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CMS! > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

Define musculoskeletal disease

A

disorders of joints and bones that may or may not also affect other bodily systems

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2
Q

name the two categories of joint disease

A
  1. osteoarthritis

2. connective tissue diseases

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3
Q

name 3 types of connective tissue diseases

A
  • rheumatoid arthritis
  • systemic sclerosis
  • systemic lupus erythematosus (SLE)
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4
Q

name 4 types of bone disease

A
  • hyperparathyroidism
  • paget’s disease
  • osteomalacia
  • osteoporosis
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5
Q

general symptoms for joint disease is.. 6 things

A 
inflammation 
- hot 
- red 
- swollen 
- painful 
destruction 
- deformity 
- instability
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6
Q

list the 4 joints that are most likely to be affected by osteoarthritis

A
  • hands
  • hips
  • knees
  • ankles
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7
Q

3 things that predispose a person to osteoarthritis

A
  • genetics
  • obesity
  • previously damaged joints
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8
Q

which part of the joint does osteoarthritis affect (or all of it)?

A

whole joint affected

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9
Q

what are 3 pathophysiological changes that occur in osteoarthritis?

A
  • cartilage worn away
  • cartilage fragments in synovial fluid
  • bone spurs (overgrowth)
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10
Q

what is the full definition of osteoarthritis

A

progressive destruction of the cartilage due to inflammation which can go on to affect the whole joint

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11
Q

who is most at risk of having osteoarthritis?

A

women over 60

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12
Q

what % of patients have no symptoms of osteoarthritis?

A

50% (25% of the 50% of over 60s who have radiographic evidence)

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13
Q

what are 4 symptoms of osteoarthritis

A
  • pain that is worsened by movement and eased by rest
  • immobility which is worse in the morning
  • deformity
  • swelling
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14
Q

which nodes on the hands are closer to where a ring would sit?

A

heberden’s nodes

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15
Q

what are the nodes closest to your finger nails called?

A

bouchards nodes

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16
Q

what are 5 ways to manage osteoarthritis

A
  • lose weight
  • physiotherapy
  • analgesia
  • steroid injection (temporary relief)
  • joint replacement
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17
Q

what type of disease is rheumatoid arthritis

A

autoimmune disease with unknown aetiology

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18
Q

what does the immune system do to give rheumatiod arthritis?

A

makes antibodies against bodies own antibodies - commonly IgM

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19
Q

which part of the joint experiences the most inflammation in rheumatoid arthritis?

A

synovial inflammation leads to joint destruction

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20
Q

what 3 changes occur to a joint with rheumatoid arthritis?

A
  • inflammed synovium
  • generalised bone loss/erosion
  • cartilage loss
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21
Q

what % of the population is affected by rheumatoid arthritis

A

1-3%

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22
Q

rheumatoid arthritis - how many times more common is it in female?

A

3x

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23
Q

when is the usual onset of rheumatoid arthritis?

A

30 - 50 years old

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24
Q

what parts of the body are usually initially affected by RA?

A

hands and feet

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25
Q

what areas are then affected later on by RA?

A
  • cervical spine
  • knees
  • ankles
  • elbows
  • shoulders
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26
Q

what are 2 symptoms of established RA?

A

deformity (restriction)

sub-luxation

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27
Q

give the 5 signs of RA in the hands

A
  1. ulnar deviation
  2. rheumatoid nodule(s)
  3. Z thumb
  4. swan neck deformity
  5. boutonniere deformity
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28
Q

what are 7 systemic issues with RA?

A
  • kidney failure
  • nervous system issues
  • heart disease
  • lung issues
  • systemic inflammation
  • eye issues
  • sjogrens syndrome
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29
Q

what are the 2 nervous system complications with RA?

A
  • peripheral neuropathy

- cervical cord compression (paralysis)

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30
Q

what lung complications can occur with RA?

A

pulmonary fibrosis

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31
Q

what systemic inflammatory associated issues can occur with RA?

A
  • malaise

- anaemia

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32
Q

what can occur to the eyes in RA pt?

A

inflammation

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33
Q

what is sjogrens syndrome defined as?

A

an autoimmune chronic inflammatory condition where the WBCs attack the bodies moisture producing glands (eg salivary & lacrimal)

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34
Q

what 3 ways can RA be diagnosed?

A

Clinically

  • ulnar deviation
  • Z-thumb
  • rheumatoid nodules
  • swan neck deformity
  • boutonniere deformity

Blood tests

Radiology (destructive arthritis)

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35
Q

what is the management of RA?

A
  1. pharmacologically
  2. surgery
  3. physio (to optimise joint function)
  4. occupational therapy (optimise functional abilities)
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36
Q

name the 3 groups of drugs that will be given to a patient with RA?

A
  • analgesics
  • corticosteroids
  • disease modifying anti-rheumatic drugs
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37
Q

what 2 ways can corticosteroids be administered?

A
  1. systemically

2. local injection into joints

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38
Q

name 6 DMARDs

A
  1. sulphasalazine
  2. penicillamine
  3. methotrexate
  4. gold
  5. hydrochloroquine
  6. azathioprine
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39
Q

what surgery options are there for RA?

A

joint replacement

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40
Q

dental aspects of RA?

A
  • reduced dexterity
  • TMJ disease
  • Sjogrens syndrome
  • drug side effects
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41
Q

what are some orally relevant side effects of DMARDs?

A
  • oral ulceration
  • stomatitis
  • taste loss/disturbance
  • vomiting
42
Q

systemic sclerosis is also called?

A

scleroderma

43
Q

systemic sclerosis pathophysiology is…

A
  • autoimmune disease
  • multi organs
  • skin mainly effected (thickened and bound to underlying structures)
44
Q

how common is systemic sclerosis?

A

rare

45
Q

how many times more is a woman likely to be affected with systemic sclerosis?

A

3-5 x more

46
Q

when will systemic sclerosis present itself?

A

middle age

47
Q

what are 7 symptoms of systemic sclerosis?

A
  • sclerodactyly
  • telangiectasia
  • calcinosis
  • beaked nose
  • fixed expression
  • limited mouth movements
  • radial furrowing of lips
48
Q

what is sclerodactyly?

A
  • thickening/tightness of the skin in fingers and toes
49
Q

what is telangiestasia?

A

dilation of capillaries giving spider like appearance (small red or purple blisters

50
Q

2 ways that systemic sclerosis is diagnosed?

A
  • clinically

- blood tests

51
Q

what does SLE stand for?

A

systemic lupus erythematousus

52
Q

what is SLE?

A
  • an autoimmune multi system disease that has unknown aetiology.
  • widespread vascular immune complex deposition
53
Q

what are antibodies formed against in SLE?

A

cell nuclear components

54
Q

how common (in %) is SLE?

A

0.1%

55
Q

which 2 groups are at higher risk of SLE?

A
  1. african origin

2. women aged 20-40

56
Q

what are the 6 main areas affected by SLE?

A
  1. Joints
  2. Heart
  3. Skin
  4. Nervous system
  5. Lungs
  6. Kidneys (failure)
57
Q

what condition can be associated with SLE?

A

Raynauds in 20% of cases

58
Q

what kind of joint issue is associated with SLE?

A

small joint arthritis (90%)

59
Q

what kind of heart issues are associated with SLE?

A
  • valve disease

- endocarditis (aseptic)

60
Q

what kind of skin issues are associated with SLE?

A
  • photosensitivity

- butterfly rash

61
Q

what kind of nervous system issues are associated with SLE?

A
  • fits
  • neuropathy
  • psychosis
  • paralysis
62
Q

what kind of respiratory issue can be associated with SLE?

A
  • pleural effusions (fluid in pleural space)
63
Q

2 ways of diagnosing SLE?

A
  • clinical

- specific auto-antibodies

64
Q

what is the management of SLE?

A
  1. pharmacological (as RA)
    - analgesic
    - corticosteroids
    - DMARDs
  2. psychological/practical support
65
Q

what is gout?

A

a form of arthritis caused by the accumulation of urate (uric acid) crystals in joints

66
Q

which category of people are most likely to have gout?

A

older men

67
Q

what is the main symptom of gout in an acute attack?

A

extremely painful joints

68
Q

what can cause a gout attack?

A
  • starvation
  • alcohol excess
  • certain foods (high in uric acid)
69
Q

how is gout managed?

A
  • drugs

- surgery

70
Q

what is the chronic symptom of gout?

A

trophic deposition - usually painless but can get in the way

71
Q

what is psoriatic arthritis?

A

arthritis associated with psoriasis

72
Q

what is hyperparathyroidism?

A
  • excess parathyroid hormone
73
Q

what is usually the cause of hyperparathyroidism?

A

adenoma of the parathyroid glands

74
Q

what % of the population is affected with hyperparathyroidism?

A

0.1%

75
Q

what is the 2 main symptoms of hyperparathyroidism?

A

hypercalcaemia & bone pain

76
Q

what does hypercalcaemia cause?

A
  • malaise
  • depression
  • constipation
  • abdominal pain
  • kidney stones
77
Q

what is the common saying about hyperparathyroidism symptoms?

A

“bones, stones and abdominal groans”

78
Q

what is the management of hyperparathyroidism?

A

drugs

79
Q

what are the dental aspects of hyperparathyroidism?

A
  • giant cell lesions

- loss of lamina dura around roots on radiographs

80
Q

what is the pathophysiology of pagets disease?

A
  • abnormal bone remodelling

- abundant new bone formation

81
Q

what is the abundant new bone formation like in pagets disease?

A
  • structurally normal

- prone to fracture

82
Q

what is pagets disease closely related to?

A

age

83
Q

what are the possible symptoms of pagets disease?

A
  • bone deformities (skull enlargement/nerve compression)

- fractures

84
Q

what are the two possible outcomes of nerve compression?

A
  • deafness

- spinal cord compression (paralysis)

85
Q

define osteomalacia?

A

a vitamin D deficiency

86
Q

what are 3 causes of Vit D deficiency?

A
  1. lack of sunshine
  2. poor intake
  3. malabsorption in intestine (it is a fat soluble vitamin)
87
Q

what are the 2 at risk groups for osteomalacia?

A
  • asian origin

- frail elderly

88
Q

what are 2 symptoms of osteomalacia?

A
  • diffuse bony pains

- proximal muscle weakness

89
Q

what is the treatment fot osteomalacia?

A

vitamin D replacement

90
Q

what is the dental relevance of osteomalacia?

A

affects tooth development in children

91
Q

what is the definition of osteoporosis?

A

loss of bone mass with increased fracture risk

92
Q

what is the % of women affected by osteoporosis aged 50?

A

15%

93
Q

what is the % of women affected by osteoporosis aged 80?

A

70%

94
Q

where are the 3 most common places to get an osteoporotic fracture?

A
  • vertebral
  • hips
  • wrist/humerus neck
95
Q

what will be associated with vertebral fractures?

A
  • pain
  • loss of height
  • kyphosis
96
Q

what will be associated with hip fractures?

A
  • disability

- high mortality/morbidity

97
Q

what are 11 risk factors for osteoporosis?

A
  • female
  • white
  • smoking
  • alcohol
  • lack of exercise
  • steroids
  • thin
  • short menstrual history
  • malabsorption
  • hyperthyroidism
  • hypogonadism
98
Q

what are the 3 treatments of osteoporosis?

A
  • drugs
  • calcium and vit d
  • risk factor modification
99
Q

what can be a side effect of bisphosphonates?

A

osteonecrosis of the jaw

100
Q

what advice should be given to patients on bisphosphonates?

A
  • good OH to avoid extraction

- new recommended dental assessment pre prescription

CMS! (23 decks)

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