Locomotor conditions

Question 1

Symptoms of osteoarthritis?

Answer 1

Joint pain eased at rest and worse on movement, most painful at end of day. Joint instability and stiffness for up to 30 mins after rest. Localised disease - usually affects weight bearing joints (knee/hip).

Question 2

What nodes are seen in hands of those with osteoarthritis?

Answer 2

Heberden’s nodes at DIP

Bouchard’s nodes at PIP

Question 3

What do X-rays show in osteoarthritis?

Answer 3

L - Loss of joint space
O - Osteophytes
S - Subarticular sclerosis
S - Subchondral cysts

Question 4

Management of osteoarthritis?

Answer 4

Exercise to improve local muscle strength and general aerobic fitness. Weight loss. Regular paracetamol and topical NSAIDs. Intra-articular steroid injections temporarily relieve symptoms. Physios and OTs vital
Surgery (joint replacement) if large impact on life

Question 5

What are the 2 types of joint infection in septic arthritis?

Answer 5

Native joint infection: cartilage erosion causes joint space narrowing and facilitates seeding of infection into synovial cavity
Prosthetic joint infection (more common): joint surface and cement provide surface for bacterial attachment

Question 6

What pathogens tend to cause septic arthritis?

Answer 6

S.aureus (most common)
Streptococci (2nd most common)
H. influenza, Neisseria gonorrhoea, E.coli, M.tuberculosis

Question 7

Symptoms of septic arthritis?

Answer 7

Painful, hot, swollen joint. Knee in >50% cases. Usually monoarticular

Question 8

What investigation needs to be carried out urgently in septic arthritis?

Answer 8

Joint aspiration for synovial fluid MC+S

Question 9

Gout is an inflammatory arthritis due to deposition of what type of crystals within joints?

Answer 9

Monosodium urate (MSU) monohydrate crystals

Question 10

Risk factors for gout?

Answer 10

Hereditary, purine rich diet, alchohol excess, diuretics, leukaemia, cytotoxics, trauma, surgery, starvation, infection

Question 11

What is the typical presentation of gout?

Answer 11

Sudden severe pain, swelling and redness at first MTP joint.

Question 12

Management of gout?

Answer 12

Acute attacks: high dose NSAIDs or coxibs reduce pain and swelling.
Prevention: weight loss, avoid prolonged fats/excess alcohol/purine-rich meat and low dose aspirin. Allopurinol for prophylaxis if >1 attack in 12 months

Question 13

What is rheumatoid arthritis?

Answer 13

Chronic systemic inflammatory autoimmune disease characterized by a symmetrical deforming peripheral polyathritis

Question 14

What causes rheumatoid arthritis?

Answer 14

Genetics, F sex hormone involvement.

On going T cell activation causes local production of rheumatoid factor autoantibodies in the joint

Question 15

Symptoms of rheumatoid arthritis?

Answer 15

Typically, symmetrical, swollen, painful, stiff small joints of hands and feet. Worse in morning, better with exercise

Question 16

What is seen in blood tests of those with RA?

Answer 16

Rheumatoid factor, Anti Cyclic Peptide Antibodies (ACPA), raised platelets/CRP/ESR

Question 17

Management of RA?

Answer 17

No cure but deterioration preventable.
Symptomatic: NSAIDs and coxibs, night sedation and steroids
DMARDs: Methotrexate, sulfasalazine, hydroxychloroquinine
Biological agents: TNF-alpha inhibitors (infliximab), B-cell depletion (rituxinab), IL-1 and IL-6 inhibition (Tocilizumab), disruption of T cell function (Abtacept)

Question 18

What bone is commonly fractured in osteoporosis?

Answer 18

Proximal femur

Question 19

What symptoms are seen in vertebral crush fracture?

Answer 19

Sudden onset severe pain in spine radiating to front. Also leads to increasing kyphosis, height loss, abdominal protuberance

Question 20

What is the result in a DEXA scan of someone with ostroporosis?

Answer 20

Normal: T score of -1 and above
Osteopenia: Between -2.5 and -1
Osteoporosis: Below -2.5