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Phase 1c: Conditions > MSK > Flashcards

MSK Flashcards

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1
Q

What are the symptoms of osteoarthritis (OA)?

A

Joint pain that is exacerbated by exercise and relieved by rest
Joint stiffness in the morning or after rest (brief, rare)
Functional difficulties
Knee, hand, hip, or spine involvement
Bouchard’s nodes (PIP joints)
Heberden’s nodes (DIP joints)
Joint swelling/synovitis
Crepitus

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2
Q

What are the 1st line investigations for OA?

A

X-ray of affected joints (osteophytes, narrowing of joint spaces, subchondral sclerosis, cysts)
Normal CRP (exclude RA)
Normal ESR (exclude RA)

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3
Q

When do investigations not need to be considered for OA?

A

Patient is >45 years old, has activity-related joint pain, and has either no morning joint-related stiffness or has stiffness that lasts <30 minutes

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4
Q

What is the management plan for OA?

A

Topical NSAIDs and oral paracetamol (if not enough, oral NSAID and PPI)
Weight loss and exercise
Intra-articular corticosteroid injections
POTENTIAL JOINT REPLACEMENT THERAPY

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5
Q

What are the risk factors for OA?

A

Age >50 years
Female sex
Obesity
Family history
Physically demanding occupation/sport
Post-trauma/injury

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6
Q

What are the symptoms of SLE?

A

Photosensitive malar rash
Discoid rash
Raynaud’s phenomenon
Pericarditis/myocarditis
Fatigue, fever, mouth ulcers, lymphadenopathy
Arthralgia and non-erosive arthritis
Pleurisy
Proteinuria and glomerulonephritis
anxiety, depression, psychosis, seizures

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7
Q

What are the risk factors for SLE?

A

women
Afro-Caribbean

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8
Q

What are the first-line investigations for SLE?

A

Urinalysis (assess renal involvement)
FBC (normocytic anaemia of chronic disease, haemolytic anaemia)
APTT (prolonged in patients with antiphospholipid antibodies)
ANAs (less specific)
Anti-dsDNA antibodies, Smith antigen (more specific)
ESR and CRP (ESR elevated, CRP normal unless infection)
Complement (low C3 and C4)

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9
Q

How is SLE treated?

A
  1. Hydroxychloroquine
    NSAID (naproxen)
    Corticosteroid (prednisolone)
    Immunosuppressant (methotrexate/azathioprine)
    Belimumab/Rituximab (biologic)
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10
Q

What are the key diagnostic factors for rheumatoid arthritis (RA)?

A

Active symmetrical arthritis lasting >6 weeks
Joint pain and swelling (MCP, PIP, MTP)
Morning stiffness
Ulnar deviation
Rheumatoid nodules
Pleuritic chest pain (pleuritis/pericarditis)
Scleritis/uveitis

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11
Q

How is RA investigated?

A

Rheumatoid factor
Anti-CCP antibodies
X-ray (bony erosions, osteopenia, joint space narrowing)

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12
Q

Differentiate between radiographs of osteoarthritis and rheumatoid arthritis

A

Both have joint space narrowing (primary in OA, secondary to synovitis in RA)
OA has subchondral sclerosis and osteophytes
RA has bony erosions and osteopenia

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13
Q

How is RA treated?

A

Hydroxychloroquine or methotrexate (DMARD)
Consider corticosteroid (prednisolone)
Consider NSAID (ibuprofen or naproxen)
Consider biologic agent (infliximab, rituximab)

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14
Q

What are the key diagnostic factors for reactive arthritis?

A

Previous chlamydial or GI infection
Painful, swelling of joint (asymmetrical monoarthritis)
Spinal inflammation (non-specific lower back pain)
Fever, fatigue, weight loss
Enthesitis
Keratoderma blenorrhagia
Conjunctivitis, anterior uveitis

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15
Q

What are the risk factors for reactive arthritis?

A

Male sex
HLA-B27 genotype
Preceding chlamydial or GI infection

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16
Q

How is reactive arthritis treated?

A

analgesia, NSAIDs, intra-articular steroids
sulfasalazine and methotrexate for persistent disease

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16
Q

How is reactive arthritis investigated?

A

ESR and CRP (elevated)
ANA and Rheumatoid factor (negative)
X-ray (sacroiilitis, enthesitis)
Joint aspiration and gram staining to exclude septic arthritis

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17
Q

What are the key diagnostic factors for septic arthritis?

A

Hot, swollen, painful joint with restricted movement
Acute presentation
Fever
Large, single joint
Erythema migrans

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18
Q

How is septic arthritis investigated?

A

Joint aspiration and synovial fluid analysis (culture and sensitivities, microscopy, Gram stain, polarising microscopy)
ESR and CRP

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19
Q

How is septic arthritis treated?

A

Surgical lavage and IV antibiotics
Immobilise joint in acute phase
Physiotherapy once acute phase over

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20
Q

What are the key diagnostic factors for ankylosing spondylitis?

A

Inflammatory back pain >3 months
Early morning back stiffness, improvement with exercise
Enthesitis
Presentation in late teens/early 20s
Fatigue and sleep disturbance
Tenderness at sacroiliac joint
Dyspnoea
Loss of lumbar lordosis and kyphosis

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21
Q

What are the risk factors for ankylosing spondylitis?

A

HLA-B27 gene
Family history
Male sex

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22
Q

What are the investigations for ankylosing spondylitis?

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A

X-ray (sacroiliitis, subchondral erosions, sclerosis, and squaring of lumbar vertebrae)
CXR (apical fibrosis)
Bamboo spine (late and unncommon)
MRI

23
Q

What are the extra-articular manifestations of ankylosing spondylitis?

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A

Iritis/uveitis
Psoriasis
Inflammatory bowel disease

24
What is the treatment for adults with ankylosing spondylitis?
NSAID physiotherapy sulphasalazine if peripheral joint involvement
25
What is osteomyelitis?
Infection in the bone and bone marrow, typically in the metaphysis of long bones Infection may be introduced directly via open fracture or through the blood
26
What are the risk factors for osteomyelitis?
More common in boys and children <10 years Open bone fracture Orthopaedic surgery Immunocompromised Sickle cell anaemia HIV Tuberculosis
27
What are the symptoms of osteomyelitis?
Pain Fever Swelling and erythema Refusal to use limb or weight bear
28
How is osteomyelitis investigated?
MRI (best imaging for establishing diagnosis) X-ray (can be normal) ESR and CRP (raised) FBC (raised WCC) Blood culture (establish causative organism)
29
What is the most common causative organism for osteomyelitis?
Staphylococcus aureus In patients with sickle cell, Salmonella species dominate IV drug users are also predisposed to pseudomonas aeruginosa
30
How is osteomyelitis treated?
Flucloxacillin for 6 weeks Clarithromycin if allergic May require surgery for drainage and debridement of the infected bone
31
What is gout and pseudogout?
Gout is the deposition of urate crystals Pseudogout is the deposition of calcium pyrophosphate crystals
32
What are the symptoms of gout?
Commonly affects 1st MTP joint Pain, swelling, tenderness, stiffness
33
How is gout investigated?
Synovial fluid analysis (needle shaped negatively birefringent monosodium urate crystals) Urate (high) X-ray (joint effusions, 'rat bite' erosions, soft tissue tophi)
34
How is gout managed?
NSAIDs or colchicine Prednisolone if NSAIDs/colchicine are contraindicated Intra-articular steroid injection? Allopurinol as urate-lowering therapy
35
What are the risk factors for pseudogout?
Increasing age Haemochromatosis Hyperparathyroidism Low magnesium, low phosphate Acromegaly Wilson's disease
36
How is pseudogout investigated?
Knee, wrist and shoulders commonly affected Joint aspiration: positively birefringent rhomboid-shaped crystals X-ray (chondrocalcinosis)
37
How is pseudogout investigated?
Knee, wrist and shoulders commonly affected Joint aspiration: positively birefringent rhomboid-shaped crystals X-ray (chondrocalcinosis - thin white line in the middle of the joint space)
38
What are the risk factors for gout?
Male Obesity High purine diet (e.g. meat and seafood) Alcohol Diuretics FHx
39
What is osteomalacia?
Defective bone mineralisation, due to insufficient vitamin D levels
40
What are the causes of osteomalacia?
Vitamin D deficiency (malabsorption, lack of sunlight, diet) CKD Drug-induced, e.g. anticonvulsants Coeliac disease Liver disease, e.g. cirrhosis
41
What are the features of osteomalacia?
bone pain bone/muscle tenderness pathological fractures: especially femoral neck proximal myopathy: may lead to a waddling gait
42
How is osteomalacia investigated?
FBC and bony profile (low vitamin D, low calcium, raised ALP) X-ray (looser zones, pseudofractures, osteopenia) DEXA (low bone mineral density)
43
How is osteomalacia treated?
Supplementary vitamin D (cholecalciferol) - loading dose often initially needed Calcium supplementation if dietary calcium is inadequate
44
What is osteoporosis?
Presence of bone mineral density of less than 2.5 SDs below the young adult mean density
45
What are the risk factors for osteoporosis?
Increasing age Female sex Long-term corticosteroid use Smoking Alcohol Low BMI FHx
46
How is fracture risk assessed?
FRAX score estimates the 10-year risk of fragility fracture Low risk – reassure Intermediate risk – offer DEXA scan and recalculate the risk with the results High risk – offer treatment
47
How is osteoporosis managed?
Vitamin D and calcium supplementation Alendronate (bisphosphonate) Strontium ranelate and raloxifene if bisphosphonates not tolerated
48
What are the side effects of bisphosphonates?
Reflux and oesophageal erosions - bisphosphonates taken on an empty stomach to prevent this Atypical fractures (e.g. atypical femoral fractures) Osteonecrosis of the jaw Osteonecrosis of the external auditory canal
49
What is polymyalgia rheumatica?
Inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck - strong association with giant cell arteritis
50
What are the risk factors for polymyalgia rheumatica?
>50 years Female Caucasian
51
What are the features of polymyalgia rheumatica?
rapid onset (<1 month) bilateral shoulder pain that may radiate to the elbow, pelvic girdle pain worse with movement and interferes with sleep morning stiffness weight loss, fatigue, low grade fever and low mood upper arm tenderness carpel tunnel syndrome pitting oedema
52
How is polymyalgia rheumatica investigated?
ESR and CRP (usually raised) Creatine kinase and EMG are normal
53
How is polymyalgia rheumatica treated?
15mg prednisolone OD - if no symptom improvement after 1 week, consider alternative diagnosis
54
What are the features of dermatomyositis?
Muscle pain, fatigue and weakness - bilateral Affects shoulder and pelvic girdle Gottron papules on knuckles, elbows and knees Photosensitive erythematous rash Perioribital oedema
55
How is dermatomyositis investigated?
Malignancy screen (lung, breast, ovarian, gastric) Creatinine kinase levels (raised) ANAs, anti-Jo-1, anti-Mi-2 EMG Muscle biopsy
56
How is dermatomyositis treated?
High-dose corticosteroids - CK is monitored to taper the dose Methotrexate or azathioprine IV immunoglobulins

Phase 1c: Conditions (18 decks)

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