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medicine can be fun > MSK > Flashcards

MSK Flashcards

1
Q

how to treat primary Reynaud’s

A

calcium channel blocker

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2
Q

features of primary Reynaud’s

A

young women <30
Reynaud’s bilaterally with no other symptoms

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3
Q

cause and epidemiology of osteoarthritis

A
  • wear and tear
  • old obese women with overuse jobs (gardener, hairdresser)
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4
Q

describe 2 effects of osteoarthritis on the joint

A
  • unilateral pain improves with rest (hip, knee, DIP, PIP)
  • little to no morning stiffness
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5
Q

signs of osteoarthritis on examination

A
  • Bouchard’s (PIP swelling)
  • Heberden’s (DIP swelling)
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6
Q

how to diagnose osteoarthritis

A
  • clinical in any patient >45 yrs with movement related joint pain and no morning stiffness
  • X-ray to confirm
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7
Q

what do you see on X-ray in osteoarthritis

A

LOSS
- loss of joint space
- osteophytes
- subchondral cysts
- subchondral sclerosis

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8
Q

how to manage osteoarthritis

A

i) paracetamol
ii) oral NSAID/topical capsaicin
iii) joint replacement

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9
Q

what is rheumatoid arthritis and what is its epidemiology

A
  • chronic autoimmune inflammation of joints for more than 6 weeks
  • seen in females of all ages
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10
Q

describe 2 effects of rheumatoid arthritis on the joint

A
  • bilateral pain and swelling of small joints (spares DIP)
  • morning stiffness
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11
Q

what are 2 signs of rheumatoid arthritis

A
  • Boutonniere’s: PIP flexion
  • Swan neck: DIP flexion
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12
Q

what are 5 extra-articular features of rheumatoid arthritis

A
  • anaemia of chronic disease
  • fatigue
  • rheumatoid nodules
  • eye problems
  • pulmonary fibrosis
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13
Q

what is the triad of Felty’s syndrome

A
  • rheumatoid arthritis
  • neutropenia
  • splenomegaly
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14
Q

how would you diagnose rheumatoid arthritis

A
  • mostly clinical
  • bloods suggest aggressive disease (start biologics)
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15
Q

when to refer and when to do a 2ww referral for rheumatoid arthritis

A
  • refer anyone with persistent synovitis
  • 2ww if small joints, >3 weeks
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16
Q

what bloods would you do for rheumatoid arthritis

A

i) rheumatoid factor (first line)
ii) anti-CCP (more specific)
- raised ESR
- raised CRP
- FBC anaemia
- LFTs low albumin

17
Q

how do you induce remission of rheumatoid arthritis

A

i) methotrexate + short course pred
ii) DMARD combination
iii) methotrexate + biologic

18
Q

what are 3 side effects of methotrexate

A
  • myelosuppression
  • megaloblastic anaemia folate deficiency
  • pulmonary fibrosis
19
Q

what biologic would you use first line for rheumatoid arthritis and what would be the risk of it

A
  • infliximab (anti-TNF alpha)
  • reactivation of TB
20
Q

how do you manage an acute flare of otherwise well controlled rheumatoid arthritis

A

IM prednisolone

21
Q

4 seronegative spondyloarthropathies: what are they, epidemiology, gene

A
  • PEAR:
    Psoriatic arthritis
    Enterohepatic arthritis
    Ankylosing spondylitis
    Reactive arthritis
  • rheumatoid factor negative
  • gene: HLA-B27
  • more common in young males
22
Q

what is the main presentation of ankylosing spondylitis

A
  • > 3 months lower back pain and stiffness
  • worse in the morning
  • improves with exercise
  • back pain worse at night
23
Q

how do you test for ankylosing spondylitis on examination

A
  • Schober’s test
  • reduced lumbar motility means distance <5cm when patient bends forwards
24
Q

what are two late signs of ankylosing spondylitis

A
  • cervical kyphosis
  • loss of lumbar lordosis
25
Q

what happens to the tragus to wall distance in ankylosing spondylitis

A

increases

26
Q

what are extra-articular features of ankylosing spondylitis

A
  • apical lung fibrosis
  • aortic regurgitation
  • anterior uveitis
27
Q

what imaging is used for ankylosing spondylitis

A
  • first line: X-ray (diagnostic)
  • MRI if normal X-ray (early stages)
28
Q

what are 4 features of ankylosing spondylitis on an X-ray

A
  • sacroilitis
  • squaring of lumbar vertebrae
  • subchondral erosions
  • bamboo spine (late and uncommon)
29
Q

how do you manage ankylosing spondylitis

A

exercise + NSAIDs + physiotherapy

30
Q

what happens to chest expansion in ankylosing spondylitis

A

reduced

31
Q

what pattern can be seen in spirometry with ankylosing spondylitis and why

A
  • restrictive
  • kyphosis
32
Q

what are three features of dermatomyositis

A
  • proximal myopathy
  • Gottron’s papules (fingers)
  • heliotrope rash (around eyes)
33
Q

what is an important screening after diagnosing dermatomyositis

A

malignancy screening because dermatomyositis is a paraneoplastic syndrome

34
Q

what are two causes of spinal cord compression classified by epidemiology

A

a) young: trauma
b) older: tumour

35
Q

what tumours can cause spinal cold compression

A
  • metastatic
  • multiple myeloma
36
Q

which cancers commonly metastasise to bone

A

5 Bs
- breast
- bronchi
- bidney (kidney)
- brostate (prostate)
- byroid (thyroid)

37
Q

what are 3 symptoms of spinal cord compression

A
  • bilateral leg weakness
  • lower back pain
  • constipation
38
Q

how do you investigate suspected spinal cord compression

A
  • urine dip for Bence Jones proteins in multiple myeloma
  • bloods for multiple myeloma
  • urgent spine MRI
39
Q

how to manage suspected spinal cord compression

A

urgent high-dose oral dexamethasone while awaiting investigations

medicine can be fun (12 decks)

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