Muscleskeletal

Question 1

Gout

Cause
Diagnosis
treatment

Answer 1

Caused by: high uric acid–> form crustal in synovial fluid–> inflammation

Diagnosis: serum uric acid, CRP, ESR, Xray
Treatment:

1. For chronic gout: 1st line: XOIS (Xanthine oxidase inhibtors): an enzyme needed to form uric acid: allopurinol
2. For acute gout: 1st line: NASAID (Indomethacin is the best). 2nd line: cochcine (inhibit neutrophil migration)

Non drug:
Weight loss
Hydration
Vitamin C: reduce urate level

Question 2

Secondary gout

Answer 2

Gout triggered by stuff

Diuretic
Alcohol
Low dose aspirin
Trauma
Medical stress (infection)

Question 3

Pseudogout

Answer 3

Same symptoms as gout but caused by high calcium pyrophasphate dehydrate (CPPD) crystals

Question 4

Rheumatoid arthritis

Cause
S&S
Diagnosis
Treatment

Answer 4

Cause: autoimmune inflammation
S&S: symmetrical, morning stiff/ pain > 30 min, affect small joints (knuckle, MCP, DIP), rheumatoid nodules (over bone prominence), some people have systemic S&S: fever, fatigue, ulnar drift, swan neck. |—–

Diagnose: rheumatoid factor
Treatment:
1. Warm shower
2. Healthy lifestyle (diet, balanced exercise), no bedrest
3. Orthopaedic showes: good support
4. Joint splint: reduce local inflammation

Drug:

1st line: : Methotrexate: a folic acid antagonist and antimitotic: suppress inflammatory leukocyte activity. slow or stop RA. Take with folic acid. Takes 3 weeks to show effect

Question 5

Synovial joint juvenile arthritis

Answer 5

RA onset before 16 yr old

Not as painful
Affect large joints
Check ANA antibody (antinuclear antibody)

Question 6

Osteoarthritis

Answer 6

Wear and tear: reduce flexibility and elasticity of articulate cartilage –> worse in handling mechanical stress & bone remodeling

Primary: unknown etiology; secondary: caused by injury, disease, congenital

S&S:

Reduce ROM
Muscle atrophy

Diagnosis: Xray

Treatment:
Weight loss
Exercise: strengthening, stretching
1st line: tylenol
2nd line: NSAID

Question 7

Hormones that affect bone metabolism

Answer 7

1. Estrogen: reduce estrogen increases bone destruction
2. Calcitonin: this hormone decrease osteoclast’s activity
3. Parathyroids hormone: increase Ca reabsorption & increase phosphate excretion

Question 8

Osteoporosis

Osteopenia

Answer 8

<-2.5: osteoporosis

-2.5—1.0: osteopenia

> 1: normal

T score: compared to young adult’s baseline
Treatment: risedronate+ calcium+ vitamin D

Question 9

Bisphosphonate

Answer 9

“Dronate”

MOA: they go to the place where bone’s destruction to prevent bone from reabsorption + inhibit osteoclast function

Contrandication: hx o gastritis, peptic ulcer

Question 10

Ankylosing spondylitis

Answer 10

Question 11

Fibrimyalgia

Answer 11

Chronic widespread pain, high pain response to pressure

Patho: unknown etiology

Treatment: symptom control.

1st: improve sleep: very important: amitriptyline
Depression/ anxiety: SSRI
Body discomfort: muscle relaxant: cyclobenzaprine

Question 12

Osteomyelitis

Answer 12

Bone infection (could caused by virus, fungi, bacteria)

S&S: if chronic, S&S is vague; if acute: acute onset inflammation

Treatment:

Chronic vancomycin
Acute: penicillin

Question 13

What food & drug can trigger gout

Answer 13

Organ meat
Seafood
Sweet beverage
Alcohol

Diuretic
Cyclosporine
Aspirin< 1g/day