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PHASE 2A > MSK > Flashcards

MSK Flashcards

1
Q

Where does osteoarthritis commonly effect?

A

Heberden’s nodes- distal interphalangeal
Bouchard’s- proximal interphalangel
It commonly will effect the base of the thumb and the big toe

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2
Q

What is seen on a x ray for osteoarthritis?

A

L- loss of joint sapce
O-osteophytes
S-subchonral cysts
S- Subarticular sclerosis

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3
Q

What is the management of osteoarthritis?

A

Exercise to build up muscle
Para or NSAIDS for pain (No NSAIDs in elderly or diabetic)
Then go to NSAIDs/COX-2 inhibitors
Intra-articular corticosteroid injection

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4
Q

What are gout crystals composed of?

A

Monosodium urate

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5
Q

What are pseudogout crystals composed of?

A

Calcium pyrophosphate

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6
Q

What can cause gout?

A

Hereditary, increased red meat, alcohol excess, diuretics, trauma, leukaemia, sugery

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7
Q

What prevents a gout attack?

A

Allopurinol

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8
Q

What do we see on X ray for gout?

A

Soft tissue swelling and punched out lesions

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9
Q

What test do we do for gout and psuedogout?

A

Polarised light microscopy of synovial fluid

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10
Q

How do we treat acute gout?

A
  • Ice and elevate
  • NSAID/ colchicine
  • Joint aspiration and intra articular corticosteroids
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11
Q

What is seen on a pseudogout x ray?

A

Soft tissue calcium deposition

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12
Q

How do we treat chronic gout?

A

Methorexate (DMARD) and hydrochloroquine

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13
Q

What produces monosodium urate from nucleic acid?

A

Xanthine Oxidase

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14
Q

Where does gout and pseudogout effect?

A

Gout- small joints and usually monoarthropathy

Pseudogout- Large joints and polyarthropathy

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15
Q

What is the diagnostic antibody for rheumatoid athritis?

A

Anti-CCP antibodies

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16
Q

What gene is Rheumatoid arthritis associated with?

A

HLA-DR4

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17
Q

What will we see on investigation for rheumatoid arthritis?

A

Rheumatoid factor, Anti CCP (specific), high platelet, normocytic aneamia, high ESR and CRP

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18
Q

What is seen on an Xray for rheumatoid arthritis?

A 
LESS
Loss of space
Erosion
Soft tissue swelling
Soft bones
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19
Q

Which joints does rheumatoid often effect?

A

Small joints of the hands and feet, MCP and PIP joint

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20
Q

What are the signs for rheumatoid arthritis?

A

Ulnar deviation, boutinniere, swan neck deformaty, Z thumb, muscle wasting

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21
Q

How does rheumatoid arthritis occur?

A

Macrophages enter the synovium, producing angiogenic cytokines and synovium that grows over cartilage to form a pannus. The synoviocytes produce RANKL and proteases which cause cartilage degregation.

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22
Q

How long doe pain last in the morning for rheumatoid?

A

Greater than 30 minutes

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23
Q

First treatment of rheumatoid arthritis?

A

2 DMARDs including methotrexate and a glucocorticoid

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24
Q

What is used in the treatment of rheumatoid flares?

A

Short term glucocorticoids

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25
Q

What is an alternative to DMARDs for rhuematoid treatment?

A

Anti-TNF

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26
Q

Which of osteoarthritis and rheumatoid arthritis responds well to NSAID use?

A

Rheumatoid arthritis

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27
Q

What is seen on a X-ray of someone with alkylosing spondylitis?

A

Syndesmophytes
Sacroiliitis
Bony proliferations
calified ligaments to create a bamboo spine

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28
Q

What antigens are and aren’t present in spondyloarthropathies?

A

HLA B27 is present but there is no rheumatoid factor present

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29
Q

What joints are affected in spondyloarthropathies?

A

Sacroiliac joint and spine

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30
Q

What is the posture seen in ankylosing spondylitis called?

A

Kyphosis

Question mark spine

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31
Q

What is the management of ankylosing spondylitis?

A

First exercise and manage CVD risk
Can add NSAIDS or coxib
If still bad then use corticosteroid injections and TNF alpha inhibitors

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32
Q

What are the 3 main signs of reactive arthritis?

A

Reiter’s traid:

Urethritis, arthritis and conjunctivitis

33
Q

Which joints does reative arthritis affect?

A

Large joints

34
Q

Is reactive arthritis sterile or not?

35
Q

What bacteria cause reactive arthritis?

A

Chlamydia, ureaplasma, campylobacter, shigella, salmonella or Yersinia

36
Q

What is the investigation for ankylosing spondylitis?

37
Q

What is the management of reactive arthritis?

A

Aspirate synovial fluid, NSAIDs, Corticosteroids, antibiotics
Methotrexate if longer than 6 months

38
Q

What pattern does psoriatic arthritis present with?

A

Relapsing remitting

39
Q

How does psoriatic arthritis present?

A

Rash, swelling, pain and tenderness, dactylitis and onycholysis

40
Q

What defromity is seen in psoriatic arthritis?

A

Pencil in cup

41
Q

Management of psoriatic arthritis?

A

NSAIDs, DMARDs, ciclosporin, anti-TNF

42
Q

What is the triad for septic arthritis?

A

Low grade fever
Impaired range of motion
Painful large joint such as the knee

43
Q

Common causes of septic arthritis?

A

S.Aureus, Streptococci, Nisseria gonococcus

44
Q

What are the investigations for septic arthritis?

A

Aspirate the joint
Blood cultures
Plain x ray as CRP can be normal

45
Q

What is the management of septic arthritis?

A 
Splint limb
IV antibiotics (flucloxacillin- clyd if allergic) for 2-3 weeks then oral antibiotics for 2-4 weeks
Replace infected prosthetic joint
46
Q

What is the treatment for MRSA?

A

Vancomycin or teicoplanin

47
Q

What is septic arthritis an infection of?

A

surface cartilage

48
Q

What is osteomyelitis an infection of?

A

The bone and is seen most commonly in children

49
Q

How do you diagnose osteomyelitis?

A

Bone culture

50
Q

What is the treatment for Raynaud’s disease?

A

Keep warm, stop smoking, Nifedipine (CCB)

51
Q

What is discoid lupus?

A

Lupus where only the skin is effected

52
Q

What gender is SLE more common in?

A

Women (esp black and asians)

53
Q

What are the signs of SLE?

A 
SOAP BRAIN MD
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood(anemia and thrombocytopenia)
Renal
Ana positive
Immunologic (DS DNA)
Neurologic (seizures)

Malor rash
Discoid rash

54
Q

What is the key blood feature of SLE?

A

High ESR but normal CRP

55
Q

What type of sensitivity is SLE?

56
Q

What is the drug treatment for acute flares of SLE?

A

IV prednisolone and IV cyclophosphamide

57
Q

What is the drug treatment for chronic SLE?

A

NSAIDs and hydroxychloroquine

58
Q

Where does Sjogren’s effect?

A

Exocrine glands

59
Q

What are signs and symptoms of Sjogren’s?

A

Dry eye and mouth, enlarged salivary glands, rash, fatigue, malaise

60
Q

How do we test for Sjorgens?

A

Schirmer’s test
Serology- ANA, RF, Anti-ro
Biopsy shows infiltration of plasma cells and lymphocytes

61
Q

How do we treat sjorgens?

A

Tear replacement
Vaginal lube
NSAID
Immunosuppressant

62
Q

How does dermatomyositis present?

A

Lilac periorbital rash, sunburnt cheeks, sholder, subcutaneous calcifications, weakness so hard to get out of chairs

63
Q

What is the treatment for dermatomyostits?

A

Corticosteroids

64
Q

What is polymyositis?

A

Inflammation and progressive necrosis of skeletal muscle fibres

65
Q

What is the presentation of polymyositis?

A

Difficulty squatting and with stairs, can’t raise hands above head

66
Q

What is systemic sclerosis?

A

Abnormal growth and deposition of connective tissue effecting skin, face, forearms and lower leg

67
Q

What is antiphospholipid linked to?

A 
CLOT
Coagulation defects
Livedo reticularis
Obstetric- multiple miscarriages
Thrombocytopenia
68
Q

What is the treatment for antiphospholipid syndrome?

A

Low dose aspirin or warfarin

69
Q

What confirms a Giant cell arteritis diagnosis?

A

Temporal artery biopsy

70
Q

What is the treatment for giant cell arteritis?

A

Prednisolone

71
Q

What is Wegner’s?

A

Necrotizing GRANULOMATOUS vasculitis mediated by neutrophils

72
Q

What are the symptoms of Wegener’s?

A

Cough, stuffy nose, sinusitis, haemoptysis, haematuria, saddle nose deformity

73
Q

What special tests are done for Wegener’s?

A

c-ANCA and PR-3 ab

Renal and lung biopsy for granulomas

74
Q

What is maintenance treatment for wegeners?

A

Azathioprine

75
Q

What is the triad for Churg-strauss syndrome?

A

Asthma, eosinophilia and vasculitis (like wegeners)

76
Q

What are the common secondary sites of bone tumours?

A 
Breast
Lung
Thyroid
Renal
Prostate
77
Q

What are the risk factors for osteoporosis?

A 
ACCESS
Alcohol use, Corticosteroid use Calcium low
Estrogen low
Smoking
Sedimentary lifestyle
78
Q

What is the FRAX score?

A 
Acesses osteoporosis risk
Country
Age
Weight
Height
Previous fracture
Hip fracture in parents
Smoking
Glucocorticoids
Rhuematoid
Linked disease
3+ drinks a day
Bone mineral density

PHASE 2A (14 decks)

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