Diseases of the musculoskeletal system Flashcards Preview

Module 204 Theme 2 > Diseases of the musculoskeletal system > Flashcards

Flashcards in Diseases of the musculoskeletal system Deck (71):
1

What prefix is used to describe a problem with bones?

Osteo

2

What prefix is used to describe a problem with muscle?

My/Myo

3

What prefix is used to describe a problem with joints

Arth

4

What prefix describes a problem with cartilage?

Chondro

5

Which suffix denotes inflammation?

-itis

6

Which suffix denotes pain?

-algia

7

What is tendonitis a problem of?

Tendon

8

What is bursitis?

Inflammation of bursa

9

What are bursae?

Bursae are synovial membrane lined pockets

10

What is the function of bursae?

allow free movement of adjacent structures where otherwise, there could be friction.

11

What is enthesistis?

Inflammation of an enthesis.

12

What are entheses?

points where tendons, ligaments or joint capsules insert into bone.

13

Where is the largest site of an enthesis?

Achilles insertion.

14

What is osteoporosis?

Reduced bone density

15

What is osteomalacia?

Poor bone mineralization

16

What is osteomyelitis?

Bone infection

17

What is osteosarcoma?

Malignant bone tumour

18

Which word is used for muscle inflammation?

Myositis

19

What is myalgia?

Muscle pain

20

How common is myalgia?

Very common

21

What is myalgia commonly associated with?

Viral infection
Drugs (satins)

22

What can myositis be?

Autoimmmune

23

How common is myositis?

Less common than myalgia

24

What is a joint?

Where or more bones meet one another

25

How would you approach a patient with a msk problem?

Full history - often enough to make diagnosis
Physical examination
Serology tests - help support diagnosis

26

List some ways of classifying Rheumatic disease

Articular
Non-articular/periarticular
Inflammatory
Non-inflammatory/degenerative/Mechanical
Number of joints affected
Duration of onset

27

Describe periarticular pain

Point tenderness over the involved structure

Pain reproduced by movement involving that structure

28

Describe articular pain

Joint line tenderness

Pain at end of movement in any direction

29

Which structures does periartciular pain affect?

Bursae
Tendon
Tendon sheath
Ligaments

30

How can articular pain be further differentiated?

Inflammatory/mechanical

31

What is monoarthritis?

Arthritis affecting 1 joint

32

What Is oligoarthritis?

Arthritis affecting 4 or fewer joints

33

What is Polyarthritis?

Arthritis affecting 5 or more joints

34

You are asked to review a patient presenting with thenar eminence atrophy. Which nerve do you think is affected?

Median nerve

35

Which epicondyle is affected in tennis elbow?

Lateral

36

What are soft tissue conditions?

Problems with radiolucent moving tissues

37

Give some examples of soft tissue conditions

Tennis elbow (lateral epicondylitis)
Golfers elbow (medial epicondylitis)
Carpal tunnel (median nerve compression at the wrist)

38

What is the importance of rheumatic disease?

Increasingly common
Important
Expensive
Leading cause of disability

39

Which is the most common form of arthritis in the UK?

Osteoarthritis

40

Describe the worldwide impact of MSK disorders

2nd most common cause of disability

Low back pain is leading cause

Disability due to MSK problems is increasing - ageing population and sedentary lifestyle

41

How much do you estimate the NHS in the UK spends in a year on treating musculoskeletal conditions?

10 billion

42

How do msk problems affect work?

Barrier to work
People with these conditions are less likely to be employed

43

What is septic arthritis classed as?

Medical emergency

44

You are asked to review a 35 year old male, who presents with a 2 days history of a painful, swollen right knee. What are your differential diagnosis?

Posttraumatic hemarthrosis
Gout
Septic arthritis

45

What must be considered in cases of hot swollen joints?

joint aspiration and gram stain

46

Describe septic arthritis

Single, hot and swollen joint
Most common organisms are staph and strep
Patient may be systemically well and able to bear weight

47

What are the mortality rates of septic arthritis?

11% which rises to 50% in polyarticular disease with sepsis

48

What is gout?

Most common arthropathy worldwide
Serum urate levels are high (>408)
Monosodium urate crystals form and deposit In cartilage, bone, periarticular tissues of peripheral joints

49

Who gets gout?

2.5% of population
Men over 40
Women over 65

50

What is associated with the risk of gout?

Increasing age
Male sex
Metabolic syndrome components - insulin resistance, obesity, hypercholesterolemia and hypertension
Drugs - loop and thiazide diuretics
Osteoarthritis
Genetics
Chronic kidney disease
Diet

51

What crystals are you expecting to find in the knee fluid aspirated from a patient if you suspect clinically that he has gout?

Monosodium urate

52

What is gout caused by?

Negatively birefringent rods – monosodium urate

53

How do you manage acute attacks of gout?

– NSAIDs e.g. naproxen
– Colchicine
– Steroids

54

How do you manage gout in the long term?

Urate-lowering therapy e.g. allopurinol or febuxostat

55

What is pseudo out caused by?

positively birefringent rhomboids – calcium pyrophosphate

56

Describe rheumatoid arthritis

Common, chronic, multisystem inflammatory condition affecting up to 0.5-1% of the world population

Unknown cause with around 30% genetic susceptibility and the rest environmental

More common in women (3:1)

Peak onset is 45-65 years

57

In rheumatoid arthritis which is the first joint component affected?

Synovium

58

In osteoarthritis which is the first joint component affected?

Cartilage

59

What is the most important environmental risk factor is Rheumatoid arthritis?

Smoking

60

Describe the pathophysiology of Rheumatoid arthritis?

Early lymphocyte invasion of the synovium

Acute inflammatory reaction - swelling and increased vascular permeability

Synovial proliferation

Pannus formation

Cartilage destruction and bone erosion

61

What are the symptoms and signs of rheumatoid arthritis

Onset varies, can be acute or chronic

Symmetrical pain and boggy swelling of the small joints of the hands and feet (MCP, PIP, wrist, MTP, subtalar.
NOT the DIPs)
Early morning stiffness > 1 Hour

Malaise and fatigue are common

Systemically unwell

Examination - look for pain, swelling and restriction of movement

Also really important to examine other organ systems as RA is a systemic disease

62

List some extra articular manifestations of rheumatoid arthritis

Nodules (20%)

Bursitis / Tenosynovitis

Eyes: dry eyes (secondary Sjogren’s syndrome) / Scleritis / Scleromalacia

Splenomegaly (Felty’s)

Anaemia of chronic disease

Lung fibrosis /effusion /Nodules (Caplan’s)

Pericarditis

Neurological: Atlanto-axial subluxation / Carpal tunnel syndrome / Mononeuritis multiplex

Renal amyloidosis (AA)

Leg ulcers / Pyoderma gangenosum

Vasculitis

Increased risk of cardiovascular disease

63

List some investigations for rheumatoid arthritis

•  ESR and CRP
• FBC:  Anaemia of chronic disease (normochromic normocytic)
•  Rheumatoid factor positive
– IgM antibody against the FC portion of human IgG antibodies
– can be falsely elevated by illness
– normal raised levels in 1 in 20 of population
•  Anti CCP antibodies - cyclic citrullinated peptide antibodies
– Antigen present on inflamed synovium
– 98% specific for diagnosis of RA
•  X-Rays : normal in early disease.. erosions / peri-articular osteoporosis and reduced joint space / cysts

64

Describe the management of rheumatoid arthritis

• Early and aggressive treatment to reduce inflammation and joint damage
•  Non-steroidal anti-inflammatory drugs for short periods
•  Corticosteroids
• Intra-articular joint injections if only 1 or 2 troublesome
Systemic if many joints are a problem. The main routes are IM or PO though in severe disease we may give IV steroid.

DMARDs – Disease Modifying Anti-Rheumatic Drugs
Synthetic DMARDs
• Methotrexate
• Sulfasalazine • Hydroxychloroquine
• Leflunomide
Biologic Agents • Anti TNF agents ( Etanercept, Adalimumab, Infliximab)
Anti B-cell (Rituximab) • Anti Interleukin-6 receptor blocker (Tociluzumab) • Anti T-cell – selective co-stimulation modulator- CTLA4-Ig (Abatacept)
Janus kinase inhibitor (JAK 2) (Tofacinitib, Baricitinib)

65

Describe osteoarthritis

• Common, degenerative disease of which the prevalence increases with age
•  Affects 70% of over 65 years olds
•  Most commonly clinically affects the knees, hips and small joints of the hands (DIP, PIP, 1st CMCJ)
• Characterised by joint pain and very variable degrees of functional limitation

66

Describe the pathophysiology of osteoarthritis

• Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles)
•  Focal destruction of articular cartilage
•  Remodelling of adjacent bone = hypertrophic reaction at joint margins (osteophytes)
•  Remodelling and repair process (efficient but SLOW)
•  Secondary synovial inflammation and crystal deposition

67

List the clinical features of osteoarthritis

• Age > 50 years• Morning stiffness < 30 minutes• Persistent joint pain aggravated on use
• Crepitus• NO INFLAMMATION• Bony enlargement and/or tenderness

68

Is there a clinical correlation between the radiological changes and the symptoms in osteoarthritis?

No

69

Are blood tests helpful in diagnosis osteoarthritis?

No

70

Describe SLE

Chronic, relapsing, remitting disease
Broad spectrum of clinical features involving almost all organs and tissues
Prevalence in the UK: 97 per 100,000
F:M= 10-20:1
Peak onset between 15- 40 years
More common and severe in those of Afro-Caribbean, India, Hispanic and Chinese origin living in USA and Europe> Caucasians

71

List some SLE investigations

Urinalysis – urinary protein: creatinine ratio
Full blood count
Urea and electrolytes
ESR
CRP
Liver function test
Antibodies: ANA; ENA; Anti –dsDNA; Lupus anticoagulant; ANTI C1q;
C3, C4