MSK week: conditions Flashcards
3 types of acute inflammatory arthritis
- septic arthritis
- gout/ pseudogout
- reactive arthritis
3 types of chronic inflammatory arthritis
- RA
- psoriatic arthritis
- chronic tophaceous gout
Type of inflammatory arthritis that affects spine
Ankylosing spondylitis
Risk factors for septic arthritis
- overlying/ penetrating infection
- prosthetis, surgery
- age
- diabetes
- RA
- corticosteroids
What kind of aspirate does one get with acute gout
Chalky white aspirate,
contains uric acid crystals
Risk factors for acute gout
- alcohol
- diet (too much urate)
- renal failure
- chemotherapy
- dehydration
- psoriasis
- haemolysis
What condition might tophus (chalky white deposits) indicate
Chronic tophaceous gout
Difference between crystal content of gout and pseudogout
Gout: uric acid crystals
Pseudogout: calcium pyrophosphate crystals
Is varus or valgus more common? Why?
Varus = bow legged Valgus = knock kneed
VARUS is more common, due to medial side of knee wearing out first
Which condition is associated with
- subcutaneous skin nodules
- bony nodules
subcutaneous skin nodules: RA
bony nodules: OA
Which condition is associated with:
Malar flush
SLE
Which condition is associated with:
episodic ischaemia fingers
Raynaud’s
Which condition(s) is associated with:
Conjuctivitis
- ankylosing spondylitis
- reactive arthritis
Which condition(s) is associated with:
Blue sclera
Osteogenesis imperfecta
Which condition(s) is associated with:
Mouth ulcers
SLE
Which condition(s) is associated with:
Dry eyes, dry mouth
- RA
- Sjorgrens
Important class of drug to ask about in MSK history + why
Corticosteroids
Long term use can lead to vascular necrosis
Which type of arthritis might symmetrical symptoms point to
RA
OA usually affects 1 side worse than the other
Which joints are most commonly affected in RA
Fingers: MCP, PIP
Toes: MTP
Which joints are most commonly affected in OA
Fingers: DIP, PIP, base of thumb
Weight bearing joints: hip, knee, spine
In which type of arthritis does morning stiffness last over 30min
RA
Order of describing a bone xray/MRI
- coverage
- alignment
- bones
- spacing
- soft tissue
- edge of image
What type of injuries cause flexion-distraction injuries of the spine
High force deceleration injuries
Where do flexion-distraction injuries of the spine occur most commonly
Thoraco-lumbar region
What may cause anterior compression injury of the spine
Traumatic hyperflexion with compression
common in osteoporotic patients, occur from low impact injuries/movements
4 cardinal signs of arthritis on Xray
- joint space loss
- osteophytes
- subchondral sclerosis
- subchondral cysts
Which joints are most commonly affected in psoriatic arthritis
All joints
What type of infections might lead to reactive arthritis
HIV
chlamydia
gastroenteritis
Triad of symptoms of reactive arthritis (Reiter’s syndrome)
- Inflammation of multiple large joints
- UTI
- Uveitis/ conjunctivitis
What kind of distinctive feature would be seen on xray/MRI of a person with ankylosing spondylitis
Bamboo spine
3 signs of synovitis
- warmth
- swelling
- tenderness
Common sites of osteoporotic fractures
Thoracic and lumbar vertebrae
Proximal femur
Distal radius (colles fracture)
In which group of people does gout almost never occur
Premenopausal women
Can soft tissue swelling be seen on x-ray in gout
yes
What would positive versus negative birefringent crystals on a joint aspirate indicate
Negative: gout
Positive: pseudogout
What is haemochromatosis
Build up of iron in body
Which joints are most commonly affected in haemochromatosis
MCP joints of thumb and index finger
Symptoms of haemochromatosis
- finger arthritis
- chronic fatigue, weakness, lethary
- RUQ or diffuse abdominal pain
- enlarged liver, abnormal liver function, cirrhosis, liver cancer
- cardiomyopathy
- T2DM
- loss of sex drive in men
- oligomenorrhoea/ amenorrhoea in women
- grey/bronze skin
- neuro disorders: impaired memory, mood swings, depression
- decreased body hair
Where are Heberden and Bouchard nodes?
Which type of arthritis are they associated with?
Heberden: DIP
Bouchard: PIP
Associated with OA
In which type of arthritis would one get squaring of the hands (due to thumb base protrusion)
OA
List 5 hand deformities one might find with rheumatoid arthritis
- Ulnar deviation
- Swan neck
- Boutonnieres deformity of the fingers
- Z deformities of thumb
- Piano key deformity of wrist
What might one find in a CXR of a patient with rheumatoid arthritis
Nodules, fibrosis, effusions
What type of anaemia will one get with rheumatoid arthritis
Normochromic, normocytic
anaemia of chronic disease
Which types of arthritis are seronegative - HLA-B27
- ankylosing spondylitis
- psoriatic arthritis
- reactive arthritis
What is oncholysis and what conditions is it associated with?
Oncholysis: painless detachment of the nail from the nail bed
Associated with psoriasis, psoriatic arthritis, thyrotoxicosis
What is dactylitis and what arthritic conditions is it associated with
Swelling of entire digit (due to swelling of tendons surrounding the joint)
Associated with seronegative arthritis: ankylosing spondylitis, psoriatic arthritis, reactive arthritis
Specific investigations for rheumatoid arthritis
- CRP, ESR
- rheumatoid factor
- anti-CCP
- xray
3 most common places affected by reactive arthritis
- joints
- eyes
- urethra
Conditions that cause osteoporosis
- alcoholism
- anorexia
- hyperthyroidism
- kidney disease
- surgical removal of ovaries
- smoking
- insufficient exercise
- menopause
Which arthritis may cause sausage toes
Psoriatic arthritis
