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Phase 2a Green Conditions > 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

Risk factors of osteoporosis

A

SHATTERED

  • steroids
  • hyperthyroid/hyperparathyroid
  • alcohol/tobacco
  • thin
  • testosterone decrease
  • early menopause
  • renal/liver failure
  • erosive/inflammatory bone disease
  • dietary Ca deficiency/DMT1
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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 20-40yrs
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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
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
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
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

33
Q

Management for acute gout

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

Management of chronic gout

A
  1. allopurinol → inhibits xanthine oxidase
  2. febuxostat

consider coprescribing clolchicine with allopurinol for 6 months

35
Q

Signs and symptoms of septic arthritis

A

LIFE THREATENING

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

Causes and risks of septic arthritis

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

What bugs cause septic arthritis?

A
  • S.aureus
  • Neisseria gonorrhoea
  • gram -ve bacteria eg E.coli
  • haemophilius influenza (kids)
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
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
40
Q

Treatment for septic arthritis

A

Sepsis 6

41
Q

What is osteomyelitis?

A

infection of the bone marrow

42
Q

What are the 3 ways of entry for osteomyelitis?

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

Risk factors for osteomyelitis

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

Presentation of osteomyelitis

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

Investigations for osteomyelitis

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

Management for osteomyelitis

A
  • antibiotics
  • supportive care
  • surgery
47
Q

What are the 3 seronegative spondyloarthropathies?

A
  • ankylosing spondylitis
  • reactive arthritis
  • psoriatic arthritis
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
49
Q

What is ankylosing spondylitis?

A
  • inflammation of sacroiliac joints
  • loss of spinal movements
50
Q

Investigations for ankylosing spondylitis

A
  • bloods = HLA B27
  • xray
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
52
Q

Treatment for ankylosing spondylitis

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

54
Q

Treatment for psoriatic arthritis

A

same as ankylosing spondylitis

55
Q

What causes reactive arthritis?

A
  • mainly due to infection
  • think about if someone has an active sexual history
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
57
Q

Investigations for reactive arthritis

A
  • bloods = inflammatory markers
  • imaging to determine extent of damage from enthesitis
58
Q

What inflammatory markers can you see in reactive arthritis bloods?

A
  • RF
  • ANA
  • CRP
  • ESR
59
Q

Treatment for reactive arthritis

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

What is vasculitis?

A

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

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
  • >50yrs
  • North European
  • females
  • 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 is multiple myeloma?

A

neoplastic proliferation of bone marrow plasma cells

69
Q

Pathophysiology of multiple myeloma

A
  • malignant plasma cells produce excess immunoglobulin
  • multiple organ dysfunction esp kidneys
  • 2/3 IgG, 1/3 IgA
70
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
71
Q

Investigations for multiple myeloma

A
  • FBC → normocytic anaemia
  • films → rouleaux formation (RBC aggregations)
  • U&Es → raised Ca, urea, creatinine
  • raised ESR
  • xray → pepper-pot skull, vertebral collapse, fractures
  • serum/urine electrophoresis → bence jones protein band
  • bone marrow biopsy → raised plasma cells
72
Q

Treatment for multiple myeloma

A
  • analgesia
  • bisphosphonates
  • local radiotherapy → reduce focal disease
  • transfusion →
  • fluids/dialysis
  • Abs
  • chemo

Phase 2a Green Conditions (10 decks)

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