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medicine phase 2 a > MSK > Flashcards

MSK Flashcards

1
Q

What are the 4 key X-ray findings in osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral stenosis (increased density in bone along joint line)
subchondral cysts (fluid filled holes in bone)

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2
Q

What are the key presentations of osteoarthritis?

A

joint stiffness and pain, worsened with activity

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3
Q

What signs of osteoarthritis may be present on the hands?

A

heberdens nodes (DIPs)
bouchards nodes (PIPs)
squaring at the base of the thumb

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4
Q

What lifestyle factors may help symptoms of osteoporosis?

A

losing weight
physiotherapy

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5
Q

What oral medications can be used to control symptoms of osteoarthritis?

A

paracetamol - 1st line
NSAIDs + PPI - 2nd line

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6
Q

what are the other treatments for osteoarthritis?

A

intra-articular steroid injections
hip/knee replacement

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7
Q

What antibody is present in 70% of patients with RA?

A

rheumatoid factor (RF)

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8
Q

What antibody predates the development of RA and is more specific and sensitive to RA?

A

anti-CCP antibodies

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9
Q

What are the key presentations of RA?

A

symmetrical distal polyarthropathy
joint pain, stiffness and swelling

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10
Q

How does activity effect the pain from RA?

A

it improves it

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11
Q

What is palindromic rheumatism?

A

short episodes of inflammatory arthritis

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12
Q

Which joints are almost never effected in RA but are often effected in osteoarthritis?

A

distal interphalangeal joints

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13
Q

What are the X-ray findings of RA?

A

Loss of bone space
osteopenia
erosion of bone
swelling of soft tissue

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14
Q

What hand deformities are common with RA?

A

Z shaped thumb
swan neck deformity
boutonnieres deformity
ulnar deviation of fingers at the knuckle

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15
Q

What is swan neck deformity?

A

extension of the PIPs and flexion of the DIPs

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16
Q

What is boutonnieres deformity?

A

extension of the DIPs and flexion of the PIPs due to a tear in the central slip of the finger extensors

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17
Q

What are some of the extra-articular manifestations of rheumatoid arthritis?

A

pulmonary fibrosis
bronchiolitis obliterans
feltys syndrome
sjogrens syndrome

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18
Q

What blood tests can be used to diagnose RA?

A

anti-CCP antibodies and RF
ESR/CRP

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19
Q

What are the 4 diagnostic criteria for RA?

A
  1. number/size of joints affected
  2. serology (anti-CCP, RF)
  3. inflammation (CRP/ESR)
  4. duration of symptoms (</>6 weeks)
    score is added up
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20
Q

What score is used to monitor RA and response to treatment?

A

DAS28 score

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21
Q

What combination of medications can be used initially or with flare ups of RA?

A

NSAIDs/Cox-2i + PPIs

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22
Q

what is the 1st line treatments for RA?

A

monotherapy with either:
methotrexate, sulfasalazine or leflunomide

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23
Q

Give an example of an anti-TNF drug used to treat RA

A

infliximab, adalimumab

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24
Q

Give and example of an anti-CD20 drug used to treat RA

A

rituximab

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25
Q

What is the action of methotrexate?

A

it interferes with folate metabolism and suppresses the immune system

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26
Q

What are the side effects of methrotrexate?

A

mouth ulcers and mucositis
liver toxicity
damages bone marrow - low WCC
teratogenic (harmful in pregnancy)

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27
Q

What is the action of leflunomide?

A

it is an immunosuppressant that effects the production of pyrimidine (DNA synthesis)

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28
Q

What are the side effects of leflunomide?

A

hypertension
peripheral neuropathy

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29
Q

How does sulfasalazine work?

A

not clear but seems to effect folate metabolism, is an immunosuppressant and anti-inflammatory

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30
Q

What are the side effects of sulfasalazine?

A

temporary male infertility
can be used in pregnancy

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31
Q

What is action hydroxychloroquine?

A

interferes with toll-like receptors - immunosuppressant

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32
Q

What are the side effects of hydroxycholorquine?

A

nightmares
reduced visual acuity

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33
Q

What is tumour necrosis factor (TNF)?

A

a cytokine involved in inflammation

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34
Q

What are some of the side effects of anti-TNF drugs?

A

vulnerability to sepsis and infection
reactivation of TB or hep B

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35
Q

What are the main side effects of rituximab?

A

night sweats
thrombocytopenia

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36
Q

What is the action of rituximab?

A

monoclonal antibody against B cells

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37
Q

What medications can be a risk factor for oeseoporosis?

A

long term corticosteroids
SSRIs, PPIs
anti-oestrogens
anti-epileptic

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38
Q

what tool is used to assess the 10 year risk of fragility fracture?

A

FRAX tool

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39
Q

What is the first line treatment for osteoporosis?

A

bisphosphonates - alendronate, zoledronic acid

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40
Q

What are some of the side effects of bisphosphonates?

A

reflux and oesophageal erosions

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41
Q

What is the key sign of SLE?

A

malar rash that gets worse in the sunlight

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42
Q

What other symptoms/signs may be present in SLE?

A

hair loss
SOB
arthralgia
myalgia
hepatomegaly
lymphadenopathy

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43
Q

What type of hypersensitivity is SLE?

A

type 3

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44
Q

What antibodies is SLE associated with?

A

anti-nuclear antibodies (ANA)

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45
Q

What antibody is highly specific to SLE?

A

anti-smith

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46
Q

What are the two criteria used for diagnosis of SLE?

A

SLICC or ACR criteria
involves presence of ANA and certain symptoms

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47
Q

What are some of the complications of SLE?

A

cardiovascular disease
infection
lupus nephritis
interstitial lung disease
anaemia
pericarditis
(all related to inflammation)

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48
Q

What is the first line treatment for mild SLE?

A

hydroxychloroquine

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49
Q

What other initial medication may be used for SLE?

A

NSAIDs
prednisolone

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50
Q

What medication may be used in more severe SLE?

A

methotrexate

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51
Q

What is antiphospholipid syndrome?

A

disorder associated with antiphospholipid antibodies that causes a hyper-coagulable state

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52
Q

What are the main associations with antiphospholipid syndrome?

A

venous thromboembolism (DVT)
arterial thrombosis (stroke)
miscarriage

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53
Q

What condition can cause antiphospholipid syndrome?

A

SLE

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54
Q

What antibodies in antiphospholipid syndrome associated with?

A

lupus anticoagulant
anticardiolipin antibodies
anti-beta-2 glycoprotein 1 antibodies

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55
Q

What is the diagnostic criteria for antiphospholipid syndrome?

A

at least on clinical characteristic and at least one antibody

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56
Q

What is the management for antiphospholipid syndrome?

A

warfarin

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57
Q

What is the management for antiphospholipid syndrome in pregnancy?

A

LMWH (warfarin contraindicated in preg)
+ aspirin to reduce chance of complications in pregnancy

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58
Q

What is Sjogrens sydnrome?

A

an autoimmune condition that effects the exocrine glands leading to dry mucous membranes

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59
Q

what are the typical symptoms of Sjorgens?

A

dry eyes, mouth, vagina

60
Q

What is secondary Sjorgens syndrome?

A

Sjorgens related to SLE or RA

61
Q

What antibodies is Sjorgens syndrome associated with?

A

anti-Ro, anti-La

62
Q

What test can be used to assess the dryness of eyes?

A

schirmer tear test

63
Q

What medication can be used to halt the progression of Sjogrens?

A

hydroxychloroquine

64
Q

What is raynauds associated with?

A

SLE, RA, systemic sclerosis, dermatomyositis

65
Q

What are the two main patterns of disease in systemic sclerosis?

A

limited cutaneous systemic sclerosis
diffuse cutaneous systemic sclerosis

66
Q

What are the features of limited cutaneous systemic sclerosis?

A

calcinosis
raynauds
oesophageal dysmotility
sclerodactyly
talengiectasia

67
Q

What extra features does diffuse cutaneous systemic sclerosis have?

A

cardiovascular - hypertension/CAD
pulmonary - hypertension/fibrosis
renal - glomerulonephritis

68
Q

What is scleroderma?

A

hardening of the skin

69
Q

What is sclerodactyly

A

loss of range of motion in the hands

70
Q

hat is talengiectasia

A

dilated blood vessels in the skin

71
Q

What is calcinosis?

A

calcium deposits under the skin, often in the fingertips

72
Q

What antibodies are positive in most patients with systemic sclerosis?

A

anti-nuclear antibodies

73
Q

What examination can help diagnose systemic sclerosis?

A

nailfold capillaroscopy
(looking at the capillaries under a microscope in the nail bed)

74
Q

What lifestyle changes can help systemic sclerosis?

A

physio
gentle skin stretching
no smoking
avoid cold triggers

75
Q

What medications can be used for diffuse systemic sclerosis?

A

Steroids/immunosuppresants

76
Q

What is poly/dermatomyositis?

A

autoimmune disorder when there is inflammation of the muscle/skin and muscles

77
Q

What is the key investigation for mysositis?

A

raised serum creatine kinase

78
Q

What can cause myositis?

A

cancers - lung, breast, ovarian, GI

79
Q

What is the presentation of myositis?

A

bilateral muscle pain, weakness and fatigue
normally proximal muscles
effects shoulder and pelvic girdle
occurs over several weeks

80
Q

what are the main skin features of dermatomyositis

A

Gottron lesions - scaly red patches on knuckles of hand
photosensitive erythematosus on back, shoulders and neck

81
Q

What antibodies are present in myositis?

A

antinuclear, anit-Jo-1, anti-Mi-2

82
Q

What is the first line treatment for poly/dermatomyositis?

A

corticosteroids - prednisone

83
Q

What is paget’s disease?

A

a disorder that results in increased bone turnover

84
Q

what are the key presentations of pagets disease?

A

bone pain
enlarged bone pain
fractures
hearing loss (bones in ear)

85
Q

What is one of the key xray presentations of pagets disease?

A

cotton wool appearance - areas of sclerosis and lysis (dense and thin bone)

86
Q

What may be seen in LFTs in pagets disease?

A

raised alkaline phosphatase

87
Q

What is the main treatment for pagets disease?

A

bisphosphonates - alendronate

88
Q

What are the two key complications of pagets disease?

A

osteogenic sarcoma (bone cancer)
spinal stenosis

89
Q

Name two conditions in which vit D deficiency is common

A

IBD, CKD

90
Q

apart from osteomalacia, what can low Vit D lead to?

A

secondary hyperparathyroidism as parathyroid detects low calcium

91
Q

What are the potential symptoms of osteomalacia?

A

bone pain
fatigue
muscle pain/weakness
abnormal fractures

92
Q

What blood test can be used to investigate potential osteomalacia?

A

25-hydroxyvitamin D will be low

93
Q

How is osteomalacia treated?

A

colecalciferol (vit D supplementation)

94
Q

What is septic arthritis?

A

infection in the joint - present with red, swollen joint

95
Q

What is the management of septic arthritis?

A

septic six
oxygen
IV antibiotics
IV fluids
joint aspiration - culture
check lactates
and urine output

96
Q

What is reactive arthritis?

A

synovitis as a reaction to an infective trigger without infection in the joint?

97
Q

What 3 symptoms are associated with reactive arthritis?

A

cant see, pee or climb a tree
bilateral conjunctivitis
anterior uveitis
circinate balanitis (dermatitis at the head of the penis)

98
Q

What are gouty tophi?

A

subcutaneous deposits of uric acid

99
Q

Which joints does gout most typically effect?

A

DIPs, base of thumb/big toe, wrist

100
Q

What will joint aspirated fluid show in gout?

A

no infection
needle shaped crystals
negatively birefringent of polarised light
monosodium urate crystals

101
Q

What would be seen on an x ray of of a joint with gout?

A

joint space maintained
punched out erosions
lytic lesons
overhanging edges

102
Q

What would blood tests show in gout?

A

hyperuricaemia

103
Q

What medications can increase the amount of uric acid?

A

thiazide like diuretics
insulin

104
Q

What dietary factors can increase purines and hence uric acid?

A

meat and seafood

105
Q

What is the first line treatment in acute flair ups of gout?

A

NSAIDs

106
Q

What can be used instead of NSAIDs to treat acute gout?

A

colchicine

107
Q

What prophylactic treatment can be started after stabilisation of acute gout?

A

xanthine oxidase inhibitors - allopurinol

108
Q

What is pseudogout?

A

crystal arthropathy caused by calcium pyrophosphate crystals

109
Q

what will be shown on joint aspiration in pseudogout?

A

no bacteria
calcium pyrophosphate crystals
rhomboid shaped crystals
positively birefringent of polarised light

110
Q

What is a common x ray finding of pseudogout?

A

chondrocalcinosis, a thin white line in the joint caused by calcium deposition

111
Q

What other condition does psuedogout present similarly to on x ray?

A

osteoarthritis
Loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis

112
Q

What is the management of pseudogout?

A

if symptomatic - NSAIDs/steroids

113
Q

What is the most common route of infection in osteomyelitis?

A

haemotogenous osteomyelitis - through the blood

114
Q

What might x rays show in osteomyelitis?

A

periosteal reaction
destruction of bone
localised osteopenia

115
Q

What is the best imaging tool to diagnose osteomyelitis?

A

MRI

116
Q

What surgical treatment is used for osteomyelitis?

A

surgical debridement (cleaning) of infected bone/tissue

117
Q

What medications are used to treat osteomyelitis?

A

6 week course of flucloxacillin

118
Q

What are the seronegative spondyloarthropathies?

A

ankylosing spondylitis
reactive arthritis
psoriatic arthritis
inflammatory bowel disease arthritis

119
Q

What gene are the seronegative spondyloarthropathies related to?

A

HLA B27 gene

120
Q

What joints does ankylosing spondylitis mainly effect?

A

sacroiliac joints, vertebral column

121
Q

How does ankylosing spondylitis effect joints?

A

causes inflammation - stiffness and pain
eventually causes fusion

122
Q

What are some of the other symptoms of ankylosing spondylitis?

A

anterior uveitis
chest pain - costosternal inflammation
weight loss, fatigue

123
Q

What test is used to assess the flexibility of the spine and help diagnose AS?

A

schober’s test

124
Q

What other tests can be done for AS?

A

HLA B27 genetic testing
CRP/ESR

125
Q

What would be seen on x ray of a spine in AS?

A

bamboo spine
squaring of vertebral bodies
fusion

126
Q

What medications can help with pain in AS?

A

NSAIDs

127
Q

What medication can be used in flair ups of AS?

A

steroids

128
Q

What other medications can be used in AS?

A

anti-TNF - infliximab

129
Q

What are the signs/symptoms of reactive arthritis?

A

stiff, swollen and painful joints
psoriatic plaques
dactylitis

130
Q

how is reactive arthritis treated?

A

NSAIDs, corticosteroids, anti-TNF

131
Q

What is polymyalgia rheumatica?

A

an inflammatory condition mainly effecting the shoulder, neck and pelvic girdle

132
Q

What are the typical presentations of polymyalgia rheumatica?

A

sleep disruption
morning stiffness

133
Q

What is giant cell arteritis?

A

inflammation of the medium and large arteries, typically the temporal arteries

134
Q

what is the main complication of giant cell arteritis?

A

vision loss

135
Q

What are the key presentations of giant cell arteritis?

A

sever unilateral headache around temple
scalp tenderness
jaw claudication
blurred/double vision

136
Q

How is giant cell arteritis diagnosed?

A

clinical manifestations
raised CRP
temporal artery biopsy

137
Q

What is seen in temporal arterial biopsy in giant cell arteritis?

A

mutlinucleated giant cells

138
Q

What is giant cell arteritis closely associated with?

A

polymyalgia rheumatica

139
Q

How are both giant cell arteritis and polymyalgia rheumatica treated?

A

steroids - prednisone

140
Q

What is fibromyalgia?

A

chronic pain syndrome - widespread over body

141
Q

What is osteosarcoma?

A

primary bone malignancy in kids
metaphysis of long bone

142
Q

What is ewing sarcoma

A

very rare, arises for mesenchymal cells in the bone

143
Q

What is osteochondroma?

A

benign overproduction of bone

144
Q

What is Behçets’s disease?

A

a complex inflammatory condition

145
Q

What are the key presentations of Behçets’s disease?

A

mouth and genital ulcers

146
Q

What test can be used to diagnose Behçets?

A

pathergy test

147
Q

How is Behçets treated?

A

prednisolone

medicine phase 2 a (10 decks)

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