Locomotor Flashcards
Osteoarthritis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - wear and tear of joints, loss of cartilage, sclerosis and eburnation of subchondral joint
Epidemiology - 8.5 million people uk
Pathogenesis - genetics, overuse, injury, obesity, age, female
Presentation - joint pain, functional difficulty, tenderness, crepitus
Investigations - joint examination, ESR, CRP, X-ray of affected joints
Differentials - bursitis, gout, pseudogout, RA, psoriatic arthritis, avascular necrosis, internal derangements
Risk Factors - genetics, injury, overuse, physical occupation
Treatment - 1st line: local analgesia: capsaicin topical
2nd line: paracetamol + local analgesia
3rd line: NSAIDs, paracetamol + local analgesia
4th line: opioids + above
Gout:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - high uric acid, hyperuricaemia + deposits of rate crystals causing acute inflammatory arthritis, commonly affects big toe, foot, ankle, knee and fingers
Epidemiology - 1.6 per 1000 in men, 0.3 per 1000 women
Pathogenesis - uric acid end product breakdown of purines + exist as sodium rate in extracellular fluid
Presentation - sever pain, swelling, joint effusion, tenderness, erythema, warmth
Investigations - joint examination, FBC, uric acid, X ray, athrocentesis with synovial fluid analysis
Differentials - pseudogout, septic arthritis, trauma, RA, reactive arthritis
Risk Factors - older age, male, menopause, high mean/seafood diet
Treatment - Acute
1st line: NSAID
2nd line: colchicine
3rd line: corticosteroid
Recurrent:
1st line: allopurinol
2nd line: febuxostat
3rd line: probenecid
Septic Arthritis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - infection of 1 or more joints, direct inoculation or haematogenous spread
Epidemiology - mainly in adults
Pathogenesis - staph aureus, neisseria gonorrhoea
Presentation - hot swollen, tender joint
Investigations - joint examination, blood culture, FBC, ESR, CRP, ultrasound/Xray, synovial fluid gram stain
Differentials - OA, RA, PA, gout, haemarthrosis, trauma
Risk Factors - underlying joint disease, joint prostheses, IV drug abuse, diabetes
Treatment - 1st line: vancomycin plus joint aspiration
2nd line: clindamycin or cephalosporin plus joint aspiration
Suspected gram negative:
1st line: 3rd generation cephalosporin
2nd line: IV ciprofloxacin plus joint aspiration
Prolapsed Disc:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - disorders affecting intervertebral discs
Epidemiology - common
Pathogenesis - lumbosacral or thoracic disk
Presentation - shooting pain, numbness, parasthesia
Investigations - neurological examination, MRI, CT
Differentials - degenerative disc disease, discitis
Risk Factors - increased age, job type i.e lorry drivers
Treatment - 1st line: analgesia
Rheumatoid Arthritis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - chronic inflammation of joints
Epidemiology - 1% of population
Pathogenesis - autoimmune - synovial shows increase angiogenesis cellular hyperplasia, influx of inflammatory cells, many cytokines
Presentation - swelling, pain, stiffness, fatigue, weight loss
Investigations - joint examination, RF, Anti CCP, ultrasound, X ray
Differentials - psoriatic arthritis, infectious arthritis, gout, SLE, OA
Risk Factors - genetic, age
Treatment - DMARDs + steroids for flare ups
- TNF inhibitor
Osteoporosis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - complex skeletal disease, low bone density and microartchitechtural defects
Epidemiology - menopausal women, 1 in 2 women, 1 in 5 men
Pathogenesis - imbalances in bone remodelling
Presentation - pain, kyphosis, impaired vision, gait impairment, vertebral tenderness
Investigations - general examination, serum alkaline phosphate, X ray, DEXA
Differentials - multiple myeloma, osteomalacia, CKD, primary hyperparathyroidism
Risk Factors - prior frailty fracture, female, increased age, low BMI, low CA + vitamin D
Treatment - 1st line: oral bisphosphonates: alendrotnic acid
2nd line: denosumab
alongside vitamin D and calcium supplements
