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MSK Flashcards

1
Q

What is meant by ‘wear and tear’ arthritis

A

Osteoarthritis

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2
Q

What type of arthritis is worse at the end of the day?

A

Osteoarthritis

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3
Q

What type of arthritis affects symmetrical, swollen, painful small joints?

A

Rheumatoid

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4
Q

What type of arthritis causes pain with movement and background pain at rest?

A

Osteoarthritis

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5
Q

What type of arthritis is worse in the morning?

A

Rheumatoid

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6
Q

What is ‘joint gelling’ associated with osteoarthritis?

A

Stiffness after rest

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7
Q

What joint deformities might be seen in osteoarthritis?

A
  • Heberden’s nodes distally
  • Bouchard’s nodes proximally
  • Tenderness, derangement, swelling
  • Mild synovitis
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8
Q

What would be seen on an X ray of someone with osteoarthritis?

A
  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • subchondral cysts
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9
Q

How is osteoarthritis managed?

A
  • Exercise to improve strength and fitness
  • Weight loss
  • Analgesia inc steroid injections
  • Joint replacement
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10
Q

What joint deformities can occurs in rheumatoid arthritis?

A
  • Early: swollen wrist, MCP, PIP & MTP
  • Later: ulnar deviation of fingers.
    - Wrist sublaxation
    - Boutonniere and swan neck finger deformity
    - Z thumb
    - Rupture of hand extensor tendons
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11
Q

Systemic signs of rheumatoid arthritis?

A
  • Nodules: elbows, lungs
  • Lymphadenopathy
  • Vasculitis
  • Fibrosing alveolitis, obliterative bronchiolitis, pleural effusion
  • Raynauds
  • Splenomegaly
  • Carpal tunnel
  • Scleritis
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12
Q

What gene is rheumatoid arthritis associated with?

A
  • HLA DR4/DR1
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13
Q

What are specific blood markers of rheumatoid arthritis?

A
  • Rheumatoid factor
  • ANCA
  • Anti-CCP
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14
Q

What would be seen on an X ray of someone with rheumatoid arthritis?

A
  • Soft tissue swelling
  • Osteopenia
  • Sublaxation
  • Reduced joint space
  • Bone erosions
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15
Q

What is DAS28 Criteria?

A

For Rheumatoid Arthritis:

  1. Joint involvement
  2. Serology: RF & anti-CCP
  3. Acute reactants: ESR & CRP
  4. Symptoms for more than 6 weeks
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16
Q

How is rheumatoid arthritis managed?

A
  • Aim for <3 Das 28
  • DMARDS: Methotrexate
  • Biologics: TNF alpha inhib
  • Steroids
  • NSAIDs
  • Manage CV risk factors
  • Surgery: reduce pain & deformity - increasing function
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17
Q

What must be ruled out in a hot, swollen joint?

A

Septic arthritis

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18
Q

What are risk factors for septic arthritis?

A
  • Joint disease
  • Recent joint surgery
  • Prosthetic
  • Immunosuppression
  • Diabetes
  • Chronic renal failure
  • Over 80
  • IV drug abuse
19
Q

What signs would there be in septic arthritis?

A
  • Temperature over joint
  • Effusion
  • Very tender to move
  • Pyrexial, tachycardic
20
Q

What are the differentials for a hot, swollen joint?

A
  • Osteoarthritis
  • Septic arthritis
  • Rheumatoid arthritis flare
  • Reactive arthritis
  • Vasculitis
  • Gout
21
Q

What are the investigations for suspected septic arthritis?

A

Bloods: LFTs, clotting, CRP, FBC & CULTURES
X ray
URGENT joint aspiration: synovial microscopy and culture

22
Q

How to managed septic arthritis?

A
  • Empirical ABx: flucloxacillin, vancomycin, cefotaxime
  • Analgesia & splint
  • Drain
23
Q

What are the risk factors for osteoporosis?

A 
Steroids
Hyperthyroidism
Alochol/tobacco
Thin <22 BMI
Testosterone low
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease
Dietary Ca low/ malabsorption, Diabetes type 1
24
Q

When would you not do DEXA scan in suspected osteoporosis?

A

If they are over 75

25
Q

What does osteoporosis of trabecular bone put people at risk of?

A

Crushed vertebra

26
Q

What is the bone mass density in osteoporosis?

A

Reduced: 2.5

27
Q

What does osteoporosis of cortical bone put people at risk of?

A
  • Long bone fractures
28
Q

What is the medical management of osteoporosis?

A
  • Bisphosphonates: Alendronate
  • Calcium & vit D
  • HRT
  • SC Denosumab
29
Q

What changes in lifestyle can help managed osteoporosis?

A
  • Quit smoking & alcohol
  • Weight bearing exercise
  • Balance exercises to reduce risk of falls
  • Diet rich in calcium and vit D
  • Fall prevention
30
Q

What happens in a prolapsed disc?

A

Soft inner nucleus pulposus herniates through fibrous outer layer.
Commonly lumbar

31
Q

What are risk factors for a prolapsed disc?

A
  • Natural weakness
  • Job: lifting/sitting
  • Sports
  • Obesity
  • Smoking
  • Age
32
Q

What are the symptoms of a prolapsed disc?

A
  • Sudden severe back pain
  • Eased by lying flat
  • Exacerbated by moving, coughing and sneezing
  • Nerve root pain/sciatica
33
Q

When may surgery be considered for a prolapsed disc?

A

If symptoms don’t improve over 6 weeks

34
Q

What red flag must you check for in prolapsed disc history?

A

Cauda Equina:

  • Lower back pain
  • Saddle anaesthesia
  • Leg weakness
  • Bowel and bladder issues
35
Q

How is a prolapsed disc managed?

A
  • Exercise and live as normal
  • Pain relief/muscle relaxant: diazepam
  • Physio
  • Surgery
36
Q

What is gout?

A

Deposition of monosodium urate crystals in joints

37
Q

What can cause gout?

A
  • Hereditary
  • Diuretics
  • Increase dietary purines: red meat
  • Alcohol
  • Leukaemia
  • Cytotoxic drugs
38
Q

What can be associated with gout?

A
  • CVD & hypertension
  • Increased plasma urate
  • Diabetes
  • Chronic renal failure
39
Q

What are the signs and symptoms of gout?

A
  • Acute monoarthropathy
  • Severe joint inflammation
  • Metatarsopharyngeal of big toe
40
Q

What investigations should be carried out for gout?

A
  • Polarised light microscopy of synovial fluid

- Raised sodium uvate

41
Q

What may be seen on gout x ray?

A
  • Swelling

- Punched out aromas

42
Q

How is gout managed?

A
  • High dose NSAIDs
  • Allupurinol: preventative
  • Steroids
  • Rest, elevation, ice
43
Q

Complications of gout?

A
  • Tophi

- Renal disease/stones

44
Q

What lifestyle changes can be made to prevent gout?

A
  • Lose weight

- Avoid prolonged fasts, alcohol, purine rich meat and low dose aspirin

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