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Year 3 ICSM COPY > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Define amyloidosis

A

Heterogenous group of diseases characterised by extracellular deposition of amyloid fibrils

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2
Q

Recall the subtypes of amyloidosis

A

Type AA: serum Amyloid A protein
Type AL: monoclonal Ig Light chains
Type ATTR: genetic variant TransThyRetin

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3
Q

Which are the main 2 organs affected by amyloidosis?

A

Kidneys

Heart

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4
Q

What sort of cardiomyopathy do you get in amyloidosis?

A

Restrictive

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5
Q

Exactly define ankylosing spondylitis

A

Seronegative inflammatory arthropathy preferentially affecting the axial skeleton and large proximal joints

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6
Q

What is the HLA association of ankylosing spondylitis?

A

HLA-B27

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7
Q

What is the main symptom of ankylosing spondylitis?

A

Lower back and sacral pain that is worse in the morning and better with exercise

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8
Q

What is the Schober test and what is it used for?

A 
Mark at 5th lumbar spinous process
Mark at 10cm above this
Get patient to lean forwards
Gap --> 15cm
= test for ankylosing spondylitis
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9
Q

Recall the 5 As of extraarticular disease that may be seen alongside ankylosing spondylitis

A 
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
Amyloidosis
Achilles tendonitis
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10
Q

Recall two x ray findings in ankylosing spondylitis

A

Bamboo spine

Sacroiliac joint fusion

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11
Q

Define anti-phospholipid syndrome (mnemonic = APL)

A

Arterial and venous thrombi
Platelet-producing cells decrease
Loss of foetuses

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12
Q

Describe the pathophysiology of anti-phospholipid syndrome

A

Develops secondary to infection in susceptible individuals

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13
Q

Recall the triad of symptoms in anti-phospholipid syndrome

A

Headaches
Chorea
Epilepsy

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14
Q

What would an FBC show in anti-phospholipid syndrome?

A

Thrombocytopaenia

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15
Q

What is Bechet’s disease?

A

Multisystem inflammatory disease that causes uveitis and orogenital ulceration

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16
Q

What is the HLA association of Bechet’s disease?

A

HLA-B51

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17
Q

What is the pethergy test and what is it used to diagnose?

A

Prick skin with needle and it will form a sterile pustule within 48 hours
Bechet’s disease

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18
Q

What is carpal tunnel syndrome?

A

Compression of median nerve by the flexor reticulum

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19
Q

Recall 3 signs of carpal tunnel syndrome

A
  1. Thenar eminence wasting
  2. Tinel’s sign (symptoms come on when you tap carpal tunnel)
  3. Phalen’s test (symptoms come on following flexion of wrist for one min)
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20
Q

Recall the aetiology of cervical spondylitis

A

Osteoarthritic degeneration –> osteophyte formation –> protrusion into spinal foramina
Nerve root compression –> radiculopathy
Anterior spinal cord compression –> myelopathy

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21
Q

What is the most common symptom of cervical spondolysis?

A

Pain in neck and arms with paraesthesia

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22
Q

How do the arms appear in cervical spondylitis?

A

Forearm and hand may be wasted but upper arm spared

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23
Q

What investigation is required to diagnose cervical spondylitis?

A

Lateral X ray of spine

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24
Q

How long do fibromyalgia symptoms have to persist in order for a diagnosis to be made?

A

More than 3 months

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25
Q

What sort of inflammation causes giant cell arteritis?

A

Granulomatous

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26
Q

Recall the symptoms of giant cell arteritis

A

Headache on one side of head at temple
Swelling and tenderness over temporal artery
Jaw claudication
Sudden blindness

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27
Q

Describe the ESR and CRP in temporal arteritis

A

Both elevated

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28
Q

Recall the medical management of temporal arteritis

A

Analgesia
High dose prednisolone
Aspirin

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29
Q

Inflammation in which branch of the external carotid causes jaw claudication in giant cell arteritis?

A

Maxillary

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30
Q

What sort of crystals are deposited in gout?

A

Monosodium urate

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31
Q

Recall a sign of gout that appears away from the sore hallux

A

Tophi

= little lumps of uric acid on elbows/ ears

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32
Q

What dietay excess increases risk of gout?

A

Purines

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33
Q

Why does lymphoma carry a risk of gout?

A

Tumour lysis syndrome –> uric acid release

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34
Q

How high does urate need to be to diagnose gout?

A

> 250

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35
Q

What shape are the crystals in gout?

A

Negative birefrigent needle-shaped crystals

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36
Q

What shape are the crystals in pseudogout?

A

Positive birefrigent rhomboid-shaped

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37
Q

What is the diagnostic test for gout?

A

Needle-stick to obtain crystals

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38
Q

Recall the management of gout

A

NSAIDs (but note: cannot give to pts with renal failure)
Steroids
Chronic: allopurinol (xanthinine oxidase inhibitor)

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39
Q

Recall 4 groups of people who are at increased risk of getting gout

A
  1. Those with high purine diet
  2. Those with luekaemia/ lymphoma
  3. Renal failure patients
  4. Men (10 x more common)
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40
Q

Which joint is most commonly affected by gout?

A

Metatarsophalangeal joint of hallux

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41
Q

After how long does gout usually resolve?

A

7-10 days

42
Q

Define septic arthritis

A

Arthritis resulting from intra-articular infection

43
Q

What will be seen upon joint aspiration in infective arthritis?

A

Grossly purulent synovial fluid

44
Q

What is the common name for lumbosacral radiculopathy?

A

Sciatica

45
Q

What is the most common cause of sciatica?

A

Disc herniation

46
Q

Recall some symptoms of sciatica

A

Pain in buttocks and limbs moreso than the back
Numbness and tingling that radiates down leg
Calf weakness

47
Q

What extra test should be done on limb examination to test for sciatica?

A

Straight leg raise

Positive result = pain between 30 and 70 degree flexion

48
Q

Name one relieving factor of osteoarthritis pain

A

Rest - pain is worse on activity (although joints can grow stiffer on rest)
Although painful, activity can improve symptoms by contributing to weight loss and regional muscle strengthening

49
Q

Recall the types of nodes that appear in osteoarthritis

A

Bouchard’s (proximal interphalangeal joint)

Heberden’s (distal interphalangeal joint)

50
Q

Recall the 4 classic X ray features of osteoarthritis

A

Subchondral sclerosis
Subchondral cysts
Osteophytes
Narrowing of joint spaces

51
Q

What are the 2 most common pathogens implicated in osteomyelitis

A

Staphylococcus aureus

Streptoccus Group A

52
Q

In which demographic is osteomyelitis most common?

A

Young children

53
Q

What are the investigations required to diagnose osteomyelitis?

A

Bloods
Swabs of wound
Radiographs

54
Q

Recall 3 possible causes of osteomyelitis

A

Need a route of infection so:
Trauma
Post-operative
Pressure ulcers

55
Q

Describe the pain from polymyalgia rheumatica

A

Shoulder, neck and pelvic girdle pain
Bilateral
Worse in morning

56
Q

In which demographic is PMR most common?

A

> 50 y/o caucasian females

57
Q

How long must polymyalgia rheumatica symptoms last in order to make a diagnosis?

A

More than 2 weeks

58
Q

Which key blood marker is raised in PMR?

A

ESR

59
Q

Recall the management options for PMR

A
  1. Physiotherapy

2. Prednisolone

60
Q

What are polymyositis and dermatomyositis?

A

Connective tissue disease characterised by muscle inflammation

61
Q

Recall the aetiology of polymyositis and dermatomyositis

A

Autoimmune, with viral trigger

62
Q

Differentiate the age distribution of polymyositis and dermatomyositis

A

Polymyositis: between 30 and 60
Dermatomyositis: peaks at 5-10 and 50+

63
Q

Differentiate the symptoms of polymyositis and dermatomyositis

A

Polymyositis: weakness of proximal muscles with distal sparing, pharyngeal weakness (causing dysphagia)
Dermatomyositis: rash, systemic organ complication and fever

64
Q

What investigation result will confirm a diagnosis of polymyositis

A

Creatine kinase 50 x higher than normal

65
Q

What investigation result will confirm a diagnosis of dermatomyositis

A

Antibodies present in blood

66
Q

What sort of crystals are deposited in pseudogout?

A

Calcium pyrophosphate dihydrate

67
Q

Define reactive arthritis

A

Sterile arthritis occuring after an extra-articular infection (usually GI or urological)

68
Q

What is Reiter’s syndrome?

A

Triad of:
Reactive arthritis
Urethritis
Conjunctivitis

69
Q

What is the HLA association of reactive arthritis?

A

HLA-B27

70
Q

What is the most commonly implicated pathogen in reactive arthritis?

A

Chlamydia trachomitis

71
Q

What is a common precipitating factor for reactive arthritis?

A

Heavy drinking

72
Q

What is the HLA association of rheumatoid arthritis?

A

HLA-DR4

73
Q

What are the most commonly-affected joints in rheumatoid arthritis?

A

MCP and PIP

74
Q

Recall 3 signs in the hands of rheumatoid arthritis

A

Swan-neck deformity
Boutonierre’s deformity
Ulnar deviation due to MCP subluxation (later sign)

75
Q

In what % of rheumatoid arthritis patients are they RF pos?

A

70%

76
Q

What does joint aspiration show in the acute setting of rheumatoid arthritis presentation?

A

Nothing - but it rules out septic arthritis

77
Q

What is sarcoidosis?

A

Multisystem granulomatous inflammatory disorder of unknown aetiology

78
Q 
Recall a symptom of sarcoidosis for each of the following systems:
Respiratory
MSK
Eyes
Skin
Neurological
Cardiac
A 
Dry cough
Polyarthralgia/dactylitis
Keratoconjunctivitis sicca/ uveitis/ papilloedema
Erythema nodosum
Cerebellar ataxia
Arrhythmias/ cardiomyopathy
79
Q

Recall an electrolyte imbalance that is common in sarcoidosis

A

Hypercalcaemia

80
Q

Describe the LFTs of someone with sarcoidosis

A

High ALP and GGT

81
Q

What would lung biopsy show in sarcoidosis?

A

Granulomas

82
Q

What is Sjorgen’s syndrome?

A

Inflammation and destruction of exocrine glands- usually salivary and lacrimal

83
Q

What is the HLA association of Sjorgen’s syndrome?

A

HLA-DR3

84
Q

Describe the symptoms of Sjorjen’s syndrome

A 
Dryness of:
Eyes - keratoconjunctivitis sicca
Mouth - dysphagia
Airways - dry cough
Vagina - dyspareunia
Intestinal system - constipation
85
Q

Recall 2 abnormal blood findings in Sjorgen’s syndrome

A 
Raised ESR 
Raised amylase (due to salivary gland involvement)
86
Q

Recall the mnemonic for and the criteria for diagnosis of SLE

A 
SOAP BRAIN MD
Serositis
Oral ulcers
Arthritis
Photosensitivity
Bloods (leuko/thrombocytopaenia)
Renal disease
ANA
Immunoglobulins
Neurological disorders

Malar rash
Discoid rash

87
Q

Recall the 2 key antibodies that can be identified in a high proportion of SLE patients

A

Anti-dsDNA

RF

88
Q

What is scleroderma also known as?

A

Systemic sclerosis

89
Q

What is scleroderma?

A

Widespread damage to small blood vessels and fibrosis of skin and internal organs

90
Q

Recall the 4 types of scleroderma

A

Pre-scleroderma
Diffuse cutaneous slceroderma
Limited cutaneous scleroderma
Scleroderma sine scleroderma

91
Q

Describe pre-scleroderma

A

Raynaud’s phenomenon

ANA positive

92
Q

Describe diffuse cutaneous scleroderma

A

Raynaud’s
Tendon friction + joint contracture
Heart, GI and renal disease

93
Q

Describe limited cutaneous scleroderma

A 
Scleroderma gives you CRUSTy skin
Calcinosis
Raynaud's
"U"sophageal dysmotility
Sclerodactyly
Telangiectasia
94
Q

What is scleroderma sine scleroderma

A

Internal organ disease without skin changes

95
Q

What is the main antibody implicated in systemic sclerosis?

A

Anti-centromere

96
Q

What are vasculitides?

A

Inflammation of the blood vessels

97
Q

Give 2 examples of large vessel vasculitides

A

Giant cell arteritis

Takasayu’s arteritis

98
Q

Give an example of a medium vessel vasculitides

A 
Polyarteritis nodosa
(usually on feet)
99
Q

Give an example of a small vessel vasculitides

A

Microscopic polyangiitis

100
Q

Recall 3 symptoms of polyarteritis nodosa

A

Microaneurysms
Thromboses
Testicular pain

101
Q

What would a urine dip show in vasculitides?

A

Haematuria, proteinuria

Year 3 ICSM COPY (17 decks)

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