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Phase 2a Revision > MSK > Flashcards

MSK Flashcards

1
Q

Osteoarthritis

A

Described as Wear & Tear in the joints.

It occurs in the synovial joints & results from genetic factors, overuse & injury.

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2
Q

Osteoarthritis Pathology

A

Thought to result from an imbalance between the cartilage wearing down & the Chondrocytes repairing it → leading to Structural issues in the joint.

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3
Q

Osteoarthritis Risks

A
  • Obesity
  • Age
  • Occupation
  • Trauma
  • Female
  • Family Hx
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4
Q

Osteoarthritis affected joints

A
  • Hips
  • knees
  • Sacroiliac joints
  • Distal - interphalangeal joints in the hands
  • Carpometacarpal joint at the base of the thumb
  • Wrist
  • Cervical spine (cervical Spondylosis)
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5
Q

Osteoarthritis Diagnosis

A
  • Diagnose without Ix if patient over 45, has typical pain, no morning stiffness.
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6
Q

Osteoarthritis X-ray changes

A 
L = Loss of joint space
O = Osteophytes (bone spurs)
S = Subarticular sclerosis 
S = Subchondral cysts (fluid- filled holes in bone)
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7
Q

Ostoearthritis symptoms

A
  • Joint enlargement & bone swelling in fingers (Heberden & Bouchard)
  • Restricted range of motion - Stiffness on rest
  • Crepitus on movement
  • Effusions (fluid) around joint
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8
Q

Osteoarthritis Signs

A

In Hands:

→ Heberden’s nodes (in DIP joints)
→ Bouchard’s nodes (in PIP joints)
→ Weak grip
→ Squaring at base of the thumb (at carpometacarpal joint)

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9
Q

1Osteoarthritis Management

A
  1. Oral paracetamol & topical NSAIDs
  2. Analgesics
  3. Intra-articular Steroid injection - methylprednisolone
  4. Joint replacement
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10
Q

Rheumatoid arthritis.

A

Autoimmune condition that causes Chronic inflammation of the synovial lining (synovitis) of the joints, tendon sheaths & bursa.
RA is symmetrical & affects multiple joints (symmetrical polyarthritis).

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11
Q

Rheumatoid Arthritis Risks

A

Gene:
→ HLA DR4
→HLA DR1

  • Female
  • Develops in middle age
  • Family risk
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12
Q

Rheumatoid Arthritis Pathology

A

Anti - CCP antibodies - indicate that R.A. will form.

Rheumatoid Factor → autoantibody.
Targets the Fc portion of the lgG antibody → causes activation of the immune system against the Patients own lgG causing systemic inflammation,

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13
Q

Rheumatoid Arthritis Symptoms

A

Symmetrical Distal Polyarthropathy

  • Pain
  • Swelling
  • Morning Stiffness
    Deformities of the hand:
    → Ulnar deviation
    → Swan neck
    → Boutenniere deformities
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14
Q

Osteoarthritis VS Rheumatoid Arthritis Diff.

A

R.A = Pain is worse after rest but improves with activity.

Osteoarthritis = Pain worse after activity but improves with rest.

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15
Q

Extra- articular manifestations of Rheumatoid Arthritis

A 
→ Pulmonary fibrosis with nodules
→ Bronchiolitis obliterans 
→ Felty's syndrome (RA, neutropenia, & splenomegaly) 
→ Secondary Sjogren's Syndrome
→ Anaemia of chronic disease
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16
Q

Rheumatoid Arthritis Investigations

A

Bloods:

  • Check Rheumatoid Factor
  • anti-CCP Antibodies
  • Check inflammatory markers - CRP & ESR
  • X-Ray of hands & feet
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17
Q

Rheumatoid Arthritis X-Ray changes

A 
L = Loss of joint space
0 = Osteopenia
E = Erosion of bone
S = Swelling of soft tissue
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18
Q

Rheumatoid Arthritis Management

A 
- Methotrexate + Folate
(DMARDs)
- Hydroxychloroquine
- TNF blocker (Infliximab)
- B-cell inhibitors (Rituximab)
- NSAIDs for pain
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19
Q

Main TNF inhibitors for R. A.

A
  • Adalimumab
  • Infliximab
  • Etanercept
  • Rituximab
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20
Q

Side Effects:

→ Methotrexate

→ Leflunomide

→ Sulfasalazine

→ Hydroxychloroquine

→ Anti-TNF medications

→ Rituximab

A

→ Methotrexate = Bone marrow suppression & Leukopenia & highly teratogenic.

→ Leflunomide = Hypertension & Peripheral neuropathy

→ Sulfasalazine = Male infertility (low sperm count)

→ Hydroxychloroquine = Nightmares & reduced visual acuity

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21
Q

Osteoporosis

A

Reduction in the density & mass of the bones & micro- architectural deterioration.

→ more fragility prone to fractures.

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22
Q

Risk factors for Osteoporosis

A
  • Old age
  • Female - especially post- menopausal
  • Reduced mobility
  • low BMI
  • Rheum. Arthritis
  • Alcohol & Smoking
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23
Q

Osteoporosis Investigations

A
  • FRAX Tool - gives risk of a fragility fracture over next 10 yrs.
  • Bone mineral density measured using a DEXA scan (Dual- Energy X-Ray absorptiometry) → check T score at the hip.
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24
Q

Osteoporosis Management

A
  • 1st Line = Bisphosphonates (e.g. Alendronate, Zoledronic, Risedronate)
    → Reduce osteoclast activity preventing reabsorption of bone.
  • Denosumab (monoclonal antibody) used if Bisphosphonates is contraindicated.
  • Hormone Replacement Therapy
  • Calcium supplementation with Vitamin D
    (Calcichew - D3 + ColecalciferoI)
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25
Q

Giant Cell Arteritis (Temporal)

A

Systemic vasculitis of the medium & large arteries.

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26
Q

Giant Cell Arteritis Symptoms

A

Main is severe unilateral headache around temple & forehead

  • Scalp tenderness
  • Jaw claudication
  • Blurred or Double vision
  • Irreversible painless complete sight loss

→ Fever
→ Muscle aches & weight loss
→ Fatigue
→ Peripheral oedema

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27
Q

Giant Cell Arteritis Diagnosis

A
  • Temporal artery biopsy (find multinucleated giant cells)
  • Bloods (Raised ESR & CRP levels)
  • LFT (raised alkaline phosphatase)
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28
Q

Giant Cell Arteritis Management

A

→ Steroids 40-60mg Prednisolone
→ Aspirin
→ PPIs (Omeprazole)

DON'T = Don't stop taking steroids abruptly → Risk of adrenal crisis
S = Sick day rules
T = Treatment Card
O = Osteoporosis - Bisphosphonates with Calcium & VitD
p = PPI for gastric protection
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29
Q

Giant Cell Arteritis Complications

A

→ vision loss
→ Cerebrovascular accident (stroke)

→ Relapse of condition
→ Aortitis leads to aortic aneurysm & aortic dissection

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30
Q

Osteoporosis Causes

A
  • Endocrine (Cushing’s & Parathyroid)
  • Haematology (Myeloma)
  • GI (Malabsorption)

→ Iatrogenic (Steroid use)

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31
Q

Systemic Lupus Erythematosus (SLE)

A

Inflammatory multisystem autoimmune disorder with arthralgia (joint pain) & rashes.

Type III hypersensitivity.

  • Female
  • 20-40 yrs
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32
Q

SLE Presentation

A
  • Joint pain
  • Skin - Malar butterfly rash, discoid rash, Photosensitive rash
  • Serositis - Scleritis, Pericarditis, Pleuritis, Oral ulcers
  • kidneys - Glomerulonephritis with proteinuria
  • GNS - Depressions, Psychosis
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33
Q

SLE Diagnosis

A
  • Bloods - ESR/ CRP

- ANA, Anti-dsDNA, Serum C3 & C4

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34
Q

SLE Treatment

A
  • NSAIDs
  • Hydroxychloroquine
  • Steroids
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35
Q

Antiphospholipid

A

Antibody - mediated acquired thrombophilia characterised by thrombosis &/ recurrent miscarriages.

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36
Q

Antiphospholipid Signs & Symptoms

A
  • Coagulation defects
  • Livedo reticularis
  • Obstetric issues
  • Thrombocytopenia
37
Q

Antiphospholipid Diagnosis

A

Clinical criteria : Vascular thrombosis, Pregnancy morbidity

Lab Criteria : Anticardiolipin antibody, Lupus anticoagulant, Anti-Beta 2 Glycoprotein 1 antibody

38
Q

Antiphospholipid Treatment

A
  • Blood clots (anticoagulate with heparin)
  • Chronix (Warfarin)
  • Pregnancy (Heparin with aspirin)

Prevent CVS issues → Quit smoking, More exercise

39
Q

Sjogren’s Syndrome

A

Chronic inflammatory autoimmune disorder.

  • Immunologically mediated destruction of epithelial exocrine glands especially the lacrimal & salivary glands.
40
Q

Sjogren’s Signs & Symptoms

A
  • Dry eyes, mouth, Parotid gland enlargement
  • Joint pain
  • Raynauds
  • Systemic features

Associated with RA, SLE, PBC & Scleroderma

41
Q

Sjogren’s Diagnosis

A

Schirmer Tear Test

  • Rose Bengal staining & sit lamp exam

Rheumatoid Factors, Anti Nuclear Antibody, Anti - Ro, Anti-La

42
Q

Sjogren’s Treatment

A

NSAID
Hydroxychloroquine
M3 agonist - Pilocarpine

Lifestyle: Humidifier, Eye-drops, Mouth wash

43
Q

Poly / Dermato myositis

A

Polymyositis = Rare muscle disorder where there’s inflammation & necrosis of skeletal muscle fibres.

Dermatomyositis = Poly + skin involvement

44
Q

Poly | Dermato myositis

A

Polymyositis:
Symmetrical progressive muscle weakness & wasting affecting the proximal muscles of the shoulder & pelvic girdle.

Dermatomyositis:
Heliotrope (purple) discolouration of eyelids.
Scaly erythematous plaques over the knuckles.
- Arthralgia, Dysphagia

45
Q

Poly/ Dermato myositis Diagnosis

A
  • Muscle biopsy
  • Bloods: Raised Serum creatine kinase, Aminotransferases, Lactate dehydrogenase & Aldolase
  • Immunology - ANA, Anti jo1, Anti mi2
46
Q

Poly | Dermato myositis Management

A
  • IV prednisolone
  • Stronger Immunosuppressants
  • Symptomatic treatment of skin disease
47
Q

Septic Arthritis Causes

A
  • IV Drug Use
  • Immunocompromised
  • Intra-articular injections
48
Q

Septic Arthritis Risks

A 
Common Bugs:
→ Staphylococcus Aureus
→ Neisseria Gonorrhoea
→ Gram -ve Bacteria (E. Coli)
→ Haemophilus Influenza
49
Q

Septic Arthritis Treatment

A

→ Flucloxacillin

→ Penicillin or Clindamycin

→ If MRSA give Vancomycin Or Telcoplanin

→ If Gram -ve, Cefotaxime Or Ceftriaxone

50
Q

Uric Acid Formation & Pathology

A

Cell breakdown → Hypoxanthine → Xanthine → Uric Acid
+ Diet (Xanthine Oxidase)

Build-up of uric acid → Uric acid crystals → Deposits in joint spaces causing inflammation

51
Q

Hyperuricaemia Types

A

Pseudogout = + ve Birefringent Ca Pyrophosphate.

Gout = - ve Birefringent Monosodium Urate

52
Q

Stages of Gout progression

A

High Uric acid levels

Acute Gout

Intercritical Gout

Chronic Gout

53
Q

Hyperuricaemia

A

> 420umol / L (Male)

> 360umol / L (Female)

Asymptomatic

54
Q

Hyperuricaemia Causes

A

Diuretics - Thiazides

High insulin levels

High fructose intake

Dysfunction of URAT-1 transporter

55
Q

Hyperuricaemia Symptoms

A
  • Red, Hot joint
  • Painful
  • Swollen
  • Acute onset
    → Mainly affects Big toe, Midfoot, Ankle, Knee, Wrist
56
Q

Hyperuricaemia Investigations

A

1St Line = Bloods

Gold = Joint aspiration

U+E + eGFR - Renal family history

Uric acid levels

57
Q

Hyperuricaemia Management

A

ACUTE:
1st Line = NSAIDs or Colchicine
2nd line = Intra - articular Steroid injection

CHRONIC:
1st Line = Allopurinol - inhibit Xanthine Oxidase
2nd Line = Febuxostat

58
Q

Osteomyelitis

A 
Infection of bone marrow. 
Ways of entry:
→ Haematogenously
→ Open wound
→ Contiguously = Skin into blood
59
Q

Osteomyelitis formation

A

Acute inflammation → Subperiosteal abscess → Sequestrum → Involcrum → Cloacae

60
Q

Osteomyelitis Diagnosis

A

Labs: High CRP, ESR, WBC

Imaging: X- Ray, CT, MRI, Bone scan

Bone biopsy

Bone culture

61
Q

Osteomyelitis Management

A

Antibiotic - Penicillin or Clindamycin

Amoxicillin

Cefotaxime

62
Q

Ankylosing Spondylitis

A

Inflammation of sacroiliac joints.

Loss of spinal movements

63
Q

Ankylosing Spondylitis Investigations

A
  • Bloods = HLA B27

- X Ray = Bamboo spine

64
Q

Ankylosing Spondylitis X- Ray changes

A
  • Bamboo spine due to fusion
  • Sacroiliac joints - eroded & Sclerotic
  • Unclear margin between rims
  • Bone spurs aka syndesmophytes
65
Q

Reactive Arthritis

A

Mainly due to infection

66
Q

Reactive Arthritis Symptoms

A
  • Can’t see - Uveitis
  • Can’t pee - Urethritis
  • Entheritis

→ Keratoma Blennorhagica
→ Circinate Balanitis

67
Q

Reactive Arthritis Investigations

A

Bloods: Inflammatory markers
High ESR, CRP, ANA, Rheumatoid factor

Imaging

68
Q

Psoriatic Arthritis Signs & Symptoms

A 
Painful
Swollen
Stiff joints
Psoriatic plaques
Dactylitis
69
Q

Ankylosing Spondylitis Treatment

A
  • Supportive
  • Pain management : NSAIDs or Corticosteroids
  • Biological therapy - Infliximab
70
Q

Lower Back pain Management

A 
Analgesia ladder
Paracetamol
NSAIDs 
Weak opiates
Neuropathic Pain Tx - Gabapentin / Tricyclic
71
Q

Fibromyalgia

A

Chronic widespread Pain

72
Q

Fibromyalgia Investigations

A

Exclude all other differentials with bloods & imaging

73
Q

Fibromyalgia Treatment

A

Neuropathic pain relief

→ Tricyclic Acid (TCA)
→ Gabapentin
→ Pregabalin

Opiates

74
Q

Scleroderma

A

Disease characterised by fibrosis across multiple organ systems.

  • Most common in women aged 30-50
  • Due to increased production of collagen in tissues.
75
Q

Scleroderma Investigations

A 
Usually in fingers:
→ skin becomes tight
→ fingers become stiff & inflexible
→ Symptoms of Raynauds
→ Joint & Muscle pain
76
Q

Scleroderma Management

A

→ Immunosuppressants (e.g. Cyclophosphamide)
→ Physiotherapy / Occupational Therapy

Symptomatic Treatment:

  • Analgesia
  • Calcium Channel blocker
  • Topic skin emollients
  • PPI & antacids (Oesophageal reflux)
  • Treating Pulmonary Artery Hypertension ( Bosentan, Sildenafil, Iloprost )
77
Q

Bone Tumours Types

A

→ Osteosarcoma = Primary bone malignancy, metaphysis of long bones

→ Ewing Sarcoma = From mesenchymal cells originating from long bones

→ Osteochondroma = (Benign) Overproduction of bone which deposits on metaphysis

78
Q

Secondary Bone Tumours Metastasis

A 
P = Prostate 
B = Breast 
k = Kidneys 
T = Thyroid
L = Lungs
79
Q

Bone Tumour Investigations

A

Bloods: FBC, U&E, ALP, PSA

Imaging

X-Ray - Lytic lesions

CT Scan - metastases

80
Q

Bone Tumours Management

A
  • Pain Management
  • Bisphosphonates
  • Radiotherapy
  • Chemotherapy
81
Q

Paget’s Disease

A

Disorder of excessive bone turnover due to excessive activity of both Osteoblasts & clasts

Leads to patchy areas of sclerosis & lysis.

Mainly affects axial skeleton

82
Q

Paget’s Disease Sx

A
  • Bone pain
  • Bone deformity
  • Fractures
  • Bone enlargement
83
Q

Paget’s Disease Ix

A
  • Osteoporosis circumscripta (less dense)
  • Cotton wool appearance of Skull
  • V-shaped defects in Long bones
  • Raised alkaline phosphatase
84
Q

Paget’s Disease Tx

A

Bisphosphonates

NSAIDs
Calcium & Vit. D

85
Q

Septic Arthritis

Sx

Common Bac.

A

Infection occurs in joint.

Sx: Hot, red, swollen painful joint
Stiffness
Fever

Staphylococcus Aureus
Neisseria Gonorrhoea
Strep. pyogenes
E. coli

86
Q

Septic Arthritis Tx

A

Joint aspiration

Flucloxacillin + Rifampicin

Vancomycin + Rifampicin (penicillin allergy)

Clindamysin

87
Q

Gout
Risks
Joint’s

A

High blood uric acid levels.

Risk: High purine diet, Diuretics, Obesity

Joints: Metatarsophalangeal joint, Wrists, Carpometacarpal joints, knee, Ankle

88
Q

Gout Ix

Tx

A

Aspiration of fluid:
No bac. growth
Needle shaped urate crystals
-ve Birefringent of Polarised light

Joint X-ray: Lytic lesions, Punched out erosions

Tx
NSAIDS 
Colchicine
Steroids
Allopurinol - Xanthine Oxidase inhibitor
89
Q

Pseudogout

Sx

Ix

Tx

A

Caused by calcium pyrophosphate crystals.

Sx: hot, swollen, Stiff, Painful knee

Ix: Aspirated fluid = Rhomboid crystals, +ve Birefringent of Polarised light

Tx: NSAIDS, Colchicine, joint aspiration, steroids

Phase 2a Revision (9 decks)

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