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SJ Phase 2a > MSK + rheumatology > Flashcards

MSK + rheumatology Flashcards

1
Q

Clinical presentation of osteoarthritis

A
  1. F>M
  2. Obesity
  3. Large weight bearing joints
  4. Pain worsened with movement
  5. Stiffness on rest
  6. Bone swelling on fingers
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2
Q

Treatment of osteoarthritis

A
  1. Paracetamol (work up analgesic ladder)
  2. Cortisol injections
  3. Joint replacement
  4. Weight loss
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3
Q

Define rheumatoid arthritis

A
  1. Autoimmune disease
  2. Symmetrical
  3. Deforming
  4. Peripheral polyarthritis
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4
Q

Clinical presentation of RA

A
  1. Pain in affected joints
  2. Hand deformities
    • Ulnar deviation
    • Swan neck
    • Boutenniere deformity (concave thumb)
  3. Scleritis (eyes)
  4. Pleural effusion
  5. Pericarditis
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5
Q

Diagnosis of RA

A

MORE THAN 6 WEEKS + MORE THAN 6 OF BELOW
1. Rheumatoid factor = +ve
2. Finger/hand/wrist involvement
3. Rheumatoid nodules
4. 3 or more joints
5. Morning stiffness
6. Erosion on x ray
7. Symmetrical
BLOODS
1. Rheumatoid factor
2. Anti-ccp
3. ESR

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6
Q

Treatment of RA

A
  1. Methotrexate with folate (but not same time)
  2. DMARDs
  3. Steroids
  4. Anti-TNF
  5. NSAIDs + opioids for pain management
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7
Q

Define osteoporosis

A
  1. Decrease in bone mass + micro-architectural deterioration
  2. Increase in bone fragility
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8
Q

Aetiology of osteoporosis

A
  1. ENDOCRINE
    • Cushing’s
    • Parathyroid
  2. HAEMTOLOGY
    • Myeloma
  3. GI
    • Malabsorption
  4. LATROGENIC
    • Steroid use
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9
Q

Presentation + diagnosis of osteoporosis

A
  1. Not clinically apparent until fracture
  2. DEXA scan (T-score < -2.5)
  3. RISK ASSESSMENT
    • FRAX
    • Qfracture
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10
Q

Treatment of osteoporosis

A
  1. Bisphosphonates
  2. Monoclonal antibody
  3. HRT
  4. Smoking + alcohol cessation
  5. Calcium + Vit D
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11
Q

Define Lupus (SLE)

A
  1. Inflammatory
  2. Multisystem
  3. Autoimmune
  4. With arthralgia
  5. Rashes
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12
Q

Clinical presentation of SLE

A
  1. Joint pain
  2. Skin rash
  3. Serositis
  4. Glomerulonephritis + proteinuria
  5. Depression + psychosis
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13
Q

Diagnosis of SLE

A
  1. ESR/CRP
  2. Antinuclear antibody
  3. Serum C3 and C4
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14
Q

Treatment of SLE

A
  1. Steroids
  2. Hydrochloroquine
  3. Methotrexate
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15
Q

State microbes involved in septic arthritis

A
  1. Staph. Aureus - most common
  2. Staph. epidermis - prosthetic joints
  3. Strep. Pyogenes - children < 5
  4. Neisseria gonorrhoeae - sexually active
  5. Pseudomoonas aeruginosa - immunosuppressed, elderly, IVDU
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16
Q

Clinical presentation of septic arthritis

A
  1. Hot tender swollen joint
  2. Fever
  3. Limited range of movement
  4. Difficulty weight bearing
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17
Q

Diagnosis of septic arthritis

A
  1. Joint aspiration
    • Yellow and cloudy synovial fluid
  2. Blood cultures
  3. FBC: leukocytes
  4. CRP + ESR
  5. US + MRI
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18
Q

Treatment of septic arthritis

A
  1. Antibiotics
    • IV 2/52 then oral 4/52
    • Flucloxacillin (Clindamycin if penicillin allergy)
    • MRSA = vancomycin
    • Gonococcal or gram -ve = cefotaxime
  2. Surgery
    • Arthroscopic washout if above fails or prosthetic joint
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19
Q

Define Osteomyelitis

A
  1. Bacterial infection of any bone of skeleton
  2. inflammatory
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20
Q

State microbes involved in Osteomyelitis

A
  1. Staph. aureus
  2. Coagulase-negative staph.
  3. Strep. Pneumonia
  4. Haemophilus influenzae
  5. Pseudomonas aeruginosa
  6. Salmonella
21
Q

Clinical presentation of Osteomyelitis

A
  1. Fever
  2. Pain + swelling
  3. Fatigue
  4. Reduced ROM
  5. Ulceration
  6. Wound
22
Q

Diagnosis of Osteomyelitis

A
  1. FBC
  2. ESR
  3. CRP
  4. Blood culture
  5. Wound swab
  6. X-ray of affected area
23
Q

Treatment of Osteomyelitis

A
  1. Acute peripheral OM or OM with diabetic foot
    • IV flucloxacillin
    • MRSA = vancomycin
    • Pseudomonas = Piperacillin
    • Surgical debridement
  2. Vertebral osteomyelitis
    • Refer to infectious disease + spinal surgery team
    • Spinal surgery if neurological involvement
    • Broad spec IV Abx if no neurological involvement
    • Vancomycin and Ceftriaxone
24
Q

Aetiology of ankylosing spondylitis

A
  1. Autoimmune disease
  2. Attacks entheses (where tendon attaches to bone)
  3. Inflammation
  4. Bone erosion
  5. Syndesmophyte formation (bony growth in ligament)
25
Q

Clinical presentation of ankylosing spondylitis

A
  1. Usually begins young age
  2. Back pain
  3. Morning and night stiffness
  4. Eases with activity
  5. Reduced lumbar flexion
  6. Dyspnoea (if costochondral involvement)
  7. Peripheral arthritis
  8. Painful red eye
26
Q

Diagnosis of ankylosing spondylitis

A
  1. CRP and ESR = raised
  2. Spinal X-ray/ MRI
27
Q

Treatment of ankylosing spondylitis

A
  1. Exercise
  2. NSAIDs
  3. Corticosteroid injections
  4. Anti-TNF-a
  5. DMARDs - methotrexate
  6. Surgery
28
Q

Define of gout

A
  1. Inflammatory arthritis
  2. Deposition on monosodium urate crystals within joints
  3. 1st MTP (metatarsophalangeal joint) = MOST COMMON
29
Q

Aetiology of gout

A
  1. URIC ACID OVERPRODUCTION
    • Increased cell turnover
    • Purine rich diet (meat, seafood, alcohol)
    • Obesity
  2. REDUCED EXCRETION OF URIC ACID
    • CKD
    • Diuretics
    • Pyrazinamide
30
Q

Clinical presentation of gout

A
  1. Relapse Remit pattern
  2. Rapid onset severe joint pain
  3. Joint stiffness
31
Q

Diagnosis of gout

A
  1. Joint aspiration
    • Needle shaped crystal with -ve birefringence
  2. Serum urate
    • Taken 4-6 weeks after flare up
  3. X ray
32
Q

Treatment of gout

A
  1. Anti-inflammatory
    • NSAIDs
    • Colchicine
    • Co-prescribe PPI
  2. Corticosteroids
  3. Prevention
    • Urate- lowering therapy
      • Allopurinol
33
Q

Define pseudogout

A
  1. Inflammatory arthritis
  2. Deposition of calcium pyrophosphate crystals in synovium
34
Q

Clinical presentation of pseudogout

A
  1. Knee, shoulder and wrist
  2. Weakly +ve birefringement
  3. Rhomboid shaped crystals
35
Q

Define Fibromyalgia

A
  1. Widespread pain
  2. Tender points at specific anatomical sites
  3. Problem with pain processing
36
Q

Clinical presentation of Fibromyalgia

A
  1. Chronic pain
  2. Fatigue
  3. Sleep disturbance
  4. TENDER POINTS
    • Occiput
    • Low cervical region
    • Trapezius
    • Supraspinatus
    • Gluteal region
    • Knees
37
Q

Diagnosis of Fibromyalgia

A
  1. Investigation is to exclude other conditions
  2. Questionnaire to assess symptom location and severity
38
Q

Define Psoriatic arthritis

A
  1. Autoimmune chronic inflammatory
  2. Rheumatoid factor -ve
  3. Strong genetic predisposition
39
Q

Clinical presentation of psoriatic arthritis

A
  1. Joint pain + (morning) stiffness
  2. Swollen entire fingers or toes
  3. Joint tenderness + warmth
  4. Inflammation of plantar fascia and achilles’ tendon
  5. Psoriasis
40
Q

Diagnosis of psoriatic arthritis

A
  1. RF test
  2. X-ray
41
Q

Treatment of psoriatic arthritis

A

SIMILAR TREATMENT TO RA
1. NSAIDs + physio
2. Intra - articular steroids
3. DMARDs
4. Anti-TNF

42
Q

Define + aetiology reactive arthritis

A
  1. Inflammatory arthritis
  2. Response to infection
  3. BUT organism cannot be isolated from affected joint
  4. STI or gastroenteritis organisms
43
Q

State microbes involved in reactive arthritis

A
  1. Chlamydia trachomatis
  2. Neisseria gonorrhoea
  3. Salmonella
  4. Shigella
  5. Yersinia enterocolitica
  6. Campylobacter
44
Q

Pathophysiology of reactive arthritis

A

Cross reactivity between original bacterial antigens and synovium affected joints

45
Q

Clinical presentation of reactive arthritis

A
  1. Asymmetrical Joint pain and swelling
  2. Urethral discharge
  3. Conjunctivitis
  4. rash
  5. Rectal discharge
46
Q

Diagnosis of reactive arthritis

A
  1. Swab of infected site
  2. Stool sample
  3. Joint aspiration
  4. STI screening
47
Q

Treatment of reactive arthritis

A
  1. NSAIDs
  2. Intra-articular steroid injections
  3. Antibiotic therapy
  4. DMARDs
48
Q

Which 5 cancers can spread to the bone?

A

Breast
Byroid
Bidney
Bronchus
Brostate

SJ Phase 2a (13 decks)

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