Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA Content > MSK - Level 1 > Flashcards

MSK - Level 1 Flashcards

1
Q

Description of septic arthritis?

A
  • Infection producing inflammation in native/prosthetic joint or more than one joint
  • Medical emergency and can destroy joint or develop sepsis <24 hour
  • Reaches via bloodstream, adjacent osteomyelitis or external skin puncture wounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Epidemiology of septic arthritis?

A
  • Knee in >50% cases, followed by hip, shoulder, ankle and wrists
  • 1-2% incidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk Factors of septic arthritis?

A 
o	Age>80
o	Rheumatoid arthritis/Gout
o	DM
o	Immunosuppresion
o	Renal failure
o	Prosthetic joints/Recent surgery
o	IVDU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causative organisms of septic arthritis?

A 
o	S.aureus (most common)
o	Streptococcus
o	N.gonorrhoea
o	TB
o	Salmonella
o	Coagulase neg staph – prosthetic joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms and signs of septic arthritis?

A

o Monoarticular
o Red, painful, swollen joint developing acutely
o Pain on active and passive movement and often held in position of most comfort (slightly flexed)
o May be fever, rigors, shaking, vomiting
- Signs may be less marked in elderly, IVDU, immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations needed in septic arthritis?

A
  • Bloods
    o FBC, ESR, CRP, blood cultures
  • Joint aspiration
    o Send for leukocyte count, Gram staining, microscopy and culture, ?AAFB
    o Infectious aspiration – yellow, turbid, purulent, >10000 cells, neutrophils, Gram stain and culture +ve
    o Normal aspiration – colourless/pale yellow, clear, 200-1000 cells, mononuclear cells, Gram stain and culture -ve
  • X-rays
    o Normal or soft tissue swelling with displacement of capsular fat planes and swelling of soft tissue
    o Later, bone destruction occurs
  • CT/MRI scan reserved for difficult cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Initial Management of septic arthritis? Orthopaedic management after referral?

A

o Analgesia
o IV Flucloxacillin for 2 weeks then oral switch for 4 weeks
 If penicillin allergic - Clindamycin
 If MRSA – Vancomycin
 If gonococcal – cefotaxime
 Empirical and start after aspiration
o Refer to Orthopaedic team for Joint irrigation/drainage, Analgesia, Splinting (In position of function, once infection under control then mobilisation will promote healing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of osteomyelitis/septic arthritis?

A
  • Flucloxacillin for 6 weeks
    o Consider adding fusidic acid or rifampicin for 1st 2 weeks
    o If penicillin allergic – clindamycin
    o If MRSA – vancomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prognosis of septic arthritis?

A

o Mortality is 10-20%

o Around half regain baseline joint function after treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Description of giant cell arteritis?

A
  • Chronic immune-mediated vasculitis characterised by granulomatous inflammation in walls of medium and large arteries
  • Preferentially extracranial branches of carotid artery and branches of ophthalmic artery
  • GCA and polymyalgia rheumatica often occur together in 50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Epidemiology of giant cell arteritis?

A
  • Incidence rare before 50 and peaks at 70
  • White people 7x more common
  • 3x more common in women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of giant cell arteritis?

A 
Headache
	Unilateral over temporal region
Temporal artery and scalp tenderness
	When combing hair
Jaw claudication
	Pain while eating
Amaurosis fugax
Sudden blindness in eye
Diplopia
Fever, fatigue, anorexia
Other – Neuropathy, morning stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Signs of giant cell arteritis?

A

o Ischaemic disease on fundoscopy
o Temporal arteries – prominent, beaded, tender and pulseless
o Bruits may be heard over carotid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Suspect giant cell arteritis if..?

A
  • Suspect if >50 and:
    o New onset localised headache, unilateral in temporal area
    o Temporal artery – tender, thickened, nodular, red, pulseless
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When to refer people with suspected giant cell arteritis?

A
  • Refer all people for temporal artery biopsy
    o If visual impairment – same-day ophthalmology assessment
    o If no visual impairment – urgent rheumatology assessment (biopsy within 7 days)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What bloods tests to order in giant cell arteritis?

A

o ESR, CRP raised
o FBC – normochromic normocytic anaemia, elevated platelets
o LFT – mildly elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Initial drug treatment of giant cell arteritis?

A

Immediate Prednisolone 60mg/d PO
 Assess response over 1st 48 hours – if poor seek specialist advice
 If develop visual symptoms – seek same-day assessment for IV methylprednisolone
 Treatment reduced slowly and required for 1-2 years
Aspirin 75mg OD
Omeprazole 20mg OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ongoing management of giant cell arteritis?

A

o If symptoms controlled – reduce dose of prednisolone slowly
 60mg until ESR/CRP normal, then reduce by 10mg every 2 weeks until 20mg daily, then reduce 2.5mg every 2-4 weeks until on 10mg daily, then 1mg evert 1-2 months

o Review a week after dose change and every 3 months for 1st year then 3-6 monthly
 Do ESR, CRP, BP and glucose

o Assess fracture risk and whether need bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Managing a relapse of giant cell arteritis?

A

o If visual disturbance – increase to 60mg prednisolone & same-day assessment with ophthalmologist
o If jaw claudication – increase to 60mg daily &seek specialist advice
o If headaches, or PMR – increase dose and seek specialist advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prognosis of giant cell arteritis?

A

o Relapses common – especially when steroid treatment reduced or withdrawn too quickly
o Exacerbations occur in 30-50% of people during first 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of giant cell arteritis?

A 
o	Visual Loss – total or partial
o	Aortic aneurysm, aortic dissection, large artery stenosis and aortic regurgitation
o	CVD
o	Peripheral neuropathy
o	Confusion and encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Description of spinal cord compression?

A
  • Acute spinal cord compression is a neurosurgical emergency
  • Cancers leading to MSCC – breast, bronchus, prostate, myeloma/lymphoma but can occur with any tumour
  • Caused by tumour or metastases in vertebral body or paraspinal region pressing on spinal cord
23
Q

Epidemiology of spinal cord compression?

A
  • 2/3 in thoracic region

- Occurs in 20% of patients with spinal metastases

24
Q

Aetiology of spinal cord compression?

A

o Metastases (breast, lung, prostate, thyroid, kidney)
o Cancer
o Trauma
o Cervical disc prolapse

25
Q

Symptoms of spinal cord compression?

A

o Back pain/nerve root pain
 Either unilateral/bilateral, aggravated by movement, coughing or lying flat
o Motor weakness – strength changes
o Subjective sensory disturbances
o Bladder/Bowel dysfunction generally occurs late

26
Q

Signs of spinal cord compression?

A

o Weakness/Paraparesis/Paraplegia
o Changes in sensation below level of compression
o Hyperreflexia
o Clonus and painless bladder distension
o Can lead to paraparesis, paraplegia and incontinence

27
Q

Red flags in spinal cord compression?

A 
o	Leg Weakness
o	Sensory Loss
o	Thoracic back pain
o	Constant pain
o	Urinary retention/incontinence
o	Saddle Anaesthesia &amp; loss of anal tone
28
Q

Management if suspected metastatic spinal cord compression?

A

o Contact MSCC coordinator urgently if:
 Pain in thoracic or cervical spine, progressive lumbar spine, severe unremitting lower spinal pain, aggrevated by straining, local tenderness, nocturnal spinal pain

o Contact MSCC coordinator immediately if signs of MSCC

29
Q

Initial management of spinal cord compression?

A

Initial Management
 Nurse flat with neutral spine
 Offer graduated compression/anti-embolism stockings
 Catheterise in bladder incontinent

Medical
 Urgent dexamethasone 16mg PO daily commenced at suspicion
 PPI cover needed

Imaging
 Urgent Whole Spine MRI

30
Q

Definitive management of spinal cord compression?

A 
	Surgery
•	Should have before they cannot walk
•	Postoperative radiotherapy
	Radiotherapy
•	Urgent if surgery not suitable
•	Fractionated radiotherapy  if epidural tumour without neurological involvement, pain or spinal instability
31
Q

Prognosis of spinal cord compression?

A
  • Outcomes correlate with level of function at the time of treatment
  • If treated within 24 hours, 57% will walk again
  • Complete paralysis, present for several days, is almost never reversible
32
Q

What diseases have a positive rheumatoid factor?

A 
	Rheumatoid arthritis
	Sjogrens syndrome
	Felty’s syndrome
	Infection
	SLE, sclerosis
33
Q

What diseases have a positive anti-CCP antibody?

A

 Rheumatoid arthritis

34
Q

What diseases have a positive antinuclear antibody?

A 
	SLE
	Autoimmune hepatitis
	Sjogren’s syndrome
	Systemic sclerosis
	Rheumatoid arthritis
35
Q

What diseases have a positive anti-double stranded DNA (dsDNA) & positive anti-Sm & positive anti-RNP??

36
Q

What diseases have a positive antihistone antibody?

A

 Drug-induced SLE

37
Q

What diseases have a positive antiphospholipid antibody (anti-cardiolipin)?

A

 Antiphospholipid syndrome

 SLE

38
Q

What diseases have a positive anti-Ro?

A

• SLE, Sjogren’s syndrome, systemic sclerosis

39
Q

What diseases have a positive anti-La?

A

• Sjogren’s syndrome, SLE

40
Q

What diseases have a positive anti-Jo-1 & anti-mi-2?

A

• Polymyositis, dermatomyositis

41
Q

What diseases have a positive anti-Scl70?

A

• Diffuse systemic sclerosis

42
Q

What diseases have a positive antimitochondrial antibodies (AMA)?

A

 Primary biliary cirrhosis
 Autoimmune hepatitis
 Idiopathic cirrhosis

43
Q

What diseases have a positive anti-smooth muscle antibodies (SMA)?

A

 Autoimmune hepatitis

 Primary biliary cirrhosis

44
Q

What diseases have a positive gastric parietal antibodies?

A

 Pernicious anaemia

 Atrophic gastritis

45
Q

What diseases have a positive intrinsic factor antibodies?

A

 Pernicious anaemia

46
Q

What diseases have a positive anti-tissue transglutaminase & anti-endomysial antibodies?

A

 Coeliac disease

47
Q

What diseases have a positive thyroid peroxidase antibodies?

A

 Hashimoto’s thyroiditis

 Graves’ disease

48
Q

What diseases have a positive islet cells Ab & glutamic acid decarboxylase?

49
Q

What diseases have a positive anti-GBM?

A

 Goodpasture’s disease

50
Q

What diseases have a positive antineutrophil cytoplasmic antibodies (ANCA) - cytoplasmic - specific for serine proteinase 3?

A
  • Granulomatosis with polyangiitis (Wegeners)
  • Microscopic polyangiitis
  • Polyarteritis nodosa
51
Q

What diseases have a positive antineutrophil cytoplasmic antibodies (ANCA) - perinuclear - specific for myeloperoxidase?

A
  • Microscopic polyangiitis

* Churg-Strauss disease

52
Q

What diseases also have a positive ANCA?

A

 ANCA also positive in Crohn’s, UC, sclerosing cholangitis, autoimmune hepatitis, Felty’s, SLE, RA, drugs (antithyroid, allopurinol, ciprofloxacin)

53
Q

What diseases have a positive acetylcholine receptor antibodies?

A

 Myasthenia gravis

54
Q

What diseases have a positive anti-voltage gated Ca-channel antibodies?

A

 Lambert Eaton Syndrome

MSRA Content (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions