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Year 3 core conditions > locomotor > Flashcards

locomotor Flashcards

1
Q

who gets osteoarthritis

A

older (>50)

W>M

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2
Q

causes of osteoarthritis

A

unknown but thought variety of minor incidental traumas and abnormal biomechanics can trigger repair processes

repairs result in structurally altered but symptom free joints. sometimes repair cannot completely sort dmaage and get symptomatic osteoarthritis

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3
Q

joints most affected by osteoarthritis

A

knee
hip
hands

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4
Q

risk factors for osteoarthritis

A

genetics
constitutional factors - ageing, female, obesiy, high bone desnity, low bone density (progression)

local, risk factors - joint injury, occupatinal and recreational stresses, reduced muscle strength, joint laxity, joint malalignment, metabolic stresses (diabetes or too much iron)

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5
Q

presentation of osteoarthritis

A

> 45
with no obvious signs of inflammation (no morning stiffness, large effsion or hot joint)

pain - during and after movement

stiffness awakening or after inactivity

tenderness

loss of flexibility

grating sensation - crepitus

bone spurs

swelling

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6
Q

signs on examination of osteoarthritis

A

gelling - pain and stiffnes caused by inactivity. once activity resumes, pain and stiffness resolves ore quickly than inflammatory arthritis

bony swellings and joint deformities, crepitus, restricted range of movement, joint tenderness, muscle wasting and weatness, warmth and instability

only a few joints problematic at one time

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7
Q

investigations for osteoarthritis

A

working diagnosis

radiology - loss of joint space, osteophytes, subchondral bone thickening and/or cysts

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8
Q

treatment of osteoarthritis

A

depend on eprsons ICE, pain level, mood and comorbidieis

physio to strengthen surrounding muscle

painkillers

topical capsaicin

intra-articular corticosteroids

surgery for knee and hip

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9
Q

who gets gout?

A

very common
more i men
older people
black and maoris ethnicity

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10
Q

causes of gout

A

common and complex form of arthritis

accumulation of urate crystals in joint, causing inflammation and intense pain of a gout attack

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11
Q

risk factors gout

A

diet - red meat, shellish, alcohol, fruit sugar
overweight
medical conditons - HTN, diabetes, obesity, metabolic syndrome, heart and kidney

medications - aspirin, diuretics, ACEi, beta blockers, antirejection drugs

family hsitory

men, then women post menopause, older

recent surgeyr or truama

= all increase levels of uric acid

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12
Q

presentation of gout

A

intense joint pain - normally big toe, most severe 4-12hrs

lingering discomfort

inflammation and redness

limited range of motion

tophi - firm white translucent nodules (10yr after first attack)

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13
Q

signs on examination of gout

A

arthritis - swelling, redness, warmth and pain on passive movement. big toe most common, bootlace area, heel, nkle, knee, finger, wrist, elbow. lower limb more than upper limb

tophi - firm white transluecnt nodules, assymmetric to joint involvement. heberdens nodes in post menopausal women taking diuretics

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14
Q

investigations for gout

A

joint fluid test - needle draw up fluid from joint for microscopy

blood test - limited in sure intially as serum uric acid can be normal during acute attack and if taking certain drugs - aspirin, corticosteroids

xray maging - rule out other causes of inflammation

USS - detect urate crystals in join and trophi

DECT- visualise urate crystals in joints

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15
Q

treatment of gout

A

reduce inflammation and pain - NSAIDs, colchicine, corticosteroids

prevent gout complications by lowering uric acid in blood - block production= allopurinol, febuxostat
- improve removal = probenecid (kidney excretion increased)

diet changes - less alcohol, less purine high foods

exercise and lose weight

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16
Q

causes of septic arthritis

A

infection with pyogenic organism, most commonly staph A

more common in immunosuppressed and elderly

infected by direct injury or by blood borne infection from infected skin lesion or other site

17
Q

risk factors for septic arthritis

A

prosthetic joints
pre-existing joint disease
recent intra-articular steroid injection
diabetes mellitus

18
Q

presentation of septic arthritis

A

hot, painful, swollen, red joints acutely

fever and evidenc eof infection elsewhere

high index in suspeciion in ledelry, immunosuppresed and RA

more than one joint in 20%

prosthetic joints within 3 months

19
Q

investigations of septic arthritis

A

joint aspiration (USS guidance if needed) and synovial fluid analysis

  • appearance and white cell count: septic = opaque, 75,000 WCC/mm, nostly neurtrophils
  • gram stain and culture
  • polarized light microscopy for crystals (gout and pseudogout)

blood - FBC, erthryocyte, sedimentation rate, CRP, blood cultures

Xrays to affected joint

swab of urethra, cervix and anorectum if gonococcal infection possible

20
Q

treatment of septic arthritis

A

pending sensitivies - flucloxacillin IV, oral fusidic acid, and gentamicin (if immunosuppressed, for gram neg)

modify treatment depending on culture and sensitivity and continue with 2 antibiotics for 6 weeks

adequate joint drainage

refer to orthopaedic surgeon

immobilise in acute phase, mobilise early to avoid contractures

NSAIDs for pain refleif

21
Q

who gets prolapsed discs

A

20-40yo (in older, disc degenerations prevent collapse)

22
Q

cuases of prolapsed disc

A

usually strenuous activity

23
Q

presentation of prolapsed disc

A

+/- sciatica
sudden onset severe back pain following strenuous activity
pain related to position and aggravated by movement
muscle spasms lead to sideways tilt when standing
radiation and pain and clinical findings depend on disc effected

24
Q

most common prolapsed discs?

A

lowest 3

L4/L5 and L5/S1 account for 90%

25
Q

investigations of prolapsed disc

A

limited value in acute disc disease and xrays are often normal

MRI reserved to patients whom surgery is considered

26
Q

treatment of prolapsed disc

A

releif of symptoms
little effect on duration of disease
acute stage - bed rest on firm mattress, analgesia, occasional epidural corticosteroid injection if severe

surgeyr if severe or increasing neurological impairment (bladder, foot drop)

physio

27
Q

who gets rheumatoid arthritis

A

increases with age - 40s-50s most common

F:M 3:1

28
Q

pathophysiology of rheumatoid arthritis

A

synovitis with thickening of the synovial lining and infiltration by inflammatory cells

synovium proliferates and grows out over surface of cartilage = pannus, destroys articular cartilage and subchondral bone causing bony erosions

29
Q

risk factors for RA

A

FHx

genetics

30
Q

presentation of RA

A

insidious onset of pain
early morning stiffness
swelling of small joints of hands and feet
spindling of fingers caused by swelling of PIPJs but not DIPJs
weakening of joint capsule casuing joint instability

characteristic deformities: ulnar deviation, boutonniere deformity and swan neck deformity

31
Q

investigations of RA

A

good history and multiple tests:
- blood count, shows anaemia (normocytic normochromic), ESR and CRP raised

  • serum antibodies anti-CCP distinguish RA from acute transient synovitis
  • Xray of affected joints
  • synovial fluid sterile with high neutrophil count in uncomplicated diseasee
32
Q

xray signs on RA

A

soft tissue swelling
joint narrowing
erosions at joint margins
porosis of periarticular bone and cysts

33
Q

treatment of RA

A

goals are remission of symptoms, no cure

NSAIDs for pain
corticosteroids to suppress disease activity
DMARDS such as methotrexate
biological DMARDs work by TNF alpha

34
Q

who gets oesteoporosis

A

increased with age

women, especially post menopause

35
Q

causes of osetoporosis

A

imbalance in normal process of bone remodelling by osteoclasts and osteoblasts

decreased bone mineral density and changes in bone composition, archiectural size, geometry

36
Q

risk factors of osteoporosis

A

things that affect bone strength - endocrine disease, malabsorption, CKD, chronic liver disease, COPD, menopause, immobility, BMI <18.5

age, oral corticosteroids, smoking, alcohol, prev fagility fractures, rehumatological conditions, parental Hx of hip fracture

37
Q

presentation of osteoporosis

A

asymptomatic and remains undiagnosed until fragility fracture occurs

38
Q

investigations of osteoporosis

A

DEXA bone scan

>2.5SDs below the mean density of bone classifies as osteoporotic

39
Q

treatment of osteoporosis

A

bisphosphonate (alendronate)

calcium if they need it along with vitamin D

Year 3 core conditions (15 decks)

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