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Module 204: Musculoskeletal system > MSJ > Flashcards

MSJ Flashcards

1
Q

Myalgia

A

Muscle pain

Can be due to

  • Viral infection
  • Drugs (e.g statins)
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2
Q

Tennis elbow

Golfer’s elbow

A

Tennis elbow
- Lateral epicondylitis

Golfer’s elbow
- Median epicondylitis

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3
Q

Worldwide impact of MSK disorders

A

MSK
- 2nd cause of disability worldwide

Lower back pain
- Leading cause of disability

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4
Q

Financial cost of MSK problem

A

10 billion cost on NHS

- 20% of GP complaints is MSK problem

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5
Q

Septic arthritis

A

Presentation

  • Monoarthritis
  • Hot, swollen joint

Diagnosis

  • Joint aspiration
  • Gram staining for infection–> mainly Strep. infection

Mortality rate- 11% mortality rate, 50% if polyarticular

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6
Q

Gout

  • Cause
  • Risk factors
A

Most common inflammatory arthropathy worldwide

Cause:

  • High serum urate levels (>408)–> precipitation of monosodium rate crystals (negatively birefringent rods)
  • 10% with hyperuricaemia develop it

Risk factors

  • Men, >40
  • Women >65
  • Genetics
  • CKD
  • Metabolic syndrome
  • Oestoarthritis
  • Dietary factors (alcohol, red meat, cauliflower, spinach, shellfish, muscles)
  • Loop and thiazide diuretics use
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7
Q

Pseudogout

A

Precipitation of calcium pyrophosphate crystal in joints. (positively birefringent rods)

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8
Q

Management of gout

A

Acute attacks

  • NSAIDs (naproxen)
  • Colchicine
  • Steroids [intrarthticular, systemic)

Long term treatment
- Urate-lowering therapy: allopurinol, febuxostat

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9
Q

Rheumatoid arthritis epidemiology

A

0.5-1% word

More common in women (3:1)
- Peak 45-65

30% genetic susceptibility w/ environmental factors

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10
Q

RA pathophysiology

A

Changes first occur in synovial

Smoking is the most important triggering environmental factor.
- Triggers generation of ACPA (Ab) which triggers RA

Mechanism

  1. Lymphocyte invade synovium–> acute inflammation
  2. Vascular permeability increases= synovial proliferation, panes formation
  3. Cartilage destruction and bone erosion
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11
Q

RA signs and symptoms

A

Symmetrical pain

Swelling of small joints of the hands and feet
- MCP, PIP, wrist, MTP, not DIPs

Early morning stiffness (>1 hour)

Systemically unwell

Malaise, fatigue

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12
Q

Extra-articular manifestation of RA

A

Nodules

Bursitis/ tenosynovitis

Eye problems: secondary Sjogren’s syndrome, scleritis

Splenomegaly

Atlanto-axial subluxation

Carpal tunnel syndrome

Renal amyloidosis

Increases risk of CVD

Anaemia

Lung fibrosis

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13
Q

RA investigations

A

FBC- anaemia of chronic disease
- Normocytic normochromic

Rheumatoid factor positive
- IgM ab against Fc component of IgG (1 in 20 is raised in normal population)

Anti CCP Ab
- 98% specific

ESR and CRP

X-ray of hands and feet

  • initially periarticular osteoporosis and reduced joint space
  • Cysts
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14
Q

RA management

A

NSAIDs for short peroids

Corticosteroids

  • 1/2 joints infected= intra-articular injection
  • Systemic if more joints affected (tablet/ intramuscular)

DMARDs (disease modifying Anti-Rheumatic drugs)

  • Methotrexate
  • Sulfasalazine
  • Hyrdoxychloroquine
  • Leflunomide

If not responding to DMARDs= biologic agents

  • Anti-TNF agents
  • Anti-B cell
  • Anti-IL-6R blocker
  • Anti-T cells
  • JAK-2 inhibitor (tablet)

Physiotherapy, occupation therapy, podiatry

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15
Q

Osteoarthritis

- Epidemiology

A

70% of people >65

common joints affected

  • 1st carpometacarpal joint
  • PIP, DIP
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16
Q

Osteoarthritis pathophysiology

A

Metabolically active, starting in the cartilage
- Articular cartilage focally destroyed

Remodelling of adjacent bone causes formation of osteophytes

Further remodelling and repair

Secondary synovial inflammation and crystal deposits.

17
Q

Osteoarthritis clinical features

A

Clinical diagnosis, blood test and imaging not very helpful

Morning stiffness, <30 minds

Persistent joint pain aggravated on use

Crepitus

Bony enlargement and tenderness

No clinical correlation in X-rays with symptoms

18
Q

SLE epidemiology

A

97:100k

More common in females (10-20 times more than males)

More common in afro-carribeans

19
Q

SLE pathophysiology

A

Genetic susceptibility and UV light exposure= abnormal immune response
- Immune complexes attack many tissues in the Body.

20
Q

SLE presentation

A

Malar rash

Inflammation of lung and heart

  • Pericarditis
  • Serositis
  • Endocarditis

Arthritis

Glomerulonephritis

Anaemia, thrombocytopenia

21
Q

SLE investigations

A

Urinanlaysis
- protein: creatinine ratio

FBC

ESR high

Not high CRP (unless serositis)

Antibodies

  • Anti-nuclear
  • Lupus anticoagulant

C3, C4 (low)

Module 204: Musculoskeletal system (22 decks)

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