MSK Flashcards
Osteoarthritis signs and symptoms
Asymmetrical joint stiffness(morning)
Joint pain, worse on activity
Weight bearing joint(hip/knee)
Obese, female, occupation
Osteoarthritis investigations
Joint crepitus
Bouchard’s, Heberden’s nodes
Squaring of thumb
Varus deformity
X ray:
Loss of joint space
Ostéophytes
Subchondral sclerosis
Subchondral cysts
Joint aspiration: straw coloured, viscous
Osteoarthritis management
Lifestyle
Physio
Occupational therapy
Topical capsaicin
Analgesia: oral paracetamol/topical NSAID, oral NSAID + PPI, opiate
Intra articular steroids
Joint replacement
RA signs and symptoms
Symmetrical poly arthritis
Joint stiffness, better with activity
Wrist, ankle, MCP, PIP, MTP swelling/tenderness
DIP joints spared
RA investigations
Swan neck deformity, Boutonnières deformity
ACD
Bloods: Rh factor, anti-CCP(specific), ESR
X ray:
Periarticular osteopenia and erosions
Soft tissue swelling
Subchondral cysts
RA management
Bridging prednisolone
1: Methotrexate
2: 2x DMARDs
3: 2x DMARDs + TNFi
DMARDs: Methotrexate, leflunomide, sulfasalazine
TNFi: etanercept, infliximab, adalimumab
anti CD20: rituximab
Surgery
Ankylosing spondylitis signs and symptoms
Lower back/hip pain/stiffness
AAA
Ulcerative colitis
Male
Ankylosing spondylitis investigations
Schober’s test(lumbar stiffness)
Tragus to wall
Stress test
HLA B27
X ray: sacroiliac joint fusion, spinous ligament fusion(bamboo spine)
MRI
Reactive arthritis signs and symptoms
Recent extra-articular infection
Urethritis
Conjunctivitis
Sero-negative arthritis
Septic arthritis investigations
Non weight bearing
ESR>40
WCC>12
Temp>38
Joint aspiration: positive culture
Septic arthritis management
Antibiotics
Joint lavage
Crystal arthritis investigations
X ray:
PG->chondrocalcinosis
G->bony erosion, soft tissue swelling
Joint aspiration:
PG: +ve biréfringence, rhombus shaped
Gout: -ve biréfringence, needle shaped
Gout management
Flare up:
Colchicine
NSAIDs
Steroids
Prophylaxis:
Allopurinol
Pseudogout management
Mono/oligoarthritis:
Paracetamol
Intra articular steroids
Poly arthritis:
NSAIDs or colchicine
Paracetamol
Steroids
Surgery:
Joint replacement
SLE signs and symptoms
Joint pain/inflammation
Malar rash
Young female
SLE investigations
ANA: sensitive but not specific
Anti-dsDNA antibody: specific
Sjögren’s syndrome signs and symptoms
Dry eyes
Dry mouth
Parotid gland enlargement
Arthritis
Raynaud’s phenomenon
Sjögren’s syndrome management
Eye drops
Sugar free gum
Steroids
Scleroderma signs and symptoms
CREST syndrome:
Calcinosis cutis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactyly(thickened skin)
Telangiectasia
Dermato/polymyositis signs and symptoms
Dermatomyositis: heliotrope rash
Polymyositis: no rash
Gottron’s papules
Subcutaneous calcinosis
Mechanic’s hands
Associated with malignancy and pulmonary fibrosis
Osteoporosis management
Bisphosphonates
Calcium and vit D
HRT
Osteoporosis signs and symptoms
Multiple fractures
Steroid use, excess alcohol, premature menopause, RA
Osteoporosis investigations
DEXA scan
X ray
Scleroderma investigations
CXR: lung fibrosis
Lung function test: restrictive, reduced gas transfer
High resolution CT thorax: lung fibrosis
ANA, ENA antibodies
Connective tissue disorder management
Steroids
Azathioprine(immuno suppression)
Poly myalgia rheumatica signs and symptoms
Stiffness and pain, worse in early morning
Shoulders and hips
NO WEAKNESS
Polymyalgia rheumatica/giant cell arteritis investigations
ESR: >40mm/h
Raised CRP
GCA:
Temporal artery biopsy
Polymyalgia rheumatica/giant cell arteritis management
1st line: Oral prednisolone 1-2 years
2nd line: Azathioprine if needed
Tocilizumab (GCA)
Osteomyelitis signs and symptoms
Pain and swelling around joint
Fever
Osteomyelitis investigations
X ray: lytic bony destruction, soft tissue swelling
MRI
FBC, CRP
Osteomyelitis management
Flucloxacillin 6/52 (clindamycin if allergic)
Analgesia
Surgical drainage
Osteomalacia/osteoporosis signs and symptoms
OM:
Muscle weakness
Joint/bone pain
Hypocalcaemia: Chvostek’ sign, Trosseau sign
OP:
Fragility fractures
Post menopausal women
Osteomalacia/osteoporosis investigations
OM:
Low vit D
Low Ca
High ALP
High PTH
OP:
DEXA scan: <-2.5
X ray: cortical thinning, increased radiolucency
Osteomalacia/osteoporosis management
OM:
Daily vit D3 supplement
OP:
Vit supplements
Physical therapy, exercise
Bisphosphonate
Strontium ranelate
HRT
SLE management
Hydroxychloroquine
Moderate/severe:
Prednisolone
Methotrexate
Rituximab
Small vessel vasculitis
ANCA associated vasculitis:
Saddle nose, lung/kidney involvement
Immune complex vasculitis:
Purpuric rash, arthritis, kidney involvement
