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*MSK-Rheum > Summary > Flashcards

Summary Flashcards

1
Q

What is the pathophysiology of Rheumatic Fever?

A

Group A beta-haemolytic strep –> Pharyngitis –> 2-4 weeks later = rheumatic fever

  1. cross reaction of antibodies against the group A b-haem strep carbohydrate cell wall
  2. TO HEART VALVE TISSUE
  3. gives –> permanent heart damage
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2
Q

How do you diagnose rheumatic fever?

A

Jones criteria

uses _2 majo_r criteria

or 1 major + 2 minor

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3
Q

What are the major criteria of the jones criteria (rheumatic fever)?

A

Major criteria include:

  1. Carditis
  2. Arthritis
  3. Subucaneous nodules
  4. erythema marginatum
  5. Sydenhams chorea
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4
Q

What are the S&Syx of carditis?

A

Cardiomegaly

conduction defects

mitral/aortic regurg

tachycardia

pericardial rub

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5
Q

What are the S & Syx of rheumatic fever arthritis?

A
  • flitting polyarthritis - one joint settles then anothe flares (= typical of acute rheum fever)
  • migratory (spreading pain from one joint to another)
  • usually affects LARGER joints
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6
Q

What are subcutaneous nodules? R.e. rheumatic fever

A

small, mobile, painless nodules on

  • extensor joint surfaces
  • spine
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7
Q

What is erythema marginatum r.e. rheumatic fever?

A

red rash w/ raised edges and clear centre

  • mainly on trunk & arms
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8
Q

What is sydenhams chorea?

(also called St Vitus’ Dance)

A
  • sydenhams chorea
  • = bi OR uni lateral
  • involuntary
  • semi-purposeful movements

(maybe) preceeded by

  1. emotional lability
  2. uncharacteristic behaviour
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9
Q

What are the minor jones criteria for rheumatic fever?

A
  1. Fever
  2. Raised ESR & CRP
  3. Arthralgia
  4. Prolonged PR interval
  5. Previous rheumatic fever

e.g. a patient comes in with joint pain and fever. their bloods show raised ESR and CRP and they have a prolonged PR interval. You ask if they have had rheumatic fever before they say yes.

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10
Q

What is the management of rheumatic fever?

A

Benzylpenicillin

  • Analgesia (carditis/ arthritis):
    • aspirin or NSAID
  • Hapolperidol or diazepam
    • for chorea
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11
Q

What is the name of the shaft of the bone?

A

diaphysis

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12
Q

what is the name for the end of the bone?

A

epiphysis

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13
Q

what is the name of the growth plate?

A

physis

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14
Q

what is the name of the cone of the bone?

A

metaphysis

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15
Q

What is the covering of the bone called and made up of?

A

Periosteum

& it has a

  1. Fibrous layer
  2. Cellular layer
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16
Q

What is the outershell of the bone called & made up of?

A

Cortex (outershell, husk)

made of lamella bone

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17
Q

what is the middle of the bone called and made up of?

A

Medulla: and it contains -

  • trabecular / cancellous bone
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18
Q

What are the causes of bone pain/tenderness?

(2 malig, 5 bone, 5 general)

A

Malignancy

  1. Myeloma or other primary malignancy e.g. sarcoma
  2. Secondary malignancy (BLT PK)

Bone problems

  1. Osteonecrosis e.g. from microemboli
  2. Osteomyelitis/ periostitis
  3. Osteosclerosis e.g. from hepC
  4. Renal osteodystrophy
  5. Paget’s disease of bone

Systemic causes

  1. Trauma/#
  2. Hydatid cyst
  3. Sickle cell anaemia
  4. CREST syndrome (systemic sclerosis)/ Sjogren’s
  5. Hyperparathyroidism
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19
Q

A patient has bone pain.

What investigations do you do?

A
  • PSA (prostate mets)
  • ESR (myeloma marker (&lymphoma)
  • Ca2+ (if ca2+ is released from bones e.g. PTH releases Ca from bones)
  • LFT (show inflam arthtitis and hep c can cause osteosclerosis)
  • electrophoresis (protein - for M proteins = myeloma, also AI conditions, anaemia, thyroid, poor nutrition and diabetes)
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20
Q

How do you treat a patient with bone pain?

A
  • Treat cause
    • bisphosphonates (bone strengthener - stop/slow bone resoprtion of remodelling cycle)
    • NSAIDs (stop inflamm e.g. bone problems can be)
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21
Q

What questions do you ask in an MSK/rheum hx?

A
  1. Name/age/occupation
  2. R/L handed
  3. Pain? - SOCRATES
    • wake up at night?
  4. Limited? (by joint problem)
    • stairs?
    • help devices e.g. orthopaedic shoes
  5. instability?
    • mechanical - problem in joints and ligaments
    • functional - joint intact but pain and unstable
  6. Comorbidities
    1. ​DM, smoking, HD, blood thinners
22
Q

What tests can be done on joint aspirates?

A
  • WCC
  • Gram stain
  • light microscopy
    • & Culture
23
Q

What does normal synovial fluid show on joint aspiration?

A

Clear and gin like (no viscoscity), WCC <200 and no neutrophils

24
Q

What does osteoarthritis show on joint aspiration?

A

Clear but straw like colour

raised viscosity

<1000 WCC

50% neutrophils

25
Q

What does haemorrhagic synovial fluid show on joint aspiration?

A

bloody and xanthochromic

variable viscocity

< or equal to 10,000 mm3 WCC

<50% neutrophils

26
Q

What does rheumatoid arthritis show on joint aspiration?

A

turbid and yellow synovial fluid

lower viscosity

WCC- 1-50,000

variable neutrophils

27
Q

What does crystal arthritis (calciumd pyrophosphate) show on joint aspiration?

A

turbid and yellow synovial fluid

lower viscosity

WCC 5-50,000

neutrophils ~80%

28
Q

What does septic arthritis show on joint apsiration?

A

Turbid and yellow synovial fluid

lower viscosity

WCC - 10-10,000

Neut - >90%

29
Q

What blood tests are done for Rheum/MSK?

A

General: FBC, U&E, CRP, ESR,

Conditions:

  • Urate
  • Blood cultures (septic arthritis)
  • Anti CPP (RA), rheumatoid factor (Ra and sjogrens)
  • ANA
  • Other autoantibodies e.g. HLAB27
30
Q

What radiological findings would be seen in an OA joint?

A

L.O.S.S.

  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis (hardening)
  • Subchondral cysts
31
Q

What radiological findings would be seen in an RA joint?

A

(seen in metacarpalphalangeal joints - e.g. knuckles)

  1. loss of joint space
  2. joint deformity
  3. juxta articular osteopenia
  4. soft tissue swelling
32
Q

What radiological findings would be seen in gout?

A

1st MTPJ (big toe knuckle)

  1. Periarticular erosions
  2. normal joint space
  3. soft tissue swelling
33
Q

What are examples of systemic rheumatic disease?

A

= inflamm disease in joints & also multiple extra articular manifestations - autoantibodies used to classify but ?u/k pathophys

  • RA
  • SLE
  • Scleroderma (chr connective tissue and skin hardening)
  • mysositis (inflam and degen of muscle tissue)
  • mixed connective tissue disease (SLE, systemic sclerosis, polymysositis; reynauds, joint pain, muscle and internal organ problems)
34
Q

What are spondyloarthropathies and its examples?

A

AKA seronegative arthropathies

a group of chronic disorders

  • sacroiliatitis (SI joint inflamm)
  • spondtlitis (vertebrae inflamm)
  • all assoc w/HLA-B27
  • Rheumatoid factor serum usually negative - (seroNEG)

Ank spond, psoriatic arthritis, reactive arthritis, enteropathic arthropathies

35
Q

What are examples of vasculitis?

A

vascultitis - inflammatory destruction of blood vessels

1ry forms:

  1. giant cell arteritis
  2. chaug strauss vasculitis
  3. wegeners granulomatosis
  4. behcets disease
  5. polyarteritis nodosa

or can be 2ry to other inflam or infectious conditions

angitis = similar to vascultis but angitis = small BV

36
Q

What is crystalline arthropathy?

A

crystal deposition in joints seen in gout and psuedogout (calcium pyrophosphate)

usually mono/oligoarticular - 1 joint/few joints

37
Q

What is infectious arthritis?

A
  • joint infefction
  • –> seen in septic arthritis,
  • often occurs in already damaged joint
  • also seen in disseminated gonococcal (N.Gono) infection
38
Q

What are the functions of bone?

A
  1. structural support/movement
  2. mineral storage
  3. haematopoietic
39
Q

What are the components of bone?

A
  1. Ca
  2. PO4-,
  3. Type 1 collagen - [makes bones (1 is straight like bone), ligaments/tendons and skin, NB: T2 (2 is wiggly) collagen is in cartilage]
  4. Proteoglycans - ECM filler substance, it attaches other PGlys, hyaline, collagen etc
  5. Water
40
Q

What are the cells in bone?

A

Cells:

osteoblasts (formation),

osteoclasts (resorption),

osteocytes (cycle, arte blasts embedded in own matrix and some bone production capacity there),

bone lining cells - dormant fibroblast like cells COVER bone surface

41
Q

What are the types of bone?

A

Cortex (husk, outershell) =

  • Compact/cortical/lamellar -
    • –> mechanical &
    • protective functions

Medulla =

  • Cancellous/spongy/trabecular -
    • –> metabolic regulation of calcium
42
Q

What happens to the spine from birth to ageing?

A

C shaped at birth, acquires curvatures & upright posture;

  • Cervical lordosis (support head) & then lumbar lordosis (support body weight)

Then loses height with ageing - 1cm loss per decade after 40yrs; caused by:

  1. Narrowing of IV disks
  2. Osteoporosis
  3. Vertebral collapse
  4. Kyphosis (thoracic spine)
  5. Loss of arches of foot
43
Q

What is varus?

A

Varus the pig

joint (e.g. from the joint to the distal part of the limb) deviation towards the midline

44
Q

What is valgus?

A

joint deviation away from the midline

(e.g. joint to distal part of the limb)

45
Q

What is the medical term for spine degeneration?

A

Spondylosis

46
Q

What is the medical term for fracture of pars interarticularis?

A

Spondylolysis

~scotty dog sign on x-ray

47
Q

what is the medical term for slipping of the vertebrae?

A

Spondylolisthesis

e.g.

(of L5 on surface of S1)

48
Q

What is a bunion?

/hallucis valgus

A

Halux valgus (“bunion”):

  1. subluxation of 1st MTP joint,
  2. joint destabilised,
  3. abductor hallucis slips below metatarsal head,
  4. loss of stability of intrinsic muscles –> adductor hallucis becomes a deforming force –> EHL & FHL eventually slide into 1st web space, accentuating the deformity
    • Lateral deviation of great toe
    • Medial deviation of metatarsal head
49
Q

What are the factors affecting bone strength/density?

A
  1. Age
  2. Bone mineral density
  3. Mineralisation
  4. Bone turnover
  5. Geometry
  6. Trabecular architecture (medulla/middle)
  7. Cortical thickness (cortex, outershell/husk)
50
Q

How does age affect bone density/strength?

A
  • men develop higher bone density than women -
  • bone density develops until late 20s/28
  • both: constolidation/plateau until ~45y/o :-
  • menopause = steeper drop in density for women –> within fracture threshold in 80s
  • men also have steady sc from 42-09 just w/o extra steep bit during menopause

*MSK-Rheum (6 decks)

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