MSK Flashcards by Blossom Bella

Where does osteoarthritis commonly effect?

Heberden’s nodes- distal interphalangeal
Bouchard’s- proximal interphalangel
It commonly will effect the base of the thumb and the big toe

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What is seen on a x ray for osteoarthritis?

L- loss of joint sapce
O-osteophytes
S-subchonral cysts
S- Subarticular sclerosis

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What is the management of osteoarthritis?

Exercise to build up muscle
Para or NSAIDS for pain (No NSAIDs in elderly or diabetic)
Then go to NSAIDs/COX-2 inhibitors
Intra-articular corticosteroid injection

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What are gout crystals composed of?

Monosodium urate

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What are pseudogout crystals composed of?

Calcium pyrophosphate

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What can cause gout?

Hereditary, increased red meat, alcohol excess, diuretics, trauma, leukaemia, sugery

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What prevents a gout attack?

Allopurinol

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What do we see on X ray for gout?

Soft tissue swelling and punched out lesions

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What test do we do for gout and psuedogout?

Polarised light microscopy of synovial fluid

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How do we treat acute gout?

Ice and elevate
NSAID/ colchicine
Joint aspiration and intra articular corticosteroids

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What is seen on a pseudogout x ray?

Soft tissue calcium deposition

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How do we treat chronic gout?

Methorexate (DMARD) and hydrochloroquine

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What produces monosodium urate from nucleic acid?

Xanthine Oxidase

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Where does gout and pseudogout effect?

Gout- small joints and usually monoarthropathy

Pseudogout- Large joints and polyarthropathy

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What is the diagnostic antibody for rheumatoid athritis?

Anti-CCP antibodies

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What gene is Rheumatoid arthritis associated with?

HLA-DR4

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What will we see on investigation for rheumatoid arthritis?

Rheumatoid factor, Anti CCP (specific), high platelet, normocytic aneamia, high ESR and CRP

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What is seen on an Xray for rheumatoid arthritis?

LESS
Loss of space
Erosion
Soft tissue swelling
Soft bones

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Which joints does rheumatoid often effect?

Small joints of the hands and feet, MCP and PIP joint

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What are the signs for rheumatoid arthritis?

Ulnar deviation, boutinniere, swan neck deformaty, Z thumb, muscle wasting

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How does rheumatoid arthritis occur?

Macrophages enter the synovium, producing angiogenic cytokines and synovium that grows over cartilage to form a pannus. The synoviocytes produce RANKL and proteases which cause cartilage degregation.

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How long doe pain last in the morning for rheumatoid?

Greater than 30 minutes

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First treatment of rheumatoid arthritis?

2 DMARDs including methotrexate and a glucocorticoid

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What is used in the treatment of rheumatoid flares?

Short term glucocorticoids

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What is an alternative to DMARDs for rhuematoid treatment?

Anti-TNF

Which of osteoarthritis and rheumatoid arthritis responds well to NSAID use?

Rheumatoid arthritis

What is seen on a X-ray of someone with alkylosing spondylitis?

Syndesmophytes Sacroiliitis Bony proliferations calified ligaments to create a bamboo spine

What antigens are and aren't present in spondyloarthropathies?

HLA B27 is present but there is no rheumatoid factor present

What joints are affected in spondyloarthropathies?

Sacroiliac joint and spine

What is the posture seen in ankylosing spondylitis called?

Kyphosis | Question mark spine

What is the management of ankylosing spondylitis?

First exercise and manage CVD risk Can add NSAIDS or coxib If still bad then use corticosteroid injections and TNF alpha inhibitors

What are the 3 main signs of reactive arthritis?

Reiter's traid: | Urethritis, arthritis and conjunctivitis

Which joints does reative arthritis affect?

Large joints

Is reactive arthritis sterile or not?

Sterile

What bacteria cause reactive arthritis?

Chlamydia, ureaplasma, campylobacter, shigella, salmonella or Yersinia

What is the investigation for ankylosing spondylitis?

MRI scan

What is the management of reactive arthritis?

Aspirate synovial fluid, NSAIDs, Corticosteroids, antibiotics Methotrexate if longer than 6 months

What pattern does psoriatic arthritis present with?

Relapsing remitting

How does psoriatic arthritis present?

Rash, swelling, pain and tenderness, dactylitis and onycholysis

What defromity is seen in psoriatic arthritis?

Pencil in cup

Management of psoriatic arthritis?

NSAIDs, DMARDs, ciclosporin, anti-TNF

What is the triad for septic arthritis?

Low grade fever Impaired range of motion Painful large joint such as the knee

Common causes of septic arthritis?

S.Aureus, Streptococci, Nisseria gonococcus

What are the investigations for septic arthritis?

Aspirate the joint Blood cultures Plain x ray as CRP can be normal

What is the management of septic arthritis?

``` Splint limb IV antibiotics (flucloxacillin- clyd if allergic) for 2-3 weeks then oral antibiotics for 2-4 weeks Replace infected prosthetic joint ```

What is the treatment for MRSA?

Vancomycin or teicoplanin

What is septic arthritis an infection of?

surface cartilage

What is osteomyelitis an infection of?

The bone and is seen most commonly in children

How do you diagnose osteomyelitis?

Bone culture

What is the treatment for Raynaud's disease?

Keep warm, stop smoking, Nifedipine (CCB)

What is discoid lupus?

Lupus where only the skin is effected

What gender is SLE more common in?

Women (esp black and asians)

What are the signs of SLE?

``` SOAP BRAIN MD Serositis Oral ulcers Arthritis Photosensitivity ``` ``` Blood(anemia and thrombocytopenia) Renal Ana positive Immunologic (DS DNA) Neurologic (seizures) ``` Malor rash Discoid rash

What is the key blood feature of SLE?

High ESR but normal CRP

What type of sensitivity is SLE?

Type 3

What is the drug treatment for acute flares of SLE?

IV prednisolone and IV cyclophosphamide

What is the drug treatment for chronic SLE?

NSAIDs and hydroxychloroquine

Where does Sjogren's effect?

Exocrine glands

What are signs and symptoms of Sjogren's?

Dry eye and mouth, enlarged salivary glands, rash, fatigue, malaise

How do we test for Sjorgens?

Schirmer's test Serology- ANA, RF, Anti-ro Biopsy shows infiltration of plasma cells and lymphocytes

How do we treat sjorgens?

Tear replacement Vaginal lube NSAID Immunosuppressant

How does dermatomyositis present?

Lilac periorbital rash, sunburnt cheeks, sholder, subcutaneous calcifications, weakness so hard to get out of chairs

What is the treatment for dermatomyostits?

Corticosteroids

What is polymyositis?

Inflammation and progressive necrosis of skeletal muscle fibres

What is the presentation of polymyositis?

Difficulty squatting and with stairs, can't raise hands above head

What is systemic sclerosis?

Abnormal growth and deposition of connective tissue effecting skin, face, forearms and lower leg

What is antiphospholipid linked to?

``` CLOT Coagulation defects Livedo reticularis Obstetric- multiple miscarriages Thrombocytopenia ```

What is the treatment for antiphospholipid syndrome?

Low dose aspirin or warfarin

What confirms a Giant cell arteritis diagnosis?

Temporal artery biopsy

What is the treatment for giant cell arteritis?

Prednisolone

What is Wegner's?

Necrotizing GRANULOMATOUS vasculitis mediated by neutrophils

What are the symptoms of Wegener's?

Cough, stuffy nose, sinusitis, haemoptysis, haematuria, saddle nose deformity

What special tests are done for Wegener's?

c-ANCA and PR-3 ab | Renal and lung biopsy for granulomas

What is maintenance treatment for wegeners?

Azathioprine

What is the triad for Churg-strauss syndrome?

Asthma, eosinophilia and vasculitis (like wegeners)

What are the common secondary sites of bone tumours?

``` Breast Lung Thyroid Renal Prostate ```

What are the risk factors for osteoporosis?

``` ACCESS Alcohol use, Corticosteroid use Calcium low Estrogen low Smoking Sedimentary lifestyle ```

What is the FRAX score?

``` Acesses osteoporosis risk Country Age Weight Height Previous fracture Hip fracture in parents Smoking Glucocorticoids Rhuematoid Linked disease 3+ drinks a day Bone mineral density ```

MSK Flashcards

(78 cards)