MSK Flashcards by Galvin Chiam

Osteoarthritis signs and symptoms

Asymmetrical joint stiffness(morning)
Joint pain, worse on activity
Weight bearing joint(hip/knee)

Obese, female, occupation

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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

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Osteoarthritis management

Lifestyle
Physio
Occupational therapy
Topical capsaicin
Analgesia: oral paracetamol/topical NSAID, oral NSAID + PPI, opiate
Intra articular steroids
Joint replacement

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RA signs and symptoms

Symmetrical poly arthritis
Joint stiffness, better with activity
Wrist, ankle, MCP, PIP, MTP swelling/tenderness
DIP joints spared

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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

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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

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Ankylosing spondylitis signs and symptoms

Lower back/hip pain/stiffness
AAA
Ulcerative colitis
Male

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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

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Reactive arthritis signs and symptoms

Recent extra-articular infection
Urethritis
Conjunctivitis
Sero-negative arthritis

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Septic arthritis investigations

Non weight bearing
ESR>40
WCC>12
Temp>38

Joint aspiration: positive culture

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Septic arthritis management

Antibiotics
Joint lavage

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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

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Gout management

Flare up:
Colchicine
NSAIDs
Steroids

Prophylaxis:
Allopurinol

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Pseudogout management

Mono/oligoarthritis:
Paracetamol
Intra articular steroids

Poly arthritis:
NSAIDs or colchicine
Paracetamol
Steroids

Surgery:
Joint replacement

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SLE signs and symptoms

Joint pain/inflammation
Malar rash

Young female

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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