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Phase 1 Exam > MSK > Flashcards

MSK Flashcards

1
Q

Definition of septic arthritis

A
  • An infection within a joint.

- Can occur at any age but mostly occurs in people with preexisting joint disorders.

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2
Q

Aetiology of septic arthritis

A
  • Haematogenous spread

- Mostly S.aureus

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3
Q

Risk factors of septic arthritis

A
  • IVDU
  • Diabetics
  • Pre existing joint conditions
  • Prosthetic joints
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4
Q

Presentation of septic arthritis

A
  • Pain, swollen, hot, tender joints.
  • Systemic features such as malaise and fatigue.
  • Early onset post prosthetic joint replacement - 3m and late onset.
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5
Q

Investigations of septic arthritis

A
  • Gram stain and culture - pre antibiotic.
  • Bloods showing ESR, CRP and white blood cell high.
  • Potential MRI for osteomyelitis
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6
Q

Management of septic arthritis

A
  • Initially fluxcocillian and then more specific and sensitivity antibiotics.
  • Fluid aspiration
  • NSAIDs for pain relief
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7
Q

Definition of chronic fatigue syndrome

A
  • Persistent disabling fatigue that lasts more than 6 months, is both mental and physical state and occurs more than 75% of the time.
  • Coexists with one or more: myalgia, polymyalgia, memory loss, unrefreshing sleep, fatigue on exertion for more than 24 hrs, persistent sore throat and tender axially/cervical lymph nodes.
  • Most commonly presents in women aged 20 to 50.
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8
Q

Aetiology of chronic fatigue syndrome

A
  • Not known
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9
Q

Risk factors of chronic fatigue syndrome

A
  • Female, EBV virus in adolescents, infectious diseases in adults, genetics.
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10
Q

Presentation of chronic fatigue syndrome

A
  • Presents with cardinal sign = chronic fatigue that is made worse by exertion.
  • Can be either mental or physical.
  • Mild, moderate or severe.
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11
Q

Investigations of chronic fatigue syndrome

A
  • There is no specific investigations.
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12
Q

Management of chronic fatigue syndrome

A
  • Graded exercise therapy, CBT, sleep management.
  • Screening for depression.
  • Reduced caffeine, alcohol, drugs and improved diet.
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13
Q

Definition of wrist fractures

A
  • Usually break in the distal end of the radius, ulna or carpal.
  • Usually seen in the distal inch.
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14
Q

Aetiology of wrist fractures

A
  • Usually falls on an outstretched hand or through sporting injuries and motor vehicle crashes.
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15
Q

Presentation of wrist fractures

A
  • Usually falls from an outstretched hand and osteopenia.

- Can be different degrees of severity, deformity and could be classic dinner fork presentation.

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16
Q

Risk factors of wrist fractures

A
  • Osteopenia/osteoporosis and falls.
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17
Q

Management of wrist fractures

A
  • Immobilisation

- Surgery may be needed.

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18
Q

Complications of wrist fractures

A
  • Malunion and compartment syndrome
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19
Q

Definition of ankle fractures

A
  • Refers to fractures medial, lateral and posterior malleolus.
  • Bimodal presentation - young men and older women.
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20
Q

Aetiology of ankle fractures

A
  • Usually low impact falls such as sporting injuries, inversion injuries, falls from a height or falls down the stairs.
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21
Q

Risk factors of ankle fractures

A
  • Osteoporosis and increased risk of falls
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22
Q

Presentation of ankle fractures

A
  • Usually swelling over the medial and lateral malleolus with pain on the bone.
  • Patient may recall a pop when falling.
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23
Q

Investigations of ankle fractures

A
  • Plain XR based on the ottwa rules.

- Classified as Weber classification.

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24
Q

Management of ankle fractures

A
  • If open then needs surgery.

- Open reduction, internal fixation, short leg casts.

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25
Q

Definition of hip fractures

A
  • Fracture of femur distal to the femoral head and proximal head a few cm below the lesser trochanter.
  • Head of femur fracture - common in elderly patients with reduced gait and bone density - common in osteoporotic women.
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26
Q

Aetiology of hip fractures

A
  • Falls from a standing height or high speed motor vehicle incidents.
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27
Q

Risk factors of hip fractures

A
  • Malignancy, increase in age and falls risk, osteoporosis, female
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28
Q

Pathophysiology of hip fractures

A
  • Falls onto the bone or twisting mechanism.

- Axial loading.

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29
Q

Presentation of hip fractures

A
  • Globular pain round the groin and greater trochanter.
  • Inability to weight bear.
  • Increased pain when internal or external rotation of the limb and flexion of the hip.
  • Shortened, externally rotated limb.
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30
Q

Investigations of hip fractures

A
  • Plain XR - anteriorposterior view and lateral view.
  • Prepare for surgery with bloods.
  • Identify if extra capsular and intracapsular.
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31
Q

Management of hip fractures

A
  • Surgery needed for internal fixation and potential for femoral head replacement.
  • Pain relief.
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32
Q

Complications of hip fractures

A
  • Avascular necrosis, VTE and non union.
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33
Q

Definition of fibromyalgia

A
  • Chronic pain syndrome diagnosed by presence of widespread body pain for at least 3 months with tenderness.
  • Women and around 35.
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34
Q

Aetiology of fibromyalgia

A
  • Abnormal pain messages, chemical imbalances, sleep problems, genetics.
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35
Q

Risk factors of fibromyalgia

A
  • Family history, rheumatological conditions, 20 to 60 and female.
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36
Q

Presentation of fibromyalgia

A
  • Chronic pain with diffuse tenderness, numbness and tingling in the peripheries, as well as stiffness and fluid retention.
  • Fatigue that is unrelieved by rest.
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37
Q

Investigations of fibromyalgia

A
  • Based on diagnosis

- 11 / 18 tender points

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38
Q

Management of fibromyalgia

A
  • Amitriptiline
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39
Q

Definition of osteoporosis

A
  • Systemic skeletal disorder that is characterised by decrease in bone mass, increase in bone fragility and susceptibility to falls.
  • BMD SD more than 2.5 lower than the young adult mean. T score = < -2.5
  • Osteopenia T score between - 1 and -2.5
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40
Q

Aetiology of osteoporosis

A
  • Inflammatory conditions such as RA and IBD.
  • Endocrine conditions such as hyperparathyroidism and hyperthyroidism.
  • Reduced skeletal loading.
  • Certain medications such as glucocorticoids.
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41
Q

Risk factors of osteoporosis

A
  • Increasing age, female, family history, early menopause or previous fragility features.
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42
Q

Presentation of osteoporosis

A
  • Fractures in the thoracic and lumbar region, proximal femur and distal radius.
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43
Q

Investigations of osteoporosis

A
  • DEXA scanning is gold standard, usually scanning of the lumbar vertebrae or proximal femur.
  • Osteoporosis = T score < - 2.5
  • FRAX and QFracture
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44
Q

Management of osteoporosis

A
  • Prevention and avoidance.
  • First line is bisphosphonates (Alendronate)
  • Denasumab/ terirparatide and HRT.
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45
Q

Definition of spondyloarthropathies

A
  • Group of inflammatory joint diseases that are characterised by arthritis that affects the spine and peripheral joints and also causes inflammation in parts where tendons and ligaments insert into the bone.
  • Most commonly presents between the ages of 20 and 40.
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46
Q

Aetiology of spondyloarthropathies

A
  • HLA - B27 allele
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47
Q

Presentation of spondyloarthropathies

A 
Sausage digits
Psoriasis
Inflammatory back pain
NSAIDs provide good control
Enthesis (Heel)
Arthritis
Chron's/colitis/raised CRP
HLA B27
Eyes (Uveitis)
- Most commonly has no evidence of rheumatoid factor (so seronegative) and peripheral arthritis presents asymmetrically.
48
Q

Defintion of axial spondylarthritis

A
  • Inflammatory disease that affects the spine.

- Most commonly seen in young adults, with males being more commonly and more severely affected.

49
Q

What does the term ‘ankylosing spondylitis’ mean?

A
  • Represents when radiographic changes occur in the sacroiliac joints
50
Q

Presentation of axial spondylarthritis

A
  • Patients usually presenting are young males (late teens/early 20’s) with increasing pain and morning stiffness in the lower back and buttock region.
  • They have progressive reduction of back function and develop loss of lumbar/ordorisis (excessive inward curvature of the spine of the spine and increased kyphosis (abornmally excessive convex curvature of the sacral and thoracic regions of the spine).
  • Loss of function and mobility in the lumbar spine - tested by the Schobes test.
  • Patients may also have achilles tendinitis, planter fasciatis as well as tenderness in the pelvis and chest wall and reduction in chest wall expansion.
51
Q

Investigations of axial spondylarthritis

A
  • Raised ESR and CRP.

- MRI indicates anklyosing spondilitis before plain XR .

52
Q

Management of axial spondylarthritis

A
  • Early diagnosis is key.
  • Use of morning exercises and slow release NSAID’s at night.
  • Use of rheumatological agents such as Methotrexate or TNF alpha blocking drugs.
53
Q

What is psoriatic arthritis?

A
  • Occurs in around 10% of patients have already have a psoriasis diagnosis.
  • Usually affects the distal interphalangeal joints and is most commonly seen as Dactylotisis.
  • Treat with NSAIDs and analgesics.
54
Q

Definition of reactive arthritis

A
  • A sterile synovitis that occurs after an enteric or sexually transmitted infection.
  • Patients that have HLA B27 allele are more susceptible to reactive arthritis.
55
Q

Presentation of reactive arthritis

A
  • Usually young men that present around 4 weeks post infection.
  • Usually lower limbs and asymmetrical pattern and also psoriasis like skin lesions.
56
Q

Investigations of reactive arthritis

A
  • Usually clinical diagnosis.

- If joint aspiration takes place then the synovial fluid will be sterile and show high neutrophils.

57
Q

Management of reactive arthritis

A
  • NSAIDs and local corticosteroid injections.
58
Q

Definition of crystal arthropathy

A
  • A group of joint diseases caused by deposits of crystals in the joints.
59
Q

Pathogenesis of crystal arthropathy

A
  • Crystal are deposited in the joint, the neutrophils ingest the crystals and degenerative them and release enzymes that damage the joint and create inflammation.
60
Q

Definition of gout

A
  • Deposits of urate within the joint lining.
  • Fairly common but seen more in men than women and in patients with a family history.
  • Rarely seen in younger adults and also pre menopausal women.
  • The incidence increases within post menopausal.
61
Q

Aetiology of gout

A
  • Caused by urate crystals.
  • Caused by hyperuricaemia due to impaired urate excretion in the kidney or overproduction of the urate.
  • Examples of underexcretion including alcohol, renal impairment, use of diuretic or low dose aspirin.
  • Examples of overproduction including psoriasis, metabolic syndrome, alcohol, excess meat, shellfish, gravy, yeast and fructose drinks.
62
Q

Presentation of gout

A
  • Usually middle aged male with sudden onset of severe, pain, swelling and redness in the metatorsophalangeal joint of the big toe.
  • Precipitated by dietary or alcohol excess, dehydration or a diuretic.
63
Q

Investigations of gout

A
  • Usually clinical diagnosis and rapid treatment but could consider aspirating fluid to look for microscopy, serum uric acid and serum urea and creatinine levels.
64
Q

Management of gout

A
  • NSAIDs such as declofenac or colchicine.

- Prophylaxis of colchicine.

65
Q

Definition of pseudogout

A
  • Caused by calcium pyrophosphate deposits.
  • Usually coexist with osteoarthirits and presents usually in the knees, wrists, shoulders and hips.
  • More common in older men.
66
Q

Aetiology of pseudogout

A
  • Unknown
  • Triggers include direct trauma, intercurrent illness, surgery (particularly parathyroidectomy), blood transfusion and mostly spontaneous.
67
Q

Presentation of pseudogout

A
  • Incidental findings.
  • Present usually in the knee then the wrist and shoulders.
  • Usually similar painful and tender joint with osteoarthritis involvement.
68
Q

Investigations of pseudogout

A
  • XR’s

- Arthrocentesis

69
Q

Management of pseudogout

A
  • NSAIDs and analgesics

- Possible use methotrexate or hydroxychlorquine

70
Q

Definition of osteomyelitis

A
  • An inflammatory condition of bone caused by an infecting organism, most commonly staph aureus.
  • Most commonly a single bone but may rarely have multiple sites.
71
Q

Types of osteomyelitis

A
  • Bone infection is either haematogenous or contiguous focus or direct inoculation (young people)
  • Can become chronic and acute.
72
Q

Aetiology of osteomyelitis

A
  • Commonly seen post injury/surgery and can be due to implantation - root canal, open fractures, joint replacement.
  • Staph aureus or streptococci, enterbactericaea
73
Q

Risk factors of osteomyelitis

A
  • Penetrating injuries, surgical contamination, IVDU and diabetes.
74
Q

Presentation of osteomyelitis

A
  • Non specific pain at site of infection
  • Systemic features such as malaise, fatigue and fever.
  • Local inflammation/swelling.
75
Q

Investigations of osteomyelitis

A
  • Bloods show increase in WBC, ESR and CRP
  • XR
  • CT/MRI/ultrasound
76
Q

Management of osteomyelitis

A
  • IV antibiotic at high dose for 2 - 4 weeks or IV for 2 weeks and oral to 2 - 4 weeks.
  • Potential surgical debridement
77
Q

Definition of vitamin D deficiency

A
  • Inadequate mineralisation of the osteoid framework, leading to soft bones, presenting as rickets in children or osteomalacia in adults.
  • Usually source through skin photosynthesis and a small amount through diet supplementation.
  • Usually presents in patients over the age of 50.
78
Q

Aetiology of vitamin D deficiency

A
  • Usually through lack of exposure to sunlight, high factor suncream use, geographical and seasonal changes.
79
Q

Risk factors of vitamin D deficiency

A
  • Inadequate exposure, increased skin pigment, over the age of 50, malabsorption, obesity, medication use or primary hyperparathyroidism
80
Q

Presentation of vitamin D deficiency

A
  • Patients present with proximal muscle weakness and pain
  • Low bone denesity and osteopenia
  • Hypocalcaemia can be due to severe vitamin D deficiencies
  • Children present with rickets = bowed legs, knocked knees and impaired growth
81
Q

Investigations of vitamin D deficiency

A
  • Vitamin levels are low
  • Phosphate and calcium either low or normal and PTH is raised
  • XR’s
82
Q

Management of vitamin D deficiency

A
  • Calcium supplement

- Vitamin D supplement can be oral or intramuscular

83
Q

Definition of rheumatoid arthritis

A
  • Chronic systemic autoimmune disorder that is characterised by symmetrical polyarthiritis.
  • Peak prevalence is between the ages of 30 and 50.
84
Q

Aetiology of rheumatoid arthritis

A
  • Sex hormones - pre menopausal women are 3 times more likely to develop RA then post menopausal when it evens out.
  • Family history and genetic factors
  • Smoking
85
Q

Presentation of rheumatoid arthritis

A
  • Symmetrical arthirtis with proximal joint involvement in the hands and feet.
  • Morning stiffness that lasts for more than 30 mins and also joint pain that can be relieved by rest.
  • Pain, loss of function, deformity and destruction
  • Extra articular involvement such as heart, lungs, skin, GI tract, eyes, kidneys
86
Q

Investigations of rheumatoid arthritis

A
  • Bloods - normachromic, normacytic anaemia and thrombocytosis as well as raised ESR and CRP.
  • Autoimmune antibodies - raised ACPA - sensitive and specific to RA
  • Rheumatoid factor positive in 30% of patients.
87
Q

Management of rheumatoid arthritis

A
  • No cure
  • NSAIDs
  • Corticosteroids
  • Anti TNF alpha drugs/ Rituximab
88
Q

Definition of osteoarthirtis

A
  • Group of conditions characterised by joint degradation.
  • Dynamic reaction pattern of a joint in response or injury with all the tissues of the joint involved.
  • Disease of the elderly.
89
Q

Aetiology of osteoarthritis

A
  • No clear underlying cause.

- Can exist with pseudogout or rheumatoid arthiritis

90
Q

Risk factors of osteoarthritis

A
  • Over the age of 45, female (postmenopausal), manual labour, footballer or farming.
91
Q

Presentation of osteoarthritis

A
  • Joint pain - worse by movement, relieved by rest.
  • Stiffness after periods of rest and transient in the mornings.
  • Distal joints involved
  • Affects weight bearing joints such as the hips, knees, vertebrae and shoulders.
  • Examination shows deformity and bone enlargement
92
Q

Investigations of osteoarthritis

A
  • FBC, ESR and CRP = Normal

- XR = Joint spacing, cyst formation and subchondral sclerosis.

93
Q

Management of osteoarthritis

A
  • Physical measures
  • Pain management
  • Potential surgery
94
Q

Definition of lupus

A
  • An inflammatory multisystem disease characterised by the presence of serum antibodies against nuclear components.
  • Usually seen in young females with peak incidence being 20 to 40.
95
Q

Aetiology of lupus

A
  • Unknown

- EBV, UV light, genetics, sex hormone are all potential triggers.

96
Q

Risk factors of lupus

A
  • Female, between 15 - 45, african/asian descent, family history, drugs, smoking and sun exposure.
97
Q

Presentation of lupus

A
  • Extremely varied
  • Symmetrical small joint arthralgia and skin manifestations (butteryfly rash)
  • Non specific features including fatigue, malaise and depression.
  • Discoid lupus - only skin involvement
  • Neurological features including epilepsy, migraine and cerebral ataxia.
98
Q

Investigations of lupus

A
  • Blood: normochromic normacytic anaemia and raised ESR but normal CRP.
  • If lupus nephiritis then albumin levels would be raised and also potential raised serum urea and creatinine.
  • Autoimmune antibodies = anti ds-DNA
99
Q

Management of lupus

A
  • NSAID’s for pain relief
  • Hydroxychloriquine and chloriquine
  • Corticosteroids = main stay - disease control then reduced dose.
  • Rituximab and azathirpine used for remission
100
Q

Defintion of systemic sclerosis

A
  • A multisystem disease with involvement of the skin and Raynaud’s phenomenon occurring early.
  • Characterised by functional and structural abnormalities of the small blood vessels, fibrosis of the skin and circulation of autoimmune antibodies.
  • It’s 3 times more common in women than men and patients are usually between the ages of 30 and 50.
101
Q

Risk factors of systemic sclerosis

A
  • This includes exposure to environmental substances and toxins.
  • Also family history
102
Q

Presentation of systemic sclerosis

A
  1. Limited cutaneous = Patients present with long history of Rayaund’s phenomenum with later stage complications including scelodactyl and pulmonary aterial HT.
  2. Diffuse cutaneous = Patients present with earlier stage Rayaund’s phenomenum with earlier complications such as renal crisis, cardiac involvement and scleroderma involving the proximal limbs and trunk.
103
Q

Investigations of systemic sclerosis

A
  • Usually based on the identification of the skin changes.

- Serum autoantibodies include anti topiomersel I and anti RNA polymerase I and II.

104
Q

Management of systemic sclerosis

A
  • This includes ACE inhibitors for hypertension and vasodilators such as Nifidepine
105
Q

Definition of Sjogren’s Syndrome

A
  • Characterised by immunological mediated obstruction of epithelial exocrine glands especially lacrimal and salivary.
  • Middle aged - 20 to 30 and the mid 50’s.
  • Common
106
Q

Aetiology and Risk Factors of Sjogren’s Syndrome

A
  • Unknown

- Female, lupus, RA, systemic sclerosis, genetic.

107
Q

Presentation of Sjogren’s Syndrome

A
  • Dry eyes and dry mouth as well as fatigue.

- Get them to eat biscuits and notice an absence of saliva.

108
Q

Investigations of Sjogren’s Syndrome

A
  • Serum autoantibodies - anti RO and rheumatoid factor

- Schirmer test

109
Q

Management of Sjogren’s Syndrome

A
  • Tear and saliva replacement
110
Q

Definition of systemic inflammatory vasculitis

A
  • A group of conditions that cause inflammation and damage to the blood vessels.
  • Seen in conditions including RA and damage to blood vessels.
  • Fairly rare other than giant cell arteritis.
  • Classification depends on the size of the vessel.
111
Q

Definition of giant cell arteritis

A
  • Over the age of 50, usually affects women more than men.
  • Temporal artery biopsy is diagnostic.
  • It usually affects the external carotid artery.
112
Q

Presentation of giant cell arteritis

A
  • When it affects the vessels closer to the top of the body: new onset headache, scalp tenderness and jaw claudication as well as stiffness and intense in the neck and shoulders.
  • In the lower limbs it causes limb claudication and pain and stiffness in the hip and lumbar vertebrae and limb claudication and polymyalgia.
113
Q

Investigations of giant cell arteritis

A
  • Temporal artery biopsy is diagnostic - needs to be before or within 7 days of starting steroids.
  • Bloods would indicate extremely high ESR and CRP and also potential normocytic normochromic anaemia.
  • MRI and PET scan could be used.
114
Q

Management of giant cell arteritis

A

Corticosteroids

115
Q

ANCA associated asculitis (AAV)

A

Typically a disease of small or medium vessels and usually between the ages of 40 to 60
About inducing remission and maintaining with Rituximab and Azathioprine.

116
Q

What are benign bone tumours?

A
  • Osteoid osteoma: benign tumour, usually seen in younger patients, with localised pain that is self limiting, usually seen in the proximal femur, tibial araphisis or spine. Investigations with CT scanning and management with NSAIDs.
  • Osteoblastoma: Rare bone producing tumours, that are more than 2cm in size, more common in males than females and management is with excision.
  • Osteochodroma: Metaphyseal lesion, covered by cartilage cap, that grows away from the growth plate and stops after puberty. It presents with a painless lump and is more common males than females and needs exicising.
117
Q

What is the most common type of malignant bone tumour?

A
  • Osteosarcoma, this is fatal if untreated.

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