ask disease profiles pt 2 Flashcards
what are inflammatory myopathies characterised by
weakness
what is polymayalgia rheumatica characterised by
pain and stiffness
what is fibromyalgia characterised by
pain and fatigue
presentation of muscle diseases
muscle pain, weakness, tiredness, stiffness, abnormal blood test, other organ features
what is a myopathy
a disease of the muscle where the fibres do not function properly
what does a myopathy result in
muscle weakness
acquired inflammatory myopathies
polymyositis, dematositis and immune mediated necrotising myopathy
prevalence of polymyositis and dermatomyositis
1/100,000
peak incidence of polymyositis and dermatomyositis
40-50 years
female to ale ratio of polymyositis and dermatomyositis
40-50
what does polymyositis and dermatomyositis put people at risk of
malignancy
clinical features of polymyositis and dermatomyositis
insidious onset, worsening over months, usually symmetrical, proximal muscles, often specific problems like brushing hair and climbing stairs and mild myalgia in 25-50%
what is seen in dermatomyositis
gottrons sign, heliotrope rash and shawl sign
what is gottrons sign
red rash over the back of fingers
what is helioscope rash
rash round the eyes
greatest risk of malignancy in people with dermatomyositis and polymyositis
men over 45
investigations of polymyopathy and dermatomyopathy
muscle enzymes (CK), inflammatory markers, electrolytes, calcium, PTH, TSH, ANA, anti-Jo-1, myositis, specific antibodies, EMG
EMG findings in myopathies
increased fibrillations, abnormal motor potentials, complex repetitive discharges
diagnosis of muscle myopathies
muscle biopsy, MRI
muscle biopsy findings in muscle myopathies
perivascular inflammation and muscle necrosis
MRI findings of muscle myopathies
muscle inflammation, oedema, fibrosis and calcification
treatment of muscle myopathies
cotricosteroids and immunosuppression
who gets polymyalgia rheumatica
over 50s
what is the prevelance of polymyalgia rheumatica
1%
what is polymyalgia rheumatica associated with
temporal arteritis and giant cell arteritis
clinical presentation of polymyalgia rheumatica
ache in shoulder and hip girdle, morning stiffness, usually symmetrical fatigue, anorexia, weight loss and fever, reduced movement of shoulders, neck and hips muscle strength is normal
what is temporal arteritis/giant cell arteritis
granulomatous arteritis of large vessels
features of granulatous arteritis
headache, scalp tenderness, jaw claudication, visual loss, tender enlarged non pulsatile temporal arteries
diagnosis of granulatous arteritis
raised ESR,plasma viscosity, CRP, temporal artery biopsy, temporal artery USS
treatment of granulates arteritis
low dose steroids gradual reduction of steroids over 18 months to 2 years
what does of prednisolone for PMR
15mg
what does of prednisolone for GCA
40-60 mg
what is a common cause of chronic musculoskeletal pain
fibromyalgia
is fibromyalgia associated with inflammation
no
female to male ratio of fibromyalgia
6:1
what might trigger fibromyalgia
emotional or physical trauma
what is the diagnostic criteria for fibromyalgia
ACR
treatment of fibromyalgia
patient education, multidisciplinary response, graded exercise programme, CBT, acupuncture, anti depressants, analgesia, gabapentin and pregabalin
what is vasculitis
inflammation of blood vessels
what does primary vasculitis occur from
inflammatory response that targets the vessel walls and has no known cause
what does secondary vasculitis occur from
triggered by infection a drug, or a toxin or another type of inflammatory disorder or cancer
clinical features of vasculitis
depends on which vessel it affects, systemic symptoms - fever, malaise, weightless and fatigue
classifications of vasculitis
immune complex mediated vasculitis, medium vessel vasculitis, large vessel vasculitis, anti GBM disease and ANCA associated small cell vasculitis
what examples of immune complex mediated vasculitis
cryoglobulinemic vasculitis, IgA vasculitis, hyppelmentamic urticarial Vasculitis
large vessel vasculitis
takayaski arteritis and giant cell arteritis
who does takayaski arteritis affect
females under 40
signs of takayaski arteritis
bruit in carotid artery and blood pressure differences
who gets giant cell arteritis
GCA over 50 years
symptoms of giant cell arteritis
temporal headache, temporary visual disturbances, blindness and/or jaw claudication
what is giant cell arteritis associated with
polymyalgia rheumatica
investigations of large vessel vasculitis
ESR,plasma viscosity and CRP is raised US and CT
management of large vessel vasculitis
40-60 mg prednisolone, steroid sparing agents (leflunamide, methotrexate, toclizumab
anca + small vessel vasculitis
churg strauss, wegeners, microscopic polyangitis
anca- small vessel vasculitis
cryoglobulnemia
what is wegeners also known as
granulonatosis with polangitis
what is churg strauss also known as
eosinophilic granulommatosis with polyangitis
GPA male to female ratio
1.5:1
age of onset of GPA
35-55 years
what is common in GPA
constitutional symptoms and arthralgia
ENT features of GPA
sinusitis, nasal crustin, epistaxis, mouth ulcers, sensorineural deafness, otitis media and deafness, saddle nose, sub glottic inflammation
ocular features of GPA
conjunctivitis, episcleritis, uveitis, optic nerve vasculitis, retinal artery occlusion, proptosis
resp symptoms of GPA
cough, heamoptysis , pulmonary infiltrates, diffuse alveolar haemorrhage, caveatting nodules on CXR
cutaneous features of GPA
palpale purpura, cutaneous ulcers
renal features of GPA
necrotising glomerulonephritis
nervous system manifestations of GPA
mononeuritis multiplex, sensorimotor polyneuropathy, cranial nerve palsies
difference between EGPA and GPA
late onset of asthma, high eosinophil count and ANCA specificity
what does microscopic polyangitis cause
renal impairment
what is Henoch - schonein purport
an acute immunoglobulin IgA mediated disorder
what does HSP involve
generalised vasculitis of small vessels of skin, gI tract, kidneys, joints and rarely lungs and CNS
what is the common infection leading to HSP
group A strep
preceding illness predates when in HSP
1-3 week s
what is the presentation of HSP
purpuric rash typically over buttocks and lower limbs, colicky abdominal pain, bloody diarrhoea joint pain, renal involvement
investigations of vasculitis
urine dipstick, FBc, liver and renal profile, inflammatory markers, ANCA and specific antibodies, connective tissue disease screen, compliment levels, Cxr, CT, nerve conduction tests, tissue biopsy
what is ANCA
auto antibodies against antigens in the cytoplasm if neutrophil granulocytes
what is used to detect ANCA
immuno fluorescenze
cANCA appearance
more round
pANCA appearance
more globular
varum
ditsal towards
valgum
distal part away
complications of knee replacememnt
deep infection, pain, stiffness, early failure/ loosening and medical complications and blood clots
what stress does MCL resist
valgus
what tsress does LCL resist
LCL
what stress does ACL RESIST
internal rotatio of the tibia
grade 1 ligament injury
sprain
grade 2 ligament injdury
partial tear
grade 3 ligamnet injury
complete tear
PCL injury leads to
recureent hyperextension
acute locked knee inidctaotes
displaced bucket handle meniscal tear
what isFAI
altered morphology of femoral neck or acetabular
PIncer typle iningement
acetabular
where is hip arthritis felt
in the groin
presentation of FAI
activity related pain in groin, difficulty sittig, C sign positive
management of FAI
observation in asymtomatic - symptomatic surgery
avascular necorosis
usually idiopathic faure of perfusion to the femoral head
risk factors of avascukar necrosis
STEROID AND TRAUMA
presentation of avascular necrosis
insiduois onset of groin pain, exacerbated by stairs or impact, examination normla
staging system for avascular necorsis
STeinberg
management of avascular necrosis
drilling,,
what stage does avascular necrosis become irreversible
stage 3
iTOH is
local hyperaremia and impaired venous return wuth marrow oedema and increased intramedullary pressure
diagnosis of ITOH
elevation ESR, radiographs, MRI and bone scan
management of OTOH
self limiting - 9-10months, analgesua, crutches
what is trochanteric bursitis caused by
repetitive trauma caused by the iliotibial band
presentation of trochanteric bursitis
pain on the lateraspect of the hip - pain palpation of the greater trochanter
management of trochanteric bursitis
analgesa, NSAIDs, physiotherapy,m steorid injection
lipomas usually occur
in the neck
what mist lipomas be
superficial
chronic back pain defined at
3 months
subacute back pain
6 weeks
back pain in the tailbone known as
coccydynia
back pain intrinsic to the spin causes
spinal MSK system, neurological, haemopoeitic system
back pain extrinsic to the spine causes
extrinsic MSK system, neighbouring viscera, neurological system
what could be causing back pain
degenerative, vascular, neoplasm, infection, inflammatory, trauma, metabolic dosorder, neighbouring viscera
red flags for back pain
neurological deficit, history of cancer, systemic features, IV drug use, immunosuppression, trauma, osteoporosis, thoracic back pain, pain at rest and at night, >50 <16
when to suspect non traumatic fractures
in patients with osteoporosis, elderly patients and patients on long term steroids
what to do in a suspected back fracture
immobilise, assess UL and LL neurology, perineal sensation assess further UMN signs
investigations of back fracture
XR, CT, urgent MRI if neurological deficit
what is caudal equine syndrome
dysfunction of multiple lumbar and sacral nerve roots
what to assess in suspected caudal equina syndrome
assess LL neurology, perineal sensation, anal tone and squeeze, bladder scan assess further if UMN signs detecte d
investigations of caudal equine syndrome
urgent MR of lumbar spine, rest of spine if negative
what is acute foot drop
weakness of ankle dorsiflexion
what is acute foot drop caused by
L4 or l5 weakness of perineal nerve pathology
presentation of acute cord compression
rapid onset spinal pain, severe weakness / numbness of extremities +/- sphincter disturbance
what is spinal osteomyelitis +/- epidural abscess
infection of the spine
what is the presentation of spinal osteomyelitis +/- epidural assess
focal back pain and low grade fevers
coronal deformity
seen when you look at the patient from the back
saggital deformi
seen when you look at the patient from the side
saggital deformi
seen when you look at the patient from the side
what happens to the spinal processes in scoliosis as the spine curves
they also rotate
specific test for scoliosis
Adams tes
what is kyphosis
accessive convex curvature of the spine commonly involving the thoracic plane
causes of kyphosis
scheuermanns disease, osteposrsis with wedge fractures
what is spondyosthesis
subluxation of one vertebra on another
commonest level of Spondylolisthesis
L5S1
what is cervical radicolpathy
a problem that results when a nerve in the neck is irritated as it leaves the spinal canal.
what is cervical radicolopathy caused by
nerve root is being pinched by a herniated disc or a bone spur.
wha is the most mobile joint in the body
shoulder girdle
rotator cuff muscles
Supraspinatus, infraspinatusm teres minor, supscapularis
who gets rotator cuff tears
over 40s
what to under 40 s get in the shoulder
labral tear
median nerve neuropathy
carpal tunnel
ulnar nerve neuropathy
cubital tinnel
what is a mucous cyst
outpouching of synvoial fluid from DIPJOA
management of mucous cyst
left or excised
what are ganglions
outpouchings of synovial cavity
managements of ganglions
usually resolve over time, wack, aspirate or excise
what is trigger finger
a condition that effects one or most of the hands tendons making it difficult to bend the effected finger or thumb
cause of trigger finger
swelling leads to irritation and more swelling and the tendom gets caight on AI pulley
presentation of trigger fonger
pain over AI pulley may need another hand to extend and may not be able to extend at all
management of trigger finger
conservative - usually resolves spontaneously, splint to prevent flexion, tendon sheath injction - steroid + LA, or surgery under GA or LA and divide AI pulley
presentation of carpal tunnel
buring, tingling or itching numbness in your palm and thumb or your index and middle fingers, weakness and trouble holding things, shock like feelings that move into fingers, tingling taht moves up into your arm
what nerve is impacted in carpal tunnel
median
median nerve supplies (motor)
lateral two lumbricals, opponens pollicis, abductor pollicis brevis and flexor pollicis brevis
sensory supply of the median nerve
palmar aspect of the hand, thumb, index, middle and radial hald of ring finger
sensory involvemnet of radial 3 and a half fingers, relieved by shaking hand, worse at night,
carpal tunnel
sensory involvemnet of radial 3 and a half fingers, relieved by shaking hand, worse at night,
carpal tunnel
femal to male ratio of carpal tunnel
5-8: 1
identifiable causes of carpal tunnel
DM, pregnancy, hypoT4, fluid overload, acromegaly, Rh arthritis
examinations of carpal tunnel
examination of lOAF muscles, pahelns test and tinels test
results of compressive neuropathy in carpal tunnel
increased latency and decrased amplitude
carpal tunnel questionnaire
kamath and starthard
management of carpal tunnel
splintage, diagnostic steroid injection or surgery
management of carpal tunnel
splintage, diagnostic steroid injection or surgery
what is de quervain tenosynovitis
a painful condition affecting the tendons on the thumb side of the wrist
presentation of de quervaisn
spontaneous, painful, swollen and red, finklesteins test,
management of dequervains
NSAIDs, splint, rest, steroid injection, decompression surgery
what is dupuytrens contracture
one or more fingers bend towards the palm
patholgy of dupuytrens contracture
thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers
presentation of dupuytrens contracture
painless gradual progression, usually starting as palmer pit/nodule
cause of dupuytrens contracture
genetics, DM, alcohol, smoking, epilepsy, trauma and dupyterns diathesis
examination of dupuytrens contracture
feel cords, MCP/PIP involvement - measure angles, table top test
treatemnt of dupuytrens contracture
surgery or steroid sht if painful
what is paronychia
infection within a nail fold
who usually gets paronychia
children
risks or paronychia
nail biting
managemnet of paronychia
elevate, antibiotics, incise and drain
what is flexor tendon sheath infection
a infection within sheath tracking up palm and arm
presentation of flexor tendon sheath
extermely painful limited extension, affected finger held in fixed flexion, fusiform swelling over finger, painful to perciss over the sheath, painful on passive extension
management of flexor tendon sheath infection
EMERGENCY wash out tendon sheath - A1 and A5 pulleys
where is A1 pulley
metacarpal head
where is A2 pulley
start of proximal phalnyx
A3 pulley
PIP joint
A4 joint
middle of middle phalynx
A5 pulley
start of distal phalynx
tedinopathy
painful tendon
tendinosis
degneration of tendon
tenosynovitis
inflammation in tendon sheath
enthesopathy
tendon inserts into bone
tendonitis
inflammation on tendon
tendonosis pathology
degeneration of collagen and extracellualr matrix
what is tendonosis likely caused by
MMPs
where does tendonosis uusuallly occur
in areas of poor blood supply
management of tendonosis
rest, physio, analgesics, injections - rotator cuff and tennis elbow, splinting
when not to use steroid injections in tendonosis
achille tendon or extensor mechanism
when to use splinting in tendonosis
achilles tendon
debridement
removal of diseased tissue
decompression can be used in
supraspinatous tendonitis and sub acromial decompression
what does synovectomy do
prevent rupture
when are synovectomies useful
tenosynovitis of the ectensor tendons of the writs in RA
clinical findings of rotator cuff pathology
achy pain down arm, difficulty sleeping on affeced side, reaching overhead and on lifting, painful arc and positive impingment tests
management of rotator cuff pathology
physia, ject and surgical subacromial decompression
presentation of biceps tendinopathy
pain anterior shoulder radiating to embow, aggregated by shoulder flexion and snapping with shoulder movements if subluxation
diagnosis of biceps tendinopathy
clinical exam and USS
what is tennis elbow kown as
lateral epicondylitis
tennis elbow presentation pain
pain and tenderness over the lateral epicondyle the origin oextensors
medial epicondylitis known as
golfers elbow
pain over styloid process
de quervains tenosynovitis
managemnet of de quervains tenosynovitis
splint, rest, physio, analgesics, inject surgical decompression
RA and weakness in wrist extension or dropped finger
extensor tendon rupture
what is trigger finger
a tenosynovitis
level of MRI used for tendons
T2
insertion of patellar tendon into tibial tuberosity
osgood schlatters disease
progressive elongation. then rupture
tenosynovitis
what does tenosynovitis of the tibilalis posterior lead to
progressive flat foot and valgus hind foot
what is a subungal haematoma
a heamatoma underneath the nail plate
type 1 ans 2 nail injury
soft tissue only
type 3 nail injury
soft, tissue nail and bone
type 4 nail injury
proximal 1/3 of the phalanx
type 5 nail injury
proximal to the DIP joint
level 1 and 2 nail injury management
dressing
level 3 nail injury management
repair nail bed and stabilise bone
level 4 nail injury management
repair and stabilise bone unless less that 5 mm of nail bed then ablate
typical age pf supra spinets tendonitis
35- 65
what rotator cuff muscle tends to cause the most trouble
Supraspinatus
who is frozen shoulder more common with
diabetics
what is bursitis
inflammation of the synovial lined sacs that protect the bony prominaces and jounts
management of bursitis
NSAIDs, antibiotics
what should you never aspire
GANGLIONS
management of gout
NSAIDs, steroids, alluopurinol
what are bouchards nodes and heberdens nodes
bony swellings of the interphalangeal joints in hands
where are bouchards nodes
proximal interphalangeal nodes
what are heberdens nodes
distal interphalangeal nodes
what is dupuytrens
progressive disease resulting in digital flexion contractors
pathophysiology of dupuytrens
nvolves a fibroplastic hyperplasia and altered collagen matrix of the palmar fascia
predisposing factors to dupuytrens
genetic, environmental, local and global protein expression
management of dupuytrens
needle fascitomy, limited fasciotomy, dermofasciectomy and graft
what is giant cell tumour of tendon sheath
regenerative hyperplasia
managemnet of giant cell tumour of tendon
NOTHING
management of lipoma
excise if problematic - S shaped incised
what is a osteochondroma
benign lesion derived from aberrant cartilage from pericondral ring
where and when do osteochondromas occur
in the knee in adolescnec
presentation of osteochindroma
painless hard lump, symptoms with activity,
pain in osteochondroma
from tendons
management of osteochndroma
watch or surgery
where do sabeceous cysts occur
around hair follicles
what are sebaceous cyst filled with
keratin (caseous aterial)
presentation of sebaceous cyst
slow growing, painless, mobile discreet swellings can become infected
what is myositis ossificans
abnormal calcification of a muscle haematoma
management of myositis ossifcans
observe, intervene if symptoms demand - wait until maturity
what is neurapraxia
hen the nerve has a temporary conduction defect from compression or stretch and resolve over time with full recovery (can take up to 28 days).
what is neurotmesis
is a complete transection of a nerve and is rare in closed injuries but can occur in penetrating injuries. No recovery will occur unless the affected nerve is surgically repaired. Again recovery is variable.
axonomesis
either a sustained compression or stretch or from a higher degree of force. Although the nerve remains in continuity and the internal structure (endoneurial tubes) remain intact, the long nerve cell axons distal to the point of injury die in a process known as Wallerian degeneration. The axons then regenerate along the endoneurial tubes at a rate of 1mm per day. Longer peripheral nerves therefore take longer to recover. Recovery is variable and full power or sensation may not be achieved. Recovery can be predicted by nerve conduction studies from around a month from the time of injury.
What type of collagen is produced in Dupuytren’s contracture?
type 3