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CP3 MDD > Fibromyalgia, OA and Crystal Arthropathies > Flashcards

Fibromyalgia, OA and Crystal Arthropathies Flashcards

1
Q

F:M fibromyalgia

A

10:1

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2
Q

RF fibromyalgia

A

Life stress
Alcoholism
Injury
Low SE status

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3
Q

general Sx of fibromyalgia (5)

A 
Multiple regional pain 
Fatigue
Low affect/irritable 
Poor [ ] 
Non-restorative sleep
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4
Q

Variable locomotor Sx - fibromyalgia

A

Early morning stiffness
Subjective swelling - fingers
Numbness fingers

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5
Q

Diagnostic criteria fibromyalgia

A

= a diagnosis of exclusion
widespread pain >3m
Widespread pain index >7 + Sx severity scale
Pain elicited at 11+ def points/4-5 regions
Hyperalgesic withdrawl in all 3 quadrants

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6
Q

Ix fibromyalgia

A 
Hx (rule out red flags + depression)
FBC - anaemia/lupus
ESR/CRP
TFT - hypothyeoid 
Ca + ALK
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7
Q

Conservative mx fibromyalgia

A

Education
Lifestyle - incr activity level
Sleep hygiene
CBT/relaxation

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8
Q

medical Mx fibromyalgia

A

Amitriptyline

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9
Q

important DDx fibromyalgia

A

chronic fatigue syndrome

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10
Q

PS chronic fatigue syndrome

A 
Persistent fatigue >6m
Affecting physical + mental fct 
Present >50% time 
\+ 4 of: 
Myalgia 
Polyarthralgia 
Reduced memory 
Unrefreshing sleep 
Fatigue after exertion for 24hrs 
Persistent sore throat 
Tender LN
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11
Q

Which joints are commonly affected in OA

A

Hip
Knee
DIP / PIP
Thumb CMJ, MTPJ

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12
Q

Which joints are classically spared in OA?

A

MCP

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13
Q

PS OA

A

Progressive pain
Activity related
Stiffness, worst after rest, lasting 30 mins

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14
Q

Later features OA (4)

A

Mm wasting
Loss mobility
Deformity
Joint instability

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15
Q

O/E OA (LFM)

A

Look: bony swelling, mm wasting
Feel: Joint line tenderness, effusion, crepitus
Move: Decr ROM

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16
Q

RF OA (7)

A 
Age 
FHx 
F 
Obesity 
Trauma 
Hypermobility 
Certain occupations
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17
Q

Protective factor OA

A

OP

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18
Q

2’ causes of OA (7)

A 
Pre-existing joint damage - inflamm, septic, crystal, AVN, trauma 
Acromegaly 
Haemochromatosis 
Haemophilia
Neuropathies
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19
Q

Hip OA - affects which gender more

A

Male

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20
Q

Is Hip OA typically unilateral or bilateral

A

Unilateral

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21
Q

ps hip OA

A

Painful
Decr internal/external rotation
+ve Trendelenburgs

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22
Q

RF knee OA (3)

A

Obesity
Trauma
Soft tissue injury

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23
Q

Is knee OA typically unilateral or bilateral

A

bilateral

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24
Q

O/E - knee OA

A

Effusion/crepitus
Decr ROM
Quad wasting

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25
Hand findings OA
CMC + MCP joint | Bouchards (PIPs) and Heberden's nodes (DIPs)
26
who tends to get nodal generalised OA
Menopausal F | People w/ autoimmune/familial link
27
Are DIP s or PIPs ore affected in nodal genrealised OA
DIPS
28
Sx early OA
asymptomatic
29
XR findings OA (7)
``` = LOSS Loss of joint space (non-uniform) Osteophytes subarticular sclerosis subchrondral cysts No soft tissue swelling Diffuse osteopenia NO erosions ```
30
Ix OA (5)
``` Bloods - CRP/ESR RF ANA XR - 2 views CT/MRI ```
31
Conservative Mx (4)
education decr W physio Decr mechanical factors
32
1st line medical Mx OA
Paracetamol + TO NSAID
33
2nd line medical Mx OA
PO NSAID + TO capsaicin
34
Surgical Mx OA
Arthroplasty (total/1 compartment) Young - arthroscopy + joint washout Arthrodesis (ankle/spine/hand)
35
Absolute C/I joint replacement
UnTx joint sepsis
36
Relative C/I joint replacement (2)
Young | Co-morbidities
37
Complications joint replacement (8)
``` Leg length discrepancy Dislocation Infection DVT Periprosthetic # Persistent pain Polythene wear acetabular compartment NV injury ```
38
Which gender dominates gout cases
Males
39
What is gout due to an increased presence of?
Monosodium urate monohydrate
40
Where are the MSUM deposited in gout
Peripheral connective tissue in + around synovial joints
41
Which joint is most classically affected in gout
1st MTPJ
42
RF gout (5)
``` Age Male Menopausal status Metabolic status High protein diet/alcohol ```
43
secondary causes of gout
``` CKD Drugs HTN HyperPTH Hypothyroid Incr uric acid prod by metabolic/myeloproliferative conditions ```
44
If a patient has gout and is <25, what cause is most likely
Inherited enzyme disorder
45
PS acute urate gout
Acute, severe pain (worst ever) Rapid onset Extreme tenderness + marked swelling/erythema Joint stiffness
46
When is the pain maximal in acute urate gout
2-6hrs
47
How long does it take for the acute urate gout attack to resolve?
5-14 days
48
Precipitants - acute urate gout attack (3)
Alcohol Food Dehydration
49
LT complications acute urate gout (3)
Renal glomerular disease Tubular + interstitial disease Urolithiasis
50
What is the main DDx for acute urate gout?
Septic arthrits
51
What do the large MSUM crystal deposits in chronic trophaceous gout form
Irregular firm nodes | = Tophi
52
Classical sites chronic trophaceous gout
Extensor surfaces fingers, hands, elbows, achilles
53
Ix gout (4)
Bloods - FBC, UEm Se uric acid Aspiration of joint/arhtrocentesis --> MCS + polarised light microscopy XR ID cause - BP/Urine dip/BM/ESR
54
Appearance of gout underpolarised light micrscopy
Negative birefringent needle shaped
55
Mx - acute ep gout (4)
PO NSAID (naproxen/diclofenac) PO colchicine if can't have NSAID Early joint asp + CCS Early mobilisation + elevation
56
What is pseudogout
Ca pyrophosphate crystals deposited in hyaline/fibrocartilage of joints --> chondrocalcinosis
57
Causes pseudogout
Sporadic Familial Metabolic disease - hyperPTH, decr PO4, decr Mg, Wilsons
58
Which 3 joints is pseduogout most comon in
Knee Wrist Pelvis
59
Polarised light microscopy appearance - pseudogout
+ve biofringent + rhomboid shape
60
XR appearnce pseudogout
Chondrocalcinosis
61
If someone PS w/ pseudogout <55, what should you do
Screen for metabolic/familial predisposition
62
What is Calcific perarthritis
CaPO4/apatite deposition
63
If CaPO4 = deposited in periarticular tissue, what does it lead to
calcific tendonitis
64
If CaPO4 = deposited in the hyaline cartilage, what does it lead to
OA
65
If CaPO4 = deposited in SC tissue/mm, what does it lead to
OA

CP3 MDD (13 decks)

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