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Phase 2a Resits > MSK > Flashcards

MSK Flashcards

1
Q

What is osteoarthritis?

A
  • loss of cartilage
  • disordered bone repair
  • most common arthritis
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2
Q

What xray findings do you get with osteoarthritis?

A

LOSS

  • loss of joint space
  • osteophytes formation
  • subchondral sclerosis
  • subchondral cysts
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3
Q

Risk factors for osteoarthritis

A
  • female

- obesity

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4
Q

Presentation of osteoarthritis

A
  • mainly in large weight-bearing joints
  • joint pain, worse with movement
  • stiffness on rest
  • limited joint movement
  • bone swelling in fingers
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5
Q

What are the two types of bone swelling in fingers?

A
  • Heberden = DIP

- Bouchard = PIP

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6
Q

Treatment for osteoarthritis

A

Biological

  • paracetamol → work up analgesics ladder
  • cortisol injections
  • joint replacement

Social

  • weight loss → required before surgery
  • lifestyle advice
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7
Q

What is Rheumatoid Arthritis?

A
  • autoimmune disease
  • symmetrical, deforming, peripheral polyarthritis
  • female 3x > male
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8
Q

What xray findings do you get with RA?

A

JOBS

  • joint space loss
  • osteopenia
  • bone erosion
  • soft tissue swelling
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9
Q

Presentation of RA

A
  • pain in affected joints
  • deformities of hand
  • morning stiffness
  • systemic presentations
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10
Q

Hand deformities in RA

A
  • ulnar deviation
  • swan neck
  • boutonniere deformity
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11
Q

Systemic presentations in RA

A
  • scleritis
  • pleural effusions
  • pericarditis
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12
Q

Diagnostic criteria for RA

A

RF RISES

  • rheumatoid factor positive
  • finger/hand/wrist involvement
  • rheumatoid nodules present
  • involvement of ≥ 3 joints
  • stiffness in the morning for > 1hr
  • erosions seen on xray
  • symmetrical movement

> 4 symptoms for > 6 weeks

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13
Q

Investigations for RA

A

bloods

  • RF = highly sensitive
  • anti-CCP = more specific
  • ESR
  • xray
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14
Q

Treatment for RA

A
  • methotrexate with folate
  • DMARDs
  • steroids
  • biologics
  • NSAIDs/opioids for pain management
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15
Q

What biologics are used to treat RA?

A
  • TNFα blockers = infliximab

- B cell inhibitors = rituximab

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16
Q

What is felty syndrome?

A
  • RA
  • splenomegaly
  • granulocytopenia
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17
Q

What is osteoporosis?

A
  • decreased bone mass/density
  • micro-architectural deterioration
  • increased bone fragility
  • increased susceptibilty to fracture
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18
Q

Causes of osteoporosis

A
  • Cushing’s, PTH
  • myeloma
  • malabsorption
  • steroids
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19
Q

Presentation of osteoporosis

A
  • not clinically apparent until a fracture occurs
  • risk assessment = FRAX and Qfracture
  • DEXA scan → T scan
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20
Q

Treatment for osteoporosis

A
  • bisphosphonates → oral alendronate/IV zoledronate
  • mAbs → denosumab
  • HRT
  • lifestyle advice → quit smoking and alcohol
  • Ca2+ and vitamin D
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21
Q

What is lupus

A
  • Systemic Lupus Erythematosus
  • inflammatory multisystem autoimmune disorder
  • arthralgia and rashes
  • type III hypersensitivity
  • female 9x > male
  • peak in 20-40yrcarditis, pls
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22
Q

Presentation of lupus

A
  • joint pain
  • malar, discoid, photosensitive rash
  • serositis
  • glomerulonephritis with proteinuria
  • depression/psychosis
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23
Q

What serositis can be seen in lupus?

A
  • scleritis
  • pericarditis
  • pleuritis
  • oral ulcers
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24
Q

Diagnosis of lupus

A
  • bloods → ESR raised, CRP normal
  • ANA
  • Anti-dsDNA
  • serum C3 and C4
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25
Q

Treatment for lupus

A
  • steroids
  • hydroxychloroquine
  • methotrexate
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26
Q

What is hyperuricaemia?

A
  • high levels of uric acid
  • > 420 M, >360 F
  • asymptomatic
  • 1 in 5 will develop gout
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27
Q

What is pseudogout?

A
  • buildup of calcium pyrophosphate

- birefringent +ve, rhomboid

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28
Q

What is gout?

A
  • buildup of monosodium urate

- birefringent -ve, needles

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29
Q

How does the buildup of uric acid lead to inflammation?

A
  • uric acid builds up
  • precipitates as uric acid crystals
  • crystals deposit in joint spaces
  • inflammation
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30
Q

Stages of gout progression

A
  1. high uric acid levels → builds up in blood → crystals form around joints
  2. acute gout → symptoms start → painful gout attack
  3. intercritical gout → periods of remission between gout attacks
  4. chronic gout → gout pain frequent and tophi form in joints
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31
Q

Signs and symptoms of gout

A
  • red hot joint → painful, swollen
  • acute onset
  • most common joint = big toe
  • also affects midfoot, ankle, knee, wrist
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32
Q

Investigations for gout

A
  1. bloods
    - U&E and eGFR for renal function
    - uric acid levels, now and 4-6 weeks later → confirm hyperuricaemia

GOLD STANDARD = joint aspiration to test for urate crystals

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33
Q

Management for acute gout

A
  1. NSAIDs or colchicine
  2. intra-articular steroid injection
    lifestyle advice
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34
Q

Management of chronic gout

A
  1. allopurinol → inhibits xanthine oxidase
  2. febuxostat

consider coprescribing clolchicine with allopurinol for 6 months

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35
Q

Signs and symptoms of septic arthritis

A

LIFE THREATENING

  • red hot swollen joints
  • cold peripheries
  • confusion
  • high temperature
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36
Q

Causes and risks of septic arthritis

A
  • IVDU
  • immunocompromised
  • intra-articular joints
  • common bugs
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37
Q

What bugs cause septic arthritis?

A
  • S.aureus
  • Neisseria gonorrhoea
  • gram -ve bacteria eg E.coli
  • haemophilius influenza (kids)
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38
Q

What is the sepsis 6?

A
  1. give O2 to keep stats above 94%
  2. take blood cultures → CSF, urine, sputum
  3. give IV antibiotics
  4. give a fluid challenge
  5. measure lactate
  6. measure urine output
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39
Q

What antibiotics can be given to treat septic arthritis?

A
  • flucloxacillin
  • if penicillin allergic → clindamycin
  • if MRSA → vancomycin
  • if gonococcal arthritis or gram -ve infection → cefotaxime
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40
Q

Treatment for septic arthritis

A

Sepsis 6

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41
Q

What is osteomyelitis?

A

infection of the bone marrow

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42
Q

What are the 3 ways of entry for osteomyelitis?

A
  • hematogenously
  • open wound
  • contiguously → skin into blood
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43
Q

Risk factors for osteomyelitis

A
  • penetration injury
  • IVDU
  • diabetes/CKD
  • HIV
  • sickle cell disease
  • RA
  • children → URT/varicella infection
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44
Q

Presentation of osteomyelitis

A
  • limp or reluctance to weight bear (kids)
  • non-specific pain at site of infection
  • low grade fever
  • malaise and fatigue
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45
Q

Investigations for osteomyelitis

A
  • FBC → raised WCC, ESR, CRP
  • xray
  • blood cultures
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46
Q

Management for osteomyelitis

A
  • antibiotics
  • supportive care
  • surgery
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47
Q

What are the 3 seronegative spondyloarthropathies?

A
  • ankylosing spondylitis
  • reactive arthritis
  • psoriatic arthritis
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48
Q

How do seronegative spondyloarthropathies present?

A

SPINACHEE

  • sausage digits
  • psoriasis
  • inflammatory back pain
  • NSAIDs (good response)
  • Arthritis
  • Crohn’s disease
  • HLA B27
  • Eye → uveitis
  • enthesitis
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49
Q

What is ankylosing spondylitis?

A
  • inflammation of sacroiliac joints

- loss of spinal movements

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50
Q

Investigations for ankylosing spondylitis

A
  • bloods = HLA B27

- xray

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51
Q

Xray findings for ankylosing spondylitis

A
  • eroded and sclerotic sacroiliac joints
  • unclear margin between rims
  • bone spurs aka syndesmophytes
  • bamboo spine due to fusion
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52
Q

Treatment for ankylosing spondylitis

A
  • NSAIDs
  • physiotherapy
  • steroid injections
  • DMARDs → methotrexate, sulfasalazine
  • TNF inhibitor or mAb → etanercept, infliximab, adalimumab
  • ustekinumab = last line
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53
Q

Signs and symptoms of psoriatic arthritis

A
  • painful swollen stiff joints
  • psoriatic plaques
  • dactylis
  • telescopic fingers → pencil in cup on xray

occurs in 10-40% of people with psoriasis

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54
Q

Treatment for psoriatic arthritis

A

same as ankylosing spondylitis

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55
Q

What causes reactive arthritis?

A
  • mainly due to infection

- think about if someone has an active sexual history

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56
Q

Signs and symptoms of reactive arthritis

A
  • can’t see = uveitis
  • can’t pee = urethritis
  • can’t climb a tree = enthesitis
  • keratoma blennorhagica
  • circinate balantis
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57
Q

Investigations for reactive arthritis

A
  • bloods = inflammatory markers

- imaging to determine extent of damage from enthesitis

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58
Q

What inflammatory markers can you see in reactive arthritis bloods?

A
  • ESR
  • CRP
  • ANA
  • rheumatoid factor
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59
Q

Treatment for reactive arthritis

A
  • NSAIDs
  • corticosteroids
  • DMARDs → chronic arthritis
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60
Q

What is vasculitis?

A

group of autoimmune diseases that cause inflammation of the blood vessel walls

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61
Q

General constitutional symptoms of vasculitis

A
  • malaise
  • fatigue
  • weight loss
  • low grade fever
62
Q

What is giant cell arteritis

A
  • large vessel vasculitis

- affects aorta and/or its major branches eg carotid and vertebral arteries

63
Q

Risk factors for giant cell arteritis

A
  • almost exclusive in >50yrs
  • North European
  • females 2-3x > males
  • history of polymyalgia rheumatica
64
Q

Presentation of giant cell arteritis

A
  • headache → new onset, typically unilateral over temporal area
  • scalp tenderness
  • jaw claudication
  • visual disturbances
65
Q

Investigations for giant cell arteritis

A
  • increased ESR and/or CRP
  • halo sign on US of temporal/axillary artery

GOLD STANDARD = temporal artery biopsy → giant cells, granulomatous inflammation

66
Q

Management of giant cell arteritis

A

high dose glucocorticoids ASAP → prednisolone

67
Q

Complications of giant cell arteritis

A
  • blindess

- irreversible neuropathy

68
Q

What are the common primary bone tumours?

A
  • chondrosarcoma
  • osteosarcoma
  • Ewing sarcoma
69
Q

Risk factors of primary bone tumours

A
  • previous radiotherapy
  • previous cancer
  • Paget’s disease
  • benign bone lesions
  • male>female
70
Q

Presentation of primary bone tumours

A
  • common sites → long bones
  • bone pain
  • atypical bony or soft tissue swelling/masses
  • pathological fractures
  • easy brusiing
  • mobility issues → unexplained limp, joint stiffness, reduced ROM
  • inflammation and tenderness over bone
  • systemic symptoms
71
Q

What is bone pain like in primary bone tumours?

A
  • worse at night
  • constant or intermittent
  • resistant to analgesia
  • may increase in intensity
72
Q

Investigations for primary bone tumours

A
  1. xray
    GOLD STANDARD = biopsy

bloods

  • FBC
  • ESR
  • ALP
  • lactate dehydrogenase
  • Ca2+
  • U&E

CT chest/abdomen/pelvis

73
Q

Management of primary bone tumours

A
  • chemo
  • radiotherapy
  • surgery → limb sparing/amputation
74
Q

What is multiple myeloma?

A

neoplastic proliferation of bone marrow plasma cells

75
Q

Pathophysiology of multiple myeloma

A
  • malignant plasma cells produce excess immunoglobulin
  • multiple organ dysfunction esp kidneys
  • 2/3 IgG, 1/3 IgA
76
Q

Presentation of multiple myeloma

A

OLD CRAB

  • old age
  • calcium elevated → bones, stones, groans, moans
  • renal impairment
  • anaemia
  • bone lytic lesions → bone/back pain
77
Q

Investigations for multiple myeloma

A
  • FBC → normocytic normochromic anaemia
  • films → rouleaux formation (RBC aggregations)
  • U&Es → raised Ca, urea, creatinine
  • haematinics → raised ESR
  • xray → pepper-pot skull, vertebral collapse, fractures
  • serum/urine electrophoresis → bence jones protein band
  • bone marrow biopsy → raised plasma cells
78
Q

Diagnostic criteria for multiple myeloma

A
  1. monoclonal protein band in serum/urine
  2. raised plasma cells on BM biopsy
  3. end organ damage → hypercalcaemia, renal failure, anaemia
  4. bone lesions on skeletal survey
79
Q

Treatment for multiple myeloma

A
  • analgesia → bone pain
  • bisphosphonates → reduce fractures and bone pain
  • local radiotherapy → reduce focal disease
  • transfusion → correct anaemia
  • fluids/dialysis → renal failure
  • Abs for infections
  • chemo
80
Q

What is osteomalacia?

A
  • poor bone mineralisation leads to soft bones

- lack of Ca2+ in adults

81
Q

What is rickets?

A

inadequate mineralisation of the bone and epiphyseal cartilage in growing skeleton of children

82
Q

Pathophysiology of osteomalacia/rickets

A
  • Ca2+ deficiency

- usually due to vitD deficiency

83
Q

Presentation of osteomalacia

A
  • widespread bone pain and tenderness → dull ache, worse on weight bearing
  • fractures → NOF
  • muscle weakness → waddling gait, difficulty with stairs
  • gradual onset, persistent fatigue
84
Q

Presentation of rickets

A
  • knock-kneed, bow-legged
  • tender swollen joints
  • growth retardation
  • bone and joint pain
  • dental deformities
  • enlargement of end of ribs → rachitic rosary
85
Q

Diagnosis of osteomalacia/rickets

A
  • xray → loss of cortical bone → defective mineralisation
  • bloods → low Ca2+ and phosphate
  • bone biopsies → incomplete mineralisation
86
Q

Management of osteomalacia/rickets

A

vitamin D supplements

  • rapid mineralisation of bone
  • resolution of symptoms
  • malabsorption → IM calcitrol
  • renal disease → alfacalcidol
87
Q

What is Paget’s disease?

A

disorder of bone turnover

88
Q

Pathophysiology of Paget’s disease

A
  • excessive bone turnover (formation and resorption)
  • due to excessive osteoblast and osteoclast activity
  • leads to patchy areas os high density (sclerosis) and low density (lysis)
  • enlarged and misshapen bones → risk of fracture
89
Q

Presentation of Paget’s disease

A
  • bone pain
  • bone deformity
  • fractures
  • hearing loss → if bones of ear affected
90
Q

Investigations for Paget’s disease

A

xray

  • bone enlargement and deformity
  • osteoporosis circumscripta → well defined osteolytic lesions
  • cotton wool appearance of skull → poorly defined areas of sclerosis and lysis
  • v-shaped defects in long bones

bloods

  • raised ALP
  • normal Ca2+ and phosphate
91
Q

Management of Paget’s disease

A
  • bisphosphonates
  • NSAIDs for bone pain
  • Ca2+ and vitD supplements
92
Q

Complications of Paget’s disease

A
  • osteosarcoma

- spinal stenosis and cord compression

93
Q

Causes of osteomalacia

A
  • malnutrition
  • drug induced
  • defective 1-alpha hydroxylation
  • liver disease
94
Q

Osteosarcoma

A
  • primary bone malignancy
  • common in kids
  • metaphysis of long bones
  • associated with Paget’s disease
95
Q

Ewing sarcoma

A
  • v rare
  • from mesenchymal cells
  • originate from long bones
96
Q

Osteochondroma

A
  • bening
  • very common in males under 25
  • overproduction of bone → deposits on metaphysis
97
Q

What are common sites of secondary bone tumours?

A

LEAD KETTLE PBKTL

  • prostate
  • breast
  • kidneys
  • thyroid
  • lungs
98
Q

Investigations for secondary bone tumour

A

bloods

  • FBC
  • U&E
  • ALP
  • PSA

imaging

  • xray → lytic lesions
  • CT scans → metastases
99
Q

Management of secondary bone tumours

A
  • pain management
  • bisphosphonates
  • radiotherapy
  • chemo
100
Q

What is fibromyalgia?

A
  • chronic pain syndrome
  • widespread over body → 11 out of 18 points
  • > 3 months
  • non-nociceptive pain
  • no organic cause
101
Q

Pathophysiology of fibromyalgia

A
  • unknown

- possibly pain perception or hyper excitability of pain fibres

102
Q

Presentation of fibromyalgia

A
  • fatigue
  • brain fog
  • pain
  • morning stiffness
103
Q

Investigations for fibromyalgia

A

exclude all other differential with bloods and imaging

104
Q

Management of fibromyalgia

A
  • exercise
  • relaxation
  • neuropathic pain relief → TCA, gabapentin, pregabalin
  • opiates
  • CBT
105
Q

Complications of fibromyalgia

A
  • can really affect QoL
  • anxiety, depression, insomnia
  • opiate addiction
106
Q

Pathophysiology of Sjogren’s syndrome

A
  • chronic inflammatory autoimmune disorder

- destruction of epithelial exocrine glands esp lacrimal and salivary glands

107
Q

Signs and symptoms of Sjogren’s

A
  • dry eyes, mouth, vagina (mucous membranes)
  • parotid gland enlargement
  • joint pain
  • Raynauds
  • systemic features
108
Q

What conditions is Sjogren’s associated with?

A
  • RA
  • SLE
  • PBC
  • scleroderma
109
Q

Risk factors of Sjogren’s

A
  • 1st degree relative = 7x increased risk
  • female
  • > 40
110
Q

Investigations for Sjogren’s

A

Schirmer tear test
- tears travelling <10mm is significant

Rose bengal staining and slit lamp exam

RFs, ANA, anti-Ro, anti-La

111
Q

Management of Sjogren’s

A
  • artificial tears/saliva, vaginal lubricant
  • humidifier, eye drops, mouth wash
  • NSAIDs, hydroxychloroquine (halts progression)
  • M3 agonist → pilocarpine
112
Q

Complications of Sjogren’s

A
  • conjunctivitis
  • corneal ulcers
  • dental cavities
  • candida infections
  • vaginal candidasis
  • sexual dysfunction
113
Q

What is Raynauds phenomenon

A
  • intermittent spasm in arteries supplying fingers and toes
  • usually precipitated by cold and relieved by heat
  • can also be caused by vibrational tools, smoking, beta blockers
  • associated with SLE, RA, systemic sclerosis, dermatomyositis
114
Q

Treatment for Raynauds phenomenon

A
  • protect hands
  • stop smoking
  • CCBs
115
Q

What is systemic sclerosis?

A
  • multisystem autoimmune disease
  • increased fibroblast activity
  • abnormal growth of connective tissue
  • 2 types → limited and diffuse
116
Q

Signs and symptoms of limited systemic sclerosis

A
  • skin involvement limited to hands, face, feet and forearms
  • characteristic beak like nose and small mouth
  • microstomia
117
Q

Signs and symptoms of diffuse systemic sclerosis

A
  • skin changes develop more rapidly and widespread
  • Raynaud’s phenomenon coincident with skin involvement
  • GI, renal, lung involvement
118
Q

Diagnosis of systemic sclerosis

A
  • ANAs
  • anaemia if renal involvement
  • limited → ACAs
  • diffuse → topoisomerase, anti-scl 70
119
Q

Treatment for systemic sclerosis

A
  • avoid smoking
  • handwarmers
  • GI → PPIs, Abs
  • renal → ACEi
  • pulmonary fibrosis → cyclophosphamide
120
Q

What is polymyositis?

A
  • muscle disorder of unknown aetiology

- inflammation and necrosis of skeletal muscle fibres

121
Q

What is dermatomyositis?

A

polymyositis and skin involvement

122
Q

Signs and symptoms of polymyositis

A
  • symmetrical progressive muscle weakness and wasting

- affect proximal muscles of shoulder and pelvic girdle

123
Q

Signs and symptoms of dermatomyositis

A
  • heliotrope discolouration of eyelids
  • scaly erythematous plaques over knuckles
  • arthralgia, dysphagia
  • Raynaud’s
124
Q

Diagnosis of poly/dermato myositis

A

muscle biopsy

bloods → raised

  • serum creatine kinase
  • aminotransferases
  • lactate dehydrogenase
  • aldolase

immunology

  • ANA
  • anti jo1
  • anti mi2
125
Q

Treatment of poly/dermato myositis

A
  • oral prednisolone
  • stronger immunosuppressants
  • symptomatic treatment of skin disease
126
Q

What is antiphospholipid syndrome?

A

antibody mediated acquired thrombophilia

127
Q

Risk factors for antiphospholipid syndrome

A
  • diabetes
  • female
  • HTN
  • obesity
  • SLE
  • oestrogen therapy for menopause
128
Q

Presentation of antiphospholipid syndrome

A
  • thrombosis
  • recurrent miscarriages
  • Livedo reticularis
  • thrombocytopaenia
129
Q

Investigations for anitphospholipid syndrome

A
  • history of thrombosis/pregnancy complications

- antibody screen

130
Q

Treatment of antiphospholipid syndrome

A
  • long term warfarin
  • LMW heparin and aspirin if pregnant
  • lifestyles changes to avoid CVS issues
131
Q

Complications

A
  • VTE
  • arterial thrombosis
  • pregnancy complications
132
Q

What is the most common type of back pain?

A

mechanical

133
Q

Differential diagnoses for back pain

A
  • congenital
  • iatrogenic
  • infection → osteomyelitis
  • trauma → fracture
  • malignancy → multiple myeloma, metastases
  • lifestyle → posture/overuse
  • inflammatoin
134
Q

What types of inflammation can cause back pain

A
  • HLA B27
  • osteoporosis
  • osteoarthritis
  • pyelonephritis
135
Q

What are the red flags for lower back pain

A
  • cauda equina syndrome
  • cancer of the spine
  • spinal fracture → trauma/osteoporotic collapse
  • spinal infection
136
Q

Investigations for back pain

A

bloods

  • inflammatory markers
  • FBC → anaemia, WBC
  • ALP levels

imaging

  • DEXA scan
  • MRI
137
Q

Treatment for mechanical back pain

A
  • analgesia ladder
  • lifestyle advice
  • physiotherapy
138
Q

What is the analgesia ladder?

A
  1. PCM
  2. NSAIDs
  3. weak opiates
  4. strong opiates
  5. neuropathic pain treatment → gabapentin/tricyclic
139
Q

Pathophysiology of granulomatosis with polyangiitis

A
  • small vessel vasculitis
  • affects respiratory tracts and kidney
  • common in late teenage years/early adulthood
140
Q

Presentation of granulomatosis with polyangiitis

A
  • saddle-shaped nose
  • epistaxis
  • crusty nasal/ear secretions → hearing loss
  • sinusitis
  • cough, wheeze, haemoptysis
141
Q

Investigations for granulomatosis with polyangiitis

A
  • high eosinophils
  • histology → granulomas
  • presence of c-ANCA
142
Q

Management of granulomatosis with polyangiitis

A
  • nasal corticosteroid
  • cyclophosphamide

complications of granulomatosis → glomerulonephritis

143
Q

Pathophysiology of Marfan syndrome

A
  • autosomal dominant

- affects gene involved in creating fibrillin

144
Q

Presentation of Marfan syndrome

A
  • tall stature
  • long limbs
  • long fingers
  • hypermobility
  • high arch palate
  • pectus carinatum
145
Q

Investigations for Marfan syndrome

A
  • physical exam

- Ghent criteria

146
Q

Management of Marfan syndrome

A
  • avoid intense exercise/caffeine
  • beta blockers/ARBs
  • annual echo
147
Q

Complications of Marfan sybdrome

A
  • mitral/aortic valve prolapse with regurgitation
  • aortic aneurysms
  • lens dislocations
148
Q

Pathophysiology of Ehlers-Danlos syndrome

A
  • group of inherited connective tissue disorders
  • faulty collagen
  • varied presentation
149
Q

Presentation of Ehlers-Danlos

A
  • joint hypermobility
  • easily stretched skin
  • easy bruising
  • chronic joint pain
  • reoccurring dislocations
150
Q

Investigations for Ehlers-Danlos

A

Beighton score → assesses hypermobility

151
Q

Management of Ehlers-Danlos

A
  • physiotherapy
  • OT
  • psychological support → chronic condition, pain
152
Q

Complications of Ehlers-Danlos

A
  • hernias
  • prolapse
  • aortic root dilation
  • joint pain
  • abnormal wound healing

Phase 2a Resits (10 decks)

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