MSK Flashcards
1
Q
pattern of starting joint pain in osteoarthritis?
A
starts at base of thumb and usually not symetrical
2
Q
predisposition to osteomyelitis?
A
DM
peripheral vascular disease
3
Q
routes of OM?
A
direct inoculation (open wound) - trauma or surgery - anything microbe
contiguous spread - constant surrounding infection in tissues for long time (prosthetic joint + diabetes) - easy access to bones
haematogenous seeding - via blood stream
4
Q
epidemology of haematogenous seeding osteomylitis?
A
in metaphysis of long bones in children
spinal vertebra in adults due to high blood supply
IV drug users
users of dialysis
sickle cells
5
Q
bacteria in sickle cells patients with osteomylitis?
A
salmonella
6
Q
ix for osteomylitis?
A
MRI is more specific for acute
XR can work for chronic
bone biopsy (open is better then needle)
blood cultures
FBC - raised CRP/ ESP
7
Q
tx for septic arthritis?
A
staph aureus - flucloxacillin
analgiasia
prednisolone (from long term steroid use) - double dose if they have infections
splinting
joint wash out
1 septic joint
8
Q
cp for gonococcal artheritis?
A
polyarticular infections
skin lesions
9
Q
genetic predispo for osteoarthritis?
A
COL2A1
10
Q
genetic predispo for RA?
A
HLA DR1 + HLA DR4
11
Q
ENVIROMENTAL RF FOR RA?
A
smoking and preivous infection
12
Q
pathophysiology for RA?
A
citrullination
arginine (found in T2 collagen and vimentin)
converted to citruline
HLA DR1/DR4 causes immune system to not recognise citrulline
relase t cells and plasma cells to cause inflammation in joints - synovial cells proliferation
13
Q
pannus?
A
thick inflammaotry tissue build up in synovial joints - filled with fibroblast, myofibroblasts and inflammatory cells
14
Q
important antibodies in RA?
A
Rheumatic factor
anti CCP
15
Q
cp of RA?
A
SYMmetrical
common MCP, PIP of hands
MTP of feet - progresses to large joints
worse in mornings or after period of no movement
ulnar deviation of fingers
buttonhole fingers - flextion of pip
swan neck deformatiy - flexion of dip
bakers in back of knee
16
Q
felty syndrome
A
triad of RA, splenomegaly, granocytopenia = life threatenting infections
17
Q
scoring system for RA?
A
DAS28
no of swollen joints
no tender joints
measure CRP
> 5.1 high activty
<2.6 remission
18
Q
biologic therpy for RA?
A
ANTI tnf ALPHA therapy
19
Q
surgical options for RA?
A
synovectomy
joint fusion if very severe in wrist
20
Q
xray with RA?
A
LESS
loss of joint space
eorsion of bone
soft tissue swelling
soft bones
21
Q
tx for staph aureus osteomylitis?
A
fusidic acid + vancomysin
22
Q
how to ix for tb osteomylitis?
A
bm biopsy with caseating granuloma +
23
Q
abx for gonnorhea infection?
A
azithromycin and ceftriaxone
24
Q
symptoms of bone tumours?
A
lumps
pressure on nerves
tendons - snapping
joints - limitations of movement
pain - NIGHT /rest
fracture - pathological
b symtpoms - weight loss + fatigue
25
ix for primary bone tumour ?
FBC - raised WCC + ALP
ESR + CRP
1 ST LINE - xray -
2nd line CT or MRI (chest, abdo, pelvis)
definitive -> biopsy - percutaneous
26
MSTS, enneking?
bone tumour staging
grade (g) - low grade G1+ high grade G2
tumour - T1 intracompartmental + extracimpartmental T2
m - M0 none metastasis or M1 metastasis
27
tx for osteochondroma?
excision
28
xray for osteochondroma?
codman's triangle and a sunburst appearance.
29
most common bone tumour?
mulitple myeloma
30
secondary bone cancers that cause osteolysis?
breast and lung
31
cp of multible myeloma?
pain in ribs/ spine
fatigue
32
tests for multible myeloma?
serum protein elextrophoresis - diagnostic
urine sample - bence jones
biopsy - monoclonal plasma cells
rouleaux in blood film - paraproteinaemia
MRI
33
tx for multiple myeloma?
chemotherapy, stem cell transplant, ,dexamethosone
34
ix for secondary bone tumour
mri, ct , bloods, x rays
35
bisphosphonate ?
osteoclast inhibitors - general bone pain in cancer
36
lesions shown on xray in chrondo sarcoma?
moutheaten pattern of bone destruction
37
xray of ewings sarcoma?
onion like layers in long bones
ewww onions
38
mnemonic for sx of reactive arthritis?
cant pee, cant see, cant climb a tree, brown discoloration - keratoderma
urethritis/ balanitis, uveitis, arthritis
39
CP of enteropathic arthritis?
assymetric joint
large joints and peripheral joints
peripheral joint inflammation will go down with treatment of IBD
SPINEACHE
40
ANTIBODY TEST that is sensitive but not specific to SLE?
anti nuclear antibodies (ANA) anti dsDNA is specific
41
ESR and CRP in SLE ?
raised ESR and normal CRP
42
mutation in marfans syndrome?
chromosome 15 mutation on FBN 1 - fibrillin is less abdundant or dysfunctional - less tisue elasticty - effect all body
AUTOSOMAL dominant
excessive tgfbeta - more growth
43
what are features of marfans body habitus ?
tall and thin
Arachnodactyly - long fingers
pigeon breast
aortic complication - abnormal root dilation, AAA
downward slant to eyes
stretch marks
44
eyes and marfans syndrome?
retinol distachment
dislocation of lens upwards
45
tx for slow aortic dilation in marfans syndrome ?
beta blockers
losartan - reduces TGF beta presentation
46
ehlers danlos syndrome?
autosomal dominant effecting collagen of tissues
47
CP of ED syndrome?
hypermobility
stretchy skin
cardiac issues - AAA, mitral regurgitation
weak valves and weak vessels
48
complication of vasculitis?
increase blood coagulation by exposure of collagen and tissue factor - clots + organ ischeamia
wall vessle get weakened - aneurysms
thicker vessle wall with fibrin - reducing diameter of lumen
49
general symptoms of vasculitis?
generlaised symtpoms of inflammation - fever, weight loss, fatigue
50
GCA? epidemology ?
older and women
giant cell arteritis- form of large vessle vasculitis
effect carotid arteries
51
symptoms of GCA?
visual problems- blindless
headaches
pain when chewing food
high ESR
52
takaysu vs GCA ?
T- asian women under 40 yrs - weakened pulse in an arm or leg - more pain in arms and legs
but very similar to GCA
53
kawasaki disease?
med size vasculitis of cornary arteries
54
polyarteritis nodosa?
med size vasculitis
confused to hep B infection
necrosis and fibrosis of vascular walls - aneurysms
string of beads on vascular wall
55
symptoms of PN?
polyarteritis nodosa
abdominal pain - mesentaric ischeamia
htn
nuerological symptoms
skin lesions
prerenal AKI
56
buergers disease?
epidemology ? rf?
small and med vessel vasculitis
clots of fingers and toes - ulcers
men 20- 40 years
smoking!
NOT bergers disease - IgA nephropathy
nephritic syndrome
57
antibody in small vessel vasculitis?
ANCA
antinuetrophilic cytoplasmic antibodies
58
GPA? antibodies?
WEGENERS DISEASE
granulomatosis with polyangitis GPA
release of cANCA
CAUSE GLOMERULONEPHRITIS
59
EPIDEMOLOGY of GPA? SYmptoms?
middle aged men
bloody mucus -ulcers
saddle shaped nose
breathing difficulty
low urine output and htn
60
microscopic polyangitis vs GPA?
MP- doesnt effect nose - no saddle shape
no granuloma
no cANCA - pANCA INSTEAD!
61
CHURG STRAUSS SYNDROME? effects where is body ? antibodies? RF?
EGPA- similar to gpa
causes gi, skin, nerve + heart damage in addition to GPA
asthma is RF
p anca
62
antibodies in henloch schonlein?
IgA antibodies
63
symptoms of HS PURPURA?
PURPURA- palpable red discoloration on skin
abdo pain
heamaturia and IGA nephropathy
64
TX FOR vasculitis?
corticosteroids - prednisone
PPI for protection from long use
ace inhibitors for htn
65
ix for GCA?
raised esr
arterial biopsy - patchy lesion of granuloma
66
ix for PN?
ct angiogram - anal bead arteries
biopsy kidneys - necrosing vasculitis
67
What is the most common vasculitis in childhood?
hsp - Henoch-Schonlein purpura (HSP)
68
pathophysiology of osteoartehritis?
chorndocytes try to repair injury - catabolic are overpowered - lots of inflammation - degrades t2 cartilage - new bone formation (T1 CARTILAGE ) (osteophytes) and ligaments become weak
69
stages of asteoarthritis?
1 - 10% cartilagous loss
2 - osteophytes devlop - joint space narrowin
3 - gaps in cartilage
4 -
70
rf of osteoarthritis?
age over 50+ more common in women - after menopause
genetic - polyarticular
athletes
manuel labour
obesity - low grade inflammation
afrocarribean and asian uncommon for osteoarthritis in hip
LOCAL TRAUMA
71
signs of OA?
boney swelling
synovitis - erosive OA similar to RA
CREPITUS
tenderness
limited rom
RF and anti ccp negative
72
indications for arthroplasty?
uncontrolled pain at night
signifcant reduced ROM
73
why gout unusal in young women?
estrogen increases uric acid secretion
74
uric acid where is it from?
diet
turnover of dna/ rna
75
diet with purine?
alcohol - beer - cider is lower purine
offal - kidney, liver
shellfish
red meat
fructose
76
medications that decrease uric acid excretion?
ketones
lactate
diuretics
aspiriin 75mg
77
acute gout symptoms?
monoarthritis
1st MTPJ classical - podagra
low grade fever
nocturnal symptoms
malaise
78
ix for gout?
joint aspiration and light microscopy - see crystals
serum uric acid decreases in acute gout - can appear normal
xrays normal in acute
gout and infection at same time
79
tx for acute gout?
prednisolone
NSAIDS - COX2 INHIBITORS
colchicine
hydrated
ice
rest
80
prevent hyperureacemia ?
dietary modification - alcohol reduction, loose weight, reduce purine foods
81
urate lowering therapy
allopurinol
febuxostate 2nd line
colchicine - to prevent flare ups
82
what proportion of women over 50 get fracture from osteoporsis?
50%
83
what is a t score?
standard deviation compared to young adults bone density
84
two proprtion of bone other than BMD which contribute to bone strength?
bone size
bone turnover
mineralisation
85
commondrugs for osteoporosis?
bisphophinates
86
osteoporosis ?
decreased bone density t<2.5
not mineralisation
fracture is end product
87
complication of osteoporosis?
hip fracture
multible spinal fractures - vertbral compression fracture
wrist fractures
88
what proportion of men over 50 will have a fracture due to osteoporosis?
20%
89
rf for osteoporosis?
steroids
hyperthyroid/ hyperparathyroid
aalcohol and smoking
t hin low bmi
testerone decrease
e early menopause - low estrogen
renal failure/ liver failure
erosive inflmmation disease - RA, CROHNS
DMT1 malabsorption
90
colle fracture
wrist fractures- women 60 years better reflexes
91
resorption signalling? cells?
load on bone
microfractures from walking
osteoclasts break it down to get repaired
92
low estrogen on bone?
more bone is resorbed by osteoclasts but not osteoblasts cant keep up and replace it - less bone density
93
DEXA pros?
low dose radiation - can be done on children
94
denosumab?
anti reabsorptive medication for osteoporosis
stop rank ligand from getting rank receptor
shuts off bone reabsorption
95
teriparatide?
anabolic tx for osteoporosis
increase bone formation
expensive!!
96
3 triad symptoms of sjogrens syndrome?
dry eyes
dry mouth
arthritis
palaple purpura
97
epidemology of sjogrens syndrome?
f>m
40 - 50 yrs old
98
primary sjorgrens synrome?
not associated with other conditions
99
complication from sjorgens syndrome?
conjuctivits and blepharitis - staph infection
high incidence of dental caries
40 fold increased risk of non hodgkins lymphoma
100
ix and antibodies associated with sjorgens syndrome?
anti - RO
anti - LA
positive RF and ANA
salivary gland biopsy - inflammation due to lymphocytic infiltration
keratoconjunctivitis sicca - dry eyes
schrimer test - tears travelling less than 10 mm
101
tx for sjorgrens syndrome/
SYMTPOMS RELIEF
- articial tears, saliva and lubrication
some steroids
102
Pain in the 1st carpo- metacarpal joints is typical of ?
osteoartritis
103
extra articular features of RA?
Subcutaneous nodules
Episcleritis
Peripheral sensory neuropathy
Pericardial effusion
104
periarticular erosions vs scleroissi?
erosions - breaking down = RA
sclerosis - hardening
105
ehler danos syndrome autoimmune or inherited disease?
inherited
106
platelet count in SLE?
thrombocytopeania
low platelet count
107
tx for SLE ?
antimalarials particularly hydroxychloroquine), sulfasalazine and methotrexate.
108
A 64 year old woman with type 2 diabetes mellitus has been struggling with
cellulitis of her right forefoot for 4 weeks. After making no progress with oral
antibiotics, she has now had 14 days of intravenous flucloxacillin and
co-amoxiclavulanic acid but the pain and erythema persist and her CRP has
only fallen to 47 from its peak of 91. What is the next most appropriate
investigation?
x ray of right foot = osteopenia
osteomylacia
109
Which of the following is the most frequent infecting
organism after hip replacement?
coagulase negative staph
s. epidermis
staph. saprophiticus
110
A 37 year old man with a 10 year history of back pain presents with a “flare”
of symptoms – pain in his lower back radiating out over his buttocks and
down the back of his thighs, and pain between the shoulder blades. Ibuprofen
has been helping significantly. He finds it very difficult to get moving in the
mornings.
Which of the following features would support a diagnosis of inflammatory
back pain?
Pain across the
costochondral joints
111
consequences of falls in old people?
fracture
pain
loss of independace
pneumonia
death
hospitalisation
112
3 phases of pagets disease?
Phase 1 - lytic phase
Osteoclasts which have up to 100 nuclei aggressively demineralise the bone (x20 more than normal).
Phase 2 - mixed phase (lytic and blastic)
Blastic phase - rapid, disorganised proliferation of new bone tissue by a large number of osteoblasts. Collagen deposited in a haphazard way.
Phase 3 - sclerotic phase
New bone formation exceeds bone resorption. The bone is structurally disorganised and weak.
Osteoblastic activity slows down leading to dormant phase - 'burned out state'
113
cp of pagets disease
- Pain - due to bone impinging on nerves
Growth of bones in skull can cause:
- Leontiasis - lion like face
- Hearing loss - narrow auditory foramen and impinge on auditor nerve
- Vision loss - bony overgrowth impinges on optic nerve
- Kyphosis - curved spine
- Lower limb muscle weakness - due to compression of spinal cord
- Pelvic asymmetry
- Bone enlargement - particularly pelvis, lumbar spine, skull, femur and tibia
- Bowlegs - if tibia and femur becomes too weak to support weight
114
tx for paagets disease?
Pain relief
- NSAIDs
Anti-resorptive medication - Biphosphonates e.g. alendronic acid
- Along with calcium and vit D supplementation
- Surgery -
Correct bone deformities
Decompress impinged nerve
Decrease fracture risk
115
blood markers for pagets disease?
ALP - raised
calcium - normal
phosphate - normal/ low
normal - vit d
116
DMARD stands for
Disease-modifying antirheumatic drugs
117
cognitive complications of SLE?
cerebral lupus- dillusional + unremitting headache
118
ix for APS?
lupus anticoagulant
IgG/M + anticardiolipin antibodies
anti b2 glycoprotein antibodies
119
tx for APS? IF pregnant?
1st line - wafarin !!
preg: aspriin + low molecular weight heparin
if no thrombosis - aspirin (preventative)
120
main sx for APS
CLOTS
c - clots - dvt, pe, stroke,
l -Livedo reticularis - A mottled, lace-like appearance of the skin on the lower limbs
o - obs - reccurent misscarriages
t - thrombocytopenia - low platelet
121
medication for gout pts with CKD?
colchicine becuase kidney damage casued by NSAIDS
The NSAID indomethacin is traditionally used first-line. For patients with a high risk of gastro-intestinal side effects, past medical history of chronic kidney disease or heart failure, colchicine may be used.
122
IDE EFFCTS OF BISPHOSPHINATES?
oesphageal ulcers
Nausea
dyspepsia
hypocalceamia
123
how is fibromyalgia different from polymyalgia reumatica?
PMR - raised ESR/ CRP - MAY HAVE NORMOCYTIC ANAEMIA
fibro - no rasied esr/ crp no serological markers
124
tx for PMR?
polymyalgia reumatica -oral prednisolone
125
psuedogout crystals vs gout crystals
CPPD crystals - rod or rhomboid and weak positive bifringence
uric acid crystals - needle sahped and stronge negative
126
epidemology of scleroderma?
mostly females - middle aged
10-20 per 100,000
127
CREST syndrome ?
for scleroderma
C - calcinosis
R - Reynauds
E- oesphageal dismobilty - GORD
S - skin sclerodactyly bright shiny skin of hands and feet consistent with sclerodactyl no prayer sign
T- Telangiectasia.- spider vessels near skin
128
ix for scleroderma?
normal CRP raised ESR
Anti-centromere antibodies (ACA) more associated with limited sclerosis
Anri-Scl-70, anti-topoisomerase and anti RNA polymerase III is most associated with diffuse systemic sclerosis
clinical diagnosis
129
antibodies in dermatomytosis and polymyotiss?
anti JO1 antibodies
anti Mi2 antibodies - only derma
130
gottrons papules?
DERMATOMYOSITIS
scaly erythematous plaques over PIP/DIP joints
shawl distrubtion of rashes
131
BLOOD ix for polymyositis?
CK raised + LDH
anti JO1 antibodies
132
role of chief cells?
secretes pepsin
133
rickets vs osteomalacia?
defective bone mineralisation before ephysieal plate = rickets
after = osteomalacia
134
ix for polymyalgi rhuematica vs GCA?
both raised ESR, clinical features and steroid response
GCA - temporal arterial biopsy (necrosis of media and fragmentation of lamina) with ulstrasound guiding
normochronic anaemia
135
If a patient over 60 develops new onset diabetes mellitus along with weightloss, what diagnosis should you consider?
pancreatic cancer
136
sx for polymyalgia rheumatica?
fatigue
bilateral stiffness and pain in shoulder and pelvic girdle
night sweats
weakness + waisting is absent
137
conditions that mimic polymyalgia rheumatica?
fibromyalgia - no inflammaotry markers or anything abnormal on bloods
hypothyroidism
RA - presence of anti CCP and RF
body myositis -raised CK abnormal muscle biopsy
138
kawasaki vs takayasus disease?
kawasaki - vasculitis of coronary arteries
takayasu - granulomatous inflammation of the aorta, branches, abdominal aorta, pulomnary artery
139
medication rf for gout ?
furosimide - loop diuretic - inhibits sodium reabsoprtion
aspirin - nsaids
140
side effects of corticosteroids?
glaucoma
weight gain
hypertension
insomnia
bone denisty loss
141
causes of osteomalacia ?
vit D defiency - gi malabsorption
hyper pth - too much Ca+ released from bone
Renal failure - no vit D synthesis (25hydroxyvit d -> 1,25 dihydroxyvit d)
liver failure cholecalciferol - 25 hydroxy vit D
142
VIT D pathway?
VITAmin d3 (cholecalciferol) - > 25 hydroxy vit D - > kidneys - > 1,25 dihydroxyvit d (ACTIVE)
143
diagnostic ix for osteomalacia ?
bone biopsy
hypocalcaemia
high pth
serum calcium
LOW 25 HYDROXY VIT d
LOOSER ZONES ON XR bones
144
tx for osteomalacia?
vit D REPLACEMENT - calcitriol
d3 tablets
egg
145
young man painless heamaturia and flank pain , high BP- physical examination is normal
PKD
146
A 60-year-old man presents to his GP with blood in his stools. He has also been experiencing fatigue and
reports unintentional weight loss of a stone over the past month. The GP requests some blood tests,
obtaining the following results:
Hb 120 g/L (130-180)
WCC 14.9 x109
/L (3.6-11.0)
MCV 69 fL (80-100)
Ferritin 18 ng/mL (25-350)
iron defiency anaemia caused by colorectal cancer
147
mechanism of methotrexate?
competetive inhibitor of DHFR essential for purine synthesis
148
why folic acid with methotrexate ? can they given at same time?
Folic acid is required in the synthesis of thymidylate (a pyrimidine) and of purine nucleotides
and thus for DNA synthesis.
Giving the folic
acid on the same day as the Methotrexate would reduce the effectiveness of the Methotrexate
149
GCA tx ?
IV Predisolone + pain management + PPI alongside steroids
150
complication of steroid therapy ?
higher dose more side effects
ulcer
adrenal crisis
hyperglyceamia
diabetes
cushing syndrome
weight gain
osteoporosis
cataracts
thinning of skin
hypertension
151
medication for prevention of gout?
Alopurinol, febuxostat
152
dexa with osteopenia/?
-1.6 t score
153
t score of osteoporos ?
t scor of -2.5 or below
154
RAPD IN RIGHT EYE sign?
A relative afferent pupillary defect is when the affected and normal eye appears to dilate when light is shone on the affected eye
155
4th nerve palsy symptoms?
eye deviated up and out
vertical diplopia
156
Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity, where is the stroke?
posterior cerebral artery
157
CP OF jia?
pain all over body
salmon pink rash
large lymph nodes
spenomegalyitis
uveitis!
158
IX of JIA?
FBC - raised CRP, ESR, ferritin,
no RF and ANA in Stills disease
ANA in oligoarthritis
159
ix of ehler danlos ?
beighton score
hyperextions of joints
easy bruising
abdo pain
gord
Prolapse
160
organ problems in diffuse scleroderma?
cv - coronary artery disease, myocardial fibrosis
lung - pulmonary htn , pulmonary fibrosis (restrictive)
kidneys glomerulonephritis
161
tx for scleroderma?
> Avoid cold triggers - Raynaud's
> Gentle skin stretching - maintain range of motion
> Physiotherapy - maintain healthy joints
> Occupational therapy - adaptations to daily living to cope with limitations
> Nifedipine (CCB) - Raynaud's as it can cause vasodilation
> Lansoprazole (PPI) - GI symptoms
> Analgesia - joint pain
> Ramipril (ACE-inhibitor) - hypertension
162
antibodies in dermatomyositis?
anti JO 1
ANA
anti MI 2
163
sx for dermatomyositis ?
symmetrical proximal weakness
shawl SIGN - shoulder, neck
v sign - chest and front of neck
rash
difficulties sitting up from chair and walking up stairs
muscle aches and pains
dysphagia - swallowing issues
skin - heliotrope rash - butterfly flash
Malor rash
gottron papules ON KNUCKLES! - PATHONUEMONIC FOR DERMATOMYOSITIS
164
ix for dermatomyositis?
CK raised - equivalent to muscle necrosis
ANA
anti JO 1
anti NI 2
ALT/ AST raised
emg - fibrillation
muscle biopsy - inflammation and fibrosis
165
stages of pagets disease?
lytic - excessive osteoclast resorption of bone
mixed - excessive resorption and idsorganised bone formation
blastic - excess osteoblast laying down disorganised bone formation
166
ALP, CALCIUM and phosphate in pagets disease?
ALP high
calcium and phosphate normal
167
tx of GCA visual symptoms?
iv methylpredisolone
168
antibodies specific and senstive to SLE?
SPECIFIC - ds DNA
sensitive - ANA
169
blotching pattern on skin in antiphospholipid syndrome
livido reticularis
170
antibodies in antiphospholipid syndrome
anti cardiolipin antibody
anti beta 2 GP 1
LUPUS ANTICOAGULANT
171
anti cardiolipin antibody positive for?
syphilis
antiphospholipid syndrome
172
ankle vs knee jerk reflex level at spine?
ankle - S1
Knee - l2,3,4
173
extra articular manifestations of RA?
Lung - pleuritis
heart - CHF
skin - ulcers and nodules (splinter haem)
GI - ischeamic bowel
Renal - glomerulonephritis
eyes - uveitis
174
Most common cause of chest pain in adults
Costochondritis
175
Symptoms of costochondritis
Worse on inhalation
Sharp chest pain
Pain on palpation
Pain on upper body excercise
Rule out serious chest pain causes !!
