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MSK Flashcards

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1
Q

What is osteoarthritis?

A
  • loss of cartilage
  • disordered bone repair
  • most common arthritis
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2
Q

What xray findings do you get with osteoarthritis?

A

LOSS

  • loss of joint space
  • osteophytes formation
  • subchondral sclerosis
  • subchondral cysts
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3
Q

Risk factors for osteoarthritis

A
  • female
  • obesity
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4
Q

Presentation of osteoarthritis

A
  • mainly in large weight-bearing joints
  • joint pain, worse with movement
  • stiffness on rest
  • limited joint movement
  • bone swelling in fingers
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5
Q

What are the two types of bone swelling in fingers?

A
  • Heberden = DIP
  • Bouchard = PIP
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6
Q

Treatment for osteoarthritis

A

Biological

  • paracetamol → work up analgesics ladder
  • cortisol injections
  • joint replacement

Social

  • weight loss → required before surgery
  • lifestyle advice
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7
Q

What is Rheumatoid Arthritis?

A
  • autoimmune disease
  • symmetrical, deforming, peripheral polyarthritis
  • female 3x > male
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8
Q

What xray findings do you get with RA?

A

JOBS

  • joint space loss
  • osteopenia
  • bone erosion
  • soft tissue swelling
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9
Q

Presentation of RA

A
  • pain in affected joints
  • deformities of hand
  • morning stiffness
  • systemic presentations
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10
Q

Hand deformities in RA

A
  • ulnar deviation
  • swan neck
  • boutonniere deformity
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11
Q

Systemic presentations in RA

A
  • scleritis
  • pleural effusions
  • pericarditis
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12
Q

Diagnostic criteria for RA

A

RF RISES

  • rheumatoid factor positive
  • finger/hand/wrist involvement
  • rheumatoid nodules present
  • involvement of ≥ 3 joints
  • stiffness in the morning for > 1hr
  • erosions seen on xray
  • symmetrical movement

> 4 symptoms for > 6 weeks

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13
Q

Investigations for RA

A

bloods

  • RF = highly sensitive
  • anti-CCP = more specific
  • ESR
  • xray
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14
Q

Treatment for RA

A
  • methotrexate with folate
  • DMARDs
  • steroids
  • biologics
  • NSAIDs/opioids for pain management
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15
Q

What biologics are used to treat RA?

A
  • TNFα blockers = infliximab
  • B cell inhibitors = rituximab
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16
Q

What is felty syndrome?

A
  • RA
  • splenomegaly
  • granulocytopenia
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17
Q

What is osteoporosis?

A
  • decreased bone mass/density
  • micro-architectural deterioration
  • increased bone fragility
  • increased susceptibilty to fracture
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18
Q

Risk factors of osteoporosis

A

SHATTERED

  • steroids
  • hyperthyroid/hyperparathyroid
  • alcohol/tobacco
  • thin
  • testosterone decrease
  • early menopause
  • renal/liver failure
  • erosive/inflammatory bone disease
  • dietary Ca deficiency/DMT1
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19
Q

Presentation of osteoporosis

A
  • not clinically apparent until a fracture occurs
  • risk assessment = FRAX and Qfracture
  • DEXA scan → T scan
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20
Q

Treatment for osteoporosis

A
  • bisphosphonates → oral alendronate/IV zoledronate
  • mAbs → denosumab
  • HRT
  • lifestyle advice → quit smoking and alcohol
  • Ca2+ and vitamin D
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21
Q

What is lupus

A
  • Systemic Lupus Erythematosus
  • inflammatory multisystem autoimmune disorder
  • arthralgia and rashes
  • type III hypersensitivity
  • female 9x > male
  • peak in 20-40yrs
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22
Q

Presentation of lupus

A
  • joint pain
  • malar, discoid, photosensitive rash
  • serositis
  • glomerulonephritis with proteinuria
  • depression/psychosis
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23
Q

What serositis can be seen in lupus?

A
  • scleritis
  • pericarditis
  • pleuritis
  • oral ulcers
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24
Q

Diagnosis of lupus

A
  • bloods → ESR raised, CRP normal
  • ANA
  • Anti-dsDNA
  • serum C3 and C4
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25
Treatment for lupus
- steroids - hydroxychloroquine - methotrexate
26
What is hyperuricaemia?
- high levels of uric acid - \>420 M, \>360 F - asymptomatic - 1 in 5 will develop gout
27
What is pseudogout?
- buildup of calcium pyrophosphate - birefringent +ve, rhomboid
28
What is gout?
- buildup of monosodium urate - birefringent -ve, needles
29
How does the buildup of uric acid lead to inflammation?
- uric acid builds up - precipitates as uric acid crystals - crystals deposit in joint spaces - inflammation
30
Stages of gout progression
1. high uric acid levels → builds up in blood → crystals form around joints 2. acute gout → symptoms start → painful gout attack 3. intercritical gout → periods of remission between gout attacks 4. chronic gout → gout pain frequent and tophi form in joints
31
Signs and symptoms of gout
- red hot joint → painful, swollen - acute onset - most common joint = big toe - also affects midfoot, ankle, knee, wrist
32
Investigations for gout
1. bloods - U&E and eGFR for renal function - uric acid levels, now and 4-6 weeks later → confirm hyperuricaemia GOLD STANDARD = joint aspiration to test for urate crystals
33
Management for acute gout
1. NSAIDs or colchicine 2. intra-articular steroid injection lifestyle advice
34
Management of chronic gout
1. allopurinol → inhibits xanthine oxidase 2. febuxostat consider coprescribing clolchicine with allopurinol for 6 months
35
Signs and symptoms of septic arthritis
LIFE THREATENING - red hot swollen joints - cold peripheries - confusion - high temperature
36
Causes and risks of septic arthritis
- IVDU - immunocompromised - intra-articular joints - common bugs
37
What bugs cause septic arthritis?
- S.aureus - Neisseria gonorrhoea - gram -ve bacteria eg E.coli - haemophilius influenza (kids)
38
What is the sepsis 6?
1. give O2 to keep stats above 94% 2. take blood cultures → CSF, urine, sputum 3. give IV antibiotics 4. give a fluid challenge 5. measure lactate 6. measure urine output
39
What antibiotics can be given to treat septic arthritis?
- flucloxacillin - if penicillin allergic → clindamycin - if MRSA → vancomycin - if gonococcal arthritis or gram -ve infection → cefotaxime
40
Treatment for septic arthritis
Sepsis 6
41
What is osteomyelitis?
infection of the bone marrow
42
What are the 3 ways of entry for osteomyelitis?
- hematogenously - open wound - contiguously → skin into blood
43
Risk factors for osteomyelitis
- diabetes/CKD - RA - children → URT/varicella infection - HIV - IVDUsickle cell disease - penetration injury - sickle cell disease
44
Presentation of osteomyelitis
- limp or reluctance to weight bear (kids) - non-specific pain at site of infection - low grade fever
45
Investigations for osteomyelitis
- FBC → raised WCC, ESR, CRP - xray - blood cultures
46
Management for osteomyelitis
- antibiotics - supportive care - surgery
47
What are the 3 seronegative spondyloarthropathies?
- ankylosing spondylitis - reactive arthritis - psoriatic arthritis
48
How do seronegative spondyloarthropathies present?
SPINACHEE - sausage digits - psoriasis - inflammatory back pain - NSAIDs (good response) - Arthritis - Crohn's disease - HLA B27 - Eye → uveitis - enthesitis
49
What is ankylosing spondylitis?
- inflammation of sacroiliac joints - loss of spinal movements
50
Investigations for ankylosing spondylitis
- bloods = HLA B27 - xray
51
Xray findings for ankylosing spondylitis
- eroded and sclerotic sacroiliac joints - unclear margin between rims - bone spurs aka syndesmophytes - bamboo spine due to fusion
52
Treatment for ankylosing spondylitis
- NSAIDs - physiotherapy - steroid injections - DMARDs → methotrexate, sulfasalazine - TNF inhibitor or mAb → etanercept, infliximab, adalimumab - ustekinumab = last line
53
Signs and symptoms of psoriatic arthritis
- painful swollen stiff joints - psoriatic plaques - dactylis - telescopic fingers → pencil in cup on xray occurs in 10-40% of people with psoriasis
54
Treatment for psoriatic arthritis
same as ankylosing spondylitis
55
What causes reactive arthritis?
- mainly due to infection - think about if someone has an active sexual history
56
Signs and symptoms of reactive arthritis
- can't see = uveitis - can't pee = urethritis - can't climb a tree = enthesitis - keratoma blennorhagica - circinate balantis
57
Investigations for reactive arthritis
- bloods = inflammatory markers - imaging to determine extent of damage from enthesitis
58
What inflammatory markers can you see in reactive arthritis bloods?
- RF - ANA - CRP - ESR
59
Treatment for reactive arthritis
- NSAIDs - corticosteroids - DMARDs → chronic arthritis
60
What is vasculitis?
group of autoimmune diseases that cause inflammation of the blood vessel walls
61
General constitutional symptoms of vasculitis
- malaise - fatigue - weight loss - low grade fever
62
What is giant cell arteritis
- large vessel vasculitis - affects aorta and/or its major branches eg carotid and vertebral arteries
63
Risk factors for giant cell arteritis
- \>50yrs - North European - females - history of polymyalgia rheumatica
64
Presentation of giant cell arteritis
- headache → new onset, typically unilateral over temporal area - scalp tenderness - jaw claudication - visual disturbances
65
Investigations for giant cell arteritis
- increased ESR and/or CRP - halo sign on US of temporal/axillary artery GOLD STANDARD = temporal artery biopsy → giant cells, granulomatous inflammation
66
Management of giant cell arteritis
high dose glucocorticoids ASAP → prednisolone
67
Complications of giant cell arteritis
- blindess - irreversible neuropathy
68
What is multiple myeloma?
neoplastic proliferation of bone marrow plasma cells
69
Pathophysiology of multiple myeloma
- malignant plasma cells produce excess immunoglobulin - multiple organ dysfunction esp kidneys - 2/3 IgG, 1/3 IgA
70
Presentation of multiple myeloma
OLD CRAB - old age - calcium elevated → bones, stones, groans, moans - renal impairment - anaemia - bone lytic lesions → bone/back pain
71
Investigations for multiple myeloma
- FBC → normocytic anaemia - films → rouleaux formation (RBC aggregations) - U&Es → raised Ca, urea, creatinine - raised ESR - xray → pepper-pot skull, vertebral collapse, fractures - serum/urine electrophoresis → bence jones protein band - bone marrow biopsy → raised plasma cells
72
Treatment for multiple myeloma
- analgesia - bisphosphonates - local radiotherapy → reduce focal disease - transfusion → - fluids/dialysis - Abs - chemo

Phase 2a Green Conditions (10 decks)

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