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MSK Flashcards

1
Q

Give 3 inflammatory causes of joint pain.

A

Autoimmune
Crystal arthritis
Infection

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2
Q

Give 2 non-inflammatory causes of joint pain.

A

Degenerative - osteoarthritis

Non-degenerative - fibromyalgia

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3
Q

Name 5 features in the hands of a patient with rheumatoid arthritis.

A 
Ulnar deviation 
Swan neck deformity
Z-thumb 
Distal interphalangeal joint sparing 
Swollen joints
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4
Q

What 5 conditions are associated with HLA-B27?

A 
Ankylosing spondylitis
Reactive arthritis 
Enteropathic arthritis 
Juvenile idiopathic arthritis
Acute anterior uveitis
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5
Q

What is the first line treatment of osteoporosis?

A

Alendronic acid (bisphosphonate), with AdCal

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6
Q

What other treatments are there for osteoporosis?

A

Denosumab

Teriparatide

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7
Q

How does denosumab work?

A

Monoclonal antibody that inhibits osteoclasts

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8
Q

How does teriparatide work?

A

Analogue of PTH - increases calcium absorption and vitamin D formation

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9
Q

Which antibody is specific to SLE?

A

Anti-dsDNA (anti double stranded DNA)

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10
Q

What condition must be ruled out in an acutely swollen joint?

A

Septic arthritis

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11
Q

What is the first line investigation for septic arthritis?

A

Aspirate joint for synovial fluid, culture fluid

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12
Q

What is the name for distal interphalangeal joint swelling seen in osteoarthritis?

A

Heberden’s nodes

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13
Q

What is the name of the classification of fractures in children involving the growth plate?

A

Salter-harris classification

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14
Q

What is a T score?

A

Bone density relative to a healthy 25 year old of the same gender

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15
Q

What is a Z score?

A

Bone density relative to the average for their age of the same gender

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16
Q

What is a FRAX score?

A

Risk of developing a fracture in the next 10 years

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17
Q

What is allopurinol primarily prescribed for?

A

Long term treatment of gout

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18
Q

What else can allopurinol be used for?

A

To prevent uric acid/calcium oxalate build up

Treatment of hyperuricaemia in tumour lysis syndrome

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19
Q

What is the mechanism of allopurinol?

A

Xanthine oxidase inhibitor - prevents the conversion of xanthine into uric acid

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20
Q

What is the first line treatment of temporal arteritis?

A

Prednisolone

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21
Q

What symptoms are associated with Wegener’s granulomatosis (granulomatosis with polyangitis)?

A

Hearing loss, sinusitis, nose bleeds

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22
Q

What is the treatment of Wegener’s granulomatosis?

A

Steroids/immunosuppressants

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23
Q

What antibodies are specific to Sjogren’s?

A

Anti-ro, anti-la

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24
Q

What other antibodies will be positive in Sjogren’s syndrome?

A

ANA, rheumatoid factor

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25
Q

What is the first line treatment of Sjogren’s?

A

Prednisolone, artificial saliva/tears

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26
Q

What is the triad of symptoms seen in Sjogren’s?

A

Dry eyes, dry mouth, inflammatory arthritis

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27
Q

What conditions is Sjogren’s often secondary to?

A

Rheumatoid arthritis, Systemic lupus erythematous

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28
Q

What antibody is specific to SLE?

A

Anti-dsDNA

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29
Q

Give 8 complications of SLE.

A 
Lupus nephritis
Recurrent miscarriage
Anaemia
Pericarditis
Pleuritis 
Interstitial lung disease 
Venous thrombosis
Cardiovascular disease
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30
Q

What features are seen on X-ray in a patient with ankylosing spondylitis?

A 
Squaring of vertebral bodies
Subchondral sclerosis
Sacroiliitis 
Ossification of ligaments
Syndesmophytes
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31
Q

Give 3 examples of anti-TNF drugs.

A

Etanercept, infliximab, adalimumab

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32
Q

What is the first line management of osteoarthritis?

A

Topical analgesia - capsaicin, diclofenac

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33
Q

What is the second line management of osteoarthritis?

A

Oral NSAIDs (given with a PPI)

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34
Q

What is the management of osteoarthritis not improved by pharacmological treatment?

A

Joint replacement surgery

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35
Q

What is Paget’s disease of bone?

A

Increased resorption, formation and remodelling of bone

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36
Q

How would the skull of someone with Paget’s disease appear on X-ray?

A

Cotton wool appearance - areas of high and low density bone

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37
Q

What LFT is abnormal in Paget’s disease?

A

ALP

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38
Q

What is the first line treatment of Paget’s disease?

A

Bisphosphonates

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39
Q

What is the most specific rheumatoid arthritis antibody?

A

Anti-CCP (anti cyclic citrullinated peptide antibody)

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40
Q

What is the first line treatment of rheuamtoid arthritis?

A

One DMARD

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41
Q

What is the second line treatment of rheumatoid arthritis?

A

Two DMARDs

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42
Q

What is the third line treatment of rheumatoid arthritis?

A

Add a biologic treatment to DMARDs

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43
Q

Name 3 DMARDs.

A

Methotrexate, sulfasalazine, hydroxychloroquine

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44
Q

What is Felty’s syndrome?

A

A complication of rheumatoid arthritis

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45
Q

What is the triad of symptoms in Felty’s syndrome?

A

Splenomegaly, neutropenia, rheuamtoid arthritis

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46
Q

What is dermatomyositis?

A

Chronic inflammation of the skin and muscles

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47
Q

What conditions is creatinine kinase raised above 1000 in?

A 
Rhabdomyolysis 
AKI
MI
Statin use
Strenuous exercise
Dermatomyositis
Polymyositis
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48
Q

What is classic of rhabdomyolysis?

A

Cola coloured urine and muscle pain

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49
Q

What antibody is seen in both dermatomyositis and polymyositis?

A

Anti-Jo-1

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50
Q

What antibodies are more specific to dermatomyositis than polymyositis?

A

Anti-Mi-2

ANA

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51
Q

What is the gold standard investigation for temporal arteritis?

A

Temporal artery biopsy

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52
Q

What is the most likely causative organism of septic arthritis post-surgery?

A

Staphylococcus aureus

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53
Q

What empirical antibodies are best for a post surgical septic arthritis?

A

Flucloxacillin (+ rifampicin for first two weeks)

Use vancomycin if penicillin allergic

54
Q

Which cancers commonly metastasise to bone?

A 
Breast
Prostate
Thyroid
Liver
Kidney
55
Q

How should alendronic acid be taken?

A

Patients should remain upright for 30 minutes after taking

Should be taken first thing in the morning with a glass of water

56
Q

What is Schirmer’s test?

A

Filter paper is placed into the eye to measure tear production

57
Q

What condition is Schirmer’s test used to investigate?

A

Sjogren’s

58
Q

What feature may be seen on X-ray of a patient with psoriatic arthritis?

A

Pencil in cup

59
Q

What is the first line pain management in ankylosing spondylitis?

60
Q

Which joint does pseudogout often present in?

61
Q

Which joint does gout most commonly present in?

62
Q

What causes osteomalacia?

A

Vitamin D or calcium deficiency

63
Q

What is the classic triad of symptoms seen in reactive arthritis?

A

Conjunctivitis, urethritis, arthritis

64
Q

What is seen in a swan neck deformity?

A

DIP hyperflexion, PIP hyperextension

65
Q

What is seen in Boutonniere’s deformity?

A

PIP hyperflexion, DIP hyperextension

66
Q

What criteria needs to be met to put a patient on allopurinol?

A

Has had more than one gout flare up or has gouty tophi

67
Q

What is given with allopurinol when a patient is first put on it and why?

A

Colchicine - allopurinol can initially increase the risk of gout flare ups

68
Q

What disease are associated with enteropathic arthritis?

69
Q

What antibodies are seen in Wegener’s granulomatosis?

70
Q

What antibodies are seen in systemic sclerosis?

A

Anti-centromere antibodies

71
Q

What antibodies are seen in polymyositis?

A

Anti-Jo-12

72
Q

What condition is HLA-DR2 associated with?

73
Q

What blood result is raised in Paget’s disease?

74
Q

Why is only ALP the only thing raised in Paget’s disease?

A

Increased bone turnover increases ALP and nothing else

75
Q

What medication can predispose a patient to gout?

A

Thiazide diuretics

76
Q

What should a gout patient be placed on instead of thiazide diuretics?

A

ARB or CCB

77
Q

Why can thiazide diuretics contribute to gout?

A

They increase the absorption of urate in the proximal tubules of the kidney

78
Q

What level lesion would lead to loss of the knee jerk reflex?

79
Q

What nerve root lesion causes sciatica?

80
Q

What type of bacteria is pseudomonas aeruginosa?

A

Gram negative bacilli

81
Q

What is the most common cause of septic arthritis?

A

Staphylococcus

82
Q

Is rheumatoid arthritis usually symmetrical or asymmetrical?

A

Symmetrical

83
Q

What is the gold standard investigation for osteoporosis?

84
Q

What is a characteristic of pseudogout on X-ray?

A

Calcifications opposite to the articular surface (due to calcium pyrophosphate deposition

85
Q

What is the last line management of osteoarthritis?

A

Intrarticular steroid injections - methylprednisolone

86
Q

Other than STIs, what is the most common cause of reactive arthritis?

A

Campylobacter jejuni

87
Q

What is the most specific antibody for Sjogren’s?

88
Q

What levels of ESR and CRP are seen in SLE?

A

High ESR

Normal CRP

89
Q

What is the action of methotrexate?

A

Folic acid inhibitor

90
Q

Why is methotrexate teratogenic?

A

Folic acid (which is inhibited), is crucial to the neurodevelopment of a foetus

91
Q

What nerve lesion can cause wrist drop?

A

Radial nerve

92
Q

What criteria need to be met to be classified as severely osteoporotic?

A

T score < 2.5, and a known pathological fracture

93
Q

What condition is highly associated with temporal arteritis?

A

Polymyalgia rheumatica

94
Q

What complement factors are reduced in lupus?

A

Complement 3 and 4

95
Q

What cancer do patients with Sjogren’s have an increased risk of?

A

Non-Hodgkin’s lymphoma

96
Q

What are the extra-articular manifestations of ankylosing spondylitis?

A

5As

  • Anterior uveitis
  • Autoimmune bowel disease
  • Apical lung fibrosis
  • Amyloidosis
  • Aortic regurgitation
97
Q

What bedside test can be used to test mobility of the spine?

A

Schober’s test

98
Q

What does Schober’s test involve?

A

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

99
Q

What features are seen on X-ray in ankylosing spondylitis?

A 
Squaring of vertebral bodies
Bamboo spine 
Syndesmophytes
Sacroiliac fusion 
Subchondral sclerosis
100
Q

What is the first line treatment of ankylosing spondylitis?

A

NSAIDs
Steroids during flares
Anti-TNF - etanercept, infliximab

101
Q

What is a key differential of osteoarthritis?

A

Rheuamtoid arthritis

102
Q

What are the first line treatments of osteoarthritis?

A

Topical NSAIDs, topical capsaicin

Oral NSAIDs/paracetamol, bisphosphonates

103
Q

What medication is used in intra-articular steroid injections?

A

Methylprednisolone

104
Q

What is the most sensitive antibody test for rheumatoid arthritis?

A

Rheumatoid factor

105
Q

How is the progression of rheumatoid arthritis monitored?

A

CRP and ESR levels

106
Q

What is a life threatening complication of rheumatoid arthritis?

A

Felty’s syndrome

107
Q

Give 5 extra-articular manifestations of rheumatoid arthritis.

A 
Sjogrens 
Vasculitis 
Pericarditis
MI
Pleuritis
108
Q

Give 3 side effects of bisphosphonates.

A

Oesophagitis
Oesophageal ulcers
Osteonecrosis of the jaw

109
Q

Give 5 risk factors for osteoporosis.

A 
Early menopause
Steroids
Hyperparathyroidism
Low weight 
Inflammatory bone disease
110
Q

What is the acute management of temporal arteritis?

A

IV methylprednisolone

111
Q

What is the long term management of temporal arteritis?

A

Oral prednisolone

112
Q

What is the most common bone tumour in children and young adults?

A

Osteosarcoma

113
Q

What FRAX score warrants a DEXA scan?

114
Q

What STI is closely linked to reactive arthritis?

A

Chlamydia pneumoniae

115
Q

What antibodies are seen in Sjogren’s syndrome?

A

Anti-ro and anti-la

116
Q

Where does Paget’s disease of the bone affect?

A

Pelvis, femur, vertebrae, skull

117
Q

What symptoms are seen in Paget’s disease?

A

Bone pain, hearing loss, growth of mandible often comes up in exam questions - bone deformities

118
Q

What is seen on X-ray in rheumatoid arthritis?

A 
Loss of joint space
Erosions
Soft tissue swelling 
Soft bones
Subluxation (dislocation)
119
Q

What is the treatment of dermatomyositis?

A

IV corticosteroids

120
Q

What investigations are performed for the diagnosis of dermatomyositis?

A

Creatine kinase
Muscle biopsy
Autoantibodies

121
Q

Which antibodies are specific to dermatomyositis?

122
Q

Give 5 risk factors for osteoarthritis.

A 
Female
Obesity
Smoking 
Inflammatory bone disease
Trauma
123
Q

What is the triad of symptoms in sarcoidosis?

A

Lofgren’s triad

124
Q

What symptoms make up Lofgren’s triad?

A

Polyarthralgia
Erythema nodosum
Bilateral hilar lymphadenopathy

125
Q

What is used to manage sarcoidosis?

A

Corticosteroids
Hydroxychloroquine
Immunosuppressants

126
Q

What is the most common cause of spread of septic arthritis?

A

Haematogenous spread

127
Q

What is the treatment of septic arthritis?

A

Flucloxacillin, needle decompression

128
Q

What is the most common cause of osteomyelitis?

A

Staphylococcus aureus

129
Q

What is the most common cause of osteomyelitis in sickle cell patients?

A

Salmonella

130
Q

What type of cancer has an onion ring appearance?

A

Erwing’s sarcoma

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