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YEAR 3: Conditions Knowledge > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Define amyloidosis

A

Heterogenous group of diseases characterised by extracellular deposition of amyloid fibrils

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2
Q

Recall the subtypes of amyloidosis

A

Type AA: serum Amyloid A protein
Type AL: monoclonal Ig Light chains
Type ATTR: genetic variant TransThyRetin

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3
Q

Which are the main 2 organs affected by amyloidosis?

A

Kidneys

Heart

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4
Q

What sort of cardiomyopathy do you get in amyloidosis?

A

Restrictive

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5
Q

Exactly define ankylosing spondylitis

A

Seronegative inflammatory arthropathy preferentially affecting the axial skeleton and large proximal joints

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6
Q

What is the HLA association of ankylosing spondylitis?

A

HLA-B27

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7
Q

What is the main symptom of ankylosing spondylitis?

A

Lower back and sacral pain that is worse in the morning and better with exercise

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8
Q

What is the Schober test and what is it used for?

A 
Mark at 5th lumbar spinous process
Mark at 10cm above this
Get patient to lean forwards
Gap --> 15cm
= test for ankylosing spondylitis
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9
Q

Recall the 5 As of extraarticular disease that may be seen alongside ankylosing spondylitis

A 
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
Amyloidosis
Achilles tendonitis
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10
Q

Recall two x ray findings in ankylosing spondylitis

A

Bamboo spine

Sacroiliac joint fusion

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11
Q

Define anti-phospholipid syndrome (mnemonic = APL)

A

Arterial and venous thrombi
Platelet-producing cells decrease
Loss of foetuses

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12
Q

Describe the pathophysiology of anti-phospholipid syndrome

A

Develops secondary to infection in susceptible individuals

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13
Q

Recall the triad of symptoms in anti-phospholipid syndrome

A

Headaches
Chorea
Epilepsy

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14
Q

What would an FBC show in anti-phospholipid syndrome?

A

Thrombocytopaenia

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15
Q

What is Bechet’s disease?

A

Multisystem inflammatory disease that causes uveitis and orogenital ulceration

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16
Q

What is the HLA association of Bechet’s disease?

A

HLA-B51

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17
Q

What is the pethergy test and what is it used to diagnose?

A

Prick skin with needle and it will form a sterile pustule within 48 hours
Bechet’s disease

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18
Q

What is carpal tunnel syndrome?

A

Compression of median nerve by the flexor reticulum

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19
Q

Recall 3 signs of carpal tunnel syndrome

A
  1. Thenar eminence wasting
  2. Tinel’s sign (symptoms come on when you tap carpal tunnel)
  3. Phalen’s test (symptoms come on following flexion of wrist for one min)
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20
Q

Recall the aetiology of cervical spondylitis

A

Osteoarthritic degeneration –> osteophyte formation –> protrusion into spinal foramina
Nerve root compression –> radiculopathy
Anterior spinal cord compression –> myelopathy

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21
Q

What is the most common symptom of cervical spondolysis?

A

Pain in neck and arms with paraesthesia

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22
Q

How do the arms appear in cervical spondylitis?

A

Forearm and hand may be wasted but upper arm spared

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23
Q

What investigation is required to diagnose cervical spondylitis?

A

Lateral X ray of spine

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24
Q

How long do fibromyalgia symptoms have to persist in order for a diagnosis to be made?

A

More than 3 months

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25
What sort of inflammation causes giant cell arteritis?
Granulomatous
26
Recall the symptoms of giant cell arteritis
Headache on one side of head at temple Swelling and tenderness over temporal artery Jaw claudication Sudden blindness
27
Describe the ESR and CRP in temporal arteritis
Both elevated
28
Recall the medical management of temporal arteritis
Analgesia High dose prednisolone Aspirin
29
Inflammation in which branch of the external carotid causes jaw claudication in giant cell arteritis?
Maxillary
30
What sort of crystals are deposited in gout?
Monosodium urate
31
Recall a sign of gout that appears away from the sore hallux
Tophi | = little lumps of uric acid on elbows/ ears
32
What dietay excess increases risk of gout?
Purines
33
Why does lymphoma carry a risk of gout?
Tumour lysis syndrome --> uric acid release
34
How high does urate need to be to diagnose gout?
>250
35
What shape are the crystals in gout?
Negative birefrigent needle-shaped crystals
36
What shape are the crystals in pseudogout?
Positive birefrigent rhomboid-shaped
37
What is the diagnostic test for gout?
Needle-stick to obtain crystals
38
Recall the management of gout
NSAIDs (but note: cannot give to pts with renal failure) Steroids Chronic: allopurinol (xanthinine oxidase inhibitor)
39
Recall 4 groups of people who are at increased risk of getting gout
1. Those with high purine diet 2. Those with luekaemia/ lymphoma 3. Renal failure patients 4. Men (10 x more common)
40
Which joint is most commonly affected by gout?
Metatarsophalangeal joint of hallux
41
After how long does gout usually resolve?
7-10 days
42
Define septic arthritis
Arthritis resulting from intra-articular infection
43
What will be seen upon joint aspiration in infective arthritis?
Grossly purulent synovial fluid
44
What is the common name for lumbosacral radiculopathy?
Sciatica
45
What is the most common cause of sciatica?
Disc herniation
46
Recall some symptoms of sciatica
Pain in buttocks and limbs moreso than the back Numbness and tingling that radiates down leg Calf weakness
47
What extra test should be done on limb examination to test for sciatica?
Straight leg raise | Positive result = pain between 30 and 70 degree flexion
48
Name one relieving factor of osteoarthritis pain
Rest - pain is worse on activity (although joints can grow stiffer on rest) Although painful, activity can improve symptoms by contributing to weight loss and regional muscle strengthening
49
Recall the types of nodes that appear in osteoarthritis
Bouchard's (proximal interphalangeal joint) | Heberden's (distal interphalangeal joint)
50
Recall the 4 classic X ray features of osteoarthritis
Subchondral sclerosis Subchondral cysts Osteophytes Narrowing of joint spaces
51
What are the 2 most common pathogens implicated in osteomyelitis
Staphylococcus aureus | Streptoccus Group A
52
In which demographic is osteomyelitis most common?
Young children
53
What are the investigations required to diagnose osteomyelitis?
Bloods Swabs of wound Radiographs
54
Recall 3 possible causes of osteomyelitis
Need a route of infection so: Trauma Post-operative Pressure ulcers
55
Describe the pain from polymyalgia rheumatica
Shoulder, neck and pelvic girdle pain Bilateral Worse in morning
56
In which demographic is PMR most common?
>50 y/o caucasian females
57
How long must polymyalgia rheumatica symptoms last in order to make a diagnosis?
More than 2 weeks
58
Which key blood marker is raised in PMR?
ESR
59
Recall the management options for PMR
1. Physiotherapy | 2. Prednisolone
60
What are polymyositis and dermatomyositis?
Connective tissue disease characterised by muscle inflammation
61
Recall the aetiology of polymyositis and dermatomyositis
Autoimmune, with viral trigger
62
Differentiate the age distribution of polymyositis and dermatomyositis
Polymyositis: between 30 and 60 Dermatomyositis: peaks at 5-10 and 50+
63
Differentiate the symptoms of polymyositis and dermatomyositis
Polymyositis: weakness of proximal muscles with distal sparing, pharyngeal weakness (causing dysphagia) Dermatomyositis: rash, systemic organ complication and fever
64
What investigation result will confirm a diagnosis of polymyositis
Creatine kinase 50 x higher than normal
65
What investigation result will confirm a diagnosis of dermatomyositis
Antibodies present in blood
66
What sort of crystals are deposited in pseudogout?
Calcium pyrophosphate dihydrate
67
Define reactive arthritis
Sterile arthritis occuring after an extra-articular infection (usually GI or urological)
68
What is Reiter's syndrome?
Triad of: Reactive arthritis Urethritis Conjunctivitis
69
What is the HLA association of reactive arthritis?
HLA-B27
70
What is the most commonly implicated pathogen in reactive arthritis?
Chlamydia trachomitis
71
What is a common precipitating factor for reactive arthritis?
Heavy drinking
72
What is the HLA association of rheumatoid arthritis?
HLA-DR4
73
What are the most commonly-affected joints in rheumatoid arthritis?
MCP and PIP
74
Recall 3 signs in the hands of rheumatoid arthritis
Swan-neck deformity Boutonierre's deformity Ulnar deviation due to MCP subluxation (later sign)
75
In what % of rheumatoid arthritis patients are they RF pos?
70%
76
What does joint aspiration show in the acute setting of rheumatoid arthritis presentation?
Nothing - but it rules out septic arthritis
77
What is sarcoidosis?
Multisystem granulomatous inflammatory disorder of unknown aetiology
78
``` Recall a symptom of sarcoidosis for each of the following systems: Respiratory MSK Eyes Skin Neurological Cardiac ```
``` Dry cough Polyarthralgia/dactylitis Keratoconjunctivitis sicca/ uveitis/ papilloedema Erythema nodosum Cerebellar ataxia Arrhythmias/ cardiomyopathy ```
79
Recall an electrolyte imbalance that is common in sarcoidosis
Hypercalcaemia
80
Describe the LFTs of someone with sarcoidosis
High ALP and GGT
81
What would lung biopsy show in sarcoidosis?
Granulomas
82
What is Sjorgen's syndrome?
Inflammation and destruction of exocrine glands- usually salivary and lacrimal
83
What is the HLA association of Sjorgen's syndrome?
HLA-DR3
84
Describe the symptoms of Sjorjen's syndrome
``` Dryness of: Eyes - keratoconjunctivitis sicca Mouth - dysphagia Airways - dry cough Vagina - dyspareunia Intestinal system - constipation ```
85
Recall 2 abnormal blood findings in Sjorgen's syndrome
``` Raised ESR Raised amylase (due to salivary gland involvement) ```
86
Recall the mnemonic for and the criteria for diagnosis of SLE
``` SOAP BRAIN MD Serositis Oral ulcers Arthritis Photosensitivity ``` ``` Bloods (leuko/thrombocytopaenia) Renal disease ANA Immunoglobulins Neurological disorders ``` Malar rash Discoid rash
87
Recall the 2 key antibodies that can be identified in a high proportion of SLE patients
Anti-dsDNA | RF
88
What is scleroderma also known as?
Systemic sclerosis
89
What is scleroderma?
Widespread damage to small blood vessels and fibrosis of skin and internal organs
90
Recall the 4 types of scleroderma
Pre-scleroderma Diffuse cutaneous slceroderma Limited cutaneous scleroderma Scleroderma sine scleroderma
91
Describe pre-scleroderma
Raynaud's phenomenon | ANA positive
92
Describe diffuse cutaneous scleroderma
Raynaud's Tendon friction + joint contracture Heart, GI and renal disease
93
Describe limited cutaneous scleroderma
``` Scleroderma gives you CRUSTy skin Calcinosis Raynaud's "U"sophageal dysmotility Sclerodactyly Telangiectasia ```
94
What is scleroderma sine scleroderma
Internal organ disease without skin changes
95
What is the main antibody implicated in systemic sclerosis?
Anti-centromere
96
What are vasculitides?
Inflammation of the blood vessels
97
Give 2 examples of large vessel vasculitides
Giant cell arteritis | Takasayu's arteritis
98
Give an example of a medium vessel vasculitides
``` Polyarteritis nodosa (usually on feet) ```
99
Give an example of a small vessel vasculitides
Microscopic polyangiitis
100
Recall 3 symptoms of polyarteritis nodosa
Microaneurysms Thromboses Testicular pain
101
What would a urine dip show in vasculitides?
Haematuria, proteinuria

YEAR 3: Conditions Knowledge (17 decks)

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