Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 diagnosis and management > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is ankylosing spondylitis and what does it mainly affect?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which gene is ankylosing spondylitis associated with?

A

HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the pattern of pain in ankylosing spondylitis?

A
  • Worse in the morning
  • Better with activity
  • Worse when resting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Apart from back pain, where else can you get pain in ankylosing spondylitis?

A
  • Pleuritic chest pain - costovertebral joints

* Heel pain - plantar fasciitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the test used for ankylosing spondylitis on examination?

A

Schober’s test
• 2 fingers placed on back 10cm apart
• Distance should increase by >5cm on forward flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of extra-articular disease in ankylosing spondylitis?

A 
5 As
• Anterior uveitis
• Apical lung fibrosis
• Achilles tendinitis
• Amyloidosis
• Aortic regurgitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations (imaging) for ankylosing spondylitis?

A
  • X-ray - bamboo spine, sclerosis, erosions

* MRI - bone marrow oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Difference between gout and pseudogout cause?

A

Gout
• disorder of uric acid metabolism
• monosodium urate crystal deposition

Pseudogout
• calcium pyrophosphate dihydrate (CPPD) crystal deposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Presentation of gout and pseudogout?

A 
Gout (more common in males)
• Sudden excruciating monoarticular pain
• Usually metatarsophalangeal joint of great toe
• Can present with cellulitis
• Renal calculi symptoms

Pseudogout (more common in females)
• acute arthritis
• chronic arthropathy, similar to osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is intercritical and chronic tophaceous gout?

A
  • Intercritical - asymptomatic between acute attacks

* Chronic tophaceous - persistent low-grade fever, painful tophi, repeated acute attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations for gout and pseudogout?

A

Synovial fluid aspirate
• Gout - needle-shaped crystals, negative birefringence
• Pseudogout - rhomboid, brick-shaped crystals, positive birefringence

(polarised light microscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is fibromyalgia?

A

Chronic pain disorder with unknown cause

mainly women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnosis of fibromyalgia?

A

Clinical

  • Widespread pain involving both sides of the body, above and below the waist for AT LEAST 3 MONTHS
  • Presence of 11 tender points among the 9 pairs of specific sites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The symptoms of which inflammatory disorder can present with giant cell arteritis?

A

Polymyalgia rheumatica - early morning pain and stiffness of muscles of shoulder and pelvic girdle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of polymyositis and dermatomyositis

A 
Polymyositis
• proximal muscle weakness
• distal muscles spared
• dysphagia
• no rash

Dermatomyositis
- Rash
• photosensitive
• heliotrope rash in periorbital region
• macular rash over back and shoulders
• Gottron's papules over extensor surfaces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for polymyositis and dermatomyositis?

A
  • High CK (better for P)
  • EMG (better for P)
  • Autoantibodies
  • Diagnostic - muscle biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Signs of osteoarthritis and rheumatoid arthritis?

A

Osteoarthritis
• Heberden’s nodes - DIP joint
• Bouchard’s nodes - PIP joint
• Pain in large weight bearing joints and carpometacarpal joints

Rheumatoid arthritis
• Swan neck deformity
• Boutonniere deformity
• Swelling of MCP and PIP joints
• Ulnar deviation of fingers
• Radial deviation of wrist
• Rheumatoid nodules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

History of osteoarthritis and rheumatoid arthritis?

A 
Osteoarthritis
• Unilateral
• (Morning stiffness <30mins)
• Pain with use
• Better with rest

Rheumatoid arthritis
• Bilateral
• Morning stiffness >45 mins
• Better with use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

X-ray findings in osteoarthritis and rheumatoid arthritis?

A 
Osteoarthritis (LOSS)
• Loss of joint space
• Osteophytes forming at joint margins
• Subchondral sclerosis
• Subchondral cysts

Rheumatoid arthritis
• Loss of joint space
• Juxta-articular osteoporosis
• Periarticular erosions/osteopaenia
• Subluxation (partial dislocation)
• Soft tissue swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rheumatoid arthritis HLA associations?

A

HLA-DR1

HLA-DR4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Best diagnostic marker for rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is reactive and septic arthritis?

A

Reactive
• Sterile arthritis
• After extra-articular infection (GI or urogenital)

Septic
• Inta-articular infection (spreading systemic infection in most cases)
• Staphylococcus aureus (G+)
• Neisseria gonorrhoeae (G-) in sexually active young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of reactive and septic arthritis?

A

Reactive
• Reiter’s syndrome - conjunctivitis, urethritis, arthritis (can’t see, can’t pee, can’t climb a tree)
• Oral ulceration
• Circinate balanitis
• Keratoderma blenorrhagica on soles and palms

Septic
• Usually monoarthropathy
• Excruciating joint pain, hot and swollen
• Most common in knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most important investigation for septic arthritis?

A

Joint aspiration
• Grossly purulent
•Gram staining
• MC&S (or PCR if viral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Reactive arthritis HLA association?
HLA-B27
26
What is osteomyelitis?
Infection of bone • Inflammation • Necrosis • New bone formation
27
Who mostly gets osteomyelitis?
Young children
28
Presentation of osteomyelitis?
* Pain * Fever, rigors * History of skin lesion, sore throat, trauma * Inflamed area * Seropurulent discharge from associated wound
29
Investigation for osteomyelitis?
* MRI - best | * Radionuclide scan - increased uptake in infected sites
30
What is polymyalgia rheumatica?
Inflammatory condition characterised by severe bilateral pain and morning stiffness of: • shoulder • neck • pelvic girlde NOT weakness
31
History of polymylagia rheumatica?
* Flu-like symptoms at onset * Difficulty getting out of bed or raising arms due to morning stiffness (> 45 mins) * Worse when walking
32
Investigations for polymylagia rheumatica?
Bloods - raised ESR (and CRP) USS - trochanteric bursitis Not required, but histology would show: • Vasculitis with giant cells • Certain sections of artery skipped • Mainly arteries of muscle bed
33
Treatment of polymyalgia rheumatica?
Oral prednisolone
34
What is Sjogren's syndrome?
Inflammation and destruction of exocrine glands (usually salivary and lacrimal) Lymphocitic infiltration and fibrosis
35
Presentation of Sjogren's?
* Fatigue, fever, weight loss * Dry eyes * Dry mouth - secondary dysphagia * Dry skin * Raynaud's
36
What is secondary Sjogren's due to?
Rheumatoid arthritis or other connective tissue disorders
37
Investigations for Sjogren's?
Diagnostic - Schirmer's test (strip of filter paper under eyelid, positive if < 10mm wet after 5 mins) Antibodies: rheumatoid factor, ANA, anti-Ro, anti-LA
38
What is spondylosis?
Degeneration of vertebral bodies and intervertebral discs - compression of spinal cord / nerve roots by osteophytes
39
Signs of spondylosis?
If roots - LMN sign (arm in cervical) If cord - UMN signs (legs in cervical) * Sensory loss * Pseudoathetosis - writhing finger movements when hands outstretched (cervical roots) * Lhermitte's sign (crepitus / paraesthesia)
40
Investigations for spondylosis?
Spinal X-ray
41
Diagnosis of SLE?
4/11 of the following: ``` SOAP BRAIN MD • Serositis • Oral ulcers • Arthritis • Photosensitivity • Bloods (haemolytic anaemia/leukopaenia/thrombocytopaenia) • Renal disease • ANA • Immunological disorder (anti-dsDNA) • Neurological disease • Malar rash • Discoid rash ```
42
Most common cardiac manifestation of SLE?
Pericarditis
43
HLA in SLE?
HLA-DR2 | HLA-DR3
44
Best diagnostic test for SLE?
Anti-dsDNA
45
Inflammatory markers in SLE?
Normal CRP | Raised ESR
46
What is systemic sclerosis?
Connective tissue disease characterised by widespread small blood vessel damage and fibrosis in skin and internal organs aka scleroderma
47
What is seen diffuse cutaneous systemic sclerosis (40%)?
Scleroderma mainly in trunk and proximal limbs * Raynaud's * Nail-fold capillary changes * Tendon friction * Joint contracture * Lung, heart, GI and renal disease * Interstitial lung disease and pulmonary arterial hypertension is main cause of death
48
What is seen in limited cutaneous systemic sclerosis (60%)?
``` CREST • Calcinosis • Raynaud's • Esophageal dysmotility • Sclerodactyly • Telangiectasia ``` Scleroderma mainly in face and distal limbs
49
What is scleroderma sine scleroderma?
Internal organ disease with no skin changes
50
Signs of systemic sclerosis? • Skin • Hands • Face
* Skin - Raynaud's * Hands - swollen, thickened, tight, shiny, ulcers * Face - microstomia, telangiectasia
51
Which antibodies are associated with limited cutaneous ss and diffuse cutaneous ss?
Limited cutaneous - anti-centromere Diffuse cutaneous - anti-topoisomerase II (anti-Scl-70)
52
Which vessel size does eosinophilic granulomatosis with polyangiitis (Churg-Strauss) affect?
Small (may also affect medium)
53
Which vessel size does granulomatosis with polyangiitis (Wegner's) affect?
Small (may also affect medium)
54
Which vessel size does microscopic polyangiitis affect?
Small
55
Which vessel size does Polyarteritis nodosa affect?
Medium
56
Which vessel size does Takayasu's arteritis affect?
Large
57
Features of eosinophilic granulomatosis with polyangiitis (Churg-Strauss) and granulomatosis with polyangiitis (Wegner's)?
EGPA • asthma • paranasal sinusitis • mononeuritis multiplex ``` GPA • Epistaxis/haemoptysis • Sinusitis • Nasal crusting • Saddle-shaped nose • Renal failure ```
58
Features of microscopic polyangiitis?
* Renal impairment * Palpable purpura * Mononeuritis multiplex
59
Antibodies in EGPA, GPA and microscopic polyangiitis?
* pANCA - EGPA and microscopic polyangiitis | * cANCA - GPA
60
Features of polyarteritis nodosa?
* Testicular pain * Livedo reticularis - mottled, lace-like purplish skin discolouration * Renal failure * Haematuria
61
Risk factor for polyarteritis nodosa? (seen in serology)
Hepatitis B
62
In whom is Takayasu's arteritis most common?
Japanese females
63
Presentation of Takayasu's arteritis?
* Absent limb pulses * Unequal blood pressure in upper limbs * Carotid bruit * Intermittent claudication * Aortic regurgitation
64
Signs of Carpal Tunnel syndrome?
* Weakness and wasting of thenar eminence * Tinel's signs - tapping the carpal tunnel causes symptoms * Phalen's test - flexion of the wrist for 1 min may cause symptoms

Year 3 diagnosis and management (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions