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Year 3 Conditions > Musc > Flashcards

Musc Flashcards

1
Q

What happens physiologically in osteoarthritis

A

Imbalance in chondrocytes breaking down and producing cartilage due to excess stress such as obesity. Breakdown of articular cartilage leads to inflammation which triggers nerves

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2
Q

Risk factors for osteoarthritis

A 
High age
Associated inflammatory conditions like rheum and SLE
Joint injuries
Obesity
Strenuous sports
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3
Q

Signs of osteoarthritis on examinations of hands

A

PIP- bouchards nodes
DIP- heberden nodes
Swollen first MCP

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4
Q

Joints affected in osteoarthritis

A

Weight bearing- knees, ankles, hips, lumbar spine and wrists

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5
Q

Symtpoms of osteoarthritis

A

Stiffness in morning of less than an hour

Sharp ache in joints worse with activity

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6
Q

X ray findings of osteoarthritis

A

Loss of joint space
Osteophytes
Sunchondral sclerosis
Subchondral cysts

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7
Q

What is eburnation

A

Where cartilage is lost leading to bones rubbing together

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8
Q

Signs on examination of osteoarthritis joints

A

Crepitus
Osteophytes
Loss of motion
NO swelling

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9
Q

What is another name for reactive arthritis

A

Reiters syndrome

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10
Q

What is genetic association of reactive arthritis and what other conditions are associated with it

A

HLA-B27
Ankylosing Spondylitis
Psoriasis
UC

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11
Q

What is reactive arthritis an example of

A

Seronegative spondyloarthropathy

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12
Q

What joints are normally affected in reactive arthritis

A

Can be multiple or often just 1 affected- often the knee

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13
Q

What is only organism causing reactive arthritis that doesnt cause a sterile joint

A

Gonorrhoea

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14
Q

Common organisms associated with reactive arthritis

A 
Shigella 
Campylobacter
Chlamydia
Gonorrhoea
Salmonella
Yersinia
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15
Q

Reiters triad

A

Conjunctivits- painful red eye
Urethritis- pain when urinating
Arthritis

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16
Q

Signs of reactive arthritis on examination

A

Keratoderma blenorrhagicum
Circinate balanitis
Mouth ulcers

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17
Q

Other organs that can be affected in reiters syndrome but less commonly

A

Cervix

Pericarditis

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18
Q

What is triad of feltys syndrome

A

Neutropenia
Splenomegaly
Associated with RA

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19
Q

When is osteoarthritis pain worse

A

Evening

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20
Q

How can osteoarthritis be classified

A

Generalised

Localised-often nodal

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21
Q

Which joint is most commonly affected in nodal osteoarthritis

A

DIP

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22
Q

What joints other than DIP and PIP are affected in nodal osteoarthrits

A

First carpometacarpal joint

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23
Q

What happens to first carpometacarpal joint in osteoarthrits

A

Bony swelling leading to square appearance of hand

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24
Q

When is polymyalgia rheumatica pain worse

A

Morning

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25
Q

Rheumatoid x ray findings

A 
Reduced joint space
Soft tissue swelling
Periarticular osteopenia
Bony erosions
Subluxation
Deformity of joint
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26
Q

Most common spetic arthritis cause

A

S aureus

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27
Q

Common septic arthritis cause in young people

A

Gonococcus

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28
Q

Main investigations for septic arthritis

A

Aspiration and blood cultures

Then think about X ray

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29
Q

What in joints can reactive arthritis also affect

A

Entheses

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30
Q

Common ethesitis of reactive arthritis

A

Achilles tendonitis
Plantar fasciitis
Note aslo get dactylitis

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31
Q

Non joint symptom of ankylosing spondylitis

A

Conjunctivitis

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32
Q

Which joint does nodal OA affect most commonly

A

DIP

Then first MCP

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33
Q

What is seen in legs in OA

A

Varus or valgus deformation

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34
Q

What are crystals in gout

A

Uric acid

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35
Q

Physiology of uric acid

A

Comes from purine metabolism

Should be excreted by kidneys

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36
Q

What joint is most commonly affected in gout

A

1st MTP

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37
Q

Birefringe result of gout and pseudogout

A

Gout- negative

Pseudogout- positive

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38
Q

Blood test findings of gout

A

Raised CRP and ESR

Raised urate

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39
Q

Who does pseudogout occur in

A

Elderly

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40
Q

Which joints does pseudogout occur in

A

Knees and wrists

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41
Q

How does pseudogout present

A

Acute onset wrist or knee pain

Swelling

42
Q

How does gout appear on X ray

A

Peri-articular erosion

43
Q

Examination of gout

A

Swelling

Tophi present

44
Q

What are soft tissue deposits of gout called

A

Tophi

45
Q

Systemic complications of RA

A 
Pericarditis
Vasculitis
Episcleritis
Keratitis
ILD
RF nodules
Felty syndrome
Raynauds
46
Q

What eases RA symptoms

A

Exercise

47
Q

Joint pain that eases with exercise

A

RA

48
Q

Is RA symmetrical or asymmetrical

A

Symmetrical

49
Q

Joint pain in PMR

A

Stiffness in neck, spine, shoulders and hips

50
Q

What is only sign on X ray you see of RA early on

A

Soft tissue swellin

51
Q

In RA which hand joint is often spared early

A

DIP

52
Q

How can you get carpal tunnel syndrome in RA

A

Inflammation of flexor tendon sheath

53
Q

Signs on examination of RA

A

Boutonniere
Swan neck
Ulnar deformity
Carap tunnel syndrome

54
Q

What percentage of psoriatic patients get arthritis

A

5-10%

55
Q

Which joint does psoriatic arthritis tend to affect

A

Most commonly asymmetrical DIP

56
Q

What is a good indicator psoriasis patient will get arthritis

A

Onochylysis

57
Q

What is main risk of psoriatic arthrits

A

Arthritis mutilans where osteolysis occurs shortening the finger

58
Q

How does dermatomyositosis present

A

Proximal limb weakness with skin changes too

59
Q

What are crystals in gout

A

Monosodium urate

60
Q

Risk factors for gout

A

High protein- red meat
Alcohol
Kidney dysfunction

61
Q

Where are rheumatoid nodules found

A

Pressure points like the elbows

62
Q

What do rheumatoid nodules feel like

A

Very firm

63
Q

Why would you get recurrent infections in rheumatoid

A

Feltys syndrome

64
Q

Associated conditions of seronegative spondyloarthropathies

A

Achilles tendonitis
Plantar fasciitis
Sacrolillitis

65
Q

Presentation of ank spond

A

Back pain worse in morings
Stiffness in morning
Wake up latter half of the night

66
Q

Later examination findings of ank spond

A

Abnormal schobers test
Abnormal wall to tragus test
Reduced chest expansion

67
Q

Other features of ank spond

A 
6as
Anterior uveitis
Aortitis
Aortic regurg
AV conduction block from fibrosis
Apical lung fibrosis
IgA nephropathy
68
Q

Investigations for ank spond

A

Raised ESR and CRP
RF and Accp negative
X ray- sacroilitis
MRI- enthesitis, sacroilitis

69
Q

What is bamboo spine seen in

A

Ank spond

70
Q

Why are MRIs better than x ray in ank spond

A

MRIs pick up pathology earlier

71
Q

5 joint psoriasis presentations

A 
Symmetrical DIP and PIP arthritis
Asymmetrical oligoarthritis- dactylitis
DIP arthritis
Arthritis mutilans
Ank spond
72
Q

Inflammatory symmetrical DIP and PIP ddx

A

RA

Psoriatic

73
Q

Knee monoarthritis ddx

A

Crystal
Septic
Reactive arthritis

74
Q

Investigations for reactive arthritis

A

Urethral/cervical swab for gonorrhoea
PCR- chlamydia
Stool sample if dysentery
Joint aspiration to exclude gout and septic arthritis

75
Q

Is swelling normally seen in OA

A

No

76
Q

Most common cause of hip pain in elderly

A

OA

77
Q

Most common organ leading to clubbing

A

Lung

78
Q

What chemical exposure is well known cause of clubbing

A

Asbestos

79
Q

Cause of unilateral swollen leg

A 
DVT
Cellulitis
Ruptured bakers cyst
Muscular sprain
Septic arthritis
Allergic response to insect bite
Compartment syndrome
80
Q

Causes of bilateral swollen legs

A 
Right heart failure 
Lymphoedema
Venous insufficiency
Pregnancy
Vasodilators
Hypoalbuminaemia
Pelvic tumour compressing the IVC
Fluid overload iatrogenic
81
Q

What could cause vessel injury in virchows triad in leg

A

Trauma

Surgery

82
Q

What would cuts and insect bites suggest about leg swelling

A

Insect bite- cellulitis, allergy

Cuts- cellulitis

83
Q

Swelling getting bigger in unilateral leg swelling suggests what

A

Cellulitis

84
Q

What does abdo pain and vaginal bleeding suggest about leg swelling

A

Ovarian mass compressing IVC

85
Q

What does flaws suggest about unilateral leg swelling

A

Pelvic mass

86
Q

What does recent surgery or radiotherapy to leg or abdo suggest about unilateral leg swelling

A

Lymphoedema

87
Q

What does joint pain on movement suggest about unilateral leg swelling

A

Spetic arthritis

88
Q

What are looking for in inspection of the leg in unilateral swelling

A 
Cuts, punctures or insect bites- cellulitis or inflammatory response to bites
Location of swelling
Size
Lymphadenopathy
Abdominal masses
Neurovascular status
Pain on movement
Febrile?
89
Q

Why is location of swelling significant in unilateral leg swelling

A

Septic arthritis would be over a joint
Bakers cyst would come out of popliteal fossa and extend downwards
Compartment syndrome would be a whole muscle group

90
Q

What would groin lymphadenopathy in unilateral leg swelling suggest

A

Infection of leg

91
Q

Why is neurovascular status of limb important in unilateral leg swelling

A

Could be compartment syndrome

92
Q

Investigations for DVT

A

Doppler US of leg
D-dimer
FBC- polycythaemia can cause it
Clotting study- thrombophillia

93
Q

Management of DVT

A

Anticoagulation
Copression stockings
Lifestyle advice

94
Q

How can ruptured bakers cyst be diagnosed

A

US

95
Q

What is Volkmanns contracture

A

Irreversible atrophy of the limb

96
Q

Management of cellulitis

A

Take FBC looking for neutrophillia
Flucloxacillin covering strep and staph
Demarcate progression using pen
Elevate leg

97
Q

How to manage mosquito bite leg swelling

A

Topical steroids

Antihistamines

98
Q

Management of bakers cyst

A

Elevation of limb
Aspirate fluid
Injection of corticosteroids into joint

99
Q

What is chondrocalcinosis

A

Deposition of calcium pyrophosphate crystals

100
Q

What arthritis is chondrocalcinosis seen in

A

OA

101
Q

Main diagnostic marker of PMR

A

ESR over 40

Year 3 Conditions (33 decks)

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