MSK Flashcards
Give 3 inflammatory causes of joint pain.
Autoimmune
Crystal arthritis
Infection
Give 2 non-inflammatory causes of joint pain.
Degenerative - osteoarthritis
Non-degenerative - fibromyalgia
Name 5 features in the hands of a patient with rheumatoid arthritis.
Ulnar deviation Swan neck deformity Z-thumb Distal interphalangeal joint sparing Swollen joints
What 5 conditions are associated with HLA-B27?
Ankylosing spondylitis Reactive arthritis Enteropathic arthritis Juvenile idiopathic arthritis Acute anterior uveitis
What is the first line treatment of osteoporosis?
Alendronic acid (bisphosphonate), with AdCal
What other treatments are there for osteoporosis?
Denosumab
Teriparatide
How does denosumab work?
Monoclonal antibody that inhibits osteoclasts
How does teriparatide work?
Analogue of PTH - increases calcium absorption and vitamin D formation
Which antibody is specific to SLE?
Anti-dsDNA (anti double stranded DNA)
What condition must be ruled out in an acutely swollen joint?
Septic arthritis
What is the first line investigation for septic arthritis?
Aspirate joint for synovial fluid, culture fluid
What is the name for distal interphalangeal joint swelling seen in osteoarthritis?
Heberden’s nodes
What is the name of the classification of fractures in children involving the growth plate?
Salter-harris classification
What is a T score?
Bone density relative to a healthy 25 year old of the same gender
What is a Z score?
Bone density relative to the average for their age of the same gender
What is a FRAX score?
Risk of developing a fracture in the next 10 years
What is allopurinol primarily prescribed for?
Long term treatment of gout
What else can allopurinol be used for?
To prevent uric acid/calcium oxalate build up
Treatment of hyperuricaemia in tumour lysis syndrome
What is the mechanism of allopurinol?
Xanthine oxidase inhibitor - prevents the conversion of xanthine into uric acid
What is the first line treatment of temporal arteritis?
Prednisolone
What symptoms are associated with Wegener’s granulomatosis (granulomatosis with polyangitis)?
Hearing loss, sinusitis, nose bleeds
What is the treatment of Wegener’s granulomatosis?
Steroids/immunosuppressants
What antibodies are specific to Sjogren’s?
Anti-ro, anti-la
What other antibodies will be positive in Sjogren’s syndrome?
ANA, rheumatoid factor
What is the first line treatment of Sjogren’s?
Prednisolone, artificial saliva/tears
What is the triad of symptoms seen in Sjogren’s?
Dry eyes, dry mouth, inflammatory arthritis
What conditions is Sjogren’s often secondary to?
Rheumatoid arthritis, Systemic lupus erythematous
What antibody is specific to SLE?
Anti-dsDNA
Give 8 complications of SLE.
Lupus nephritis Recurrent miscarriage Anaemia Pericarditis Pleuritis Interstitial lung disease Venous thrombosis Cardiovascular disease
What features are seen on X-ray in a patient with ankylosing spondylitis?
Squaring of vertebral bodies Subchondral sclerosis Sacroiliitis Ossification of ligaments Syndesmophytes
Give 3 examples of anti-TNF drugs.
Etanercept, infliximab, adalimumab
What is the first line management of osteoarthritis?
Topical analgesia - capsaicin, diclofenac
What is the second line management of osteoarthritis?
Oral NSAIDs (given with a PPI)
What is the management of osteoarthritis not improved by pharacmological treatment?
Joint replacement surgery
What is Paget’s disease of bone?
Increased resorption, formation and remodelling of bone
How would the skull of someone with Paget’s disease appear on X-ray?
Cotton wool appearance - areas of high and low density bone
What LFT is abnormal in Paget’s disease?
ALP
What is the first line treatment of Paget’s disease?
Bisphosphonates
What is the most specific rheumatoid arthritis antibody?
Anti-CCP (anti cyclic citrullinated peptide antibody)
What is the first line treatment of rheuamtoid arthritis?
One DMARD
What is the second line treatment of rheumatoid arthritis?
Two DMARDs
What is the third line treatment of rheumatoid arthritis?
Add a biologic treatment to DMARDs
Name 3 DMARDs.
Methotrexate, sulfasalazine, hydroxychloroquine
What is Felty’s syndrome?
A complication of rheumatoid arthritis
What is the triad of symptoms in Felty’s syndrome?
Splenomegaly, neutropenia, rheuamtoid arthritis
What is dermatomyositis?
Chronic inflammation of the skin and muscles
What conditions is creatinine kinase raised above 1000 in?
Rhabdomyolysis AKI MI Statin use Strenuous exercise Dermatomyositis Polymyositis
What is classic of rhabdomyolysis?
Cola coloured urine and muscle pain
What antibody is seen in both dermatomyositis and polymyositis?
Anti-Jo-1
What antibodies are more specific to dermatomyositis than polymyositis?
Anti-Mi-2
ANA
What is the gold standard investigation for temporal arteritis?
Temporal artery biopsy
What is the most likely causative organism of septic arthritis post-surgery?
Staphylococcus aureus
What empirical antibodies are best for a post surgical septic arthritis?
Flucloxacillin (+ rifampicin for first two weeks)
Use vancomycin if penicillin allergic
Which cancers commonly metastasise to bone?
Breast Prostate Thyroid Liver Kidney
How should alendronic acid be taken?
Patients should remain upright for 30 minutes after taking
Should be taken first thing in the morning with a glass of water
What is Schirmer’s test?
Filter paper is placed into the eye to measure tear production
What condition is Schirmer’s test used to investigate?
Sjogren’s
What feature may be seen on X-ray of a patient with psoriatic arthritis?
Pencil in cup
What is the first line pain management in ankylosing spondylitis?
NSAIDs
Which joint does pseudogout often present in?
The knee
Which joint does gout most commonly present in?
Big toe
What causes osteomalacia?
Vitamin D or calcium deficiency
What is the classic triad of symptoms seen in reactive arthritis?
Conjunctivitis, urethritis, arthritis
What is seen in a swan neck deformity?
DIP hyperflexion, PIP hyperextension
What is seen in Boutonniere’s deformity?
PIP hyperflexion, DIP hyperextension
What criteria needs to be met to put a patient on allopurinol?
Has had more than one gout flare up or has gouty tophi
What is given with allopurinol when a patient is first put on it and why?
Colchicine - allopurinol can initially increase the risk of gout flare ups
What disease are associated with enteropathic arthritis?
IBD
What antibodies are seen in Wegener’s granulomatosis?
c-ANCA
What antibodies are seen in systemic sclerosis?
Anti-centromere antibodies
What antibodies are seen in polymyositis?
Anti-Jo-12
What condition is HLA-DR2 associated with?
SLE
What blood result is raised in Paget’s disease?
ALP only
Why is only ALP the only thing raised in Paget’s disease?
Increased bone turnover increases ALP and nothing else
What medication can predispose a patient to gout?
Thiazide diuretics
What should a gout patient be placed on instead of thiazide diuretics?
ARB or CCB
Why can thiazide diuretics contribute to gout?
They increase the absorption of urate in the proximal tubules of the kidney
What level lesion would lead to loss of the knee jerk reflex?
L4
What nerve root lesion causes sciatica?
S1
What type of bacteria is pseudomonas aeruginosa?
Gram negative bacilli
What is the most common cause of septic arthritis?
Staphylococcus
Is rheumatoid arthritis usually symmetrical or asymmetrical?
Symmetrical
What is the gold standard investigation for osteoporosis?
DEXA scan
What is a characteristic of pseudogout on X-ray?
Calcifications opposite to the articular surface (due to calcium pyrophosphate deposition
What is the last line management of osteoarthritis?
Intrarticular steroid injections - methylprednisolone
Other than STIs, what is the most common cause of reactive arthritis?
Campylobacter jejuni
What is the most specific antibody for Sjogren’s?
Anti-La
What levels of ESR and CRP are seen in SLE?
High ESR
Normal CRP
What is the action of methotrexate?
Folic acid inhibitor
Why is methotrexate teratogenic?
Folic acid (which is inhibited), is crucial to the neurodevelopment of a foetus
What nerve lesion can cause wrist drop?
Radial nerve
What criteria need to be met to be classified as severely osteoporotic?
T score < 2.5, and a known pathological fracture
What condition is highly associated with temporal arteritis?
Polymyalgia rheumatica
What complement factors are reduced in lupus?
Complement 3 and 4
What cancer do patients with Sjogren’s have an increased risk of?
Non-Hodgkin’s lymphoma
What are the extra-articular manifestations of ankylosing spondylitis?
5As
- Anterior uveitis
- Autoimmune bowel disease
- Apical lung fibrosis
- Amyloidosis
- Aortic regurgitation
What bedside test can be used to test mobility of the spine?
Schober’s test
What does Schober’s test involve?
Locate L5 vertebrae while patient is standing
Measure 10cm above and 5cm below
Have patient bend over
If distance between points is < 20cm, indicates ankylosing spondylitis
What features are seen on X-ray in ankylosing spondylitis?
Squaring of vertebral bodies Bamboo spine Syndesmophytes Sacroiliac fusion Subchondral sclerosis
What is the first line treatment of ankylosing spondylitis?
NSAIDs
Steroids during flares
Anti-TNF - etanercept, infliximab
What is a key differential of osteoarthritis?
Rheuamtoid arthritis
What are the first line treatments of osteoarthritis?
Topical NSAIDs, topical capsaicin
Oral NSAIDs/paracetamol, bisphosphonates
What medication is used in intra-articular steroid injections?
Methylprednisolone
What is the most sensitive antibody test for rheumatoid arthritis?
Rheumatoid factor
How is the progression of rheumatoid arthritis monitored?
CRP and ESR levels
What is a life threatening complication of rheumatoid arthritis?
Felty’s syndrome
Give 5 extra-articular manifestations of rheumatoid arthritis.
Sjogrens Vasculitis Pericarditis MI Pleuritis
Give 3 side effects of bisphosphonates.
Oesophagitis
Oesophageal ulcers
Osteonecrosis of the jaw
Give 5 risk factors for osteoporosis.
Early menopause Steroids Hyperparathyroidism Low weight Inflammatory bone disease
What is the acute management of temporal arteritis?
IV methylprednisolone
What is the long term management of temporal arteritis?
Oral prednisolone
What is the most common bone tumour in children and young adults?
Osteosarcoma
What FRAX score warrants a DEXA scan?
> 10%
What STI is closely linked to reactive arthritis?
Chlamydia pneumoniae
What antibodies are seen in Sjogren’s syndrome?
Anti-ro and anti-la
Where does Paget’s disease of the bone affect?
Pelvis, femur, vertebrae, skull
What symptoms are seen in Paget’s disease?
Bone pain, hearing loss, growth of mandible often comes up in exam questions - bone deformities
What is seen on X-ray in rheumatoid arthritis?
Loss of joint space Erosions Soft tissue swelling Soft bones Subluxation (dislocation)
What is the treatment of dermatomyositis?
IV corticosteroids
What investigations are performed for the diagnosis of dermatomyositis?
Creatine kinase
Muscle biopsy
Autoantibodies
Which antibodies are specific to dermatomyositis?
Anti-Mi-2
Give 5 risk factors for osteoarthritis.
Female Obesity Smoking Inflammatory bone disease Trauma
What is the triad of symptoms in sarcoidosis?
Lofgren’s triad
What symptoms make up Lofgren’s triad?
Polyarthralgia
Erythema nodosum
Bilateral hilar lymphadenopathy
What is used to manage sarcoidosis?
Corticosteroids
Hydroxychloroquine
Immunosuppressants
What is the most common cause of spread of septic arthritis?
Haematogenous spread
What is the treatment of septic arthritis?
Flucloxacillin, needle decompression
What is the most common cause of osteomyelitis?
Staphylococcus aureus
What is the most common cause of osteomyelitis in sickle cell patients?
Salmonella
What type of cancer has an onion ring appearance?
Erwing’s sarcoma