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MSK Flashcards

1
Q

what is the treatment for ankylosing spondylitis?

A
  • NSAIDs and physiotherapy
  • steroids during flares
  • anti-TNF e.g. infliximab
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2
Q

first line appropriate management for septic arthritis?

A

aspirate the joint and send blood cultures, then immediate antibiotic treatment following determination of causative organism

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3
Q

what features would be seen on an XR of osteoarthritis?

A

LOSS of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts

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4
Q

what is the most specific investigation for RA?

A

anti-citrullinated peptide anti body (anti-CCP)

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5
Q

what is the drug colchicine used for?

A

reduces inflammatory responses e.g. acute gout

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6
Q

what is the drug allopurinol used for?

A

preventative gout drugs - long term and should not be given in a flare up as it can further exacerbate the joint

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7
Q

What is the mechanism of action for bisphosphonates?

A

Inhibit bone resorption through the inhibition of enzyme (Farnesyl Pyrophosphate synthase) which reduces osteoclast activity

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8
Q

what is the first line treatment for osteoporosis?

A

alendronic acid (oral bisphosphonate) and AdCal (vit D and calcium supplement)

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9
Q

what is the second line treatment for osteoporosis?

A

addition of denosumab
- monoclonal antibody which binds to RANK ligand, blocking osteoclast maturation/function/survival, thus reducing bone resorption

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10
Q

list 5 risk factors for septic arthritis

A
  • PMH of other joint disease (e.g. RA)
  • > 80 years old
  • IVDU
  • diabetes mellitus
  • recent joint surgery
  • penetrating trauma
  • prosthetic joint
  • recent intra-articular steroid injections
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11
Q

which primary cancers metastasise to bone?

A

breast, lung, kidney, thyroid, prostate

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12
Q

which antibody is most specific for SLE?

A

anti-dsDNA

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13
Q

which antibody is most sensitive for SLE?

A

antinuclear antibody (ANA)

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14
Q

which class of drugs is the first line medication for osteoporosis?

A

bisphosphonates (e.g. allendronic acid)

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15
Q

how should the first line medication for osteoporosis be taken?

A

allendronic acid should be taken once a week on an empty stomach and the patient should remain upright for at least 30mins following

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16
Q

which joints do Heberden’s nodes occur?

A

distal interphalangeal joints

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17
Q

which joints do Bouchard’s nodes occur?

A

proximal interphalangeal joints

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18
Q

name 4 characteristics of the hands in rheumatoid arthritis

A
  • swan neck deformity
  • Boutonniere deformity
  • ulnar deviation
  • “Z-thumb”
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19
Q

what is the Boutonniere deformity?

A

finger flexed at PIP, hyperextended at DIP, seen in RA

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20
Q

what is the treatment for acute gout?

A

high dose NSAIDs and corticosteroids, e.g. colchicine

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21
Q

describe the 3 phases of pathophysiology of Paget’s disease

A
  • lytic phase: excessive osteoclastic resorption
  • mixed phase: excessive resorption and diagnosed bone formation
  • blastic (latent) phase: osteoblasts lay down excess disorganised, weak bone
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22
Q

blood results of Paget’s?

A

everything normal except raised ALP

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23
Q

give 4 complications of Paget’s disease

A
  • skull thickening
  • osteosarcoma
  • fractures
  • tibial bowing
  • deafness
  • high output cardiac failure
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24
Q

first line treatment for management of Paget’s?

A

bisphosphonates (e.g. alendronic acid)

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25
Q

proper term for temporal arthritis?

A

chronic granulomatous large vessel vasculitis, mainly affecting carotid artery and its branches

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26
Q

first line of action for large vessel vasculitis when presenting with vision loss and why?

A

urgent, high dose corticosteroids to prevent further blindness (due to lack of ophthalmic artery blood flow)

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27
Q

give the 4 diagnostic criteria for large vessel vasculitis (temporal)

A
  • > 50 years
  • temporal artery abnormality (e.g. tender/decreased pulse)
  • abnormal biopsy
  • elevated ESR (> 50mm/hr)
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28
Q

what condition associated with large cell vasculitis can cause stiffness in muscles in shoulder area and hips?

A

polymyalgia rheumatica

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29
Q

what type of hypersensitivity reaction is systemic lupus erythematosus?

A

type III

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30
Q

give 6 signs of SLE

A
  • discoid rash
  • pleuritis
  • peritonitis
  • myocarditis
  • oral / mucosal ulcers
  • alopecia
  • lupus nephritis
  • photosensitivity
  • anaemia
  • migraines
  • seizures
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31
Q

what marker is used to monitor SLE?

A

ESR

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32
Q

how do you treat arthralgia / skin symptoms associated with SLE?

A

hydroxychloroquine (+- NSAIDs +- corticosteroids)

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33
Q

list some presentations of antiphospholipid syndrome

A
  • recurrent miscarriages
  • recurrent DVTs
  • PEs
  • livedo reticularis: blotchy pattern on skin
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34
Q

what would blood results show for someone with antiphospholipid syndrome?

A

prolonged APTT

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35
Q

give 3 antibodies associated with antiphospholipid syndrome

A

lupus anticoag, anti-cardiolipin, anti-beta2GP1

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36
Q

antiphospholipid syndrome could give a false positive result for which condition?

A

syphilis - due to anti-cardiolipin Ab

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37
Q

most common age and gender for fibromyalgia?

A

female; 30-60y

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38
Q

what four categories must be considered when presented with “back pain”?

A
  • symptoms associated with cauda equina
  • symptoms of spinal fracture
  • cancer red flags
  • symptoms of infection
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39
Q

2 risk factors for osteomalacia?

A
  • decreased sun exposure (less vit D activation)
  • decreased dietary vit D (less available for bone mineralisation)
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40
Q

which reflex is lost with a nerve root lesion at s1?

A

ankle jerk

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41
Q

list 5 presentations of cauda equina syndrome

A
  • bilateral leg neuropathy
  • new urinary / faecal retentions and/or incontinence
  • perianal or perineal sensory loss
  • poor anal tone PR
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42
Q

list 5 presentations of spinal fracture

A
  • sudden onset
  • high impact trauma
  • structural deformity
  • point tenderness over vertebral body
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43
Q

what condition does Shober’s test help diagnose?

A

ankylosing spondylitis

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44
Q

most common cause of osteomyelitis?

A

staph aureus EXCEPT in patients with sickle cell disease, otherwise salmonella

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45
Q

what would Ewing’s sarcoma show on an XR?

A

onion skin appearance, lytic bone lesions

46
Q

what would an osteosarcoma show on an XR?

A

“sunray spiculation”, Codman’s triangle

47
Q

XR of rheumatoid arthritis?

A

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

48
Q

risk factors for osteoporosis? (hint: SHATTERED)

A
  • Steroids
  • Hyperthyroid / Hyperparathyroid
  • Alcohol / tobacco
  • Thin - low BMI
  • Testosterone
  • Early menopause
  • Renal / liver failure
  • Erosive / inflammatory bone disease
  • Dietary Ca2+ decrease / DMT1
49
Q

is osteoarthritis symmetrical or asymmetrical?

A

asymmetrical

50
Q

common presentations of Paget’s disease in a q?

A

hearing loss, pelvic pain, raised ALP

51
Q

4 common presentations of fibromyalgia?

A

“pain all over”, headaches, poor concentration, sleep disturbances

52
Q

features of cauda equina syndrome?

A
  • can be progressive
  • bilateral sciatica
  • perianal or perineal sensory loss
  • decreased anal tone on PR
  • new urinary / faecal retentions / incontinence
53
Q

list 4 causes of osteomalacia

A
  • vit D deficiency
  • renal failure
  • inheritance
  • liver disease
54
Q

what is the first line treatment for neuropathic pain?

A

amitriptyline

55
Q

Which is the genetic component most associated with ankylosing spondylitis?

A

HLA-B27

56
Q

Which medication can cause recurrence of gout?

A

thiazide diuretics increase urate reabsorption in the proximal tubules, predisposing those to gout

57
Q

which nerve root is responsible for the knee jerk reflex?

A

L4

58
Q

what 2 infections are most likely to lead to reactive arthritis?

A

chlamydia and campylobacter jejuni

59
Q

gram negative rod-shaped microorganisms that cause septic arthritis in IVDU?

A

pseudomonas aeruginosa

60
Q

what does the joint pain presentation typically look like in reactive arthritis?

A

symmetrical and polyarticular

61
Q

common presentations of reactive arthritis in a q?

A
  • dactylitis: “sausage fingers” (inflammatory condition associated with spondyloarthropathies)
  • DIPJ involvement
  • presence of psoriasis or a 1st degree relative with
62
Q

XR of pseudogout?

A

chondrocalcinosis -> calcification parallel to articular surfaces

63
Q

Which antibody in the typical screen used in the diagnosis of Sjogren’s syndrome is most specific?

A

anti-La

64
Q

is minimal change disease seen more commonly in adults or children?

A

children

65
Q

why is methotrexate teratogenic?

A

it is a folic acid inhibitor -> crucial in neurodevelopment so inhibition will cause a miscarriage

66
Q

which nerve is responsible for wrist drop and Saturday night palsy?

A

radial nerve

67
Q

describe the crystals in pseudogout

A

positively birefringent rhomboid-shaped crystals

68
Q

what is a normal DEXA T score?

A

-1 to +1

69
Q

what is an osteopenic DEXA T score?

A

-1 to -2.5

70
Q

what is an osteoporotic DEXA T score?

A

< -2.5 (severely: < -2.5 AND a known pathological fracture)

71
Q

Name 3 genes associated with an increased risk of SLE

A
  • HLA B8
  • HLA DR2
  • HLA DR3
72
Q

Name 4 features of SLE that are required to make a clinical diagnosis

A

4 of … (remember as ‘A RASH POINTS AN MD’)
- Arthritis
- Renal disorder
- ANA+
- Serositis
- Haematological disorder
- Photosensitivity
- Oral ulcers
- Immunological disorder
- Neurological disorder
- Malar rash
- Discoid rash

73
Q

What are 2 lifestyle changes that can be performed by the patient to reduce symptoms in SLE?

A
  • Decrease sunlight exposure
  • Wear high factor sunblock
  • Decrease cardiovascular risk factors (Obesity, Smoking, Exercise, Cholesterol)
74
Q

What medications should be given for an acute attack of SLE and what route should they be given?

A

IV cyclophosphamide and prednisolone

75
Q

What causes the articular cartilage damage in osteoarthritis?

A

Apoptosis of chondrocytes leads to decreased cartilage production/increased cartilage breakdown 🡪 loss of cartilage, this causes clefts in the articular surface.

76
Q

Name 2 joints that are commonly affected in Osteoarthritis

A

Interphalangeal joints
- Carpometacarpal joints
- Metatarsophalangeal joints
- Vertebra
- Hips
- Knees

77
Q

Give 2 surgical treatment options for Osteoarthritis

A
  • Arthroscopy / Arthroplasty
  • Osteotomy
  • Fusion
78
Q

Give 3 characteristics of osteoarthritis that can be used to differentiate between rheumatoid arthritis.

A
  • Pattern of joint involvement / Asymmetrical joints affected
  • Absence of systemic features
  • Morning stiffness <30mins
79
Q

Give 3 risk factors for osteoarthritis.

A
  • Joint hypermobility
  • Insufficient joint repair
  • Diabetes
  • (increasing) Age
  • Gender (female)
  • Genetic predisposition
  • Obesity
  • Occupation
  • Local trauma
  • Inflammatory arthritis
80
Q

give 4 differentials for a patient being HLA-B27 positive

A

ankylosing spondylitis, psoriatic, reactive and enteropathic arthritis

81
Q

what scoring system is used for fractures involving the growth plate of bones in children?

A

Salter-Harris classification

82
Q

what is the difference between T/Z scores in DEXA scans?

A

T: bone density compared to healthy 25 y/o of same sex
Z: bone density compared to healthy same age same sex

83
Q

what is a FRAX score measuring?

A

the likelihood of a fracture in the next 10 years

84
Q

what is a common side effect of alendronic acid?

A

oesophagitis

85
Q

what is Sjogren’s syndrome?

A

immune destruction of exocrine glands

86
Q

presentations of Sjogren’s syndrome?

A

arthritis, dry eyes, dry mouth

87
Q

common test used to diagnose Sjogren’s syndrome?

A

Schirmer’s test - placing a small strip of paper in the eye to measure tear production

88
Q

what XR sign is most commonly seen in psoriatic arthritis?

A

pencil in cup

89
Q

RF for pseudogout?

A

parathyroidectomy, IV fluids -> can both derange calcium levels

90
Q

what is the first sign on XR seen in ankylosing spondylitis?

A

sacroiliitis

91
Q

features of ankylosing spondylitis?

A
  • gradual onset back and buttock pain
  • relieved slightly by exercise
  • psoriasis
  • dactylitis
  • IBD
  • eye involvement
92
Q

name the causative molecules of gout and pseudogout

A

gout: monosodium urate
pseudogout: calcium pyrophosphate

93
Q

state 4 causes of reduced urate excretion

A

elderly, post menopausal females, HTN, impaired renal function

94
Q

state 3 causes of excess urate production

A

dietary, dehydration, genetic disorders

95
Q

What is the treatment for gout if NSAIDs are contraindicated?

A

colchicine

96
Q

what does DEXA stand for?

A

Dual Energy Xray Absorptiometry

97
Q

fbc in osteoporosis?

A

normal calcium, phosphate and ALP

98
Q

fbc in osteomalacia?

A

low calcium, low phosphate, high ALP

99
Q

what parts of the skeletal system are inflamed in ankylosing spondylitis?

A

spine, rib cage, sacroiliac joints

100
Q

what are vertebral syndesmophytes?

A

bony proliferations due to enthesitis between ligaments and vertebra

101
Q

give 2 examples of something that would indicate a worse prognosis for those with ankylosing spondylitis

A

onset <16y, early hip involvement, poor NSAID response

102
Q

what is the mechanism of action of NSAIDs (e.g. naproxen)?

A

non-selective inhibitors of COX1 and COX2 enzymes

103
Q

Give two potential extra-articular manifestations of ankylosing spondylitis

A

5 A’s:
- anterior uveitis
- autoimmune bowel disease
- apical lung fibrosis
- aortic regurgitation
- amyloidosis

104
Q

What bedside test can be used to assess mobility in the spine?

A

Schober’s test

105
Q

Describe some aspects of how you perform Schober’s test and what is a positive result?

A
  • Have the patient stand,
  • locate L5 vertebrae
  • mark a point 10cm above and 5cm below
  • Ask the patient to bend over forwards as far as they can and measure the distance between the two points
  • A distance of less than 20cm indicates reduced lumbar movement
106
Q

Give three potential findings on X-ray of the spine of a patient with ankylosing spondylitis

A

bamboo spine, subchondral sclerosis, ossification, fusion of joints

107
Q

give 1 topical and 2 oral management options of OA

A
  • topical: NSAIDs
  • oral: paracetamol, bisphosphonates
108
Q

what is dermatomyositis?

A
  • a rare disease that causes muscle weakness and skin rash.
  • Symptoms include a red or purple rash on sun exposed skin and eyelids, calcium deposits under the skin, muscle weakness, and trouble talking or swallowing.
  • “trouble going up stairs”
109
Q

what is cut to release pressure on the median nerve?

A

transverse carpal ligament

110
Q

top differential for pagets disease?

A

osteomalacia

111
Q

name 3 bones paget disease affects

A

femur, skull, vertebrae, pelvis

112
Q

DMARDS: what do they stand for? what does it target? give an example

A
  • Disease Modifying Anti Rheumatic Drug
  • inflammatory cytokines
  • methotrexate

past questions (11 decks)

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