MSK Flashcards
Bouchard’s and Heberden’s, which joints do they affect? Which disease condition do you find them in?
Osteoarthritis
Bouchard’s - Proximal Interphalangeal Joints
Heberden’s - Distal Interphalangeal Joints
[B before H in alphabet]
Give two signs on X-ray of osteoarthritis
Loss of joint space
Osteophytes
Subaticular sclerosis
Subchondral cysts
[LOSS]
Name two diagnostic tests for rheumatoid arthritis
Anti-Cyclic Citrullinated Peptide Antibody (ACCP) - Most specific test
Rheumatoid factor
Anti Nuclear Antibodies
Name two DMARDs
Methotrexate
Hydroxychloroquine
Sulphasalazine
Azathioprine
Give two clinical signs of rhumatoid arthritis
Pain worse in morning (lasting >30mins)
Tends to affect proximal interphalangeal joints + writsts.
Swan neck deformity
Responds to NSAIDs
Ulnar Deviation
Give two extra-articular complications of rheumatoid arthritis
Pericarditis
Pulmonary fibrosis (esp in smokers)
Scleritis
Amyloidosis
Which is more specific for rheumatoid arthritis, ACCP or RF?
ACCP is more specific than RF.
[RF is +ve in about 80% of patients. Having a negative RF doesn’t mean you don’t have RA]
What is Felty Syndrome?
Triad of:
1) Rheumatoid Arthritis
2) Splenomegaly
3) Neutropenia
[AKA Super Rheumatoid]
What is the most common causative organism of septic arthritis?
Staph aureus (G+)
What is the first line treatment for septic arthritis?
Empirical antibiotics:
Vancomycin (G+)
Ceftriaxone (G-)
Debridement
True or false methotrexate is safe in pregnancy or breast feeding?
False. It is teratogenic.
True or false, it is safe to give methotrexate and trimethoprim together?
False. Both impair folate metabolism.
Name two biological DMARDs
Anti-TNF (infliximab, golimumab) - most common
B-cell inhibitors: Rituximab
T-cell inhibitors: Abatacept
IL6 inhibitos: Tocilizumab
JAK inhibitors: Baricitinib
True or false, DMARDs must be stopped when a patient is acutely unwell, has an infection or is going into surgery?
True.
True or false, biological DMARDs like rituximab increase the risk of organ cancers?
False. No evidence of this.
They do increase the risk of non-melanoma skin cancers.
What is the treatment of MRSA?
Vancomycin or Clindamycin
How does De Quervain Tendinopathy present?
Pain on the radial side of the wrist which radiates up the arm and is worse on use.
Caused by repetitive movements and caused by inflammation of the tendon sheaths of the thumb.
Give two risk factors for trigger finger (stenosing tenosynovitis)
Diabetes type 2 Thyroid disease Inflammation Renal disease Injury
Why is trigger finger called that? How does trigger finger differ from Dupuytren’s contracture?
The tendon makes a popping sound on extension.
Trigger finger is painful on flexion.
Lateral epicondylitis and Medial epicondylitis are also known as?
Tennis elbow (BaboLateral!)
Golfer’s elbow
What are tophi?
Uric acid crystals deposited in joints in gout
What is the first line treatment for acute gout?
NSAIDs (1st)
Colchicine
Steroids
What is the treatment for chronic gout?
Allopurinol
What enzyme is blocked by allopurinol?
xanthine oxidase - reduces uric acid production
True or false, NSAIDs are contraindicated in patients with peptic ulcers?
True
Give two lifestyle changes for gout
Exercise
Reduce purine rich foods
Avoid alcohol
What do you find on birefringence in gout following synovial aspirate?
Negative birefringence
Spindles
What crystals cause pseudo-gout?
Calcium pyrophosphate
What do pseudo-gout crystals look like under microscope/polarised light?
Postive birefringence
Rhomboid shape
True or false, hypothyroidism is a risk factor for pseudo-gout?
True
Give two signs of ankylosing spondylitis
[SPINE ACHE]
Sausage digits Psoriasis Inflammatory back pain NSAID responsive Enthesitis (esp heel)
Arthritis
CRP raised
HLAB27
Eyes (uveitis)
What sign of ankylosing spondylitis would you expect to see on a spinal X-ray?
Bamboo spine (calcification of the spinous ligaments)
What is the cause of ankylosing spondylitis?
Human Leukocyte Antigen B27 - 90% of cases.
True or false, ankylosing spondylitis is a seronegative condition?
True. RF negative
What level of T-score is diagnostic of osteoporosis?
-2.5 SD
What causes osteoporosis?
Increased osteoclast activity vs osteoblast activity.
Give two risk factors for osteoporosis
Steroid use Alcohol Early menopause Rheumatoid arthritis Malnutrition
Give two treatments for osteoporosis
Bisphosphonates
Vit D + Calcium
HRT
Exercise
What is the FRAX score?
10 year risk of a fracture
Age Sex BMI Previous fracture Parent hip fracture Smoker Steroids RA Secondary osteoporosis Alcohol >3U/d Femoral neck BMD
What is osteomalacia?
Softening of bone due to reduced mineral content
What investigations would you carry out to investigate osteomalacia?
X-ray
Blood calcium
Vit D
Phosphate levels
What is the difference between raynaud’s syndrome and phenomenon?
Syndrome - idiopathic
Phenomenon - induced by a stressor e.g. cold, stress.
What is Reiter’s syndrome? What is the triad of symptoms?
Secondary inflammation caused by an infection e.g. chlamydia or salmonella causing arthritis.
Can’t see (Conjunctivitis)
Can’t pee (Urethritis)
Can’t climb a tree (Arthritis)
What is the gold standard investigation for Giant Cell Arteritis?
Biopsy
What is the treatment for giant cell arteritis?
Steroids (prednisone)
Bisphosphonates
PPI
What type if vasculitis are Antineutrophil Cytoplasm Antibodies (ANCA) associated with?
Small vessel
- Granulomatosis with polyangiitis (Wegener’s)
- Microscopic polyangiitis
What vasculitis is commonly associated with a saddle nose?
Granulomatosis with Polyangiitis (Wegener’s) - Caused by granulomas
Name a medium vessel vasculitis
Polyarteritis Nodosa (PAN)
What type of hypersensitivity reaction is Lupus?
Type 3 (complement)
Give two signs of Lupus
Malar rash Photosensitivity Discoid eczema Arthralgia ESR raised CRP normal
True or false, women in childbirth are 10x more likely to get lupus?
True
What inheritance pattern does Marfan’s follow?
AD
What mutation is responsible for Marfan’s?
FBN1
Changes fibrillin
Give three signs of marfans
Tall stature Pectus excavatum/carinatum Flexible joints Mitral valve prolapse AAA High palate
What diagnostic criteria are used to diagnose marfans?
Ghent criteria
What treatment would you give a patient with marfan’s?
BBlocker / CCB
+ ACEi
What treatment would you offer a patient with fibromyalgia?
Pregabalin
Amitriptyline
Duloxetine
True or false, cauda equina requires a same day surgical referral?
True
Give two sigsn of cauda equina syndrome
Bilateral sciatica-like pain Saddle anaethesia Bladder / Bowel incontinence Sexual dysfunction Reduced reflexes Loss of tone/power
How do reflexes differ in cauda equina syndrome vs cord compression?
Cauda equina = reduced reflexes
Compression = Brisk reflexes.
