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2A content- Sameera > 11. MSK > Flashcards

11. MSK Flashcards

1
Q

what is the most common type of arthritis

A

osteoarthritis

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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

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3
Q

risk factors of osteoarthritis 4

A

women, obesity, age, occupation

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4
Q

symptoms of osteoarthritis 2

A
  1. painful, hard joints
  2. morning stiffness for less than 30 mins
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5
Q

state and explain two clinical signs of osteoarthritis

A
  1. Bouchards nodes (bony growths on PIP joints)
  2. Heberdens nodes (bony growths on DIP joints)
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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

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7
Q

2 investigations into osteoarthritis and results

A
  1. bloods= normal
  2. x-ray of joint (LOSS- los of joint space, osteophytes, subchondral sclerosis, sunchondral cysts)
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8
Q

what are osteophytes

A

bony growths on joint

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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

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10
Q

what is the treatment of osteoarthritis 3

A
  1. lifestyle changes: physio, weight bearing
  2. pain relief: NSAIDs
  3. last resort: joint replacement
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11
Q

complications of osteoarthritis 2

A
  1. destruction of joint
  2. loss of function
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12
Q

what is rheumatoid arthritis and what happens

A

inflammatory disease
autoimmune destruction of synovium (soft tissue of the joints)

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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

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14
Q

risk factors of rheumatoid arthritis 2

A

HLADR4/1
women

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15
Q

symptoms of rheumatoid arthritis 2

A
  1. painful swollen joints
  2. morning stiffness lasting more than 30 mins
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16
Q

state and explain the 3 clinical signs of rheumatoid arthritis

A
  1. rheumatoid skin nodules
  2. boutinniere deformity
  3. swan neck thumb
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17
Q

investigations for R arthritis 4 and results

A
  1. bloods: high ESR/CRP
  2. serology: positive rheumatoid factor, positive anti-CCP antibodies
  3. genetic test for HLA DR1/4
  4. X-ray (LESS- lost joint spaces, bony erosion, soft tissue swelling, periarticular osteopenia)
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18
Q

treatment for R arthritis 3

A
  1. Disease modifying anti rheumatic drugs- methotrexate/ hydroxychloroquine/ sulfsalazine
  2. analgesia- NSAIDs/ steroid injections
  3. biologics
    -> 1st line: TNF alpha inhibitor infliximab (given with methotrexate)
    -> 2nd line: B cell inhibitor (CD20 target)- rituximab
    RADAB
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19
Q

what is gout’s pathophysiology 3

A
  1. uric acid build up
  2. leads to urate crystal deposition along joints
  3. causes joints to become hot, swollen and painful
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20
Q

risk factors for gout 2

A
  1. purine rich food: high meat, seafood, alcohol diet
  2. middle aged overweight man
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21
Q

presentation of gout 2 and what joint is usually affected 1

A
  1. sudden onset
  2. severe swollen red joint
  3. usually big toe (metatarsophalangeal joint)
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22
Q

investigations for gout 2 and result

A
  1. joint aspiration and polorised light microscopy showed needle shaped negatively birefringent crystals
  2. bloods: high uric acid
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23
Q

treatment for acute gout 3

A

1st line NSAIDs
2nd line colchine (alternative to NSAIDs)
3rd line steroids

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24
Q

prophylactic treatment for gout 2

A
  1. allopurinol
  2. lifestyle changes: decrease meat, seafood and alcohol
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25
Q

how does allopurinol prevent gout 2

A

it is a xanthine oxidase inhibitor which reduces uric acid production

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26
Q

what is the crystal composition for gout and pseudogout?

A

gout= monosodium urate crystals
pseudogout= calcium pyrophosphate crystals

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27
Q

What is pseudogout

A

calcium pyrophosphate crystals deposits along joint capsule

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28
Q

risk factors for pseudogout 3

A
  1. hypercalcaemia
  2. hyperparathyroidism
  3. hyperthyroidism
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29
Q

presentation of pseudogout 2

A
  1. swollen red hot joint
  2. multiple widespread joints affected
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30
Q

what joint is usually affected in pseudogout

A

knee

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31
Q

investigations for pseudogout 2

A
  1. joint aspiration and polarised light microscopy shows positively birefringent, rhomboid shaped crystals
  2. bloods show high calcium
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32
Q

treatment for pseudogout 2

A
  1. same acute management as gout- NSAIDs, colchine and sterouds
  2. joint aspiration in severe cases
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33
Q

what is osteoporosis 1 and measurement critera

A

decreased bone density by 2.5 standard deviations below the young adult mean value

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34
Q

what are the risk factors for osteoporosis 9

A

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

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35
Q

presentation of osteoporosis 1

A

fractures

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36
Q

investigation of osteoporosis 2 and explain each one

A
  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
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37
Q

What is T score and Z score and how can they be calculated

A

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

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38
Q

treatment for osteoporosis in order 3

A
  1. bisphosphonates (alendronate) AND vitamin D AND calcium supplements
  2. monoclonal antibody eg derosumab
  3. hormone replacement therapy (esp for women after menopause)
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39
Q

what is osteopenia and osteoporosis T values

A

osteopenia= T value of -1 to -2.5
osteoporosis= T value of -2.5 or less

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40
Q

what reaction is SLE and what does it stand for in full

A

hypersensitivity T3 reaction (antigen-antibody complex deposition)
systemic lupus erythromatosis

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41
Q

what is the pathophysiology of SLE

A

anti nucleur antibodies (ANA) and anti double stranded DNA antibodies (anti dsDNA) attack soft tissues

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42
Q

risk factors of SLE 3

A

females
afrocarribean
young-middle aged

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43
Q

symptoms of SLE 4

A

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

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44
Q

investigations for SLE 2

A
  1. bloods: high ESR, normal CRP, low C3&4
  2. serology + ANA and dsDNA
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45
Q

what is diagnostic for SLE 3

A

+ ANA and + anti dsDNA and symptoms

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46
Q

treatment for SLE 2

A

1st line- corticosteroids eg prednisolone
severe- hydroxychloroquine

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47
Q

what is antiphospholipid syndrome pathophysiology 2

A
  1. immune system produces abnormal antibodies called antiphospholipid antibodies
  2. these increase the risk of blood clots
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48
Q

types of antiphospholipid syndrome 2

A
  1. primary/ idiopathic
  2. secondary to an autoimmune disorder eg SLE
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49
Q

main risk factor for antiphospholipid syndrome 1

A

females

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50
Q

presentation of antiphospholipid syndrome 4

A

CLOT
coagulopathy (increased risk DVT/PE/stroke/MI)
levido reitcularis-characteristic purple discolouration of skin which is lace-like
obstetric issues- miscarriages
thrombocytopenia

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51
Q

investigation for Antiphospholipid syndrome 3

A
  1. blood have raised:
    -> lupus anticoagulant
    -> anticardiolipin antibodies (IgM/G) positive
    -> anti beta2 glycoprotein-1 antibodies
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52
Q

diagnosis for antiphospholipid syndrome 1

A

2 abnormal blood test 12 weeks apart

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53
Q

treatment for antiphospholipid syndrome 2

A

1st line: warfarin- long term if they have a past thrombus
2nd line: if pregnant give aspirin and heparin instead

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54
Q

what is sjorgen syndrome 1

A

autoimmune exocrine dysfunction

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55
Q

types of sjorgen syndrome 2

A
  1. primary/ idiopathic
  2. secondary to another condition eg SLE/ rheumatoid arthritis
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56
Q

risk factors for sjorgen syndrome 2

A

HLAB8/ DR3
females

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57
Q

presentation of sjorgen syndrome 1

A
  1. dry mucous membranes eg eyes, mouth, vagina
58
Q

investigations for sjorgen syndrome 2

A
  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
Q

treatment for sjorgens 2

A
  1. artificial tears, saliva and lubricant for sexual activity
  2. hydroxychloroquine to prevent progression
60
Q

main 2 complications for sjorgens

A

infection of all dry sites
sexual dysfunction

61
Q

what is scleroderma CREST also known as and what is it 3

A

Limited Cutaneous Systemic Sclerosis
1. autoimmune condition
2. causing fibrosis
3. and hardening and tightening of skin

62
Q

what is the presentation of scleroderma 5

A

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
Q

what are the investigations for scleroderma CREST 1

A
  1. serology
    -> positive anti centromere antibodies (ACA)
64
Q

treatment for scleroderma CREST 2

A
  1. symptomatic treatment eg PPI for GI symptoms
  2. immunosuppressants to slow progression eg cyclophosphamide
65
Q

what is Polymyotitis and what is Dermatomyositis

A

Polymyotitis= condition of chronic inflammation of muscles
Dermatomyositis= chronic inflammation of skin and muscles

66
Q

presentation of Polymyotitis/ Dermatomyositis 3

A
  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
Q

investigations for Polymyotitis/ Dermatomyositis 2 + diagnostic

A
  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
Q

treatment for Polymyotitis/ Dermatomyositis 2

A

1st line: corticosteroids eg prednisolone
2nd line: immunosuppressants eg azathioprine

69
Q

what is fibromyalgia

A

chronic widespread MSK pain for 3+ months

70
Q

risk factors for fibromyalgia 2

A

females
stress

71
Q

pathophysiology of fibromyalgia 1

A

unknown (fibromyalgia is the MSK equivalent of IBD)

72
Q

presentation of fibromyalgia 3

A

widespread pain
fatigue
sleep difficulties

73
Q

investigations of fibromyalgia and how is it diagnosed and why

A
  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
Q

treatment for fibromyalgia 2

A
  1. educate patient on condition
  2. tricyclic antidepressants for severe pain
75
Q

differential for fibromyalgia

A

polymalgia rheumatica

76
Q

three categories of vasculitis

A

large, medium and small vessel

77
Q

give an example of each of the three types of vasculitis

A

large vessel- giant cell arteritis
medium vessel- polyartheritis nodosa
small vessel- granulomatosis with polyangitis

78
Q

what is the general treatment for vasculitis 1

A

corticosteroids

79
Q

what is giant cell arteritis

A

inflammation of large arteries eg aorta and major branches

80
Q

risk factors for giant cell arteritis 2

A

females
history of polymyalgia rheumatica

81
Q

presentation of giant cell arteritis 4

A

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
Q

what branch is affected for 3 symptoms for giant cell arteritis

A

scalp tenderness= temporal
vision= opthalmic
jaw= facial branch

83
Q

investigations for giant cell arteritis

A

1st line: ESR (high-over 50)
diagnosis: temporal artery biopsy showing granulomatous inflammation

84
Q

treatment of giant cell arteritis

A

prednisolone asap

85
Q

complications of giant cell arteritis 2

A

amaurosis fugax/ permanent blindness

86
Q

what are Spondylarthropathies and what are they all associated with

A

group of conditions that involve chronic inflammation of the joints and skeleton
HLA B27

87
Q

what are the Spondylarthropathies 4

A

PAIR
psoriasis arthritis
ankylosing spondylitis
IBD associated arthritis
reactive arthritis

88
Q

presentation of Spondylarthropathies 9

A

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
Q

what is Ankylosing Spondylitis 2

A

chronic inflammation of the spine, involving new bone formation

90
Q

presentation of Ankylosing Spondylitis 4

A

young male
progressively worsening back stiffness
pain better with exercise
pain worse after inactivity

91
Q

investigations for Ankylosing Spondylitis (1,3)

A
  1. x ray of spine and sacrum
    -> bamboo spine
    -> squaring of vertebral bodies
    -> syndesmophytes (fusion of vertebral bodies)
92
Q

treatment for Ankylosing Spondylitis 2

A
  1. symptomatic relief: exercise and NSAIDs
  2. TNF alpha inhibitors eg infliximab
93
Q

what is Psoariatic arthritis

A

inflammatory arthritis that 1/5 with Psoriasis get

94
Q

presentation of Psoariatic arthritis 4

A
  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
Q

investigations of psoariatic arthritis 1,3

A
  1. x ray
    -> osteolysis
    -> dactylitis
    -> pencil in cup appearance
96
Q

treatment for psoariatic arthritis 2

A
  1. symptomatic relief: NSAIDs
  2. DMARD eg methotrexate
97
Q

complication of psoriatic arthritis 1

A

arthritis mutilans

98
Q

what is reactive arthritis

A

sterile inflammation of synovial membranes and tendons

99
Q

what causes reactive arthritis 3

A

reaction to a distant GI/GU infection
normally by chlamydia trachomatis or campylobacter jejuni

100
Q

presentation of reactive arthritis 2

A
  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
Q

investigations of reactive arthritis 1

A
  1. joint aspirate: plane polarised light microscopy is negative for crystalarthropathy
102
Q

treatment for reactive arthritis 3

A
  1. symptomatic relief: NSAIDs/ steroid injection
  2. give antibiotics until septic arthritis is ruled out
  3. methotrexate for chronic
103
Q

what are the two types of infective arthritis

A

septic arthritis
osteomyelitis

104
Q

what is septic arthritis and how does it spread

A

direct bacterial infection of joint
due to bacteria travelling in blood

105
Q

risk factors for septic arthritis 3

A

prosthetic joints
joint disease (osteo/ rheumatoid arthritis)
IVDU

106
Q

main organisms responsible for septic arthritis 5

A

S.aureus (most common), H.influenza, N.gonorrhoeas, E.coli, psuedomonas
S E P I G (like septic)

107
Q

presentation of septic arthritis 2 and what joint does it usually affect

A
  1. painful hot swollen joint
  2. systemic symptoms: fever
    knee
108
Q

investigations for septic arthritis 2

A
  1. urgent joint aspirate with MC + S and polarised light microscopy will ID the causative organism
  2. bloods: high ESR/ CRP
109
Q

treatment for septic arthritis 3

A
  1. joint aspirate drainage
  2. then empirical antibiotics eg flucloxacillin (vancomycin for S aureus, ceftriaxone and azithromycin for gonorrhoea)
  3. NSAID analgesia
110
Q

what is the joint aspirate and polorised light microscopy positive results for septic arthritis, reactive arthritis, gout and pseudogout

A

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
Q

what is osteomyelitis

A

inflammatory condition of bone

112
Q

cause of osteomyelitis 2 and how does it spread

A

staph aureus
salmonella in those with sickle cell
haematogenous spread

113
Q

presentation of osteomyelitis 3

A

bone pain
swelling of area
limp/ reluctance to weight bear (pain is worse with movement)

114
Q

investigations for osteomyelitis 3

A
  1. x-ray : osteopenia
  2. MRI: shows bone marrow oedema
  3. bone marrow biopsy + culture to ID causative organism
115
Q

treatment for osteomyelitis 1

A
  1. antibiotics: vancomycin for S aureus and flucoxacillin for salmonella
116
Q

What does granulomatosis with polyangitis affect

A

respiratory tract and kidneys

117
Q

presentation of granulomatosis with polyangitis 4

A

saddle shaped nose
epistaxis
crusty nasal/ ear secretions
glomerulonephritis

118
Q

investigations for granulomatosis with polyangitis 1

A

cANCA +

119
Q

management of granulomatosis with polyangitis 2

A

corticosteroid
cyclophosphamide

120
Q

complication of granulomatosis with polyangitis

A

glomerulonephritis

121
Q

what is osteomalacia and what causes it

A

poor bone mineralisation causing soft bone due to vit D deficiency

122
Q

what is pagets disease

A

excessive bone turnover leading to sclerosis and lysis patches (high and low density areas)

123
Q

what is marfans (mutation, inheritence and what does it cause)

A

mutation of fibrillin 1
autosomal dominant
decreased tensile strength of connective tissue

124
Q

what is ehler danlos syndrome

A

defective collagen causing hypermobility of joints

125
Q

what is lumbar spondylosis

A

mechanical back pain caused by degeneration of inter vertebral discs

126
Q

what are the 3 main types of primary bone cancer

A

chondrosarcoma, osteosarcoma and Ewing sarcoma

127
Q

what is chrondrosarcoma

A

cancer of cartilage

128
Q

what cells does osteosarcoma start in

A

osteoblasts

129
Q

what does osteosarcoma metastasise to 1

A

lung

130
Q

specific finding when investigating for osteosarcoma 1

A

xray shows ‘sunburst’ appearing bone

131
Q

what cells does ewing sarcoma start in

A

mesenchymal stem cells

132
Q

what is polymyalgia rheumatica

A

inflammatory condition causing pain and stiffness in shoulders, neck and pelvic girdle

133
Q

presentation of bone cancers 2

A
  1. bone pain worse at night
  2. decreased range of motion
134
Q

investigation for bone cancer 1st, GS

A

1st line: x-ray
GS: bone biopsy

135
Q

what is polyarteritis nodosa and what is it associated with

A

inflammation of medium sized vessels eg GI/ kidneys/ skin
Hep B

136
Q

what 5 cancers metastasise to bone

A

KIDNEY (renal), PROSTATE, BREAST, LUNG, THYROID
PbKLT (lead kettle)

137
Q

what drug increases risks of non-traumatic fractures

A

carbamazepine

138
Q

how are bisphosphonates meant to be taken and why

A

taking in the morning on an empty stomach
remain upright for 30 minutes after taking it
side effect is oesophagitis

139
Q

mechanism of action of bisphosphonates

A

inhibition of osteoclasts which reduces bone resorption

140
Q

what is sjorgens syndrome associated with

A

hashimotos thyroiditis

141
Q

what is the mutation in marfans syndrome

A

fibrillin 1

2A content- Sameera (21 decks)

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