1. 15mg Prednisolone OD for 3/52 2. Reduce to 12.5mg for 3/52 then 10mg OD for 4-6/52 then reduce by 1mg every 4-8 weeks. 3. Advise that steroid's should be continued for 1-2 years. This should resolve ALL the symptoms.

Conditions MSK (FCM) Flashcards by Naadiya Hall

What types of things might you look out for in a basal skull fracture? (4 things)

Periorbital ecchymosis ( racoon eyes)
2.Battle sign (bruising behind the ears
Hemotympanum (Blood in the middle ear)
Ottorhea/ rhinorrhoea (bloody discharge mixed with clear CSF)

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What would you find on history for someone with inflammatory joint conditions? (6 things)

morning stiffness >1 hour
Swelling/ erythema
Stiffness
Better with activity
ESR and CRP elevated
May help with steroids + cDMARD’s

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Name 4 inflammatory joint conditions

Rheumatoid arthritis
Psoriatic arthritis
Reactive arthritis
Lupus

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What would you find on history for someone with non-inflammatory joint conditions? (6 things)

Morning stiffness <1 hour
Less swelling
Pain more than stiffness
Worse with activity
ESR and CRP normal
Not helped with cDMARD’s

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Name a non-inflammatory joint condition

Osteoarthritis
- weight bearing joints (knees, hips)

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What is rheumatoid arthritis and what joints are typically affected?

An autoimmune inflammatory joint disease

Generally poly arthritis (many joints affected- usually wrist, MCP and PIP joints)
Symmetrical
progresses to joint destruction and deformity
Systemic signs

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What bones do OA not affect and what bones do RA not affect?

OA:

OA affects the DIP’s and PIP bones
Not MCP’s

RA:
RA affects the PIP’s and MCP bones
Not DIP’s

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What is Psoriatic arthritis? How does it present (5 things)

Chronic inflammatory disease associated with psoriasis

-The knee and DIP’s are common areas of disease.
- Non symmetrical (mono/oligoarthritis)
-Pitting of the nails
-Dactylitis (entire digit is swollen)
-Enthesitis (swelling where bone attaches to tendon)

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Is CCP, positive or negative in Psoriasis arthritis?

Negative !
Otherwise this would be RA

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How do you manage Sjrogens disease? (3 things)

Conservative management

Eyedrops (Hypromellose)
Sialogogues (makes them salivate)
Punctal plugs (plugs in the tear glands to stop the tears draining)

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What is Sjrogens disease? What are some symptoms? (7 things)

An immune disorder that affects how well the body is able to produce fluids. It is characterised by dry eyes and a dry mouth

Inflammatory condition.

Sx:
- Dry eyes
- Dry mouth
- Rash after being in the sun
- Muscle pain
- Swelling
- Vaginal dryness
- Fatigue

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What is reactive arthritis? how does it usually present?

An inflammatory arthritis that occurs after exposure to a GI or GU infection

Classic triad:
“I can’t see, pee, or climb a tree”
1. Arthritis
2. Uveitis
3. Urethritis

Large joints
Systemic sx. fever, malaise etc.

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What is Polymyalgia rheumatica (PMR)?

Inflammatory condition causing PAIN in the hip and shoulder girdles.
It tends to be episodic

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How is PMR managed?

15mg Prednisolone OD for 3/52
Reduce to 12.5mg for 3/52 then 10mg OD for 4-6/52 then reduce by 1mg every 4-8 weeks.
Advise that steroid’s should be continued for 1-2 years.

This should resolve ALL the symptoms.

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What do you need to ask someone with PMR? (4 things)

Any visual changes?
Any headaches?
Any scalp tenderness?
headaches?? **

This is because GCA is associated with PMR and can cause permanent vision loss. (These patients need high dose steroids to save vision)

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What is the main differences between PMR and Polymyositis?

PMR causes shoulder and hip girdle pain
and polymyositis causes shoulder and hip girdle weakness !

PMR - Causes raised ESR
Polymyositis causes raised CK

What is Polymyositis? How do es it present and what would you expect on bloods? How is it diagnosed ? What is the treatment ?

Inflammatory condition of the muscles. Causes weakness in the proximal muscles.

Sx:
- Trouble getting out of their chair
- Trouble brushing their hair
- Typically >40yrs old

Ix:
- Very raised CK

Dx:
- EMG (Electromyography)
- Muscle biopsy ** (definitive diagnosis)

Tx:
- Steroids

What is juvenile arthritis?

Arthritis in patients <16yrs +>6 weeks old.

Characterised by joint pain/swelling (commonly in knees) + intermittent spiking fevers (1-2 spikes per day)

What condition is characterised by trigger points ?

Fibromyalgia

There are 18 trigger points. patient’s need <11 to have the condition

What is Fibromyalgia? How is it treated?

Long term condition that causes pain all over the body.
It is treated via symptomatic relief

What is Systemic lupus erythematosus(SLE)?

A chronic multi- system disorder. The immune system attacks its own tissues which causes many symptoms

Symptoms of SLE (use mnemonic “imdamnsharp)

I - Immunoglobulins present
M- Malar rash

D- Discoid rash
A- Anti nuclear antibodies (ANA)
M- Mucositis
N- Neurological disorders

S- Serositis
H- Haematologic disorders
A- Arthritis
R- Renal disorders
P- photophobia

What would you expect to find on examination for osgood schlatter’s disease? (2 things)

Point tenderness on the tibial tuberosity
Pain worsens with activity

What is the most common ankle sprain ?

Anterior talofibular (ATF) ligament

What is plantar fasciitis and how does it present? (5 things)

This is the most common cause of heel pain. Commonly caused by obesity, physical activity, pregnancy, occupation or foot structure. Sx: - Heel pain - Stabbing pain on the bottom of the foot - Worse when walking bare foot - Most painful during the "first few steps" in the morning - Pain relieved by rest

What is Mortons neuroma ? How would it present?

Pain between the 3rd and 4th toes. Described as "walking on marbles" - Pain when squeezing toes - Mulder sign -Mulder click

What is the first line for fibromyalgia?

Non pharmacological - ptx education - Increase exercise - CBT Pharmacology: - Amitriptyline (1st line)

How do you differentiate Septic arthritis from cellulitis?

Septic arthritis is found in the joint whereas Cellulitis can be found on any part of the limb. Also people tend to not get systemic. symptoms with cellulitis

List some risk factors for Osteomyelitis. (5 things)

1. Sickle cell disease 2. Diabetes 3. Recent surgery 4. IV drug misuse 5. HIV infection

How would you manage acute (5 things) and prophylactic (1 thing) gout?

ACUTE: 1. NSAID's (technically 1st line) 2. Colchicine 500mg BD or Prednisolone 1st line meds. 3. Rest 4. Elevate the foot 5. ICE Note: Never give allopurinol during an acute attack. - Also cannot give steroid injection if theres infection. PROPHYLAXIS: - Allopurinol OD This is for people who get gout >2-3 times yearly.

How is pseudo gout treated?

1. NSAID's 2. or steroids - These have positively birefringent crystals

Which is worse, osteopenia or osteoporosis?

Osteoporosis

How does osteoarthritis present? +what would you see on X-ray (5 things )

1. Activity related joint pain 2.Morning stiffness no longer than 30mins X-ray: 3.Joint space narrowing 4. Osteophytes 5. subchondral bone thickening and/or cysts

X-ray findings of Rheumatoid arthritis? (4 things)

1. Joint destruction and deformity 2. Soft tissue swelling 3. Periarticular osteopenia (earliest signs of RA) 4. Boney erosions

Symptoms for a blow out fracture? (5 things)

1. Diplopia (to differentiate from other things) 2. Bruising 3. Tenderness and swelling around the eye 4. Redness of the eye 5. numbness of the cheek, nose or teeth

What gram positive and what gram negative bacteria lead to septic arthritis?

Pos+ - Staphylococcus aureus Neg- -Neisseria gonorrhoeae

what population are likely to isolate Pseudomonas aeruginosa in a diagnosis of septic arthritis ?

IVDU

How does pages disease of the bone present? (4 THINGS)

- Cotton wool appearance of the skull - bone aches and joint pain - increased head size -BLOODS: normal PTH, calcium and increased ALP