MSK

Question 1

Osteoarthritis aetiology

Answer 1

Age
hereditary disposition
Female
Obesity

Question 2

Osteophytes form in

Answer 2

Osteoarthritis

Also known as Heberden (DIP) and Bouchard nodes (PIP)

Question 3

Osteoarthritis Sx

Answer 3

Joint pain & discomfort
- Gets worse with activity

Stiffness 
Bony swellings (herbedens and bouchards)

Question 4

Osteoarthritis Ix

Answer 4

Often clinical diag

XRAY 4 things (LOSS)

• Loss of joint space
• Osteophytes
• Subcondral cysts
• Subarticular sclerosis

Question 5

RA aetiology

Answer 5

AI

HLA-DR1/4 association

Question 6

What is rheumatoid factor?

Answer 6

IgM antibody which recognises Fc portion of IgG as targen antigen

Question 7

Rheumatoid arthritis Sx

Answer 7

SYMMETRICAL
Swollen
Painful and stiff small joints
WORSE IN MORNING - improves with movement

Warm, tender joints 
Fingers ulnar deviation 
Radial deviation of wrist 
Swan neck 
Boutonniere 
Z deformity 
Trigger finger 
Palmar erythema

Question 8

Extra-articular features of RA

Answer 8

Rhematoid nodules

- firm nodules on elbows, ulnar margins, palms & extensor tendons

Question 9

RA Ix

Answer 9

Rhematoid factor
Antinuclear antibodies

Joint X-ray (BONDS)

• Bone erosions
• Osteopaenia
• Narrowing of joint space
• Soft tissue swelling

Question 10

Reactive arthritis

Answer 10

Inflammatory sterile arthritis following extra-articular infeciton (GI/urogenital)

Question 11

Reiter’s syndrome

Answer 11

TRIAD

Reactive arthritis
Urethritis
Conjunctivitis

Question 12

Aetiology reactive arthritis

Answer 12

Associated with infections

• GI (Salmonella, shigella, yersinia, C. jej)
• Urogenital (Chlam, Ureaplasma)

HLA-B27

Question 13

Reactive arthritis Sx

Answer 13

Burning/stinging when piss 
Arthritis 
Low back pain 
Painful heels 
Conjunctivits

Question 14

REactive arthritis Signs

Answer 14

ABCD

Arthritis (asymmetrical, often painful in morning )

Blanitis circinate (painless ulcer on penis glans)

Conjunctivitis

keratoDerma Blenorrhagica
- Brown/red macule s on soles and palms

Question 15

Reactive arthritis Ix

Answer 15

Stool/urethral swabs & culture

Question 16

Ankylosing Spondylitis aetiology

Answer 16

Association with HLA-B27 gene

Question 17

Ankylosing Spondylitis Sx

Answer 17

Gradual onset back pain

Early morning stiffness with exercise

Resolution with NSAIDS

Question 18

Ankylosing Spondylitis Ix

Answer 18

Schober’s Test

Pelvic Xray - 1st investigaion

Radiographs - MRI best at detecting early disease

Question 19

Ankylosing Spondylitis Extra-articular features

Answer 19

5 A’s

Anterior uveitis 
Apical lung fibrosis 
Achilles tendinitis 
Amyloidosis 
Aortic regurgitaiton

Question 20

Septic arthritis RFs

Answer 20

RA
Osteoarthritis 
Joint prosthesis 
IV drug abuse 
Alcoholism 
DM 
Osteomyelitis

Question 21

Septic arthritis causative organisms

Answer 21

Bacterial

• S. aureus
• TB
• N. gonorrhoea
• <4 yrs (S. pneu, S. pyoge, N. meningitid)

Viruses

• Rubella
• Mumps
• Hep B

Question 22

Septic arthritis Sx

Answer 22

Sudden onset

Excruciating hot swollen immobile joint

Question 23

Septic arthritis Ix

Answer 23

Joint aspiraiton
- MC&S

Bloods

• FBC
• Cultures
• Viral serology

Question 24

Gout aetiology

Answer 24

HYPERURICAEMIA

• Increased urate intake or production
  
  • inc diet intake purines
  • inc nucleic acid turnover (haem cancers)
• Renal excretion
  
  • Idiopathic
  • Dehydration
  • Alcohol excess

Question 25

Gout acute attack Sx

Answer 25

Suddent excruciating monoarticular pain Afects MTP of big toe (podagra)

Question 26

Gout chronic Sx

Answer 26

Follow repeated acute attacks Persistent fever Polyarticualr pain Renal calculi

Question 27

Gout Ix

Answer 27

Arthrocentesis with synovial fluid analysis - -ve birefringent with needle shape Bloods - inc urate

Question 28

Pseudogout crystal type

Answer 28

Calcium pyrophosphate dehydrate

Question 29

Conditions that increase risk of psuedogout

Answer 29

Haemochromatosis Hyperparathyroidism Hypomagnaesmia Hypophosphatasia

Question 30

Pseudogout Sx

Answer 30

Painful, swollen joint

Question 31

Pseudogout Ix

Answer 31

Arthrocentesis with synovial fluid analysis - +ve birefringence rhonboid shaped crystals Plain radiography of joint - Chondrocalcinosis

Question 32

GCA aetiology

Answer 32

Common with inc age HLA-DR4 HLA-DRB1 Associated with polymyalgia rheumatica

Question 33

GCA Sx

Answer 33

``` Subacute onset Headache Scalp tender (brushing hair) Jaw claudication Suddent blundness in one eye ```

Question 34

Polymyalgia rheymatica Sx

Answer 34

Early morning pain and stiffness of muscles of shoulder and pelvic girdle

Question 35

GCA Ix

Answer 35

Bloods (Inflam markers) Temporal artery biopsy

Question 36

Guidelines for diagnosis of GCA

Answer 36

3 of following: ``` Age >50 New headache ESR > 50mm/h Clincally abnormal temporal artery Biopsy showing mononuclear cell infiltration or granuloma ```

Question 37

Rx for GCA

Answer 37

No visual changes - Pred | Visual Sx - Methylpred pulse theray IV