MSK Flashcards
Rheumatoid Arthritis deformities
Boutonniere
Ulnar deviation
Swan-neck
Z thumb
Osteoarthritis deformities
Bouchard - (PIP)
Osteoporosis mx:
1L, 2L
1L: Alendronic acid (bisphosphonate) + AdCal (vitD + Ca)
2: DMARD - Denosumab (monoclonal Ab to RANK > inhibit osteoclasts)
Gout Mx
+ brief pharmacology
Flare-up: COLCHICINE
Prophylaxis: Allopurinol + Febuxostat
Allopurinol = xanthine-oxidase inhibitor)
Osteoarthritis X-ray px
LOSS
Loss joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Rheumatoid arthritis X-ray
Bony erosions Joint subluxation Reduced joint space Osteopenia Soft tissue swelling
Bisphosphonate Pharmacology
Inhibit Farnesyl Pyrophosphate Synthase > inhibit osteoclasts
Denosumab Pharmacology
Monoclonal Ab to RANK Ligand > inhibit osteoclasts
Osteoporosis Mx + pharmacology
Include tx option for someone post-menopausal or on a glucocorticoid
1L] Bisphosphonate - Alendronate; inhibit cholesterol synthesis > slows osteoclasts
2L] Denosumab; RANK Ligand Ab > matures osteoclasts
(Deno DINO BONES + -mAB = Ab)
Raloxifene; (post-menopause/ on glucocorticoid) - binds estrogen receptor, inhibits osteoclasts
Teriparatide; PTH analogue
Side effects of Bisphosphonates
Oesopagheal ulcers
Take with big glass of water, once weekly. Sit upright for 30 minutes after.
What is a DEXA scan?
DEXA Scan - T-score; compares bone density to younger pt of same sex
Used to diagnose osteoporosis
Osteoarthritis joints affected + X-ray findings
Wt-bearing, DIP, PIP
Weight-bearing joints = knee, hip, lumbar spine.
DIP - Heberden’s
PIP - Bouchard’s
X-RAY: Lost joint space Osteophytes Subchondral sclerosis Subchondral cysts
Rheumatoid Arthritis joints affected + deformities + other presentations
Symmetrical. MCP, PIP
Swan-neck
Boutonniere
Ulnar deviation
Rheumatoid nodules + factor
Dry cough (pleural effusion/ fibrosis). Neck pain. Splenomegaly.
Rheumatoid arthritis GOLD investigation
Anti-cyclic citrullinated peptide Ab (Anti-CCP/ ANCPA)
Rheumatoid arthritis management
DAS28 score.
NSAIDs, paracetamol
DMARDs - Methotrexate (Sulfasalazine/ hydroxychloroquine). Prednisolone.
TNF-a inhibitors - Infliximab
RA risk factors
F, HLA-DR4, 40-60, Rheumatoid Factor, smoking
Osteoarthritis management
Physio, wt loss, aerobics.
Paracetamol, NSAIDs.
Short-term intra-articular steroids.
Curative = joint replacement
Most common overall cause of osteomyelitis and septic arthritis
Staphylococcus aureus
Moat common cause of osteomyelitis in IVD users
Pseudomonas
E coli
Most common cause of osteomyelitis in Sickle Cell patients
Salmonella
Most common cause of osteomyelitis/ septic arthritis following a joint-replacement
Staphylococcus epidermis
Treatment of osteomyelitis
Flucloxacillin + Fusidic Acid
or
Vancomycin + Cefotaxime
Most common cause of septic arthritis in young sexually-active adults
Neisseria gonorrhoea
Most common cause of septic arthritis in IVD users
Pseudomonas aeruginosa
Treatment of septic arthritis
- Drainage of joint
- Remove prosthetic
- EMPIRICAL - Flucloxacillin + Vancomycin
- S. aureus - vancomycin
N. gonorrhoea - Ceftriaxone
Most common bacterial STI?
Second most common bacterial STI?
Investigations?
Most common: Chlamydia Trachomatis
Second most common:
Neisseria gonorrhoea
1L: NAAT
Gold: Microscopy:
N. gonorrhoea: Gram-negative diplococci with polymorphs
Management of Chlamydia Trachomatis
Avoid sex until course finished
Doxycycline/ azithromycin
Contact trace
Management of Neisseria gonorrhoea
Ceftriaxone + Azithromycin
Sjorgren syndrome investigations
Salivary Gland Biopsy -
ANA, Anti-Ro, Anti-La
Schirmer’s Test, Rose Bengal Stain
Sjorgren syndrome shows a ____ __ _________ of minor glands
Type 4 Hypersensitivity
Significantly raised ALP indicates…
Paget’s Disease of Bone
Methotrexate uses
= anti-metabolite + immunosuppressant
- breast, skin, head, neck cancers
Autoimmune disorders:
- Inflammatory arthritis
- Psoriasis
- Crohn’s
DEXA T-scores
Normal: T >-1
Osteopenia: -1> T >-2.5
Osteoporosis: T < -2.5
Classical symptoms of Reactive Arthritis
Classic triad:
- Conjunctivitis
- Urethritis
- Arthritis
CAN’T SEE
CAN’T PEE
CAN’T CLIMB A TREE
Pt cannot flex ring finger. He has a Hx of alcohol abuse.
Likely diagnosis?
Dupuytren contracture
- affected palma fascia of 4th and 5th fingers
- RF: alcohol, liver disease
30yr old pt presents with joint pain. He describes <30 minutes of morning stiffness.
Likely diagnosis? Initial management?
Osteoarthritis
Arthroscopy because he is UNDER 45 so may be more sinister
Young Pt uses his arms to move forward in a seated position. Name of sign? Indicates?
Gower’s sign
Suggests Duchenne Muscular Dystrophy
Gorlin sign. Suggests?
Ability to touch tip of nose with tongue
Ehlers Danlos Syndrome
Lasegue Sign. Suggests?
Pain when lying flat on back, with leg raised vertically, and ipsilateral knee is straight.
Herniated disk.
Tinnel’s sign. Suggests
Pins and needles in area innervated by nerve, when nerve is tapped.
Carpal tunnel - median nerve
ADPKD presentations, investigations, management
Px: 30-40yrs
- renal dysfunction
- side/back pain
- renal enlargement
- Bulging abdomen + GI symptoms
- Uremic encephalopathy (confusion, unstable)
Screen for:
- liver cysts
- heart valve prolapse
- brain aneurysmys
