MSK

Question 1

Differential for a toe hurting?

Answer 1

SEPTIC ARTHRITIS
Gout 
Pseudogout 
Psoriatic Arthritis 
Rheumatoid Arthritis 
Osteoarthritis 
Reactive Arthritis 
Trauma

Question 2

If septic arthritis has been ruled out do you need to do any investigations if you suspect gout?

Answer 2

Not routinely

Question 3

What investigations could you do to confirm gout?

Answer 3

Joint aspiration
Serum uric acid
X-ray - normal unless disease addvanced

Question 4

What causes gout?

Answer 4

Disorder of purine metabolism leading to build up of urate crystals in joints

Question 5

What causes Hyperuricaemia in the majority of cases?

Answer 5

Impaired renal excretion of urate

Question 6

Risk factors for gout

Answer 6

Male 
Age
Obesity
HTN
Diuretics

Question 7

What is the prognosis for an acute gout attack?

Answer 7

Acute attacks usually completely resolve within 1-2 weeks without treatment.

Question 8

What 2 things would you want to screen for in a pt presenting with gout?

Answer 8

Renal disease

CVD

Question 9

Management options in acute gout?

Answer 9

Self Care
Pharmacological intervention
Refer is not resolving or uncertain

Question 10

What is the self care advice to someone with gout?

Answer 10

Rest and elevate the limb.
Avoid trauma to the affected joint.
Keep the joint exposed and in a cool environment.
Consider the use of an ice pack or bed-cage.

Question 11

1st line pharmacological mgmt of gout?

Answer 11

NSAIDs at max dose for 1-2 days following acute attack

PPI to protect from above

Question 12

What is 2nd line pharma intervention for gout?

Answer 12

Colchicine

Question 13

What do you do about allopurinol or febuxostat during an acute attack of gout?

Answer 13

Keep taking as normal

Question 14

Safety net with gout?

Answer 14

advise the person to return if symptoms get worse, or if there is no improvement after 1-2 days

Question 15

What are the preventative drug options for gout?

Answer 15

allopurinol or febuxostat

Question 16

When will a pt stop allopurinol or febuxostat for prevention of gout?

Answer 16

Usually life long

Pts may reach “cure” levels of uric acid after modifying lifestyle but this is usually after years

Question 17

Key aspects of history for knee pain

Answer 17

Trauma
SOCRATES
Systemic symptoms
Recent infections

Question 18

Red flags for septic arthritis

Answer 18

Redness, swelling, heat, and reduced movement of the knee, especially if:
Rapid onset.
Movement is severely restricted,
Only one joint is affected
Knee pain is severe or, in people with pre-existing joint disease out of proportion to the usual symptoms.
Difficulty weight bearing, particularly in children.
Fever is present (although the absence of fever does not exclude septic arthritis); the person is systematically unwell.
There are risk factors for infection

Question 19

Red flags for malignancy in knee pain

Answer 19

Pain at rest/night
B symptoms
Unexplained bone pain

Question 20

If someone had knee pain with the following symptoms, what would you suspect?

Answer 20

Osteoarthritis

Question 21

When would you refer someone with knee pain?

Answer 21

Septic arthritis can’t be ruled out
Suspected fracture
Osteonecrosis
Suspected inflammatory arthritis

Question 22

Red flags for inflammatory arthritis

Answer 22

Pain that is worse at rest or during periods of inactivity.
Joint swelling, tenderness, and warmth — giving a ‘boggy’ feel on palpation.
Stiffness in the morning and after inactivity that lasts more than 15-30 minutes