Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD2 Musculoskeletal > Approach to Joint Pain > Flashcards

Approach to Joint Pain Flashcards

1
Q

What are the 3 broad categories of joint disorders?

A

Disorders of cartilage
Disorders of the synovial membrane
Disorders of the synovial fluid
(Also important to consider disorders of surrounding structures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Example of a disorder of cartilage

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Example of a disorder of synovial membrane

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Examples of disorders of synovial fluid

A

Gout

Septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 6 characteristics of mechanical joint pain?

A 
Chronic pain (months to years)
Slowly worsening
Worse on movement
Improved with rest
Not much swelling
Little stiffness (lasts <30 minutes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 6 characteristics of inflammatory joint pain?

A 
Acute or subacute pain (days to weeks)
May change quickly
Better with movement
Worse with rest
Swelling may be prominent
Stiffness prolonged (lasts hours, worse in morning or after prolonged immobility)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 4 main findings of OA on XR?

A

Osteophytes
Reduced joint space
Sclerosis of subchondral bone
??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is arthritis more common in males or females?

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 most important investigations for joint disorders?

A

XRs
Blood tests for Abs, markers of inflammation, etc
Synovial fluid analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 2 examples of Abs involved in joint pathology

A 
Rheumatoid factor (RA)
Antinuclear Ab (SLE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What kind of joint pathology can RA predispose to?

A

OA

Knee joint infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What joint pathology never affects distal interphalangeal joints?

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What conditions may cause an increase in ESR and CRP?

A

RA
SLE
Gout
Pseudo-gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When can OA develop?

A

As a result of primarily mechanical degeneration OR due to long-standing joint disease (e.g. RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some non-specific markers of joint pathology which can be assessed in a blood test?

A

Urate

Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most useful form of imaging for diagnosis of joint pathology?

A

Plain XR

MRI (>CT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is CT useful for in the context of musculoskeletal disorder?

A

Picking up suspected fractures not seen on XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is US useful for in the context of musculoskeletal disorder?

A

Joint effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common presentation of joint pathology in the setting of SLE?

A

Small joint inflammation that comes and goes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What type of joint pathology is classically symmetrical?

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of joint pathology is classically non-symmetrical and oligoarthritic?

A

Psoriatic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Distinguish between mono-, oligo- and polyarthritis

A

Mono: 1 affected joint
Oligo: 2-5
Poly: >5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give an example of a joint pathology that affects axial joints

A

Ankylosing spondylitis

24
Q

Pain in the upper lateral thigh is suggestive of what conditions?

A

Gluteal tendonopathy

Intertrochanteric bursitis

25
Q

What does “clicking” and “locking” of the knee usually indicate?

A

Meniscal damage

26
Q

What does “giving way” of the knee usually indicate?

A

Ligamentous injury

27
Q

What does a full joint examination in the lower limb involve?

A 
Posture (looking for varus or valgus deformity)
Gait
Muscle atrophy
Scarring
Erythema, warmth
Joint effusion
Active and passive movement of the joint
Examination of joints above and below
Full back examination
28
Q

If active movement of a joint is more limited than passive, what does this suggest?

A

Problem with surrounding structures, not the joint itself (a problem with the joint cannot be overcome with passive movement)

29
Q

What is the most sensitive part of the hip examination?

A

Internal rotation (if this can be done without bother there is probably no true hip pathology)

30
Q

What are some common findings on examination in the setting of OA of the knee?

A

Quadriceps (especially vastus medialis) atrophy on the affected side
Genu varus of affected side
Tender joint line +/- joint effusion
Limited ROM

31
Q

What is important to note about the relationship between XR findings and the symptoms of OA? What is the clinical relevance of this?

A

XR findings do not necessarily correlate with pain and functional limitation
When deciding which joint to replace, the decision should be made based on the pt’s level of pain and discomfort (not the imaging)

32
Q

What is the main predisposing factor for pseudogout?

A

Age

33
Q

List some predisposing factors for knee joint infection

A 
Penetrating injury
Surgery/prosthesis
Systemic sepsis
Immunosuppression
Damaged joint (e.g. in the setting of RA)
34
Q

List some predisposing factors for gout

A

Age
European ancestry
Alcohol
Thiazide diuretics
Anything causing high metabolic turnover (e.g. post-surgery, psoriasis)
CKD (due to impaired uric acid excretion)

35
Q

What is another name for pseudogout?

A

Calcium pyrophosphate disease (CPPD)

36
Q

What is the relationship between PTH levels and pseudogout?

A

Pseudogout may be precipitated by hypercalcaemia

Hypercalcaemia can be caused by elevated PTH

37
Q

What is the differential diagnosis for a presentation of acute joint pain and swelling?

A

Knee joint infection
Gout/pseudogout
Haemarthrosis
Inflammatory arthritis

38
Q

List 3 predisposing factors for haemarthrosis

A

Trauma
Blood-thinning medications
Some rare tumours

39
Q

What diagnosis should not be missed in the setting of acute onset joint pain?

A

Septic arthritis (this is a medical emergency)

40
Q

When is joint aspiration contraindicated?

A

With a prosthetic joint

41
Q

What synovial fluid WCC would be expected in the setting of inflammatory arthritis?

A

> 50,000 cells/mL

42
Q

What WCC would be suggestive of septic arthritis?

A

Elevated where 75-80% were neutrophils

43
Q

How can gout be diagnosed?

A

Negatively birefringent crystals on polarising light microscopy of the joint aspirate

44
Q

What are some features of SLE?

A 
Fever
Alopecia
Raynaud's syndrome
Mouth ulcers
Secondary Sjrogen's syndrome
Photosensitivity
45
Q

What is Raynaud’s syndrome?

A

Excessively reduced blood flow in response to cold or emotional stress, causing discolouration of the fingers, toes, and occasionally other areas

46
Q

What is Sjogren’s syndrome?

A

AI disease causing dryness of the eyes and mouth

47
Q

What joint pathology can result following diarrhoeal illness?

A

Reactive arthritis

48
Q

What joints tend to be affected by seronegative arthritis?

A

Larger joints

49
Q

What is the relationship between smoking and RA?

A

Causative factor
Impacts treatment
Associated with poorer prognosis

50
Q

What does soft tissue swelling indicate?

A

Synovitis

51
Q

Why is it important to perform a CXR in someone diagnosed with RA who has respiratory symptoms?

A

Methotrexate can cause pulmonary fibrosis; important to assess respiratory function before commencing

52
Q

Which is the more specific test for RA: RF or CCP Abs?

A

CCP Abs (90%)

53
Q

Which is the more sensitive test for RA: RF or CCP Abs?

A

Equally sensitive (70%)

54
Q

What are the ACR 1987 classification criteria for RA?

A 
Patients must have 4 of 7:
Morning stiffness >1 hour*
Swelling in ≥3 joints*
Swelling in hand joints*
Symmetric joint swelling*
Erosions or decalcification on XR
Rheumatoid nodules
Abnormal serum RF
*Must be present ≥6 weeks
55
Q

What have the ACR criteria for RA largely been replaced by diagnostically?

A

CCP

56
Q

What is gonococcal arthritis?

A

Form of septic arthritis caused by disseminated gonoccocal infection

MD2 Musculoskeletal (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions