MSK symptoms and signs

Question 1

Name three examples of autoimmune inflammatory MSK diseases

Answer 1

Rheumatoid arthritis
Spondyloarthropathies
Vasculitis

Question 2

Describe inflammatory conditions

Answer 2

Eases with use
more than 60 mins stiffness
Stiff in the evening
Hot and Red
Young, FHx
Hands and feet
Responds to NSAIDs

Question 3

What is expected for MSK examinations

Answer 3

Arthritis research UK

Question 4

Describe degenerative conditions

Answer 4

Increases with use
Stiffness <30mins
Older, prior occupation/sport
1st CMCJ, DIPJ, knees
Less convincing response to NSAIDs

Question 5

Questions to ask in MSK history

Answer 5

Where is the pain?
Nature of it?
Stiffness?
Swelling?
History of symptoms?
Has it affected function?

Question 6

Where does RA affect

Answer 6

PIPJ
Elbows, shoulders
Knee
DCMCJ
(peripheral)

Question 7

Where does OA affect

Answer 7

Spine
Hips
1st CMCJ, DIPJ, knees
(central)

Question 8

What three places does psoriatic arthritis affect

Answer 8

Enthesitis
Dactylitis
Joints

Question 9

How would describe the history of RA

Answer 9

Once onset it will continue, fluctuate slightly.

Question 10

What can start RA

Answer 10

Sudden stress

Question 11

Which type of arthritis, can come and go completely

Answer 11

Palindromic rheumatoid arthritis

Question 12

Describe the history of gout

Answer 12

Acute phase:
Self limiting, short
Chronic phase:
Constant

Question 13

what is pondagra

Answer 13

Gout of the big toe

Question 14

When after infection does reactive arthritis occur

Answer 14

2-3 weeks

Question 15

Common associated symptoms with joint pain

Answer 15

Rash (photosensitive)
Raynauds
Mouth ulcers
Sicca symptoms
Diarrhoea
Preceding factors (infection)

Question 16

What are sicca symptoms

Answer 16

Dry eyes and mouth

Question 17

Which kind of infection most commonly causes arthritis

Answer 17

Bowel

STI

Question 18

Autoimmunity family history diseases

Answer 18

Thryoid
Vitiligo
T1DM
Pernicious anaemia
RA/CTD/MS

Question 19

HLA B27 spectrum family history

Answer 19

Psoriasis
Crohns/UC
Ankylosing Spondylitis
Reactive (reiters)

Question 20

Lifestyle factors in genetically susceptible individuals

Answer 20

Smoking
Occupation
Alcohol

Question 21

Describe the classic RA presentation and first investigation outcome

Answer 21

Symmetrical, deforming polyarthritis

Erosion on XRay

Question 22

Describe the hand signs in RA

Answer 22

Ulnar deviation of fingers
Radial deviation of wrist
Swan neck deformity
Boutonniere deformity
Digital vasculitis
Z thumb

Question 23

Describe the hand signs in OA

Answer 23

Heberdens nodes

Bouchards nodes

Question 24

Where are heberdens nodes

Answer 24

Distal DIPJ

Question 25

Where are bouchards nodes

Answer 25

Proximal DIPJ

Question 26

What are the classic changes in RA

Answer 26

Swan neck deformity and boutonniere

Question 27

Name four spondyloarthropathies

Answer 27

Ankylosing spondylitis Reactive arthritis Psoariatic arthritis Enteropathic arthritis

Question 28

What is enteropathic arthritis associated with

Answer 28

Crohns/UC

Question 29

Why do AnkSpond get inflammatory spinal pain

Answer 29

In reaction to previous bony inflammation, new bone forms and calcifies. Causing severe limitation of movement.

Question 30

Where are the two places commonly affected by AnkSpond

Answer 30

Sacro-iliitis | Spine

Question 31

Where is often firstly involved in AnkSpond

Answer 31

Sacroiliitis

Question 32

Where can be affected by Enthesitis

Answer 32

Tennis elbow Golfers elbow Anterior knee Achilles

Question 33

What inflammatory eye disease do spondyloarthropathies

Answer 33

Anterior uveitis aka iritis

Question 34

Where is commonly affected by spondyloarthropathies

Answer 34

Large joint oligoarthritis

Question 35

Features of psoaritic arthritis of the hand

Answer 35

Psoarisis of the nails (nail pitting) Dactylitis Inflammation of DIPJ

Question 36

DIPJ arthritis must be

Answer 36

OA | Psoriatic

Question 37

Which places of skin are often affected by psoarisis

Answer 37

``` Scalp Behind ears Umbilicus Nails Hands and feet ```

Question 38

Hidden places for psoriasis

Answer 38

Natal cleft Umbilicus Genitals

Question 39

3 examples of connective tissue disease

Answer 39

SLE Scleroderma Polymyositis/dermatomyocits

Question 40

Signs of SLE

Answer 40

Non erosive arthritis Butterfly rash Photosensitivity Mouth ulcers

Question 41

Describe raynuads

Answer 41

Circulatory changes in the fingers, responding to changes in temperature

Question 42

Which phases of raynauds are painful

Answer 42

White! and red

Question 43

When does raynuads often start

Answer 43

Menarche

Question 44

Who with raynauds has a good prognosis

Answer 44

Started at menarche, no ANA