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Phase 3a - GP > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Where is pain and stiffness felt in PMR?

A
  1. Neck
  2. Shoulders
  3. Pelvic girdle
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2
Q

What cdtn is PMR associated with?

A

GCA (aka temporal arteritis)

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3
Q

Epidemiology of PMR

A

> 50 yrs
White
Female

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4
Q

Describe the features of PMR:
1. How long is it present for?
2. Where is the pain?
3. Pain exacerbated?
4. When and how long is stiffness present?
5. Systemic features?

A
  1. Pain present for >2 wks
  2. Bilateral shoulder pain - can radiate to elbow, bilateral pelvic girdle pain
  3. Pain worse with movement and can interfere with sleep
  4. Stiff AM and lasts 45 min
  5. low grade fever, wgt loss, fatigue, low mood
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5
Q

DDx of PMR

A

OA
RA
SLE
Fibromyalgia
Hypothyroidism
Myositis

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6
Q

Ix for PMR

A

FBC
U&E
Infl Markers -> CRP and ESR (inc) - since PMR is an inflammatory cdtn!
Calcium
Serum protein electrophoresis

Can do other Ix to rule out ddx

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7
Q

Tx of PMR

A

STEROIDS!!!

Improvement should be seen within 1 wk of steroid use if it’s PMR

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8
Q

What is fibromyalgia?

A

Chronic cdtn characterised by widespread pain and hypersensitivity to pressure

Fibro = fibrous tissue
Mya = Muscle tissue
Algia = Pain

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9
Q

Fibromyalgia symptoms?

A
  1. Chronic widespread pain
  2. Hypersensitivity to pressure
  3. Fatigue and sleep disturbance
  4. Cognitive impairment
  5. Paresthesia (pins and needles)
  6. Muscle spasms
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10
Q

How to diagnose fibromyalgia?

A
  1. 9 pairs of tender points
  2. Duration of > 3 mths
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11
Q

Tx for fibromyalgia

A

No cure

Exercise
CBT

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12
Q

What are the commonly Affected Joints in osteoarthritis?

A

Hips
Knees
Distal interphalangeal (DIP) joints in the hands
Carpometacarpal (CMC) joint at the base of the thumb
Lumbar spine
Cervical spine (cervical spondylosis)

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13
Q

X-ray changes in osteoarthritis

A

L – Loss of joint space
O – Osteophytes (bone spurs)
S – Subarticular sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone)

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14
Q

Sx of osteoarthritis

A

Joint pain and stiffness - worsen with activity and at the end of the day.

Bulky, bony enlargement of the joint

Restricted range of motion

Crepitus on movement

Effusions (fluid) around the joint

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15
Q

Signs in the Hands of osteoarthritis px?

A

Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb (CMC joint)
Weak grip

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16
Q

Dx of osteoarthritis?

A

if px is over 45, has typical pain associated with activity and has no morning stiffness = osteoarthritis

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17
Q

Tx of osteoarthritis

A

Topical NSAIDs first-line for knee osteoarthritis

Oral NSAIDs where required and suitable (co-prescribed with a proton pump inhibitor for gastroprotection)

Weak opiates and paracetamol are only recommended for short-term, infrequent use - strong opiates not recommended for osteoarthritis

18
Q

What is bursitis?

A

Acute or chronic inflammation of a bursa.

A bursa is a sac containing a small amount of synovial fluid that lies between a tendon and either skin or bone to act as a friction buffer and facilitate movement of adjacent structures.

19
Q

Sx of bursitis

A

pain at site of bursa
tenderness to palpation
decreased active ROM
+
If septic bursitis:
low-grade temperature
erythema/swelling
warmth of overlying skin

20
Q

RF of bursitis

A

Occupational
RA
Gout or pseudogout

21
Q

Ix for bursitis

A

Clinical diagnosis
Gram stain and fluid aspirate - sus septic bursitis

22
Q

Tx for bursitis (non-septic and septic)

A

Non-septic:
1st line - analgesia + conservative
2nd line - corticosteroid injection
3rd line - surgery

Septic:
1st line - abx (dicloxacillin) + bursa aspiration
2nd line - surgery to drain bursa

23
Q

RF for gout (4)

A

Male
Family history
Obesity
High purine diet (e.g., meat and seafood)
Alcohol
Diuretics
Cardiovascular disease
Kidney disease

24
Q

Typical joints affected by gout?

A

The base of the big toe – the metatarsophalangeal joint (MTP joint)

The base of the thumb – the carpometacarpal joint (CMC joint)

Wrist

Larger joints (e.g., knee and ankle)

25
Q

Ix for gout

A

Blood test - serum urate level (uric acid)
Joint aspiration - monosodium urate crystals of gout are needle-shaped and negatively birefringent of polarised light.

26
Q

X-ray of gout?

A

Maintained joint space (no loss of joint space)
Lytic lesions in the bone
Punched out erosions
Erosions can have sclerotic borders with overhanding edges

27
Q

Tx of gout?

A

Acute flares
1st line - NSAIDs (naproxen)
note: prescribe with PPI for gastroprotection
2nd line - Colchicine - short course

Prophylaxis/long term - started weeks after acute attack resolved
Allopurinol (xanthine oxidase inhibitor which decreases uric acid levels)

28
Q

Side effects of colchicine?

A

Abdominal symptoms and diarrhoea

29
Q

Sx of pseudogout?

A

Rapid onset, hot, swollen, stiff and painful joint

30
Q

Commonly affected joints in pseudogout?

A

Shoulders, hips and wrists

31
Q

Ix for pseudogout?

A

Joint aspiration - calcium pyrophosphate crystals, rhomboid-shaped and positively birefringent of polarised light.

32
Q

X-ray findings in pseudogout?

A

Chondrocalcinosis - calcium deposits in the joint cartilage - thin white line in the middle of the joint space.

33
Q

Tx of pseudogout?

A

1st line - NSAIDS (i.e. naproxen) + PPI
2nd line - Colchicine
Intra-articular steroid injections
Oral steroids

34
Q

Which cancers metastasise to the bone?

A

PoRTaBLe mnemonic:

Po – Prostate
R – Renal
Ta – Thyroid
B – Breast
Le – Lung

35
Q

What is reactive arthritis?

A

Synovitis in one or more joints in response to an infective trigger.

36
Q

What gene is reactive arthritis linked to?

A

HLA B27 gene

37
Q

Triggers of reactive arthritis?

A

Gastroenteritis/ GI infections
STIs
** Chlamydia Trachomatis

38
Q

Main Ddx for reactive arthritis?

A

Septic arthritis

39
Q

Which bacteria is most likely to cause reactive arthritis and septic arthritis?

A

Chlamydia - reactive arthritis
Gonorrhoea - septic arthritis

40
Q

Sx of reactive arthritis?

A

Can’t pee, can’t see, can’t climb the tree

Reiter’s syndrome:
Bilateral conjunctivitis + anterior uveitis
Urethritis
Arthritis

Painful, swollen, warm, red stiff joints

41
Q

Ix for reactive arthritis?

A

Give abx until septic arthritis excluded

NSAIDs
Steroid injection into the affected joints

If recurrent/not resolved within 6 mths:
DMARDs or anti-TNF medications

Phase 3a - GP (15 decks)

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