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Phase 2a Summaries > MSK > Flashcards

MSK Flashcards

1
Q

What is the mechanism of action of bisphosphonates?

A

Reduce bone turnover by inhibiting osteoclasts and promoting apoptosis

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2
Q

Give an adverse effect of bisphosphonates?

A

Oesophagitis can occur when taken orally

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3
Q

What is the mechanism of Allupurinol?

A

Xanthine oxidase inhibitor which blocks metabolism of xanthine to uric acid

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4
Q

What is the most common side effect of Allupurinol?

A

Skin rash

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5
Q

What are the side effects of colchicine?

A

GI distrubances, myalgia, fever

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6
Q

How does methotrexate work?

A

Inhibits folic acid synthesis which is required for DNA and protein synthesis

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7
Q

Which biologic agent is used in osteoporosis to reduce fractures?

A

Denusomab

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8
Q

Which drug is used in poly and dermatomyositis?

A

Azathiproine

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9
Q

Which joints does osteoarthritis commonly affect?

A

CArpo-metacarptal joint, DIPJ, Knees

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10
Q

Which two signs do you see in the hands of an OA patient?

A

Heberdens at DIP , BOuchards at PIP

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11
Q

Give 3 non-pharmacological management of OA?

A

Phsyiotherapy, muscle strength, splints, walking aids, heat and cold packs

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12
Q

Give 2 pharmacological OA treatment methods?

A

Analgesia (paracetamol)

Intra articular steroids or hyaluronic acid

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13
Q

What are the risk factors for septic arthritis?

A

Pre-existing joint disease, immunosuppression, prosthetic joints, diabetes (sensation loss in feet), renal failure, old age, skin breaks

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14
Q

Which organisms commonly cause septic arthritis?

A

Staph aureus, neisseria gonococcus , E,coli, neisseria gonorrhoea

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15
Q

Which antibiotics are commonly given in septic arthritis?

A

Flucoaxcillin - vancomycin (if MRSA)

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16
Q

Which bones are commonly affected by osteomyelitis in a) adults and b) children?

A

a) Vertebrae and pelvis

b) Long bones - often acute

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17
Q

What are the causes of osteomyelitis in adults?

A

IVDU, immunosuprresion, underlying disease, TB

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18
Q

What is deposited in the joints in gout?

A

Monosodium urate crystals

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19
Q

What is deposited in pseudo gout?

A

Calcium pyrophosphate

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20
Q

What are the risk factors of pseudo gout?

A

Ilness, surgery, trauma, hyperparathryoidisim, haemachromatosis, diabetics, hypophospahataemia

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21
Q

What does SHATTERED stand for?

A

Steroid use, hyperthyroidism, alcohol and smoking, testosterone decrease, thin, early menopause renal ir liber failure, erosive/inflammatory bone disease and dietary calcium low

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22
Q

Which treatment methods prevents osteoporosis in post menopausal women?

A

HRT or raloxidene which is a selective oestrogen receptor modulator

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23
Q

What is teriparatide?

A

PTH to prevent fractures occurring

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24
Q

What is the first line bisphosophonate used in osteoporosis?

A

Alendronate

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25
Q

Name 5 risk factors of gout?

A

Dehydration, diet (shellfish and red meat), drug induced eg diuretics, secondary to renal disease, hereditary

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26
Q

what X-Ray changes are typically seen in rheumatoid arthritis?

A

Loss of joint space,
Soft tissue swelling,
Peri-arctular erosions

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27
Q

What are the classic 3 features seen in reactive arthritis?

A

Urethritis, arthritis and conjunctivitis

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28
Q

What are the classic 3 features seen in septic arthritis?

A

Fever, reduced range of movement and pain

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29
Q

Give 3 signs of OA?

A

Joint tenderness, crepitus, limited ROM, joint instability

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30
Q

Give 3 occasions where there is an increased production of uric acid?

A

Myeloproliferative disorders cytotoxic drugs, severe psoriasis

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31
Q

What are the first 3 treatment methods in acute gout?

A
  1. Protest, rest, ice and elevate joint
  2. NSAID or coaching
  3. Joint aspiration and intra-articular steroids
  4. Short should cortiscoeroids or single IM injection
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32
Q

Which drug do you give if intolerant to allupurinol in prevention of gout?

A

Febuxostat

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33
Q

What would you see on an X-Ray of pseudo gout?

A

Calcium deposition in soft tissue

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34
Q

Why are women of child bearing age not given methotrexate?

A

Is teratogenic

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35
Q

Other than methotrexate name 2 other DMARDS>

A

Sulfasalazine, hydrocholquine

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36
Q

In what percentage of patients is Rheuatoid factor positive in for RA patients?

A

70%

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37
Q

What is sublaxation and what disease is it seen in?

A

Partial dislocation of joint, seen in RA

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38
Q

What is the pathophysiology of RA?

A

Synovial proliferation, inflammatory infiltration- pannus of inflamed synovial forms which leads to damage of underlying cartilage by blocking nutrition

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39
Q

Where does RA commonly affect?

A

Symmetrical, Metocarpalphalangeal, PIP, wrist or MTP, tensysynotivits or bursitis may be common

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40
Q

Give 5 extra-articular involvement of RA?

A

Pericarditis, amyloidosis, pulomary fibrosis, scleritis, peripheral sensory neuropathy, sjogrens and raynauds

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41
Q

Give 3 non-pharmacological management steps of RA?

A

Physiotherapy, podiatry, psychological support

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42
Q

Name 3 pharmacological methods to treat RA?

A

DMARDS, corticosteroids, Anti-TNF (etanercept), B-cell depleted (rituximab)

43
Q

What are syndemophytes and what condition are they seen in?

A

Bony growth growing in ligament (can cause vertebral fusion) seen in Ank Spon

44
Q

Name 4 factors that all spondyloarthropathies are associated with?

A
  1. Axial inflammation
  2. Assymetrical peripheral arthritis
  3. Absence of rheumatoid factor
  4. HLA- B27
45
Q

What are the patterns of joint involvement in spondyloarthropathy?

A

Inflammation of sacroiliac joint and spine, asymmetrical large joint oligioarthritis or mono arthritis

46
Q

What is enthetesis and what condition are they seen in?

A

Inflammation at the point of insertion of tendons or ligaments to bone

47
Q

Give 3 signs of ankylosing sponydlitits?

A

Kyphosis, enthesisi, neck hyperextension, loss of spinal movement, pain radiates to buttocks/hips, decreased chest expansion, , relieved by exercise, question mark posture

48
Q

Name 4 symptoms you see in adults under 50 that would indicate ankylosing spondylitis?

A

Morning stiffness >30
Improvement with exercise
Wakening in 2nd half of night
Alternating buttock pain

49
Q

Name 3 sings you would see on an X-ray of ankylosing spondylitis?

A

Sacroilitis, syndesmophytes, bony proliferations, calcification of ligaments (bamboo spine)

50
Q

Give an example of two infections that lead to reactive arthritis?

A

Urethritis (chlamydia)

Dysentry (camplobacter, shigella, salmonella)

51
Q

Give 5 features of reactive arthritis?

A

Iritis, keratoderma blenorrhagia, circinate balantis (penile ulceration), mouth ulcers

52
Q

What are the 5 patterns of involved of psoriatic arthritis?

A 
Arthritis mutilans 
Assymetrical oligioarthritis 
Spinal arthritis 
Symmetrical polarthritis 
DIP joint arthritis
53
Q

Give 3 features of psoriatic arthritis?

A

Oncholysis (peeling of nails)

Dactylitis

54
Q

What would you see on an X-ray of psoriatic arthritis?

A

Erosive changes with pencil in cup deformity

55
Q

What are the 3 ways septic arthritis can develop?

A

Local spread from adjacent tissues, direct inoculation eg penetrating injury or surgery , hamatogenous (synvovium = septic arthritis, metaphysis = osteomyelitis)

56
Q

What are three investigations you would do in septic arthritis?

A
  1. Urgent joint aspiration
  2. Blood cultures
  3. Plain X-Ray and CRP
57
Q

Which phamalogical treatment would you use in Raynauds?

A

Nifedipine (calcium channel blocker)

58
Q

What is Raynauds disease?

A

Peripheral digital iscahemia due to vasospasm

59
Q

Give 3 secondary causes of raynauds?

A

Connective tissues disease, occupation (vibration tools), drug induced (beta blocker)

60
Q

What antibodies are seen in SLE?

A

ANA - Anti-Nuclear antibodies

61
Q

Name 6 signs of SLE?

A

Phosensitivity, malar rash, ANA, arthritis, oral ulcers, bloods (all low)

62
Q

In what disease is the ESR high but CRP low?

A

SLE

63
Q

What is the management of SLE?

A

Avoid sunlight & smoking.
NSAIDs & corticosteroids for arthralgia.
Acute severe flares - IV prednisolone + IV cyclophosphamide
Chronic Mx: NSAIDS + hydroxychloroquine

64
Q

What is the presentation of polymyositis?

A

Difficulty squatting, walking up and down stirs, raising hands above head

65
Q

What do you see in dermatomyositis>

A

Macular rash on back and shoulder, heliotrope rash on eye lids, subcutaneous calcifications

66
Q

How do you detect limited systemic sclerosis?

A

Anti-centromere

67
Q

How do you detect diffuse systemic sclerosis?

A

Anti- topoisomerse and anti-Ro

68
Q

What are the causes of anti-phospholipid syndrome? (CLOT)

A

Coagulation defect, lived reticular, obstetric problems, thrombocytopenia

69
Q

What is the immediate management of giant cell arteritis?

A

Prednisolone

70
Q

What is seen in the blood in GPA?

A

c-ANCA

71
Q

What is Churg-strauss syndrome?

A

Asthma + eosinophilia + vasculitis

72
Q

What is the gold standard diagnosis for Cauda- Equina?

A

MRI

73
Q

What is the function of the articular cartilage?

A

Reduce friction and shock absorption

74
Q

Which rheumatological condition is DIP sparing?

A

DIP sparing

75
Q

What does it mean if you have rheumatoid factor in RA?

A

Progression of the disease will be quicker

76
Q

What is the pathophysiology of osteoarthritis?

A

Wear and tear - imbalance of articular cartilage damage and repair, increases metalloproeteases - osteophytes

77
Q

What are the risk factors of OA?

A

Age, female, genetics, obesity, joint trauma, RA, occupations

78
Q

How do diuretics cause gout?

A

Decreased excretion of uric

Switch from diuretics to losartan

79
Q

Where does septic arthritis most commonly affect?

A

Knee

80
Q

What does the SPINEACHE stand for in ankylosing spondylitis?

A

Sausage digit, psoriasis, inflammatory back pain, NSAID good response, enthesitis, arthritis, Chrons, , HLA B27, Eye (anterior uvitriis)

81
Q

What are the 4 spondyloarthropathies?

A

Psoriatic, Enterohepatic, Ankylosing spondylitis, reactive arthritis

82
Q

How do you diagnose ank soon?

A

Sacrolilitis (XR?MRI) + Spinach

83
Q

Why do you get a low Hb in Ank Spon?

A

Anaemic of chronic disease

84
Q

What are the first 3 line treatments for Ank Spin?

A

Exercise and physio, NSAIDS, Anti-TNF

85
Q

Give 4 investigations in reactive arthritis?

A

Bloods, stool culture if diarrhoea, STI screen, X-ray

86
Q

Which disease do you rest and splint the joint?

A

Reactive arthritis

87
Q

What is the epidemiology of SLE?

A

Women, Afro-caribbean/asian, EBC, Drugs, UV light

88
Q

Which biological therapy is used in SLE?

A

Rituximab (anti-CD20)

89
Q

What are the diagnostic criteria of SLE (MD SOAP BRAIN)?

A

Malar rash, discoid rash, serositis (pericarditis), oral ulcers arthritis, phosensitivity, blood (all low), renal disorder, ANA (+ve 90%), immunological (anti-dsDNA), neurological (seizures)

90
Q

Which antibody is seen in anti-phospholipid syndrome?

A

Anti-cardiolipin antibody

91
Q

What is the treatment of anti-phospholipid?

A

Manage RF: Smoking weight, diet, exercise, HTN, DM

92
Q

What is the sicca complex?

A

Dry eyes and ears

93
Q

What is the treatment of sjogrens syndrome?

A

Artificial tears, sugar free pastilles, frequent drinks

NSAIDS for arthlagia

94
Q

How do you treat pulmonary hypertension?

A

Sildefanil

95
Q

Which drugs is contraindicated in Rayndauds?

A

Propanaolol

96
Q

In systemic sclerosis where is skin involvement limited to?

A

Face, hands and feet

97
Q

What disease would you expect in symmetrical proximal muscle weakness?

A

Polymyositis, dermatomyositis

98
Q

Which disease would you see increased muscle enzymes?

A

Polymyositis, dermatomyositis

99
Q

What emergency presentation occurs in giant cell arteritis?

A

Ischaemic optic neuritis

100
Q

Where does polymysia rheumatic commonly affect?

A

Shoulders and pelvic girdle

101
Q

How does Wegners affect the Kidneys?

A

Glomerulonephritis - haematuria

102
Q

What is fibromyalgia commonly associated with?

A

Sleep disturbance, IBS, chronic headache, depression, chronic fatigue syndrome

103
Q

What are the 4A’s in Ankylosing spondylitis complications?

A

Aortic regurgitation
Atalantoaxial sublaxation
Anterior uveitis
Atypical pulmonary fibrosis

104
Q

Why do you see sequestra in osteomyelitis?

A

Increased pressure causes interruption of periosteal blood supply - necrosis and small vessel thrombosis - nectotic bone (sequestra)

Phase 2a Summaries (12 decks)

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