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Year 3 Conditions MEGADECK > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is ankylosing spondylitis?

A

Ankylosing spondylitis (AS) is a chronic progressive inflammatory arthropathy. Patients present with severe pain and spinal stiffness, which ultimately may lead to spinal fusion

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2
Q

What are the signs and symptoms of ankylosing spondylitis?

A 
> Inflammatory back pain
> Iritis/ uveitis
> Enthesitis
> Fatigue 
> Sleep disturbance
> tenderness at sacroiliac
> Dyspnoea 
> Loss of lumbar lordosis
> Peripheral joint involvement> Kyphosis
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3
Q

What are the risk factors of ankylosing spondylitis?

A

HLA-B27ERAP1 and IL23RFHx

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4
Q

What is the epidemiology of ankylosing spondylitis?

A

The prevalence of AS correlates with that of HLA-B27 within a population. The mean AS prevalence per 10,000 people (from 36 eligible studies) has been estimated as 23.8 in Europe, 16.7 in Asia, 31.9 in North America, and 10.2 in Latin America.

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5
Q

What investigations would you do for ankylosing spondylitis?

A

Pelvic X Ray (sacroiliitis)

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6
Q

What is gout?

A

Gout is a syndrome characterised by: hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis; tophi around the joints and possible joint destruction; renal glomerular, tubular and interstitial disease; and uric acid urolithiasis.

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7
Q

What is pseudogout?

A

Calcium pyrophosphate deposition (CPPD) is associated with both acute and chronic arthritis. Acute CPP crystal arthritis is an acute inflammatory arthritis of one or more joints.Happens to older people

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8
Q

What are the risk factors of gout?

A

older agemale sexmenopausal statusconsumption of meat, seafood, alcoholuse of diureticsuse of ciclosporin (cyclosporine) or tacrolimususe of pyrazinamideuse of aspiringenetic susceptibilityhigh cell turnover state

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9
Q

What are the risk factors of pseudogout?

A 
> Age
> Injury
> Hyperparathyroidism
> Haemochromatosis
> FHx
> Hypomagnesaemia
> Hypophosphatasia
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10
Q

What is the epidemiology of gout?

A

The prevalence in the western world is about 1%, with a male to female ratio of 7:1 to 9:1; in the UK

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11
Q

What is the epidemiology of pseudogout?

A

In the UK, the prevalence of cartilage calcification associated with knee pain was 4.5%, with a strong age association.

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12
Q

What are the signs and symptoms of gout and pseudogout?

A

> rapid onset severe pain> Joint stiffness> Foot joint distribution> Few joints affected> Swelling and joint effusion> Tenderness> Tophi> Erythema/ warmPseudo: Painful joints, osteoarthritis joints involved, suddenly worse osteo

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13
Q

What are the investigations you would do for pseudogout?

A

> Athrocentesis with synovial fluid analysis (positively birefringent rhomboid-shaped crystals under polarised light)
X Rays affected joint (linear, stippled radio-opaque deposits in the cartilage)
Bloods- calcium, PTH, iron [Normal or elev.], magnesium, alk phos [Normal or decreased]

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14
Q

What are the investigations you would do for gout?

A

> Arthrocentesis with analysis- High WCC and negative birefringent needle shaped crystals

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15
Q

What is fibromyalgia?

A

Fibromyalgia is a chronic pain syndrome diagnosed by the presence of widespread body pain (front and back, right and left, both sides of the diaphragm) for at least 3 months in addition to tenderness (digital palpation at an approximate force of 4 kg) of at least 11 out of 18 designated tender point sites as defined by the American College of Rheumatology 1990 classification criteria.

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16
Q

What are the risk factors of fibromyalgia?

A

> Fhx fibromyalgia> Rheumatology > Age between 20-60> Female

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17
Q

What are the signs and symptoms of fibromyalgia?

A 
> Chronic pain 
> Diffuse tenderness on examination
> Fatigue unrelieved by rest
> Sleep disturbance
> Mood disturbance
> Cognitive dysfunction
> Headaches
> Numbness
> Stiffness
> Fluid Retention
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18
Q

What is the epidemiology of fibromyalgia?

A

Fibromyalgia is a common condition worldwide in all ethnic and socio-economic groups. Studies show the prevalence in the general population to be between 0.5% and 5%.

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19
Q

What investigations would you do for fibromyalgia?

A

> Clinical diagnosis first line

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20
Q

What is Giant Cell Arteritis?

A

Giant cell arteritis (GCA) is a granulomatous vasculitis of large and medium-sized arteries. It primarily affects branches of the external carotid artery, and it is the most common form of systemic vasculitis in adults.

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21
Q

What are the risk factors of giant cell arteritis?

A

> Age > 50

> Female

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22
Q

What is the epidemiology of giant cell arteritis?

A

In Olmsted County, Minnesota, the average annual incidence is about 19 cases per 100,000 people 50 years of age or older. This is similar to that reported in northern European populations.

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23
Q

What are the signs and symptoms of GCA?

A

HeadachePolymyalgia rheumatic symptomsExtreity claudicationCranial artery abnormalitiesSystemic symptoms

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24
Q

What are the investigations of GCA?

A

Bloods> ESR (raised)> CRP (raised)> FBC (anaemia, WCC high, transaminases and alk phos mildly elevated)Temporal artery biopsy- granulomatous inflammationTemporal artery US- halo sign

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25
Q

What are the complications of GCA?

A

> Large vessel stenoses
Aortic aneurysms
Glucocorticoid related adverse effects
Vision loss

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26
Q

What is the management of GCA?

A

> Prednisolone> Aspirin (adjunct)+ methotrexate

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27
Q

What is the prognosis of GCA?

A

The majority of patients respond rapidly to initial treatment with glucocorticoids, and vision loss in treated patients is rare. Lack of response to therapy should alert the physician to question the diagnosis; however, up to 50% of adequately treated patients experience unpredictable disease relapses and recurrence of symptoms.

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28
Q

What are idiopathic inflammatory myopathies?

A

Idiopathic inflammatory myopathies constitute a heterogeneous group of sub-acute, chronic, and, rarely, acute diseases of skeletal muscle that have in common the presence of moderate-to-severe proximal muscle weakness and inflammation on muscle biopsy.

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29
Q

What are the 3 groups?

A

Based on distinct features, they are divided into 3 groups: polymyositis, dermatomyositis, and inclusion body myositis. Polymyositis and dermatomyositis seem to have an autoimmune pathogenesis, whereas inclusion body myositis seems to have an autoimmune and degenerative pathogenesis

30
Q

What are the risk factors?

A

children and age >40 yearsexposure to high intensity of global UV radiationgenetic predispositionfemale sex and/or black ethnicity (polymyositis and dermatomyositis)male sex and/or white ethnicity (inclusion body myositis)

31
Q

What are the signs and symptoms?

A

> Difficulty with motor tasks> Muscle weakness> Muscle atrophy> Frequent falls> Fatigue and generalised malaise> Weight loss> SOB> Mild fever> Abnormal breath sounds

32
Q

What investigations would you do?

A 
Bloods (all elevated)
> CK
> Aldolase
> LDH
> Alanine transaminases
> Myoglobin

Muscle biopsy (Polymyositis: endomysial inflammatory infiltrates, muscle necrosis, atrophy, muscle fibre regeneration 
Dermatomyositis: perifascicular atrophy, perivascular/perimysial inflammation Inclusion body myositis: endomysial inflammatory infiltrate, fibre size variability, fibre necrosis, rimmed vacuoles)

EMGshort duration, low amplitude, polyphasic units with early recruitment on voluntary activity; diffuse spontaneous activity with fibrillation and positive sharp waves at rest

33
Q

What is osteoarthritis?

A

Osteoarthritis (OA) is the result of mechanical and biological events that destabilise the normal process of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix, and subchondral bone.

34
Q

What are the risk factors of osteoarthritis?

A

> Age over 50> Female> Obesity> Genetic factors> Physical/ manual occupation> Knee malalignment

35
Q

What are the signs and symptoms of osteoarthritis?

A 
> Pain
> Functional difficulties
> Knee, hip, hand, spine involvement
> Bony deformities
> Limited range of motion
> Malalignment
> Tenderness 
> crepitus
36
Q

What is the epidemiology of osteoarthritis?

A

About 8.5 million people in the UK have OA, and this figure is likely to increase due to an ageing population.

37
Q

What investigations would you do for osteoarthritis?

A

> X ray of joint- osteophytes, joint space narrowing, subchondral sclerosis and cysts> CRP- normal> ESR- normal

38
Q

What is polymyalgia rheumatica?

A

Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years.

39
Q

What are the risk factors for polymyalgia rheumatica?

A

> 50 yearsgiant cell arteritis (GCA)female gender

40
Q

What are the signs and symptoms of polymyalgia rheumatica?

A

shoulder/hip girdle stiffnessshoulder/hip girdle painrapid response to corticosteroidsacute onsetlow-grade feveranorexiaweight loss

41
Q

What is the epidemiology of polymyalgia rheumatica?

A

For those 50 and older, the US prevalence has been estimated at 6/1,000, and the US average annual age- and sex-adjusted incidence estimated at 52.5/100,000. The incidence is higher in females at 61.7/100,000, compared with 39.9/100,000 in males.

42
Q

What are the investigations for polymyalgia rheumatica?

A

> ESR- elevated> CRP- elevated> FBC- variable> US- bursitis

43
Q

What is the management of polymyalgia rheumatica?

A

> Prednisolone> Calc/ Vit D/ bisphosphonate> NSAID (e.g. naproxen)> Methotrexate/ folic acid (2nd line)> Tocilizumab (3rd line)

44
Q

What are the complications of polymyalgia rheumatica?

A

> Chronic relapsing PMR> Steroids- T2DM, infections, osteoporosis etc.> PMR related vascular events> Methotrexate- ulcers, hepatotoxicity, ILD

45
Q

What is the prognosis of polymyalgia rheumatica?

A

The overall prognosis is good. Although response to treatment typically occurs within 24 to 72 hours, relapses or symptom exacerbations are common.

46
Q

What is reactive arthritis?

A

An inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections.

47
Q

What are the signs and symptoms of reactive arthritis?

A 
peripheral arthritis
axial arthritis
constitutional symptoms
enthesitis
mucous membrane involvement
skin rash
48
Q

What are the risk factors of reactive arthritis?

A

male sexHLA-B27 genotypepreceding chlamydial or GI infection

49
Q

What is the epidemiology of reactive arthritis?

A

The prevalence is thought to be 30 to 40 cases per 100,000 adults, with an annual incidence of 4.6 per 100,000 for Chlamydia-induced arthritis and 5 per 100,000 for enterobacteria-induced arthritis.

50
Q

What investigations would you do for reactive arthritis?

A

Blood> ESR (high)> CRP (high)> ANA (neg)> Rh factor (neg)Urogenital and stool culture (neg)Plain X rays (sacroiliitis or enthesopathy)Arthrocentesis (neg)

51
Q

What is rheumatoid arthritis?

A

It primarily affects the small joints of the hands and feet and, if not treated aggressively, can be a major cause of work loss, decreased quality of life, need for joint replacement surgery, and mortality.

52
Q

What are the signs and symptoms of rheumatoid arthritis?

A

> Joint pain and swelling> Swan neck or boutonnieres deformity> Ulnar deviation> rheumatoid nodules> vasculitic lesions> pleuritic chest pain> Scleritis and or uveitis

53
Q

What are the risk factors of rheumatoid arthritis?

A

> Genetic predisposition> Smoking

54
Q

What is the epidemiology of rheumatoid arthritis?

A

Rheumatoid arthritis (RA) is a chronic inflammatory condition affecting around 1% of the population, making it the most common inflammatory arthritis seen by physicians

55
Q

What investigations would you do for rheumatoid arthritis?

A

RA is a clinical diagnosis; laboratory and radiographic tests help to confirm the diagnosis and provide useful prognostic information.

56
Q

What is septic arthritis?

A

Septic arthritis is defined as the infection of 1 or more joints caused by pathogenic inoculation of microbes. It occurs either by direct inoculation or via haematogenous spread.

57
Q

What are the signs and symptoms of septic arthritis?

A

hot, swollen, tender, restricted jointlow socioeconomic statushistory of intravenous drug abusehistory of diabeteshistory of cutaneous ulcers

58
Q

What are the risk factors of septic arthritis?

A

underlying joint diseasejoint prosthesesintravenous drug abusediabetescutaneous ulcers

59
Q

What is the epidemiology of septic arthritis?

A

The estimated incidence of septic arthritis in developed countries is 6 cases per 100,000 population per year.

60
Q

What investigations would you do for septic arthritis?

A

Bloods- ( culture, growths, WCC raised, ESR high, CRP high)
Synovial fluid- culture (growths), WCC (high)
XR (chondrocalcinosis or degeneration)
US (presence of effusion)

61
Q

What is spondylosis?

A

Spondylosis is the degeneration of the vertebral column from any cause.

62
Q

What are the signs and symptoms of spondylosis?

A

> Pain> Lhermitte sign> Reduced range of neck motion

63
Q

What are the risk factors of spondylosis?

A 
Age
Occupation
Neck injuries
Genetic factors
Smoking
64
Q

What is the epidemiology of spondylosis?

A

The incidence of lumbar spondylosis is 27-37% of the asymptomatic lower back pain population

65
Q

What investigations would you do for spondylosis?

A

> MRI/ CT for degenerative changes

66
Q

What is Carpal tunnel syndrome?

A

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel.

67
Q

What are the signs and symptoms of Carpal tunnel syndrome?

A

numbness of hand(s)night-time worseningnumbness in median nerve distributionsymptoms are intermittentonset is gradualweakness of handclumsinessAching or pain in one armthenar weaknessnormal reflexes

68
Q

What are the risk factors of Carpal tunnel syndrome?

A

age over 30 years
high BMI
female sex

alterations in carpal tunnel space
fractured wrist/carpal bones
square wrist
rheumatoid arthritis
diabetes
dialysis
pregnancy
congenital carpal tunnel stenosis
occupation involving exposure to repetitive bending, twisting, or vibration of the hands or wrists
mobility aids
69
Q

What is the epidemiology of Carpal tunnel syndrome?

A

US incidence: 3.5 cases per 1000 person-years,

Prevalence is approximately 10 times the incidence rate, at 3.7%

70
Q

What investigations would you do for Carpal tunnel syndrome?

A

> EMG- focal slowing of conduction in median sensory nerves/ prolongation of median distal motor latency/ lower amplitude

Year 3 Conditions MEGADECK (15 decks)

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