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Year 3 > Locomotor Core Conditions > Flashcards

Locomotor Core Conditions Flashcards

1
Q

What is the most common form of arthritis?

A

Osteoarthritis

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2
Q

Who gets OA?

A

Women >55

Younger people who suffered injuries

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3
Q

Causes of OA?

A

Wear and Tear
Active/inflammatory processes in response to injury
Ligament/tendon problems
Bone/cartilage damage

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4
Q

What is the difference between primary and secondary OA?

A

Primary - no known cause

Secondary - known cause (joint damage, systemic disease)

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5
Q

Risk factors for OA?

A 
Increasing age
Female 
FHx
Previous joint injury/infection 
Intra-articular # or ligament tear 
Joint malalignment 
Slipped upper femoral epiphysis
Congenital dislocation of the hip 
Obesity 
Occupational stress 
Ethnic origin
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6
Q

Symptoms of OA?

A 
Seen in synovial joints 
Cartilage loss and periarticular bone response
Stiffness in the morning 
Pain 
Loss of ROM 
Grating/crepitus 
Joint effusion 
NO systemic illness 
Bony swelling and deformity
Heberden's and Bouchard's
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7
Q

Differentials for OA?

A 
Bursitis 
Referred pain from hip/spine
Psoriatic/Rh/infective arthritis
Pseudogout 
Connective tissue disease 
Seronegative arthritis 
Sarcoidosis/endocarditis which can present with arthropathy
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8
Q

Investigations for OA?

A 
Examination of joint 
Plain XR (osteophytes, narrow joint space, subarticular sclerosis, bone cysts )
BMI/weight 
MRI
FBC, CRP, creatinine, LFTs
Joint aspiration of synovial fluid
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9
Q

Treatment for OA?

A 
Education 
Weight loss 
Exercise 
NSAIDs (oral/gel)
COX-2 inhibitors (w/PPI)
IA corticosteroid injections 
Arthroscopic lavage (for joint locking)
Joint arthroplasty (if pain, stiffness,
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10
Q

How many adults int he UK are affected by gout?

A

1 in 70

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11
Q

Who gets gout?

A

M>F
Post menopausal women
People of Asian/Pacific island populations have more severe disease

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12
Q

Causes of gout?

A

Hyperuricaemia
Kidneys usually excrete uric acid but an excess ends up in blood and can deposit crystals in cool temperature joints (distal)

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13
Q

Risk factors for gout?

A 
Diet rich in red meat
Diuretics 
Niacin 
Male 
Alcohol use 
FHx
Obesity 
HTN
Hyperlipidaemia 
Chronic renal failure 
DM
CHD
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14
Q

Symptoms of acute sodium urate gout?

A 
Sudden, agonising onset 
Swelling and redness of 1st MTP
Precipitating factor (food, alcohol, dehydration, diuretic)
W/o treatment will last 7 days 
Overlying cellulitis 
Mainly affects the great toe
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15
Q

Symptoms of chronic polyarticular gout?

A

Unusual
Long standing diuretics w/renal failure
Men
Allopurinal started too soon after an acute attack

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16
Q

Symptoms of chronic tophaceous gout?

A 
Sodium urate forms tophi in skin at joints 9usually ear, finger, achilles tendon)
Chronic pain 
Restricted movement 
Crepitus 
Deformity 
Renal impairment/diuretics 
Punched out bone cysts on XR 
Urate renal stones formed
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17
Q

General symptoms of gout?

A 
Acute pain 
Swollen joints 
Tender
Erythematous 
Peaks in 25 hours 
Fever malaise 
Untreated should resolve in 5-15 days 
Itching and desquamation of overlying skin
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18
Q

Differentials for acute gout?

A

Pseudo gout
Septic arthritis
Haemoarthrosis
Palindromic RhA

19
Q

Differentials for chronic gout?

A

RhA
Generalised nodal OA
Xanthomatosis w/arthropathy
Multicentric reticulohistiocytosis

20
Q

Investigations for gout?

A

Joint fluid microscopy
Serum uric acid (>600micromol/L - check again several weeks later as levels fall quickly after attack)
U+E
Renal function

21
Q

Treatment for gout?

A

Ice, elevate
Weight loss, exercise, diet (inc reducing alcohol)
Increase fluid intake
NSAIDs (+PPI)
Colchicine (for pts with HF and anticoag)
Corticosteroids
Allopurinol

22
Q

Who gets pseudogout?

A

> 50
M>F
Those with metabolic/familia causes

23
Q

What causes pseudogout?

A

Calcium pyrophosphate deposition in synovial fluid of joints
Runs in families

24
Q

Risk factors for pseudogout?

A 
Male 
Increased age 
FHx 
Hypothyroidism 
Hyperparathyroidism 
Hypercalcaemia 
Mg def 
Haemophilia 
Ochronisis
Amyloidosis
Haemochromatosis
25
Q

Symptoms of pseudogout?

A

Bouts of joint pain
Swelling of affected joint with fluid build up
Chronic arthritis
Commonly affects knees (but also ankles, elbows, wrists)

26
Q

Investigations for pseudogout?

A

Joint fluid aspiration and analysis

XR - calcification of cartilage and joint cavities

27
Q

Differentials for pseudo gout?

A

RhA
Gout
OA

28
Q

Treatment for pseudo gout?

A 
Synovial fluid drain 
NSAIDs 
Colchicine 
Hydroxychloroquine 
Methotrexate 
Interleukin-1-B-antagonists
29
Q

What % of prosthetic joints get infected?

A

2-10%

30
Q

Who gets septic arthritis?

A

Any age
Elderly with multiple morbidities
Immunosuppressed

31
Q

Causes of SA?

A 
Staph aureus (and other staph)
Strep
Neisseria gonorrhoea 
H. flu in children 
Other gram -ve in the elderly
32
Q

Risk factors for SA?

A 
Artificial joint 
Bacterial infection elsewhere
Chronic illness 
IVDU 
Immunosuppression 
Recently injured/surgery 
Overlying infection of skin/soft tissues
33
Q

Symptoms of SA?

A

Single, red hot, swollen, painful, immobile joint
Medical emergency
Fever, rigors, systemic illness
Vomiting, hypotension
Effusion
May be an abscess or loosening of prosthetic joint

34
Q

Differentials for SA?

A 
Gout/pseudogout
Vasculitis 
Drug/reactive/viral arthritis 
Post infection diarrhoeal syndrome
Post meningococcal/gonococcal arthritis 
Arthritis of intrinsic bowel disease
Lyme disease 
Infective endocarditis
35
Q

Investigations for SA?

A

FBC, inflammatory markers
Aspirate and exam synovial fluid
Culture bloods and synovial
Swabs of anus, cervix, urethral, pharynx if gonorrhoea suspected
Lyme disease test
Immunology serology for RhA and vasculitis
US
CT/MRI for osteomyelitis/periarticular abscesses

36
Q

Treatment for SA?

A

Abx - Pencillin + gentamicin, or cephalosporins
IV Abx for 2-3 weeks
Then oral for 2-4 weeks
Joint drainage if not responding
Splint in position of function
Once infection is controlled immediately mobilise to prevent contractures

37
Q

How many cases of subacute backpain are prolapsed discs?

A

<1 in 20

38
Q

Who gets slipped discs?

A

30-50

M>F

39
Q

Causes of slipped disc?

A

Annulus fibrosus braks and the nucleus pulposus protrudes
Old age decreases water content of discs
Sneezing
Awkward bending
Heavy lifting

40
Q

Risk factors for slipped disc?

A 
Lots of sitting 
Smoking 
Overweight 
Weight bearing sports 
Traumatic injury to back 
Lots of lifting
41
Q

Symptoms of slipped disc?

A 
Pain in lower back 
Severe, acute
Better when lying flat 
Worsened by movement/coughing/sneezing 
Can be asymptomatic if no cord compression 
Sciatica (lasting, aching pain in leg)
Muscle pain/spasm from affected nerve supply 
Urinary incontinence
42
Q

Symptoms of cauda equina and nerve roots involved?

A 
Loss of function of L2-S5 Lower back pain 
Saddle anaesthesia
Paralysis of one or both legs 
Rectal pain 
Bowel disturbances 
Urinary incontinence 
Inner thigh pain
43
Q

Investigations for slipped disc?

A 
Physical exam (peripheral nerves)
Straight leg raise (no more than 2/3rds before tingling, pain, numbness)
XR
MRI for surgery 
Discography (contrast and XR)
44
Q

Treatment for slipped disc?

A 
Exercise and maintain AODL 
Paracetamol/NSAIDs
Codeine 
Diazepam for muscle spasms 
Physio 
Osteopath 
Surgical removal of prolapse

Year 3 (9 decks)

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