MSK Flashcards
1
Q
what is the treatment for ankylosing spondylitis?
A
- NSAIDs and physiotherapy
- steroids during flares
- anti-TNF e.g. infliximab
2
Q
first line appropriate management for septic arthritis?
A
aspirate the joint and send blood cultures, then immediate antibiotic treatment following determination of causative organism
3
Q
what features would be seen on an XR of osteoarthritis?
A
LOSS of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts
4
Q
what is the most specific investigation for RA?
A
anti-citrullinated peptide anti body (anti-CCP)
5
Q
what is the drug colchicine used for?
A
reduces inflammatory responses e.g. acute gout
6
Q
what is the drug allopurinol used for?
A
preventative gout drugs - long term and should not be given in a flare up as it can further exacerbate the joint
7
Q
What is the mechanism of action for bisphosphonates?
A
Inhibit bone resorption through the inhibition of enzyme (Farnesyl Pyrophosphate synthase) which reduces osteoclast activity
8
Q
what is the first line treatment for osteoporosis?
A
alendronic acid (oral bisphosphonate) and AdCal (vit D and calcium supplement)
9
Q
what is the second line treatment for osteoporosis?
A
addition of denosumab
- monoclonal antibody which binds to RANK ligand, blocking osteoclast maturation/function/survival, thus reducing bone resorption
10
Q
list 5 risk factors for septic arthritis
A
- PMH of other joint disease (e.g. RA)
- > 80 years old
- IVDU
- diabetes mellitus
- recent joint surgery
- penetrating trauma
- prosthetic joint
- recent intra-articular steroid injections
11
Q
which primary cancers metastasise to bone?
A
breast, lung, kidney, thyroid, prostate
12
Q
which antibody is most specific for SLE?
A
anti-dsDNA
13
Q
which antibody is most sensitive for SLE?
A
antinuclear antibody (ANA)
14
Q
which class of drugs is the first line medication for osteoporosis?
A
bisphosphonates (e.g. allendronic acid)
15
Q
how should the first line medication for osteoporosis be taken?
A
allendronic acid should be taken once a week on an empty stomach and the patient should remain upright for at least 30mins following
16
Q
which joints do Heberden’s nodes occur?
A
distal interphalangeal joints
17
Q
which joints do Bouchard’s nodes occur?
A
proximal interphalangeal joints
18
Q
name 4 characteristics of the hands in rheumatoid arthritis
A
- swan neck deformity
- Boutonniere deformity
- ulnar deviation
- “Z-thumb”
19
Q
what is the Boutonniere deformity?
A
finger flexed at PIP, hyperextended at DIP, seen in RA
20
Q
what is the treatment for acute gout?
A
high dose NSAIDs and corticosteroids, e.g. colchicine
21
Q
describe the 3 phases of pathophysiology of Paget’s disease
A
- lytic phase: excessive osteoclastic resorption
- mixed phase: excessive resorption and diagnosed bone formation
- blastic (latent) phase: osteoblasts lay down excess disorganised, weak bone
22
Q
blood results of Paget’s?
A
everything normal except raised ALP
23
Q
give 4 complications of Paget’s disease
A
- skull thickening
- osteosarcoma
- fractures
- tibial bowing
- deafness
- high output cardiac failure
24
Q
first line treatment for management of Paget’s?
A
bisphosphonates (e.g. alendronic acid)
25
proper term for temporal arthritis?
chronic granulomatous large vessel vasculitis, mainly affecting carotid artery and its branches
26
first line of action for large vessel vasculitis when presenting with vision loss and why?
urgent, high dose corticosteroids to prevent further blindness (due to lack of ophthalmic artery blood flow)
27
give the 4 diagnostic criteria for large vessel vasculitis (temporal)
- > 50 years
- temporal artery abnormality (e.g. tender/decreased pulse)
- abnormal biopsy
- elevated ESR (> 50mm/hr)
28
what condition associated with large cell vasculitis can cause stiffness in muscles in shoulder area and hips?
polymyalgia rheumatica
29
what type of hypersensitivity reaction is systemic lupus erythematosus?
type III
30
give 6 signs of SLE
- discoid rash
- pleuritis
- peritonitis
- myocarditis
- oral / mucosal ulcers
- alopecia
- lupus nephritis
- photosensitivity
- anaemia
- migraines
- seizures
31
what marker is used to monitor SLE?
ESR
32
how do you treat arthralgia / skin symptoms associated with SLE?
hydroxychloroquine (+- NSAIDs +- corticosteroids)
33
list some presentations of antiphospholipid syndrome
- recurrent miscarriages
- recurrent DVTs
- PEs
- livedo reticularis: blotchy pattern on skin
34
what would blood results show for someone with antiphospholipid syndrome?
prolonged APTT
35
give 3 antibodies associated with antiphospholipid syndrome
lupus anticoag, anti-cardiolipin, anti-beta2GP1
36
antiphospholipid syndrome could give a false positive result for which condition?
syphilis - due to anti-cardiolipin Ab
37
most common age and gender for fibromyalgia?
female; 30-60y
38
what four categories must be considered when presented with "back pain"?
- symptoms associated with cauda equina
- symptoms of spinal fracture
- cancer red flags
- symptoms of infection
39
2 risk factors for osteomalacia?
- decreased sun exposure (less vit D activation)
- decreased dietary vit D (less available for bone mineralisation)
40
which reflex is lost with a nerve root lesion at s1?
ankle jerk
41
list 5 presentations of cauda equina syndrome
- bilateral leg neuropathy
- new urinary / faecal retentions and/or incontinence
- perianal or perineal sensory loss
- poor anal tone PR
42
list 5 presentations of spinal fracture
- sudden onset
- high impact trauma
- structural deformity
- point tenderness over vertebral body
43
what condition does Shober's test help diagnose?
ankylosing spondylitis
44
most common cause of osteomyelitis?
staph aureus EXCEPT in patients with sickle cell disease, otherwise salmonella
45
what would Ewing's sarcoma show on an XR?
onion skin appearance, lytic bone lesions
46
what would an osteosarcoma show on an XR?
"sunray spiculation", Codman's triangle
47
XR of rheumatoid arthritis?
LESS:
- Loss of joint space
- Erosions
- Soft tissue swelling
- Soft bones (osteopenia)
48
risk factors for osteoporosis? (hint: SHATTERED)
- Steroids
- Hyperthyroid / Hyperparathyroid
- Alcohol / tobacco
- Thin - low BMI
- Testosterone
- Early menopause
- Renal / liver failure
- Erosive / inflammatory bone disease
- Dietary Ca2+ decrease / DMT1
49
is osteoarthritis symmetrical or asymmetrical?
asymmetrical
50
common presentations of Paget's disease in a q?
hearing loss, pelvic pain, raised ALP
51
4 common presentations of fibromyalgia?
"pain all over", headaches, poor concentration, sleep disturbances
52
features of cauda equina syndrome?
- can be progressive
- bilateral sciatica
- perianal or perineal sensory loss
- decreased anal tone on PR
- new urinary / faecal retentions / incontinence
53
list 4 causes of osteomalacia
- vit D deficiency
- renal failure
- inheritance
- liver disease
54
what is the first line treatment for neuropathic pain?
amitriptyline
55
Which is the genetic component most associated with ankylosing spondylitis?
HLA-B27
56
Which medication can cause recurrence of gout?
thiazide diuretics increase urate reabsorption in the proximal tubules, predisposing those to gout
57
which nerve root is responsible for the knee jerk reflex?
L4
58
what 2 infections are most likely to lead to reactive arthritis?
chlamydia and campylobacter jejuni
59
gram negative rod-shaped microorganisms that cause septic arthritis in IVDU?
pseudomonas aeruginosa
60
what does the joint pain presentation typically look like in reactive arthritis?
symmetrical and polyarticular
61
common presentations of reactive arthritis in a q?
- dactylitis: "sausage fingers" (inflammatory condition associated with spondyloarthropathies)
- DIPJ involvement
- presence of psoriasis or a 1st degree relative with
62
XR of pseudogout?
chondrocalcinosis -> calcification parallel to articular surfaces
63
Which antibody in the typical screen used in the diagnosis of Sjogren’s syndrome is most specific?
anti-La
64
is minimal change disease seen more commonly in adults or children?
children
65
why is methotrexate teratogenic?
it is a folic acid inhibitor -> crucial in neurodevelopment so inhibition will cause a miscarriage
66
which nerve is responsible for wrist drop and Saturday night palsy?
radial nerve
67
describe the crystals in pseudogout
positively birefringent rhomboid-shaped crystals
68
what is a normal DEXA T score?
-1 to +1
69
what is an osteopenic DEXA T score?
-1 to -2.5
70
what is an osteoporotic DEXA T score?
< -2.5 (severely: < -2.5 AND a known pathological fracture)
71
Name 3 genes associated with an increased risk of SLE
- HLA B8
- HLA DR2
- HLA DR3
72
Name 4 features of SLE that are required to make a clinical diagnosis
4 of … (remember as ‘A RASH POINTS AN MD’)
- Arthritis
- Renal disorder
- ANA+
- Serositis
- Haematological disorder
- Photosensitivity
- Oral ulcers
- Immunological disorder
- Neurological disorder
- Malar rash
- Discoid rash
73
What are 2 lifestyle changes that can be performed by the patient to reduce symptoms in SLE?
- Decrease sunlight exposure
- Wear high factor sunblock
- Decrease cardiovascular risk factors (Obesity, Smoking, Exercise, Cholesterol)
74
What medications should be given for an acute attack of SLE and what route should they be given?
IV cyclophosphamide and prednisolone
75
What causes the articular cartilage damage in osteoarthritis?
Apoptosis of chondrocytes leads to decreased cartilage production/increased cartilage breakdown 🡪 loss of cartilage, this causes clefts in the articular surface.
76
Name 2 joints that are commonly affected in Osteoarthritis
Interphalangeal joints
- Carpometacarpal joints
- Metatarsophalangeal joints
- Vertebra
- Hips
- Knees
77
Give 2 surgical treatment options for Osteoarthritis
- Arthroscopy / Arthroplasty
- Osteotomy
- Fusion
78
Give 3 characteristics of osteoarthritis that can be used to differentiate between rheumatoid arthritis.
- Pattern of joint involvement / Asymmetrical joints affected
- Absence of systemic features
- Morning stiffness <30mins
79
Give 3 risk factors for osteoarthritis.
- Joint hypermobility
- Insufficient joint repair
- Diabetes
- (increasing) Age
- Gender (female)
- Genetic predisposition
- Obesity
- Occupation
- Local trauma
- Inflammatory arthritis
80
give 4 differentials for a patient being HLA-B27 positive
ankylosing spondylitis, psoriatic, reactive and enteropathic arthritis
81
what scoring system is used for fractures involving the growth plate of bones in children?
Salter-Harris classification
82
what is the difference between T/Z scores in DEXA scans?
T: bone density compared to healthy 25 y/o of same sex
Z: bone density compared to healthy same age same sex
83
what is a FRAX score measuring?
the likelihood of a fracture in the next 10 years
84
what is a common side effect of alendronic acid?
oesophagitis
85
what is Sjogren's syndrome?
immune destruction of exocrine glands
86
presentations of Sjogren's syndrome?
arthritis, dry eyes, dry mouth
87
common test used to diagnose Sjogren's syndrome?
Schirmer's test - placing a small strip of paper in the eye to measure tear production
88
what XR sign is most commonly seen in psoriatic arthritis?
pencil in cup
89
RF for pseudogout?
parathyroidectomy, IV fluids -> can both derange calcium levels
90
what is the first sign on XR seen in ankylosing spondylitis?
sacroiliitis
91
features of ankylosing spondylitis?
- gradual onset back and buttock pain
- relieved slightly by exercise
- psoriasis
- dactylitis
- IBD
- eye involvement
92
name the causative molecules of gout and pseudogout
gout: monosodium urate
pseudogout: calcium pyrophosphate
93
state 4 causes of reduced urate excretion
elderly, post menopausal females, HTN, impaired renal function
94
state 3 causes of excess urate production
dietary, dehydration, genetic disorders
95
What is the treatment for gout if NSAIDs are contraindicated?
colchicine
96
what does DEXA stand for?
Dual Energy Xray Absorptiometry
97
fbc in osteoporosis?
normal calcium, phosphate and ALP
98
fbc in osteomalacia?
low calcium, low phosphate, high ALP
99
what parts of the skeletal system are inflamed in ankylosing spondylitis?
spine, rib cage, sacroiliac joints
100
what are vertebral syndesmophytes?
bony proliferations due to enthesitis between ligaments and vertebra
101
give 2 examples of something that would indicate a worse prognosis for those with ankylosing spondylitis
onset <16y, early hip involvement, poor NSAID response
102
what is the mechanism of action of NSAIDs (e.g. naproxen)?
non-selective inhibitors of COX1 and COX2 enzymes
103
Give two potential extra-articular manifestations of ankylosing spondylitis
5 A's:
- anterior uveitis
- autoimmune bowel disease
- apical lung fibrosis
- aortic regurgitation
- amyloidosis
104
What bedside test can be used to assess mobility in the spine?
Schober's test
105
Describe some aspects of how you perform Schober's test and what is a positive result?
- Have the patient stand,
- locate L5 vertebrae
- mark a point 10cm above and 5cm below
- Ask the patient to bend over forwards as far as they can and measure the distance between the two points
- A distance of less than 20cm indicates reduced lumbar movement
106
Give three potential findings on X-ray of the spine of a patient with ankylosing spondylitis
bamboo spine, subchondral sclerosis, ossification, fusion of joints
107
give 1 topical and 2 oral management options of OA
- topical: NSAIDs
- oral: paracetamol, bisphosphonates
108
what is dermatomyositis?
- a rare disease that causes muscle weakness and skin rash.
- Symptoms include a red or purple rash on sun exposed skin and eyelids, calcium deposits under the skin, muscle weakness, and trouble talking or swallowing.
- "trouble going up stairs"
109
what is cut to release pressure on the median nerve?
transverse carpal ligament
110
top differential for pagets disease?
osteomalacia
111
name 3 bones paget disease affects
femur, skull, vertebrae, pelvis
112
DMARDS: what do they stand for? what does it target? give an example
- Disease Modifying Anti Rheumatic Drug
- inflammatory cytokines
- methotrexate
