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CP3 MDD > Joint disease > Flashcards

Joint disease Flashcards

1
Q

List the RFs for OA (7)

What is a protective factor for OA?

A 
Age
Gender (esp post-meno)
FH
Obesity
H/o trauma
Occupation (miners, farmers etc)
Hypermobility

Osteoporosis is protective

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2
Q

List some causes of 2º OA (3; 11)

A

Pre-existing joint damage:
Septic / Inflamm / Crystal
Trauma / AVN

Metabolic:
Acromegaly
Haemochromatosis
Chondrocalcinosis

Systemic:
Neuropathies
Haemphilia
Haemoglobinopathies

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3
Q

What are the common features in the Hx for OA

A

Progressive pain
Activity related
Stiffness after rest (lasts <30mins)
Good/bad days

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4
Q

What may be seen O/E in OA

A

LOOK: Gait / Deformity / Swelling / Wasting
FEEL: Joint line tenderness / Crepitus / ± Effusion
MOVE: Reduced RoM
TEST: N/a

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5
Q

List some specific features O/E seen in Hip OA (4)

+ for Knee OA (5)

A 
HIP:
Trendelenberg +ve
Fixed flexion (Thomas' test)
Held in adduction/ext. rotation
Leg shortening
KNEE:
Obese
Bilateral
Varus deformity
Moderate effusion 
Quadriceps wasting
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6
Q

How does Nodal Generalised OA typically present?

A

Post-menopausal women
With FH
One-by-one fingers (DIPs –> PIPs –> 1st CMC/MCP)
Pain / swelling / impaired func

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7
Q

What material is involved in pseudo gout?
Where does typically effect?

What Ix (2) / what is seen

A 
Calcium pyrophosphate (deposits = CPPD)
Knees/wrists

XR: Costocalcinosis
Polarised light microscopy: +ve biofringe rhomboids

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8
Q

What Ix are done into OA? (4)

A

Bloods:
FBC/ESR
RA/ANA

XR
CT/MRI if XR –ve but Hx suggestive

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9
Q

What are the surgical options for OA (5)

A

Arthroscopy/washout (young, h/o locking - delays replacement)
Realignment osteotomy (young pts w. intact surfaces)
Arthrodesis (ankle/spine/hand)
Total arthroplasty
One compartment arthroplasty

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10
Q

What are the CIs for joint replacement (3)

A

Relative:
Young
Co-morbid disease

Absolute:
Untreated joint sepsis

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11
Q

List the complications of Total Joint Replacement (4+3)

A

Length length discrepancy (15%)
Dislocation (3%)
Persistent pain (1-5% depends on joint)
Joint infection (0.5-1%)

Artificial joint polythene wear
Periprosthetic fracture (peri-op)
Neurovascular injury
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12
Q

List RFs for Gout (5) inc. assoc conditions (6)

A 
Age
Male (10:1)
High protein diet
High alcohol
FH / Inherited defect (if <25 + renal urates)
Metabolic syndrome
ASSOC CONDITIONS
Impaired excretion:
Hypothyroid
HyperPTH
CKD
HTN
NSAIDs/Thiazides

Increased prodn:
Myelo/lymphoproliferatives
Metabolic conditions

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13
Q

What is the main DDx for acute gout?

What are the differentiating features (4)

A 
Septic arthritis:
Systemic Sx
More Subacute (days)
Severity increases
Reduced RoM
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14
Q

What Ix are done into Tophaceous Gout

A

Bloods: FBC / UEs / Urate (normal ≠ exclude)
Aspiration: –ve biofringe crystals / turbid fluid
XR: bony erosions (chronic)

More Ix when attack settled:
Urine dip / Glucose / BP / Lipids
FBC-ESR (myeloprolifs)

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15
Q

List the indications for Allopurinol (5)

A 
Recurrent gout attacks
Tophaceous gout
Joint/bone damage
High urate levels
Renal disease
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16
Q

What lifestyle measures for management of gout?

A

Reduce alcohol / chol / cals

Avoid food grps (fish/spinach)

17
Q

What alternative drugs can be used in gout?

A

Acute: Colcichine (CKD/CCF where NSAIDs CI)

Chronic: uricosurics (probenecid/sulfinpyrazone)
These are CI in:
High urate producers
CKD
H/o stones
18
Q

What are some metabolic RFs for pseudogout (5)

A

HyperPTH
Wilson’s
Hypomag
Hypophos

19
Q

How is Pseudogout managed?

A

Acute: same as gout
Chronic: joint injections

20
Q

Which tissues can Apatite deposition occur in? (3)

A 
Periarticular (e.g. calcific tendonitis)
Hyaline cartilage (assoc w. OA)
Subcut/mm (in CTDs)
21
Q

What are the main causative organisms in joint infections (4)

A

S.aureus**
Gonococcal (young adults)

Haemophilus (children)
Strep Pneumonia (children)
22
Q

List some RFs for joint infections (5)

A 
Age extremes
Recent operative / injective procedure
Pre-existing joint disease (esp RA)
IVDU
Immunosupp / DM
23
Q

List common sites for acute / chronic osteomyelitis

A

Acute:
Growth plates (children)
Spine (immunosupp)

Chronic:
Post-open fracture site
Post-Op

24
Q

What are the 6 S’s of Septic Arthritis

A 
Subacute
Single joint
Swollen
Still (held in loose pack)
Screaming in pain
Systemic sx
25
Q

List the DDx for Septic Arthritis (CROOM)

A 
Crystal Arthritis*
Reactive Arthritis
Osteomyelitis*
Overlying cellulitis
Monoarticular RA/CTD/Sero–ve
26
Q

How is the joint aspiration processed in ?Septic Arthritis

When is it done in theatre?

A

Aspirate: turbid / blood-stained
Gram stain: 50% +ve
Culture: 90% +ve (30% gono)
Crystal scan

Done in theatre if:
Inaccessible joint (hip/spine/SIJ)
Prosthetic joint
27
Q

What other bloods should be done in ?Septic Arthritis

A 
FBC
CRP-ESR
Blood cultures
Uric acid
Clotting
28
Q

What XR changes are seen in Septic Arthritis (later) (4)

A

Soft tissue swelling
Joint space widening (effusion)
Later joint space narrowed (cartilage destroyed)
Later poss ankylosis

29
Q

What XR changes are seen in Osteomyelitis (later) (2)

A

None in first 10d, after 2wks:
↓ Bone density
New bone formation

(NB radioisotope early – increased activity)

30
Q 
What are some features of viral arthropathy in contrast to bacterial (3)
What bloods (3)
A

Non-destructive
Symmetrical
± Rash

Viral titres / antigens / RF

31
Q

What bloods should be done in osteomalacia?

A

Vit D / Ca / Phos / PTH
U+Es
LFTs (ALP)

CP3 MDD (7 decks)

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