Intro To Musculoskeletal Diseases

Question 1

What are bursa?

Answer 1

Synovial membrane lined pockets that allow free movement to adjacent structures where friction would be

Question 2

Enthesitis?

Answer 2

Inflammation. Where tendons ligaments join onto bone e.g Achilles

Question 3

Oliogoarthritis?

Answer 3

2-4 joints

Question 4

Poly arthritis?

Answer 4

More than 5 joints

Question 5

Example of non inflammatory problems?

Answer 5

Osteoarthritis

Question 6

Immune mediators and conditions?

Answer 6

IL 1 - gout and autoinflammatory

IL 17- seronegative spondyloarthritis

TNF a- rheumatoid arthritis

Auntoantibodies- connective tissue disease and vascularised

Question 7

Rheumatoid arthritis doesn’t affect spine but?

Answer 7

Atlanta-axial joint

Question 8

Clinical measurements for rheumatoid arthritis?

Answer 8

Positve autoantibodies-rheumatoid factor

And or anti-cyclic citrullinated peptide antibodies in around 70%

Question 9

Seronegative spondyloarthropathy is…

Answer 9

Don’t have autoantibodies

Can Affect spine

Associated with HLA B27 gene

Question 10

Seronegative spondyloarthropathy includes?

Answer 10

PEAR

Ankylosis spondylitis
Psoriatic arthritis
Reactive arthritis- STI bacterial diarrhoea illness
Enteropathic arthritis- IBD

Question 11

Most common connective tissue disease?

Answer 11

Lupus

Connective tissue diseases associated with anti nuclear antibodies

Question 12

MSK disorders are the …… most common cause of disability?

Answer 12

Second

Question 13

How much pop see GP about MSK problems?

Answer 13

20%

Question 14

How much does NHS spend each year of treating MSK problems?

Answer 14

10 billion

Question 15

Osteoarthritis affects how many males and females over 60?

Answer 15

10% males

18% females

Question 16

Rheumatoid arthritis affects how much of UK pop?

Answer 16

1%

Question 17

Rheumatoid arthritis is how much more common in women than men?

Answer 17

2-4 times

Question 18

How many people with rheumatoid arthritis stop work within 2 years of its onset?

Answer 18

1/3

Question 19

Prevalence/ mean age of seronegative spondyloarthropathy?

Answer 19

1 in 200, 0.5%

Mean age of onset- 24

Question 20

Gout affects how much of UK population?

Answer 20

2.5%

Question 21

For septic arthritis what should you do?

Answer 21

Joint aspiration

Check: clarity, colour viscosity

Question 22

What will you send joint aspirate for?

Answer 22

Gram stain
Bacterial culture
Crystals
White cell differential

Question 23

Mortality rate for septic arthritis?

Answer 23

11%

Question 24

Polyarticular disease with sepsis has a mortality rate of?

Answer 24

5O%

Question 25

Commonest organism for septic arthritis is ?

Answer 25

Staph and strep

Question 26

Sepsis 6?

Answer 26

Take: Cultures Lactate Urine output Give: High flow oxygen Fluids IV antibiotics

Question 27

What causes gout?

Answer 27

Mono sodium urate crystals | Needle shaped, in cooler area

Question 28

What is pseudo gout?

Answer 28

Calcium pyrophosphate crystals

Question 29

Many people have high urate but only what percent actually have clinical gout?

Answer 29

10%

Question 30

What do MSU crystals do?

Answer 30

Activate inflammasome causing IL-1B production and initiation of an intense inflammatory response

Question 31

What causes hyperuricaemia ?

Answer 31

``` Age Fam history Mostly men Renal disease, reduced excretion Obesity Diuretics, thiazides Alcohol excess Sweetened soft drinks High dietary purine intake High cell turnover, psoriasis and high grade lymphoma ```

Question 32

Protective for hyperuricaemia?

Answer 32

Weight loss Dairy intake Coffee Cherries

Question 33

Treatment of gout?

Answer 33

Colchine NSAIDs Steroids

Question 34

Acute flares last?

Answer 34

2-7 days

Question 35

What is first line for gout?

Answer 35

Allopurinol Less than 300micromol/L 12% patients have properly titrated dose

Question 36

Chondrocalcinosis?

Answer 36

Deposition of calcium pyrophosphate, pseudo gout

Question 37

What happens in osteoarthritis?

Answer 37

Thinneing of articular cartilage Mild thickened inflamed synovium Ostephytes Thickened stretched capsule

Question 38

What happens in osteoarthritis?

Answer 38

Inflammatory factors activate chondrocytes and subchondral osteoblasts

Question 39

Risk of osteoarthritis?

Answer 39

``` Obesity Joint injury Genetic Gender, more women Previous joint disease Biomechanical stress Metabolic processes Age ```

Question 40

Osteoarthritis nodes?

Answer 40

PIPS- Bouchards nodes | DIPS- heberdens nodes

Question 41

Clinical features of PIPS and DIPS nodes?

Answer 41

``` Over 50 Crepitus Bony enlargement and tenderness Morning stiffness less than 30 mins Persistent joint pain aggravated on use ```

Question 42

RA occurs usually at what age?

Answer 42

Peaks at 30-50

Question 43

Septic arthritis classic signs?

Answer 43

Hot red knee painful cant move it and generally poorly

Question 44

Treatment for osteoarthritis?

Answer 44

``` Education Strengthening exercises Weight loss Paracetamol Topical NSAIDs ```