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MSK Flashcards

1
Q

Causes of primary vasculitis

Large
Medium
Small

A

L -> giant cell / Takayasu

M -> PAN, kawasaki

S -> HSP, Wegener’s, Churg-Strauss, microscopic poyangitis

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2
Q

Causes of secondary vasculitis

A

aortitis in RA

autoimmune, malignancy, drugs, infection

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3
Q

Eg of infective / drug / autoimmune causes of secondary vasculitis

A

Infective -> BBV, strep

Drugs -> penicillin, steroids

Autoimmune-> RA, SLE, Sjogrens

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4
Q

ANCA assos vasculitis?

A

Wegener’s
microscopic poyangitis
Churg-Strauss

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5
Q

What is ANCA?
how detected?
2 types?

A

Anti-neutrophil cytoplasmic antibodies

detected with indirect immunofluorescence microscopy

c-ANCA (cytoplasmic)
p-ANCA (peri-nuclear)

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6
Q

Pres of wegeners?

A

Nasal/sinus problems - epistaxis; saddle-nose deformity
Lungs - haemoptysis
Kidneys - rapidly progressing glomerulonephritis
+/- conductive hearing loss, arthritis, subcutaneous nodules, neuropathy

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7
Q

c-ANCA / PR3 = ?

A

Wegeners –>

now should instead be called ‘granulomatosis with polyangitis’

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8
Q

p-ANCA / MPO = ?

A

Churg-Strauss

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9
Q

Triad of affected areas in Wegeners?

A

lung
kidney
ENT

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10
Q

usual vasculitis with raised eosinophils?

A

Churg-strauss

–> often get new onset / worsening asthma

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11
Q

New name for Wegeners?

A

granulomatosis with polyangitis

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12
Q

Who does wegeners affect?

A

Men 25-60

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13
Q

Causes of cavitation on CXR?

A

wegeners, malignancy, TB, klebsiella

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14
Q

alternate name for churg strauss?

A

Eosinophilic granulomatosis with poyangitis

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15
Q

Pres of churg-strauss

A

Lungs - new/worsening asthma, pulmonary infiltrates, alveolar haemorrhage

CNS - neuropathy

ENT - polyps, conductive hearing loss, allergic rhinitis

Skin - purpura, nodules

RENAL DISEASE IS RARE

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16
Q

How to differentiate wegeners/churg-strauss?

A

wegeners affects kidneys (c-ANCA)

eosinophilia in churg (p-ANCA)

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17
Q

Mx of Churg-Strauss / Wegners?

A

Induce remission [high dose steroids + cyclophosphomide/Rituximab]

Maintain remission [MTX + pred + folic acid]

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18
Q

Features of HSP

A 
children
IgA
purpuric rash 
arthritis 
abdo pain 
glomerulonephritis
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19
Q

Features of polyarteritis nodosa

A

Medium vessel

Aneurysms

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20
Q

Mx of GCA?
if no visual sx?
if visual sx?

A

Prednisolone

40mg if no visual disturbance

60mg if visual disturbance

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21
Q

Condition linked to GCA?

A

polymyalgia rheumatica

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22
Q

Sx of GCA

A

headache, severe, sharp, dull throbbing, (won’t stop without steroids)

TA -> swollen, tender, pulseless

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23
Q

Features of PMR

A

shoulder/pelvic pain
morning stiffness
weakness on exertion (due to pain)

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24
Q

ix in PMR?

r/o?

A 
ESR/CRP
RhF/Anti-CCP
ANA
CK - to r/o muscle pathology eg polymyositis
TFT
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25
Q

Mx of PMR

A

Prednisolone 15mg
Bone protection
PPI

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26
Q

Vasculitic screen?

A 
FBC
Urinalysis
ESR/CRP
LFTs
ANCA
CXR
Biopsy
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27
Q

How to describe fracture?

A 
Complexity
Type (FIG-TACOS)
Comminution 
Location
Displacement
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28
Q

what is FRAX score for?

A

10 year risk of fracture

Age, sex, BMI

Prev fracture, FH fracture, low femoral neck BMD

Alcohol, smoking, glucocorticoids

RA, secondary osteoporosis

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29
Q

2 fractures which can lead to avascular necrosis?

A

femoral head

scaphoid

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30
Q

what is a colles fracture?

A

distal radius with dorsal displacement of fragments
(fall onto wrist in extension)
FOOSH

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31
Q

Mx of wrist fracture

A

reduction via manipulation + anaesthesia

immobilise -> avoid full cast initially due to swelling

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32
Q

Sign of scaphoid fracture

A

tenderness in anatomical snuffbox

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33
Q

what runs through anatomical snuff box

A

Radial nerve - sensory branch

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34
Q

comps of Colles?

A

median nerve damage

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35
Q

Fall backwards?

what is opposite of Colles?

A 
Smiths fracture (fall onto flexed wrist)
distal fracture of radius with ventral displacement

Garden spade deformity

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36
Q

Seen on lateral X-Ray of colles?

A

dinner fork sign

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37
Q

How does NOF fracture present

A

affected leg shortened, adducted and externally rotated

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38
Q

main types of NOF fracture?

which is worse?

A

intracapsular
extra-capsular

intra = worse -> avascular necrosis more likely

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39
Q

Ix in fractured NOF

A

AP + lateral X-Ray

FBC, cross match, U+Es, glucose, ECG

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40
Q

Mx of intracapsular fracture

A

analgesia (NOT NSAIDs)

surgery in 1d

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41
Q

when to X-Ray an ankle?

A

ottawa ankle rules

> 55
Inability to wt bear
Bony tenderness

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42
Q

Mx of ankle fracture if dislocated

A

reduce immediately under sedation

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43
Q

Signs of compartment syndrome?

A

pain out of proportion
+ signs of compartment syndrome
-> pain, paraesthesia, pallor, paralysis, pulseless, perishingly cold

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44
Q

mx of compartment syndrome

A

fasciotomy

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45
Q

stages of fracture healing

A
  1. haematoma
  2. soft callus
  3. bony callus
  4. bone remodelling
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46
Q

what is frozen shoulder?

A

thickening and contraction of glenohumeral joint capsule +/- adhesions

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47
Q

pres of frozen shoulder

A

pain + loss of function

-> external rotation lost

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48
Q

osteoporosis?

A

low bone mass + micro-architectural deterioration leading to fragility and fracture risk

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49
Q

DEXA for osteoporosis?

osteopenia?

A

Osteoporosis < - 2.5SDs

-2.5

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50
Q

Pathogenesis of osteoporosis?

A

increased osteoclast

decreased osteoblast

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51
Q

osteoporotic fractures

A

spine
distal radius
NOF
pelvis

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52
Q

secondary RFs for osteorporosis

A 
SHATTERED
Steroids
Hyper -thyroid; -PTH
Alcohol/tobacco
Thin
Testosterone decreased
Early menopause
Renal/liver function
Erosive/inflam disease
Dietary
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53
Q

Why do steroids increase risk of osteoporosis?

A

Decreased Ca absorption from gut

increased osteoclast

decreased muscle mass

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54
Q

DDx in osteoporosis

A

myeloma

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55
Q

ix in osteoporosis

A

FBC, ESR, CRP

Bone profile (NAD in osteoporosis)

U+Es, LFT, TFT, Ca
Serum Ig

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56
Q

Mx for osteoporosis

A

lifestyle (exercise, stop smoking+alcohol)
Calcium+Vit D
Bisphosphonates

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57
Q

Fall prevention?

A

avoid polypharmacy

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58
Q

alternative medication if intolerant of bisphosphonates

A

Denosumab

monoclonal antibody to RANKL

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59
Q

how do bisphosphonates work

A

inhibit osteoclasts

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60
Q

SEs of bisphosphonates

A

oesophagitis
gastric ulcers
osteonecrosis of the jaw

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61
Q

osteomalacia?

A

disorder of mineralisation due to Vit D deficiency

In kids = Rickets

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62
Q

Functions of Vit D?

A

Bone - increase Ca mobilisation, increase osteoclast

Intestine - increase Ca absorp, PO4 absorp

Decreases PTH

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63
Q

PTH mech?

A

Bone - increase osteoclasts

Kidney - increase 1,25vD3 + decrease Ca excretion + increase PO4 excretion

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64
Q

What stimulates PTH

A

low Ca

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65
Q

Pres of Rickets

A

leg bowing, knock knees, softening of skull, frontal bossing, waddling gait
widespread bone pain + tenderness

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66
Q

Paget’s disease of bone?

A

increased bone turnover

Lytic - osteoclasts

Sclerotic - rapid bone formation by osteoblasts -> deformed

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67
Q

Where affected by Paget’s?

A

axial skeleton

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68
Q

sx in pagets

A

bone pain

deformity

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69
Q

comps of pagets

A

pathological fractures + lots of bleeding (vascular)

deafness/tinnitus

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70
Q

ix in pagets

A

ALP - high
(Ca, PO4, PTH normal)
isotope bone scans

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71
Q

XR of pagets?

A

osteolysis and osteosclerosis

‘blade of grass lesion’

‘cotton wool pattern’ in skull

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72
Q

mx pagets

A

NSAIDs

bisphosphonates

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73
Q

inflam vs degenerative arthritis?

A

inflam -> ease on use, stiff in morning (>60mins), hot and red, responds to NSAIDs, swelling

Degenerative -> worse with use, morning (<30mins), no swelling, not inflamed, ‘gelling’

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74
Q

joints affected in OA

A

knees, hips, thumb base, spine

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75
Q

signs of OA

A

reduced ROM
crepitus
pain on movement
heberdens, bouchards

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76
Q

XR of OA

A

Loss of jt space
Ostophytes
Subchondral cysts
Subchondral sclerosis

77
Q

Mx of OA

A

lifestyle
analgesia

+/- intra-articular steroids (methyl prednisolone)

+/- replacement [arthroplasty], fusion [arthrodesis]

78
Q

RA XR?

A

Loss of jt space
Erosions
Soft bones
Soft tissue swelling

79
Q

What is formed in proliferation of RA

80
Q

extra-articular pres of RA

A 
rheumatoid nodules 
vasculitis
pleuritic chest pain
eye problems
neuro
anaemia of chronic disease
81
Q

Ix in RA

A

RhF
Anti-CCP
Xray hands + feet

82
Q

Mx of RA?

A

physio

  1. DMARD
  2. biologics
83
Q

how often give MTX

84
Q

SEs of MTX

A

bone marrow suppression
mouth ulcers
pulmonary fibrosis

85
Q

monitoring in MTX

A

CXR, FBC, LFT, U+Es

86
Q

biologics used in RA

A

Anti-TNFa

infliximab, adalimumab, enteracept

87
Q

when can you give biologics in RA

A

failure to respond to 2xDMARDs after trials of 6months

88
Q

RFs for gout

A

alcohol, purine rich foods, fructose, diuretics, DM, CKD, CHD, HTN,

89
Q

ix in gout

A 
serum urate (can be N)
joint aspiration 
XR
90
Q

seen on joint aspiration in gout

A

negatively birefringent needles of mono sodium urate

91
Q

mx of acute gout

A

NSAID - naproxen

+/- colchicine

92
Q

prophylaxis in gout

A

lifestyle

allopurinol / febuxostat

93
Q

crystal in pseudogout?

where common?

A

calcium pyrophosphate

knee/wrist

94
Q

mx pseudogout

A

RICE
NSAIDs
IA steroid injection

95
Q

antibodies in SLE?

96
Q

genetics in SLE?

A

HLA DR2/DR3

97
Q

common pres of SLE

98
Q

Drug mx of SLE

A

hydroxychloroquine

99
Q

signs of SLE

A 
Oral ulcers
Photosensitive rash
arthritis
malar rash
seizures/psychosis
ESR raised (CRP normal)
renal disorder
pleuritis/pericarditis
100
Q

ix in SLE

A 
autoantibodies [ANA, anti-dsDNA, antiSmith]
Complement [low C3+C4]
ESR raised, CRP normal
FBC
Urinalysis
U+Es
CXR
ECG
101
Q

mx of joints in SLE?

A

NSAID, hydroxychloroquine, steroids

102
Q

mx of kidney/neuro sx in SLE?

A

cyclophosphamide

103
Q

antibody in antiphospholipid syndrome

A

anti-cardiolipin

104
Q

pres of antiphospholipid

A

thrombosis, DVT, recurrent miscarriages, pre-eclampsia, thrombocytopenia, stroke

105
Q

mx of antiphospholipid

A

warfarin (aim 2-3)

lifestlye -> avoid smoking, COCP, poor diet, alcohol

106
Q

clotting studies of antiphospholipid?

A

paradoxically low platelets

prolonged APTT

107
Q

gene in Sjogrens

108
Q

complex in Sjogrens

A

sicca complex diminished lacrimal and salivary glands

109
Q

pres of sjogrens

A

dry eyes
dry mouth
enlarged parotid

110
Q

ix in sjogrens

A

schirmer tear test
autoantibodies
sialography
biopsy salivary gland

111
Q

mx of sjogrens

A

artificial tears
oral pilocarpine

joint involvement -> NSAID + hydroxychloroquine + steroid

112
Q

sx of limited sclerosis

A 
CREST
Calcium deposits in skin
Raynauds
Esophageal dysfunction
Scleordactyly
Telangiectasia

+ fatigue, wt loss

113
Q

Features of systemic sclerosis

A

pulm HTN
GI bleed
Renal crisis

114
Q

ix in systemic sclerosis?

A 
spirometry
CXR
autoantibodies - ANA 
ECG
FBC
U+E
Barium swallow if oesophageal disorder
115
Q

drug for raynauds

A

nifedipine

116
Q

mx of pulm HTN/fibrosis in systemic sclerosis

A

sildenafil

cyclophosphamide

117
Q

monitoring in systemic sclerosis

A

BP (weekly)

spirometry (annually)

118
Q

pres of polymyositis?

A 
not painful, progressive symmetrical proximal muslce weakness (chair, stairs, hair)
pharyngeal weakness (dysphagia)
119
Q

ix of polymyositis?

A

CK elevated x 50
autoantibodies - anti-Jo1
muscle enzymes - LDH
muscle biopsy

120
Q

what is the worry with polymyositis?

what ix?

A

can be paraneoplastic (lung, ovarian, bowel)

Ca125, Ca19-9, CEA
CXR

121
Q

Pres of dermatomyositis?

A

rash, purple scaly patches on extensors -> Gottron’s papules
nailfold erythema

fever, weight loss,

122
Q

ix in dermatomyositis

A

CK, LDH, aldolase
autoantibodies -> Anti-Mi2, ANA
EMG + muscle biopsy

123
Q

mx of polymyositis and dermatomyositis?

if lungs involved?

A

steroids

if fail -> immunosuppresants

lungs -> cyclophosphamide

124
Q

features of Ehler-Danos

A

increased elasticity + fragility of skin
hypermobile joints

mitral valve prolapse, aortic root dilatation

125
Q

mx of Ehler-Danos

A

physio, regular gentle exercise, genetic counselling

echo screening for heart comps (MV prolapse, aortic root dilatation)

126
Q

gene in Marfans

A

AD fibrillin gene

127
Q

usual cause of death in Marfans

A

aortic root dilatation and aortic dissection

128
Q

features of Marfans

A

hypermobility
arachnodactyly
pectus excavatum
high arched palate

pneumothorax
aortic dilatation/dissection
mitral regurgitatoin
closed angle glaucoma

129
Q

monitoring in marfans

A

annual echo

CV MRI every 5years

130
Q

prophylactic medication in marfans

A

propanolol

131
Q

sero-negative arthropathies?

where do they effect?

A

RhF -ve

axial skeleton, peripeheral joint, enthesitis and dactylitis

Anterior uveitis, IBD

132
Q

gene in seronegative arthropathies

133
Q

egs of seronegative arthropathies

A 
ankylosing spondylitis
Reiter's syndrome
enteropathic arthritis
psoriatic arthritis
Behcet's disease
JIA
OA
134
Q

features of ankylosing spondylitis?

A

<40 onset
inflammatory back pain + enthesitis

tender sacroiliac region, limited spinal RoM

peripheral enthesitis -> achilles, plantar fascia

peripheral arthritis -> asymmetrical

135
Q

extra articular sx of ankylosing spondylitis

A

eyes -> ant uveitis
CV -> aortitis, AR
Lung -> apical fibrosis

136
Q

o/e ankylosing spondylitis

A

reduced chest expansion

schober’s test -> reduced forward flexion + loss of lumbar lordosis

reduced lateral flexion

137
Q

ix in ankylosing spondylitis

A

HLA-B27
XR whole spine
Spirometry
Pelvic XR -> sacroiliitis

138
Q

associations with ankylosing spondylitis

A 
A's
Apical fibrosis
Anterior uveitis
Aortic regurg
Achilles tendonitis
AV node block
Amyloidosis
139
Q

Mx for ankylosing spondylitis

A

physio + rehab + exercise
NSAIDs
steroids/sulfasalazine for tendon/joint involvement

140
Q

mx of enthesitis in ankylosing spondylitis?

A

intra-articular corticosteroid injection

141
Q

mx of peripheral arthritis in ankylosing spondylitis

A

DMARD - sulfasalazine

142
Q

Most common joint in psoriatic arthritis

A

DIPJ

(+nail changes)

remember that closest to the nail..

143
Q

XR of feet/hands in psoriatic arthritis?

A

erosion in DIP
‘pencil in cup’ deformity
periarticular new bone formation

144
Q

ix in psoriatic arthritis?

A

RhF -ve
Anti-CCP -ve
ESR/CRP

145
Q

Mx of psoriatic arthritis?

A

if limited -> NSAID + physio +/- joint injection

if severe -> DMARD (methotrexate)

146
Q

When does reactive arthritis occur?

egs

A

1-4 weeks post GI/GU infection

eg. chlamydia, campylobacter, salmonella, shigella

147
Q

sx of reactive arthritis

A

conjunctivitis
urethritis
post-infectious arthritis

“cant see, cant wee, cant bend your knee”

148
Q

ix in reactive arthritis?

A

ESR, CRP, FBC
joint aspiration -> r/o septic/crystal arthropathies
serology
cultures

149
Q

mx of reactive arthritis?

A

NSAID + rest +/- intra-articular steroids

+/- abx -> azithromycin for chlamydia

150
Q

enteropathic arthritis?

A

arthritis assos with IBD or coeliac

151
Q

mx of enteropathic arthritis?

A

sulfasalazine

152
Q

Behcet’s disease?

Genetics?

A

recurrent oral ulcers
joints -> non-erosive arthritis (lower limb)

HLA B51

153
Q

mx of Behcet’s disease?

A

topical corticosteroids

systemic steroids

154
Q

pres of Takayasu’s vasculitis?

A

aka pulseless disease
young women 20-40
chronic, progressive, inflammatory, occlusive disease of aorta and branches

155
Q

stages of Takayasus?

A

systemic: fever, fatigue, wt loss, arthralgia, tender arteries
occlusive: limb claudication, TIA, HTN, angina

156
Q

o/e takayasus?

A

SBP differs between arms
impalpable peripheral pulse
arterial bruits + AR

157
Q

ix in takayasus

A

ESR>50

aortic angiography

158
Q

mx takayasus?

A

glucocorticoids + aspirin + bone protection

2nd line = TNFa

159
Q

Polyareteritis nodosa (PAN) association?

160
Q

what is PAN?

A

necrotising inflammation of M / S arteries

161
Q

pres of PAN?

A

nerves - mononeuritis
skin - purpura, nodules, ulcers
GI - post prandial pain (from ischaemia)
renal - HTN

162
Q

ix in PAN?

A

Look for Hep B (HBsAg)
p-ANCA (negative)
arteriography
biopsy

163
Q

mx of PAN?

A

prednisolone +/- cyclophosphamide

164
Q

Causes of septic arthritis?

A

S. aureus

GBS

gonorrhoea

165
Q

RFs for septic arthritis

A 
prosthetic joint
IVDU
DM
skin infection
immunocomp
166
Q

ix in septic arthritis

A

joint aspiration for MC+S, gram stain

blood cultures

167
Q

mx of septic arthritis

A

surgical drainage + lavage

IV abx

168
Q

which abx in septic arthritis?
Gonorrhoeal
Staph
MRSA

A

Gon -> vancomycin/ceftriaxone

Staph -> fluclox

MRSA -> vancomycin

169
Q

what is Pott’s disease?

A

vertebral osteomyelitis from haematogenous spread of TB -> abscess

170
Q

ix osteomyelitis

A

X-ray
FBC
Blood cultures
bone culture

171
Q

seen on XR of osteomyelitis

A

dark, soft tissue swelling, periosteal thickening, patchy osteopenia

172
Q

mx of ostemoyelitis

A

bone/soft tissue debridement

stabilise + immobilise
IV abx

173
Q

mx of fibromyalgia

A

amitryptiline + CBT

174
Q

Red flags of back pain

A 
TUNA FISH
Trauma 
Unexplained wt loss
Neuro sx
Age >50 / <20 
Fever+night sweats
Immunocomp
Steroids
Hx of cancer
175
Q

Main worries in back pain

A

Cauda equina
multiple myeloma
metastatic cancer
psoas abscess

176
Q

usual cause of cervical back pain

A

cervical spondylosis

177
Q

pres of cervical spondylosis

A

neck pain
+ radiculopathy
+myelopathy

178
Q

ix cervical spondylosis

179
Q

pres of disk prolapse

A

pain localised to spine + radiculopathy, sensory disturbance in dermatomal distribution

180
Q

Differentiate pain between spinal fracture and Ca/infection?

A

spinal fracture: sudden onset pain relieved by lying down

Cancer/infection -> pain REMAINS on lying down, night pain

181
Q

mx of herniation disk?

A

active!
analgesia

discectomy if severe nerve compression

182
Q

What is osteoid sarcoma?

A

dense osteoid, cancer in young adults (15-19yo)

183
Q

Ewings sarcoma?

A

primitive neuroectodermal tumour

184
Q

who gets ewings sarcoma?

185
Q

pres of ewings sarcoma?

A

mass or swelling on long bones

186
Q

ewings on XR?

A

bone destruction with onion skin layers of periosteal bone formation

187
Q

mets to bone?
lytic lesions?
sclerotic lesions?
both?

A

lytic - myeloma [pepperpot skull]

sclerotic - prostate

both - breast

188
Q

Mx of NOF fracture

A

ABCDE
analgesia + nerve block
VTE prophylaxis
early surgery -> mobilise on day 1, physio

Finals (20 decks)

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