MSK Flashcards
(23 cards)
Main risk factors of Osteoporosis
Female (post menopause)
Low BMI
Long term steroids (inc cushings)
Dx osteoporosis
FRAX score
DEXA scan
T scores for DEXA scan
> -1 Normal
-1 to 2.5 osteopenia
<2.5 osteoporosis
Components of FRAX score
TFT
Bone profile
Bone turnover (CTX)
Mx osteoporosis
Conservative
Bisphosphonates (alendronates SEs GORD + osteonecrosis of jaw) Take on empty stomach, sit upright, wait 30 mins before eating.
Features of OA on XRay
Cyst formation
Osteophyte formation on joint edge
Narrowing of joint space
Sclerosis of subchondral bone
Mx OA
Conservative, weight loss + physio
1st - analgesia, topical nsaid + paracetamol
2nd - Oral NSAIDs + PPI + topical capsaicin
IA corticosteroids
Partial/total joint replacement
Risk factors of RA
Female, Family history (HLA DR4)
RA Dx
Rheumatoid factor (Present 70%)
anti-CCP antibodies (more specific)
Ix RA
Disease activity score (>5.5 need for biologics -mabs)
Normocytic anaemia of chronic disease
ESR/CRP elevated
Joint XR
Subluxation
Osteoporosis juxta articular
Loss of joint space
Erosions of periarticular space
RA Mx
Smoking cessation
Acute flare, NSAIDS + PPI
Glucocorticoids/sterois IM methylprednisolone
Chronic maintenance
1. Methotrexate
Sulfalazine
Hydroxychloriquine
Anti-TNF drugs (e.g. infliximab)
Commonest organisms in SA
Overall Staph aureus
young adults Neisseria gonhorroea
Children Strep pneumoniae or H influenza
Ix SA
Aspirate
MC&S
Crystal microscopy
Mx SA
Washout
IV Abx 2g fluclox QDS 2 wks
PO Abx for 4 weeks
Features of Gout
Monosodium Urate monohydrate crystals
Chronic hyperuricaemia (uric acid)
IX Gout
Serum uric acid raised
Punched out lesions on XRay
Joint aspirate gold standard (Crystals, negative birefringent needle shaped)
Mx Gout
Acute flare
- Diclofenac
- Colchicine (if renal impaired)
- Steroid IA
Chronic
- Allopurinol (only after flare subsided)
- Lifestyle
Features pseudogout
Calcium pyrophosphate crystals
Risks, inc calcium, hyperparathyroidism
Ix Pseudogout
Chondrocalcinosis on Xray
Joint aspirate
- Rhomboid shaped crystals, positive birefringent
Henloch Schonlein Purpura
IgA vasculitis
Purpuric rash LL or buttocks in kids
Joint pain
Abdo pain
Renal (IgA nephritis)
REactive arthritis
Synovitis due to infective trigger
Cant see, pee, climb a tree
Bilateral conjunctivitis, balanitis, reactive arthritis
Abx until Septic A excluded
- NSAIDS
- Steroids
- Sulfalazine
Ankylosing Spondylitis
Affects vertebral column and sacroiliac
Progressive stiffening > fusion
Male young adults, pain and stiffness in lower back
Syndesmophytes
Calcification of ligament structures e.g. discs
