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Year 3 Conditions - Jan > MSK > Flashcards

MSK Flashcards

1
Q

Osteoarthritis aetiology

A

Age
hereditary disposition
Female
Obesity

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2
Q

Osteophytes form in

A

Osteoarthritis

Also known as Heberden (DIP) and Bouchard nodes (PIP)

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3
Q

Osteoarthritis Sx

A

Joint pain & discomfort
- Gets worse with activity

Stiffness 
Bony swellings (herbedens and bouchards)
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4
Q

Osteoarthritis Ix

A

Often clinical diag

XRAY 4 things (LOSS)

  • Loss of joint space
  • Osteophytes
  • Subcondral cysts
  • Subarticular sclerosis
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5
Q

RA aetiology

A

AI

HLA-DR1/4 association

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6
Q

What is rheumatoid factor?

A

IgM antibody which recognises Fc portion of IgG as targen antigen

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7
Q

Rheumatoid arthritis Sx

A

SYMMETRICAL
Swollen
Painful and stiff small joints
WORSE IN MORNING - improves with movement

Warm, tender joints 
Fingers ulnar deviation 
Radial deviation of wrist 
Swan neck 
Boutonniere 
Z deformity 
Trigger finger 
Palmar erythema
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8
Q

Extra-articular features of RA

A

Rhematoid nodules

- firm nodules on elbows, ulnar margins, palms & extensor tendons

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9
Q

RA Ix

A

Rhematoid factor
Antinuclear antibodies

Joint X-ray (BONDS)

  • Bone erosions
  • Osteopaenia
  • Narrowing of joint space
  • Soft tissue swelling
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10
Q

Reactive arthritis

A

Inflammatory sterile arthritis following extra-articular infeciton (GI/urogenital)

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11
Q

Reiter’s syndrome

A

TRIAD

Reactive arthritis
Urethritis
Conjunctivitis

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12
Q

Aetiology reactive arthritis

A

Associated with infections

  • GI (Salmonella, shigella, yersinia, C. jej)
  • Urogenital (Chlam, Ureaplasma)

HLA-B27

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13
Q

Reactive arthritis Sx

A 
Burning/stinging when piss 
Arthritis 
Low back pain 
Painful heels 
Conjunctivits
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14
Q

REactive arthritis Signs

A

ABCD

Arthritis (asymmetrical, often painful in morning )

Blanitis circinate (painless ulcer on penis glans)

Conjunctivitis

keratoDerma Blenorrhagica
- Brown/red macule s on soles and palms

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15
Q

Reactive arthritis Ix

A

Stool/urethral swabs & culture

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16
Q

Ankylosing Spondylitis aetiology

A

Association with HLA-B27 gene

17
Q

Ankylosing Spondylitis Sx

A

Gradual onset back pain

Early morning stiffness with exercise

Resolution with NSAIDS

18
Q

Ankylosing Spondylitis Ix

A

Schober’s Test

Pelvic Xray - 1st investigaion

Radiographs - MRI best at detecting early disease

19
Q

Ankylosing Spondylitis Extra-articular features

A

5 A’s

Anterior uveitis 
Apical lung fibrosis 
Achilles tendinitis 
Amyloidosis 
Aortic regurgitaiton
20
Q

Septic arthritis RFs

A 
RA
Osteoarthritis 
Joint prosthesis 
IV drug abuse 
Alcoholism 
DM 
Osteomyelitis
21
Q

Septic arthritis causative organisms

A

Bacterial

  • S. aureus
  • TB
  • N. gonorrhoea
  • <4 yrs (S. pneu, S. pyoge, N. meningitid)

Viruses

  • Rubella
  • Mumps
  • Hep B
22
Q

Septic arthritis Sx

A

Sudden onset

Excruciating hot swollen immobile joint

23
Q

Septic arthritis Ix

A

Joint aspiraiton
- MC&S

Bloods

  • FBC
  • Cultures
  • Viral serology
24
Q

Gout aetiology

A

HYPERURICAEMIA

  • Increased urate intake or production
    • inc diet intake purines
    • inc nucleic acid turnover (haem cancers)
  • Renal excretion
    • Idiopathic
    • Dehydration
    • Alcohol excess
25
Q

Gout acute attack Sx

A

Suddent excruciating monoarticular pain

Afects MTP of big toe (podagra)

26
Q

Gout chronic Sx

A

Follow repeated acute attacks

Persistent fever
Polyarticualr pain

Renal calculi

27
Q

Gout Ix

A

Arthrocentesis with synovial fluid analysis
- -ve birefringent with needle shape

Bloods - inc urate

28
Q

Pseudogout crystal type

A

Calcium pyrophosphate dehydrate

29
Q

Conditions that increase risk of psuedogout

A

Haemochromatosis
Hyperparathyroidism
Hypomagnaesmia
Hypophosphatasia

30
Q

Pseudogout Sx

A

Painful, swollen joint

31
Q

Pseudogout Ix

A

Arthrocentesis with synovial fluid analysis
- +ve birefringence rhonboid shaped crystals

Plain radiography of joint
- Chondrocalcinosis

32
Q

GCA aetiology

A

Common with inc age
HLA-DR4
HLA-DRB1

Associated with polymyalgia rheumatica

33
Q

GCA Sx

A 
Subacute onset 
Headache
Scalp tender (brushing hair)
Jaw claudication 
Suddent blundness in one eye
34
Q

Polymyalgia rheymatica Sx

A

Early morning pain and stiffness of muscles of shoulder and pelvic girdle

35
Q

GCA Ix

A

Bloods (Inflam markers)

Temporal artery biopsy

36
Q

Guidelines for diagnosis of GCA

A

3 of following:

Age >50
New headache 
ESR > 50mm/h
Clincally abnormal temporal artery 
Biopsy showing mononuclear cell infiltration or granuloma
37
Q

Rx for GCA

A

No visual changes - Pred

Visual Sx - Methylpred pulse theray IV

Year 3 Conditions - Jan (9 decks)

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