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Year 5 MSK questions Flashcards

1
Q

Is septic arthritis more common in native or prosthetic joints

A

more common in prosthetic joints

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2
Q

what is the most common causative agents for spetic arthritis

1) streptococci
2) Staphylocccus aureus
3) Neisseria gonorrhoea
4) HIB in children
5) TB

A

S. Aureus is the most common causative agent

but all other options here are also common causative agents –> streptococci 2nd most common

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3
Q

What is the most important diagnostic investigation for septic arthritis

1) FBC
2) CRP/ESR
3) urgent joint aspiration
4) X-ray of affected joint
5) Skin swabs/sputum/throat swab/urine culture

A

most important investigation =urgent joint aspiration –> for synovial fluids gram stain and culture & synovial fluids WBC

all options here are required investigations

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4
Q

Which of the following is the most appropriate & common management for septic arthritis

1) immobilise joint to prevent muscle stiffness and wasting
2) flucloxacillin & sodium fusidate for 1-2 weeks
3) flucloxacillin & gentamicin for 1-2 weeks
4) Oral penicllin, ciprofloxacin for 2 weeks

A

flocloxacillin and sodium fusidate for 1-2 weeks = most common initial treatment for S.aureus infection

immobilise joint to prevent muscle stiffness and wasting - should do in all scenarios

flucloxacillin & gentamicin for 1-2 weeks = if immunosuppressed

Oral penicllin, ciprofloxacin for 2 weeks = if gonococcus/meningocccus

Ticoplanin = if MRSA

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5
Q

what is another name for temporal arteritis

A

giant cell arteritis

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6
Q

which artery does temporal arteritis most commonly affect

1) abdominal aorta
2) internal carotid artery
3) external carotid artery

A

external carotid artery whcih supplies the temporal side of the face, jaw and back of haed

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7
Q

which of the following symptom is most resemblant for late stage temporal artertitis?

1) temproal headahce
2) scalp tenderness
3) Dipolar/blurred vision/amaurosis fugax
4) facial pain
5) jaw/tongue claudication

A

3) Dipolar/blurred vision/amaurosis fugax - can also lead to perminant vision loss

all other options are symptoms of temproal arteririts but much earlier stage

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8
Q

which of the following conditon is associated with temproal arteritis?

1) polymyalgia rheumatica
2) aortic aneruysm/dissection
3) intermittent or persistent brain ischaemia/brain stem stroke
4) subclavian steal syndrome
5) all of the above

A

5) all of the above

polymyalgia rheumatica - same spectrum of disease

subclavian steal syndriome = intermittent or persistent brain ischaemia/brain stem stroke

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9
Q

what is the most important investigation for temporal arteritis

A

temporal artery biopsy

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10
Q

what does temporal artery biopsy show

A

vasculitis characterised bt predominance of mononuclear cell infiltration or ganulomatous inflammation, giant cell

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11
Q

which of the following is the most appropriate initial treatment for tmproal arteritis without visual symptoms

1) prednisolone 60mg + aspirin 75 mg
2) prednisolone 40mg + aspirin 75 mg
3) prednisolone 20mg + aspirin 75 mg
4) prednisolone 60mg + aspirin 150 mg
5) prednisolone 40mg + aspirin 150 mg

A

2) prednisolone 40mg + aspirin 75 mg - for TA without visual symptoms

prednisolone 60mg + aspirin 75 mg - for TA with visual symptoms + urgent same day opatham referral

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12
Q

what are some of the symptoms of cauda equina syndrome

A

pain

radicular sensory changes

loss of sensation in perianal area

leg weakness

loss of bowel and bladder function

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13
Q

what are some of the clinical features of spinal cord compression

A

backpain

numbness/paraesthesia

weakness or paralysis

bladder and bowel dysfunction

hyper-reflexia

sensory loss

muscle weakness or wasting

loss of tone below the level of suspected injury

hypotension and bradycardia (neurogenic shock)

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14
Q

which of the following is the most important investigation for spinal cord compression in the event of a trauma

1) MRI spine
2) CT head
3) CT Spine

A

CT spine

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15
Q

Management of spinal cord compression caused by acute trauma

A

Immobilisation + decompression/stabilisation surgery

IV corticosteroid –> dexamethasone

VTE prophylaxis

maintenance of volume and BP

prevention of gastric ulcers

nutritional support

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16
Q

Management of non-traumatic intervertebral disc compression

A

decompressive laminectomy

VTE prophylaxis

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17
Q

Management of SCC caused by malignant spinal compression

A

16 mg dexamethasone +/- surgery +/- radiotherapy

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18
Q

Is male or female more susceptive for osteoarthritis

A

Female is 3 x male

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19
Q

what is the pathophysiology of osteoarthritis

A

damage to cartilage –> repair attempt but is disordered –> cartilage ulceration exposes underlying bone to inc stress –> bone attempts to repair but produces abnor sclerotic subchondral bone and overgrowth at join margins (osteophytes)

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20
Q

which of the following secondary causes of osteoarthitis

1) RA
2) Gout
3) Seronegative spndyloarthropathy
4) Paget’s disease of bone
5) all of the above

A 
RA 
gout 
seronegative spondyloarthropathy 
Paget's disease of bone 
vascular necrosis eg corticosteriod therapy 
haemarthrosis
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21
Q

which of the following symptom is not commonly associated with osteoarthritis

1) relieved by rest
2) worse on exercise
3) worse on rest
4) involvement of PIP joint

A

worse on rest - it is more common associated with RA

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22
Q

what are the acronym “LOSS” stands for when it is related to radiological changes caused by osteoarthritis

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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23
Q

which of the following is an appropriate management for osteoarthritis

1) azathioprine
2) vit D - calcium supplement
3) Bisophopnates
4) topical capsaicin
4) None of the above

A

topical capsaicin

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24
Q

which T score describes osteoporosis

1) -1.4
2) -1.9
3) -2.4
4) -2.9
5) -3.4

A

4) T score of -2.5 or less (ie 2.5 SD lower to the median number) = osteoporosis
- 1 to -2.5 = osteopenia
- 1 = normal

T score of -2.5 or less & 1 fracture = severe osteoporosis

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25
what is the single most important clinical feature of osteoporosis
low-trauma fragility fracture
26
what is the most used risk assessment of osteoporosis fracture risk
FRAX risk assessment (10 - year risk of fracture)
27
what is the most important investigation conducted for osteoporosis
DEXA scan - bone density scan conducted in either the hip, wrist and spine
28
what is the general regime of managing osteoporosis
Vit D + calcium = colecalciferol Bisphosphonates (alendronate) reduced activity of osteocast
29
What is the main pathology/aetiology of ankylosing Spondylitis
a from of chronic inflammation of bones which results in fusion of the bones, especially common in the spine and iliosacro joint aetiology unknown
30
what is the gene affected in ankylosing spondylitis
HLA B27
31
what are some of the most common intra-articular symptoms of ankylosing spondylitis
back/buttock pain which is worsen by rest and improved by exercise. morning pain is common Chest pain can be present due to involvment of costosternal / costovertebral joints reduced range of movment Question Mark Posture --> loss of lumbar lordosis, exaggravated thoracis kyphosis with neck sticking forward like a question mark Peripheral enthesitis --> where tendon and ligament insert into bone --> causing plantar fascilitis & Achilles tedonitis Peripheral athritis --> hip, shoulder and chest wall
32
what are some of the most common extra-articular symptoms of ankylosing spondylitis
fever, weight loss, fatigue acute anterior uveitis aortitis & aortic regurgitation & heart block IgA nephropathy & amyloidosis cauda equina syndrome, atlanto-axial subluxation osteopenia nad osteoporosis
33
investigation for ankylosing spondylitis
FBC - normochromic normocytic anaemia of chronic disease U&E - kidney damage ALP - elevated due to chronic disease CRP - often elevated X-ray of the joint involved - most helpful MRI - for early AS DEXA - osteoporosis Schober's test
34
which creteria is used to diagnose AS
modiefed New York Criteria Clinical criteria 1) low back pain for > 3 months - worsened by rest and improve by exercise 2) limitation of lumbar spine motion 3) limit to chest wal expanision Radiological criteria 1) sacroiliitis in X-ray Definite AS = radiological + at least 1 of clinical criteria Possible AS = all 3 clinical criteria or just radiological criteria
35
Management for anklosing spondylitis ?
symptoms control 1st line - NSAIDs + PPI +/- pain ladder 2nd line - TNF-alpha inhibitos (etanercept) / mnoclonal antibody against TNF eg (adelimumab) oral corticosteriods for short term measurement
36
Is male more common to get RA or OA
Neither - female more common to get both
37
what is the pathophysiology of RA
production of rheumatoid factor in synovium by plasma cells rheumatoid factor interact with macrophages, T and B cells --> overproduction of TNF & macrophages also releases chemoattrants to de-activate osteoblast but activate osteoclast --> bone erosion & further bone damages
38
which genes are more susceptible to RA
HLA-DR4 and HLA-DRB
39
what are the most prominent associating symptoms of RA
joint pain most commonly affecting the MCP, PIP (DIP is usually OA and never affected) worse with rest and better with exercise progressive, symmetricla, peripheral polyarthritis ulnar deviation, Z thrumb, swan neck & Boutonniere deformity
40
what are some of the common extra-artiuclar problem of RA
fatigue and weakness vasculitis fibrosing alveolitis pleural and pericardial effusions Raynaud's carpel tunnel syndrome splenomegaly osteoporosis amyloidosis
41
which criteria is used to diagnose RA
the ACR/EULAR 2010 criteria for RA if more than 6/10 = diagnostic
42
what are some of the investigations for RA
FBC - anaemia U&E CRP/ESR - acute phase proteins Serology - rheumatoid factors & anti citrullinated peptide antibodies X-ray of affected joints aspiration of joint to exclude septic arthritis
43
what is the mainstay management of RA
simple analgesia +/- NSAIDs or COX2 inhibitors DMARDs - disease modifying antirhuematic rugs eg methotrexate, sulfaszalazine, leflunomide corticosteroids - short term measure - oral/intra-articular injection
44
what is the treatment
Methotrexate + 1x DMARDs + glucocorticoids (cortisone)
45
which drug can you use if RA fails to response
if 2 x 6 month trial of traditional DMARDs therapy fails to control symptoms
46
Definition of Polymyalgia Rheumatica
inflammatory condition of unknown cause which is characterised by severe bilateral pain and morning stiffness of the shoulder neck and pelvic girdle
47
what is the earliest age which polymyalgia rheumatica has been reported?
50 yrs old
48
what are the 4 diagnostic criteria for polymyalgia rheumatica
1) 50 yrs old 2) subacute/acute onset of bilateral, severe and persistent pain in the neck, shoulder and pelvic girdle 3) morning stiffness > 45 min 4) evidence of acute phase response (raised ESR/CRP) - can still be diagnosed if ESR/CRP normal if classic clinical picture & response to steroids
49
what are some of the clinical features of polymyalgia rheumatica
pain in the neck, shoulder and pelvic girdle morning stiffness proximal weakness systemic - low grade fever, malaise, fatigue, anorexia, weight loss, depression upper arm tenderness carpal tunnel syndrome
50
investigations for polymyalgia rheumatica
basically a diagnosis of exclusion ESR/CRP FBC, U&Es, LFT, Bone profile, TFTs, CK protein electrophoresis Rheumatoid factors Urinary Bence Jones’ protein (multiple myeloma) Anti-nuclear antibody (SLE) USS of shoulder +/- hip if uncertain  subdeltoid bursitis
51
what is the treatment for polymyalgia rheumatica
prednisolone weak 1-3 15mg daily prednisolone then reducing dose
52
what causes gout
accumulation of uric acid which results in crystal in the joint space --> can be explained by increase purine intake from cheese, meat and red wine
53
is male or female more likely to get gout
male 3.6:1
54
which joint is the most commonly affected joints in Gout
big toe, metattatso-phalangeal joint (then ankle, wrist, base of thumb)
55
what are some of the clinical features of gout
sudden onset severe pain associated with swelling, redness, warmth and tenderness --> reach max pain in 24 hours Tophi maybe able to be felt
56
what are the investigations for gout
asppiration of joints --> -ve birefringence polarised light joint x-ray - space between joint maintined, lytic lesions, punched out erosions, serum uriac acid - not acute phase investigation
57
management of gout
acute flare - NSAIDs (diclofenac) + PPI - colchicine prophylaxis - allopurionol/ febuxostat
58
which molecules cause pseudogout
calcium pyrophosphate
59
which of the following is a risk factor for pseudogout 1) inc meat consumption. 2) hypoparathyroidism 3) infection 4) haemochromatosis 5) CKD
Haemochromatosis ``` other causes • Dehydration • intercurrent illness • hyperparathyroidism • long-term use of steroids • hypothyroidism • any causes of arthritis • haemochromatosis • Wilson’s disease • Acromegaly • Dialysis ```
60
single most prominent clinical features for pseudogout
sudden onset, red, hot, tender joint & swelling in one joint
61
which does pseudogout affects the most?
knee --> wrist --> shoulders --> ankles --> hands and feet
62
investigation for pseudogout?
join spiration --> _ve bifringement in polarised light joint x-ray --> linear opacification of articular cartilage serum calcium - elevated serum PTH - elevated
63
management of pseudogout
supportive + symptomatic control - RICE, NSAIDs, colchicine

Year 5 Conditions (19 decks)

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