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3rd Year > Locomotor conditions > Flashcards

Locomotor conditions Flashcards

1
Q

What ratio of men:women does osteoarthritis effect?

A

3 women:1 man

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2
Q

How is OA characterised?

A

By localised loss of cartilage, remodelling of adjacent bone and associated inflammation

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3
Q

What are the most commonly affected peripheral joints in OA?

A

Knees
Hips
Small joints of hands

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4
Q

Constitutionl risk factors for OA?

A

Age
Female sex
Obesity
High/low bone density

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5
Q

Local, largely biomechanical risk factors include?

A 
Joint injury
Occupational and recreational stresses on joints
Reduced muscle strength
Joint laxity
Joint malalignment
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6
Q

Symptoms of OA?

A

Joint pain exacerbated by exercise and relieved by rest
Joint stiffness in the morning or after rest
Reduced function and participation restriction

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7
Q

Signs of OA?

A 
Reduced range of joint movement
Pain on movement of the joint
Joint swellings/synovitis
Periarticular tenderness
Crepitus
Absence of systemic features
Osteophytes
Joint instability
Muscle weakness/wasting around the affected joint
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8
Q

What is the classical presentation of osteophytes in OA?

A

DIP joint swelling - Heberdens nodes

PIP joint swelling - Bouchards nodes

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9
Q

Investigations into OA?

A 
Clinical examination
Plain X rays (LOSS)
MRI
Blood tests (should be normal in OA)
Joint aspiration
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10
Q

What do plain radiographs show i OA?

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondrial cysts

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11
Q

What are the core treatments for OA?

A

Education, advice and info
Exercise
Weight loss
Surgery (joint replacement for severe OA)

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12
Q

Drug treatments for OA?

A

Paracetamol/topical NSAIDS
If inneffective use short-term oral NSAIDs or codeine
Topical capsaicin (found in chillies)
Intra-articular steroid injection (for severe symptoms)

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13
Q

What is the biggest side effect of NSAIDs?

A

gastrointestinal bleeding

renal impairement

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14
Q

Patients taking what medication should avoid NSAIDs?

A

Aspirin

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15
Q

What are the four types of gout?

A

Asymptomatic
Hyperuricaemia
Acute gout
Intercritical gout and tophaceous gout

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16
Q

What is the most common joint for gout to present at?

A

Metatarsophalangeal joint of the big toe

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17
Q

What causes gout?

A

Deposition of monosodium urate crystals precipitated by trauma, surgery, starvation, infection or diuretics

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18
Q

What are the risk factors for gout?

A 
Male sex
Meat
Seafood
Alcohol
Diuretics
Obesity
Hypertension
Coronary heart disease
Diabetes mellitus
Chronic renal failure
high triglycerides
19
Q

What diagnosis must be excluded in any acute monoarthropy?

A

Septic arthritis

20
Q

How does gout present?

A

Acute pain in a joint which becomes tender, swollen and erythematous which reaches its crescendo over a 6-12 hour period

21
Q

How is gout investigated?

A

Polarized light microscopy of synovial fluid shows negatively bi-refringent urate crystals
Serum urate is usually raised but may be normal

22
Q

What is the pharmaceutical treatment of gout?

A

Use high-dose NSAID or coxib

23
Q

If NSAIDS are contraindicated what drug should be used?

A

Colchicine

24
Q

How quickly should gout symptoms subside with suitable treatment?

A

3-5 days

25
Q

What medication can be used for gout prophylaxis?

A

If >1 attack in 12 months start allopurinol

26
Q

When should allopurinol be started?

A

Never during an acute attack. Wait for 1-2 weeks after the attack resolves

27
Q

How quickly can septic arthritis destroy a joint?

A

> 24 hours

28
Q

Risk factors for septic arthritis?

A 
Increasing age
Diabetes mellitus
RA
Joint surgery
Hip or knee prosthesis
Skin infection in combination with joint prosthesis
Infection with HIV
29
Q

In what joint is septic arthritis most common?

A

The knee (>50%)

30
Q

How does septic arthritis classically present?

A

Single swollen joint with pain on active or passive movement

Fevers and rigors (may be absent)

31
Q

Conditions associated with immunosuppressive disease?

A 
Pre-existing joint disease
Immunosuppressive disease
Recent steroid injection
STDs
Intravenous drug use
32
Q

What are the red flags for septic arthritis in children?

A

Fever
Refusal to use a joint
ESR and CRP elevated

33
Q

Investigations for joint aspiration?

A

Urgent joint aspiration for synovial fluid microscopy and culture is the key investigation.
CRP and radiographs may be normal

34
Q

Treatment for septic arthritis?

A

Empirical IV antibiotics (after aspiration) until sensitivities are known
Adequate analgesia
Consider physiotherapy

35
Q

What red flag symptoms suggest cauda equina syndrome?

A

Saddle anaesthesia or paraesthesia
Recent onset of bladder dysfunction
Recent onset of faecal incontinence
Severe or progressive neurological deficit in the lower extremities

36
Q

What red flag symptoms suggest a high risk of permanent damage to the compressed nerve?

A

Significant muscle weakness or wasting
Loss of tendon reflexes
Positive babinski reflex

37
Q

What age group are most at risk of a prolapsed invertebral disc?

A

under 40 years

degeneration of discs tends to present in those aged over 40 years

38
Q

What is meant by the term sciatica?

A

Pain, tingling and numbness that arise due to nerve root entrapment in the lumbrosacral spine

39
Q

How does a lumrosacral disc herniation present?

A

Unilateral leg pain (radiating to below the knee)
The leg pain being more sever than the back pain
Numbness, paraesthesia, weakness and/or loss of tendon reflexes
Positive straight leg test
Pain relieved by lying down and exacerbated by long walks

40
Q

How does thoracic disc herniation present?

A

Shooting pain down legs

Pain, paraesthesia or dysaesthesia in a dermatomal distribution

41
Q

Investigations for prolapsed disc?

A

No investigations needed if symptoms settle within six weeks
MRI is very sensitive
Plain x rays are sometimes useful

42
Q

What is the management for prolapsed disc?

A

Analgesia
Encouragement to keep active
Avoidance of activities that may aggravate pain
Physiotherapy
Surgery (if symptoms do not settle within 6 weeks)

43
Q

What analgesia is used for prolapsed disc?

A

paracetemol/NSAIDS (first line)
codeine/tramadol
Consider benzodiazepine if there is muscle spasm
Consider tricyclic antidepressant/ gabapentin if persistent sciatica

3rd Year (18 decks)

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