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2 MSK > Muscle Disease, Back Pain and Vasculitis Tutorial > Flashcards

Muscle Disease, Back Pain and Vasculitis Tutorial Flashcards

1
Q

useful investiagtions for suspected RA?

A 
FBC
inflammatory markers
anti-CCP
ANA
X rays
US
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2
Q

why would you test for ANA antibody in a suspected RA patient?

A

CT disease is a differential

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3
Q

what would you expect on X ray of someone with RA?

A

peri-articular osteopenia

erosions in MCP joint

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4
Q

what blood results suggest anaemia of chronic disease

A

low Hb but normal MCV

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5
Q

can you get seronegative RA?

A

yes

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6
Q

is anaemia of chronic disease common in RA?

A

yes

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7
Q

where does back pain tend to radiate to?

A

buttocks

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8
Q

what would you suspect in a young person (20-40) with a 3 month history of back pain?

A

ankylosing spondylitis

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9
Q

what is the significance of back pain radiating to the buttocks?

A

suggests involvement of the sacroiliac joint which is common in seronegative arthritis and ank spond

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10
Q

cause of a bamboo spine?

A

too much calcium

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11
Q

questions to ask in a history of someone with suspected AS?

A

stiffness > 30 mins
better with exercise?
pain at night?

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12
Q

is ank spond an inflammatory arthritis?

A

yes

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13
Q

define polyarthritis?

A

> 4 joints affected

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14
Q

define oligoarthritis?

A

1-4 joints affected

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15
Q

define monarthritis?

A

only 1 joint affected

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16
Q

name the main 4 types of seronegative arthritis?

A

psoriatic arthritis
reactive arthritis
enteropathic arthritis
ankylosing spondylitis

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17
Q

what is enthesitis?

A

inflammation at the points where tendons and ligaments attach to bone

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18
Q

what is the disease process behind tennis elbow and achilles tendonitis?

A

enthesitis

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19
Q

what causes the spinal involvement in AS?

A

enthesitis

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20
Q

why can you get achilles tendonitis along with AS?

A

both caused by enthesitis

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21
Q

tests for AS?

A

modified schober’s test
MRI
HLA B27 test

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22
Q

why is CRP not that useful in AS?

A

enthesises are very avascular so inflammation there wont show up

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23
Q

what should you do an MRI of and why?

A

whole spine and sacroiliac region to see enthesitis

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24
Q

management for AS?

A
  1. NSAIDs eg diclofenac, naproxen
  2. add another NSAID
  3. anti-TNF
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25
Q

go-to treatment for spinal disease?

A

NSAIDs

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26
Q

treatment for synovitis?

A

methotrexate

steroids

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27
Q

what disease commonly presents with hip and shoulder pain?

A

polymyalgia rheumatica (PMR)

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28
Q

what is polymyalgia rheumatica?

A

muscle pain because of an inflamed JOINT

29
Q

what is polymyositis?

A

muscle pain/weakness because of inflamed muscle fibres

30
Q

do you get pain/stiffness in the morning with polymyositis or PMR?

A

polymyositis

31
Q

do you get muscle wasting in PMR or polymyositis?

A

polymyositis

32
Q

is there an age group limit on PMR? if so, what is it?

A

yes, over 50s

33
Q

is there an age group for polymyositis? if so, what is it?

A

no

34
Q

why would you not include fibromyalgia in a differential of an elderly woman with weight loss, myalgia, pain in hip/shoulder and fatigue?

A

only affects younger people
pain is everywhere, not localised
don’t get weight loss in fibromyalgia

35
Q

examination in someone with suspected PMR/polymyositis?

A

muscle power reading

joint/muscle examination

36
Q

what investigation could you do to differentiate between polymyositis and PMR and why?

A

CK, it is high in polymyositis but normal in PMR

37
Q

treatment for PMR?

A

start on low dose prednisolone 15mg daily

38
Q

when should the patient’s symptoms stop when taking meds for PMR?

A

1 week

39
Q

if the patient didnt take medication for PMR, how long woudl it take for their symptoms to go away?

A

2 years

40
Q

what should be done if a diagnosed PMR patient doesn’t respond to low dose steroids?

A

reconsider diagnosis

41
Q

complications of steroids?

A 
osteoporosis
cataracts
diabetes
skin thinning
muscle atrophy
diabetes
peptic ulcers
CVD risk
42
Q

what should do to protect a patient from osteoporosis if they’re on steroids?

A

give:
bisphosphonates
calcium
vit d

43
Q

common complication of PMR?

A

giant cell arteritis

44
Q

where does giant cell arteritis get to the temporal artery?

A

vasculitis of large vessels -> aorta -> external carotid artery -> temporal artery

45
Q

what clinical symptom do you get from facial artery vasculitis?

A

jaw claudication

46
Q

is the pronounced artery in giant cell arteritis pulsatile or not?

A

no

47
Q

treatment for giant cell arteritis?

A
  1. temporal artery biopsy
  2. increase steroid dose to 1mg/kg
  3. check CRP and PV
48
Q

investigations for suspected fibromyalgia?

A 
fibromyalgia tender points
exclude CT disease by checking:
ANA
ENA
CK
CRP
PV
49
Q

treatment for fibromyalgia?

A

gabapentin
pregabalin
antidepressants
cognitive behavioural therapy

50
Q

what is dermatomyositis?

A

polymyositis with skin features

51
Q

what skin features can be present in dermatomyositis

A

heliotrope rash

52
Q

what investigations should you do for suspected PMR or polymyositis?

A 
PV/CRP
FBC
U+E
LFT
CK
Anti-Jo-1
53
Q

what monitoring should be done for a patient on steroids?

A

blood glucose for diabetes
CV monitoring
give bone protection

54
Q

why should you be worried about weight loss in dermatomyositis?

A

it is associated with malignancy

55
Q

investigations for someone with weight loss and dermatomyositis?

A

colonoscopy
endoscopy
CT chest/abdo/pelvis
mammogram

56
Q

investigation for dermatomyositis?

A 
CK
ANA
Anti-Jo-1
EMG test for electrical activity
MRI
57
Q

what would you expect to see on MRI of someone with dermatomyositis?

A

white muscle from oedema

damaged muscle -> get fat and fibrous tissue forming

58
Q

treatment for dermatomyositis?

A
  1. steroid + azathioprine long term
    bone protection
  2. long term immunosuppression
59
Q

at what times is the risk of cancer in dermatomyositis highest?

A

2 years before and after diagnosis

60
Q

what should you suspect in someone who has joint pain and ENT involvement?

A

granulomatosis with polyangiitis

61
Q

tests for someone with suspected vasculitis?

A 
1. urinalysis
FBC
U+E
LFT
ANCA
PR3
MPO
urinalysis
CT chest
biopsy of rash or lung lesion
62
Q

what could you see on CXR of someone with GPA?

A

necrotising granulomatous cavities in the lower lung fields

63
Q

is GPA ANCA+ve or -ve?

A

positive

64
Q

what does a vasculitic rash look like?

A

purpuric
inflamed leaky capillaries
non blanching

65
Q

what inflammatory marker results would you expect to see in vascultis?

A

increased CRP and PV

decreased C3/4

66
Q

what urinalysis result would prompt you to do a renal biopsy?

A

> 500mg in urine over 24 hours

67
Q

treatment for severe vasculitis?

A

high dose steroid + cyclophosphamide

68
Q

treatment for mild/moderate vascultis?

A

methotrexate
oral steroids
bone protection

2 MSK (61 decks)

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