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Disease summaries > MSK > Flashcards

MSK Flashcards

1
Q

What is a yellow flag

A

Psychosocial RF fro chronic pain + long term disability development

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2
Q

Fibromyalgia presentation

A 
Widespread pain 
fatigue 
Fatigue + pain with small increases in physical exertion 
Easily woken and can't fall back asleep 
Poor memory 
Loww mood 
Headaches 
Parasthesiae 
Morning stiffness
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3
Q

Firbomyalgia Diagnosis

A

Chronic pain > 3m
Presence of pain at 11/8 tender sites
No joint inflammation
Widespread tenderness

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4
Q

Differential diagnosis for fibromyalgia

A 
Hypothyrodism 
SLE 
Inflammatory arthiritis 
Hypercalcaemia 
Vit D def
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5
Q

Fibromyalgia management

A

Amitryptyline - Normal sleeping pattern

Pregabalin - Muscle relaxation

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6
Q

What is Anti-phospholipid syndrome

A

AI syndrome charecterised by thrombosis

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7
Q

Anti-phospholipid syndrome presentation

A 
Stroke 
TIA
MI 
DVT
Misscarraige
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8
Q

Anti-phospholipid syndrome Ab can cause?

A 
CLOT
C - Coag defect
L - LIvedo reticualris 
O - Obstetric issues 
T - Thrombocytopenia
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9
Q

Anti-phospholipid syndrome Ix

A

Anti-cardiolipin
Lupus anticoagulant
Anti - B2

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10
Q

Limited cutaneous scleroderma presentation

A 
CREST
C - Ca2+ deposition 
R - Raynauds 
E - Oesophageal dysmotility 
S - Sclerodactyly 
T - Telengectasia

Beak like nose

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11
Q

Systemic sclerosis Investigations

A

Serum Ab

  • Anti-nuclear Ab
  • Anti scl 70

X - ray
- Ca2+ deposits

Barium swallow

Bloods

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12
Q

What to avoid in Raynauds

A

Beta blockers

Smoking

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13
Q

Serum antibodies present in Sjrogren syndrome

A

Anti - Ro Ab

Anti - Lo Ab

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14
Q

Polymyositis presentation

A 
Symmetrical muscle weakness + wasting 
Difficulty:
- Squatting 
- Going upstairs 
- Hands above head
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15
Q

Presentation of mechanical back pain

A

Suddne onset
pain worse in evening
Morning stiffness
Excercise aggrevates pain

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16
Q

Back pain red flags

A 
TUNA FISH 
T - Thoracic back pain 
U - Unexplained WL
N - Nocturnal pain 
A - Age

F - Fever
I - Immunosuppressed
S - Spinal stenosis
H - Hx of malignancy

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17
Q

Clinical presentation of giant cell arteritis

A 
Temporal branch - Severe unilateral headaches
Opthalmic. A Visual disturbance 
Facial. A Claudication when chewing 
Scalp tenderness 
Weight loss
 fever
Malaise
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18
Q

Giant cell arteritis investigations

A

Bloods - High ESR
Duplex US
Biopsy - Long sections due to skip lesions

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19
Q

Giant cell arteritis management

A

PO Prednisolone
Asprin
PPI
Steroid failure –> DMARDs

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20
Q

What is polymyalgia rheumatica

A

Inflammatry condition causing pain and stiffness in shoulders, neck and pelvic girdle

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21
Q

PMR Presentation

A 
Bilateral shoulder pain - radiation to elbow
Bilateral pelvic girdle pain 
Pain worse with movement 
Intefers with sleep 
Morning stiffness >45 mins
Weight loss
Upper arm tenderness 
Carpal tunnel syndrome 
Pitting oedema
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22
Q

c - ANCA positive conditions

A

Granulomatosis with polyangitis - wegners granulomatosis

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23
Q

What is polyarteritis nodosa

A

Necrotising vasculitis leading to aneurysms + thrombosis in medium sized vessels
- Assosciated with Hep B

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24
Q

Polyarteritis nodosa investigations

A

Bloods

  • Increase WCC
  • Increase ESR/CRP

ANCA -ve

Angiogram

  • String of beads
  • organ ischaemia
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25
Q

Microscopic polyangitis description

A

Necrotising vasculitis of blood vessels in lungs and kidney

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26
Q

Granulomatosis with polyangitis presentation

A 
Chronic Sinusitis 
Cough 
Cardiac arrhythmias 
Non - caesiating granulomas 
Ulcers in resp tract
- Bloody mucus 
Saddle nose deformity - Curvy nose 
Pulmonary nodules 
Decreased urine output 
Increase BP
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27
Q

Granulomatosis with polyangitis investigations

A

Bloods - Increase ESR
CXR Nodules
cANCA positive

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28
Q

Psoriatic arthiritis investigations

A 
X-ray - Pencil in a cup 
Periostitis 
Ankylosis - bones join together
Osteolysis 
Dactylisis - S.T swelling
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29
Q

Features of arthiritis mutilans

A

Osteolysis

Telescopic finger

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30
Q

Common triggers for reactive arthiritis

A

Gastroenteritis

Chlamydia

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31
Q

Reactive arthiritis presentation

A

Conjunctivitis
Urethritis
Arthiritis/ Enthesitis

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32
Q

Temporal arterities Tx

A
  • 60mg Prednisolone
  • 75mg Apsirin
  • PPI
  • Prophylactic Bisphosphonates
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33
Q

Common organisms causing reactive arthirtis

A

Campylobacter - Bloody diarrhoea
Salmonella
Shigella

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34
Q

Antibodies specific to SLE

A

Anti-dsDNA

Anti-Smith

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35
Q

Antibodies specific to Dermatomyositis

A

Anti-Jo-1

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36
Q

Antibodies specific to Systemic sclerosis

A

Anti-Scl-70

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37
Q

Conditions where Raynauds are present

A

SLE
Scleroderma
Sjrogrens
RA

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38
Q

Describe degeneritive joint disease

A

Worse with activity
Improved with rest

OA

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39
Q

Describe Inflammatory joint disease

A

Worse after rest
Improved with activity

RA

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40
Q

BMI Ranges

A

<18.5 - Underweight
18.5 - 24.9 - Healthy weight
25 - 29.9 - Overweight
30 - 39.9 - Obese

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41
Q

2 differentials is MSK diseases when the DIPJ is involved

A

OA

Psoriatic arthiritis

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42
Q

HLA - B27 positive diseases

A

AS
Reactive
Psoriatic

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43
Q

Spondyloarthropathies common generic sx

A 
SPINEACHE 
S - Dactylitis 
P - Psoriasis 
I - Inflamm back pain 
N - NSAIDs good response 
E - Enthesitis 
A - Arthiritis
C - Chrons / UC / CRP
H - HLA-B27
E - Anterior uveitis
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44
Q

p - ANCA positive conditions

A

Polyareritis nodosa - Heart/Kidney/Skin/CNS

Microscopic Polyangitis

Eosinophilic granulomatosis with Polyangitis

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45
Q

Seropositive conditions

A 
RA
SLE
Scleroderma
Vasculitis 
Sjogren's
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46
Q

Seronegative conditions

A

AS
Psoriatic
Reactive

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47
Q

What is the sciatic stretch test

A

Sciatic stretch test -
+ve = Posteriot thigh/buttock pain

Suggestive of sciatic nerve irritation secondary to disc prolpase

48
Q

Schober test

A

Restricted flexion of lumbar spine

- Distance should increase

49
Q

What causes knee hyperextension

A

Cruciate ligament injury

50
Q

What causes joint effusion

A

ACL rupture
Septic arthirits
Inflammatory arthirits - RA
Osteoarthirits

51
Q

What does the Lateral collateral ligament test show

A

Varus

52
Q

What does the Medial collateral ligament test show

A

Valgus

53
Q

Thomas’ test

A

Loss of hip extension - suggests a fixed flexion deformity

+ve = Affected thigh rises off the bed (Contralateral hip flexion)

54
Q

Trendelenburg’s test

A

Hip adbuctor weakness
Gluteus medias + minimus

+ve = Pelvis drops on the side of the raised leg

Contralateral hip abductor weakness

55
Q

Rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

56
Q

Muscles for arm abduction

A

Supraspiantus
Deltoid
Trapezium

57
Q

What is Jobe’s test

A

Supraspinatus assessment

  • Impingement
  • Tear in tendon
58
Q

What does the painful arc test show

A

Subacromial impingement - Supraspinatus tendonitis

59
Q

What does the lift off test show

A

Subscapularis

  • Tendonitis
  • Tear
  • Subscapular nerve lesion
60
Q

What does the ecternal rotation against resistance test show

A

Infraspinatus + teres minor

Pain = Infraspinatus tendonitis

Falls back to internal rotation

  • Tear
  • Muscle wasting
  • LMN lesion (Axillary/Suprascapular)
61
Q

What does the scarf test show

A

ACJ pathology

62
Q

Primary bone tumours (3)

A

Osteosarcoma
Chondrosarcoma
E-wings sarcoma

63
Q

Osteosarcoma

  • Assosciation
  • X - ray
A

Paget’s disease

Sunburst appearance
Codmans triangle

64
Q

E - Wing’s sarcoma

- X - ray

A

Codmann’s triangle

Onion like apperance

65
Q

Precipitants of gouty attack

A 
Trauma 
surgery
Diuretics 
Dehydration 
Alcohol 
Infection
66
Q

Acute gout tx

A

High dose NSAIDs

Colchicine

67
Q

Gout prophylaxis

A
  • Avoid low dose aspirin
  • Stop diuretics

Allopurinol
- Inhibits xanthase oxidase

Febuxostat
- For pt’s intolerant to allopurinol

68
Q

SLE presentations

A

MD SOAP BRAIN
M - Malar rash
D - Discoid rash

S - Serositis/ Pericarditis
O - Oral ulcers
A - Arthralgia
P - Photosensitivity

B - Blood - Pancytopenia 
R - Renal - Glomerulonephritis 
A - ANA +ve 
I - Immuno - Anti - dsDNA
N - Neuro - Seizures
69
Q

SLE investigations

A

Bloods

  • FBC
  • U+E
  • ANA

Antibodies

Biopsy - Kidney
IgG + complement deposition

Urinalysis
- Protein:Creatnine ratio

70
Q

SLE mild tx

A

Hydroxychloroquine

71
Q

SLE management

A
  • NSAIDs
  • Prednisolone
  • Suncream and avoidance
  • Methotrexate
  • High dose prednisolone
  • Rituximab - refractory
72
Q

What is myeloma

A

Malignant disorder of plasma cells - Mature B lymphocytes

73
Q

What is found in the urine of a patient with myeloma

A

Bence jones protein

74
Q

Myeloma key features

A

C - Hypercalcaemia
R - Renal failure
A - Anaemia
B - Bone lesions

Paraproteinuria
Immunoparesis

75
Q

Myeloma pathology

  • Anaemia
  • Bone disease
  • Renal disease
  • Hyperviscocity
A

Bone marrow infiltration –> Pancytopenia
- Easy bleeding/bruising/Increased infection

Increased RANKL

  • Osteolytic lesions
  • Hypercalcaemia - Pain (Bone/Abdo)

Light chain deposition

Blurred vision
SOB

76
Q

Myeloma investigations

A

Bloods

BLIP 
B - Urine electrophoresis 
L - Light chain assay 
I - Immunoglobulins 
P - Protein electrophoresis

Bone marrow biopsy

Whole body MRI

77
Q

Myeloma X ray findings

A

Punched out lytic lesions

Raindrop skull

78
Q

Myeloma management

A

Chemo
High dose dexamethasone
Stem cell transplant

79
Q

Myeloma supportive management

A

EPO transfusions - Anaemia
Hydration
Bishosphonates
AVOID NSAIDs

80
Q

Secondary causes of OA

A

Joint disease
trauma
Haemochromatosis
Obesity

81
Q

OA presentation

A

Joint pain

  • Worse with movement
  • improves with rest
Joint stiffness 
crepitus 
Muscle wasting 
Knee effusion 
Unstable joint
82
Q

OA Investigations

A

Bloods

  • ESR
  • RF

X-ray

MRI

83
Q

OA management

A

1st - Paracetamol
2nd - NSAIDs + PPI
3rd - Intra articualr joint injection
4th - surgery

84
Q

Common causes of osteomyelitis

A

S.Aureus
H. Influnzae
E.Coli

85
Q

Osteomyelitis presentation

A 
fever
local pain - worse on movement 
Malaise 
Sweats 
Erythema
86
Q

Osteomyelitis investigations

A

Bloods

  • Culture
  • WCC
  • CRP/ESR

X-Ray

MRI - Bone marrow oedema

Biopsy and culture

87
Q

Osteomyelitis management

A

Immobolisation
Abx
- Flucloxacillin
Surgical debriedment

88
Q

Secondary causes of osteoperosis

A 
Steroids 
Hyperthyroidism 
Alcohol
Testosterone low
Early menopause 
Renal/Liver failure 
Rheumatoid arthiritis
89
Q

Alcohols effect on osteoperosis

A

Inhibits osteoblasts

90
Q

Cushing’s effect on osteoperosis

A

High cortisol increases bone resorption + induces osteoblast apoptosis

91
Q

Glucocorticoids effect on osteoperosis

A

Increased bone turnover

92
Q

Presintation of osteoperosis

A

Vertebral fractures

  • back pain
  • kyphosis
  • loss of height

Colles fracture

Hip fracture

Proximal femur

93
Q

Osteoperosis conservative management

A 
Excercise 
Smoking cessation 
decrease alcohol 
Calcium rich diet 
Fall prevention programme
94
Q

Osteoperosis pharmacological tx

A
  • Bisphophonates
  • HRT
  • Denosumab
    MAB to RANKL
  • PTH analgoue
    Teriparatide
95
Q

Pseudogout risk factors

A 
Old age 
Hyperparathyroidism 
Haemochromatosis 
Hypophosphotaemia 
Wilsons disease
96
Q

Feature of pseudogout on X ray

A

Chondracalcinosis

LOSS

97
Q

Triggers of pseudogout attack

A 
Trauma
Intercurrent illness
Surgery - parathyroidectomy 
T4 Replacemnt 
Blood transfusion
98
Q

What antibodies are most associated with Limited cutaneous systemic sclerosis

A

Anti-centromere Ab

99
Q

Rheumatoid arthiritis presentation

A

Joint pain

  • worse in mornings
  • worse after hot weather

Joint stiffness>30 mins

Joint tenderness

Joint swelling

100
Q

Rheumatoid arthiritis X Ray findings

A 
LESS
L - Loss of joint space 
E - Erosions
S - S.T swelling 
S - Soft bones
101
Q

Rheumatoid Management

A

Symptomatic
- Paracetamol + NSAIDs

1st line - MXT
2nd line - Combination of DMARDs
3rd line - MXT + Etanercept
4th line - MXT + Rtuximab

102
Q

Rheumatoid arthirits complications

  • Respiratory
  • Cardiac
  • Nodules
A

Pulmonary fibrosis
Pleural effusions

IHD
Pericarditis
Pericardial effusions

Skin 
Lung 
Cardiac 
CNS 
Lymphadenopathy 
Vasculitits
103
Q

Methotrexate adverse effects

A

Pulmonary fibrosis
Diarrhoea
Pancytopenia
Mouth ulcers

104
Q

Sulfasalazine adverse effects

A

Male infertility
GI upset
Oral ulcers

105
Q

Anti-TNF medications

A

Influximab
Etanercept
Rituximab

106
Q

Rituximab adverse effects

A

Night sweats

Thrombocytopenia

107
Q

Causes of septic arthirits

A

A.Aureus
Neisseria gonorrhoea
Pseudomonas aerginosa - IVDU
S. Epidermidis - Joint replacement

108
Q

Septic arthirits management

A

Emperical - Flucloxacillin
Immobolisation
Joint drainge
NSAIDs

109
Q

What do you do if a patient with R.A develops septic arthiritis

A

Stop immunosuppresion - DMARDs

110
Q

What should you do if a patient currently taking steroids develops septic arthirits

A

Double the dose

111
Q

Ankylosing spondylitis presentation

A 
Lower back pain 
Pain worse at night 
Spinal morning stiffness >30mins
stiffness relieved by excercise
Sacroiliatic pain 
Pain wakes from sleep
112
Q

Ankylosing sponylitis manageemnt

A

1st - Excercise
2nd - NSAIDs
3rd - Anti-TNF alpha blockers
4th - steroid injections

113
Q

Presentation of fracture of the surgical neck of humerus

A

Axillary nerve

  • Teres minor weakness
  • Deltoid weakness
  • Loss of sensation of regimaental patch
114
Q

Rotator cuff movements

A 
Subscapularis - Internal rotation 
Suprascapularis - Abduction 
External rotation 
- teres minor 
- Infraspiantus
115
Q

Shoulder abduction - muscles involved

A

0 - 15 = Supraspinatus
15 - 90 = Deltoid
90 - 180 = Deltoid + serrartus anterior

116
Q

Nerve assesed when adducting and abducting the fingers

A

Ulnar

117
Q

Nerve assessed with thumb abduction against resistance

A

Median

Disease summaries (9 decks)

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