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MSK Flashcards

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1
Q

What is the mechanism of action of bisphosphonates?

A

Reduce bone turnover by inhibiting osteoclasts and promoting apoptosis

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2
Q

Give an adverse effect of bisphosphonates?

A

Oesophagitis can occur when taken orally

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3
Q

What is the mechanism of Allupurinol?

A

Xanthine oxidase inhibitor which blocks metabolism of xanthine to uric acid

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4
Q

What is the most common side effect of Allupurinol?

A

Skin rash

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5
Q

What are the side effects of colchicine?

A

GI distrubances, myalgia, fever

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6
Q

How does methotrexate work?

A

Inhibits folic acid synthesis which is required for DNA and protein synthesis

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7
Q

Which biologic agent is used in osteoporosis to reduce fractures?

A

Denusomab

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8
Q

Which drug is used in poly and dermatomyositis?

A

Azathiproine

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9
Q

Which joints does osteoarthritis commonly affect?

A

CArpo-metacarptal joint, DIPJ, Knees

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10
Q

Which two signs do you see in the hands of an OA patient?

A

Heberdens at DIP , BOuchards at PIP

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11
Q

Give 3 non-pharmacological management of OA?

A

Phsyiotherapy, muscle strength, splints, walking aids, heat and cold packs

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12
Q

Give 2 pharmacological OA treatment methods?

A

Analgesia (paracetamol)

Intra articular steroids or hyaluronic acid

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13
Q

What are the risk factors for septic arthritis?

A

Pre-existing joint disease, immunosuppression, prosthetic joints, diabetes (sensation loss in feet), renal failure, old age, skin breaks

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14
Q

Which organisms commonly cause septic arthritis?

A

Staph aureus, neisseria gonococcus , E,coli, neisseria gonorrhoea

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15
Q

Which antibiotics are commonly given in septic arthritis?

A

Flucoaxcillin - vancomycin (if MRSA)

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16
Q

Which bones are commonly affected by osteomyelitis in a) adults and b) children?

A

a) Vertebrae and pelvis

b) Long bones - often acute

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17
Q

What are the causes of osteomyelitis in adults?

A

IVDU, immunosuprresion, underlying disease, TB

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18
Q

What is deposited in the joints in gout?

A

Monosodium urate crystals

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19
Q

What is deposited in pseudo gout?

A

Calcium pyrophosphate

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20
Q

What are the risk factors of pseudo gout?

A

Ilness, surgery, trauma, hyperparathryoidisim, haemachromatosis, diabetics, hypophospahataemia

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21
Q

What does SHATTERED stand for?

A

Steroid use, hyperthyroidism, alcohol and smoking, testosterone decrease, thin, early menopause renal ir liber failure, erosive/inflammatory bone disease and dietary calcium low

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22
Q

Which treatment methods prevents osteoporosis in post menopausal women?

A

HRT or raloxidene which is a selective oestrogen receptor modulator

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23
Q

What is teriparatide?

A

PTH to prevent fractures occurring

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24
Q

What is the first line bisphosophonate used in osteoporosis?

A

Alendronate

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25
Name 5 risk factors of gout?
Dehydration, diet (shellfish and red meat), drug induced eg diuretics, secondary to renal disease, hereditary
26
what X-Ray changes are typically seen in rheumatoid arthritis?
Loss of joint space, Soft tissue swelling, Peri-arctular erosions
27
What are the classic 3 features seen in reactive arthritis?
Urethritis, arthritis and conjunctivitis
28
What are the classic 3 features seen in septic arthritis?
Fever, reduced range of movement and pain
29
Give 3 signs of OA?
Joint tenderness, crepitus, limited ROM, joint instability
30
Give 3 occasions where there is an increased production of uric acid?
Myeloproliferative disorders cytotoxic drugs, severe psoriasis
31
What are the first 3 treatment methods in acute gout?
1. Protest, rest, ice and elevate joint 2. NSAID or coaching 3. Joint aspiration and intra-articular steroids 4. Short should cortiscoeroids or single IM injection
32
Which drug do you give if intolerant to allupurinol in prevention of gout?
Febuxostat
33
What would you see on an X-Ray of pseudo gout?
Calcium deposition in soft tissue
34
Why are women of child bearing age not given methotrexate?
Is teratogenic
35
Other than methotrexate name 2 other DMARDS>
Sulfasalazine, hydrocholquine
36
In what percentage of patients is Rheuatoid factor positive in for RA patients?
70%
37
What is sublaxation and what disease is it seen in?
Partial dislocation of joint, seen in RA
38
What is the pathophysiology of RA?
Synovial proliferation, inflammatory infiltration- pannus of inflamed synovial forms which leads to damage of underlying cartilage by blocking nutrition
39
Where does RA commonly affect?
Symmetrical, Metocarpalphalangeal, PIP, wrist or MTP, tensysynotivits or bursitis may be common
40
Give 5 extra-articular involvement of RA?
Pericarditis, amyloidosis, pulomary fibrosis, scleritis, peripheral sensory neuropathy, sjogrens and raynauds
41
Give 3 non-pharmacological management steps of RA?
Physiotherapy, podiatry, psychological support
42
Name 3 pharmacological methods to treat RA?
DMARDS, corticosteroids, Anti-TNF (etanercept), B-cell depleted (rituximab)
43
What are syndemophytes and what condition are they seen in?
Bony growth growing in ligament (can cause vertebral fusion) seen in Ank Spon
44
Name 4 factors that all spondyloarthropathies are associated with?
1. Axial inflammation 2. Assymetrical peripheral arthritis 3. Absence of rheumatoid factor 4. HLA- B27
45
What are the patterns of joint involvement in spondyloarthropathy?
Inflammation of sacroiliac joint and spine, asymmetrical large joint oligioarthritis or mono arthritis
46
What is enthetesis and what condition are they seen in?
Inflammation at the point of insertion of tendons or ligaments to bone
47
Give 3 signs of ankylosing sponydlitits?
Kyphosis, enthesisi, neck hyperextension, loss of spinal movement, pain radiates to buttocks/hips, decreased chest expansion, , relieved by exercise, question mark posture
48
Name 4 symptoms you see in adults under 50 that would indicate ankylosing spondylitis?
Morning stiffness >30 Improvement with exercise Wakening in 2nd half of night Alternating buttock pain
49
Name 3 sings you would see on an X-ray of ankylosing spondylitis?
Sacroilitis, syndesmophytes, bony proliferations, calcification of ligaments (bamboo spine)
50
Give an example of two infections that lead to reactive arthritis?
Urethritis (chlamydia) | Dysentry (camplobacter, shigella, salmonella)
51
Give 5 features of reactive arthritis?
Iritis, keratoderma blenorrhagia, circinate balantis (penile ulceration), mouth ulcers
52
What are the 5 patterns of involved of psoriatic arthritis?
``` Arthritis mutilans Assymetrical oligioarthritis Spinal arthritis Symmetrical polarthritis DIP joint arthritis ```
53
Give 3 features of psoriatic arthritis?
Oncholysis (peeling of nails) | Dactylitis
54
What would you see on an X-ray of psoriatic arthritis?
Erosive changes with pencil in cup deformity
55
What are the 3 ways septic arthritis can develop?
Local spread from adjacent tissues, direct inoculation eg penetrating injury or surgery , hamatogenous (synvovium = septic arthritis, metaphysis = osteomyelitis)
56
What are three investigations you would do in septic arthritis?
1. Urgent joint aspiration 2. Blood cultures 3. Plain X-Ray and CRP
57
Which phamalogical treatment would you use in Raynauds?
Nifedipine (calcium channel blocker)
58
What is Raynauds disease?
Peripheral digital iscahemia due to vasospasm
59
Give 3 secondary causes of raynauds?
Connective tissues disease, occupation (vibration tools), drug induced (beta blocker)
60
What antibodies are seen in SLE?
ANA - Anti-Nuclear antibodies
61
Name 6 signs of SLE?
Phosensitivity, malar rash, ANA, arthritis, oral ulcers, bloods (all low)
62
In what disease is the ESR high but CRP low?
SLE
63
What is the management of SLE?
Avoid sunlight & smoking. NSAIDs & corticosteroids for arthralgia. Acute severe flares - IV prednisolone + IV cyclophosphamide Chronic Mx: NSAIDS + hydroxychloroquine
64
What is the presentation of polymyositis?
Difficulty squatting, walking up and down stirs, raising hands above head
65
What do you see in dermatomyositis>
Macular rash on back and shoulder, heliotrope rash on eye lids, subcutaneous calcifications
66
How do you detect limited systemic sclerosis?
Anti-centromere
67
How do you detect diffuse systemic sclerosis?
Anti- topoisomerse and anti-Ro
68
What are the causes of anti-phospholipid syndrome? (CLOT)
Coagulation defect, lived reticular, obstetric problems, thrombocytopenia
69
What is the immediate management of giant cell arteritis?
Prednisolone
70
What is seen in the blood in GPA?
c-ANCA
71
What is Churg-strauss syndrome?
Asthma + eosinophilia + vasculitis
72
What is the gold standard diagnosis for Cauda- Equina?
MRI
73
What is the function of the articular cartilage?
Reduce friction and shock absorption
74
Which rheumatological condition is DIP sparing?
DIP sparing
75
What does it mean if you have rheumatoid factor in RA?
Progression of the disease will be quicker
76
What is the pathophysiology of osteoarthritis?
Wear and tear - imbalance of articular cartilage damage and repair, increases metalloproeteases - osteophytes
77
What are the risk factors of OA?
Age, female, genetics, obesity, joint trauma, RA, occupations
78
How do diuretics cause gout?
Decreased excretion of uric | Switch from diuretics to losartan
79
Where does septic arthritis most commonly affect?
Knee
80
What does the SPINEACHE stand for in ankylosing spondylitis?
Sausage digit, psoriasis, inflammatory back pain, NSAID good response, enthesitis, arthritis, Chrons, , HLA B27, Eye (anterior uvitriis)
81
What are the 4 spondyloarthropathies?
Psoriatic, Enterohepatic, Ankylosing spondylitis, reactive arthritis
82
How do you diagnose ank soon?
Sacrolilitis (XR?MRI) + Spinach
83
Why do you get a low Hb in Ank Spon?
Anaemic of chronic disease
84
What are the first 3 line treatments for Ank Spin?
Exercise and physio, NSAIDS, Anti-TNF
85
Give 4 investigations in reactive arthritis?
Bloods, stool culture if diarrhoea, STI screen, X-ray
86
Which disease do you rest and splint the joint?
Reactive arthritis
87
What is the epidemiology of SLE?
Women, Afro-caribbean/asian, EBC, Drugs, UV light
88
Which biological therapy is used in SLE?
Rituximab (anti-CD20)
89
What are the diagnostic criteria of SLE (MD SOAP BRAIN)?
Malar rash, discoid rash, serositis (pericarditis), oral ulcers arthritis, phosensitivity, blood (all low), renal disorder, ANA (+ve 90%), immunological (anti-dsDNA), neurological (seizures)
90
Which antibody is seen in anti-phospholipid syndrome?
Anti-cardiolipin antibody
91
What is the treatment of anti-phospholipid?
Manage RF: Smoking weight, diet, exercise, HTN, DM
92
What is the sicca complex?
Dry eyes and ears
93
What is the treatment of sjogrens syndrome?
Artificial tears, sugar free pastilles, frequent drinks | NSAIDS for arthlagia
94
How do you treat pulmonary hypertension?
Sildefanil
95
Which drugs is contraindicated in Rayndauds?
Propanaolol
96
In systemic sclerosis where is skin involvement limited to?
Face, hands and feet
97
What disease would you expect in symmetrical proximal muscle weakness?
Polymyositis, dermatomyositis
98
Which disease would you see increased muscle enzymes?
Polymyositis, dermatomyositis
99
What emergency presentation occurs in giant cell arteritis?
Ischaemic optic neuritis
100
Where does polymysia rheumatic commonly affect?
Shoulders and pelvic girdle
101
How does Wegners affect the Kidneys?
Glomerulonephritis - haematuria
102
What is fibromyalgia commonly associated with?
Sleep disturbance, IBS, chronic headache, depression, chronic fatigue syndrome
103
What are the 4A's in Ankylosing spondylitis complications?
Aortic regurgitation Atalantoaxial sublaxation Anterior uveitis Atypical pulmonary fibrosis
104
Why do you see sequestra in osteomyelitis?
Increased pressure causes interruption of periosteal blood supply - necrosis and small vessel thrombosis - nectotic bone (sequestra)

Phase 2a Summaries (12 decks)

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