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phase 2 > MSK > Flashcards

MSK Flashcards

1
Q

What is rheumatology

A

Medical management of musculoskeletal disease, mainly inflammatory

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2
Q

What are the three classes of inflammatory MSK

A

Autoimmune, crystal arthitis and infection

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3
Q

What are the two classes of non inlammatory MSK

A

Degenerative and non degenerative

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4
Q

Examples of autoimmune inflammatory MSK disorders

A

Rheumatoid arthitis, spondyloarthropathy (HLA B27) and connective tissue disease

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5
Q

Example of degenerative non inflammatory MSK disorders

A

Osteoarthritis

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6
Q

Example of non degenerative non inflammatory MSK disorders

A

Fibromyalgia

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7
Q

What is vasculitis

A

systemic inflammation of the blood vessels

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8
Q

What is the tell tale sign of bone pain

A

Pain at rest and at night

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9
Q

What are the causes of bone pain

A

Tumour, infection and fracture

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10
Q

What is the tell tale sign of inflammatory joint pain

A

Pain and stiffness in joints in the morning, at rest and wirth use

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11
Q

What are the causes of inflammatory joint pain

A

Inflammation or infection

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12
Q

What are the tell tale signs of osteoarthritis

A

Pain on use, at end of the day

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13
Q

What are the tell tale signsof neuralgic pain

A

Pain and paraesthesia in a dermatomal distribution, made worse by specific action

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14
Q

What is paraesthesia

A

Abnormal sensation, typically a tingling or prickling feeling

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15
Q

What causes neuralgic pain

A

Root or peripheral nerve compression

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16
Q

What is the tell tall sign of referred pain

A

Pain unaffected by local movement

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17
Q

Distal interphalyngeal arthritis cause

A

Osetoarthritis or psoriatic arthritis

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18
Q

Base of the thumb arthritis cause

A

Osteoarthritis

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19
Q

Proximal interphalangeal arthritis cause

A

Rheumatoid arthritis

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20
Q

Which arthrites does not affect the spine or hips

A

Rheumatoid

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21
Q

Which arthritis affects the shoulder

A

Rheumatoid

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22
Q

What are unique features of psoariatic arthritis

A

Enthesitis and dactylitis

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23
Q

Describe the chronicity of gout

A

Comes on quickly and is episodic but can become chronic over time

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24
Q

Describe the chronicity of reactive arthritis

A

Acute event, will peak and then slowly decline

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25
Q

Describe the chronicity of rheumatoid arthritis

A

Can be brought on by traumatic event (e.g bereavement), will fluctuate but gradually worsen over time

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26
Q

Describe the chronicity of palindromic rheumatoid arthritis

A

Episodic but does not go completely

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27
Q

What is enthesitis

A

Inflammation of a tendon

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28
Q

What is dactylitis

A

Inflammation of a digit

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29
Q

Is rheumatoid arthritis inflammatory or degenerative

A

Inflammatory

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30
Q

Is osteoarthritis inflammatory or degenerative

A

Degenerative

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31
Q

What causes swan neck deformity

A

Extensor tendons pulling in the distal phalyngeal joint

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32
Q

What is ankylosing spodylitis and spondyloathropathy

A

Fusing of the spine

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33
Q

What are the hand features of rheumatoid arthritis

A

Ulnar deviation, swan neck deformity and erosion on XRay

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34
Q

What are the hand features of osteoarthritis

A

Bouchards and Heberdens nodes on IPJs

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35
Q

Which other joint is distinctive of osteoarthritis

A

The knee

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36
Q

What are the features of connective tissue disease

A

Non erosive arthritis and butterfly rash

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37
Q

What are the features of SLE disease

A

Photo sensitivity and mouth ulcers

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38
Q

Where is gout most common

A

Big toe 1st MTPJ

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39
Q

What is the most severe form of gout

A

Chronic polyarticular tophaceous gout

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40
Q

What is ESR practically

A

Rate that red blood cells settle to the bottom of a test tube after centrifugation. High ESR due to high fibrinogen an acute phase protein

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41
Q

False positives for ESR

A

Old, female, obese, SE Asia, hypercholesterolaemia, high immunoglobulins, anaemia

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42
Q

Which disease causes high immunoglobulins

A

Myeloma

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43
Q

What is C-reactive protein (CRP)

A

Pentameric peptide made in response to IL-6 by the liver (High at 6hrs, peaks at 48)

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44
Q

When is CRP better than ESR

A

CRP rises and falls quickly so can see acute inflammation

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45
Q

Define autoantibodies

A

Immunoglobulins that bind to self antigens

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46
Q

Which two factors will be raised in rheumatoid arthritis

A

Rheumatoid factor (RF) and Cyclic citrullinated peptide (CCP)

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47
Q

Which two factors will be raised in SLE

A

antinuclear antibody (ANA) and dsDNA (double stranded DNA)

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48
Q

What does anti nuclear antibody do

A

Binds to antigens within cell nucleus

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49
Q

What has the blood serum been screened for to give a serum positive or serum negative response

A

Rheumatoid factor

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50
Q

What is HLA-B27 and which diseases is it associated with

A

Human leukocyte antibody- B27. Associated with seronegative spondylosing arthropathies

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51
Q

What is rheumatoid factor

A

Autoantibody against the Fc portion of IgG, made by B cells

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52
Q

Define osteomyelitis

A

Infection localised to bone

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53
Q

Why are gentamycin beads used

A

To avoid the systemic side effects but treat infection locally

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54
Q

What type of osteomyelitis do children get

A

Haematogenous

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55
Q

What type of osteomyelitis do adolescents and adults get

A

Contiguous (from trauma)

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56
Q

Why do older patients get osteomyelitis

A

DM/PVD/ arthroplasties

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57
Q

What are the three ways you can get osteomyelitis

A

Direct innoculation, contiguous spread of infection to bone and haematogenous seeding

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58
Q

Where is haematogenous seeding in children vs adults

A

Children- long bone Adults- vertebrae. Due to good blood flow at metaphysis in children and vertebra in old

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59
Q

What are risk factors for bacteraemia

A

Central lines, dialysis, sickle cell disease, urethral catheterisation, UTI

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60
Q

Why is osteomyelitis more common in the metaphyses of child long bone

A

More blood flow and slower blood flow, Endothelial basement membranes and phagocytic linings are missing

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61
Q

Which three bacteria are common in osteomyelitis

A

Staph aureus, coagulase negative staphylococci (S. epidermidis) and aerobic gram negative bacilli

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62
Q

Which bacteria is a cause of osteomyelitis in sickle cell disease

A

Salmonella

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63
Q

Which bacteria are causes of osteomyelitis in IV drug users

A

Pseudomonas aeruginosa and serratia marcescens

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64
Q

Which acute histopathological changes occur in osteomyelitis

A

Inflammatory cells, oedema, vascular congestion and thrombosis of small vessels

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65
Q

Which chronic histopathological changes occur in osteomyelitis

A

Sequestra of bone, involucrum, neutrophil exudates, lymphocytes and histiocytes

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66
Q

What are sequestra of bone

A

Necrotic bone sections

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67
Q

What are involucrum of bone

A

New bone growth sections

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68
Q

Symptoms of osteomyelitis

A

Dull pain at the site of osteomyelitis which comes on over several days and may be aggravated by movementq

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69
Q

What are the systemic signs of osteomyelitis

A

Fever, rigors, sweats and malaise

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70
Q

What are signs of acute osteomyelitis

A

tenderness, warmth, erythema and swelling

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71
Q

What are the signs of chronic osteomyelitis

A

Tenderness, warmth, erythema and swelling; draining sinus tract; non healing deep ulcers and fractures

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72
Q

Define septic arthritis

A

The infections breaks through the cortex and discharges

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73
Q

How is osteomyelitis seen on xray

A

cortical erosion, periosteal reaction, mixed lucency, sclerosis, sequestra, soft tissue swelling

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74
Q

Causes of avascular necrosis of the bone

A

Trauma, steroid, radiation, bisphosphonate use

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75
Q

Surgical treatment of OM

A

Debridement, hardware placement or removal

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76
Q

What is debridement

A

The removal of damaged tissue or foreign objects from a wound

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77
Q

What investigate is needed for TB OM

A

Biopsy essential

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78
Q

What determines how long the treatment should be in osteomyelitis

A

Vascular supply and microbial virulence

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79
Q

What type of bacteria most commonly causes prosthetic joint infection

A

Gram positive

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80
Q

What is listeria monocytogenes associated with

A

Meningitis and sepsis in pregnancy

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81
Q

What does DAIR procedure for infected prosthetics stand for

A

Debridement, antibiotics and implant retention

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82
Q

Is resistance of bacteria permanent

A

No the genes take energy to maintain so sometimes the bacteria will ditch the resistance

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83
Q

How long do contaminants of the lower limb take to grow

A

7 days

84
Q

How long do contaminants of the upper limb take to grow

A

10 days

85
Q

Where do propionibacteria infect

A

From the chest upwards. skin commensal.

86
Q

What are the two main things important in prosthetic joint infection diagnosis

A

History and examination. Also XRays, blood tests and microbiology culture

87
Q

What would you expect to hear in a prosthetic joint infection history

A

Slow to heal after the operation, recent dental work

88
Q

Can you aspirate someone on antibiotics

A

No, they should have been off antibiotics for two weeks

89
Q

When is antibiotic suppression used for prosthetic joint infection

A

When the patient is unfit for surgery and the organism has been identified

90
Q

Does one or two stage exchange joint prosthesis infection tend to be more effective

A

Two stage as there is a delay between removal and implantation. There is a greater range of prosthesis as you are going into a clean area.

91
Q

In a history what does PC stand for

A

Presenting complaint

92
Q

In a history what does HPC stand for

A

History of presenting complaint

93
Q

In a history what does PMH stand for

A

Past medical history

94
Q

In a history what does DH stand for

A

Drug history

95
Q

In a history what does SH stand for

A

Social history

96
Q

In a history what does FH stand for

A

Family history

97
Q

What does a gradual onset of knee pain suggst

A

Osteoarthritis

98
Q

Investigations for osteoarthritis

A

Bloods and radiographs (standing AP and lat)

99
Q

What are the four things you see on XRay for osteoarthritis

A

Joint space narrowing, subchondral sclerosis, subchondral cysts, osteophytes

100
Q

What are osteophytes

A

Bony projections associated with cartilage degradation at joints

101
Q

What is osteoarthritis treatment

A

Analgesia, physio, walking aids, therapeutic injection and arthroplasty

102
Q

What is arthroplasty

A

Surgical reconstruction or replacement of a joint

103
Q

What is classified as intracapsular in the hip

A

Above the line between the greater and lesser trochanters. The head and neck.

104
Q

What is a type 1 intracapsular hip fracture

A

Fracture isnt all the way through the bone

105
Q

What is a type 2 intracapsular hip fracture

A

Fracture is all the way through the bone but hasnt moved

106
Q

What is a type 3 intracapsular hip fracture

A

Complete fracture and slight displacement

107
Q

What is a type 4 intracapsular hip fracture

A

Complete fracture and complete displacement

108
Q

How many degrees of mobilisation are normally lost with hip fracture

A

One degree

109
Q

Being able to get out of bed into a chair reduces your chance of

A

Chest infection and blood clots

110
Q

What is TARN

A

Trauma audit research network, collect data on hospital performance

111
Q

What is a closed fracture

A

Where the skin is intact

112
Q

What is an open fracture

A

Where the skin is not intact

113
Q

What is a simple fracture

A

A fracture of the bone only, where the bone is broken into two sections

114
Q

What is a comminuted fracture

A

A fracture where the bone is broken into more than two pieces

115
Q

What is an intraarticular fracture

A

Involves the joint

116
Q

What is an extraarticular fracture

A

Does not involve the joint

117
Q

What kind of force is a spiral fracture associated with

A

Torsional

118
Q

What is a segmented fracture

A

Where the bone is broken at two levels within the same bone

119
Q

How is a fracture treated

A

Analgesia, examination (neurovascular before and after examination), reduce, immobilise, rehabilitate (RIR)

120
Q

Name four methods of holding the fracture

A

Cast, splint, brace, halo

121
Q

Name four methods of holding the fracture internally

A

Wires, screws, plates and nails

122
Q

Name three types of external fixation frame

A

Monolateral, hybrid or circular frames

123
Q

Define osteoporosis

A

A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

124
Q

What proportion of women over 50 will have an osteoporotic fracture

A

50%

125
Q

What proportion of men over 50 will have an osteoporotic fracture

A

20%

126
Q

What is a T score

A

Standard deviation score which compares your bone density with a gender matched young adult average

127
Q

What are the most commonly used drugs for osteoporosis

A

Bisphosphonates

128
Q

Name activities of daily living

A

Eating, bathing, dressing, toileting, transferring and continence

129
Q

What determines bone quality

A

Bone turnover, architecture and mineralisation

130
Q

What determines BMD

A

Peak bone mass and rate of bone loss

131
Q

What determines bone strength`

A

Bone size, quality and BMD

132
Q

What is the most important independent risk factor for fracture

A

Age

133
Q

Where is most bone mass added during childhood

A

Mainly limbs

134
Q

Where is most bone mass added during puberty

A

Spine

135
Q

When does bone mass peak

A

25

136
Q

What is a colles fracture

A

Distal forearm where broken end of the radius is bent backwards

137
Q

Top three types of fracture in men and women over 60

A

1-hip 2-vertebrae 3-colles’

138
Q

Is trabecullar or cortical bone remodelled more in bone remodelling

A

Trabecullar because it has a larger surface area

139
Q

What is trabecullar bone also known as

A

Cancellous

140
Q

What happens to trabecullae bone with age

A

Thinner (especially the horizontal non weight bearing), less connections, more porous, less strength

141
Q

Why are horizontal trabecullae lost more than verticle

A

Mechanoreceptors detect stress and maintain strength in the weight bearing direction

142
Q

What is the eular buckling theory

A

Loss of horizontal trabecullae leads to a 16x loss in bone strength

143
Q

What are common causes of osteoporosis apart from menopause

A

Inflammatory disease, endocrine and medication

144
Q

What DXA bone mass density is used for diagnosis of osteoporosis

A

T score below 2.5

145
Q

What are the two classes of drugs used in treatment

A

Antiresorptive and anabolic

146
Q

What does a T score of less than -1 suggest

A

Normal bone mass density

147
Q

What does a T score of -1 to -2.5 suggest

A

Osteopenia

148
Q

What does a T score of more than -2.5 suggest

A

Osteoporosis

149
Q

What does a T score of more than -2.5 with fracture suggest

A

Severe osteoporosis

150
Q

Why is inflammatory disease a cause of osteoporosis

A

Inflammatory cytokines increase bone resorption

151
Q

Which hormones increase bone turnover

A

Thyroid and parathyroid

152
Q

Which hormone causes bone resorption and induces osteoblast apoptosis

A

Cortisol

153
Q

Which hormones reduce/control bone turnover

A

oestrogen and testosterone

154
Q

What syndrome is associated with increased cortisol

A

Cushings

155
Q

What effect does reduced skeletal loading have on bone

A

Reduced skeletal loading increases resorption

156
Q

What affect do thyroid hormones have on osteoclasts

A

Drive their metabolism

157
Q

What can cause excess cortisol

A

Excess treatment or endogenous like cushings

158
Q

What can cause hypogonadism or menopause

A

Treatment for prostate disease, chemo, excess exercise

159
Q

What is depoprovera

A

Progesterone only contraceptive

160
Q

Why is alcohol a risk factor for osteoporosis

A

Directly poisons your osteoblasts

161
Q

Why is smoking a risk factor for osteoporosis

A

Drives Vitamin D metabolism

162
Q

FRAX criteria

A

Age, sex, weight height, previous fracture, parent fractured hip, current smoking, glucocorticoids, RA, secondary osteoporosis, more than 3 alcohol units, femoral neck BMD

163
Q

What should you do if you have bad menopausal symptoms and osteoporosis

A

Take HRT until 60

164
Q

Risks of HRT

A

Breast cancer, stroke, CVD, venous thrombo-embolic disease, vaginal bleeding

165
Q

HRT reduces your risk of which cancer

A

colon

166
Q

Whats the first line treatment for osteoporosis

A

Bisphosphonates such as alendronate

167
Q

How do bisphosphonates act

A

Inhibit farnesyl pyrophophate synthase in the cholesterol pathway

168
Q

How does denosumab act

A

Monoclonal antibody to RANK ligand

169
Q

What is teriparatide

A

Synthetic PTH used as first line anabolic treatment

170
Q

What is the index condition of crystal arthropathy

A

Gout

171
Q

What is a homogenous solid

A

Ions bonded closely in ordered, repeating, symmetric arrangement

172
Q

What are crystals in the kidney and liver called

A

Nephrolithiasis (stones)

173
Q

Which type of crystals cause gout

A

Urate

174
Q

Which type of crystals cause pseudogout

A

Calcium pyrophosphate

175
Q

What is crystal arthropathy

A

arthritis caused by crystal deposition in the joint lining

176
Q

Diagnosis of crystal arthropathy

A

Based on history, pattern, aspiration of joint to look for crystals, blood tests and XRays

177
Q

How do gout crystals appear in synovial fluid

A

Negatively befringement needles

178
Q

How do pseudogout crystals appear in synovial fluid

A

Positively befringement rhomboids

179
Q

What type of arthritis is from acute inflammation from crystals

A

Gouty arthritis- gout attack

180
Q

What type of arthritis is from long term deposition of crystals

A

Tophaceous gout

181
Q

Why is the gender gap in gout reducing

A

Due to gout caused by medications such as diuretics

182
Q

Which enzyme is needed to convert purines to uric acid

A

Xanthine oxidase

183
Q

What are the two purines

A

Adenine and guanine

184
Q

How is uric acid excreted

A

2/3 renal, 1/3 intestinal

185
Q

What is the main cause of hyperuricaemia

A

underexcretion

186
Q

What are causes of underexcretion of uric acid

A

Alcohol. obesity, diabetes. Renal impairment, HTN, metabolic hyperthryoid and drugs

187
Q

Which drugs cause underexcretion of uric acid

A

Low dose aspirin, diuretics, cyclosporin, tacrolimus, ethambutol, pyrazinamide

188
Q

What are causes of overproduction of uric acid

A

Metabolic syndrome (hyperlipidaemia), proliferative (myeloproliferative disease, cytotoxic drugs), psoriasis, lesch-nyhan syndrome, diet

189
Q

What foods cause an overproduction of uric acid

A

Excess alcohol, meat, shellfish, offal, gravy, meat extract, yeast, fructose sweetened drinks

190
Q

How do you treat an acute attack of gout

A

Antiinflammatories. NSAIDS, colchicine and steroids

191
Q

Who are the main group that get pseudogout

A

Old women

192
Q

How do you see gout on an XRay

A

Periarticular punched out erosions

193
Q

Why do you get tophi in the early cartilage

A

Because the blood supply is slow

194
Q

Define tophi

A

Onion like aggregates of urate crystals with inflammatory cells

195
Q

Name a xanthine oxidase inhibitor used in the treatment of gout

A

Allopurinol

196
Q

What is pyrophosphate arthropathy

A

Pseudogout

197
Q

Define pyrophosphate arthropathy

A

Deposition of calcium pyrophosphate crystals on joint surface

198
Q

What do calcium pyrophosphate crystals in a young person suggest

A

Metabolic disease. Haemachromatosis

199
Q

What is present on xray in pseudogout

A

Chondrocalcinosis

200
Q

Pseudogout is most common in which two joints

A

Knee and wrist

201
Q

How to distinguish OA from pyrophophate arthropathy

A

Pattern of involvement, marked inflammatory component and superimposition of acute attacks

202
Q

What causes an acute pyrophosphate arythropathy attack

A

Most are spontaneous but they can be caused by trauma, illness, surgery or fluids

203
Q

When should you suspect metabolic disease in pyrophosphate arthropathy

A

Early onset (<55), polyarticular, frequent recurrance. Other clinical clues

204
Q

Who gets calcium hydroxyapatite crystals

A

Older women

205
Q

Which bone cancers are most common in the young

A

Euings sarcoma and osteosarcoma

206
Q

What makes a lump a red flag

A

Tender, enlarging, deep to fascia, above 5cm in diameter

phase 2 (17 decks)

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