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2B - GRIND > MSK > Flashcards

MSK Flashcards

1
Q

Sx of OA?

A 
Localised disease (hip/knee): Pain and crepitus on movement with background ache at rest - joints may feel unstable. Symptoms worse with prolonged activity.
Generalized disease (nodal): Bouchard's nodes (PIP) and Heberden's nodes (DIP), reduced range of movement and mild synovitis
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2
Q

What is seen on X-ray in OA?

A

Loss of joint space, Osteophytes, Subchondral cysts and Subarticular sclerosis

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3
Q

Tx of OA?

A

Exercise to improve local muscle strength and weight loss if obese.
Analgesia (regular paracetamol or NSAIDs), intra-articular corticosteroids, joint arthroplasty.

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4
Q

Sx of septic arthritis?

A

Sudden onset severe joint pain and swelling, colour change in the skin around the joints and fever

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5
Q

Tx of septic arthritis?

A

Aspirate the joint and send for microbiological culture

Start antibiotic treatment ASAP.

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6
Q

Common causative organisms of septic arthritis? How can you identify them?

A

Staph. aureus = gram positive catalase positive cocci which is also coagulase positive
Neisseria gonococcus = gram negative diplococci
Streptococcus and Gram -ve bacilli

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7
Q

Sx of RA?

A

Symmetrical swollen, painful and stiff small joints of the hands/feet which is worse in the morning.
Ulnar deviation, Boutonniere deformitiy and Swan-neck deformity
Fever, fatigue, weight loss and pericarditis

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8
Q

Dx of RA?

A

Anti-CCP positive
X-ray = Loss of joint space, Errosions, Soft bones (juxta-articular osteopenia), Soft tissue swelling and joint deformity

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9
Q

Tx of RA?

A

Eary use of DMARDs, steroids, TNF-alpha inhibitors e.g. infliximab. Give NSAIDs for pain

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10
Q

Sx of gout?

A

Sudden onset severe joint pain and swelling (often in the MTP joint of the big toe). Tophi indicate long term high urate levels

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11
Q

RFs for gout?

A

Impaired renal function: hypertension, diuretics, anti-hypertensives, aspirin and DM
High purine diet e.g. red meat, seafood, alcohol etc.
Tumour lyisis syndrome

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12
Q

Dx and Tx of gout?

A

ASPIRATE! Negativley birefringent, needle shaped, monosodium urate crystals seem on microscopy.
High dose NSAIDs/steroids/colchicine. Allopurinol for long term prevention.

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13
Q

Dx and Tx of pseudogout?

A

ASPIRATE! Positivley birefingent phosphate crystals - usually affects the knee.
Intra-articular steroids. NSAIDs and colchicine for long term prevention

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14
Q

Name the spondylarthropathies. What do they have in common?

A

Ankylosing spondylitis, Psoriatic arthritis and Reactive arthritis.
Seronegative (RF -ve), associated with HLA B27, generally asymmetrical, enthesitis, dactylitis and iritis

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15
Q

Sx of ankylosing spondylitis?

A

Young man with gradual onset lower back pain which radiates down the buttocks and is worse at night. Has morning stiffness which is relieved by exercise and progressive loss of spinal movement

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16
Q

Tx of ankylosing spondylitis?

A

Exercise, NSAIDs, local steroid injections and TNF-alpha-blockers e.g. adalimumab

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17
Q

Sx of psoriatic arthritis?

A

Pain, swelling and stiffness in the joints, nail changes e.g. pitting, synovitis => dactylitis and errosive bone changes e.g. pencil-in-cup X-ray deformity

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18
Q

Tx of psoriatic arthritis?

A

NSAIDS, sulfsalazine/methotrexate and anti-TNF agents

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19
Q

Sx of reactive arthritis?

A 
Iritis/conjunctivitis, urethritis and pain/joint stiffness = Reiter's triad
Keratoderma blenorrhagica (brown plaques on palms/soles), painless penile ulceration (if chlamydia)
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20
Q

Sx and Dx of Sjogren’s syndrome?

A

Decreased tear production = dry eyes, decreased salivation = dry mouth and parotid swelling
Schirmer’s test, usualy ANA positive

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21
Q

Sx of systemic sclerosis?

A

Thickening of the skin, patchy itchy skin discolouration, Raynaud’s phenomenom.
Limited (aka CREST syndrome) = face, hand and feet invoment only
Diffuse = weight loss, fatigue, joint pain/stiffness, dyspnoea and hypertension

22
Q

Dx of systemic sclerosis?

A

ANA positive

23
Q

Sx of SLE?

A

Butterfly rash, photosensitive rash, erythema, Raynaud’s phenomenom, alopecia, oral/nasal ulcers, joint stiffness, seizures and weight loss.
High risk of kidney issues

24
Q

Dx of SLE?

A

ANA positive, anti-dsDNA antibodies = BEST TEST, raised ESR but normal CRP

25
Q

Tx of SLE?

A

High factor sun-block, hydroxycholorquine, topical steroids, DMARDs e.g. Azothioprine

26
Q

Sx of anti-phospholipid syndrome?

A

CLOT = Coagulation defects, Livedo reticularis, Obstetric issues and Thrombocytopenia
OFTEN SEEN IN SLE PATIENTS

27
Q

Name the types of blood vessels affected by vasculitis, give an example for each?

A 
Large = GCA
Medium = Polyarteritis nodosa
Small = ANCA associated e.g. Wegener's granulomatosis or immune compex associated e.g. Goodpasture's syndrome
28
Q

Sx of GCA?

A

Headache, scalp tenderness, tongue/jaw claudication, amaurosis fugax.
Malaise, weight loss, dyspnoea and morning stiffness

29
Q

Dx and Tx of GCA?

A

Temporal artery biopsy, very raised ESR and CRP

Oral prednisolone or IV methylprednisolone (if vision loss)

30
Q

Sx of Polymyalgia Rheumatica (PMR)

A

Sub-acute (<2 weeks) bilateral aching, tenderness and morning stiffness of the shoulders/hips/proximal muscles.
Fatigue, fever, weight loss and depression.
Associated with GCA

31
Q

Tx of PMR?

A

Prednisolone

32
Q

What is fibromyalgia?

A 
Chronic pain (>3 months) that is widesperad (left and right sided, above and below the waist and involving the axial skeleton) for which no organic cause can be found.
Sx: Un-refreshing/disturbed sleep, fatigue/pain with small amounts of exertion and morning stiffenss
33
Q

Tx of fibromyalgia?

A

Low dose amitriptyline

34
Q

Sx of cauda equina syndrome?

A

Back pain. Bilateral leg pain, saddle (perianal) anaesthesia, loss of anal tone on PR, bladder incontience, bowel incontinence

35
Q

Sx of acute spinal cord compression?

A

Bilateral pain, LMN signs at the level of compression, UMN signs below the level of compression. May be sphincter disturbance

36
Q

What is osteomyelitis? What causes it?

A

Infection of the bone either from direct innoculation, contiguous spread from adjacent tissues or haematogenously e.g. from pneumonia/UTI via the blood.
Most common casue = staphylococcus aureus

37
Q

Sx of osteomyelitis?

A

Malaise, fever and fatiuge. Swelling, redness and pain over the infection area

38
Q

What is mechanical back pain?

A

Any type of back pain caused by placing abnormal stress and strain on muscles of the vertebral column.
RF = poor posture, poor lifting technique, frequent bending/stooping and whole body vibrations

39
Q

What are the most common discs affected in vertebral disc disease?

A

S1 (ankle jerk reflex lost), L4 (knee jerk reflex lost) and L5

40
Q

Where do secondary bone tumours metastasize from?

A

Breast, thyroid, lung, kidney and prostate.

41
Q

What are the red flags for bone tumours?

A

History of cancer, weight loss, night sweats, unremitting pain, pain which is worse at night, pain in children

42
Q

What is the most common primary bone cancer?

A

Multiple myeloma - most common

Osteosarcoma - most common in children

43
Q

Sx of multiple myeloma?

A

Oesteolytic bone lesions = bone/back pain, pathological fractures and vertebral collapse
Hypercalcaemia = bone pain, renal stones, nausea/vomiting, constipation, abdominal pain, polyuria/polydypsia, weakness and confusion/depression
Pancytopenia and renal impairment

44
Q

Dx of multiple myeloma?

A

Monoclonal protein bands on electrophoresis, increased plasma cells on BM biopsy, evidence of end-organ damage (hypercalcaemia/renal insuffisiency/anaemia) and bone lesions seen on x-ray - commonly spine/skull/pelvis

45
Q

Tx of multiple myeloma?

A

Analgesia for bone pain (not NSAIDs due to renal impairment), bisphosphonates e.g. zolendronate, transfusions, local radiotherapy, chemotherapy and stem cell transplant

46
Q

Which bone types are most often affected in osteoporosis?

A

Trabecular bone = vertebral crush fractures

Cortical bone = NOF

47
Q

How is the risk of osteoporosis assessed?

A

FRAX (measures the 10 year oesteoporotic fracture risk)

48
Q

How do DEXA scans assess osteoporosis?

How do you treat it?

A

The T-score = number of SDs the bone mineral density is from the youthful gender matched average
-1 to -2.5 = osteopenia
-2.5 or worse = osteoporosis
Alendronic acid alongside calcium and vitamin D supplements

49
Q

Sx of osteomalacia?

A

In children it causes rickets = growth retardation, knock-knees or bow legs
In adults = bone pain/tenderness, increased fractures and waddling gait

50
Q

What is Wegener’s granulomatosis?

A

Now known as granulomatosis with polyangiitis. It is necrotizing granulomatous inflammation and vasculitis of the small and medium vessels

51
Q

Sx of Wegener’s granulomatosis (GPA)?

A

Upper airway disease (nasal obstruction, ulcers, epistaxis and saddle-nose deformity)
Renal disease = haematuria and proteinuria
Pulmonary disease = haemoptysis
Skin purpura. ANCA positive!

2B - GRIND (11 decks)

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