MSK Flashcards
Osteoarthritis x-ray findings
LOSS
- Loss of joint space
- Osteophytes formation
- Subchondral sclerosis
- Subchondral cysts
Osteoarthritis pres/treatment
- HEBERDEN NODES and BOUCHARD NODES
- F>M
- Worse with movement
- Morning stiffness <1 hour
- Paracetamol (work up analgesics ladder)
- Cortisol injections
- Joint replacement
Rheumatoid arthritis x-ray findings
LOES
- Loss of joint space
- Osteopenia
- Erosion of bone
- Swelling of soft tissues
Rheumatoid arthritis pres
- HAND DEFORMITIES
- Ulnar deviation
- Swan neck deformity
- Boutonniere deformity
- Morning stiffness >1 hour
- Systemic presentations - scleritis, pleural effusions, pericarditis and serositis
Rheumatoid arthritis diagnosis/treatment
- 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
Osteoporosis treatment
- BISPHOSPHONATES (oral alendronate/IV zolendronate)
- Monoclonal antibody (denosumab)
SLE pres
- Skin rash - MALAR RASH, discoid rash, photosensitive rash
- Joint pain
- ORAL ULCERS
- CNS - depressions and psychosis
- F 9x>M
SLE diagnosis/treatment
- 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
Antiphospholipid syndrome def
Disorder of immune system causing increased risk of clots, characterised by thrombosis and recurrent miscarriages
Associated with SLE in 20-30%
Antiphospholipid syndrome treatment
- Lifestyle
- Anticoagulate blood clots with HEPARIN
- Chronic WARFARIN on long term basis
- Heparin and aspirin for pregnancy
Sjogren’s syndrome def
Chronic inflammatory autoimmune disorder
Destruction of epithelial exocrine glands, especially LACRIMAL AND SALIVARY GLANDS
Sjogren’s syndrome pres/diagnosis/treatment
- 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
Raynauds treatment
- NIFEDIPINE - calcium channel blocker
- Lifestlye - protect hands, stop smoking
Systemic sclerosis def
Multisystem autoimmune disease with increased FIBROBLAST activity - increased collagen deposition resulting in abnormal growth of CONNECTIVE TISSUE
Systemic sclerosis pres
Limited
- Skin involvement limited to hands, face, feet and forearms
- ‘BEAK’ LIKE NOSE and SMALL MOUTH
Diffuse
- Skin changes develop RAPIDLY AND WIDESPREAD
Systemic sclerosis diagnosis/treatment
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
Poly/dermomyositis def
Rare muscle disorder of unknown aetiology with inflammation and necrosis of skeletal muscle fibres
- Dermatomyositis is poly + skin involvement
Poly/dermatomyositis pres/diagnosis/treatment
- 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
Paget’s disease
Chronic disease of skeleton including bowed tibia and skull changes
Treat with BISPHOSPHONATES for bone remodelling and NSAIDs for joint and bone pain
Osteomalacia/rickets def
Defective mineralisation of newly formed bone matrix due to inadequate phosphate or calcium or increased bone resorption (hyperPTH)
Rickets- same but in kids
Osteomalacia presentation/diagnosis/treatment
- 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
Sepsis management give 3 take 3
- Administer oxygen - keep sats >94% or 88-92% if risk of CO2 retention in COPD
- Take blood cultures - consider CSF, urine, sputum and CXR and urinalysis for all adults
- Give IV antibiotics
- Give IV fluids
- Check serial lactates
- Measure urine output
Septic arthritis def/cause/treatment
- 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
Hyperuricaemia/crystal arthritis info
- Red hot swollen joint
- Pseudogout - 1 or more places around body
- Gout - usually 1 place on body i.e. big toe
