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Phase 2a > MSK > Flashcards

MSK Flashcards

1
Q

What is ankylosing spondylitis?

A

A chronic progressive inflammatory arthropathy.

It involves radiological changes in the spine and sacroiliac joints, mainly affecting the axial skeleton.

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2
Q

What is the pathophysiology of ankylosing spondylitis?

A
  • Inflammation
  • Cartilage erosion
  • Ossification
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3
Q

What are the risk factors for ankylosing spondylitis?

A
  • Genetics
  • Family history
  • Male sex
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4
Q

What are the signs and symptoms of ankylosing spondylitis?

A
  • Gradual onset back pain
  • Progressive loss of spinal movement
  • Question mark posture
  • Enthesitis
  • Costochondritis
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5
Q

What are the extra-articular manifestations of ankylosing spondylitis?

A
  • Osteoporosis
  • Acute iritis (anterior uveitis)
  • Aortic valve incompetence
  • Apical pulmonary fibrosis
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6
Q

What investigations should be ordered for ankylosing spondylitis?

A
  • Pelvic X-ray (sacroiliitis)
  • Diagnosis made clinically due to late X-ray changes
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7
Q

What are the differentials for ankylosing spondylitis?

A
  • Osteoarthritis
  • Diffuse idiopathic skeletal hyperostosis
  • Psoriatic arthritis
  • Reactive arthritis
  • Infection
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8
Q

What is the aim of treatment for ankylosing spondylitis?

A
  • Prevent disease progression
  • Maximising quality of life
  • Manage symptoms and inflammation
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9
Q

What is the management of ankylosing spondylitis?

A
  • Physio and exercise
  • NSAIDs
  • Anti-TNF (if severe)
  • Bisphosphonates
  • Hip replacement
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10
Q

What are the complications of ankylosing spondylitis?

A
  • Osteoporosis
  • Iritis
  • Cardiac involvement
  • Hip involvement
  • Pulmonary involvement
  • Neurological involvement
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11
Q

What is psoriatic arthritis?

A

A chronic inflammatory condition associated with psoriasis.

Seronegative inflammatory arthritis differentiated from RA by severe clinical features.

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12
Q

What is the pathophysiology of psoriatic arthritis?

A
  • CD8 T-cells play a primary role
  • Angiogenic growth factors are over-expressed
  • Vascular changes and bone changes
  • Cytokines cause activation and proliferation of osteoclasts (erosion and osteolysis)
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13
Q

What are the risk factors for psoriatic arthritis?

A
  • Psoriasis
  • Family history
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14
Q

What is the clinical presentation of psoriatic arthritis?

A
  • Joint pain and stiffness (inc morning stiffness)
  • Peripheral arthritis
  • Dactylitis
  • Pain at sight of tendon attachment
  • Spinal stiffness
  • Reduction of cervical mobility
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15
Q

What are the investigations for psoriatic arthritis?

A

X-ray hands and feet (distal interphalangeal joint erosion)

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16
Q

What are the differentials for psoriatic arthritis?

A
  • Rheumatoid arthritis
  • Gout
  • Erosive osteoarthritis
  • Reactive arthritis
  • Mycobacterial tenosynovitis
  • Sarcoid dactylitis
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17
Q

What is the management of psoriatic arthritis?

A
  • NSAIDs
  • Sulfasalazine, methotrexate etc
  • Anti-TNF
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18
Q

What are the complications of psoriatic arthritis?

A

Cardiovascular disease

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19
Q

What is reactive arthritis?

A

Inflammatory arthritis which occurs after exposure to some GU and GI infections

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20
Q

What is the pathophysiology of reactive arthritis?

A

Immune-mediated syndrome triggered by recent infection:
- T cells attack synovium and other self-antigens through molecular mimicry

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21
Q

What are the causes of reactive arthritis?

A
  • Chlamydia
  • Salmonella
  • Shigella
  • Campylobacter
  • C.diff
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22
Q

What are the risk factors for reactive arthritis?

A
  • Male sex
  • HLA-B27 genotype
  • 20-40 years old
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23
Q

What are the signs and symptoms of reactive arthritis?

A
  • Asymmetrical lower limb oligoarthritis
  • Iritis/conjunctivitis
  • Plaques on soles/palms
  • Painless penile ulceration
  • Enthesitis
  • Mouth ulcers
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24
Q

What investigations are ordered for reactive arthritis?

A
  • X-rays:
  • Sacroiliitis
  • Enthesopathy
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25
Q

What are the differentials for reactive arthritis?

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Rheumatoid arthritis
  • Disseminated gonococcal disease
  • Gout
  • Septic arthritis
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26
Q

What is the management of reactive arthritis?

A
  • NSAID
  • Local steroids
  • Sulfasalazine/methotrexate for relapse
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27
Q

What is osteoarthritis?

A

A degenerative joint disorder:
- Prevalence increases with age
- Degeneration of hyaline cartilage

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28
Q

What is the pathophysiology of osteoarthritis?

A
  • Failure of homeostatic balance of cartilage matrix synthesis and degradation
  • Involvement of other joint structures (eg. bone marrow lesions of subchondral bone)
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29
Q

What are the risk factors for osteoarthritis?

A
  • Age
  • Obesity
  • Local trauma
  • Female sex
  • Genetic predisposition
  • Occupation
  • Inflammatory arthritis
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30
Q

What are the symptoms of osteoarthritis?

A
  1. Pain
    - Often the reason patients seek medical advice
    - May not be present
  2. Functional impairment
    - Walking
    - Activities of daily living
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31
Q

What are the signs of osteoarthritis?

A
  • Alteration in gait
  • Joint swelling (eg. bony enlargement, synovitis)
  • Limited range of movement
  • Deformities
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32
Q

How is osteoarthritis diagnosed?

A

X-ray LOSS:
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts

May additionally be changes to bone contour.

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33
Q

What are the differentials for osteoarthritis?

A
  • Bursitis
  • Gout
  • Pseudogout
  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Avascular necrosis
  • Meniscal tears
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34
Q

What is the conservative management of osteoarthritis?

A
  • Weight loss
  • Less sport, more rest
  • Physio
  • Walking aids and home modifications
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35
Q

What is the medical management of osteoarthritis?

A
  • Analgesia (paracetamol and NSAIDs)
  • Joint injection (local anaesthetic and steroids)
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36
Q

What is the surgical management of osteoarthritis?

A
  • Arthroscopy
  • Arthroplasty
  • Osteotomy
  • Fusion
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37
Q

What is gout?

A

A syndrome categorised by hyperuricaemia and deposition of urate crystals causing an attack of acute inflammatory arthritis.

Can affect any joint.

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38
Q

What is the epidemiology of gout?

A
  • More common in males
  • Increasing age
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39
Q

What is the pathophysiology of gout?

A
  • Inability to metabolise uric acid
  • Urate reabsorbed in kidneys
  • High urate levels → crystal formation → gout
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40
Q

What are the risk factors for gout?

A
  • Age
  • Male
  • Menopause
  • Meat, seafood and beer
  • Diuretics
  • Drugs (aspirin, ciclosporin etc)
  • Genetic disposition
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41
Q

What are the signs and symptoms of gout?

A
  • Rapid-onset severe pain
  • Joint stiffness
  • Few affected joints
  • Cardinal symptoms of inflammation
  • Malaise and systemic symptoms
42
Q

What investigations are ordered for gout?

A
  • Arthrocentesis synovial fluid analysis (High WCC and crystals)
  • Polarised light microscopy
  • Serum uric acid (decreases)
  • X-rays
43
Q

What are the differentials for gout?

A
  • Pseudogout
  • Septic arthritis
  • Trauma
  • Rheumatoid arthritis
  • Reactive arthritis
  • Psoriatic arthritis
44
Q

How are acute attacks of gout managed?

A
  • NSAIDs or COX-2 inhibitors (avoid NSAIDs in patients with CKD)
  • Colchicine
  • Prednisolone
45
Q

What is the conservative management of gout?

A
  • Rest
  • Ice
  • Stay hydrated
  • Continue urate lowering therapy
46
Q

How is gout prevented?

A
  • Urate lowering therapy
  • Dietary modification
  • CV risk assessment and treatment
47
Q

What are the complications of gout?

A
  • Acute uric acid nephropathy
  • Nephrolithiasis
48
Q

What is osteoporosis?

A

Low bone density and micro-architectural defects in bone tissue.

Results in increased bone fragility and susceptibility to fracture.

49
Q

What is the pathophysiology of osteoporosis?

A

The mismatch between osteoclastic bone resorption and osteoblastic bone formation.

Genetic factors have the biggest influence on peak bone mass.

50
Q

What are the risk factors for osteoporosis?

A
  • Prior fragility fracture
  • Female sex
  • White
  • Increasing age
  • Low BMI
  • FHx of maternal hip fracture
  • Post-menopause
51
Q

What are the signs and symptoms of osteoporosis?

A
  • Back pain
  • Kyphosis
  • Impaired vision and gait
  • Imbalance
  • Vertebral tenderness
52
Q

What investigstiond should be ordered for osteoporosis?

A

Dual-energy X-ray absorptiometry (DEXA)

T-score < -2.5 = osteoporosis

(T-score is standard deviation compared with gender-matched young adult average peak bone mass)

53
Q

What are the differentials for osteoporosis?

A
  • Multiple myeloma
  • Osteomalacia
  • Primary hyperparathyroidism
  • Metastatic bone malignancy
  • Vertebral deformities
54
Q

What is the management of osteoporosis?

A
  • Diet and lifestyle
  • Antiresorptive drugs (bisphosphonates, HRT, denosumab)
  • Anabolic drugs (teriparatide)
55
Q

How do anti-resorptive drugs work?

A

Decrease osteoclast activity and bone turnover.

56
Q

How do anabolic drugs work?

A

Increase osteoblast activity and bone formation.

57
Q

What are the complications of osteoporosis?

A
  • Hip/rib/wrist fractures
  • Chronic pain syndrome
58
Q

What is pseudogout?

A

Calcium pyrophosphate arthritis

  • Caused by calcium deposition of calcium pyrophosphate crystals
  • Associated with both acute and chronic arthritis
59
Q

What is the pathophysiology of pseudogout?

A
  • CPP crystals are shed from the cartilage into articular space
  • Unknown how inflammation occurs
60
Q

What are the risk factors for pseudogout?

A
  • Age
  • Injury
  • Hyperparathyroidism
  • Haemochromatosis
  • Family history
61
Q

What are the signs and symptoms of pseudogout?

A
  • Cardinal signs of inflammation
  • Osteoarthritis-like involvement of joints (wrists, shoulders)
  • Sudden worsening
  • Joint effusion
62
Q

What investigations are ordered for the diagnosis of pseudogout?

A
  • Arthrocentesis with synovial fluid analysis (presence of rod-shaped crystals)
  • X-ray of affected joints
63
Q

What are the differentials for pseudogout?

A
  • Acute gouty arthritis
  • Acute septic arthritis
  • Milwaukee shoulder syndrome
  • Osteoarthritis
  • Rheumatoid arthritis
64
Q

What is the management of pseudogout?

A
  • Intra-articular corticosteroids
  • NSAIDs for pain
65
Q

What is rheumatoid arthritis?

A

A chronic inflammatory condition primarily affecting small joints of the hands and feet.

66
Q

What is the pathophysiology of rheumatoid arthritis?

A

Inflamed synovium showing angiogenesis, cellular hyperplasia, and influx of inflammatory cells.

67
Q

What are the signs and symptoms of rheumatoid arthritis?

A
  • Asymmetrical arthritis
  • Cardinal signs of inflammation
  • Morning stiffness (>30 mins)
  • Stiffness improves with exercise
  • Symmetrical pain/stiffness
68
Q

What are the hand deformities associated with rheumatoid arthritis?

A
  • Ulnar deviation
  • Swan neck/Z-thumb
  • Boutonniere deformity
69
Q

What are the extra-articular manifestations of rheumatoid arthritis in the lungs?

A
  • Pleural effusion
  • Fibrosing alveolitis
  • Interstitial lung disease
70
Q

What are the extra-articular manifestations of rheumatoid arthritis in the heart?

A
  • Pericarditis
  • Pericardial rub
  • Raynaud’s
  • Pericardial effusion
71
Q

What are the extra-articular manifestations of rheumatoid arthritis in the eyes?

A
  • Dry eyes
  • Episcleritis/scleritis
72
Q

What are the extra-articular manifestations of rheumatoid arthritis in the nervous system?

A
  • Peripheral sensory neuropathy
  • Compression/entrapment neuropathies
  • Cord compression
73
Q

What are the extra-articular manifestations of rheumatoid arthritis in the kidneys?

A
  • Amyloidosis
  • Nephrotic syndrome
  • CKD
74
Q

What are the extra-articular manifestations of rheumatoid arthritis in the skin?

A

Subcutaneous nodules

75
Q

What investigations are ordered for the diagnosis of rheumatoid arthritis?

A
  • Rheumatoid factor
  • Anti-cyclic citrullinated peptide (anti-CCP) antibody
  • Radiographs (erosions)
  • US (synovitis)
  • X-ray
76
Q

What is seen on an X-ray in rheumatoid arthritis?

A

LESS:
- Loss of joint space
- Erosion
- Soft tissue swelling
- Soft bones (osteopenia)

77
Q

What are the differentials for rheumatoid arthritis?

A
  • Psoriatic arthritis
  • Infectious arthritis
  • Gout
  • Systemic lupus erythematous
  • Osteoarthritis
78
Q

What is the conservative management for rheumatoid arthritis?

A
  • Smoking cessation
  • Reduce weight
  • Exercise
79
Q

What is the medical treatment for rheumatoid arthritis?

A
  • Analgesia (NSAIDs/Cox-inhibitors)
  • Corticosteroids
  • DMARDs (methotrexate)
  • Biological DMARDs
80
Q

What is the surgical management for rheumatoid arthritis?

A

Synovectomy

81
Q

What is septic arthritis?

A

The infection of one or more joints caused by pathogenic inoculation of microbes.

It occurs either by direct inoculation or via haematogenous spread.

82
Q

What are the risk factors for septic arthritis?

A
  • Existing joint problems
  • Artificial joint
  • Medication for RA
  • Skin fragility
  • Immunocompromised
  • Joint trauma
83
Q

What are the signs and symptoms of septic arthritis?

A
  • Cardinal signs of inflammation
  • Acute presentation
  • Fever
  • Usually a single, large joint (may be prosthetic)
84
Q

What are the investigations for septic arthritis?

A
  • Synovial fluid aspirate (presence of micro-organisms)
  • Synovial fluid WCC
85
Q

What are the differentials for septic arthritis?

A
  • Other forms of arthritis
  • Gout and pseudogout
  • Haemarthrosis
  • Trauma
  • Cellulitis
86
Q

What is the management of septic arthritis?

A
  • Antibiotics
  • Therapeutic joint aspiration
  • Analgesia
87
Q

What are the possible complications of septic arthritis?

A
  • Osteomyelitis
  • Joint destruction
88
Q

What is osteomyelitis?

A

An inflammatory condition usually caused by Staph aureus.

Generally limited to one bone but can be at multiple sites, in periphery or axial skeleton.

89
Q

What are the causes of osteomyelitis?

A
  • S. aureus
  • Strep
  • Enterobacter spp
  • H. influenza
  • P. aeruginosa
90
Q

What are the risk factors for osteomyelitis?

A
  • Diabetes mellitus
  • Immunosuppression
  • Alcohol
  • Intravenous drug users
91
Q

What is the clinical presentation of osteomyelitis?

A
  • Reluctance to weight bear (limp)
  • Non-specific pain at site
  • Malaise
  • Systemic symptoms
  • Paravertebral muscle tenderness/spasm
  • Fever
  • Spinal cord nerve root compression
92
Q

How is osteomyelitis diagnosed?

A

Culture from bone biopsy at debridement.

93
Q

What are the differentials for osteomyelitis?

A
  • Septic arthritis
  • Juvenile idiopathic arthritis
  • Reactive arthritis
  • Transient synovitis
  • Cellulitis
  • Necrotising fasciitis
94
Q

What is the management of osteomyelitis?

A
  • Antibiotics
  • Analgesia
  • Immobilise limb
  • Debridement/drainage of abscess
95
Q

What is systemic lupus erythematous?

A

A chronic multi-system disorder commonly affecting women of reproductive age.

Characterised by the presence of antinuclear antibodies and constitutional symptoms.

96
Q

What is the pathophysiology of systemic lupus erythematous?

A

Antigen-driven immune-mediated disease.

T cell dysregulation of B cells leads to auto-immune response.

97
Q

What are the risk factors for SLE?

A
  • Female sex
  • Age 15-45
  • Drugs
  • FHx
  • Smoking
98
Q

What are the signs and symptoms of SLE?

A
  • Rash
  • Fatigue
  • Oral ulcers
  • Fibromyalgia
  • Raynaud’s phenomenon
  • Chest pain
  • Thrombosis
  • Abdo pain (N+V)
99
Q

What types of rash are seen in SLE?

A
  • Malar (butterfly) rash
  • Photosensitive rash
  • Discoid rash
100
Q

What are the differentials for systemic lupus erythematous?

A
  • Rheumatoid arthritis
  • Antiphospholipid syndrome
  • Systemic sclerosis
  • Mixed connective tissue disease
  • HIV
  • Infectious mononucleosis
101
Q

What is the management of SLE?

A
  • NSAIDs
  • Hydroxychloroquine for fatigue
  • Steroid tablets, injections and creams for kidney inflammation and rashes
102
Q

What are the complications of SLE?

A
  • Anaemia
  • Leukopenia
  • Thrombocytopenia
  • Raynaud’s phenomenon

Phase 2a (11 decks)

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