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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
Antiphospholipid syndrome - Treatment
Lifestyle Warfarin (anticoag) Aspirin (antiplatelet)
26
Sjogren's syndrome - Pathophysiology
Chronic inflammatory autoimmune disease | Primary fibrosis of exocrine glands
27
Sjogren's syndrome - Symptoms
Dry eyes and mouth Parotid swelling (enlarged salivary glands) Dry cough
28
Sjogren's syndrome - Investigation
Schirmer's test (measures conjunctival dryness)
29
Sjogren's syndrome - Treatment
Artificial tears and saliva | NSAIDs (arthralgia)
30
Systemic sclerosis/CREST syndrome - Pathophysiology
Autoimmune disorder
31
Systemic sclerosis/CREST syndrome - Symptoms
All skin fibrosed Organ fibrosis (lungs, cardio, renal) Raynaud's (Digital ischaemia - spasm of blood vessels in response to cold/stress,)
32
Systemic sclerosis/CREST syndrome - Treatment
No cure | Treat organs involved
33
Raynaud's - Pathophysiology
Digital ischaemia due to paroxysmal vasospasm | White>blue>red (Ischaemia, deoxygenation, reactive hyperaemia)
34
Raynaud's - Treatment
Stop smoking Keep warm Propanolol
35
Polymyositis - Pathophysiology
Symmetrical proximal muscle weakness (stairs, chairs, hair analogy) due to striated muscle inflammation
36
Polymyositis - Symptoms
Myalgia | Arthralgia
37
Polymyositis - Investigation
Muscle enzymes - Raised CK, ALT, AST Muscle biopsy Malignancy screen
38
Polymyositis - Treatment
Prednisolone
39
Dermatomyositis - Pathophysiology
Polymyositis + skin affected
40
Dermatomyositis - Symptoms
Macular rash (Purple eyelid rash)
41
Dermatomyositis - Treatment
Prednisolone
42
Ankylosing spondylitis - Pathophysiology
Chronic inflammatory disease of spine and sacro-iliac joints | Ankylosis occurs which prevents flexion and rotation due to fusion during erosive repair phase
43
Ankylosing spondylitis - Cause
Enthesitis (Inflamed entheses - sites where tendons/ligaments insert to bone)
44
Ankylosing spondylitis - Symptoms
``` Back inflammation Back/buttock pain M>F Age 16-30 Morning waking due to pain Hips and knees flexed Question mark posture ```
45
Ankylosing spondylitis - End stage Sign
Bamboo spine
46
Ankylosing spondyitis - Investigation
XR MRI Bloods - Raised CRP/ESR
47
Ankylosing spondylitis - Treatment
Exercise/physio NSAIDs Anti-TNF alpha (Etanercept) No response to DMARDs!
48
Psoriatic arthritis - Joints affected
Skin - psoriatic plaques Spine - asymmetrical sacroiliac joint Nails - hyperkeratosis
49
Psoriatic arthritis - Investigations
Bloods - Anaemia, raised ESR | XR - erosive changes
50
Psoriatic arthritis - Treatment
NSAIDs DMARDs - Methotrexate, sulfasalazine, ciclosporin Exercise
51
Reactive arthritis - Pathophysiology
Sterile inflammation of synovial membranes, tendons, fascia
52
Reactive arthritis - Causes
Distal infection (GI/STI) - Shigella, chlamydia, gonorrhoea, salmonella, campylobacter
53
Reactive arthritis - Symptoms (triad of reiter's)
Can't see (conjunctivitis) Can't pee (urethritis) Can't climb a tree (arthritis)
54
Reactive arthritis - Investigations
Bloods - Raised ESR/CRP Stool culture (diarrhoea) STI screen XR (enthesitis, sacroiliitis)
55
Reactive arthritis - Treatment
Antibiotics (infection) NSAIDs Steroid joint injections (methotrexate)
56
Vasculitis - Pathophysiology
Inflammatory disorder of blood vessel walls, which can affect any organ by causing destruction (aneurysm/rupture) or stenosis of a vessel
57
Giant cell arteritis (GCA) - Pathophysiology
Inflamed temporal artery
58
Giant cell arteritis (GCA) - Symptoms
``` Headache Scalp tenderness (on combing hair) Acute visual changes Jaw claudication (pain when chewing) ```
59
Giant cell arteritis (GCA) - Investigation
Temporal artery biopsy | Bloods - ESR raised
60
Giant cell arteritis (GCA) - Treatment
Prednisolone (steroid) Refer to ophthalmologist IV methylpred (vision)
61
Polymyalgia rheumatica - Pathophysiology
Auto-inflammatory process affecting muscles and joints
62
Polymyalgia rheumatica - Symptoms
Symmetrical aching and tenderness | Morning stiffness in shoulders and proximal limb muscles
63
Polymyalgia rheumatica - Investigations
Bloods - Raised CRP/ESR
64
Polymyalgia rheumatica - Treatment
Prednisolone (steroids)
65
Granulomatosis with polyangiitis - Pathophysiology
Arterioles and capillaries affected
66
Granulomatosis with polyangiitis - Symptoms
Upper respiratory tract (Sinusitis, nasal crusting) Pulmonary nodules (lungs) Glomerulonephritis (Kidney)
67
Granulomatosis with polyangiitis - Investigations
Bloods - Raised ESR | CXR - Nodules
68
Granulomatosis with polyangiitis - Treatment
Prednisolone (steroid) | Biologics
69
Gout - Pathophysiology
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
Gout - Causes
``` High intake, low excretion High purine diet (alcohol, red meat, sea food, fructose) Genetics Drugs (diuretics) Renal disease ```
71
Gout - Symptoms
Severe inflammation Severe pain Recurrent
72
Gout - Investigations
Raised serum urate | Polarised light microscopy - needle shaped crystals
73
Gout - Treatment
``` NSAIDs Lifestyle - diet, weight, alcohol Dairy, cherries, vitC is protective! Allopurinol (xanthine oxidase inhibitor) - preventitive Switch diuretics to losartan ```
74
Pseudogout - Pathophysiology
Calcium pyrophosphate crystals
75
Pseudogout - Risk factors
Age (as oppose to gout) Hyperparathyroidism Haemochromatosis Diabetes
76
Pseudogout - Symptoms
Acute hot joint | Large joints affected such as knee
77
Pseudogout - Investigation
Aspirate to rule out septic arthritis Polarised light microscopy - rhomboid-shaped crystals as oppose to gout XR - Chondrocalcinosis
78
Pseudogout - Treatment
Ice pack Intra-articular steroids NSAIDs Methotrexate/sulfasalazine
79
Fibromyalgia - Pathophysiology
Non-specific muscular disorder with unknown cause | Pain occurs without inflammation
80
Fibromyalgia - Risk factors
F>M Middle age Psychosocial factors - low household income, divorced
81
Fibromyalgia - Symptoms
``` Pain exacerbated with stress, cold weather Morning stiffness lasting <1hr Headache Abdo pain Fatigue Poor sleep ```
82
Fibromyalgia - Investigation
Presence of pain in >11/18 palpation sites in body
83
Fibromyalgia - Treatment
``` Exercise CBT (Cognitive behavioural therapy) Analgesia Acupuncture Amitriptyline (sleep and anti-depressant) ```
84
Lumbago/mechanical lower back pain - Pathophysiology
Damage to muscle/soft tissue causing spasm which leads to pain and this spasm-pain cycle conitnues
85
Lumbago/mechanical lower back pain - Symptoms
Lower back pain and stiffness | Worse on movement
86
Lumbago/mechanical lower back pain - Risk factors
``` Manual labour work Smoking Low socioeconomic status F>M (pregnancy) Age ```
87
Lumbago/mechanical lower back pain - Yellow and red flags
Yellow - psychological disorders | Red - Trauma, TB, steroid use, cancer history
88
Lumbago/mechanical lower back pain - Investigations
Bloods - Raised ESR/CRP (tumour, infection, myeloma) | XR (only if red flags)
89
Lumbago/mechanical lower back pain - Treatment
``` Don't rest, continue normal activities Heat pads Swimming Analgesic ladder (Diazepam) Physio/acupuncture CBT ```
90
Septic arthritis - Causes
Staph aureus N. gonorrhoeae (young, sexually active) Staph epidermidis (prosthesis) E. coli (immunocompromised)
91
Septic arthritis - Risk factors
``` Immunosuppression Pre-existing joint disease Recent joint surgery/prosthetic joints Skin breaks/ulcers (diabetics) Elderly ```
92
Septic arthritis - Symptoms
Knee site affected commonly | Acute pain, red, hot, swollen, fever (septic until proven otherwise)
93
Septic arthritis - Treatment
Urgent aspiration (joint washout) for MCS IV antibiotics for 2 weeks then oral antibiotics Analgesia Stop immunosuppressive drugs
94
Osteomyelitis - Pathophysiology
Bone infection due to haematogenous origin (boils), direct inoculation into bone, spread of infection from adjacent tissues to bone
95
Osteomyelitis - Causes
Staph aureus Salmonella E.coli Strep
96
Osteomyelitis - Symptoms
Fever | Localised bone pain worse on movement
97
Osteomyelitis - Investigations
Bloods - WCC, CRP/ESR Bone biopsy XR MRI (more sensitive)
98
Osteomyelitis - Treatment
Surgical drainage of abscess or dead bone | IV antibiotics
99
Osteomyelitis - Complication
Without treatment, bone death occurs
100
Bone tumours - Risk factors
Primary - Radiation (XR, CT) | Secondary - 5Bs (Breast, brostate, bidney, bronchus (lung), byroid)
101
Bone tumours - Types
Osteosarcoma - knees, humerus Ewing sarcoma - hips, long bones Chondrosarcoma - pelvis
102
Bone tumours - Symptoms
``` Nocturnal bone pain Local red, swelling Fatigue Weight loss Anaemia Fractures ```
103
Bone tumours - Investigations
XR MRI Biopsy
104
Bone tumours - Treatment
Chemo Radio Surgery Bisphosphonates
105
Bone tumours - Myeloma - Pathophysiology
Malignancy of plasma cells leads to increased osteoclast activity
106
Bone tumours - Myeloma - Symptoms (CRAB)
``` Hypercalcaemia Renal failure Anaemia Bone lytic lesion (pepper-pot skull) Bone marrow infiltration - Fatigue, infection, bruising/bleeding ```
107
Bone tumours - Myeloma - Investigations
Serum/urine electrophoresis Bone marrow aspirate Bone profile
108
Bone tumours - Myeloma - Treatment
``` 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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