MSK Flashcards
(130 cards)
1
Q
Give 3 inflammatory causes of joint pain.
A
Autoimmune
Crystal arthritis
Infection
2
Q
Give 2 non-inflammatory causes of joint pain.
A
Degenerative - osteoarthritis
Non-degenerative - fibromyalgia
3
Q
Name 5 features in the hands of a patient with rheumatoid arthritis.
A
Ulnar deviation Swan neck deformity Z-thumb Distal interphalangeal joint sparing Swollen joints
4
Q
What 5 conditions are associated with HLA-B27?
A
Ankylosing spondylitis Reactive arthritis Enteropathic arthritis Juvenile idiopathic arthritis Acute anterior uveitis
5
Q
What is the first line treatment of osteoporosis?
A
Alendronic acid (bisphosphonate), with AdCal
6
Q
What other treatments are there for osteoporosis?
A
Denosumab
Teriparatide
7
Q
How does denosumab work?
A
Monoclonal antibody that inhibits osteoclasts
8
Q
How does teriparatide work?
A
Analogue of PTH - increases calcium absorption and vitamin D formation
9
Q
Which antibody is specific to SLE?
A
Anti-dsDNA (anti double stranded DNA)
10
Q
What condition must be ruled out in an acutely swollen joint?
A
Septic arthritis
11
Q
What is the first line investigation for septic arthritis?
A
Aspirate joint for synovial fluid, culture fluid
12
Q
What is the name for distal interphalangeal joint swelling seen in osteoarthritis?
A
Heberden’s nodes
13
Q
What is the name of the classification of fractures in children involving the growth plate?
A
Salter-harris classification
14
Q
What is a T score?
A
Bone density relative to a healthy 25 year old of the same gender
15
Q
What is a Z score?
A
Bone density relative to the average for their age of the same gender
16
Q
What is a FRAX score?
A
Risk of developing a fracture in the next 10 years
17
Q
What is allopurinol primarily prescribed for?
A
Long term treatment of gout
18
Q
What else can allopurinol be used for?
A
To prevent uric acid/calcium oxalate build up
Treatment of hyperuricaemia in tumour lysis syndrome
19
Q
What is the mechanism of allopurinol?
A
Xanthine oxidase inhibitor - prevents the conversion of xanthine into uric acid
20
Q
What is the first line treatment of temporal arteritis?
A
Prednisolone
21
Q
What symptoms are associated with Wegener’s granulomatosis (granulomatosis with polyangitis)?
A
Hearing loss, sinusitis, nose bleeds
22
Q
What is the treatment of Wegener’s granulomatosis?
A
Steroids/immunosuppressants
23
Q
What antibodies are specific to Sjogren’s?
A
Anti-ro, anti-la
24
Q
What other antibodies will be positive in Sjogren’s syndrome?
A
ANA, rheumatoid factor
25
What is the first line treatment of Sjogren's?
Prednisolone, artificial saliva/tears
26
What is the triad of symptoms seen in Sjogren's?
Dry eyes, dry mouth, inflammatory arthritis
27
What conditions is Sjogren's often secondary to?
Rheumatoid arthritis, Systemic lupus erythematous
28
What antibody is specific to SLE?
Anti-dsDNA
29
Give 8 complications of SLE.
```
Lupus nephritis
Recurrent miscarriage
Anaemia
Pericarditis
Pleuritis
Interstitial lung disease
Venous thrombosis
Cardiovascular disease
```
30
What features are seen on X-ray in a patient with ankylosing spondylitis?
```
Squaring of vertebral bodies
Subchondral sclerosis
Sacroiliitis
Ossification of ligaments
Syndesmophytes
```
31
Give 3 examples of anti-TNF drugs.
Etanercept, infliximab, adalimumab
32
What is the first line management of osteoarthritis?
Topical analgesia - capsaicin, diclofenac
33
What is the second line management of osteoarthritis?
Oral NSAIDs (given with a PPI)
34
What is the management of osteoarthritis not improved by pharacmological treatment?
Joint replacement surgery
35
What is Paget's disease of bone?
Increased resorption, formation and remodelling of bone
36
How would the skull of someone with Paget's disease appear on X-ray?
Cotton wool appearance - areas of high and low density bone
37
What LFT is abnormal in Paget's disease?
ALP
38
What is the first line treatment of Paget's disease?
Bisphosphonates
39
What is the most specific rheumatoid arthritis antibody?
Anti-CCP (anti cyclic citrullinated peptide antibody)
40
What is the first line treatment of rheuamtoid arthritis?
One DMARD
41
What is the second line treatment of rheumatoid arthritis?
Two DMARDs
42
What is the third line treatment of rheumatoid arthritis?
Add a biologic treatment to DMARDs
43
Name 3 DMARDs.
Methotrexate, sulfasalazine, hydroxychloroquine
44
What is Felty's syndrome?
A complication of rheumatoid arthritis
45
What is the triad of symptoms in Felty's syndrome?
Splenomegaly, neutropenia, rheuamtoid arthritis
46
What is dermatomyositis?
Chronic inflammation of the skin and muscles
47
What conditions is creatinine kinase raised above 1000 in?
```
Rhabdomyolysis
AKI
MI
Statin use
Strenuous exercise
Dermatomyositis
Polymyositis
```
48
What is classic of rhabdomyolysis?
Cola coloured urine and muscle pain
49
What antibody is seen in both dermatomyositis and polymyositis?
Anti-Jo-1
50
What antibodies are more specific to dermatomyositis than polymyositis?
Anti-Mi-2
| ANA
51
What is the gold standard investigation for temporal arteritis?
Temporal artery biopsy
52
What is the most likely causative organism of septic arthritis post-surgery?
Staphylococcus aureus
53
What empirical antibodies are best for a post surgical septic arthritis?
Flucloxacillin (+ rifampicin for first two weeks)
| Use vancomycin if penicillin allergic
54
Which cancers commonly metastasise to bone?
```
Breast
Prostate
Thyroid
Liver
Kidney
```
55
How should alendronic acid be taken?
Patients should remain upright for 30 minutes after taking
| Should be taken first thing in the morning with a glass of water
56
What is Schirmer's test?
Filter paper is placed into the eye to measure tear production
57
What condition is Schirmer's test used to investigate?
Sjogren's
58
What feature may be seen on X-ray of a patient with psoriatic arthritis?
Pencil in cup
59
What is the first line pain management in ankylosing spondylitis?
NSAIDs
60
Which joint does pseudogout often present in?
The knee
61
Which joint does gout most commonly present in?
Big toe
62
What causes osteomalacia?
Vitamin D or calcium deficiency
63
What is the classic triad of symptoms seen in reactive arthritis?
Conjunctivitis, urethritis, arthritis
64
What is seen in a swan neck deformity?
DIP hyperflexion, PIP hyperextension
65
What is seen in Boutonniere's deformity?
PIP hyperflexion, DIP hyperextension
66
What criteria needs to be met to put a patient on allopurinol?
Has had more than one gout flare up or has gouty tophi
67
What is given with allopurinol when a patient is first put on it and why?
Colchicine - allopurinol can initially increase the risk of gout flare ups
68
What disease are associated with enteropathic arthritis?
IBD
69
What antibodies are seen in Wegener's granulomatosis?
c-ANCA
70
What antibodies are seen in systemic sclerosis?
Anti-centromere antibodies
71
What antibodies are seen in polymyositis?
Anti-Jo-12
72
What condition is HLA-DR2 associated with?
SLE
73
What blood result is raised in Paget's disease?
ALP only
74
Why is only ALP the only thing raised in Paget's disease?
Increased bone turnover increases ALP and nothing else
75
What medication can predispose a patient to gout?
Thiazide diuretics
76
What should a gout patient be placed on instead of thiazide diuretics?
ARB or CCB
77
Why can thiazide diuretics contribute to gout?
They increase the absorption of urate in the proximal tubules of the kidney
78
What level lesion would lead to loss of the knee jerk reflex?
L4
79
What nerve root lesion causes sciatica?
S1
80
What type of bacteria is pseudomonas aeruginosa?
Gram negative bacilli
81
What is the most common cause of septic arthritis?
Staphylococcus
82
Is rheumatoid arthritis usually symmetrical or asymmetrical?
Symmetrical
83
What is the gold standard investigation for osteoporosis?
DEXA scan
84
What is a characteristic of pseudogout on X-ray?
Calcifications opposite to the articular surface (due to calcium pyrophosphate deposition
85
What is the last line management of osteoarthritis?
Intrarticular steroid injections - methylprednisolone
86
Other than STIs, what is the most common cause of reactive arthritis?
Campylobacter jejuni
87
What is the most specific antibody for Sjogren's?
Anti-La
88
What levels of ESR and CRP are seen in SLE?
High ESR
| Normal CRP
89
What is the action of methotrexate?
Folic acid inhibitor
90
Why is methotrexate teratogenic?
Folic acid (which is inhibited), is crucial to the neurodevelopment of a foetus
91
What nerve lesion can cause wrist drop?
Radial nerve
92
What criteria need to be met to be classified as severely osteoporotic?
T score < 2.5, and a known pathological fracture
93
What condition is highly associated with temporal arteritis?
Polymyalgia rheumatica
94
What complement factors are reduced in lupus?
Complement 3 and 4
95
What cancer do patients with Sjogren's have an increased risk of?
Non-Hodgkin's lymphoma
96
What are the extra-articular manifestations of ankylosing spondylitis?
5As
- Anterior uveitis
- Autoimmune bowel disease
- Apical lung fibrosis
- Amyloidosis
- Aortic regurgitation
97
What bedside test can be used to test mobility of the spine?
Schober's test
98
What does Schober's test involve?
Locate L5 vertebrae while patient is standing
Measure 10cm above and 5cm below
Have patient bend over
If distance between points is < 20cm, indicates ankylosing spondylitis
99
What features are seen on X-ray in ankylosing spondylitis?
```
Squaring of vertebral bodies
Bamboo spine
Syndesmophytes
Sacroiliac fusion
Subchondral sclerosis
```
100
What is the first line treatment of ankylosing spondylitis?
NSAIDs
Steroids during flares
Anti-TNF - etanercept, infliximab
101
What is a key differential of osteoarthritis?
Rheuamtoid arthritis
102
What are the first line treatments of osteoarthritis?
Topical NSAIDs, topical capsaicin
| Oral NSAIDs/paracetamol, bisphosphonates
103
What medication is used in intra-articular steroid injections?
Methylprednisolone
104
What is the most sensitive antibody test for rheumatoid arthritis?
Rheumatoid factor
105
How is the progression of rheumatoid arthritis monitored?
CRP and ESR levels
106
What is a life threatening complication of rheumatoid arthritis?
Felty's syndrome
107
Give 5 extra-articular manifestations of rheumatoid arthritis.
```
Sjogrens
Vasculitis
Pericarditis
MI
Pleuritis
```
108
Give 3 side effects of bisphosphonates.
Oesophagitis
Oesophageal ulcers
Osteonecrosis of the jaw
109
Give 5 risk factors for osteoporosis.
```
Early menopause
Steroids
Hyperparathyroidism
Low weight
Inflammatory bone disease
```
110
What is the acute management of temporal arteritis?
IV methylprednisolone
111
What is the long term management of temporal arteritis?
Oral prednisolone
112
What is the most common bone tumour in children and young adults?
Osteosarcoma
113
What FRAX score warrants a DEXA scan?
>10%
114
What STI is closely linked to reactive arthritis?
Chlamydia pneumoniae
115
What antibodies are seen in Sjogren's syndrome?
Anti-ro and anti-la
116
Where does Paget's disease of the bone affect?
Pelvis, femur, vertebrae, skull
117
What symptoms are seen in Paget's disease?
Bone pain, hearing loss, growth of mandible often comes up in exam questions - bone deformities
118
What is seen on X-ray in rheumatoid arthritis?
```
Loss of joint space
Erosions
Soft tissue swelling
Soft bones
Subluxation (dislocation)
```
119
What is the treatment of dermatomyositis?
IV corticosteroids
120
What investigations are performed for the diagnosis of dermatomyositis?
Creatine kinase
Muscle biopsy
Autoantibodies
121
Which antibodies are specific to dermatomyositis?
Anti-Mi-2
122
Give 5 risk factors for osteoarthritis.
```
Female
Obesity
Smoking
Inflammatory bone disease
Trauma
```
123
What is the triad of symptoms in sarcoidosis?
Lofgren's triad
124
What symptoms make up Lofgren's triad?
Polyarthralgia
Erythema nodosum
Bilateral hilar lymphadenopathy
125
What is used to manage sarcoidosis?
Corticosteroids
Hydroxychloroquine
Immunosuppressants
126
What is the most common cause of spread of septic arthritis?
Haematogenous spread
127
What is the treatment of septic arthritis?
Flucloxacillin, needle decompression
128
What is the most common cause of osteomyelitis?
Staphylococcus aureus
129
What is the most common cause of osteomyelitis in sickle cell patients?
Salmonella
130
What type of cancer has an onion ring appearance?
Erwing's sarcoma
