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Phase 2A Med Concise > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Which is the most common type of arthritis?

A

Osteoarthritis

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2
Q

Osteoarthritis - Pathophysiology

A

Non-inflammatory, wear and tear resulting from loss of articular cartilage
Imbalance of cartilage damage and repair process
Exposed bone prone to microfractures and cysts

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3
Q

Osteoarthritis - Risk factors

A 
Elderly
F>M
Obesity
Occupation 
RA
Gout
*Osteoporosis reduces risk of OA*
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4
Q

Osteoarthritis - Symptoms

A 
Weight-bearing joints - Knee, hip
Pain on movement
Worse at end of day
Minimal swelling
Crepitus (cracking/popping sounds)
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5
Q

Osteoarthritis - Investigations

A

XR (LOSS - Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts)
Bloods - normal

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6
Q

Osteoarthritis - Treatment

A 
Exercise/physio
Hot/cold packs
Analgesic ladder 
Intra-articular steroids
Surgery - Remove osteophytes, joint replacement/fusion (if severe)
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7
Q

Rheumatoid arthritis - Pathophysiology

A

Chronic systemic inflammatory disease due to deposition of immune complexes in synovial joints which causes symmetrical, deforming polyarthritis

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8
Q

Rheumatoid arthritis - Risk factors

A 
Age
F>M
Smoking
Stress
Infection
Autoimmune conditions
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9
Q

Rheumatoid arthritis - Symptoms

A

Symmetrical swollen, painful and stiff joints
Hands and feet
Worse in morning
Worse in hot weather
Extra-articular manifestations - Weight loss, increased CV event risk

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10
Q

Rheumatoid arthritis - Signs

A

Swollen MCP, MTP joints
Boutonniere/swan-neck deformity
Muscle wasting
Carpal tunnel syndrome

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11
Q

Rheumatoid arthritis - Investigations

A

Rheumatoid factor (Not-specific)
Anti-CCP (Specific)
FBC - Raised platelets, CRP, ESR
XR - LESS (Loss of joint space, Erosions, Soft tissue swelling, Soft bones (osteopenia)

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12
Q

Rheumatoid arthritis - Treatment

A 
NSAIDs
Refer to rheumatologist 
DMARDs (Methotrexate)
Biologics (Etanercept)
Exercise
MDT approach
Steroids (acute exacerbations)
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13
Q

Differences between OA and RA

A

OA - Degenerative, pain increases with use, <30mins morning stiffness, bony swelling, no inflammation, older people, knees/hips
RA - Inflammatory, pain eases with use/worst at rest, 1hr> morning stiffness, swelling due to joint effusions, hot and red joints (inflamed), younger people, hands/feet, respond to NSAIDs

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14
Q

Osteoporosis - Pathophysiology

A

Low bone mass due to increased resorption and decreased formation, leading to increased bone fragility and fracture risk

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15
Q

Osteoporosis - Classification

A

Primary - Menopause, age
Secondary - Disease, steroid use, alcohol, smoking, hyperthyroid/parathyroid, renal/liver failure, family history, low dietary calcium (lactose intolerance)

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16
Q

Osteoporosis - Symptoms

A

Asymptomatic until fracture (Hip, wrist, vertebra)

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17
Q

Osteoporosis - Investigations

A

FRAX (Fracture risk assessment tool - Age, sex, BMI, previous fracture, steroids)

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18
Q

Osteoporosis - Treatment

A

Bisphosphonate (Alendronate, risedronate)
Strontium ranelate
Prevention - Adcal D3 (VitD, calcium), calcium-rich diet, exercise, stop smoking and alcohol

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19
Q

Systemic lupus erythematosus (SLE) - Pathophysiology

A

1) Multisystemic autoimmune inflammatory disease in which autoantibodies are produced by B cells
2) Autoantibodies target variety of autoantigens
3) Formation of immune complexes at various sites
4) This activates complement system and influx of neutrophils causing inflammation in those tissues

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20
Q

Systemic lupus erythematosus (SLE) - Risk factors

A 
F>M
Age 20-40
Afro-carrib
Hereditary
UV light (sunlight)
Drugs
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21
Q

Systemic lupus erythematosus (SLE) - Symptoms

A 
Remitting and relapsing
Fatigue
Myalgia/arthalgia 
Skin problems
Fever
Lymphadenopathy
Weight loss
MD SOAP BRAIN - Malar rash, Discoid rash, Serositis (pleuritis, pericarditis), Oral ulcer, Arthritis, Photosensitivity, Bloods (All low - anaemia, leukopenia), Renal disorder (proteinuria), Neurological (seizures)
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22
Q

Systemic lupus erythematosus (SLE) - Investigations

A

ANA screening (sensitive)
Anti-dsDNA (specific)
Raised ESR/CRP (Inflammation markers)

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23
Q

Systemic lupus erythematosus (SLE) - Treatment

A

Lifestyle
Analgesia/NSAIDs
Prednisolone
Biologics (Rituximab)

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24
Q

Antiphospholipid syndrome - Complications

A

Increased risk of clots - coagulation defects (DVTs, strokes)
Recurrent miscarriages
Thrombocytopenia (Reduced platelet levels)

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25
Q

Antiphospholipid syndrome - Treatment

A

Lifestyle
Warfarin (anticoag)
Aspirin (antiplatelet)

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26
Q

Sjogren’s syndrome - Pathophysiology

A

Chronic inflammatory autoimmune disease

Primary fibrosis of exocrine glands

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27
Q

Sjogren’s syndrome - Symptoms

A

Dry eyes and mouth
Parotid swelling (enlarged salivary glands)
Dry cough

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28
Q

Sjogren’s syndrome - Investigation

A

Schirmer’s test (measures conjunctival dryness)

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29
Q

Sjogren’s syndrome - Treatment

A

Artificial tears and saliva

NSAIDs (arthralgia)

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30
Q

Systemic sclerosis/CREST syndrome - Pathophysiology

A

Autoimmune disorder

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31
Q

Systemic sclerosis/CREST syndrome - Symptoms

A

All skin fibrosed
Organ fibrosis (lungs, cardio, renal)
Raynaud’s (Digital ischaemia - spasm of blood vessels in response to cold/stress,)

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32
Q

Systemic sclerosis/CREST syndrome - Treatment

A

No cure

Treat organs involved

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33
Q

Raynaud’s - Pathophysiology

A

Digital ischaemia due to paroxysmal vasospasm

White>blue>red (Ischaemia, deoxygenation, reactive hyperaemia)

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34
Q

Raynaud’s - Treatment

A

Stop smoking
Keep warm
Propanolol

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35
Q

Polymyositis - Pathophysiology

A

Symmetrical proximal muscle weakness (stairs, chairs, hair analogy) due to striated muscle inflammation

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36
Q

Polymyositis - Symptoms

A

Myalgia

Arthralgia

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37
Q

Polymyositis - Investigation

A

Muscle enzymes - Raised CK, ALT, AST
Muscle biopsy
Malignancy screen

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38
Q

Polymyositis - Treatment

A

Prednisolone

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39
Q

Dermatomyositis - Pathophysiology

A

Polymyositis + skin affected

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40
Q

Dermatomyositis - Symptoms

A

Macular rash (Purple eyelid rash)

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41
Q

Dermatomyositis - Treatment

A

Prednisolone

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42
Q

Ankylosing spondylitis - Pathophysiology

A

Chronic inflammatory disease of spine and sacro-iliac joints

Ankylosis occurs which prevents flexion and rotation due to fusion during erosive repair phase

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43
Q

Ankylosing spondylitis - Cause

A

Enthesitis (Inflamed entheses - sites where tendons/ligaments insert to bone)

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44
Q

Ankylosing spondylitis - Symptoms

A 
Back inflammation 
Back/buttock pain
M>F
Age 16-30
Morning waking due to pain
Hips and knees flexed
Question mark posture
45
Q

Ankylosing spondylitis - End stage Sign

A

Bamboo spine

46
Q

Ankylosing spondyitis - Investigation

A

XR
MRI
Bloods - Raised CRP/ESR

47
Q

Ankylosing spondylitis - Treatment

A

Exercise/physio
NSAIDs
Anti-TNF alpha (Etanercept)
No response to DMARDs!

48
Q

Psoriatic arthritis - Joints affected

A

Skin - psoriatic plaques
Spine - asymmetrical sacroiliac joint
Nails - hyperkeratosis

49
Q

Psoriatic arthritis - Investigations

A

Bloods - Anaemia, raised ESR

XR - erosive changes

50
Q

Psoriatic arthritis - Treatment

A

NSAIDs
DMARDs - Methotrexate, sulfasalazine, ciclosporin
Exercise

51
Q

Reactive arthritis - Pathophysiology

A

Sterile inflammation of synovial membranes, tendons, fascia

52
Q

Reactive arthritis - Causes

A

Distal infection (GI/STI) - Shigella, chlamydia, gonorrhoea, salmonella, campylobacter

53
Q

Reactive arthritis - Symptoms (triad of reiter’s)

A

Can’t see (conjunctivitis)
Can’t pee (urethritis)
Can’t climb a tree (arthritis)

54
Q

Reactive arthritis - Investigations

A

Bloods - Raised ESR/CRP
Stool culture (diarrhoea)
STI screen
XR (enthesitis, sacroiliitis)

55
Q

Reactive arthritis - Treatment

A

Antibiotics (infection)
NSAIDs
Steroid joint injections (methotrexate)

56
Q

Vasculitis - Pathophysiology

A

Inflammatory disorder of blood vessel walls, which can affect any organ by causing destruction (aneurysm/rupture) or stenosis of a vessel

57
Q

Giant cell arteritis (GCA) - Pathophysiology

A

Inflamed temporal artery

58
Q

Giant cell arteritis (GCA) - Symptoms

A 
Headache
Scalp tenderness (on combing hair)
Acute visual changes
Jaw claudication (pain when chewing)
59
Q

Giant cell arteritis (GCA) - Investigation

A

Temporal artery biopsy

Bloods - ESR raised

60
Q

Giant cell arteritis (GCA) - Treatment

A

Prednisolone (steroid)
Refer to ophthalmologist
IV methylpred (vision)

61
Q

Polymyalgia rheumatica - Pathophysiology

A

Auto-inflammatory process affecting muscles and joints

62
Q

Polymyalgia rheumatica - Symptoms

A

Symmetrical aching and tenderness

Morning stiffness in shoulders and proximal limb muscles

63
Q

Polymyalgia rheumatica - Investigations

A

Bloods - Raised CRP/ESR

64
Q

Polymyalgia rheumatica - Treatment

A

Prednisolone (steroids)

65
Q

Granulomatosis with polyangiitis - Pathophysiology

A

Arterioles and capillaries affected

66
Q

Granulomatosis with polyangiitis - Symptoms

A

Upper respiratory tract (Sinusitis, nasal crusting)
Pulmonary nodules (lungs)
Glomerulonephritis (Kidney)

67
Q

Granulomatosis with polyangiitis - Investigations

A

Bloods - Raised ESR

CXR - Nodules

68
Q

Granulomatosis with polyangiitis - Treatment

A

Prednisolone (steroid)

Biologics

69
Q

Gout - Pathophysiology

A

1) Purines from diet converted to uric acid which is excreted by kidneys
2) Excessive uric acid transferred to tissues where it forms crystals

70
Q

Gout - Causes

A 
High intake, low excretion
High purine diet (alcohol, red meat, sea food, fructose)
Genetics
Drugs (diuretics)
Renal disease
71
Q

Gout - Symptoms

A

Severe inflammation
Severe pain
Recurrent

72
Q

Gout - Investigations

A

Raised serum urate

Polarised light microscopy - needle shaped crystals

73
Q

Gout - Treatment

A 
NSAIDs
Lifestyle - diet, weight, alcohol
Dairy, cherries, vitC is protective!
Allopurinol (xanthine oxidase inhibitor) - preventitive 
Switch diuretics to losartan
74
Q

Pseudogout - Pathophysiology

A

Calcium pyrophosphate crystals

75
Q

Pseudogout - Risk factors

A

Age (as oppose to gout)
Hyperparathyroidism
Haemochromatosis
Diabetes

76
Q

Pseudogout - Symptoms

A

Acute hot joint

Large joints affected such as knee

77
Q

Pseudogout - Investigation

A

Aspirate to rule out septic arthritis
Polarised light microscopy - rhomboid-shaped crystals as oppose to gout
XR - Chondrocalcinosis

78
Q

Pseudogout - Treatment

A

Ice pack
Intra-articular steroids
NSAIDs
Methotrexate/sulfasalazine

79
Q

Fibromyalgia - Pathophysiology

A

Non-specific muscular disorder with unknown cause

Pain occurs without inflammation

80
Q

Fibromyalgia - Risk factors

A

F>M
Middle age
Psychosocial factors - low household income, divorced

81
Q

Fibromyalgia - Symptoms

A 
Pain exacerbated with stress, cold weather
Morning stiffness lasting <1hr
Headache
Abdo pain
Fatigue
Poor sleep
82
Q

Fibromyalgia - Investigation

A

Presence of pain in >11/18 palpation sites in body

83
Q

Fibromyalgia - Treatment

A 
Exercise
CBT (Cognitive behavioural therapy)
Analgesia
Acupuncture
Amitriptyline (sleep and anti-depressant)
84
Q

Lumbago/mechanical lower back pain - Pathophysiology

A

Damage to muscle/soft tissue causing spasm which leads to pain and this spasm-pain cycle conitnues

85
Q

Lumbago/mechanical lower back pain - Symptoms

A

Lower back pain and stiffness

Worse on movement

86
Q

Lumbago/mechanical lower back pain - Risk factors

A 
Manual labour work
Smoking
Low socioeconomic status
F>M (pregnancy)
Age
87
Q

Lumbago/mechanical lower back pain - Yellow and red flags

A

Yellow - psychological disorders

Red - Trauma, TB, steroid use, cancer history

88
Q

Lumbago/mechanical lower back pain - Investigations

A

Bloods - Raised ESR/CRP (tumour, infection, myeloma)

XR (only if red flags)

89
Q

Lumbago/mechanical lower back pain - Treatment

A 
Don't rest, continue normal activities 
Heat pads
Swimming
Analgesic ladder (Diazepam)
Physio/acupuncture
CBT
90
Q

Septic arthritis - Causes

A

Staph aureus
N. gonorrhoeae (young, sexually active)
Staph epidermidis (prosthesis)
E. coli (immunocompromised)

91
Q

Septic arthritis - Risk factors

A 
Immunosuppression
Pre-existing joint disease
Recent joint surgery/prosthetic joints
Skin breaks/ulcers (diabetics)
Elderly
92
Q

Septic arthritis - Symptoms

A

Knee site affected commonly

Acute pain, red, hot, swollen, fever (septic until proven otherwise)

93
Q

Septic arthritis - Treatment

A

Urgent aspiration (joint washout) for MCS
IV antibiotics for 2 weeks then oral antibiotics
Analgesia
Stop immunosuppressive drugs

94
Q

Osteomyelitis - Pathophysiology

A

Bone infection due to haematogenous origin (boils), direct inoculation into bone, spread of infection from adjacent tissues to bone

95
Q

Osteomyelitis - Causes

A

Staph aureus
Salmonella
E.coli
Strep

96
Q

Osteomyelitis - Symptoms

A

Fever

Localised bone pain worse on movement

97
Q

Osteomyelitis - Investigations

A

Bloods - WCC, CRP/ESR
Bone biopsy
XR
MRI (more sensitive)

98
Q

Osteomyelitis - Treatment

A

Surgical drainage of abscess or dead bone

IV antibiotics

99
Q

Osteomyelitis - Complication

A

Without treatment, bone death occurs

100
Q

Bone tumours - Risk factors

A

Primary - Radiation (XR, CT)

Secondary - 5Bs (Breast, brostate, bidney, bronchus (lung), byroid)

101
Q

Bone tumours - Types

A

Osteosarcoma - knees, humerus
Ewing sarcoma - hips, long bones
Chondrosarcoma - pelvis

102
Q

Bone tumours - Symptoms

A 
Nocturnal bone pain
Local red, swelling
Fatigue
Weight loss
Anaemia
Fractures
103
Q

Bone tumours - Investigations

A

XR
MRI
Biopsy

104
Q

Bone tumours - Treatment

A

Chemo
Radio
Surgery
Bisphosphonates

105
Q

Bone tumours - Myeloma - Pathophysiology

A

Malignancy of plasma cells leads to increased osteoclast activity

106
Q

Bone tumours - Myeloma - Symptoms (CRAB)

A 
Hypercalcaemia
Renal failure
Anaemia
Bone lytic lesion (pepper-pot skull)
Bone marrow infiltration - Fatigue, infection, bruising/bleeding
107
Q

Bone tumours - Myeloma - Investigations

A

Serum/urine electrophoresis
Bone marrow aspirate
Bone profile

108
Q

Bone tumours - Myeloma - Treatment

A 
Analgesia (avoid NSAIDs due to renal failure)
Bisphosphonates
Stem cell transplant
Chemo
Transfusion for anaemia

Phase 2A Med Concise (18 decks)

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