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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
risk factors of RA ?
family history (genetic factors in 60%) 3: 1 female to male smoking
26
LOOK , FEEL, MOVE signs of RA ?
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
27
special tests for RA
difficult forming a fist painful MCPJ squeeze test
28
EXTRA-ARTICULAR FEATURES for RA
rheumatoid nodules systemic features vasculitis scleritis renal and lung involvement
29
Name of tool used in rheumatology to help identify individuals who may be at risk of developing RA
clinically suspected arthralgia score
30
Management for RA is based on 2 componenets which are what ?
prevent deformity improve pain and function
31
Primary care management for RA ?
low dose NSAID cover, rheumatology referral
32
RA management secondary care 1st line
oral methotrexate DMARD therapy +/- bridge with corticosteroid ideally within 3months of onset of persistent symptoms = early trtmt shown to improve outcomes
33
RA management secondary care 2nd line
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
3 situations where RA management includes surgical referral
acute tendon rupture infection correction deformities e.g. sublimation, malalignment
35
MDT management for RA ?
hand therapy podiatry nurse specialist physiotherapy
36
What does the monitoring for RA include ?
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
Differences between X-ray changes of Osteoarthritis vs Rheumatoid arthritis
OA loss of joint space oseophytes subchondral cysts subchondral sclerosis RA loss of joint space juxta-articular osteoporosis sublucation marginal erosions
38
Pathophysiology for Gout ? acute inflammation as a result of __ urate is 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
what is tophi ?
deposit of uric acid crystals, characteristic feature of advanced gout
40
LOOK , FEEL, MOVE signs of gout ?
LOOK: pain , swelling, tophi FEEL: warm, tender MOVE: reduced range of motion
41
Blood urate > _ as blood test for investigations for gout ?
> 360 micromol/L (6mg/dl)
42
Acute flair management for gout ?
rule out red flags -> systemic symptoms: fever, rigors, generally unwell NSAID e.g. Naproxen (+PPI), colchicine, oral corticosteroid education
43
prevention management for gout ?
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
what does allopurinol promote in gout ?
excretion of uric acid
45
Bacteria involved in septic arthritis of neonate ?
Staphylococcus aureus Neisseria gonorrhoeae Group B streptococcus
46
bacteria involved in septic arthritis of children
Staphylococcus aureus
47
bacteria of septic arthritis in adults
Staphylococcus aureus Neisseria gonorrhoeae Streptococcus pneumoniae
48
bacteria in trauma/ puncture wounds
Pseudomonas
49
bacteria in sickle cell septic arthritis z
Salmonella
50
Pathophysiology of septic arthritis ? bacteria involved in septic arthritis for neonate, children , adults __ in trauma / puncture wounds __ in sickle cell
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
what is haematogenous ?
haematogenous = dissemination of infectious agents through body via bloodstream
52
what is direct inoculation ?
= introduction of infectious agents directly into body thorugh physical contact or penetration of skin / mucous membranes
53
What is the features of an emergency regarding septic arthritis pathophysiology ? irreversible.... organism release... response of... mortality - approx % ?
irreversible joint damage within 6 hours organism release chondrocyte proteases host inflammatory response mortality - approx 10%
54
Risk factors of septic arthritis ?
more common in children immunocompromised comorbidities: RA, OA, diabetes, skin infections recent joint surgery / intra-articular injection / prosthetic joint
55
LOOK signs of septic arthritis
red, swollen, antalgic gait (walking pattern characterised by a shortened stance phase on the affected side due to pain)/ reluctance to weight bear
56
FEEL signs of septic arthritis
warm, tender, effusions
57
MOVE signs of septic arthritis
reduced range of movement systemic signs: fever, tachycardia
58
Investigations for septic arthritis ?
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
What is the kocher criteria as an investigation of septic arthritis ?
distinguish septic arthritis from transient synovitis in children with hip pain (each positive increases the likelihood of septic arthritis )
60
what is criteria for kosher criteria as an investigation of septic arthritis?
non-weight bearing temperature > 38.5 ESR > 40 WCC > 12
61
Management for septic arthritis ?
empiric IV antibiotics (flucloxacillin + gentamicin) review antibiotics with culture results
62
list other joint pathologies ?
tendonitis bursitis ligament and tendon rupture labral tear articular cartialge defects dislocation / subluxation
63
tendonitis ?
inflammation of the tendon often when load > capacity
64
bursitis ?
inflammation of bursa from trauma, infection, crystalopathy, inflammatory arthropathies
65
labral tear ?
fibrocartilage structure lining rim of socket in hip and knee - helps holds the ball and socket in place
66
why is gram staining done on synovial fluid aftern joint aspiration as a investigation for gout ?
to rule out septic arthritis
67
Why should allopurinol not be given during acute gout flare ?
causes symptoms of gout to worsen it's advised to start allopurinol after an acute flare of gout has completely settled
68
4 X-ray changes seen in RA ?
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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