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Pathology and final year > MSK (Rheum and T&O) > Flashcards

MSK (Rheum and T&O) Flashcards

1
Q

pattern of joints affected in RA

A

symmetrical polyarthritis

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2
Q

which joints are usually spared in RA?

A

DIP

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3
Q

characteristics of inflammatory joint pain

A

worse in the morning, improves with exercise

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4
Q

which joints are usually affected in primary nodal osteoarthritis

A

distal interphalangeal joints (DIP)

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5
Q

most specific antibody for RA

A

anti-citrullinated peptide Ab

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6
Q

investigations for suspected RA

A

Acute phase markers
CRP and ESR will usually be high if there is ‘active’ disease

Serological tests
Rheumatoid factor (antibody specific for IgG Fc)
~60-70 % sensitivity and specificity for RA
Anti-cyclic citrullinated peptide antibodies (‘anti-CCP’ antibodies or ‘ACPA’)
~60-70% sensitivity and ~95% specificity for RA

Radiology
US or MRI can demonstrate synovitis and early erosive damage
X rays are most useful for monitoring erosive changes

Other blood tests
FBC, U&E, LFTs will be required prior to initiating drug treatment

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7
Q

who is involved in the MDT of a pt with RA?

A

Rheumatology consultant

General practitioner

Rheumatology nurse specialist
Hand therapist
Occupational therapist
Physiotherapist
Podiatrist
Psychology/counselling services
Surgeon

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8
Q

management of RA

A
  1. analgaesics
  2. NSAIDs, hydroxychloroqine
  3. DMARDs- eg. methotrexate/ sulfazalazine (started early in the course of the disease)
  4. plus steroid (flares can do IM, interarticular or oral)
  5. anti-TNF therapy (for pts who have active disease despite DMARDs)
  6. physiotherapy
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9
Q

what deformities can occur as RA progresses?

A

ulnar deviation
palmar subluxation of metacarpophalangeal joints
Boutonniere deformity (flexion of PIP, hyperextension of DIP)
Swan neck deformity (hyperextension of PIP, flexion of DIP)
inflammation of flexor tendon sheath-> carpal tunnel syndrome

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9
Q

features of psoriatic arthritis?

A

symmetrical or asymmetrical polyarthritis
onycholysis with brown discoloration of the nails
arthritis mutilans in severe disease

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9
Q

common joints affected in RA

A

small joints of the hands and feet except DIP

proximal interphalangeal joints
metacarpophalangeal joints
metatarsophalangeal joints
wrists

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10
Q

clinical of osteoarthritis

A

worse on movement
over 60
heberdens nodes on DIP
Bouchard node on PIP
boney swelling
hips and knees common

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11
Q

radiological features of osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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12
Q

most common causative organism of septic arthritis

A

staph aureus

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13
Q

management of septic arthritis

A

joint aspiration for MC&S
emperical antibiotics ASAP
- eg. flucloxacillin, gentamycin and benpen
immobilise the joint

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14
Q

causes of reactive arthritis

A

sterile arthritis following an attack of dysentry (campylobacter, salmonella, shigella, yersinia) or urethritis (chlamydia, ureaplasma)

They are gram-negative organisms, with a lipopolysaccharide component within their cell wall

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15
Q

clinical features of reactive arthritis

A

acute, asymmetric lower limb arthritis 1-4 weeks following infection
conjunctivitis
enthesitis (plantar facitiis or achilles tendonitis)
ciricinate balanitis (painless, superficial penile ulcer)
keratoderma blenorrhagica (painless red plaques on soles or palms)
nail dystrophy
mouth ulcers

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16
Q

what is Reiters disease

A

triad of urethritis, arthritis and conjunctivitis

features of reactive arthritis

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17
Q

management of reactive arthritis

A
  1. NSAIDs
  2. local steroid injection for symptomatic control
  3. treat underlying cause
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18
Q

pathophysiology of reactive arthritis

A

CD4 T cell sensitisation of bacterial antigens

antigens disseminate systemically to joint (sterile) causing T cell activation and inflammation of the joint

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19
Q

what are the crystals of pseudogout

A

calcium pyrophosphate

20
Q

underlying conditions that may result in pseudogout

A

hypothyroidism
hyperparathyroidism
wilsons
haemachromatosis

21
Q

Xray findings of pseudo gout

A

chondrocalcinosis (calcification of hyline cartilage)

22
Q

what is seen under polarised light in gout vs pseudogout?

A

gout:
negatively birefringent needle shaped crystals

psuedogout:
positively birefringent rhomboidal crystals

23
Q

what are the crystals in gout

A

monosodium urate (MSU) crystals

24
Q

management of anklyosing spondylitis

A

NSAIDs and spinal exercises

25
Q

associated features of ankylosing spondylitis

A

anterior uevitis- sudden onset pain, blurred vison and photophobia

conjunctivitis- red, itchy eyes

plantar faciitis, achillies tendonitis

26
Q

what is GCA associated with

A

polymyalgia rheumatica

27
Q

back pain red flags

A

<20y >50yrs
sphincter disturbance
history of malignancy
neurological disturbance
leg pain

28
Q

features of feltys syndrome

A

Extraarticular features of seropositive RA

[SANTA]
splenomegaly
Arthritis
neutropenia
thrombocytopenia
anaemia

29
Q

Investigations for RA

A

Bedside:
squeeze test/ hand examination

bloods:
FBC (anaemia), CRP, ESR (inflammation)
Abs- ANA, anti CCP and RF

Imaging
Xray for basline
USS for synovitis
MRI

30
Q

features of seronegative spondyloarthropathies

A

PEARL HEADS

Psoriatic arthrtis
Eneropathic arthritis
Ank spond
Reactive arthritis
HLA B27
Enthesitis
Axial, asymmetrical, oligoarthritis
Dactylitis
Seronegative (no RF)

31
Q

associated complications of ankylosing spondylitis

A

AAAAAA

Anterior uveitis
Apical lung fibrosis
Aortic regurgitiation
AV node block
Achilles tendonitis
Amyloidosis

32
Q

Name of a grading system for ankylosing spondylitis

A

New york criteria

33
Q

management of Ank spond

A

Conservative:
Physiotherapy/ exercise

Medical:
NSAIDS –> aTNF (etanercept) –> aIL17 (secukinumab)

surgical: hip replacement

34
Q

systemic features of connective tissue disease

A

rash
hair loss
fatigue
fever
chest pain
cough
Raynauds

35
Q

features of limited systemic sclerosis (CREST syndrome)

A

Calcinosis
Raynauds
Esophogeal dysmotility
Sclerodactyle
Telangectasia

36
Q

features of polymyositis

A

Inflammation of striated muscle

o Progressive symmetrical proximal muscle weakness (associated myalgia & arthralgia)

o Wasting of shoulder and pelvic girdle

o Dysphagia, dysphonia, respiratory weakness

37
Q

features of dermatomyositis

A

§ Periorbital heliotrope rash on eyelids ± oedema

§ Gottron’s papules: knuckles, elbows, knees

§ Mechanics hands: painful, rough skin cracking of fingertips

§ Macular rash (shawl sign +ve: over back and shoulders)

§ Nailfold erythema

§ Retinopathy: haemorrhages and cotton wool spots

§ Subcutaneous calcifications

38
Q

Investigations for suspected myositis

A

bloods:
CK raised
LFTs- raised ALP, AST and LDH
myositis pannel- anti Jo1, anti mi2, anti-srp

CLAAA
CK
LDH
ALP
AST
Antibodies- anti jo anti mi anti srp

EMG
biopsy (diagnostic)
Malignancy screen- as can be a feature of a paraneoplastic syndrome

39
Q

Management of GCA

A

immediate steroids 40-60mg
ESR and temporal artery biopsy

visual symptoms –> IV methylprednisolone

40
Q

common areas of muscle wasting in polymyositis

A

shoulder
pelvic girdle muscles

41
Q

causes of peripheral muscle wasting

A

Neuro LMN disease:
ALS
cervical myelopathy

42
Q

side effects of methotrexate

A

anaemia
leukopenia and infections
thromboctyopenia
pulmonary fibrosis
GI upset
skin changes

43
Q

pathophysiology of sjogrens

A

autoimmune destruction and fibrosis of exocrine glands resulting in dry mouth, dry eyes (and also dry vagina)

anti-Ro and anti-La commonly associated

44
Q

management of acute gout

A

STOP allopurinol

  1. strong NSAID eg. indomethacin
  2. colchicine if NSAIDs CI
  3. intra articular sterid injections

prevention of future attacks
lifestyle changes- reduce ETOH, wt loos, avoid purine rich food
allopurinol
low dose aspirin

45
Q

features of bechets

A

oral and genital ulcers
occular involvement- anterior/ posterior uveitis, retinal vascular lesions

46
Q

Conditions associated with carpal tunnel syndrome/ positive tinels test

A

RA
demyelination
Pregnancy
cardiac failure
hypothyroidism

47
Q

what is the function of the ACC

A

prevents anterior translocation of the tibia at the knee

48
Q

which nerve is responsible for claw hand deformity?

A

ulnar

49
Q

which nerve is responsible for wrist drop?

A

radial

(Rist-Radial)

Pathology and final year (21 decks)

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