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CMS > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

what does osteoarthritis cause? what is it an association of?

A

hands and weight bearing joints - hip,knees,ankles

associated with genetics, obesity, previously damaged joints/bones

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2
Q

pathophysiology of osteoarthritis?

A

whole joint involved
cartilage damaged - disruption of regeneration and loss
bone beneath is exposed and erosion of bony surface
progressive inflammatory destruction

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3
Q

etiology of osteoarthritis?

A

risk increases with age
50% of over 60’s xray evidence - only 25% symptomatic
2 x more likely in women

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4
Q

symptoms of osteoarthritis?

A

pain - worse on movement relieved by rest
immobility - worse in mornings
swelling and deformities

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5
Q

how is osteoarthritis diagnosed?

A

by clinical exam
bouchards nodes medial, heberdens distal
effusion = swelling b/c of inflammation

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6
Q

radiology and osteoarthritis? MRI? arthroscopy?

A

radiology useful in advanced conditions does not diagnose
MRI - early cartilage injury/bone changes
arthroscopy visualises joint, aspirates synovial fluid

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7
Q

management of osteoarthritis?

A

lose weight, physio, analgesia
steroid injections - temp relief
joint replaced

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8
Q

dental relevance of osteoarthritis?

A

reduced dexterity, reduced mobility, medications

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9
Q

what is rheumatoid arthritis?

A

an autoimmune disease of unknown aetiology
joint destruction due to synovial inflammation
multi system disease

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10
Q

etiology of rheumatoid?

A

1-3% of population
3x more in women
onset between 30-50

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11
Q

initially where does rheumatoid begin?
acute rheumatoid?
established rheumatoid?

A

initially hands and feet, spreads to cervical spine, knees, ankles, elbows, shoulders
hot, swollen, tender joints worse in morning
deformity, restriction, sub laxation

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12
Q

clinical signs of rheumatoid?

A 
ulnar deviation
rheumatoid nodule
z thumb
boutinniere deformity
swan neck deficiency
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13
Q

what other body systems can rheumatoid affect?

A

NS - peripheral neuropathy, cervical cord compression = paralysis
lungs - pulmonary fibrosis
heart failure
kidney disease
eyes inflamed
sjogrens
systemic inflammation - malaise and anemia

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14
Q

how is rheumatoid diagnosed?

A

clinical exam and blood tests

radiology for destructive arthritis

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15
Q

management of rheumatoid?

A

analgesic - NSAIDs
disease modifying anti rheumatic drugs e.g sulphasalazine, penicillamine, methotrexate, hydrochloroquinone, gold, azathioprine
corticosteroids - orally/local injection

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16
Q

non pharmacological management of rheumatoid?

A

surgery - joint replacement, physio - optimise joint function, occ therapy - optimise functional abilities

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17
Q

dental relevance of rheumatoid?

A

TMJ disease, sjogrens, hands - used to diagnose
already diagnosed - reduced dexterity, manage sjogrens, caution if cervical spine diseased, drug side effetcs esp DMARD’s

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18
Q

what is systemic sclerosis?

A

autoimmune disease. Skin thickens and binds to underlying structures. Multi organ disease

19
Q

etiology of systemic sclerosis?

A

rare
3-5x more common in women
presents in middle age

20
Q

clinical signs of systemic sclerosis?

A 
telangiectasia - ruptured capillaries
sclerodactyly - sclerosis of fingers
calcinosis - bony hard deposits
beaked nose
fixed expressions
radial furrowing of lips
limitation of mouth movements
21
Q

how to diagnose systemic sclerosis?
management of?
dental relevance?

A

clinically/ blood tests for spec. autimmune abs
manage symptoms
oral involvement and loss of dexterity

22
Q

what is systemic lupus erythematous?

what is discoid lupus?

A

autoimmune, multi system, uknow aetiology
abs against nuclear cell components
widespread vascular immune complex deposition

confined to head/neck region

23
Q

etiology of SLE?

A

0.1% population. young women 20-40

more common if origin african

24
Q

areas affected?

A

skin - 75% photosensitivity, butterfly rash
joints - 90% - small joint arthritis
raynauds - 20%
N.S - 60% - fits, paralysis, neuropathy, psychosis
heart - valvular disease, aseptic endocarditis 25%
lungs - 50% effusions
kidney failure - 30%

25
Q

how to diagnose SLE?
how to treat?
dental relevance?

A

clinically - blood tests for spec. autoimmune abs
same meds as rheumatoid arthritis
drug side effects, reduced dexterity

26
Q

what is gout?

A

accumulation of urate crystals in joints
more common in older men
precipitated by excess alcohol, starvation, certain foods, operations, drugs

27
Q

acute gout?

chronic gout?

A

acute - painful joints

chronic - tophi deposition

28
Q

what is psoriatic arthritis?

A

destructive arthritis associated with psoriasis

29
Q

what is hyperparathyroidism?

A

excess parathyroid hormone
usually an adenoma in gland
0.1% of population

30
Q

symptoms of hyperparathyroidism?

A

hypercalcaemia - malaise/depression, kidney stones, constipation, abdominal pains
bone pain

31
Q

how to diagnose hyperparathyroidism?

how to treat?

A

blood tests, xrays show sub periostal erosions

parathyroidectomy/ drugs to treat

32
Q

effects of bone resorption dentally?

A

giant cell lesions, loss of lamina dura around roots

33
Q

what is pagets disease?

A

abnormal bone remodelling - abundant new bone formation, structually abnormal, prone to fracture
age related
10% by 90

34
Q

symptoms of pagets?

A

most pt’s totally asymptomatic
bone deformities - enlarged skulls, nerve compression leading to deafness, spinal cord compression
fractures

35
Q

how to diagnose pagets?

A

clinically

xrays are characteristic

36
Q

what is osetocalcaemia?

A

a vitamin d deficiency - lack of sunlight, poor intake, malabsorption of intestine = fat sol.vitamins
asian origin/ frail elderly

37
Q

symptoms of osteocalcaemia?

A

diffuse bony pains, proximal muscle weakness

38
Q

diagnosis of osteocalcaemia?
treatment?
dental relevance?

A

history taken, xrays, blood tests
increase uptake of vit d
affects tooth development in children

39
Q

what is osteoporosis?

A

loss of bone and increased fracture risk
15% women aged 50, 70% of women aged 80
less common in men

40
Q

where can fractures happen?

A

vertebral - pain, loss of height, kyphosis
hip - disabling, high mortality/morbidity 20% of 80 year old women
wrists - less disabling, marker of underlying osteoporosis

41
Q

risk factors of osteoporosis?

A

alcohol, smoking, female, white, lack of exercise, steroids, thin, short menstrual history, malabsorption, hyperthyroidism, hypogonadism

42
Q

management of osteoporosis?

A

diagnosis by DEXA screening
treated by pharmacological
calcium and vitamin D

43
Q

side effects of bisphosphonates?

A

osteonecrosis of the jaw

poor oh

CMS (42 decks)

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