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CMS > Week 8 - Musculoskeletal Disease > Flashcards

Week 8 - Musculoskeletal Disease Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

general signs and symptoms of joint disease?

A
  • inflammation: hot, red, swollen, painful

- destruction: immobility, deformity, instability

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2
Q

osteoarthritis: what joints affected? associated with?

A
  • hands
  • weight bearing joints (hips, knees, ankles)
  • genetic
  • obesity
  • previously damaged joints or bones
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3
Q

osteoarthritis - pathophysiology?

A
  • inflammation in the joint,
  • body tries to remodel bone back to original state, but does more damage than benefit
  • joint space reduced
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4
Q

osteoarthritis - symptoms?

A
  • pain: worse on movement, relieved by rest
  • immobility: worse in morning
  • swelling
  • deformity
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5
Q

osteoarthritis - how is it diagnosed?

what are the physical landmarks of osteoarthritis?

A
  • clinical: history & examination
  • radiology: plain x-rays
  • heberden’s and bouchard’s nodes
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6
Q

what is the difference between heberden and bouchard nodes?

A
  • heberden nodes located on distal interphalangeal joints

- bouchard’s nodes are located at distal interphalangeal nodes

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7
Q

osteoarthritis - management?

surgical management?

A
  • lose weight
  • physiotherapy
  • analgesia
  • steroid injection: temporary relief only
  • joint replacement. but difficult to repair if goes wrong. dont do on young pts.
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8
Q

osteoarthritis - dental considerations?

A
  • reduced dexterity
  • reduced mobility
  • associated medication?
  • recognition
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9
Q

rheumatoid arthritis - pathophysiology?

A
  • autoimmune disease of unknown aetiology
  • joint destruction, due to synovial inflammation
  • multi-system disease
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10
Q

rheumatoid arthritis - signs and symptoms?

presentation in acute and in established RA?

A

on joints: hands and feet initially, later cervical spine, knees, ankles, elbows, shoulders

presentation:
- acute - hot, swollen, tender
- established: deformity, restriction, sub-luxation (veers off to one side)

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11
Q

rheumatoid arthritis - physical deformities in those affected?

A
  • ulnar deviation
  • rheumatoid nodule
  • Z thumb
  • Boutonniere deformity
  • swan neck deformity
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12
Q

rheumatoid arthritis - signs and symptoms?

A
  • nervous system: peripheral neuropathy, cervical cord compression - paralysis
  • lungs: pulmonary fibrosis
  • heart disease
  • kidney failure
  • eyes: inflammation
  • sjogren’s syndrome: dry mouth & eyes
  • systemic inflammation: malaise, anaemia
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13
Q

rheumatoid arthritis - methods of diagnosis?

A
  • clinical exam
  • blood tests
  • radiology
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14
Q

rheumatoid arthritis - medical management?

A
  • analgesia
  • disease modifying anti-rheumatic drugs
  • corticosteroids: systemic & local (for joint infection)
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15
Q

examples of disease modifying anti-rheumatic drugs?

A
  • sulphasalazine
  • penicillamine
  • methotrexate
  • gold (?)
  • hydrochloroquine
  • azathioprine

biologicals: adalimumab, infliximab

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16
Q

rheumatoid arthritis - what do the following help with?

  • surgery?
  • physiotherapy?
  • occupational therapy?
A
  • joint replacements
  • optimise joint function
  • optimise functional abilities
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17
Q

rheumatoid arthritis - dental considerations for making diagnosis?

A
  • TMJ disease?
  • sjogren’s syndrome?
  • hands?
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18
Q

rheumatoid arthritis - dental considerations for those with established disease?

A
  • reduced manual dexterity
  • managing the patient’s sjogren’s syndrome
  • c-spine vulenrability: lying back?
  • drug side effects
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19
Q

systemic sclerosis/scleroderma - pathophysiology? describe the condition

A
  • autoimmune disease: mainly affecting the skin.
  • thickening and bound to underlying structures
  • multi-organ disease
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20
Q

systemic sclerosis/scleroderma - physical signs and symptoms?
characteristic appearance?

A
  • sclerodactyly
  • telangiectasia
  • calcinosis
  • beaked nose, fixed expression, radial furrowing of lips, limitation of mouth movements
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21
Q

systemic sclerosis/scleroderma - diagnosis?

A
  • clinical
  • blood test: specific auto-antibodies
  • management: symptomatic
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22
Q

systemic sclerosis/scleroderma - dental considerations about diagnosis and management?

A

diagnosis: dentist may suspect from oral findings

mouth care:

  • limitation of opening
  • atrophic mucosa
  • loss of dexterity for OH
  • side effects of medication
23
Q

systemic lupus erythematous -
pathophysiology?
antibodies against?
widespread deposition of?

A
  • autoimmune + multi-system disease
  • aetiology unknown
  • antibodies against cell nuclear components
  • widespread vascular complex deposition
24
Q

systemic lupus erythematous - signs and symptoms?

A
  • skin: photosensitivity, butterfly rash
  • joints: small joint arthritis
  • raynaud’s syndrome
25
Q

what is raynaud’s syndrome?

A

temporary spasm of blood vessels, blocking the flow of blood
- affected experience pain, numbness, pins and needles

26
Q

SLE - signs and symptoms?

A
  • nervous system: fits, paralysis, neuropathy, psychosis
  • heart: valve disease, endocarditis
  • lungs: effusions
  • kidney failure
27
Q

systemic lupus erythematous - diagnosis?

A
  • clinical exam

- test for specific auto-antibodies

28
Q

systemic lupus erythematous - management?

A
  • pharmacological same as rheumatoid arthritis

- psychological, for practical support

29
Q

systemic lupus erythematous - dental considerations? (diagnosis & established)

A
  • recognition of orofacial features (butterfly rash) -> diagnosis

diagnosed disease:

  • drug side effects
  • reduced anxiety
  • secondary sjogren’s syndrome
30
Q

gout - what is it? caused by? more common in?

A
  • accumulation of urate crystals in joints (overnourished + change in metabolism + high protein diet)
  • common in older men
31
Q

gout - acute presentation? precipitated by?

A
  • extremely painful joints

- starvation, alcohol excess, certain foods, operations, drugs

32
Q

gout - chronic presentation?

A

tophi deposition (crystalline uric acid at joints)

33
Q

psoriatic arthritis: psoriasis associated with? can rarely affect where?

A
  • destructive arthritis associated with psoriasis

- can rarely affect TMJs

34
Q

name 4 bone disorders?

A
  • hyperparathyroidism
  • paget’s disease
  • osteomalacia
  • osteoporosis
35
Q

hyperparathyroidism: pathophysiology?

A
  • excess thyroid hormone

- usually adenoma in parathyroid gland

36
Q

hyperparathyroidism - hypercalcaemia associated with what symptoms?

A
  • malaise and depression
  • constipation
  • abdominal pains
  • bone pain
  • kidney stones
37
Q

hyperparathyroidism: untreated hypercalcaemia leads to?

A

cardiac disrhythmia and death

38
Q

hyperparathyroidism: diagnosis?

A
  • blood tests

- xrays: look for sub-periosteal erosions

39
Q

hyperparathyroidism: management?

A
  • parathyroidectomy

- drugs

40
Q

hyperparathyroidism: dental considerations?

A
  • consider the effect of bone resorption: giant cell lesions, loss of lamina dura around roots
  • may have had treatment with bisphosphonates
41
Q

paget’s disease: pathophysiology?

A
  • abnormal bone remodelling: abundant bone formation.

bone formed is structurally abnormal and prone to fracture

42
Q

paget’s disease: signs and symptoms?

A
  • most is asymptomatic
  • bone deformities
  • enlargement of skull
  • nerve compression (due to the narrowing of foramina in skull). leading to deafness & spinal cord compression
  • fractures
43
Q

paget’s disease: diagnosis?

A
  • clinical exam: presence of gross deformities, can’t bear weight
  • xray characteristics: cotton wool deposits on mandible? hypercementosis, possible ankylosis of teeth
44
Q

paget’s disease: dental considerations - initial and established diagnosis?

A

initial:
- recognition of radiological features & dental changes

established diagnosis:

  • care with surgery to bone, risk of infection and fracture
  • awareness of osteosarcoma risk
  • may be treated with bisphosphonates
45
Q

osteomalacia - deficiency in? due to? what is it called in children?

A

vitamin D deficiency

  • due to lack of sunlight
  • poor intake (lack oily fish, eggs, red meat, fortified cereal/margarine)
  • malabsorption in intestine
  • rickets -> typical deformity
46
Q

osteomalacia - epidemiology in UK:

  • what increases risk?
  • who is it also likely to affect?
A
  • darker skin increases risk
  • frail/elderly/institutionalized patients
  • increased demand (babies, children, pregnancy, breastfeeding)
47
Q

osteomalacia - symptoms?

A
  • diffuse bony pains

- proximal muscle weakness

48
Q

osteomalacia - diagnosis and treatment?

A

diagnosis:

  • history
  • investigations: x-rays, blood tests. looser’s zone fracture: pseudofracture, area of radiolucency

treatment: replacement, change in diet: Healthy Start

49
Q

osteoporosis - pathophysiology?

A
  • loss of bone mass

- increased fracture risk

50
Q

osteoporosis: characteristics in:
- vertebrae?
- hip?
- wrist/neck or humerus?

A
  • pain, loss of height, kyphosis
  • disabling, high mortality, moribidity
  • less disabling, but marker of underlying osteoporosis
51
Q

osteoporosis: risk factors?

A
  • white, female, smoking, alcohol
  • lack of exercise
  • steroids
  • thin
  • short menstrual history: less abundance of protective hormones
  • malabsorption
  • hyperthyroidism
  • hypogonadism
52
Q

osteoporosis: diagnosis?

A

DEXA (dual energy x-ray absorptiometry)

53
Q

osteoporosis : treatment?

A
  • calcium & vitamin D

- treat risk factors

54
Q

osteoporosis: dental considerations?

A
  • bisphosphonates: risk of MRONJ

CMS (16 decks)

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