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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
Q

Kidney RA features

A

amyloidosis, vasculitis

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26
Q

Bone RA features

A

osteopoenis

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27
Q

Nodules in RA form

A

Local vascular damage allows IgM rheumatoid factor complex to embed in vessel walls. Stimulates monocytes and leads to pallisading granuloma formation

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28
Q

palisading granuloma

A

macrophages and giant cells in tier formation

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29
Q

RA diagnosis

A

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

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30
Q

Non joint complications of RA

A

GI bleed due to aspirin therapy, infections/osteoporosis due to steroids, amyloidosis

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31
Q

DDx in early RA

A

reactive arthritis, seronegative spondyloarthropathies, polymyalgia rheumatica, acute nodal OA

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32
Q

Gout investigations

A

FBC, CRP, ESR, serum urate, synovial fluid aspiration, HbA1c, lipid profile
xray (punched out erosions)

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33
Q

Gout diagnostic test for crystals

A

negatively birefringent needle - > urate

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34
Q

Primary gout

A

Either excess uric acid production or reduced excretion. Alcohol and obesity predispose

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35
Q

Secondary gout

A

10% of cases. Associated with increased nucleic acid turnover
- diuretics, aspirin, nicotinic acid, lead, glycogen storage disease

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36
Q

Pathophysiology of gout

A

Typically monoarticular
Crystals activate Hageman factor (inflammation and chemo attractant -macrophages/neutrophils phagocytose crystals and secrete lysozymes, PGs etc which inflame and cause synovitis)

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37
Q

Renal effects of gout

A

tophi, intratubular urate deposition, nephrolithiasis, chronic urate nephropathy

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38
Q

Pseudogout associated conditions

A

Typically elderly patients

Associated with hyperparathyroidism, hypophosphataemia, hypomagnesaemia, Wilson’s disease. But may be sporadic

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39
Q

Typical pseudogout joints

A

often knee, but can get wrist

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40
Q

Pseudogout investigations

A

Chondrocalcinosis (calcification of articular cartilage and menisci on xray)
Weakly positive,blunted rhomboid calcium pyrophosphate dihydrate crystals)

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41
Q

Most common septic arthritis in children

A

H influenzae

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42
Q

Most common septic arthritis in older childrenadults

A

Staphylococcus aureus

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43
Q

Pott disease

A

Spinal TB

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44
Q

TB arthritis

A

insidious, chronic onset. Often haematogenous spread, or from osteomyelitis focus.

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45
Q

Lyme disease arthritis

A

Post skin signs. Migrates. Involves large joints. Often clears spontaneously but may cause long term damage

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46
Q

Enthesitis

A

Inflammation of ligament/tendon insertion at bone

47
Q

Tendonitis

A

Tendon inflammation by trauma, crystals or infection

48
Q

Tenosynovitis

A

Inflammation of tendon sheath. Can co-exist with tendonitis

49
Q

Sprain

A

Ligament tearing (stretch/rupture)

50
Q

Strain

A

Muscle fibre stretching or rupture

51
Q

Subacromial buritis location

A

between acromion and supraspinatus, between deltoid tendon and greater tubercle of humerus

52
Q

Subacromial bursitis symptoms

A

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
Q

Lateral epicondylitis

A

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
Q

Plantar fasciitis

A

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
Q

scleroderma overview

A

Rare autoimmune
F4x
25-55
up to 20% deelop another CT disorder (arthritis, lupus, myositis)

56
Q

Scleroderma S+S

A

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
Q

SLE demographics

A

10x female
8X Black people
20s-40s

58
Q

SLE types

A

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
Q

SLE S+S

A

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
Q

Seronegative spondoarthridities

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
IBD related arthopathy

61
Q

Ankylosing spondilitis

A

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
Q

Psoriatic arthritis

A

equal M:F, often symmetrical with DIPJ involvement, nail changes (ochylolysis), spondylitis, dactylitis, psoriasis

63
Q

reactive Arthritis

A

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
Q

IBD related arthropathy

A

Symmetrical arthritis, may have spinal or SIJ involvement. In UC, remission of IBD associated with arthritis remission, but less so in Crohns.

65
Q

facet joints

A

synovial, allows flex/extension in lumbar spine - no lateral rotation or flexion.
Rotation and lateral flexion in thoracic spine

66
Q

Spinal ligament

A

Posterior longitudinal C2-sacrum for stability
Anterior longitidinal C1-sacrum -stability
Supraspinous C7-sacrum
Ligamentum flavum

67
Q

Adult spinal cord termination

A

L1

68
Q

Disk prolapse tends to go

A

laterodorsal

69
Q

Mechanical back pain

A
  • 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
Q

Lumbar spine sprain/strain

A

often due to lifting. Intense pain, then spasm

71
Q

Degenerative disc/facet

A

Often older
Gradual pain onset, worse after rest.
Can be due to OA
Can affect sacroiliac

72
Q

Back pain worse on extension

A

?facet joint

73
Q

Back pain worse on flexion

A

? disc

74
Q

Herneated nucleus pulposis

A

Aging disc in older, trauma in younger. Typically lumbar with dermotomal leg pain. Worse on straight leg raise

75
Q

Spondylolysis

A

Congenital. Anterior displacement of L5 body and transverse process (posterior remains in place over sacrum) - Scottie dog

76
Q

Spondylolithesis

A

Acquired anterior displacement of L5 body and transverse process, posterior part remains over sacrum. Scottie dog on ray

77
Q

Back pain red flags

A

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
Q

Infective causes of back pain

A

discitis, osteomyelitis, epidural abscess - consider infection nearby, surgeries, IVDU, steroids?

79
Q

Inflammatory causes of back pain

A

spondyloarthropathies such as AS, Psoriatic arthritis - RA in neck and sarcoiliac joint

80
Q

Cortical bone

A

osteons, outer bone layer. Has central bone marrow

81
Q

Spongy bone

A

Found in long bones. No bone marrow. Has cortical bone outside

82
Q

Osteoporosis bone type affected

A

trabecular

83
Q

Secondary osteoporosis

A

primary hyperparathyroidism, thyrotoxicosis, steroid induced, Cushing’s disease, anorexia nervosa, malabsorptive conditions, chronic inflammation/neoplastic disease (suppresses bone formation)

84
Q

RF for osteoporosis

A

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
Q

Diagnosis of osteoporosis

A

DEXA gives T score (Deviation of bone density from young adult. T

86
Q

FRAX

A

10 year osteoporosis risk

87
Q

DEXA T score

A

less than -2.5 is osteoporosis. Less than -1 is osteopoenisa

88
Q

Z score DEXA

A

comparison to age matched control

89
Q

Osteoporosis prevention

A

calcium intake, vitamin D supplements, weight bearing exercise, smoking cessation, alcohol reduction, medication risks, referral to falls team,

90
Q

Osteoporosis management

A

symptomatic with analgesia. Use antireabsorptives (bisphophonates, denosumab), anabolic steroids, dual action bone agents.
Can also have surgical management (kyphoplasty, vertebroplasty)

91
Q

Ankle plantarflexion

A

S1

92
Q

Finger abduction

A

T1

93
Q

Wrist extension

A

C6

Radial nerve

94
Q

C7

A

Elbow extension, wrist flexion

95
Q

C8

A

Thumb extension, finger flexion

96
Q

Hip flexion

A

L2

97
Q

Knee extension

A

L3

98
Q

Ankle dorsiflexion

A

L4

99
Q

Big toe extension

A

L5

100
Q

Shoulder shrugs

A

C4

101
Q

Shoulder abduction, external rotation, elbow flexion

A

C5

102
Q

Median nerve Roots

A

C6-T1

103
Q

Median nerve motor in arm

A

Sites in anterior forarm compartment, involved in flexion and pronation.

104
Q

Median nerve in hand

A

Thenar muscles.
Lateral 2 lumbracles
Sensation to palmar thumb, 1st, 2nd and 1/2 3rd

105
Q

Radial nerve roots

A

C5-T1

106
Q

Radial nerve sensation in hand

A

Dorsum of lateral 3 1/2 digits, plus back of thumb

107
Q

Motor radial nerve

A

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
Q

ulnar nerve

A

C8-T1

Runs between medial epicondyl and olecranon

109
Q

Ulnar nerve motor

A

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
Q

Ulnar sensation

A

medial 1.5 of fingers on palm

111
Q

Common fibular nerve

A

L4-S2
Innervates lateral leg compartment (foot eversion via superficial) and anterior compartment (deep branch) - includes dorsiflexion

112
Q

Damage causing foot drop

A

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
Q

Medial foot sensation

A

Saphenous

114
Q

Heel and sole of foot sensation

A

Tibial (from sciatic)

CP1 revision (16 decks)

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