MSK and Derm Flashcards
Osteomyelitis symptoms
What are the key causative organisms?
Investigation
Management
unwell child with a limp/reluctance to weight bear, or in an immunocompromised patient.
Pain at sight of infection, inflammation, tenderness, erythema or swelling
Chronic osteomyelitis usually has a history of discharging sinus, soft tissue abscess, etc
Overall = staph aureus
IV drug users = pseudomonas aeruginosa
Sickle cell anemia/ other hemoglobinopathies = salmonella
X-ray
Flucloxacillin
Osteoporosis symptoms
Investigation
Management
Asymptomatic vertebral fracture, spinal kyphosis, back pain
Radial/hip fracture
Female, age, Corticosteroid use = Rfs
DXA Scan = T-score ≤-2.5 OR history of prior fragility fracture (fall from standing height or less i.e. minimal trauma. Also includes spontaneous vertebral compression fracture )
-1 to -2.5 = Osteopenia
Bisphosphonates 1st line - all end in “dronate” e.g. alendronate = ALENDRONIC ACID. And also Zolendronic acid
+ calcium and vitamin d supplementation
Denosumab second line
Septic arthritis symptoms
Acute onset < 2 weeks
Hot, painful, red, swollen, restricted joint. Typically ONE joint.
Rfs: sexual activity, IV drug misuse, skin infection
Synovial fluid gram stain, culture and white cell count
Antibiotics
Ankylosing spondylitis symptoms
Investigations
Management
Back pain
iritis/uveitis
Loss of lumbar lordosis, kyphosis
fusion of sacroiliac joints, bamboo spine
Costovertebral ankylosis may cause restrictive lung disease
Enthesitis (inflammation of tendon/ligaments) - most commonly achilles tendon
Pelvic xray
NSAIDS
Reactive arthritis symptoms
Causative agent
Treatment
Classic triad of conjunctivitis, urethritis and arthritis. “Cant see, cant pee, cant bend my knee)
Uncommonly: maculopustular rash on palms and soles, oral ulcers
GI or urogenital bacteria
Chlamydia
NSAIDS
SLE symptoms?
Management?
Classic presentation is rash, joint pain, and fever, typically in a female of reproductive age
RASH - malar or discoid, photosensitive
ARTHRITIS - non erosive
SEROSITIS - pleuritis and SOB or pericarditis
HEMATOLOGICAL DISORDERS - thrombocytopenia, leukopenia, hemolytic anemia etc
ORAL ULCERS
RENAL DISEASE
PHOTOSENSITIVITY
ANTINUCLEAR ANTIBODIES
IMMUNOLOGICAL DISORDERS - anti-dsDNA, anti-Sm, antiphospholipid
Raynaud’s phenomenon
Joint symptoms and serositis, mucocutaneous disease - hydroxychloroquine
Hematological manifestations/neuropsychiatric symptoms - Immunosuppressants like methotrexate and and azathioprine
Lupus nephritis - induction therapy (cyclophosphamide or mycophenolate mofetil) + hydroxychloroquine + corticosteroid
Rheumatoid arthritis symtoms
Investigations
Management
Active symmetrical arthritis >6 weeks.
Joint pain and swelling - most commonly MCP, PIP and MTP
Morning stiffness improving with use
Other:swan neck deformity, boutonniere’s deformity, ulnar deviation, rheumatoid nodules, scleritis/uveitis, pleuritic chest pain
Rheumatoid factor, anti-ccp
X-rays
DMARD - hydroxychloroquine is 1st line. Methotrexate is more severe. Second line is sulfasalazine
Osteoarthritis symptoms
Investigations
Management
Asymmetric joint involvement
Pain in joint after use improving with rest
Knee, hip, hand(heberden nodes, bouchard nodes - joints at distal end of fingers), spine
X-ray - loss of joint space, subchondral sclerosis, osteophytes
CRP and ESR - normal - raised in inflammatory causes of arthritis like Rheumatoid Arthritis
Topical analgesia - capsaicin, diclofenac, ketoprofen, methylsalicylate
Persistent pain = surgery
Polymyalgia Rheumatica
Symptoms
Investigations
Management
Pain and stiffness of proximal muscles - shoulders, hips - difficulty rising from seated or prone positions
Normal muscle strength
RFs: giant cell arteritis, women >50
Examination findings + elevated ESR and CRP
Cortocosteroids
Gout symptoms
Investigations
Management
Swollen, painful monoarthritis, joint stiffness - usually big toe
Tophus formation - external ear, olecranon bursa= bursitis, achilles tendon
Arthrocentesis with synovial fluid analysis - Needle shaped crystals. Negatively birefringent. Elevated wbc
Acute = NSAID, colchicine and corticosteroids Recurrent = allupurinol
Pseudogout symptoms
Investigations
Management
Pain and swelling of joints
Osteoarthritis like involvement of joints - wrists, shoulders, knees - chronic degeneration
Arthrocentesis with synovial fluid analysis - Rhomboid shaped crystals. Positively birefringent
Acute = nsaids, intra-articular corticosteroids Prophylaxis = colchicine
Pagets disease
Symptoms
Investigation
Management
Long bone or back pain
Pathological fracture - pain
bony deformities (e.g., frontal bossing, prognathism, bone bowing). HEARING LOSS
serum or bone-specific alkaline phosphatase - ELEVATED
Calcium and vit D - NORMAL
Plain x ray - lytic changes
bisphosphonate - alendronic acid, zoledronic acid, risedronate sodium
Or calcitonin
Osteomalacia
Symptoms
Investigation
Management
Fractures, diffuse bone pain and tenderness, proximal muscle weakness
low vitamin D level in the setting of low or normal calcium and an elevated intact parathyroid hormone (PTH) level.
Bone x rays may show looser pseudo fractures.
Acute hypocalcemia = IV calcium gluconate
Ongoing treatment = calcium + vitamin D
Osteogenesis imperfecta
Symptoms
Investigations
Management
Multiple fractures and bone deformities with minimal trauma
Blue sclerae
Opalescent teeth
Hearing loss
Genetic testing - COL1A1 and COL1A2 genes implicated
Bisphosphonates
Atopic dermatitis
Symptoms
Management
Dry, itchy skin
Erythema, scaling, vesicles or lichenification in skin flexures
Sites - cheeks, forehead, scalp, extensor surfaces common - weeping and crusting can occur
Emollients
