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Phase 2a Medicine > MSK > Flashcards

MSK Flashcards

1
Q

What are the 4 pillars of inflammation?

A
  1. Rubor (red)
  2. Dolor (pain)
  3. Calor (hot)
  4. Tumor (swollen)
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2
Q

How might joint inflammation present?

A
  1. Hot, painful, red swollen joint
  2. Stiffness
  3. Poor mobility/function
  4. Deformity
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3
Q

Describe inflammatory pain

A
  1. Eases with use
  2. Stiffness > 60 mins
  3. Synovial swelling
  4. Young pt.
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4
Q

Describe degenerative pain

A
  1. Increases with use
  2. Stiffness < 30 mins
  3. Bony swelling
  4. Old pt.
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5
Q

Where is a common place for osteoarthritis (OA) to present?

A

Base of thumb

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6
Q

Describe rheumatoid arthritis (RA)

A
  1. Symmetrical
  2. Polyarthritis
  3. Deformity
  4. Erosion on X-ray
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7
Q

What are the hallmarks of RA?

A
  1. Ulnar drift

2. Erosion of bone

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8
Q

What are proximal nodes in OA called?

A

Bouchard’s nodes

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9
Q

What are distal nodes in OA called?

A

Heberden’s node

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10
Q

What is the pathophysiology of Raynaud’s?

A

Capillaries clamp down causing hypoxia in fingers

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11
Q

What is the colour changes in Raynaud’s?

A

White > blue > red

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12
Q

What inflammatory markers are used for MSK?

A
  1. ESR (erythrocyte sedimentation rate)

2. CRP

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13
Q

What markers are used to test for rheumatoid arthritis?

A
  1. Rheumatoid factor

2. Cyclic citrullinated peptide (CCP)

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14
Q

What markers are used to test for SLE?

A
  1. Anti nuclear antibody (ANA)

2. dsDNA

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15
Q

Which tissue type is associated with spondyloarthritis (SpA)?

A

HLA B27

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16
Q

What is the prevalence of HLA B27?

A

Further from equator is higher prevalence; 9% in UK

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17
Q

What are the theories for why B27 is linked with SpA?

A
  1. Molecular mimicry
  2. Mis-folding theory
  3. HLA B27 heavy chain homodimer hypothesis
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18
Q

What are the important therapeutic targets in HLA-B27 misfolding?

A

IL17 and IL23

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19
Q

What are the clinical features of SpA?

A
  1. Stooped posture
  2. Achilles inflamed
  3. Swollen knee
  4. Psoriasis
  5. Inflammation of eye
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20
Q

What are the other features of SpA?

A

SPINE ACHE

  1. Sausage digit (dactylitis)
  2. Psoriasis
  3. Inflammatory back pain
  4. NSAID good response
  5. Enthesitis (heel)
  6. Arthritis
  7. Crohn’s
  8. HLA B27
  9. Eye (uveitis)
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21
Q

What is axial spondyloarthritis (AS)?

A

Inflammatory arthritis of spine and rib cage

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22
Q

When does AS usual onset?

A

Late teens - 20s

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23
Q

What increases risk of AS?

A
  1. Male
  2. Smokers
  3. B27 +ve
  4. Syndesmophytes
  5. High CRP
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24
Q

What features are seen in AS?

A
  1. Syndesmophytes

2. Sacroiliitis

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25
Q

How is AS diagnosed?

A

Bone marrow oedema on MRI

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26
Q

What is the progression of disease in AS?

A
  1. Inflammation
  2. Erosive damage
  3. Repair
  4. New bone formation
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27
Q

What is the progression of AS?

A

Back pain with:

  1. Sacriliitis on MRI
  2. Radiographic sacroiliitis
  3. Syndesmophytes
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28
Q

What are the classifications for AS?

A
  1. > 3m back pain
  2. Onset <45 years old
  3. Sacroiliitis on imagine plus >1 AS feature
  4. HLA B27 plus >2 AS features
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29
Q

What is the Rx for AS?

A
  1. NSAIDs
  2. Physiotherapy
  3. Anti-TNF drugs
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30
Q

What are the patterns for psoriatic arthritis?

A
  1. DIPJ only
  2. RA like
  3. Large joint oligoarthritis
  4. Axial
  5. Arthritis mutilans
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31
Q

What is the presentation of psoriatic arthritis?

A
  1. Patches of psoriasis incl. in the nail
  2. Telescoping
  3. Pencil in cup X-ray changes
  4. Dactylitis
  5. Pitting
  6. Oncolysis
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32
Q

What is the Rx for psoriatic arthritis?

A
  1. DMARDs e.g. MTX
  2. Anti-TNF drugs e.g. etanercept, infliximab
  3. IL-12/23 blockers e.g. ustekinumab
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33
Q

What is reactive arthritis?

A

Sterile inflammation of synovial membrane, tendons and fascia triggered by an infection at a distant site, usually GI or genital

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34
Q

Name 3 infections related to reactive arthritis

A
  1. Salmonella
  2. Shigella
  3. Chlamydia
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35
Q

What are the features of reactive arthritis?

A
  1. Arthritis (2 days to 2 weeks post infection)
  2. Conjunctivitis
  3. Urethritis
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36
Q

What is the DDx for reactive arthritis?

A
  1. Septic arthritis

2. Gout

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37
Q

What is the investigation for reactive arthritis?

A
  1. Raised ESR/CRP
  2. Aspirate joint to exclude infection/ crystals
  3. Urethral swab
  4. Stool culture
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38
Q

What is the Rx for reactive arthritis?

A
  1. Physiotherapy
  2. NSAIDs e.g. indomethacin
  3. Anti-TNF e.g. etanercept
  4. Abx if indicated
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39
Q

What is osteoporosis?

A

A systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

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40
Q

How many osteoporotic fracture are there in the UK each year?

A

230,000

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41
Q

How does menopause increase risk of osteoporosis?

A
  1. Peak bone mass reduces with age
  2. Bone resorption decreases due to remodelling imbalance
  3. Loss of restraining effects of oestrogen on bone turnover
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42
Q

How can postmenopausal osteoporosis be prevented?

A

Oestrogen replacement

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43
Q

How is postmenopausal osteoporosis characterised?

A
  1. High bone turnover (resorption > formation)
  2. Predominantly cancellous bone loss
  3. Microarchitecture disruption
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44
Q

What is the result of increased bone turnover?

A

Less trabeculae so less strength to withstand fracture

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45
Q

What are the changes to trabecular with ageing?

A
  1. Decrease in trabecular thickness
  2. Decrease in connections between horizontal trabeculae
  3. Decrease in trabecular strength and increased fractures
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46
Q

How is osteoporosis diagnosed?

A
  1. Bone densitometry
  2. DXA (measures fracture sites)
  3. T-score (comparative bone loss)
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47
Q

What DXA score defines osteoporosis?

A

1.

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48
Q

What are the disease risk factors for osteoporosis?

A
  1. Inflammatory disease e.g. RA
  2. Endocrine disease e.g. hyperthyroidism, Cushing’s
  3. Reduced skeletal load e.g. immobility
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49
Q

What medications increase risk of osteoporosis?

A
  1. Glucocorticoids
  2. Aromatase inhibitor
  3. GnRH analogues
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50
Q

What Hx risk factors increase risk of osteoporosis?

A
  1. Previous fracture
  2. FHx of osteoporosis or fracture
  3. Alcohol
  4. Smoking
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51
Q

What is the risk assessment tool for fracture?

A

FRAX

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52
Q

What types of osteoporosis drugs are there?

A
  1. Anti-resorptive

2. Anabolic

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53
Q

What is the mechanism of anti-resorptive drugs?

A

Decrease osteoclast activity and bone turnover

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54
Q

Give examples of anti-resorptive Rx

A
  1. Biphosphonates
  2. HRT
  3. Denosumab
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55
Q

What is the mechanism of anabolic osteoporotic drugs?

A

Increase osteoblast activity and bone formation

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56
Q

Give an example of an anabolic drug

A

Teriparatide

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57
Q

What are the risks of HRT?

A
  1. Breast cancer
  2. Stroke
  3. CVD
  4. Venous thromboembolic disease
  5. Vaginal bleeding
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58
Q

Give 3 examples of biphosphonates

A
  1. Alendronate
  2. Risedronate
  3. Ibandronate
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59
Q

What are the common vasculitis diseases in the UK?

A
  1. Giant cell arteritis
  2. Polymyalgia rheumatica
  3. ANCA associated vasculitis (AAV)
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60
Q

How is vasculitis characterised?

A
  1. Vessel size

2. Consensus classification

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61
Q

How does giant cell arteritis (GCA) present?

A
  1. Stroke

2. Blindness

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62
Q

What are the clinical patterns of GCA?

A
  1. Cranial GCA (headache)

2. Large vessel GCA (malaise, weight loss)

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63
Q

What is the pathogenesis of GCA?

A
  1. Activation of dendritic cells in adventitia
  2. Recruitment and activation of T cells
  3. Recruitment of CD8 cells and monocytes
  4. Vascular damage and remodelling
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64
Q

What are the symptoms of cranial GCA?

A
  1. New headache
  2. Scalp tenderness
  3. Visual symptoms e.g. loss, amarosis
  4. Jaw claudication
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65
Q

Describe GCA headache

A
  1. Abrupt
  2. Unilateral
  3. Temporal
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66
Q

What are the symptoms of LV-GCA?

A
  1. Constitutional symptoms e.g. malaise, fever
  2. Polymyalgia
  3. Limb claudication
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67
Q

What are the signs of GCA?

A
  1. Scalp tenderness
  2. Temporal artery tenderness
  3. Reduced/absent pulsation
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68
Q

What are the complications of GCA?

A
  1. Visual loss

2. Strokes

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69
Q

What are the investigations for GCA?

A
  1. Temporal artery biopsy
  2. USS
  3. PET-CT scan (LV-GCA)
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70
Q

What is the Rx for GCA?

A
  1. Glucocorticoids - promptly (prednisolone)

2. DMARD e.g. MTX

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71
Q

What are the side effects of GCA Rx?

A
  1. Osteoporosis

2. DM

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72
Q

What are AAV?

A

Rare life-threatening, multi-system diseases causing damage to predominantly small vessels

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73
Q

What are the 3 key AAV conditions?

A
  1. Granulomatosis with polyangiitis (GPA)
  2. Eosinophilic granulomatosis with polyangiitis
  3. Microscopic polyangiitis
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74
Q

What is vasculitis?

A

Neutrophil driven necrotising inflammation causing direct vessel wall damage

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75
Q

What is the pathogenesis of AAV?

A
  1. Pathogenic anti-neutrophil cytoplasmic antibodies (ANCA)
  2. Vasculitis
  3. Granulomatous inflammation
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76
Q

What are the 2 patterns of AAV?

A
  1. PR3-ANCA (C-ANCA pattern)

2. MPO-ANCA (P-ANCA pattern)

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77
Q

Give 5 symptoms of GPA

A
  1. Epistaxis
  2. Hearing loss
  3. Hoarseness
  4. Iritis
  5. Cough
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78
Q

What are the investigations for GPA?

A
  1. ANCA testing
  2. Tissue biopsy (renal)
  3. CT thorax
  4. CRP/U&E
  5. CT head
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79
Q

What is the Rx for GPA?

A
  1. Cyclophosphamide or rituximab
  2. Glucocorticoids
  3. Plasma exchange
  4. DMARD e.g. azathioprine
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80
Q

What joints does OA affect?

A

Synovial joints

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81
Q

How many people in the UK have OA?

A

8.75m people

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82
Q

What is OA?

A

An age-related, dynamic reaction pattern of a joint in response to insult or injury

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83
Q

Which joint type is most affected by OA?

A

Articular cartilage

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84
Q

What are the main pathological features of OA?

A
  1. Loss of cartilage

2. Disordered bone repair

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85
Q

What is the pathogenesis of OA?

A
  1. Wear and tear
  2. Mechanical forces
  3. Metabolically active mediated by cytokines
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86
Q

What are the risk factors for OA?

A
  1. Age
  2. Female
  3. Genetic pre-disposition
  4. Caucasian
  5. Obesity
  6. Occupation - manual labour
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87
Q

Why is age a risk factor for OA?

A
  1. Cumulative effect of traumatic insult

2. Decline in neuromuscular function

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88
Q

What are the symptoms of OA?

A
  1. Pain

2. Functional impairment

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89
Q

What are the signs of OA?

A
  1. Alteration in gait (valgus)
  2. Joint swelling
  3. Limited ROM
  4. Crepitus
  5. Tenderness
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90
Q

What are the radiological features of OA?

A
  1. Joint space narrowing
  2. Osteophyte formation
  3. Subchondral sclerosis
  4. Subchondral cysts
  5. Abnormalities of bone contour
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91
Q

Describe nodal OA

A
  1. Early inflammatory phase in joint - red, swelling
  2. Bone swelling and cyst formation
  3. Reduced hand function
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92
Q

What compartment of the knee is most commonly affected by OA?

A

Medial

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93
Q

What is a key feature of OA of the hip?

A

Groin pain

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94
Q

What is the additional management for inflammatory OA?

A

DMARDs

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95
Q

What is loose body in the knee associated with?

A

Locking of knee

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96
Q

What is the non-medical management for OA?

A
  1. Weight loss
  2. Physiotherapy
  3. Occupational therapy
  4. Footwear
  5. Walking aids
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97
Q

What is the pharmacological management for OA?

A
  1. NSAIDs
  2. Capsaicin
  3. Opioids - tramadol
  4. Puprenorphine
    Intra-articular steroid injections
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98
Q

What is the surgical management for OA?

A
  1. Arthroscopy
  2. Osteotomy
  3. Arthroplasty
  4. Fusion
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99
Q

What are the indications for arthroplasty?

A
  1. Uncontrolled pain

2. Significant limitation of function

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100
Q

What are the features of Marfan’s syndrome?

A
  1. Tall with wide arm span
  2. Dislocations
  3. High arches palate
  4. Arachnodactyly
  5. Aneurysms
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101
Q

What are the features of Ehler Danlos syndrome?

A

Hyperflexibility and hyperelasticity

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102
Q

What is the pathology of autoimmune connective tissue disorders (CTD)?

A

Inflammation leading to scarring in organs affected

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103
Q

Which group is most at risk for Systemic Lupus Erythematosus (SLE)?

A

Afro-Caribbeans

104
Q

What genes are associated with SLE?

A

HLA DR2/3

105
Q

What is the pathogenesis of SLE?

A
  1. Immune complex mediated inflammation -> tissue damage

2. Phospholipid antibodies cause thrombosis

106
Q

What are the skin features of SLE?

A
  1. Malar butterfly rash
  2. Generalised erythema
  3. Bullous LE
  4. Annular
  5. Discoid
107
Q

How doe arthritis present in SLE?

A
  1. Symmetrical
  2. Deforming
  3. Non-erosive
108
Q

What are the features of lupus nephritis?

A
  1. Hypertension
  2. Proteinuria
  3. Renal failure
109
Q

What are the haematological features of SLE?

A
  1. Anaemia
  2. Thrombocytopenia
  3. Neutropenia
  4. Lymphopenia
110
Q

What is the Dx for SLE?

A
  1. Anti-nuclear antibody
  2. Double stranded DNA antibody
  3. Rheumatoid factor
111
Q

What is the management for SLE pt.?

A
  1. UV protection
  2. Assess lupus activity
  3. Screen for major organ involvement
112
Q

What drugs are used to treat SLE?

A
  1. Topical e.g. sunscreen
  2. NSAID
  3. Antimalaria - HCQ
  4. Steroids
  5. Azathioprine or MTX
  6. Rituximab
113
Q

What are the features of systemic sclerosis?

A
  1. Vasculopathy
  2. Excessive collagen deposition
  3. Inflammation
  4. Auto-antibody production
114
Q

What are the subsets of systemic sclerosis (SSc)?

A
  1. Limited cutaneous
  2. Diffuse cutaneous
  3. Sine scleroderma
  4. Overlap syndromes
115
Q

What are the features of limited cutaneous SSc?

A
  1. Sclerodactyly
  2. Long Hx Raynaud’s phenomenon
  3. Late-stage complications
  4. Pulmonary arterial HTN
116
Q

What are the features of diffuse cutaneous SSc?

A
  1. Proximal scleroderma and trunk involvement
  2. Short Hx of Raynaud’s
  3. Increased risk renal crisis, cardiac involvement, ILD
117
Q

What are the symptoms of SSc?

A
  1. Strictures
  2. Ulceration in chronic ischaemia
  3. Capillaries in nailfolds
  4. Calcification in fingers
  5. Telaugioctasia
  6. Oesophageal dysmotility
118
Q

What is the Rx for SSc?

A
  1. Treat symptoms

2. Early detection of pulmonary arterial hypertension - annual ECG and pulmonary function tests

119
Q

What is the Rx for Raynaud’s?

A
  1. Physical protection
  2. Vasodilators e.g. nifedipine
  3. Fluoxetin
120
Q

What are the causes of secondary Sjögren’s syndrome?

A
  1. SLE
  2. RA
  3. Scleroderma
  4. Primary biliary cirrhosis
121
Q

What are the symptoms of primary Sjögren’s syndrome?

A
  1. Dry eyes
  2. Dry mouth
  3. Arthritis
  4. Rash
122
Q

What are the lab features of primary Sjögren’s syndrome?

A
  1. ANA +
  2. RF +
  3. Ro and La +
  4. dsDNA -
123
Q

What is the Rx for Sjögren’s syndrome?

A
  1. Tear and saliva replacement
  2. HCQ
  3. Corticosteroids/ immunosuppressants
  4. Biological therapies
124
Q

What are the features of dermatomyositis?

A
  1. Rash and muscle weakness

2. ILD

125
Q

What is the investigation for dermatomyositis?

A
  1. Increase creatinine kinase
  2. Antibody screen
  3. EMG
  4. Muscle/skin biopsy
  5. PET
  6. CXR
126
Q

What is the Rx for dermatomyositis?

A
  1. Steroids

2. Immunosuppressants

127
Q

When does CRP suggest infection rather than inflammation?

A

> 100

128
Q

How is joint infection diagnosed?

A

Joint aspirate

129
Q

When does joint aspirate indicate infection?

A
  1. Turgid fluid (yellow and cloudy)
  2. Leucocytes
  3. Gram stain
130
Q

What is the management for joint infection?

A
  1. Stop DMARD and anti-TNF
  2. Abx e.g. flucloxacillin
  3. Prednisolone double
  4. Analgesia
  5. Splinting
131
Q

What is the most common age for septic arthritis?

A

> 65

132
Q

Name 3 organisms that commonly cause joint infection

A
  1. S. aureus
  2. Streptococci
  3. Neisseria gonorrhoea
133
Q

Why do immunocompromised need synovial lining biopsy when joint infection is suspected?

A

To check for unusual organisms as causes

134
Q

When does gonococcal arthritis occur?

A

With disseminated gonococcal infection

135
Q

What are the symptoms of gonococcal arthritis?

A
  1. Fever
  2. Arthritis
  3. Tenosynovitis
  4. Maculopapular-pustular rash
136
Q

What are the risk factors for septic joint?

A
  1. Any cause for bacteraemia
  2. Direct/penetrating trauma
  3. Local skin breaks/ulcers
  4. Damaged joints
137
Q

What people are at risk for septic joint?

A
  1. Immunosuppression
  2. Elderly
  3. RA
  4. DM
138
Q

What is the typical presentation of a septic joint?

A
  1. Painful, red, swollen, hot joint
  2. Fever
  3. Monoarthritis (90%)
  4. Knee > hip > shoulder
139
Q

What is the management for septic joint?

A
  1. Aspiration
  2. Long course Abx
  3. Joint washout
  4. Rest/splint/physio
  5. Analgesia
  6. Stop immunosuppressant therapy
140
Q

Where can listeria infection come from?

A

Soft cheese

141
Q

Why is propionibacteria more of a problem in upper limbs?

A
  1. Colonises humans above the waist

2. Can be shed by blinking

142
Q

Why are propionibacteria difficult to treat?

A
  1. Slow growing therefore hard to diagnose
  2. Seldom cause acute infections
  3. Don’t significantly raise inflammatory markers
143
Q

What is the incidence of osteomyelitis?

A

10-100 per 100,000 pa

144
Q

Why is there an increasing prevalence of chronic osteomyelitis?

A

Due to increasing prevalence of predisposing conditions e.g. DM, PVD

145
Q

Describe acute osteomyelitis

A
  1. Associated with inflammatory bone changes caused by pathogenic bacteria
  2. Symptoms typically present within 2 weeks
146
Q

Describe chronic osteomyelitis

A
  1. Involves bone necrosis

2. Symptoms may not occur until 6w after onset of infection

147
Q

What is direct inoculation?

A

Direct inoculation into bone via trauma or surgery

148
Q

What is contiguous spread?

A

Spread of infection to bone from adjacent soft tissues and joints, or conditions e.g. DM, chronic ulcers

149
Q

What is haematogenous seeding?

A

Children (long bones) > adults (vertebrae)

150
Q

What are the host factors for osteomyelitis with an example?

A
  1. Behavioural factors e.g. risk of trauma
  2. Vascular supply e.g. DM
  3. Pre-existing bone or joint problem e.g. inflammatory arthritis
  4. Immune deficiency e.g. drugs
151
Q

Where does most haematogenous OM occur?

A

Long bone metaphysis

152
Q

Why is metaphysis more common for haematogenous OM?

A

Slower blood flow which allows bacteria to penetrate BM

153
Q

What bacteria is most commonly associated with haematogenous OM?

A

S. aureus

154
Q

What bacteria often cause OM?

A
  1. S. aureus
  2. Coagulase-negative staphylococci
  3. Aerobic gram-negative bacilli
155
Q

What is the histopathology in OM?

A
  1. Inflammatory exudate in marrow
  2. Increase intramedullary pressure
  3. Extension of exudate into bone cortex
  4. Rupture through periosteum
  5. Interruption of periosteal blood supply causing necrosis
  6. Leaves pieces of separated dead bone sequestra
  7. New bone forms here - involucrum
156
Q

What are the symptoms for OM?

A
  1. Dull pain at site of OM
  2. Aggravated by movement
  3. Malaise
  4. Fever
  5. Sweats
157
Q

What are the signs of acute OM?

A
  1. Tenderness
  2. Warmth
  3. Erythema
  4. Swelling
158
Q

What are the signs of chronic OM?

A
  1. Signs of acute OM
  2. Draining sinus tract
  3. Deep ulcers that fail to heal
  4. Non-healing fractures
159
Q

What is the Dx of OM?

A
  1. High WCC (acute)
  2. High ESR/CRP (acute)
  3. X-ray of joint
  4. MRI
  5. CT
  6. Nuclear bone scan
  7. Bone biopsy
160
Q

What is the DDx for OM?

A
  1. Soft tissue infection
  2. Charcot joint
  3. Avascular necrosis of bone
  4. Gout
  5. Fracture
161
Q

What is the Rx for OM?

A
  1. Debridement
  2. Hardware replacement
  3. Abx
162
Q

How long is Abx treatment usually in OM?

A

2-6 weeks

163
Q

What guides stopping OM Abx Rx?

A

ESR/CRP levels

164
Q

How are septic joint infections diagnosed?

A
  1. Hx
  2. Examination
  3. X ray
  4. FBC, ESR, CRP
  5. Microbiology culture
165
Q

How is septic joint infection confirmed?

A

Aspiration with pt. OFF Abx for 2 weeks

166
Q

What is the Rx for septic joint infection?

A
  1. Abx suppression
  2. Debridement and retention of prosthesis
  3. Excision arthroplasty
  4. 1-/2-stage exchange arthroplasty
  5. Amputation
167
Q

When is Abx suppression done?

A
  1. Pt. unfit for surgery
  2. Multiple prosthetic joint infections
  3. Poor distal tissues
168
Q

What are the risk factors for primary bone cancer (PBC)?

A
  1. Previous radiotherapy
  2. Previous primary bone cancer
  3. Paget’s disease of bone
  4. Childhood cancer
  5. Germline abnormalities
  6. Benign bone lesions
169
Q

What are the red flag symptoms of PBC?

A
  1. Bone pain worse at night
  2. Atypical bony of soft tissue swelling/masses
  3. Pathological fractures
170
Q

Describe bone pain in PBC

A
  1. Worse at night
  2. Constant or intermittent
  3. Resistant to analgesia
  4. May increase in intensity
171
Q

What are the other symptoms of PBC?

A
  1. Easy bruising
  2. Mobility issues e.g. stiff, limp
  3. Inflammation and tenderness over bone
  4. Systemic symptoms
172
Q

What are the investigations for PBC?

A
  1. Plain X-ray
  2. ESR, ALP, LDH, FBC, U&E, Ca
  3. 40+ -> CT chest, abdo, pelvis
  4. Biopsy
173
Q

What is the management of PBC?

A
  1. Neoadjuvant and adjuvant chemo
  2. Radiotherapy
  3. Surgery (limb sparing or amputation)
174
Q

What are the radiological features in PBC?

A
  1. Bone destruction
  2. New bone formation
  3. Soft tissue swelling
  4. Periosteal elevation
175
Q

What are the most common types of PBC?

A
  1. Chondrosarcoma
  2. Osteosarcoma
  3. Ewing sarcoma
176
Q

When is the highest incidence for chondrosarcoma?

A

30-60 years

177
Q

What are the common sites for chondrosarcoma?

A
  1. Rubs
  2. Long bones
  3. Pelvis
178
Q

What is the typical radiology for chondrosarcoma?

A

Popcorn calcification

179
Q

What is the Rx for chondrosarcoma?

A

Excision only (chemo and radiotherapy resistant)

180
Q

When is the incidence peak in osteosarcoma?

A
  1. 15-19

2. 70-89

181
Q

What are the common sites for osteosarcoma?

A

Long bones, eps. around the knee

182
Q

What is the typical radiology for osteosarcoma?

A
  1. Sunday spiculation

2. Codman’s triangle

183
Q

What is the Rx for osteosarcoma?

A

Surgery, chemo

184
Q

What cells does Ewing sarcoma effect?

A

Neural crest cells

185
Q

What age is highest incidence for Ewing sarcoma?

A

10-20

186
Q

What bones are commonly affected by Ewing sarcoma?

A
  1. Long bones
  2. Pelvis
  3. Ribs
  4. Vertebrae
187
Q

What is the typical radiology for Ewing sarcoma?

A

Onion ring sign

188
Q

What is the Rx for Ewing sarcoma?

A
  1. Chemo
  2. Surgery
  3. Radiotherapy
189
Q

What is a cardinal sign of malignancy on imaging?

A

Wide zone of transition (ill-defined border)

190
Q

What is the management for hip fractures?

A
  1. Reduction
  2. Immobilisation
  3. Rehabilitation
191
Q

What are the stages in fracture healing?

A
  1. Haematoma formation
  2. Fibrocartilaginous callus formation
  3. Bony callus formation
  4. Bone remodelling
192
Q

Give 5 early complications of fracture

A
  1. Infection
  2. Compartment syndrome
  3. Fat embolus
  4. Shock
  5. Crush syndrome
193
Q

Give 5 late complications of fracture

A
  1. Delayed union
  2. Avascular necrosis
  3. Stiffness
  4. Arthritis
  5. Osteomyelitis
194
Q

What are the features of compartment syndrome?

A
  1. Pain disproportionate to injury
  2. Paresthesia
  3. Tense compartment
195
Q

What are the symptoms of compartment syndrome?

A

5 Ps

  1. Pain
  2. Pallor
  3. Perishing cold
  4. Paralysis
  5. Pulselessness
196
Q

What is the Rx for compartment syndrome?

A

Fasciotomy then leave for 24hr to see if still viable and remove dead tissue

197
Q

What is the presentation of ACL injuries?

A
  1. Swelling
  2. Knee giving way
  3. Pain
198
Q

What is the Dx of ACL injuries?

A
  1. Positive Lachman’s
  2. Anterior draw test
  3. MRI
199
Q

What is the Rx for ACL injury?

A
  1. RICE - rest
  2. Conservative - physiotherapy
  3. Surgical - tendon repair, artificial graft
200
Q

What are the red flags of cauda equine syndrome?

A
  1. Bilateral sciatica
  2. Severe neurological deficit of legs
  3. LUTS
  4. Loss of sensation of rectal fullness
  5. Perianal, perineal or genital sensory loss
  6. Laxity of anal sphincter
201
Q

What is the Rx for cauda equine syndrome?

A

Urgent decompression and discectomy

202
Q

What is the initial management for trauma fractures?

A
  1. Analgesia
  2. Examination (neurovascular)
  3. Reduce
  4. Immobilise
  5. Rehabilitate
203
Q

What can be used to immobilise a fracture?

A
  1. Cast
  2. Splint
  3. Brace
  4. Halo
  5. Traction
  6. Internal fixation e.g. screws
  7. Excision and arthroplasty
  8. External fixation (frames)
204
Q

What is crystal arthropathy?

A

Arthritis caused by crystal deposition in joint lining

205
Q

What crystal is in gout?

A

Urate

206
Q

What crystal is in pseudogout?

A

Pyrophosphate

207
Q

How do crystal arthropathies present?

A

Hot, swollen joints

208
Q

How are crystal arthropathies diagnosed?

A
  1. Hx
  2. Pattern
  3. Aspiration of joint
  4. Blood tests
  5. XR
209
Q

Describe the crystals found in gout

A

Negatively birefringent needles

210
Q

Describe the crystals found in pseudogout

A

Positively birefringent rhomboids

211
Q

Where is uric acid produced from?

A

Nucleic acids and purine metabolism

212
Q

What is the key enzyme in uric acid production?

A

Xanthine oxidase

213
Q

Where is urate found in the diet?

A
  1. Shellfish
  2. Red meat
  3. Liver
  4. Fizzy drinks
214
Q

What is the pathogenesis of gout?

A
  1. Renal, diet, drugs
  2. Excessive urate
  3. Urate crystals
  4. Phagocyte activation
  5. Inflammation
215
Q

What are the risk factors for gout?

A
  1. OA
  2. Trauma
  3. Age
  4. Hereditary
  5. Metabolic disease
216
Q

What is a major risk factor for gout?

A

Hyperuricaemia

217
Q

Name 3 things that cause under-excretion of urate

A
  1. Alcohol
  2. Low dose aspirin
  3. HTN
218
Q

Name 3 things that cause over-excretion of urate

A
  1. Psoriasis
  2. Yeast extract
  3. Alcohol
219
Q

What can cause a sudden change in uric acid concentration?

A
  1. Hypouricaemic therapy
  2. Alcohol or shellfish binge
  3. Sepsis
  4. Trauma
220
Q

What is the Rx for gout attack?

A
  1. Anti-inflammatories
  2. NSAIDs
  3. Colchicine
  4. Steroids
221
Q

What are tophi?

A

Onion like aggregates of urate crystals with inflammatory cells

222
Q

How long does it take to treat tophi?

A

6-9 months

223
Q

What is the aim in long term treatment for gout?

A

Urate < 300umol/L

224
Q

What is the long term Rx for gout?

A
  1. Xanthine oxidase inhibitors e.g. allopurinol

2. Colchicine

225
Q

What are the side effects of allopurinol?

A
  1. Rash
  2. Headache
  3. Myalgia
226
Q

What causes pseudogout?

A

Deposition of calcium pyrophosphate crystals on joint surface

227
Q

Where does pseudogout tend to occur?

A

Wrists, knees

228
Q

What is seen on pseudogout XR?

A

Chondrocalcinosis

229
Q

What are the symptoms of pseudogout?

A
  1. Severe pain
  2. Stiffness
  3. Swelling
  4. Synovitis
  5. Fever
230
Q

What can trigger pseudogout attack?

A
  1. Trauma
  2. Intercurrent illness
  3. Surgery
  4. Blood transfusion
  5. T4 replacement
231
Q

When should pseudogout pt. be screened for metabolic diseases?

A
  1. Early onset <55
  2. Polyarticular
  3. Frequent recurrent attack
  4. Additional clinical or radiographic clues
232
Q

What is the acute management for pseudogout?

A
  1. NSAIDs
  2. Analgesia
  3. Aspiration
  4. Injection
  5. Physiotherapy
233
Q

What is the long term management for pseudogout?

A
  1. Anti-rheumatic Rx e.g. MTX, HCQ
  2. Synovectomy
  3. Surgery
234
Q

What are the symptoms of RA?

A
  1. Tender, warm, swollen joints
  2. Joint stiffness worse in morning and after inactivity
  3. Fatigue
  4. Fever
  5. Anorexia
235
Q

What are the investigations for RA?

A
  1. Raised ESR
  2. Raised CRP
  3. Rheumatoid factor
  4. Anti-CCP
  5. XR
236
Q

What are the Rx for RA?

A
  1. Ibuprofen
  2. Prednisone
  3. MTX
  4. Rituximab
237
Q

What is the pathophysiology of fibromyalgia?

A

Abnormalities in neuroendocrine and autonomic nervous systems

238
Q

What are the symptoms of fibromyalgia?

A
  1. Widespread pain
  2. Extreme sensitivity
  3. Stiffness
  4. Fatigue
  5. Cognitive problems
239
Q

What is the Ix for fibromyalgia?

A
  1. FBC
  2. CCP test
  3. Rheumatoid factor
  4. TFTs
240
Q

What is the Rx for fibromyalgia?

A
  1. Analgesia
  2. Duloxetine
  3. Gabapentin
  4. Physical therapy
  5. Occupational therapy
241
Q

What is the source of pain in mechanical lower back pain?

A
  1. Spinal joints
  2. Discs
  3. Vertebrae
  4. Soft tissues
242
Q

What are the symptoms of mechanical lower back pain?

A
  1. Pain in lower back
  2. Pain radiates to buttocks and thighs
  3. Spasms
  4. Noticeable with flexion and when lifting
243
Q

What are the Ix for lower back pain?

A
  1. XR
  2. MRI or CT
  3. Bloods
  4. Nerve studies
244
Q

What are the Rx for mechanical lower back pain?

A
  1. Stay active
  2. Back exercise and stretches
  3. Ibuprofen
  4. Diazepam
245
Q

What is the pathophysiology of osteomalacia?

A
  1. Softening of bones
  2. Impaired bone metabolism
  3. Inadequate P, Ca, Vitamin D, resorption of Ca
246
Q

What are the symptoms of osteomalacia?

A
  1. Diffuse joint and bone pain
  2. Muscle weakness
  3. Waddling gait
  4. Hypocalcaemia
  5. Compressed vertebrae
247
Q

What is the Ix for osteomalacia?

A
  1. Vitamin D levels
  2. Ca and P levels
  3. XR - cracks
  4. Bone biopsy
248
Q

What is the Rx for osteomalacia?

A

Vitamin D supplements

249
Q

What is the pathology of vertebral disc degeneration?

A

One or more discs between vertebrae of spinal cord deteriorate or break down leading to pain

250
Q

What are the symptoms of vertebral disc degeneration?

A
  1. Low grade continuous pain around disc
  2. Pain on exertion
  3. Giving out sensation
  4. Muscle spasms
  5. Radiating pain
251
Q

What are the Ix for vertebral disc degeneration?

A
  1. XR
  2. MRI
  3. Physical exam
252
Q

What is the Rx for vertebral disc degeneration?

A
  1. Aspirin
  2. Ibuprofen
  3. Physical therapy
  4. Steroids
  5. Discectomy
253
Q

What is the pathophysiology of Paget’s disease?

A
  1. Increased and disorganised bone remodelling

2. Dense but fragile and expanding bones

254
Q

What are the symptoms of Paget’s disease?

A
  1. Bone pain
  2. Joint pain
  3. Sciatica
  4. Peripheral neuropathy
255
Q

What is the Ix of Paget’s disease?

A
  1. XR
  2. Bloods - Alk Phos
  3. Bone biopsy
  4. Scintigraphy
256
Q

What is the Rx for Paget’s disease?

A
  1. Alendronate
  2. Calcitonin
  3. Surgery

Phase 2a Medicine (15 decks)

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