MSK Flashcards
What are the common primary bone tumours?
- chondrosarcoma
- osteosarcoma
- Ewing sarcoma
Risk factors of primary bone tumours
- previous radiotherapy
- previous cancer
- Paget’s disease
- benign bone lesions
- male>female
Presentation of primary bone tumours
- 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
What is bone pain like in primary bone tumours?
- worse at night
- constant or intermittent
- resistant to analgesia
- may increase in intensity
Investigations for primary bone tumours
- xray
GOLD STANDARD = biopsy
bloods
- FBC
- ESR
- ALP
- lactate dehydrogenase
- Ca2+
- U&E
CT chest/abdomen/pelvis
Management of primary bone tumours
- chemo
- radiotherapy
- surgery → limb sparing/amputation
What is multiple myeloma?
neoplastic proliferation of bone marrow plasma cells
What are common sites of secondary bone tumours?
LEAD KETTLE PBKTL
- prostate
- breast
- kidneys
- thyroid
- lungs
Investigations for secondary bone tumour
bloods
- FBC
- U&E
- ALP
- PSA
imaging
- xray → lytic lesions
- CT scans → metastases
Management of secondary bone tumours
- pain management
- bisphosphonates
- radiotherapy
- chemo
What is fibromyalgia?
- chronic pain syndrome
- widespread over body → 11 out of 18 points
- >3 months
- non-nociceptive pain
- no organic cause
Pathophysiology of fibromyalgia
- unknown
- possibly pain perception or hyper excitability of pain fibres
Presentation of fibromyalgia
- fatigue
- brain fog
- pain
- morning stiffness
Investigations for fibromyalgia
exclude all other differential with bloods and imaging
Management of fibromyalgia
- exercise
- relaxation
- neuropathic pain relief → TCA, gabapentin, pregabalin
- opiates
- CBT
Complications of fibromyalgia
- can really affect QoL
- anxiety, depression, insomnia
- opiate addiction
Pathophysiology of Sjogren’s syndrome
- chronic inflammatory autoimmune disorder
- destruction of epithelial exocrine glands esp lacrimal and salivary glands
Signs and symptoms of Sjogren’s
- dry eyes, mouth, vagina (mucous membranes)
- parotid gland enlargement
- joint pain
- Raynauds
- systemic features
What conditions is Sjogren’s associated with?
- RA
- SLE
- PBC
- scleroderma
Risk factors of Sjogren’s
- 1st degree relative = 7x increased risk
- female
- >40
Investigations for Sjogren’s
Schirmer tear test
- tears travelling <10mm is significant
Rose bengal staining and slit lamp exam
RFs, ANA, anti-Ro, anti-La
Management of Sjogren’s
- artificial tears/saliva, vaginal lubricant
- humidifier, eye drops, mouth wash
- NSAIDs, hydroxychloroquine (halts progression)
- M3 agonist → pilocarpine
Complications of Sjogren’s
- conjunctivitis
- corneal ulcers
- dental cavities
- candida infections
- vaginal candidasis
- sexual dysfunction
What is Raynauds phenomenon
- 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
Treatment for Raynauds phenomenon
- protect hands
- stop smoking
- CCBs
What is systemic sclerosis?
- multisystem autoimmune disease
- increased fibroblast activity
- abnormal growth of connective tissue
- 2 types → limited and diffuse
Signs and symptoms of limited systemic sclerosis
- skin involvement limited to hands, face, feet and forearms
- characteristic beak like nose and small mouth
- microstomia
Signs and symptoms of diffuse systemic sclerosis
- skin changes develop more rapidly and widespread
- Raynaud’s phenomenon coincident with skin involvement
- GI, renal, lung involvement
Diagnosis of systemic sclerosis
- ANAs
- anaemia if renal involvement
- limited → ACAs
- diffuse → topoisomerase, anti-scl 70
Treatment for systemic sclerosis
- avoid smoking
- handwarmers
- GI → PPIs, Abs
- renal → ACEi
- pulmonary fibrosis → cyclophosphamide
What is polymyositis?
- muscle disorder of unknown aetiology
- inflammation and necrosis of skeletal muscle fibres
What is dermatomyositis?
polymyositis and skin involvement
Signs and symptoms of polymyositis
- symmetrical progressive muscle weakness and wasting
- affect proximal muscles of shoulder and pelvic girdle
Signs and symptoms of dermatomyositis
- heliotrope discolouration of eyelids
- scaly erythematous plaques over knuckles
- arthralgia, dysphagia
- Raynaud’s
Diagnosis of poly/dermato myositis
muscle biopsy
bloods → raised
- serum creatine kinase
- aminotransferases
- lactate dehydrogenase
- aldolase
immunology
- ANA
- anti jo1
- anti mi2
Treatment of poly/dermato myositis
- oral prednisolone
- stronger immunosuppressants
- symptomatic treatment of skin disease
What is antiphospholipid syndrome?
antibody mediated acquired thrombophilia
Risk factors for antiphospholipid syndrome
- diabetes
- female
- HTN
- obesity
- SLE
- oestrogen therapy for menopause
Presentation of antiphospholipid syndrome
- thrombosis
- recurrent miscarriages
- Livedo reticularis
- thrombocytopaenia
Investigations for anitphospholipid syndrome
- history of thrombosis/pregnancy complications
- antibody screen
Treatment of antiphospholipid syndrome
- long term warfarin
- LMW heparin and aspirin if pregnant
- lifestyles changes to avoid CVS issues
Complications of antiphospholipid syndrome
- VTE
- arterial thrombosis
- pregnancy complications
