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3B > MSK > Flashcards

MSK Flashcards

1
Q

What are the Xray findings in RA?

A 
SOLD 
Soft tissue swelling 
Osteopenia 
Loss of joint space 
Deformity/erosions - marginal
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2
Q

Give the deformities you might see in the hands of someone with bad RA?

A
  • Ulnar deviation
  • Swan neck
  • Boutonniere
  • Z shaped thumb
  • MCP subluxation
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3
Q

What are some of the extra-articular manifestations of RA?

systems

A

Lung - ILD, nodules (plural effusions) Caplans (coal workers)
Haem - anaemia
Heart - pericartitis + HTN
Eyes - episcleritis and scleritis

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4
Q

What serum markers can you look for in RA?

A
  • Anti cyclic citrullinated peptide abs

- Rheumatoid factor

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5
Q

What is RF?

A

It is the ab against the FC portion of IgG

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6
Q

What are the treatment steps for RA?

A

1) Analgesia = NSAIDs
2) Steroids = low dose pred for flares
3) DMARS = methotrexate + sulphasalazine/hydroxychloroquine
4) Biologics = infliximab

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7
Q

When would you consider biologics in RA?

A

Failure to respond to 2 DMARDS

2x 6m trials

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8
Q

How does methotrexate work?

A

Its a cytotoxic folate inhibitor that prevents cellular/DNA replicating
It has anti-inflammatory and immunosuppressive effects by inhibiting IL6, IL8 and TNFa

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9
Q

What are the SE of methotrexate?

A

Mucosal damage - sore mouth and GI upset
BM suppression - neutropenia and infection risk
LT = hepatic cirrhosis + pulmonary fibrosis

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10
Q

Give examples of the Anti-TNF drugs

A

Infliximab
Adalimumab
Etancercept

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11
Q

Give an example of a monoclonal ab against the CD20 portion on B cells

A

Rituximab

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12
Q

What are the crystals in Gout?

A

Monosodium urate

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13
Q

What investigations would you do if you suspected gout and what would you see?

A

Joint aspiration:
Long needle shaped crystals which are -ve bifringent
XR - soft tissue swelling with punched out lesions

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14
Q

How does allopurinol work?

A

It is a xanthine oxidase inhibitor

It reduces uric acid formation and may inhibit purine synthesis

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15
Q

What are the crystals in pseudo gout and what would you see in XR?

A
  • Calcium pyrophosphate

- Linear opacification of the articular cartilage (mineralisation of the fibrocartilage)

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16
Q

What would you seen on an XR in the spine of a person with untreated Ank Spond?

A

BESS

  • Bamboo spine is these are ossified
  • Erosions
  • Vertebral squaring
  • Syndesmophyte formation
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17
Q

What are the extra-articular manifestations of Ank Spond?

A
  • Anterior uveitis
  • AR
  • Amyloidosis
  • Apical fibrosis
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18
Q

What are the treatment steps for Ank Spond?

A

1) Analgesia = NSAIDs
2) Intra-articular steroid injections
3) Biologics = Anti-TNFa = adalimumab, etanercept

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19
Q

What is the Xray deformity seen in psoriatic arthritis?

A

Pencil in cup

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20
Q

What are the extra-articular manifestations of reactive arthritis?

A 
Conjunctivitis 
Skin: erythema nodosum 
Nais: onchyolysis/pitting 
GI: adbo pain, D 
CV: aortitis +/- AR
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21
Q

What are the organisms involved in septic arthritis?

A

Staph aureus

Neisseria gonorhroea

22
Q

How do you manage septic arthritis?

A

Surgical drainage and lavage
IV abx
- Vancomycin + ceftriaxone then tailor to the culture results

Staph - flucloxacillin

23
Q

What conditions pre-dispose you to osteomyelitis?

A
  • DM
  • Sickle cell anaemia
  • IVDU
  • immunosuppression/HIV
  • alcohol excess
24
Q

What investigations do you do if you suspect osteomyelitis?

A

Bloods: FBC, ESR + CRP
Cultures
Imaging: MRI

25
Q

What is fibromyalgia?

A

It is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites
? altered pain perception and somatisation

26
Q

What are some of the features of fibromyalgia?

A 
Chronic pain 'all over pain'
Lethargy 
Cognitive impairment - fibre-fog 
Sleep disturbance, headache, depression/anxiety, irritable bladder, IBS 
11/18 tender points
27
Q

How would you manage someone with fibromyalgia?

A

S: Patient education
C: aerobic exercise
P: CBT
B: Amitriptyline

28
Q

What are the red flags of back pain?

A

TUNA FISH

  • Trauma
  • Unexplained weight loss/anorexia
  • Neuro - bladder/bowel issues
  • Age >50 or <20
  • Fever/night sweats
  • IVDU/Immunosuppression
  • Steroid use
  • Hx of malignancy
29
Q

What do you need to have to Dx SLE?

A

4/11 features
DOPAMIN RASH
Discoid, oral ulcers, photosensitivity, ANA, malar rash, immunological (ds DNA, smith) neuro (siezures/psychosis)
Renal, arthritis, serositis (pleuritis, pericarditis) Haem (anaemia, leukopenia, thrombocytopenia)

30
Q

What ix would you do if you suspected SLE?

A

Raised ESR - normal CRP
Complement: low C3 and C4
Auto abs: ANA, Anti-ds DNA, Anti-smith
Antiphospholipid abs

31
Q

How do you treat mild SLE?

A

IA CS injections
PO pred if a flare up
Hydroxychloroquine

32
Q

How do you treat mod SLE

A

Hydroxychloroquine + immunosuppressants

  • High dose CS
  • Azathioprine, cyclophosphamide
  • Ciclosporin, tracolimus
33
Q

How do you treat refractory SLE

A

Rituximab (Monoclonal ab against B cells)

- when 2 immunosuppressants have failed

34
Q

How do you treat anti-phospholipid syndrome?

A

Warfarin

35
Q

What is sjogrens?

A

Immunologically mediated destruction of the epithelial exoglands - mainly the lacrimal and salivary glands

36
Q

What HLA is Sjogrens associated with?

A

HLA DR3

37
Q

What investigations can you do in Sjogrens?

A
  • Schirmer test (paper strip into eye <10mm wetting)
  • Auto abs: Anti-Ro + anti-La
  • Sialography: Looking at function of salivary gland
  • Biopsy of salivary gland: mononuclear infiltrate
38
Q

How do you treat sjogrens?

A

Artificial tears + saliva
Pilocarpine
Systemic: NSAIDs, hydroxychloroquine and steroids

39
Q

What are the SE of steroids?

A 
SHIP DOC 
Syndromes - cushings 
HTN 
Infections (immunosuppressive) 
Psychosis 
DM + weight gain 
Osteoporosis 
Cataracts
40
Q

How are the small vessel vasculitis divided up?

Give examples in each group

A

ANCA + ve = granulomatosis with polyangiitis + Esinophilic granulomatosis with polyangiitis (chrug-strauss

ANCE -ve = Henoch-schonlien purpura (immune complex mediated)

41
Q

What is ANCA?

A

Anti-neutrophil cytoplasm Abs = auto-abs
They bind to 2 proteins in neutrophil cytoplasm (PR3 + MPO)
The binding of ANCA to neutrophils causes a toxic release of substances - inflam to the vessels - N migrate through vessel wall and release pro-inflammatory cytokines

42
Q

How can you test for ANCA?

A

ELISA

Indirect Immunofluorescence

43
Q

What is Wegener’s - granulomatosis polyangiitis?

A

ELK
It is a necrotising granuloma of the upper and lower airways with focal glomerulonephritis

ENT - Lungs - Kidneys

44
Q

How might someone present with granulomatosis polyangiitis?

A 
URT - otorrhoea, sinus pain, nasal d/c 
LRT - SOB, CP, haemoptysis, cough 
Renal - oedema, HTN, haematuria 
\+ Eyes - periorbital oedema
MSK - myalgia and arthralgia 
Neuro - numbness and weakness
45
Q

How would you induce remission in someone with graulomatosis polyangiitis if it was:

a) Non-lifethreatening
b) Life threatening

A

a) Non-lifethreatening = IV methylpred + methotrexate

b) Life threatening = IV methylpred + cyclophosphamide

46
Q

What is the triad of Churg-stauss?

A

1) Vasculitis
2) Asthmas
3) Esinophilia
Vasculitis in a person with atopy

47
Q

What is Goodpastures?

A

Anti-GMB disease - pulmonary renal disease

Auto-abs to the alpha 3 chain of type 3 collagen in BM of alveoli and glomeruli

48
Q

How do you treat Goodpstures?

A

Immunosuppression (PO pred + cyclophosphamide)

Plasmapharesis

49
Q

What is polyarteritis nodosa?

A

Necrotising arteritis with formation of micro aneurysms, thrombus and infarction
Spares the lungs and the kidneys
Due to the deposition of complement –> inflammation

50
Q

What is the sign in polyarteritis nodosa that is due to micro aneurysms and focal narrowing?

A

Rosary sign

51
Q

Describe polymyalgia Rheumatica

A

Pain and stiffness in the shoulders, neck and pelvic girdle >2weeks with systemic symptoms at onset - malaise, fever, fatigue

3B (21 decks)

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