Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK lectures > Osteoarthritis, Crystal arthritis and Soft Tissue Rheumatism > Flashcards

Osteoarthritis, Crystal arthritis and Soft Tissue Rheumatism Flashcards

1
Q

What is osteoarthritis?

A

Articular cartilage thinning or loss

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

Is osteoarthritis a consequence of aging?

A

Yes

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

What are some risk factors for osteoarthritis?

A 
Age
Female
Obesity
Previous injury
Muscle weakness
Proprioceptive deficits
Genetic elements
Acromegaly
Joint inflammation
Crystal deposition in cartilage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathogenesis of OA?

A
  1. Normal joint - healthy cartilage is lubricated by synovial fluid
  2. OA causes the cartilage to begin breaking down, making it thinner and then creating cracks in the surface
  3. Gaps in the cartilage can expand until they reach the bone
  4. Synovial fluid leaks into cracks which form in the bones surface when the replacement cartilage wears away. This causes further damage and can lead to cysts or bone deformities
  5. If not treated, damage can progress to the point where the bones in the joint become permanently deformed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two types of OA?

A

Idiopathic

Secondary

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

What can OA be secondary to?

A

Previous injury
Calcium crystal deposition disease
Rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

At what sites is OA likely to occur?

A 
Hip
Knee
Foot (mtp joints)
Cervical spine
Lumbar spiner
Hand - DIP, PIP, IP, MCP, CMC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of OA?

A

Pain - worse on activity, relieved by rest (mechanical pain)

Stiffness - Morning usually lasts less than 30 minutes

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

What would be seen on examination of OA?

A

Crepitus
Joint swelling - bony enlargements due to osteophytes
Joint tenderness
Joint effusion

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

What are bony enlargements at the DIPs called?

A

Heberdens nodes

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

What are bony enlargements at the PIPs called?

A

Bouchards nodes

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

What else may be seen in the hands of an OA patient?

A

Squaring of the hand

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

What may be seen in the knee of an OA patient?

A 
Osteophytes 
Effusions
Crepitus
Restriction of movement
Genu varus 
Valgus deformities
Bakers cyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What may be seen in the hip of an OA patient?

A

Pain in groin or radiating to knee
Pain in hip from lower back
Restricted hip movements

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

What may be seen in the spine of an OA patient?

A

Cervical - pain and restriction of neck movement
Lumbar - Pain on standing or walking for some time
Spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is OA diagnosed?

A

Clinical + Radiological

  • Loss of joint space
  • Subchondral sclerosis
  • Subchondral cysts
  • Osteophytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the categories for the Kellgren-Lawrence Radiographic grading scale of osteoarthritis?

A

Grade 0 - No radiographic findings of OA
Grade 1 - Minute osteophytes of doubtful significance
Grade 2 - Definitive osteophytes with unimpaired joint space
Grade 3 - Definitive osteophytes with moderate joint space narrowing
Grade 4 - Definitive osteophytes with severe joint space narrowing and subchondral sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Do symptoms of OA tend to improve?

A

Yes - not fully however

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

What is the non-pharmacological management of OA?

A

Explanation - not because of normal use
Physiotherapy - Muscle strengthening
Common sense measures - weight loss, exercise, trainers, walking stick, insoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the pharmacological management of OA?

A

Analgesia - Paracetamol, compound analgesics, topical analgesia
NSAIDs - topical/systemic, may give additional symptomatic relief, consider risk/benefit ratio
Pain modulators - Tricyclics (amitriptyline, anti-convulsants)
Intra-articular - steroids

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

What is the surgical management of OA?

A

Arthroscopic washout, loose body, soft tissue trimming

Joint replacement

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

What is gout?

A

Inflammation in the joint triggered by uric acid crystals

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

What two factors contribute to purine levels?

A

Diet

DNA/RNA

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

What can lead to increased uric acid levels?

A

Excess consumption
Over production
Under excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the clinical level for hyperuricaemia?

A

> 0.42mmol/l

26
Q

What are some reasons for increased urate production?

A 
Inherited enzyme defects
Psoriasis
Haemolytic disorders
Alcohol
High dietry intake
27
Q

What are some reasons for reduced urate excretion?

A 
Chronic renal impairment 
Volume depletion
Hypothyroidism
Diuretics
Cytotoxics
28
Q

What gender does gout affect more?

A

Men

29
Q

How many joints does Acute gout usually affect?

A

Just one

30
Q

What are the three most commonly affected joints by acute gout?

A

MTP
Ankle
Knee

31
Q

How long does acute gout take to settle?

A

10 days without treatment

3 Days with treatment

32
Q

What are the characteristics of acute gout?

A

Abrupt onset
Often overnight
May have normal uric acid

33
Q

What is chronic tophaceous gout?

A

Chronic joint inflammation

34
Q

What is chronic tophaceous gout associated with?

A

Diuretics
High serum uric acid
Tophi
May have acute attacks

35
Q

What are the investigations for chronic tophaceous gout?

A 
Raised inflammatory markers
Serum uric acid raised
Synovial fluid 
Renal impairment
X-ray
36
Q

What will polarising microscopy show in gout synovial fluid?

A

Needle shaped negatively birefringent crystals

37
Q

What is the acute treatment for chronic tophaceous gout?

A

NSAIDs
Colchicine
Steroids

38
Q

What is the prophylaxis treatment for chronic tophaceous gout?

A

Allopurinol

Febuxostat

39
Q

When should prophylaxis be started for chronic tophaceous gout?

A

2-4 weeks after acute attack

40
Q

What are the two types of calcium pyrophophate deposition disease?

A

Calcium pyrophosphate

Calcium hydroxyappatite crystals

41
Q

What age group is CPPD common in?

A

The elderly

42
Q

Where does CPPD affect?

A

Fibrocartilage

  • Knees
  • Wrists
  • Ankles
43
Q

What happens to chondrocalcinosis with age?

A

Increases with age

44
Q

What are acute attacks of CPPD caused by?

A

Calcium pyrophosphate crystals (pseudogout)

45
Q

What shape are calcium pyrophosphate crystals?

A

Envelope shaped

Mildly positive birefringent

46
Q

What happens to the inflammatory markers in CPPD?

A

Marked rise

47
Q

What are the associations in CPPD?

A 
Hyperparathyroidism
Hypercalcaemia
Haemochromotosis
Hypomagnesia
Hypothyroidism
Gout
Neuropathic joints
Aging
Amyloidosis
Trauma
48
Q

What is the treatment for CPPD?

A

NSAIDs
Colchicine
Steroids
Rehydration

49
Q

What does hydroxyapatite cause?

A

Milwaukee shoulder

50
Q

What are the characteristics of hydroxyapatite deposition?

A

Release of collagenases, serine proteinases and IL-1
Acute and rapid deterioration
Females
50-60 years

51
Q

What is the treatment for hydroxyapatite deposition/

A

NSAIDs
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty

52
Q

What is soft tissue rheumatism the general term to describe?

A

Pain that is caused by inflammation/damage to the ligaments, tendons, muscles or nerve near a joint

53
Q

Is the pain in STR localised or general?

A

Localised

54
Q

What should you consider with generalised soft tissue pain?

A

Fibromyalgia

55
Q

What should be considered with neck pain?

A

Muscular
Self-limiting
OA of cervical spine
Occipital migrane

56
Q

Where is the commonest area for soft tissue pain?

A

Shoulder

57
Q

What are causes of shoulder pain?

A 
Adhesive capsulitis
Rotator capsulitis
Calcific tendonitis 
Impingement
Partial rotator cuff tears
Full rotator cuff tears
58
Q

What are possible diagnoses for Elbow, wrist, pelvis and foot pain?

A

Elbow - medial and lateral epicondylitis
Wrist - De-Quervains tenosynovitis
Pelvis - Trochanteric, iliopsoas, ischiogluteal bursitis and stress enthesopathies
Foot - plantar fascitis

59
Q

What are the investigations and treatment for STR?

A 
X-ray
MRI
Pain control
Rest and Ice
PT
Steroid injections
Surgery
60
Q

What gender and age does joint hypermobility syndrome usually affect?

A

Females

Childhood

61
Q

What is the modified brighton score?

A

Testing hypermobility

62
Q

What are features of hypermobility?

A

Arthralgia
Premature osteoarthritis
Normal investigations

MSK lectures (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions