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CP1 revision > Deck 10 > Flashcards

Deck 10 Flashcards

1
Q

Infective joint pain

A

Rubella, parvovirus, mumps, Hep B, staphylococci, TB, borrelia

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2
Q

Post infective joint pain

A

rheumatic fever, reactive arthritis

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3
Q

Inflammatory causes of joint pain

A

RA, ankylosing spondylitis, SLE, scleroderma, polymyositis

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4
Q

Tumour joint pain causes

A

primary (osteosarcoma, chondrosarcoma)

Secondary (lung, breast, prostate)

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5
Q

Joint pain with hypermobility

A

Ehler’s danlos

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6
Q

OA most common joints

A

knee (often bilateral), hip and small hand joints (DIPS)

Metatarsophalangeal joint, talonavicular joinr, lumbar and cervical spine

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7
Q

crystal associated OA

A

chondrocalcinosis (calcium pyrophosphate crystals - knees and wrists).

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8
Q

OA S+S

A

Pain worse on movement, morning stiffness <30 mins
Heberdens nodes, bouchards nodes, thumb squaring, varus knees (medial tibiofemoral OA),
Osteophytes, reduced range of active/passive movement, crepitus, deformity, effusion, atalgic gate

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9
Q

OA RF

A

genetic (esp hands), aging, female, obesity, high bone density, Hx of joint injury, occupation, reduced muscle strenth, joint malalignment

Typically W>M, 50_

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10
Q

Secondary OA

A

crystal arthritis, avascular necrosis, acromegaly, haemochromatosis, chondrocalcinosis, haemophilia, haemoblobinopathies, neuropathies

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11
Q

OA definition

A

clinical outcome of various factors giving pain, disability, stricutral synovial joint failure and remodelling

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12
Q

OA diagnosis

A 
Xray scoring, but not needed for diagnosis.
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Cartilage degradation

Hip has painful and reduced rotation, and positive trendelenburg test (sound side sags)

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13
Q

RA

A

Symmetrical inflammatory polyarthropathy

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14
Q

RA pathophysiology

A

Neutrophil /T cells, macrophages infiltration during rheumatoid synovitis, exudative effusion, then vascular granulation (pannus via osteoclast and macrophages causes erosions)
Can be secondary to OA
Morning stiffness can be inflammatory mediators or excess cortisol

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15
Q

RA S+S

A

fatigue, sleep impacted. flares (can be med change, stress, poor adherence - may trigger med review), pain, swelling, erythema in small joints of hands/feet (bilateral)
MCP, PIPs, wrist, elbow, glenohumeral, cervical spine, hip, knee, ankle.

Thoracic/lumbar spine and dips are spared

Morning stiffness lasts >30 mins.

Often goes from feet to hands to knee to shoulder/hip

Valgus deformity and secondary OA can develop

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16
Q

Advanced RA

A

Ulnar MCP, radial wrist, boutoniere (dip flex, pip extend) or swan neck (pip and dip extension), Z thumb (IP extension, flexed MCP)

Joints sublux, deformity occurs with ankylosis

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17
Q

Pannus formation

A

vascularised granulation tissue. Synovial membrane becomes hypertrophied

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18
Q

Skin RA features

A

nodules (esp in seropositive RA), fragility, vasculitis, pyoderma gangrenosum

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19
Q

Heart RA features

A

pericarditis, atherosclerosis, vasculitis, valvular disease

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20
Q

Lung RA features

A

pleural effusion, fibrosis, bronchiolitis obliterans (dry cough, SOB), RA nodules, vasculitis

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21
Q

Eye RA features

A

keratoconjunctivitis sicca (sjogrens), episcleritis, scleromalacia perforans (necrotising scleritis), peripheral ulcerative kerotopathy

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22
Q

Neurological Ra features

A

carpal tunnel, peripheral neuropathy

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23
Q

Haematopoeitic Ra featuures

A

anaemia, thrombocytosis, lymphadenopathy, felty syndrome

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24
Q

Felty syndrome

A

RA , splenomegaly, neutropoenia

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25
Kidney RA features
amyloidosis, vasculitis
26
Bone RA features
osteopoenis
27
Nodules in RA form
Local vascular damage allows IgM rheumatoid factor complex to embed in vessel walls. Stimulates monocytes and leads to pallisading granuloma formation
28
palisading granuloma
macrophages and giant cells in tier formation
29
RA diagnosis
anti CCP is most specific RF also used, but can be FP as not as specific ANA raised if CT disease XR shows loss of joint space, erosions Normocytic anaemia of chronic disease, leukocytosis, raised CRP/ESR
30
Non joint complications of RA
GI bleed due to aspirin therapy, infections/osteoporosis due to steroids, amyloidosis
31
DDx in early RA
reactive arthritis, seronegative spondyloarthropathies, polymyalgia rheumatica, acute nodal OA
32
Gout investigations
FBC, CRP, ESR, serum urate, synovial fluid aspiration, HbA1c, lipid profile xray (punched out erosions)
33
Gout diagnostic test for crystals
negatively birefringent needle - > urate
34
Primary gout
Either excess uric acid production or reduced excretion. Alcohol and obesity predispose
35
Secondary gout
10% of cases. Associated with increased nucleic acid turnover - diuretics, aspirin, nicotinic acid, lead, glycogen storage disease
36
Pathophysiology of gout
Typically monoarticular Crystals activate Hageman factor (inflammation and chemo attractant -macrophages/neutrophils phagocytose crystals and secrete lysozymes, PGs etc which inflame and cause synovitis)
37
Renal effects of gout
tophi, intratubular urate deposition, nephrolithiasis, chronic urate nephropathy
38
Pseudogout associated conditions
Typically elderly patients | Associated with hyperparathyroidism, hypophosphataemia, hypomagnesaemia, Wilson's disease. But may be sporadic
39
Typical pseudogout joints
often knee, but can get wrist
40
Pseudogout investigations
Chondrocalcinosis (calcification of articular cartilage and menisci on xray) Weakly positive,blunted rhomboid calcium pyrophosphate dihydrate crystals)
41
Most common septic arthritis in children
H influenzae
42
Most common septic arthritis in older childrenadults
Staphylococcus aureus
43
Pott disease
Spinal TB
44
TB arthritis
insidious, chronic onset. Often haematogenous spread, or from osteomyelitis focus.
45
Lyme disease arthritis
Post skin signs. Migrates. Involves large joints. Often clears spontaneously but may cause long term damage
46
Enthesitis
Inflammation of ligament/tendon insertion at bone
47
Tendonitis
Tendon inflammation by trauma, crystals or infection
48
Tenosynovitis
Inflammation of tendon sheath. Can co-exist with tendonitis
49
Sprain
Ligament tearing (stretch/rupture)
50
Strain
Muscle fibre stretching or rupture
51
Subacromial buritis location
between acromion and supraspinatus, between deltoid tendon and greater tubercle of humerus
52
Subacromial bursitis symptoms
Pain on front/side of shoulder, pain on arm movement/sleeping on that side. May have stiffness. Pain on reaching up. Abduction pain, pain on anterior palpation, mild anterior swelling, reduced function
53
Lateral epicondylitis
Tennis elbow. Extensor insertion for extensor carpi ulnaris, extensor carpi raialis brevis, extensor digiti minimi, extensor digitorum comunis. Pain on extening wrist, making fist (gripping objects, supinating, opening doors). Tenderness over lateral epicondyle. Weak wrist and finger extension. PRICE and analgesia Tx
54
Plantar fasciitis
Weakness of plantar aponeurosis. Calcaneal bone spurs can develop. May be due to trainer use runing, standing, obesity Heel pain (esp after initiating movement from rest, worse in morning/after rest, imrpoves with activity) Pain worse on dorsiflexion. Achilles tendon may feel tight
55
scleroderma overview
Rare autoimmune F4x 25-55 up to 20% deelop another CT disorder (arthritis, lupus, myositis)
56
Scleroderma S+S
Skin: sclerodactyly, Reynauds syndrome, nail bed abnormalities (including splinter haemorrhage), digital calcinosis, tight skin around fingers/mouth 1/2 are cutaneous scleroderma (skin only) In Systemic: - MSK issues are arthralgia and myalgia GI features are dysphagia, reflux, dyspepsia Lung issues are pulmonary artery HTN, interstitial lung disease (large cause of death) Cardiac features are chest pain, palpitations, pericardia/myocardial disease) Systemic features: inflammation, fibrosis, vasculopaty, sicca, fatigue
57
SLE demographics
10x female 8X Black people 20s-40s
58
SLE types
Chronic autoimmune disease Can be cutaneous only, or multisystem. Has ds nucleic acid antibodies, affinity for GBM in kidney but also causes inflammation in brain, heart, spleen, lung, GI tract, peritoneum
59
SLE S+S
S: - Skin (initial signs): vasculitis, rash, malash rash, discoid rash, photosensitivity, nasal/oral ulceration - Joints: arthalgias, synovitis, swelling, pain, morning stiffness. May see reducible swan neck deformities as ligament issue rather than subluxation - Haematological: anaemia, deranged WC and platelets, acquired antiphospholipid syndrome - Lung/Cardiac: serositis (SOB, pleuritic chest pain, chest pain) - Renal: glomerulonephritis Neurological: seizures, psychosis, confusion, peripheral neuropathy, myelitis
60
Seronegative spondoarthridities
Ankylosing spondylitis Psoriatic arthritis Reactive arthritis IBD related arthopathy
61
Ankylosing spondilitis
3:1 M:F, 18-30, episodic sacroiliac inflammation. Worse in morning, relieved by exercise. May have uveitis, pulmonary fibrosis, AV node block, amyloidosis Check ESR, Pelvis XR (fusion of sacroiliac), spinal XR (bamboo spine)
62
Psoriatic arthritis
equal M:F, often symmetrical with DIPJ involvement, nail changes (ochylolysis), spondylitis, dactylitis, psoriasis
63
reactive Arthritis
Reiter's syndrome. Acute, asymmetrical lower limb arthritis 4-40 days post GI/GU infection (which may have been asymptomatic). Can be chlamydia, salmonella, campylobacter. More common in Males and HLAB27. Triad of dysuria, conjunctivitis and lower limb oligoarthritides. Skin lesions are also common.
64
IBD related arthropathy
Symmetrical arthritis, may have spinal or SIJ involvement. In UC, remission of IBD associated with arthritis remission, but less so in Crohns.
65
facet joints
synovial, allows flex/extension in lumbar spine - no lateral rotation or flexion. Rotation and lateral flexion in thoracic spine
66
Spinal ligament
Posterior longitudinal C2-sacrum for stability Anterior longitidinal C1-sacrum -stability Supraspinous C7-sacrum Ligamentum flavum
67
Adult spinal cord termination
L1
68
Disk prolapse tends to go
laterodorsal
69
Mechanical back pain
- Gets better/worse depending on position - Worse on movement - Worse in poor posture, lifting, sitting - Can be due to minor injury (e.g. ligament sprain) Improves in a few weeks, regardless of treatment
70
Lumbar spine sprain/strain
often due to lifting. Intense pain, then spasm
71
Degenerative disc/facet
Often older Gradual pain onset, worse after rest. Can be due to OA Can affect sacroiliac
72
Back pain worse on extension
?facet joint
73
Back pain worse on flexion
? disc
74
Herneated nucleus pulposis
Aging disc in older, trauma in younger. Typically lumbar with dermotomal leg pain. Worse on straight leg raise
75
Spondylolysis
Congenital. Anterior displacement of L5 body and transverse process (posterior remains in place over sacrum) - Scottie dog
76
Spondylolithesis
Acquired anterior displacement of L5 body and transverse process, posterior part remains over sacrum. Scottie dog on ray
77
Back pain red flags
Bladder/bowel issues, non lumbar issues, leg weakness/parasthaesia, erythema over spine, B symptoms, fever, saddle paraesthesia, Hx of cancer, Hx of IVDU, prolonged steroids, patient age/fragility
78
Infective causes of back pain
discitis, osteomyelitis, epidural abscess - consider infection nearby, surgeries, IVDU, steroids?
79
Inflammatory causes of back pain
spondyloarthropathies such as AS, Psoriatic arthritis - RA in neck and sarcoiliac joint
80
Cortical bone
osteons, outer bone layer. Has central bone marrow
81
Spongy bone
Found in long bones. No bone marrow. Has cortical bone outside
82
Osteoporosis bone type affected
trabecular
83
Secondary osteoporosis
primary hyperparathyroidism, thyrotoxicosis, steroid induced, Cushing's disease, anorexia nervosa, malabsorptive conditions, chronic inflammation/neoplastic disease (suppresses bone formation)
84
RF for osteoporosis
low BMI, elite female athletes, caucasian/ Asian women who cover skin, Vitamin D deficiency (and associated such as coeliac disease, kidney disease, liver disease), early menopause, late menarchy, alcohol >4 units/day, smoking, overactive thyroid, COPD (steroid use), FHx, RA
85
Diagnosis of osteoporosis
DEXA gives T score (Deviation of bone density from young adult. T
86
FRAX
10 year osteoporosis risk
87
DEXA T score
less than -2.5 is osteoporosis. Less than -1 is osteopoenisa
88
Z score DEXA
comparison to age matched control
89
Osteoporosis prevention
calcium intake, vitamin D supplements, weight bearing exercise, smoking cessation, alcohol reduction, medication risks, referral to falls team,
90
Osteoporosis management
symptomatic with analgesia. Use antireabsorptives (bisphophonates, denosumab), anabolic steroids, dual action bone agents. Can also have surgical management (kyphoplasty, vertebroplasty)
91
Ankle plantarflexion
S1
92
Finger abduction
T1
93
Wrist extension
C6 | Radial nerve
94
C7
Elbow extension, wrist flexion
95
C8
Thumb extension, finger flexion
96
Hip flexion
L2
97
Knee extension
L3
98
Ankle dorsiflexion
L4
99
Big toe extension
L5
100
Shoulder shrugs
C4
101
Shoulder abduction, external rotation, elbow flexion
C5
102
Median nerve Roots
C6-T1
103
Median nerve motor in arm
Sites in anterior forarm compartment, involved in flexion and pronation.
104
Median nerve in hand
Thenar muscles. Lateral 2 lumbracles Sensation to palmar thumb, 1st, 2nd and 1/2 3rd
105
Radial nerve roots
C5-T1
106
Radial nerve sensation in hand
Dorsum of lateral 3 1/2 digits, plus back of thumb
107
Motor radial nerve
Innervates triceps Runs in extensor compartment of forearm. Innervates wrist extension, but note sthat wrist drop does not occur in trauma beyond radial groove as branches assist
108
ulnar nerve
C8-T1 | Runs between medial epicondyl and olecranon
109
Ulnar nerve motor
Flexor carpi ulnaris (flexes and adducts) Flexor digitorum profundus (medial 1/2) - flexes at dips Intrinsic hand muscles except lateral 2 lumbicles and thenar.
110
Ulnar sensation
medial 1.5 of fingers on palm
111
Common fibular nerve
L4-S2 Innervates lateral leg compartment (foot eversion via superficial) and anterior compartment (deep branch) - includes dorsiflexion
112
Damage causing foot drop
Common fibular nerve, or deep fibular nerve Can be due to fibular fracture or tight plaster cast as deep fibular wraps around neck of fibular bone. Would also loose sensation over dorsum of foot.
113
Medial foot sensation
Saphenous
114
Heel and sole of foot sensation
Tibial (from sciatic)

CP1 revision (16 decks)

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