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MSK Flashcards

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1
Q

What are the Xray findings in RA?

A 
SOLD 
Soft tissue swelling 
Osteopenia 
Loss of joint space 
Deformity/erosions - marginal
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2
Q

Give the deformities you might see in the hands of someone with bad RA?

A
  • Ulnar deviation
  • Swan neck
  • Boutonniere
  • Z shaped thumb
  • MCP subluxation
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3
Q

What are some of the extra-articular manifestations of RA?

systems

A

Lung - ILD, nodules (plural effusions) Caplans (coal workers)
Haem - anaemia
Heart - pericartitis + HTN
Eyes - episcleritis and scleritis

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4
Q

What serum markers can you look for in RA?

A
  • Anti cyclic citrullinated peptide abs

- Rheumatoid factor

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5
Q

What is RF?

A

It is the ab against the FC portion of IgG

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6
Q

What are the treatment steps for RA?

A

1) Analgesia = NSAIDs
2) Steroids = low dose pred for flares
3) DMARS = methotrexate + sulphasalazine/hydroxychloroquine
4) Biologics = infliximab

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7
Q

When would you consider biologics in RA?

A

Failure to respond to 2 DMARDS

2x 6m trials

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8
Q

How does methotrexate work?

A

Its a cytotoxic folate inhibitor that prevents cellular/DNA replicating
It has anti-inflammatory and immunosuppressive effects by inhibiting IL6, IL8 and TNFa

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9
Q

What are the SE of methotrexate?

A

Mucosal damage - sore mouth and GI upset
BM suppression - neutropenia and infection risk
LT = hepatic cirrhosis + pulmonary fibrosis

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10
Q

Give examples of the Anti-TNF drugs

A

Infliximab
Adalimumab
Etancercept

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11
Q

Give an example of a monoclonal ab against the CD20 portion on B cells

A

Rituximab

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12
Q

What are the crystals in Gout?

A

Monosodium urate

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13
Q

What investigations would you do if you suspected gout and what would you see?

A

Joint aspiration:
Long needle shaped crystals which are -ve bifringent
XR - soft tissue swelling with punched out lesions

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14
Q

How does allopurinol work?

A

It is a xanthine oxidase inhibitor

It reduces uric acid formation and may inhibit purine synthesis

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15
Q

What are the crystals in pseudo gout and what would you see in XR?

A
  • Calcium pyrophosphate

- Linear opacification of the articular cartilage (mineralisation of the fibrocartilage)

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16
Q

What would you seen on an XR in the spine of a person with untreated Ank Spond?

A

BESS

  • Bamboo spine is these are ossified
  • Erosions
  • Vertebral squaring
  • Syndesmophyte formation
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17
Q

What are the extra-articular manifestations of Ank Spond?

A
  • Anterior uveitis
  • AR
  • Amyloidosis
  • Apical fibrosis
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18
Q

What are the treatment steps for Ank Spond?

A

1) Analgesia = NSAIDs
2) Intra-articular steroid injections
3) Biologics = Anti-TNFa = adalimumab, etanercept

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19
Q

What is the Xray deformity seen in psoriatic arthritis?

A

Pencil in cup

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20
Q

What are the extra-articular manifestations of reactive arthritis?

A 
Conjunctivitis 
Skin: erythema nodosum 
Nais: onchyolysis/pitting 
GI: adbo pain, D 
CV: aortitis +/- AR
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21
Q

What are the organisms involved in septic arthritis?

Study These Flashcards
A

Staph aureus

Neisseria gonorhroea

22
Q

How do you manage septic arthritis?

Study These Flashcards
A

Surgical drainage and lavage
IV abx
- Vancomycin + ceftriaxone then tailor to the culture results

Staph - flucloxacillin

23
Q

What conditions pre-dispose you to osteomyelitis?

Study These Flashcards
A
  • DM
  • Sickle cell anaemia
  • IVDU
  • immunosuppression/HIV
  • alcohol excess
24
Q

What investigations do you do if you suspect osteomyelitis?

Study These Flashcards
A

Bloods: FBC, ESR + CRP
Cultures
Imaging: MRI

25
What is fibromyalgia?
It is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites ? altered pain perception and somatisation
26
What are some of the features of fibromyalgia?
``` Chronic pain 'all over pain' Lethargy Cognitive impairment - fibre-fog Sleep disturbance, headache, depression/anxiety, irritable bladder, IBS 11/18 tender points ```
27
How would you manage someone with fibromyalgia?
S: Patient education C: aerobic exercise P: CBT B: Amitriptyline
28
What are the red flags of back pain?
TUNA FISH - Trauma - Unexplained weight loss/anorexia - Neuro - bladder/bowel issues - Age >50 or <20 - Fever/night sweats - IVDU/Immunosuppression - Steroid use - Hx of malignancy
29
What do you need to have to Dx SLE?
4/11 features DOPAMIN RASH Discoid, oral ulcers, photosensitivity, ANA, malar rash, immunological (ds DNA, smith) neuro (siezures/psychosis) Renal, arthritis, serositis (pleuritis, pericarditis) Haem (anaemia, leukopenia, thrombocytopenia)
30
What ix would you do if you suspected SLE?
Raised ESR - normal CRP Complement: low C3 and C4 Auto abs: ANA, Anti-ds DNA, Anti-smith Antiphospholipid abs
31
How do you treat mild SLE?
IA CS injections PO pred if a flare up Hydroxychloroquine
32
How do you treat mod SLE
Hydroxychloroquine + immunosuppressants - High dose CS - Azathioprine, cyclophosphamide - Ciclosporin, tracolimus
33
How do you treat refractory SLE
Rituximab (Monoclonal ab against B cells) | - when 2 immunosuppressants have failed
34
How do you treat anti-phospholipid syndrome?
Warfarin
35
What is sjogrens?
Immunologically mediated destruction of the epithelial exoglands - mainly the lacrimal and salivary glands
36
What HLA is Sjogrens associated with?
HLA DR3
37
What investigations can you do in Sjogrens?
- Schirmer test (paper strip into eye <10mm wetting) - Auto abs: Anti-Ro + anti-La - Sialography: Looking at function of salivary gland - Biopsy of salivary gland: mononuclear infiltrate
38
How do you treat sjogrens?
Artificial tears + saliva Pilocarpine Systemic: NSAIDs, hydroxychloroquine and steroids
39
What are the SE of steroids?
``` SHIP DOC Syndromes - cushings HTN Infections (immunosuppressive) Psychosis DM + weight gain Osteoporosis Cataracts ```
40
How are the small vessel vasculitis divided up? | Give examples in each group
ANCA + ve = granulomatosis with polyangiitis + Esinophilic granulomatosis with polyangiitis (chrug-strauss ANCE -ve = Henoch-schonlien purpura (immune complex mediated)
41
What is ANCA?
Anti-neutrophil cytoplasm Abs = auto-abs They bind to 2 proteins in neutrophil cytoplasm (PR3 + MPO) The binding of ANCA to neutrophils causes a toxic release of substances - inflam to the vessels - N migrate through vessel wall and release pro-inflammatory cytokines
42
How can you test for ANCA?
ELISA | Indirect Immunofluorescence
43
What is Wegener's - granulomatosis polyangiitis?
ELK It is a necrotising granuloma of the upper and lower airways with focal glomerulonephritis ENT - Lungs - Kidneys
44
How might someone present with granulomatosis polyangiitis?
``` URT - otorrhoea, sinus pain, nasal d/c LRT - SOB, CP, haemoptysis, cough Renal - oedema, HTN, haematuria + Eyes - periorbital oedema MSK - myalgia and arthralgia Neuro - numbness and weakness ```
45
How would you induce remission in someone with graulomatosis polyangiitis if it was: a) Non-lifethreatening b) Life threatening
a) Non-lifethreatening = IV methylpred + methotrexate | b) Life threatening = IV methylpred + cyclophosphamide
46
What is the triad of Churg-stauss?
1) Vasculitis 2) Asthmas 3) Esinophilia Vasculitis in a person with atopy
47
What is Goodpastures?
Anti-GMB disease - pulmonary renal disease | Auto-abs to the alpha 3 chain of type 3 collagen in BM of alveoli and glomeruli
48
How do you treat Goodpstures?
Immunosuppression (PO pred + cyclophosphamide) | Plasmapharesis
49
What is polyarteritis nodosa?
Necrotising arteritis with formation of micro aneurysms, thrombus and infarction Spares the lungs and the kidneys Due to the deposition of complement --> inflammation
50
What is the sign in polyarteritis nodosa that is due to micro aneurysms and focal narrowing?
Rosary sign
51
Describe polymyalgia Rheumatica
Pain and stiffness in the shoulders, neck and pelvic girdle >2weeks with systemic symptoms at onset - malaise, fever, fatigue

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