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MedEd Tutorials > 13. MSK > Flashcards

13. MSK Flashcards

1
Q

What is osteoarthritis?

A

Cartilage destruction exceeds repair, causing pain and instability

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2
Q

What is primary and secondary osteoarthritis?

A

Primary - wear and tear in obese, older patients etc.

Secondary - altered join architecture that acquires further damage

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3
Q

How does osteoarthritis present?

A

Large joins
Morning stiffness around 15 mins
Better on rest

Crepitus
Effusion, erythema
Squaring of the base of thumb
Heberden’s and bouchard’s

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4
Q

Investigations for OA?

A 
XRay
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

Joint aspiration for exclusion of other conditions

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5
Q

OA management?

A

Lifestyle stuff

Oral paracetamol and topic NSAIDs or capsaicin
Oral NSAID and PPI next
and then Opiates with caution

Intra-articular steroids
Joint replacement

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6
Q

What is RA?

A

Autoimmune, chronic and progessive inflammation of synovial lining, tendon sheaths and bursa

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7
Q

How is RA diagnosed?

A

Clinically!
Symmetrical polyarthritis and extra-articular manifestations
Rapid onset or chronic
Systemic upset

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8
Q

What are some clinical signs you many see in RA?

A

Pain and stiffness better after movement, small joints!
Swelling and tenderness
DIP sparing

Chronic signs -
Z deformity
Ulnar deviation
Swan neck deformity
Boutonniere's 
Rheumatoid nodules
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9
Q

Extra-articular manifestations of RA?

A 
Rheumatoid nodules
Tenosynovitis, bursitis
Secondary Sjogren's
Felty's syndrome
Anaemia
Pericarditis

SO many more

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10
Q

Investigations for RA?

A

RF Ab!
Anti-CCP more sensitive and specific
CRP, ESR usually raised

This helps to assess severity of disease and therefore prognosis

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11
Q

Treatment for RA?

A 
Short course steroids for flares
NSAIDs and COX-2 inhibitors
DMARDS! - 
Single, then double, then single with a biologic and finally rituximab and methotrexate
Surgery

Biologics need infection screening before as can reactivate TB etc.

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12
Q

What are the main seronegative spondyloarthropathies?

A

Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis

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13
Q

What is ankylosing spondylitis?

A

Chronic, progressive inflammatory arthropathy of axial skeleton!
HLA B27

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14
Q

Presentation of ankylosing spondylitis?

A

Pain and stiffness of lower back and hips on waking, slightly better with movement.
Extra-articular - anterior uveitis, apical lung fibrosis and aortic regurg

UC related

Chronic - kyphosis, neck extension, loss of lumbar lordosis

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15
Q

What is seen on imaging for AS?

A

Bamboo spine!

MRI is better as can pick up soft tissue changes

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16
Q

What is reactive arthritis?

A

Sterile joint inflammation post infection

17
Q

How does reactive arthritis present?

A

One-four joints painful and swelling
Nothing makes better or worse
Recent infection

Can have eye (with discharge, ank spond would have not discharge) and urological symptoms ULCERS TOO and stuff one palms and feet

18
Q

How would septic arthritis present?

A

Painful monoarthritis, erythematous, swollen, restricted ROM with fever

Caused by current infection, direct or spread

19
Q

How would gout present?

A

Acute monoarthritis of first MTP

Usually precipitated by trauma or infection
Hyperuricaemia

20
Q

How would pseudogout present?

A

Acute monoarthritis or large joints

Usually precipitated by trauma or infection
Calcium pyrophosphate crystals

High phosphate can cause pseudogout

21
Q

Risk factors for gout?

A

High purine diet, obesity, male

22
Q

What are the crystals and gout vs pseudogout?

A

Needle shaped, negative birefringent crystals for gout (rate bite of xray)
Rhomboid shaped and positively birefringent (chondrocalcinosis on xray)

Both turbid and yellow fluid, same as septic arthritis

23
Q

How do we manage septic arthritis?

A

IV abx for 2 weeks, 4 weeks orals

Stop any biologic therapies for 12 months

24
Q

Gout treatment?

A

NSAIDs for acute attack
Colchicine
Corticosteroids

Allopurinol and lifestyle long term

25
Q

Pseudogout treatment?

A

Steroids, NSAIDs etc.

26
Q

What is osteomyelitis?

A

Infection inside the bone either due to

  1. Haematogenous spread
  2. Contiguous spread - e.g. cellulitis or localised infection
  3. Direct inoculation e.g. surgery or penetrating injury
27
Q

How does osteomyelitis present?

A 
Nonspecific pain in affected area
Fever
Malaise
Rigors
Preceding lesion e.g. sore throat, surgery
Hot, swelling etc.
28
Q

Investigations for osteomyelitis?

A

Bloods for infection markers
Imaging may not see changes in first 2 qeeks but bone would darken overtime
Blood culture/wound swab

29
Q

How to treat osteomyelitis?

A

Supportive!
High dose IV abx then adapt to culture organism
Surgical debridement

MedEd Tutorials (32 decks)

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