAIDs/ steroid injections
- biologics
-> 1st line: TNF alpha inhibitor infliximab (given with methotrexate)
-> 2nd line: B cell inhibitor (CD20 target)- rituximab
RADAB
19
Q
what is gout’s pathophysiology 3
A
- uric acid build up
- leads to urate crystal deposition along joints
- causes joints to become hot, swollen and painful
20
Q
risk factors for gout 2
A
- purine rich food: high meat, seafood, alcohol diet
- middle aged overweight man
21
Q
presentation of gout 2 and what joint is usually affected 1
A
- sudden onset
- severe swollen red joint
- usually big toe (metatarsophalangeal joint)
22
Q
investigations for gout 2 and result
A
- joint aspiration and polorised light microscopy showed needle shaped negatively birefringent crystals
- bloods: high uric acid
23
Q
treatment for acute gout 3
A
1st line NSAIDs
2nd line colchine (alternative to NSAIDs)
3rd line steroids
24
Q
prophylactic treatment for gout 2
A
- allopurinol
- lifestyle changes: decrease meat, seafood and alcohol
25
how does allopurinol prevent gout 2
it is a xanthine oxidase inhibitor which reduces uric acid production
26
what is the crystal composition for gout and pseudogout?
gout= monosodium urate crystals
pseudogout= calcium pyrophosphate crystals
27
What is pseudogout
calcium pyrophosphate crystals deposits along joint capsule
28
risk factors for pseudogout 3
1. hypercalcaemia
2. hyperparathyroidism
3. hyperthyroidism
29
presentation of pseudogout 2
1. swollen red hot joint
2. multiple widespread joints affected
30
what joint is usually affected in pseudogout
knee
31
investigations for pseudogout 2
1. joint aspiration and polarised light microscopy shows positively birefringent, rhomboid shaped crystals
2. bloods show high calcium
32
treatment for pseudogout 2
1. same acute management as gout- NSAIDs, colchine and sterouds
2. joint aspiration in severe cases
33
what is osteoporosis 1 and measurement critera
decreased bone density by 2.5 standard deviations below the young adult mean value
34
what are the risk factors for osteoporosis 9
SHATTERED
steroids
hyperthyroid/ parathyroidism
alcohol and smoking
thin ie low BMI
testosterone low
early menopause
renal/ liver failure
erosive/ inflammatory bone disease eg rheumatoid arthritis
diabetes type 1
35
presentation of osteoporosis 1
fractures
36
investigation of osteoporosis 2 and explain each one
1. DEXA scan- dual energy XR absorptiometry
which generates a T and Z score
2. FRAX score (fracture risk assessment tool) to assess 10 year fracture risk in osteoporotic patients
37
What is T score and Z score and how can they be calculated
from a DEXA scan
T score= compares patients bone mass density to a healthy young adult aged 20-35
Z score= compares patients bone mass density to the same age
38
treatment for osteoporosis in order 3
1. bisphosphonates (alendronate) AND vitamin D AND calcium supplements
2. monoclonal antibody eg derosumab
3. hormone replacement therapy (esp for women after menopause)
39
what is osteopenia and osteoporosis T values
osteopenia= T value of -1 to -2.5
osteoporosis= T value of -2.5 or less
40
what reaction is SLE and what does it stand for in full
hypersensitivity T3 reaction (antigen-antibody complex deposition)
systemic lupus erythromatosis
41
what is the pathophysiology of SLE
anti nucleur antibodies (ANA) and anti double stranded DNA antibodies (anti dsDNA) attack soft tissues
42
risk factors of SLE 3
females
afrocarribean
young-middle aged
43
symptoms of SLE 4
mouth ulcers
malar (butterfly) rash
muscle pain
fevers
travel from bottom of head up: open mouth to see mouth ulcers and hurts to open so wide- muscle fatigue, travel to cheeks- malar rash then go up and measure temperature on forehead= pyrexia
44
investigations for SLE 2
1. bloods: high ESR, normal CRP, low C3&4
2. serology + ANA and dsDNA
45
what is diagnostic for SLE 3
+ ANA and + anti dsDNA and symptoms
46
treatment for SLE 2
1st line- corticosteroids eg prednisolone
severe- hydroxychloroquine
47
what is antiphospholipid syndrome pathophysiology 2
1. immune system produces abnormal antibodies called antiphospholipid antibodies
2. these increase the risk of blood clots
48
types of antiphospholipid syndrome 2
1. primary/ idiopathic
2. secondary to an autoimmune disorder eg SLE
49
main risk factor for antiphospholipid syndrome 1
females
50
presentation of antiphospholipid syndrome 4
CLOT
coagulopathy (increased risk DVT/PE/stroke/MI)
levido reitcularis-characteristic purple discolouration of skin which is lace-like
obstetric issues- miscarriages
thrombocytopenia
51
investigation for Antiphospholipid syndrome 3
1. blood have raised:
-> lupus anticoagulant
-> anticardiolipin antibodies (IgM/G) positive
-> anti beta2 glycoprotein-1 antibodies
52
diagnosis for antiphospholipid syndrome 1
2 abnormal blood test 12 weeks apart
53
treatment for antiphospholipid syndrome 2
1st line: warfarin- long term if they have a past thrombus
2nd line: if pregnant give aspirin and heparin instead
54
what is sjorgen syndrome 1
autoimmune exocrine dysfunction
55
types of sjorgen syndrome 2
1. primary/ idiopathic
2. secondary to another condition eg SLE/ rheumatoid arthritis
56
risk factors for sjorgen syndrome 2
HLAB8/ DR3
females
57
presentation of sjorgen syndrome 1
1. dry mucous membranes eg eyes, mouth, vagina
58
investigations for sjorgen syndrome 2
1. serology
-> anti-Ro and anti La antibodies positive
2. Schirmer test
-> induce tears and place filter paper under eyes
-> tears travel less than 10mm (should be 20mm+)
59
treatment for sjorgens 2
1. artificial tears, saliva and lubricant for sexual activity
2. hydroxychloroquine to prevent progression
60
main 2 complications for sjorgens
infection of all dry sites
sexual dysfunction
61
what is scleroderma CREST also known as and what is it 3
Limited Cutaneous Systemic Sclerosis
1. autoimmune condition
2. causing fibrosis
3. and hardening and tightening of skin
62
what is the presentation of scleroderma 5
CREST
-Calcinosis: calcium deposition in subcut tissue
-Raynauds phenomenon: extremity ischaemia in cold with different colour
-Eosophageal dysmotility and strictures: = GI symptoms
-Sclerodactylyl: thickening of skin over fingers= movement restriction
-Telenagiectasia: dilated capillaries visible from skin
63
what are the investigations for scleroderma CREST 1
1. serology
-> positive anti centromere antibodies (ACA)
64
treatment for scleroderma CREST 2
1. symptomatic treatment eg PPI for GI symptoms
2. immunosuppressants to slow progression eg cyclophosphamide
65
what is Polymyotitis and what is Dermatomyositis
Polymyotitis= condition of chronic inflammation of muscles
Dermatomyositis= chronic inflammation of skin and muscles
66
presentation of Polymyotitis/ Dermatomyositis 3
1. symmetrical wasting of muscles of the shoulder and pelvis girdle
2. hard to stand from sitting or to squat or to put hands on top of head (might involve respiratory muscles to complete some tasks)
3. derma= skin changes (grottens papules- scales on knuckles and heliotrope- purple eyelids)
67
investigations for Polymyotitis/ Dermatomyositis 2 + diagnostic
1. serology
-> anti Jo 1 in poly and derma
-> anti MI2/ANA in derm only
2. bloods: CK over 1000 U/L
3. diagnostic- muscle fibre biopsy showing necrosis
68
treatment for Polymyotitis/ Dermatomyositis 2
1st line: corticosteroids eg prednisolone
2nd line: immunosuppressants eg azathioprine
69
what is fibromyalgia
chronic widespread MSK pain for 3+ months
70
risk factors for fibromyalgia 2
females
stress
71
pathophysiology of fibromyalgia 1
unknown (fibromyalgia is the MSK equivalent of IBD)
72
presentation of fibromyalgia 3
widespread pain
fatigue
sleep difficulties
73
investigations of fibromyalgia and how is it diagnosed and why
1. pain or tenderness in 11 or more out of 18 sites palpated
->through clinical diagnosis because there are no serological markers or increase in ESR/CRP
74
treatment for fibromyalgia 2
1. educate patient on condition
2. tricyclic antidepressants for severe pain
75
differential for fibromyalgia
polymalgia rheumatica
76
three categories of vasculitis
large, medium and small vessel
77
give an example of each of the three types of vasculitis
large vessel- giant cell arteritis
medium vessel- polyartheritis nodosa
small vessel- granulomatosis with polyangitis
78
what is the general treatment for vasculitis 1
corticosteroids
79
what is giant cell arteritis
inflammation of large arteries eg aorta and major branches
80
risk factors for giant cell arteritis 2
females
history of polymyalgia rheumatica
81
presentation of giant cell arteritis 4
headaches which are unilateral
jaw claudication (jaw discomfort whilst chewing)
tenderness of scalp
visual changes
guy had a headache, someone gives him a head massage, he clenches his jaw and sees red
82
what branch is affected for 3 symptoms for giant cell arteritis
scalp tenderness= temporal
vision= opthalmic
jaw= facial branch
83
investigations for giant cell arteritis
1st line: ESR (high-over 50)
diagnosis: temporal artery biopsy showing granulomatous inflammation
84
treatment of giant cell arteritis
prednisolone asap
85
complications of giant cell arteritis 2
amaurosis fugax/ permanent blindness
86
what are Spondylarthropathies and what are they all associated with
group of conditions that involve chronic inflammation of the joints and skeleton
HLA B27
87
what are the Spondylarthropathies 4
PAIR
psoriasis arthritis
ankylosing spondylitis
IBD associated arthritis
reactive arthritis
88
presentation of Spondylarthropathies 9
SPINEACHE
sausage fingers (dactylitis)
psoriasis
inflammatory back pain
NSAIDs-> gosd response
enthesitis (planter fasciitis= inflammed heel tendon)
arthritis
crohns/collitis
HLA B27
eyes-> uveitis
89
what is Ankylosing Spondylitis 2
chronic inflammation of the spine, involving new bone formation
90
presentation of Ankylosing Spondylitis 4
young male
progressively worsening back stiffness
pain better with exercise
pain worse after inactivity
91
investigations for Ankylosing Spondylitis (1,3)
1. x ray of spine and sacrum
-> bamboo spine
-> squaring of vertebral bodies
-> syndesmophytes (fusion of vertebral bodies)
92
treatment for Ankylosing Spondylitis 2
1. symptomatic relief: exercise and NSAIDs
2. TNF alpha inhibitors eg infliximab
93
what is Psoariatic arthritis
inflammatory arthritis that 1/5 with Psoriasis get
94
presentation of Psoariatic arthritis 4
1. psoriatic rash on skin: hidden sites eg behind ears, scalp
2. enthesitis (inflammation of entheses)
3. dactylitis (sausage fingers)
4. oncholysis (nail separation from nail bed)
P-E-D-O
95
investigations of psoariatic arthritis 1,3
1. x ray
-> osteolysis
-> dactylitis
-> pencil in cup appearance
96
treatment for psoariatic arthritis 2
1. symptomatic relief: NSAIDs
2. DMARD eg methotrexate
97
complication of psoriatic arthritis 1
arthritis mutilans
98
what is reactive arthritis
sterile inflammation of synovial membranes and tendons
99
what causes reactive arthritis 3
reaction to a distant GI/GU infection
normally by chlamydia trachomatis or campylobacter jejuni
100
presentation of reactive arthritis 2
1. Reiters triad: can’t see, can’t pee, can’t climb a tree= uveitis, urethritis and arthritis
2. occurs a month after intiial infection onset
101
investigations of reactive arthritis 1
1. joint aspirate: plane polarised light microscopy is negative for crystalarthropathy
102
treatment for reactive arthritis 3
1. symptomatic relief: NSAIDs/ steroid injection
2. give antibiotics until septic arthritis is ruled out
3. methotrexate for chronic
103
what are the two types of infective arthritis
septic arthritis
osteomyelitis
104
what is septic arthritis and how does it spread
direct bacterial infection of joint
due to bacteria travelling in blood
105
risk factors for septic arthritis 3
prosthetic joints
joint disease (osteo/ rheumatoid arthritis)
IVDU
106
main organisms responsible for septic arthritis 5
S.aureus (most common), H.influenza, N.gonorrhoeas, E.coli, psuedomonas
S E P I G (like septic)
107
presentation of septic arthritis 2 and what joint does it usually affect
1. painful hot swollen joint
2. systemic symptoms: fever
knee
108
investigations for septic arthritis 2
1. urgent joint aspirate with MC + S and polarised light microscopy will ID the causative organism
2. bloods: high ESR/ CRP
109
treatment for septic arthritis 3
1. joint aspirate drainage
2. then empirical antibiotics eg flucloxacillin (vancomycin for S aureus, ceftriaxone and azithromycin for gonorrhoea)
3. NSAID analgesia
110
what is the joint aspirate and polorised light microscopy positive results for septic arthritis, reactive arthritis, gout and pseudogout
if septic- ID causative organism (commonly gonococcal)
if reactive-> sterile, crystal free joint
if gout-> sterile, negative birefringent needle crystals
if pseudogout-> sterile, positively birefringent rhomboid crystals
111
what is osteomyelitis
inflammatory condition of bone
112
cause of osteomyelitis 2 and how does it spread
staph aureus
salmonella in those with sickle cell
haematogenous spread
113
presentation of osteomyelitis 3
bone pain
swelling of area
limp/ reluctance to weight bear (pain is worse with movement)
114
investigations for osteomyelitis 3
1. x-ray : osteopenia
2. MRI: shows bone marrow oedema
3. bone marrow biopsy + culture to ID causative organism
115
treatment for osteomyelitis 1
1. antibiotics: vancomycin for S aureus and flucoxacillin for salmonella
116
What does granulomatosis with polyangitis affect
respiratory tract and kidneys
117
presentation of granulomatosis with polyangitis 4
saddle shaped nose
epistaxis
crusty nasal/ ear secretions
glomerulonephritis
118
investigations for granulomatosis with polyangitis 1
cANCA +
119
management of granulomatosis with polyangitis 2
corticosteroid
cyclophosphamide
120
complication of granulomatosis with polyangitis
glomerulonephritis
121
what is osteomalacia and what causes it
poor bone mineralisation causing soft bone due to vit D deficiency
122
what is pagets disease
excessive bone turnover leading to sclerosis and lysis patches (high and low density areas)
123
what is marfans (mutation, inheritence and what does it cause)
mutation of fibrillin 1
autosomal dominant
decreased tensile strength of connective tissue
124
what is ehler danlos syndrome
defective collagen causing hypermobility of joints
125
what is lumbar spondylosis
mechanical back pain caused by degeneration of inter vertebral discs
126
what are the 3 main types of primary bone cancer
chondrosarcoma, osteosarcoma and Ewing sarcoma
127
what is chrondrosarcoma
cancer of cartilage
128
what cells does osteosarcoma start in
osteoblasts
129
what does osteosarcoma metastasise to 1
lung
130
specific finding when investigating for osteosarcoma 1
xray shows ‘sunburst’ appearing bone
131
what cells does ewing sarcoma start in
mesenchymal stem cells
132
what is polymyalgia rheumatica
inflammatory condition causing pain and stiffness in shoulders, neck and pelvic girdle
133
presentation of bone cancers 2
1. bone pain worse at night
2. decreased range of motion
134
investigation for bone cancer 1st, GS
1st line: x-ray
GS: bone biopsy
135
what is polyarteritis nodosa and what is it associated with
inflammation of medium sized vessels eg GI/ kidneys/ skin
Hep B
136
what 5 cancers metastasise to bone
KIDNEY (renal), PROSTATE, BREAST, LUNG, THYROID
PbKLT (lead kettle)
137
what drug increases risks of non-traumatic fractures
carbamazepine
138
how are bisphosphonates meant to be taken and why
taking in the morning on an empty stomach
remain upright for 30 minutes after taking it
side effect is oesophagitis
139
mechanism of action of bisphosphonates
inhibition of osteoclasts which reduces bone resorption
140
what is sjorgens syndrome associated with
hashimotos thyroiditis
141
what is the mutation in marfans syndrome
fibrillin 1
