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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
Q

Hand findings OA

A

CMC + MCP joint

Bouchards (PIPs) and Heberden’s nodes (DIPs)

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26
Q

who tends to get nodal generalised OA

A

Menopausal F

People w/ autoimmune/familial link

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27
Q

Are DIP s or PIPs ore affected in nodal genrealised OA

A

DIPS

28
Q

Sx early OA

A

asymptomatic

29
Q

XR findings OA (7)

A 
= LOSS 
Loss of joint space (non-uniform) 
Osteophytes
subarticular sclerosis 
subchrondral cysts 
No soft tissue swelling 
Diffuse osteopenia 
NO erosions
30
Q

Ix OA (5)

A 
Bloods - CRP/ESR
RF
ANA
XR - 2 views
CT/MRI
31
Q

Conservative Mx (4)

A

education
decr W
physio
Decr mechanical factors

32
Q

1st line medical Mx OA

A

Paracetamol + TO NSAID

33
Q

2nd line medical Mx OA

A

PO NSAID + TO capsaicin

34
Q

Surgical Mx OA

A

Arthroplasty (total/1 compartment)
Young - arthroscopy + joint washout
Arthrodesis (ankle/spine/hand)

35
Q

Absolute C/I joint replacement

A

UnTx joint sepsis

36
Q

Relative C/I joint replacement (2)

A

Young

Co-morbidities

37
Q

Complications joint replacement (8)

A 
Leg length discrepancy 
Dislocation 
Infection 
DVT 
Periprosthetic # 
Persistent pain 
Polythene wear acetabular compartment 
NV injury
38
Q

Which gender dominates gout cases

A

Males

39
Q

What is gout due to an increased presence of?

A

Monosodium urate monohydrate

40
Q

Where are the MSUM deposited in gout

A

Peripheral connective tissue in + around synovial joints

41
Q

Which joint is most classically affected in gout

A

1st MTPJ

42
Q

RF gout (5)

A 
Age 
Male
Menopausal status 
Metabolic status 
High protein diet/alcohol
43
Q

secondary causes of gout

A 
CKD
Drugs 
HTN
HyperPTH
Hypothyroid 
Incr uric acid prod by metabolic/myeloproliferative conditions
44
Q

If a patient has gout and is <25, what cause is most likely

A

Inherited enzyme disorder

45
Q

PS acute urate gout

A

Acute, severe pain (worst ever)
Rapid onset
Extreme tenderness + marked swelling/erythema
Joint stiffness

46
Q

When is the pain maximal in acute urate gout

A

2-6hrs

47
Q

How long does it take for the acute urate gout attack to resolve?

A

5-14 days

48
Q

Precipitants - acute urate gout attack (3)

A

Alcohol
Food
Dehydration

49
Q

LT complications acute urate gout (3)

A

Renal glomerular disease
Tubular + interstitial disease
Urolithiasis

50
Q

What is the main DDx for acute urate gout?

A

Septic arthrits

51
Q

What do the large MSUM crystal deposits in chronic trophaceous gout form

A

Irregular firm nodes

= Tophi

52
Q

Classical sites chronic trophaceous gout

A

Extensor surfaces fingers, hands, elbows, achilles

53
Q

Ix gout (4)

A

Bloods - FBC, UEm Se uric acid
Aspiration of joint/arhtrocentesis –> MCS + polarised light microscopy
XR
ID cause - BP/Urine dip/BM/ESR

54
Q

Appearance of gout underpolarised light micrscopy

A

Negative birefringent needle shaped

55
Q

Mx - acute ep gout (4)

A

PO NSAID (naproxen/diclofenac)
PO colchicine if can’t have NSAID
Early joint asp + CCS
Early mobilisation + elevation

56
Q

What is pseudogout

A

Ca pyrophosphate crystals deposited in hyaline/fibrocartilage of joints –> chondrocalcinosis

57
Q

Causes pseudogout

A

Sporadic
Familial
Metabolic disease - hyperPTH, decr PO4, decr Mg, Wilsons

58
Q

Which 3 joints is pseduogout most comon in

A

Knee
Wrist
Pelvis

59
Q

Polarised light microscopy appearance - pseudogout

A

+ve biofringent + rhomboid shape

60
Q

XR appearnce pseudogout

A

Chondrocalcinosis

61
Q

If someone PS w/ pseudogout <55, what should you do

A

Screen for metabolic/familial predisposition

62
Q

What is Calcific perarthritis

A

CaPO4/apatite deposition

63
Q

If CaPO4 = deposited in periarticular tissue, what does it lead to

A

calcific tendonitis

64
Q

If CaPO4 = deposited in the hyaline cartilage, what does it lead to

A

OA

65
Q

If CaPO4 = deposited in SC tissue/mm, what does it lead to

A

OA

CP3 MDD (13 decks)

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