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MSK > MSK 3a > Flashcards

MSK 3a Flashcards

1
Q

What are the membranes of the capsule ?

A
  • fibrous outer membrane
  • inner synovial membrane
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2
Q

3 features of fibrous outer membrane:
capsular….,
helps with…,
supports….

A

capsular ligament
helps with joint stability
supports underlying synovium

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3
Q

3 features of inner synovial membrane: synovium highly….tissue,
absorbs and ….synovial fluid
mediation of ….

A

vascularised connective

secretes

mediation of nutrient exchange blood -><- joint

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4
Q

Which joints do osteoarthritis commonly affect ?

A

weight-bearing joints e.g. vertebral column, hips , knees

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5
Q

which joints does RA commonly affect ?

A

usually: small joints of hand

other joints in limbs e.g. wrist, elbow, shoulder & vertebral column e.g. cervical spine may also be affected

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6
Q

Rheumatoid arthritis usually affects small joints of the hand , which other joints may also be affected ?

A

joints of limbs e.g. wrist , elbow , shoulder
vertebral column e.g. cervial spine

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7
Q

what are the results of both osteoarthritis and rheumatoid arthritis ?

A

pain
deficient movement (disability)
deformity

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8
Q

non-modifiable risks of osteoarthritis

A

age, female, genetics, joint malalignment

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9
Q

modifiable risks of osteoarthritis

A

obesity, exercise/occupational stress, muscular weakness

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10
Q

Symptoms of osteoarthritis ?

A

insidious onset (slowy progress not obvious symtpoms at first) activity related joint pain

no morning related joint stiffness (<30 mins)

functional impairment

rule out red flags and other arthropathy types

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11
Q

you don’t need to image osteoarthritis to diagnose unless ?

A

features suggest and alternative diagnosis or there are atypical features

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12
Q

Signs of osteoarthritis ?
LOOK , FEEL , MOVE, SPECIAL TESTS

A

LOOK : swelling , deformity (e.g. Bouchard’s & Herbenden’s nodes)

FEEL : warm, tender, may have effusion (fluid , soft feeling), bony protrusions (osteophytes)

MOVE : crepitus, reduced range of motion

SPECIAL TESTS: assess function

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13
Q

OA signs on x-ray:

A

Loss of joint space

Osteophytes-bony overgrowths

Subchondral cysts

Subchondral scleorisis (increased density of bone tissue just beneath the cartilage within a joint)

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14
Q

1st line of management for osteoarthritis ? “core-treatment” & adjuncts alongside core treatment ?

A

EDUCATION : clinical diagnosis, natural history

THERAPEUTIC EXERCISE: local muscle strengthening, education about pain, consider supervised / group exercise

WEIGHT LOSS

adjuncts ALONGSIDE core treatment :

NSAIDs (nonsteroidal anti-inflammatory drugs) + PPIs (proto pump inhibitors) -> lowest dose for shortest time & considering side effects and comorbidities - consider topical (like a cream)

manual therapy for hip and knee OA

no strong evidence for paracetamol (may not be as effective as other treatments)

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15
Q

Why are proton pump inhibitors given with NSAIDs ?

A

when NSAIDs used can increase risk of GI side effects so these medications reduce production of stomach acid, helping to prevent or alleviate GI issues associated with NSAID use

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16
Q

what is 2nd line of management with osteoarthritis ?

A

corticosteroid injection

surgical intervention

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17
Q

How do corticosteroid injections support therapeutic exercise as a 2nd line of management with osteoarthritis ?

A

injections are used as supplementary treatment, addressing both inflammatory component and functional limitations associated with OA

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18
Q

Referral criteria for surgical intervention as 2nd line management of OA ?

A

symptoms are substantially impacting quality of life + failed conservative management

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19
Q

3 examples of joint surgery’s as surgical intervention as 2nd line of management of OA

A

joint preservation surgery e.g. debridement

partial joint replacement - only one side of the joint is replaced

total joint replacement - knee arthoplasty

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20
Q

MDT input for management of osteoarthritis ?

A

physiotherapy
occupational therapy

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21
Q

Rheumatoid arthritis pathophysiology

….. disease
….. condition
…. not completely understood
external trigger in ….. people
production of …..
…. of synovium, thickening of …. and finally destruction of …..

A

chronic systemic inflammatory
auto-immune
pathogenesis
external , geneticlally susceptible
autoantibodies
inflammation , synovial membrane, joint

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22
Q

RA is a systemic disease so it affects more than just the joints, where else is affected ?

A
  • eyes
  • lung
  • cardiovascular
  • mental health e.g. depression
  • osteoporosis
  • anaemia
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23
Q

possible effects of RA on eyes

A
  • scleritis
  • episcleritis
  • sjogren’s syndrome
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24
Q

possible effects on lungs because of RA

A

nodules

pulmonary fibrosis

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25
Q

risk factors of RA ?

A

family history (genetic factors in 60%)
3: 1 female to male
smoking

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26
Q

LOOK , FEEL, MOVE signs of RA ?

A

LOOK : swelling , ulnar deviation , muscle wasting, deformities e.g. swan neck, boutonniere’s deformity, Z deformity of thumbs

FEEL : warm, tender, effusions

MOVE : stiffness, reduced range of movement

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27
Q

special tests for RA

A

difficult forming a fist
painful MCPJ squeeze test

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28
Q

EXTRA-ARTICULAR FEATURES for RA

A

rheumatoid nodules
systemic features
vasculitis
scleritis
renal and lung involvement

29
Q

Name of tool used in rheumatology to help identify individuals who may be at risk of developing RA

A

clinically suspected arthralgia score

30
Q

Management for RA is based on 2 componenets which are what ?

A

prevent deformity
improve pain and function

31
Q

Primary care management for RA ?

A

low dose NSAID cover, rheumatology referral

32
Q

RA management secondary care 1st line

A

oral methotrexate DMARD therapy

+/- bridge with corticosteroid

ideally within 3months of onset of persistent symptoms = early trtmt shown to improve outcomes

33
Q

RA management secondary care 2nd line

A

biologics =

(drugs designed to target specific components of the immune system, prescribed for individuals with moderate to severe RA who haven’t responded to DMARDs)

34
Q

3 situations where RA management includes surgical referral

A

acute tendon rupture

infection

correction deformities e.g. sublimation, malalignment

35
Q

MDT management for RA ?

A

hand therapy
podiatry
nurse specialist
physiotherapy

36
Q

What does the monitoring for RA include ?

A

ensure they have rapid access for flares

how to access specialist care

ongoing drug monitoring

measure functional ability

check for comorbidities e.g.
HTN = hypertension, persistently elevated blood pressure levels
OP = osteoporosis
IHD = Ischemic heart disease
& depression
complications such as vasculitis , eye care

37
Q

Differences between X-ray changes of Osteoarthritis vs Rheumatoid arthritis

A

OA
loss of joint space
oseophytes
subchondral cysts
subchondral sclerosis

RA
loss of joint space
juxta-articular osteoporosis
sublucation
marginal erosions

38
Q

Pathophysiology for Gout ?
acute inflammation as a result of __
urate is a ___

A

acute inflammation as a result of monosodium urate crystals precipitating in the joint

urate is a purine metabolite excreted by renal and GI systems

39
Q

what is tophi ?

A

deposit of uric acid crystals, characteristic feature of advanced gout

40
Q

LOOK , FEEL, MOVE signs of gout ?

A

LOOK: pain , swelling, tophi
FEEL: warm, tender
MOVE: reduced range of motion

41
Q

Blood urate > _ as blood test for investigations for gout ?

A

> 360 micromol/L (6mg/dl)

42
Q

Acute flair management for gout ?

A

rule out red flags -> systemic symptoms: fever, rigors, generally unwell

NSAID e.g. Naproxen (+PPI), colchicine, oral corticosteroid
education

43
Q

prevention management for gout ?

A

CKD, multiple flairs, diuretics, tophi (uric acid crystal accumulation)

allopurinol 2-4 weeks after and acute flair - lifelong treatment, aiming to reduce levels to 360 micromol/L -> promotes excretion of uric acid

44
Q

what does allopurinol promote in gout ?

A

excretion of uric acid

45
Q

Bacteria involved in septic arthritis of neonate ?

A

Staphylococcus aureus
Neisseria gonorrhoeae
Group B streptococcus

46
Q

bacteria involved in septic arthritis of children

A

Staphylococcus aureus

47
Q

bacteria of septic arthritis in adults

A

Staphylococcus aureus
Neisseria gonorrhoeae
Streptococcus pneumoniae

48
Q

bacteria in trauma/ puncture wounds

A

Pseudomonas

49
Q

bacteria in sickle cell septic arthritis z

A

Salmonella

50
Q

Pathophysiology of septic arthritis ?

bacteria involved in septic arthritis for neonate, children , adults
__ in trauma / puncture wounds
__ in sickle cell

A

bacteria involved
neonate : S. aureus, N. gonorrhoeae ( neisseria), Group B streptococcus
children: S. aureus
adults: S. aureus, N. gonorrhoeae , S. pneumoniae (streptococcus)

pseudomonas
salmonella

51
Q

what is haematogenous ?

A

haematogenous = dissemination of infectious agents through body via bloodstream

52
Q

what is direct inoculation ?

A

= introduction of infectious agents directly into body thorugh physical contact or penetration of skin / mucous membranes

53
Q

What is the features of an emergency regarding septic arthritis pathophysiology ?

irreversible….
organism release…
response of…
mortality - approx % ?

A

irreversible joint damage within 6 hours

organism release chondrocyte proteases

host inflammatory response

mortality - approx 10%

54
Q

Risk factors of septic arthritis ?

A

more common in children

immunocompromised

comorbidities: RA, OA, diabetes, skin infections

recent joint surgery / intra-articular injection / prosthetic joint

55
Q

LOOK signs of septic arthritis

A

red, swollen, antalgic gait (walking pattern characterised by a shortened stance phase on the affected side due to pain)/ reluctance to weight bear

56
Q

FEEL signs of septic arthritis

A

warm, tender, effusions

57
Q

MOVE signs of septic arthritis

A

reduced range of movement
systemic signs: fever, tachycardia

58
Q

Investigations for septic arthritis ?

A

Blood tests: FBC, CRP, ESR, blood cultures
Joint aspiration: look, colour, clarity
Micro: MCS, gram stain, crystal analysis, WCC
STI screen : urine / vaginal swab / throat swab/ rectal swab NAATS
Imaging: X-ray

59
Q

What is the kocher criteria as an investigation of septic arthritis ?

A

distinguish septic arthritis from transient synovitis in children with hip pain (each positive increases the likelihood of septic arthritis )

60
Q

what is criteria for kosher criteria as an investigation of septic arthritis?

A

non-weight bearing
temperature > 38.5
ESR > 40
WCC > 12

61
Q

Management for septic arthritis ?

A

empiric IV antibiotics (flucloxacillin + gentamicin)
review antibiotics with culture results

62
Q

list other joint pathologies ?

A

tendonitis
bursitis
ligament and tendon rupture
labral tear
articular cartialge defects
dislocation / subluxation

63
Q

tendonitis ?

A

inflammation of the tendon often when load > capacity

64
Q

bursitis ?

A

inflammation of bursa from trauma, infection, crystalopathy, inflammatory arthropathies

65
Q

labral tear ?

A

fibrocartilage structure lining rim of socket in hip and knee - helps holds the ball and socket in place

66
Q

why is gram staining done on synovial fluid aftern joint aspiration as a investigation for gout ?

A

to rule out septic arthritis

67
Q

Why should allopurinol not be given during acute gout flare ?

A

causes symptoms of gout to worsen

it’s advised to start allopurinol after an acute flare of gout has completely settled

68
Q

4 X-ray changes seen in RA ?

A

periarticular osteopenia - often an early sign (indication of past inflammation around a particular joint)

joint erosions

periarticular soft tissue swelling

joint space narrowing

MSK (25 decks)

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