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Y3 Core Conditions > Locomotor > Flashcards

Locomotor Flashcards

1
Q

Osteoarthritis

A

Degenerative condition in which cartilage of the joint wears away. AKA Degenerative Arthritis

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2
Q

How common is osteoarthritis

A

Females 3x more than males

>50yo

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3
Q

Causes of Primary Osteoarthritis

A

Aging. With aging, the water content of the cartilage increases and the protein makeup of cartilage degenerates.

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4
Q

Causes of Secondary Osteoarthritis

A

Rheumatoid arthritis, gout, septic arthritis, Paget’s disease of bone, Avascular necrosis, metabolic disease e.g. acromegaly, systemic disease

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5
Q

Process of Osteoarthritis

A

Cartilage wears and degenerates.
Cartilage ulceration exposes underlying bone to stress, producing microfractures and cysts.
Bone attemts repair but produces sclerotic bone and overgrowths at joint margins calles osteophytes
Macrophages releases VEGF leading to vascularisation of the joint

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6
Q

Risk factors for Osteoarthritis

A

Genetics, increased age, female, obesity, joint injury, occupational, reduced muscle strength, joint laxity, joint misalignment, osteoporosis

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7
Q

Symptoms of Osteoarthritis

A

Joint pain, RELIEVED BY REST, WORST ON EXERCISE,joint stiffness in the morning lasting no longer than 30mins, joint instability, localised disease

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8
Q

Signs of Osteoarthritis

A 
Joint tenderness
Polyarticular (affects more than 5 joints)
Crepitus
Limitation decreases range of movement
Heberdens nodes at DIP
Bouchard's notes at PIP
Synovitis
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9
Q

Differentials for Osteoarthritis

A 
Rheumatoid arthritis (morning stiffness lasting < 30 mins, symmetrical joint pain)
Gout
Ankylosing spondylitis
Septic Arthritis
Bursitis
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10
Q

Investigations for Osteoarthritis

A

Rheumatoid Factor and anti-nuclear antibody negative
CRP normal
ESR normal

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11
Q

X-ray finding in Osteoarthritis

A 
LOSS
Loss of Joint Space
Osteophytes
Subchondral Cysts
Sclerosis
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12
Q

Drugs for Osteoarthritis Pain

A

Acetaminophen
NSAIDS e.g ibuprofen, diclofenac
Duloxetine (antidepressant)

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13
Q

Treatment for Osteoarthritis

A 
Exercise to increase muscle mass and strength around knee
Weight loss
Cortisone injections
Lubrication injections
Realigning bones
Arthroplasty (joint replacement)
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14
Q

Prognosis for Osteoarthritis

A

Most people with OA do not become severely disabled but knee OA holds the worst prognosis and hand the best

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15
Q

Rheumatoid Arthritis

A

Autoimmune disease causing symmetrical polyarthritis and synovial inflammation. Type 3 hypersensitivity reaction

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16
Q

How common is RA

A

Females 2x more than Males

Onset 50-60yo

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17
Q

Causes of RA

A

Genetics: familial pattern with high concordance in monozygotic twins
Gender
Immunology: synovial Inflammation due to T cell Activation

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18
Q

Pathology of RA

A 
Synovium shows:
Increased angiogenesis
Cellular hyperplasia
Influx of inflammatory cells
Cytokines
High level of metalloproteinase
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19
Q

Symptoms of RA

A

Symmetrical​, Deforming​, Peripheral​, Polyarthritis, Joint pain, WORST AT REST, BETTER WITH EXERCISE, morning stiffness, affect mainly hands and feet then progresses to larger joints, fatigue and weakness

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20
Q

Signs of RA on the Hand

A

Ulnar deviation of the finger and dorsal wrist subluxation
Boutonniere or swan neck deformity of fingers
Z deformity of the thumb
Raynauds
Carpal Tunnel syndrome

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21
Q

Investigations for RA

A

ESR, CRP and platelets raised
RF and anti-CCP antibodies positive
Nomochromic normocytic anaemia
X-ray: bony erosion, subluxation, carpal instability, joint involvement

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22
Q

Differentials for RA

A 
Osteoarthritis
SLE
Gout
Psoriatic arthritis
Infectious arthritis
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23
Q

Treatment for RA

A 
DMARDs (Disease Modifying Antirheumatic Drugs): Methotrexate (mmunosuppresant), Hydroxychloroquine (anti-malarial), Sulfasalazine (aminosalicylate)
NSAIDS
Glucocorticoids
Exercise, physiotherapy
Arthroplasty surgery
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24
Q

Complications of RA

A

Septic Arthritis
Amyloidosis
Carpal Tunnel Syndrome

25
Gout
Hyperuricaemia and deposition of urate crystals causing inflammatory arthritis Tophi around the joint destruction Renal glomerular, tubular and intersitial disease Uric acid urolithiasis Most commonly affects metatarsaophalangeal joint big toe, foot, ankle, knee, fingers, wrist and elbow
26
How common is Gout
Increases with age | More common in men
27
Causes of Gout
Hyperuricaemia caused by underexcretion of urate in 90% of cases and over-production of urate in 10% of cases Urate is a metabolite of purines and ionised form of uric acid
28
Risk factors for Gout
``` Age Male Consumption of seafood, meat and alcohol especially beer Haematological cancer and chemotherapy Diuretic use Ciclosporin or tacrolimus use Obesity Insulin resistance Hypertension ```
29
Symptoms and signs of Gout
``` Rapid-onset severe pain Joint stiffness Most common affected joints are feet Swelling and joint effusion Tenderness Tophi Erythema and warmth ```
30
Tophi
Nodular deposits of uric acid in soft tissues of the body
31
Differentials for Gout
``` Pseudogout (calcium pyrophosphate deposition disease) Septic arthritis Trauma Rheumatic Arthritis Reactive Arthritis Psoriatic Arthritis ```
32
Treatment for Acute Gout
1. NSAID 2. Colchicine 3. Corticosteroid
33
Treatment for Recurrent Gout
2-3 weeks post-acute episode 1. Xanthine oxidase inhibitor- Allopurinol 2. Probenecid or sulfinpyrazone 3. IV Pegloticase 4. Suppressive therapy
34
Complications for Recurrent Gout
Nephrolithiasis | Acute Uric acid Nephropathy
35
Septic Arthritis
Infection of 1 or more joints caused by pathogenic inoculation of microbes. Occurs either by direct inoculation or via haematogenous spread
36
Causes of Septic Arthritis
Staphylococcus or Streptococcus
37
Risk factors for Septic Arthritis
``` Underlying joint disease RA or OA Joint prostheses IV drug abuse Alcohol use disorder Diabetes Previous intra-articular corticosteroid injection Cutaneous ulcers ```
38
Symptoms and signs of Septic Arthritis
Hot, swollen, tender, restricted movement of joint and fever
39
Investigations for Septic Arthritis
``` Synovial fluid gram stain and culture Synovial fluid WCC Blood culture Elevated WCC CPR and ESR elevated ```
40
Differentials for Septic Arthritis
Osteoarthritis, Rheumatic Arthritis, Gout, Haemarthrosis, Trauma, Bursitis, Cellulitis
41
Treatment for Septic Arthritis
Joint aspiration | IV Abx: flucloxacillin, clindamycin if penicillin alllergic
42
Complication of Septic Arthritis
Abx associated allergic reaction Osteomyelitis Joint destruction
43
Prolapsed Disc
Disc degeneration. A soft cushion of tissue between the bones in the spine pushes out and can press on nerves. Commonly affects lumbar spine
44
Pathophysiology of a Prolapsed Disc
Each disc has a Nucleus Pulposus surrounded by Annulus Fibrosus to provide resistance and disc stability. The normal human circadian rhythm allows for fluid shifts in and out of the disc. Degenerative changes follow a loss of hydration of the nucleus pulposus.
45
Risk factors for a Prolapsed Disc
Increasing age, occupation i.e. carrying excessive load, smoking, obesity
46
Symptoms and signs of a Prolapsed Disc
Lower back pain numbness or tingling in your shoulders, back, arms, hands, legs or feet neck pain problems bending or straightening your back muscle weakness pain in the buttocks, hips or legs if the disc is pressing on the sciatic nerve (sciatica) Unilateral pain
47
Investigations for Prolapsed Disc
MRI | CT
48
Differentials for Prolapsed Disc
Sprain, Strain, Spinal Tumour, Spinal Infection, Postural back pain
49
Treatment for Prolapsed Disc
Rest if severe pain but stay active Paracetamol and NSAIDs Spinal Cord Compression
50
Osteoporosis
Skeletal disease characterised by low bone density and micro-architectural defects in bone tissue. Results in increased bone fragility and susceptibility to fracture. Common fractures are in the hip, vertebrae and wrist.
51
How common is Osteoporosis
Affect 1 in 2 women and 1 in 5 men > 50 yo Predominance in whte, post-menopausal women
52
Pathophysiology of Osteoporosis
Increases osteoclast activity (more bone resorption) Decreased osteoblast activity (less bone remodelling). Net increase in bone resorption Bone remodelling by hormone including PTH, vitamin D, calcitonin and oestrogen
53
Risk factors for Osteoporosis
Steroid use (prednisolone)​ Hyperthyroid, hyperparathyroidism, hypercalciuria ​ Alcohol and tobacco use​ Thin (BMI<22)​ Testosterone ↓​ Early menopause​ Renal failure/live failure​ Erosive/inflammatory bone disease (RA/myeloma)​ Dietary calcium ↓ and low Vit D (malabsorption) or Diabetes
54
Symptoms and signs of Osteoporosis
Back pain Kyphosis Pain and swelling at fracture sites
55
Investigations for Osteoporosis
DEXA scan to measure bone density Xray Serum Calcium, creatinine, phosphate, 25-hydroxy vitamin D, PTH, TFT
56
DEXA Scan Result
T score > -1 : Normal T score < -1 but >-2.5: Osteopenia T Score of
57
Differentials for Osteoporosis
``` RA, gout Multiple myeloma Osteomalacia CKD Primary Hyperparathyroidism Metastatic bone malignancy ```
58
Treatment for Osteoporosis
1) Bisphosphonates: Alendronic acid (PO daily), Zolendronate (IV as a single dose yearly) 2) Calcium and Vitamin D supplementation 3) Raloxifene (anti-resorptive drugs) 4) Terparatide (PTH analogue)
59
Complications of Osteoporosis
Hip, rib and wrist fractures | Jaw necrosis associated with bisphosphonate treatment

Y3 Core Conditions (13 decks)

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