MSK Flashcards
(161 cards)
1
Q
What is the functional unit of bone
A
Osteon
2
Q
Describe the structure of an osteon
A
Concentric lamellae (like tree trunk) and central haversion canals
3
Q
What is the organic and inorganic of bone made from
A
Hydroxyapatite (Ca2(PO4)3)- for stiffness
Type 1 collagen- Elasticity
4
Q
How many oesteons does 1 haversion canal supply
A
1 longitudinal
5
Q
What is the most common arthertirits
A
Oesteoarthiritis
6
Q
What are risk factors for osteoarthritis
A
50+, women, obesity, occupation/ sports, genetic
7
Q
What gene gives you a predispostion for oestoarthritis
A
COL2A1
8
Q
What is the pathology of osteoarthritis
A
Imbalance in cartilage breakdown > repair. Increase of chondrocyte metalloproteinase secretion which degrades collagen + causes cysts. Bone attempts to overcoem this with T1 collagen and you get abnormal bony growths + remodelling
9
Q
What are the abnormal bony growths known as in osteoarthritis
A
Osteophytes
10
Q
What are Sx of oesteoarthritis
A
Transient morning pain <30 min, worse as day goes on
Bouchard+ Hebderen nodes
Asymmetrical, hard non inflamed joints
Typically in most stressed joints (base of thumb, hip/knee)
No extra articular symptoms
11
Q
What do you see on XR in osteoarthritis
A
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
12
Q
What is managemnt of osteoarthirits
A
Lifestyle changes
NSIADS for pain relief
Last resort:- surgery (osteoplasty)
13
Q
In which joints does osteoplasty work very well in
A
Hip and knee
14
Q
RF for rhematoid arthiritis
A
Women 30-50, smoking, HLA DR4/ HLA DR1
15
Q
What amino acid change occurs in rheumatoid arthritis
A
Arginine to citrulline in T2 collagen
16
Q
Pain throughout day in rheumatoid arthrits
A
Worse in morning eases as day goes on
17
Q
What hand deformities do you see in rheumatoid arthritis
A
Boutonniere, Swan neck, Z thumb, ulnar finger deviation
18
Q
What join is often spared in rheumatoid arthritis
A
DIP
19
Q
Other than hand deformities, articular Sx of rheumatoid arthritis
A
Symmetrical, hot inflamed joints
MC in hand wrist feet
Bakers cyst
20
Q
What is a Bakers Cyst
A
Popliteal synovial sac buldge
21
Q
Extra-articular Sx of rheumatoid arthritis (complications)
A
PE, Pulmonary fibrosis
Episcleritis, keratoconjunctivitis sicca (dry eyes)
Spinal cord compression
CKD
Rheumatoid skin nodes
22
Q
What do blood tests show in rheumatoid arthritis
A
Raised ESR/ CRP
Normocytic normochromic anaemia
23
Q
What does serology show in rheumatoid arthritis
A
+antiCCP(80%)
+RF (70%)
24
Q
What does XR show in rheumatoid arthritis
A
LESS
Loss of joint space
Eroded bone
Soft tissue swelling
Soft bones (osteopenia)
25
What treatment is given in rheumatoid arthritis (not pain management)
DMARD:- Methotrexate
Biologies:- 1st- TNF-alpha inhibitor- infliximab
2nd- B cell inhibitor (CD20 target)- Rituximab
26
RF for Gout
Purine-rich foods (meat, seafood, Beer), CKD, Diuretics
Dairy can be Anti Gout
27
How do monosodium urate crystals form
Purines into Uric acid (by xanthine oxidase) then uric acid into monosodium urate
28
Why does CKD cause gout
Kidneys excrete Uric Acid
29
Sx of GOUT
Monoarticular typically big toe. Sudden onset severe swollen red toe
30
Dx of GOUT
Joint aspiration; Negatively birefringent needle-shaped crystal under light microscopy
31
Prevention of GOUT treatment
Allopurinol
32
Treatment for GOUT
Diet change
NSAIDS 1st line then consider colchicine then consider Steroid Injection
33
What are pseudogout crystals made of
Calcium phosphate
34
RF for Pseudogout
Elderly female, diabetes, metabolic disease, OA
35
DEXA scan T score interpretation
0-1= normal
1-2.5= osteopenia
>2.5 = osteoporosis
36
RF for oesteoporosis
SHATTERED
Steroids
Hyperthyroid/ hyperparathyroidism
Alcohol + smoking
Thin
Testosterone low
Early menopause
Renal/ liver failure
Erosive + inflammatory disease
DMT1 or malabsorption
37
Dx of Osteoporosis
DEXA scan (Dual-energy SR Absorptiometry)
38
What is used for a fracture risk assessment tool
FRAX score
39
Treatment for Osteoporosis
1st:- Bisphosphonates
2nd:- mAB denosumab
40
What type of hypersensitivity reaction is SLE
T3
41
RF for SLE
Female, HLAB8/DR2/DR3, drugs
Afro Caribbean, 20-40
42
Pathology of SLE
Impaired apoptotic debris presented to TH2
43
Sx of SLE
Butterfly rash + photosensitivity
Glomerulonephritis (nephritic syndrome)
Seizures + Psychosis
Mout Ulcers
Anaemia
Joint pain, Raynaurds, Pyrexia
44
What do blood test show in SLE
Anemia, Raised ESR normal CRP
Decreased c3 + c4
45
What does urine dipstick show in SLE
+++Haematuria, ++proteinuria (Nephritic syndrome)
46
What is the serology of SLE (sensitive and specific)
ANA Abs (99%) very sensitive
Anti-dsDNA Abs + anti smith very specific
47
What antibody in SLE is used to monitor the progression
Anti dsDNA
48
Treatment for SLE
Lifestyle changes (less sunlight)
Corticosteroids (main)
Hydroxychloroquine
NSAIDS
Try to taper off drugs so only hydroxychloroquine once stable
49
What is used to treat severe SLE
Azathiopines
50
What is antiphospholipid syndrome
An autoimmune disorder in which the immune system mistakenly produces antibodies against normal proteins in the blood
Characterised by thrombosis, recurrent miscarrge
51
What is primary vs secondary antiphospholipid syndrome
Primary is idiopathic
Secondary to other disease (SLE)
52
Sx of antiphospholipid
CLOTs
Coagulopathy
Livedo Reticularis (Purple discolouration of skin)
Obstetric issues (miscarriages)
Thrombocytopenia
Risk arterial (Stoke, MI+ DVT)
53
What antibodies are present in antiphospholipid syndrome
Anti-cardiolipin antibodies (IgG/M)
Anti beta 2 glycoprotein-1 antibodies
54
1st line treatment for antiphospholipid syndrome if they've had a thrombosis
Warfarin
Long term if they've had a thrombosis
If preggo give aspirin+ heparin
55
What is the prophylactic treatment given in Antiphospholipid syndrome
Aspirin
56
What is Sjogren syndrome
Autoimmune exocrine dysfunction can be primary or secondary
Affects moisture producing glands
57
RF for Sjogrens syndrome
Female, fHx, 40-50, HLAB8/ DR3
58
Sx of Sjogrens Syndrome
Dry eyes (keratoconjunctivitis)
Dry Mouth (Xerostomia)
Dry vagina
59
What test is used in the diagnosis of Sjogddrens syndrome
Schimer test:- Induce tears + place filter paper under eyes. In Sjogrens syndrome tears travel less than 10mm (should be 20mm)
60
What is the serology of Sjogren's syndrome
Anti-Ro Ab
Anti LA Ab
61
What is the treatment for Sjogren's Syndrome
Artificial Tears, salvia + lubricant for sexual activity
62
What cancer does Sjordens syndrome directly increase the risk of
Lymphoma
63
What is most common type of Scleroderma
Limited cutaneous scleroderma (CREST)
64
What are Sx of Scleroderma
Calcinosis (Ca deposits in SC tissue)- Renal failure
Raynauds (digit ischemia due to sudden vasospasm
Esophageal dysmotility (stricture)
Sclerodactyly (local skin thickening or tightening on fingers/ toes)
Telepgientaria (Spider veins) risk of pul Htn
65
What antibody is present in scleroderma
Anti Centromere Antibodies (ACAs)
66
What is fibromyalgia
MSK equivalent of IBS
Chronic widespread MSK pain for 3+ months w/ all other causes ruled out
67
RF for fibromyalgia
Females, depression, stress, poor, 60+
68
Sx of Fibromyalgia
Fatigue, Sleep disturbance, Morning stiffness, Esp back + kneck stiffness + pain
69
Dx of Fibromyalgia
Pain in 11/18 regions palpated
70
Treatment for fibromyalgia
Educate patient, physiotherapy
Antidepressants + CBT if severe
71
What is polymyalgia rheumatic
Large vessel vasculitis presenting as chronic pain syndrome
72
Dx of Polymyalgia rheumatica
Raised ESR + CRP
73
Treatment for polymyalgia rheumatica
Oral prednisolone
74
Are primary or secondary bone tumours more common
Secondary
75
What is most common primary bone malignancy and what disease is it assoiated with
Osteosarcoma associated with pagets (15-19 y/o patient)
76
Where does osteosarcoma metastasis too
Lung
77
What is XR appearance in osteosarcoma
Sunburst
78
What is an Ewing sarcoma
Cancer of mesenchymal stem cells of bone
79
Which secondary bone cancers are osteolytic vs osteosclerotic
Osteolytic:- Breast + Lungs
Osteosclerotic:- Prostate, Thyroid, RCC
80
General Sx of bone tumours
Local severe pain is worst at night
Weight loss, fatigue, fever, malaise
81
What imaging can be used to show bone tumours before XR
Skeletal isotope scan
82
Treatment for bone tumours
Chemo/ radio therapy
Bisphosphinates
83
What do bloods/ U&Es show in bone tumour
Raised ALP/ESR/CRP, hypercalcemia
84
What is osteomalacia
Defective bone mineralisation due to Vit D deficiency so lack of calcium and phosphate
85
What is osteomalacia known as before epiphyseal fusion
Rickets
86
What can cause osteomalacia
HyperPTH
Vitamin D deficiency, malabsorption reduced intake
CKD/ renal failure
Liver Failure
Anticonvulsant drugs
87
Why does CKD/ renal failure decrease Vit D production?
Kidney 25-hydroxy vit D to 1,25 dihydroxy Vit D
88
Why does Liver failure reduce Vit D
Liver does cholecalciferol into 25-hydroxyvit d
89
Why does anticonvulsants decrease Vit D
Increase CYP450 metabolism of Vit D
90
Sx of osteomalacia
Fractures, proximal weakness + difficulty weight bearing
91
Sx of rickets
Skeletal deformities; Knocked knees + bowed legs
Wide Epiphyses
92
Diagnostic investigation for Osteomalacia
BM biopsy; Incomplete mineralisation
93
Blood in osteomalacia show hypocalcemia, raised PTH, decreased serum Ca but what is the best marker
Decreased 25(OH)D
94
Treatment for osteomalacia
Vit D replacement (Calcitrol) + increase dietary intake
95
What is Pagets disease of bone
Excessive activity of both osteoblasts and clasts leads to excessive turnover of bone. Exessive turnover is not coordinated leading to areas of high density (sclerosis) and low density (lysis).
Leads to lsrge and mishaoedn bones
96
Which group most at risk from pagets
Female 40+
97
Sx of Pagets disease of bone
Bone pain
Bone deformities; bowed tibia
Nerve compression of CN8:- deafness
Hydrocephalus; blockage of sylvian duct
98
What do you see on XR in pagets
Osteoporosis circumscripta; describes well-defined osteolytic lesions
Cotton wool skull; due to areas of lysis + sclerosis
V-shaped defects in the long bones; V sphaped osteolytic bone lesions within healthy bone
99
How are ALP, Ca and phosphate affected in pagets diseases
Raised ALP, normal calcium and phosphate
100
What can be used to monitor disease progression in pagets
Urine hydroxyproline; protein constituent of bone collagen
101
Treatment for Pagets
Bisphosphonates
NSAIDS for pain relief
102
What inheritance pattern is Marfan's
Autosomal dominant
103
What does marfans cause
Decrease in connective tissue tensile strength due to mutation in gene coding for fibrilin
104
Sx of marfanss
'Marfans Body Habitus'; Tall + thin, long fingers, arachnodactyly, pectus excavatum or carinatum
Aortic complications; Aortic regurg, AAA, AD
105
Dx of Marfan's
Clinical Px + FBN-1 mutation
106
Classical presentation for GCA
50+ Caucasian female with unilateral temple headache, jaw claudication +/- vision change
temporal scalp tenderness
107
Which branches lead to the specific symtpoms seen in GCA
Temporal:- scalp tenderness
Vision:- Ophthalmic
Jaw:- Facial
108
1st line investigation for GCA
ESR will be raised
109
Diagnostic investigation for GCA
Temporal artery biopsy (take big chunk as patchy skip lesions)
110
Describe inflammation seen in GCA
Granulomatous inflammation of media + intima
111
Treatment for GCA
Corticosteroids (prednisolone)
112
Complications of GCA
Sudden painless vision loss in one eye (optic neuropathy)
Temporary amaurosis fugax
May be permanent if not delt with ASAP
113
How to treat sudden vison loss in GCA
High dose IV Methylyprednisolone
114
Who is more at risk from Polyarteritis Nodosa
Males or females
Males
115
What viral infection is polyarteritis nodosa associated with
HepB
116
Sx of polyarteritis nodosa
Severe systemic Sx
Mononeuritis multiplex
GI bleeds
CKD/ AKI
Skin SC nodules + haemorrhage
117
What do you see on a CT angiogram in polyarteritis nodosa
Beads on a string (microaneurysms)
118
Other than CT angiogram, what other test do ou perform in polyarteritis nodosa
Biopsy e.g. kidney
See necrotising vasculitis
119
Treatment for polyarteritis nodosa
Corticosteroids
Control htn: ACE-i
Hep B treatment after corticosteroids
120
What gene are spondyloarthropathies associated with
HLAB27
121
General features of spondyloarthropathies
SPINEAHCE
Sausage fingers
Proasisis
Inflammatory back pain
NSAIDs good response
Enthesitis
Arthritis
Chrons or colitis
HLA B27
Eyes; uveitis
122
What is the pathology of ankylosing spondylitis
Syndesmophytes (vertical abnormal bony growths) replace spinal bone damaged by inflammation make spine less mobile
123
Sx of ankylosing spondylitis
Young make with progressively worsening back stiffness. Worse in morning better w/ exercise
Anterior uveitis
Entheirits
Dacytlitis
Lumbar lordosis
124
What tests lumbar flexion
Schober test (<20cm in Ankylosing Spondylitis)
125
What does XR show of ankylosing spondylitis
Bamboo spine + sacroiliitis + syndesmophytes
126
What imaging is the best screening tool for ankylosing spond
MRI as shows sacroiliitis before XR
127
Treatment for Ankylos Spond
NSAIDs to help symptoms (+ exercise)
DMARD (tnf-alpha-blocker) to improve disease such as infliximab
128
What % of patients with psoriasis develop psoriatic arthritis
10-20%
129
Sx of Psoaritic arthritis
Moderate; Inflamed DIP joints + nail dystrophy, dactylitis and enthesitis
Psoriatic rash on skin
Severe; Arthritis mutilans= pencil in cup deformity; Osteolysis of bone = progressive shortening and fingers telescope in on themselves
130
Treatment for psoariatic arthritis
NSAIDs for symptoms (steroid injection if severe)
DMARD (methotrexate) if fials anti TNF (inflixumab)
If fails IL 12+ 23 inhibitor
131
What is used to screen patients with psoriasis for psoriatic arthritis
Psoriasis Epidemiological Screening Tool
132
What is reactive arthritis?
Sterile synovitis in reaction to a distant infection infection
133
What usually causes reactive arthritis
GI or STI infection
134
What organisms in gastroenteritis can cause reactive arthritis
C. Jejuni, Salmonella, Shigella
135
What STI infections can cause reactive arthritis
C. Trachamatis MC
N. Gonorrhoea
136
Sx of reactive arthritis
Reiters Traid
Cant see, cant pee, cant climb a tree
Uveitis, urethritis, Arthritis
137
What does a joint aspirate show in Reactive arthritis
Now organism growth
Plane polarised light microscopy is negative for crystal arthropathy
138
Treatment for reactive arthritis
NSAIDs + steroid injection for symptoms
Mostly single attack but if not Methotrexate then Inflixumab if it doesn't work
139
What are the seronegative spondyloarthropathies
Ankylosing spondylitis
Reactive Arthritis
Psoriatic Arthritis
140
What is the most common cause of Septic arthritis?
Staph Aureus
141
What than S. Aureas what organisms can cause septic arthritis
H. Influenza, E. Coli/ Pseudomonas
142
RF for septic Arthritis
IVDU, Immunosuppression, Recent surgery, Trauma, Prosthetic joints + inflammatory joint disease
143
What organism are prosthetic joints at risk of infection from
Staph epidermidis
144
Investigation for septic arthritis
Urgent joint aspirate and ID causative organism
145
Treatment for septic arthritis
Joint aspirate (drainage) then empirical Abx
Flucloxacillin (gram -ve)
Vancomycin (MRSA)
IM ceftriaxone + azithromycin (Gonorrhoea)
Stop methotrexate + inflicumab
Double prednisolone dose
NSAIDs for analgesia
146
What is osteomyelitis
Acutely inflamed infected bone marrow
147
What is the most common cause of osteomyelitis in children vs adults?
Haematgenous in children
Local in adults
148
Most common cause of osteomyelitis
S. Aureus
Salmonella in sickle cell patients
149
RF for osteomyelitis
IVDU, Immunosuppression, PVD, DM, Sickle cell, Inflammatory arthritis, trauma
150
What acute bone changes occur in osteomyelitis
Inflammation and bone oedema
151
What chronic bone changes occur in osteomyelitis
Sequestra:- Necrotic bone embeded in pus
Involucrum:- thick sclerotic bone placed around sequestra to compensate for support
152
Sx of osteomyelitis
Acutely; Dull bony pain + hot swollen area +/- joint. Worse with movement
Chronic; + deep ulcers (sequestra)
153
Investigations to carry out in osteomyelitis
BM biopsy + culture
XR= osteopenia MRI (after XR)= bone marrow oedema (MRI best for diagnosis)
Raised ESR/ CRP
154
Treatment for Osteomyelitis
Immobilise + Abx
6 weeks Flucoxacillin + Fusidic acid 2 weeks
155
What Abx to treat salmonella
Flucoxacillin
156
Vancomycin vs Teiocoplannin
Teiocplannin is longer lasting but has worse side effects (GI upset + pruritis)
157
What is a Charcot joint
Damage to sensory nerves due to diabetic neuropathy
Causes progressive degeneration of weih=ght bearing joint + bony destruction. Often affects foot
DDx for osteomyelitis
158
What do you see on XR of a patient with Ewings sarcoma
Lytic bone lesions
Onion skin apearnce
159
What does XR show in patient with chondrosarcoma
Popcorn calcification
160
What is first-line treatment for neuropathic pain
Amitriptyline
161
Treatment for pseudo gout
NSAIDs, can use colchicine or
