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2a stuff > MSK > Flashcards

MSK Flashcards

1
Q

Osteoarthritis x-ray findings

A

LOSS

  • Loss of joint space
  • Osteophytes formation
  • Subchondral sclerosis
  • Subchondral cysts
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2
Q

Osteoarthritis pres/treatment

A
  • HEBERDEN NODES and BOUCHARD NODES
  • F>M
  • Worse with movement
  • Morning stiffness <1 hour
  • Paracetamol (work up analgesics ladder)
  • Cortisol injections
  • Joint replacement
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3
Q

Rheumatoid arthritis x-ray findings

A

LOES

  • Loss of joint space
  • Osteopenia
  • Erosion of bone
  • Swelling of soft tissues
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4
Q

Rheumatoid arthritis pres

A
  • HAND DEFORMITIES
  • Ulnar deviation
  • Swan neck deformity
  • Boutonniere deformity
  • Morning stiffness >1 hour
  • Systemic presentations - scleritis, pleural effusions, pericarditis and serositis
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5
Q

Rheumatoid arthritis diagnosis/treatment

A
  • RF increases (highly sensitive but not always RA)
  • ANTI-CCP (more specific, >20 likely RA)
  • METHOTREXATE (a DMARD) (with folate) - not for pregnant women otherwise HYDROXYCHLOROQUINE
  • Steroids
  • TNF alpha blockers - INFLIXIMAB
  • B cell inhibitors - RITUXIMAB
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6
Q

Osteoporosis treatment

A
  • BISPHOSPHONATES (oral alendronate/IV zolendronate)

- Monoclonal antibody (denosumab)

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7
Q

SLE pres

A
  • Skin rash - MALAR RASH, discoid rash, photosensitive rash
  • Joint pain
  • ORAL ULCERS
  • CNS - depressions and psychosis
  • F 9x>M
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8
Q

SLE diagnosis/treatment

A
  • ESR RAISED BUT NOT CRP
  • ANA - antinuclear antibodies
  • ANTI-dsDNA DIAGNOSTIC OF LUPUS
  • Serum C3 and C4 low
  • Unlike RA start with steroids to see if any effect
  • If not then give methotrexate or other DMARDS like hydroxychloroquine
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9
Q

Antiphospholipid syndrome def

A

Disorder of immune system causing increased risk of clots, characterised by thrombosis and recurrent miscarriages
Associated with SLE in 20-30%

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10
Q

Antiphospholipid syndrome treatment

A
  • Lifestyle
  • Anticoagulate blood clots with HEPARIN
  • Chronic WARFARIN on long term basis
  • Heparin and aspirin for pregnancy
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11
Q

Sjogren’s syndrome def

A

Chronic inflammatory autoimmune disorder

Destruction of epithelial exocrine glands, especially LACRIMAL AND SALIVARY GLANDS

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12
Q

Sjogren’s syndrome pres/diagnosis/treatment

A
  • DRY EYES, MOUTH, parotid gland enlargement
  • Raynauds
  • Joint pain
  • Associated with RA, SLE, PBC, scleroderma
  • SCHIRMER TEAR TEST
  • Rose bengal staining and slit lamp exam
  • NSAIDs - hydroxychloroquine
  • M3 agonist - PILOCARPINE
  • Humidifier, eye drops, mouth wash
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13
Q

Raynauds treatment

A
  • NIFEDIPINE - calcium channel blocker

- Lifestlye - protect hands, stop smoking

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14
Q

Systemic sclerosis def

A

Multisystem autoimmune disease with increased FIBROBLAST activity - increased collagen deposition resulting in abnormal growth of CONNECTIVE TISSUE

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15
Q

Systemic sclerosis pres

A

Limited

  • Skin involvement limited to hands, face, feet and forearms
  • ‘BEAK’ LIKE NOSE and SMALL MOUTH

Diffuse
- Skin changes develop RAPIDLY AND WIDESPREAD

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16
Q

Systemic sclerosis diagnosis/treatment

A

Limited
- Check for ANTICENTROMERE ANTIBODIES (ACA)
Diffuse
- Check for ANTI-TOPOISOMERASE, Antiscl-70

  • Lifestyle - stop smoking, handwarmers
  • For GI problems - PPI, antibiotics
  • Renal - ACE inhibitors
  • Pulmonary fibrosis - cyclophosphamide
17
Q

Poly/dermomyositis def

A

Rare muscle disorder of unknown aetiology with inflammation and necrosis of skeletal muscle fibres
- Dermatomyositis is poly + skin involvement

18
Q

Poly/dermatomyositis pres/diagnosis/treatment

A
  • Symmetrical progressive muscle weakness affecting muscles of shoulder and pelvic girdle (struggle to go upstairs)
  • Dermato - heliotrope (purple) discolouration of eyelids (rash) and scaly erythematous plaques over knuckles
  • Muscle biopsy - look for necrosis of muscle
  • Serum creatine kinase increase due to muscle breakdown
  • Anti jo1, anti mi2
  • Oral prednisolone
  • Stronger immunosuppressants
19
Q

Paget’s disease

A

Chronic disease of skeleton including bowed tibia and skull changes
Treat with BISPHOSPHONATES for bone remodelling and NSAIDs for joint and bone pain

20
Q

Osteomalacia/rickets def

A

Defective mineralisation of newly formed bone matrix due to inadequate phosphate or calcium or increased bone resorption (hyperPTH)
Rickets- same but in kids

21
Q

Osteomalacia presentation/diagnosis/treatment

A
  • WIDESPREAD BONE PAIN AND TENDERNESS
  • Rickets -LEG BOWING AND KNOCK KNEES
  • X-ray - defective mineralisation
  • Bloods - U&Es, serum ALP, vit D
  • Lifestyle
  • Vit D replacement
  • Malabsorption/renal disease - IM calcitriol
22
Q

Sepsis management give 3 take 3

A
  1. Administer oxygen - keep sats >94% or 88-92% if risk of CO2 retention in COPD
  2. Take blood cultures - consider CSF, urine, sputum and CXR and urinalysis for all adults
  3. Give IV antibiotics
  4. Give IV fluids
  5. Check serial lactates
  6. Measure urine output
23
Q

Septic arthritis def/cause/treatment

A
  • Red hot swollen joint, bacteria infiltrate joint space cause inflammation and infection
  • IV drug users
  • Immunocompromised
  • Common bugs - STAPH AUREUS, NEISSERIA GONORRHOEAE
  • FLUCLOXACILLIN
  • If penicillin allergic- CLINDAMYCIN
  • If MRSA suspected, VANCOMYCIN
  • If gonococcal arthritis or gram -ve infection, CEFOTAXIME
24
Q

Hyperuricaemia/crystal arthritis info

A
  • Red hot swollen joint
  • Pseudogout - 1 or more places around body
  • Gout - usually 1 place on body i.e. big toe
25
Q

Hyperuricaema investigations/treatment

A
  • 1st line bloods
  • U&E + eGFR - renal function and uric acid levels to confirm hyperuricaemia
  • Gold standard - Joint aspiration
  • Acute 1st line - NSAIDs or COLCHICINE
  • Chronic 1st line - ALLOPURINOL
26
Q

Osteomyelitis def/diagnosis/treatment

A

Inflammation/swelling of bone marrow (RED HOT SWOLLEN JOINT) due to infection

  • STAPH AUREUS most common
  • FBC - increased WCC, ESR and CRP
  • X-ray - thickening of cortical bone and osteopenia
  • Bone MRI and biopsy
  • Antibiotics
  • Surgery
27
Q

4 types of seronegative spondyloarthropathies and def

A 
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease arthritis (enteropathic arthritis)
Umbrella term for conditions with similar features
- Axial inflammation (back pain)
- Asymmetrical peripheral arthritis
- Seronegative = NO RHEUM FACTOR
- HLA B27 FACTOR
  • Sausage digits, psoriasis, back pain, NSAIDs - good response, Crohn’s disease, Uveitis,
28
Q

Ankylosing spondylitis def and investigations

A
  • Inflammation of sacroiliac joints (pelvis/lowerspine)
  • YOUNG MALES COMMON
  • Loss of spinal movements
  • X-ray - BAMBOO SPINE due to fusion, bone spurs aka SYNDESMOPHYTES, sacroiliac joints eroded and sclerotic
29
Q

Reactive arthritis def and investigations

A
  • Mainly due to infection (not a septic arthritis)
  • Active sexual history
  • Can’t see, can’t pee, can’t climb a tree
  • Most frequent pathogen CHLAMYDIA TRACHOMATIS
  • Bloods - ESR, CRP, ANA, RF
30
Q

Psoriatic arthritis def and investigations

A
  • Occurs 10-40% people with psoriasis
  • TELESCOPIC FINGERS
  • Scaly silver skin lesions
31
Q

HLA B27 treatment

A
  • Pain management - NSAIDs or corticosteroids

- INFLIXIMAB

32
Q

Cauda equina syndrome in mechanical back pain

A

Rare and severe spinal stenosis where all nerves in low back become severely compressed

33
Q

Fibromyalgia def/investigations/treatment

A
  • Chronic pain syndrome
  • Widespread over body - 11 out of 18 points on body
  • Female
  • Needs to present for >3 months to diagnose
  • Exclude all other differentials with bloods and imaging
  • Neuropathic pain relief - TCA, GABAPENTIN, pregbalin
  • Opiates
34
Q

Osteosarcoma info

A
  • Primary bone malignancy

- Most common one in kids - metaphysis of long bones

35
Q

Ewing sarcoma info

A
  • Super rare
  • From mesenchymal cells
  • ONION SKIN changes on x-ray
36
Q

Osteochondroma info

A
  • Benign
  • Very common in males <25
  • Overproduction of bone which deposits on metaphysis
37
Q

Bone cancer investigations/management

A
  • FBC, U&E, ALP, PSA
  • Imaging - X-ray for lytic lesions, CT scans for metastases
  • Analgesic ladder
  • BISPHOSPHONATES
  • Chemo/radio

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