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MSK Flashcards

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1
Q

What is a yellow flag

A

Psychosocial RF fro chronic pain + long term disability development

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2
Q

Fibromyalgia presentation

A 
Widespread pain 
fatigue 
Fatigue + pain with small increases in physical exertion 
Easily woken and can't fall back asleep 
Poor memory 
Loww mood 
Headaches 
Parasthesiae 
Morning stiffness
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3
Q

Firbomyalgia Diagnosis

A

Chronic pain > 3m
Presence of pain at 11/8 tender sites
No joint inflammation
Widespread tenderness

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4
Q

Differential diagnosis for fibromyalgia

A 
Hypothyrodism 
SLE 
Inflammatory arthiritis 
Hypercalcaemia 
Vit D def
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5
Q

Fibromyalgia management

A

Amitryptyline - Normal sleeping pattern

Pregabalin - Muscle relaxation

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6
Q

What is Anti-phospholipid syndrome

A

AI syndrome charecterised by thrombosis

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7
Q

Anti-phospholipid syndrome presentation

A 
Stroke 
TIA
MI 
DVT
Misscarraige
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8
Q

Anti-phospholipid syndrome Ab can cause?

A 
CLOT
C - Coag defect
L - LIvedo reticualris 
O - Obstetric issues 
T - Thrombocytopenia
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9
Q

Anti-phospholipid syndrome Ix

A

Anti-cardiolipin
Lupus anticoagulant
Anti - B2

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10
Q

Limited cutaneous scleroderma presentation

A 
CREST
C - Ca2+ deposition 
R - Raynauds 
E - Oesophageal dysmotility 
S - Sclerodactyly 
T - Telengectasia

Beak like nose

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11
Q

Systemic sclerosis Investigations

A

Serum Ab

  • Anti-nuclear Ab
  • Anti scl 70

X - ray
- Ca2+ deposits

Barium swallow

Bloods

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12
Q

What to avoid in Raynauds

A

Beta blockers

Smoking

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13
Q

Serum antibodies present in Sjrogren syndrome

A

Anti - Ro Ab

Anti - Lo Ab

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14
Q

Polymyositis presentation

A 
Symmetrical muscle weakness + wasting 
Difficulty:
- Squatting 
- Going upstairs 
- Hands above head
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15
Q

Presentation of mechanical back pain

A

Suddne onset
pain worse in evening
Morning stiffness
Excercise aggrevates pain

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16
Q

Back pain red flags

A 
TUNA FISH 
T - Thoracic back pain 
U - Unexplained WL
N - Nocturnal pain 
A - Age

F - Fever
I - Immunosuppressed
S - Spinal stenosis
H - Hx of malignancy

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17
Q

Clinical presentation of giant cell arteritis

A 
Temporal branch - Severe unilateral headaches
Opthalmic. A Visual disturbance 
Facial. A Claudication when chewing 
Scalp tenderness 
Weight loss
 fever
Malaise
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18
Q

Giant cell arteritis investigations

A

Bloods - High ESR
Duplex US
Biopsy - Long sections due to skip lesions

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19
Q

Giant cell arteritis management

A

PO Prednisolone
Asprin
PPI
Steroid failure –> DMARDs

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20
Q

What is polymyalgia rheumatica

A

Inflammatry condition causing pain and stiffness in shoulders, neck and pelvic girdle

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21
Q

PMR Presentation

A 
Bilateral shoulder pain - radiation to elbow
Bilateral pelvic girdle pain 
Pain worse with movement 
Intefers with sleep 
Morning stiffness >45 mins
Weight loss
Upper arm tenderness 
Carpal tunnel syndrome 
Pitting oedema
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22
Q

c - ANCA positive conditions

A

Granulomatosis with polyangitis - wegners granulomatosis

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23
Q

What is polyarteritis nodosa

A

Necrotising vasculitis leading to aneurysms + thrombosis in medium sized vessels
- Assosciated with Hep B

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24
Q

Polyarteritis nodosa investigations

A

Bloods

  • Increase WCC
  • Increase ESR/CRP

ANCA -ve

Angiogram

  • String of beads
  • organ ischaemia
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25
Microscopic polyangitis description
Necrotising vasculitis of blood vessels in lungs and kidney
26
Granulomatosis with polyangitis presentation
``` Chronic Sinusitis Cough Cardiac arrhythmias Non - caesiating granulomas Ulcers in resp tract - Bloody mucus Saddle nose deformity - Curvy nose Pulmonary nodules Decreased urine output Increase BP ```
27
Granulomatosis with polyangitis investigations
Bloods - Increase ESR CXR Nodules cANCA positive
28
Psoriatic arthiritis investigations
``` X-ray - Pencil in a cup Periostitis Ankylosis - bones join together Osteolysis Dactylisis - S.T swelling ```
29
Features of arthiritis mutilans
Osteolysis | Telescopic finger
30
Common triggers for reactive arthiritis
Gastroenteritis | Chlamydia
31
Reactive arthiritis presentation
Conjunctivitis Urethritis Arthiritis/ Enthesitis
32
Temporal arterities Tx
- 60mg Prednisolone - 75mg Apsirin - PPI - Prophylactic Bisphosphonates
33
Common organisms causing reactive arthirtis
Campylobacter - Bloody diarrhoea Salmonella Shigella
34
Antibodies specific to SLE
Anti-dsDNA Anti-Smith
35
Antibodies specific to Dermatomyositis
Anti-Jo-1
36
Antibodies specific to Systemic sclerosis
Anti-Scl-70
37
Conditions where Raynauds are present
SLE Scleroderma Sjrogrens RA
38
Describe degeneritive joint disease
Worse with activity Improved with rest OA
39
Describe Inflammatory joint disease
Worse after rest Improved with activity RA
40
BMI Ranges
<18.5 - Underweight 18.5 - 24.9 - Healthy weight 25 - 29.9 - Overweight 30 - 39.9 - Obese
41
2 differentials is MSK diseases when the DIPJ is involved
OA | Psoriatic arthiritis
42
HLA - B27 positive diseases
AS Reactive Psoriatic
43
Spondyloarthropathies common generic sx
``` SPINEACHE S - Dactylitis P - Psoriasis I - Inflamm back pain N - NSAIDs good response E - Enthesitis A - Arthiritis C - Chrons / UC / CRP H - HLA-B27 E - Anterior uveitis ```
44
p - ANCA positive conditions
Polyareritis nodosa - Heart/Kidney/Skin/CNS Microscopic Polyangitis Eosinophilic granulomatosis with Polyangitis
45
Seropositive conditions
``` RA SLE Scleroderma Vasculitis Sjogren's ```
46
Seronegative conditions
AS Psoriatic Reactive
47
What is the sciatic stretch test
Sciatic stretch test - +ve = Posteriot thigh/buttock pain Suggestive of sciatic nerve irritation secondary to disc prolpase
48
Schober test
Restricted flexion of lumbar spine | - Distance should increase
49
What causes knee hyperextension
Cruciate ligament injury
50
What causes joint effusion
ACL rupture Septic arthirits Inflammatory arthirits - RA Osteoarthirits
51
What does the Lateral collateral ligament test show
Varus
52
What does the Medial collateral ligament test show
Valgus
53
Thomas' test
Loss of hip extension - suggests a fixed flexion deformity +ve = Affected thigh rises off the bed (Contralateral hip flexion)
54
Trendelenburg's test
Hip adbuctor weakness Gluteus medias + minimus +ve = Pelvis drops on the side of the raised leg Contralateral hip abductor weakness
55
Rotator cuff muscles
Supraspinatus Infraspinatus Teres minor Subscapularis
56
Muscles for arm abduction
Supraspiantus Deltoid Trapezium
57
What is Jobe's test
Supraspinatus assessment - Impingement - Tear in tendon
58
What does the painful arc test show
Subacromial impingement - Supraspinatus tendonitis
59
What does the lift off test show
Subscapularis - Tendonitis - Tear - Subscapular nerve lesion
60
What does the ecternal rotation against resistance test show
Infraspinatus + teres minor Pain = Infraspinatus tendonitis Falls back to internal rotation - Tear - Muscle wasting - LMN lesion (Axillary/Suprascapular)
61
What does the scarf test show
ACJ pathology
62
Primary bone tumours (3)
Osteosarcoma Chondrosarcoma E-wings sarcoma
63
Osteosarcoma - Assosciation - X - ray
Paget's disease Sunburst appearance Codmans triangle
64
E - Wing's sarcoma | - X - ray
Codmann's triangle | Onion like apperance
65
Precipitants of gouty attack
``` Trauma surgery Diuretics Dehydration Alcohol Infection ```
66
Acute gout tx
High dose NSAIDs | Colchicine
67
Gout prophylaxis
- Avoid low dose aspirin - Stop diuretics Allopurinol - Inhibits xanthase oxidase Febuxostat - For pt's intolerant to allopurinol
68
SLE presentations
MD SOAP BRAIN M - Malar rash D - Discoid rash S - Serositis/ Pericarditis O - Oral ulcers A - Arthralgia P - Photosensitivity ``` B - Blood - Pancytopenia R - Renal - Glomerulonephritis A - ANA +ve I - Immuno - Anti - dsDNA N - Neuro - Seizures ```
69
SLE investigations
Bloods - FBC - U+E - ANA Antibodies Biopsy - Kidney IgG + complement deposition Urinalysis - Protein:Creatnine ratio
70
SLE mild tx
Hydroxychloroquine
71
SLE management
- NSAIDs - Prednisolone - Suncream and avoidance - Methotrexate - High dose prednisolone - Rituximab - refractory
72
What is myeloma
Malignant disorder of plasma cells - Mature B lymphocytes
73
What is found in the urine of a patient with myeloma
Bence jones protein
74
Myeloma key features
C - Hypercalcaemia R - Renal failure A - Anaemia B - Bone lesions Paraproteinuria Immunoparesis
75
Myeloma pathology - Anaemia - Bone disease - Renal disease - Hyperviscocity
Bone marrow infiltration --> Pancytopenia - Easy bleeding/bruising/Increased infection Increased RANKL - Osteolytic lesions - Hypercalcaemia - Pain (Bone/Abdo) Light chain deposition Blurred vision SOB
76
Myeloma investigations
Bloods ``` BLIP B - Urine electrophoresis L - Light chain assay I - Immunoglobulins P - Protein electrophoresis ``` Bone marrow biopsy Whole body MRI
77
Myeloma X ray findings
Punched out lytic lesions | Raindrop skull
78
Myeloma management
Chemo High dose dexamethasone Stem cell transplant
79
Myeloma supportive management
EPO transfusions - Anaemia Hydration Bishosphonates AVOID NSAIDs
80
Secondary causes of OA
Joint disease trauma Haemochromatosis Obesity
81
OA presentation
Joint pain - Worse with movement - improves with rest ``` Joint stiffness crepitus Muscle wasting Knee effusion Unstable joint ```
82
OA Investigations
Bloods - ESR - RF X-ray MRI
83
OA management
1st - Paracetamol 2nd - NSAIDs + PPI 3rd - Intra articualr joint injection 4th - surgery
84
Common causes of osteomyelitis
S.Aureus H. Influnzae E.Coli
85
Osteomyelitis presentation
``` fever local pain - worse on movement Malaise Sweats Erythema ```
86
Osteomyelitis investigations
Bloods - Culture - WCC - CRP/ESR X-Ray MRI - Bone marrow oedema Biopsy and culture
87
Osteomyelitis management
Immobolisation Abx - Flucloxacillin Surgical debriedment
88
Secondary causes of osteoperosis
``` Steroids Hyperthyroidism Alcohol Testosterone low Early menopause Renal/Liver failure Rheumatoid arthiritis ```
89
Alcohols effect on osteoperosis
Inhibits osteoblasts
90
Cushing's effect on osteoperosis
High cortisol increases bone resorption + induces osteoblast apoptosis
91
Glucocorticoids effect on osteoperosis
Increased bone turnover
92
Presintation of osteoperosis
Vertebral fractures - back pain - kyphosis - loss of height Colles fracture Hip fracture Proximal femur
93
Osteoperosis conservative management
``` Excercise Smoking cessation decrease alcohol Calcium rich diet Fall prevention programme ```
94
Osteoperosis pharmacological tx
- Bisphophonates - HRT - Denosumab MAB to RANKL - PTH analgoue Teriparatide
95
Pseudogout risk factors
``` Old age Hyperparathyroidism Haemochromatosis Hypophosphotaemia Wilsons disease ```
96
Feature of pseudogout on X ray
Chondracalcinosis | LOSS
97
Triggers of pseudogout attack
``` Trauma Intercurrent illness Surgery - parathyroidectomy T4 Replacemnt Blood transfusion ```
98
What antibodies are most associated with Limited cutaneous systemic sclerosis
Anti-centromere Ab
99
Rheumatoid arthiritis presentation
Joint pain - worse in mornings - worse after hot weather Joint stiffness>30 mins Joint tenderness Joint swelling
100
Rheumatoid arthiritis X Ray findings
``` LESS L - Loss of joint space E - Erosions S - S.T swelling S - Soft bones ```
101
Rheumatoid Management
Symptomatic - Paracetamol + NSAIDs 1st line - MXT 2nd line - Combination of DMARDs 3rd line - MXT + Etanercept 4th line - MXT + Rtuximab
102
Rheumatoid arthirits complications - Respiratory - Cardiac - Nodules
Pulmonary fibrosis Pleural effusions IHD Pericarditis Pericardial effusions ``` Skin Lung Cardiac CNS Lymphadenopathy Vasculitits ```
103
Methotrexate adverse effects
Pulmonary fibrosis Diarrhoea Pancytopenia Mouth ulcers
104
Sulfasalazine adverse effects
Male infertility GI upset Oral ulcers
105
Anti-TNF medications
Influximab Etanercept Rituximab
106
Rituximab adverse effects
Night sweats | Thrombocytopenia
107
Causes of septic arthirits
A.Aureus Neisseria gonorrhoea Pseudomonas aerginosa - IVDU S. Epidermidis - Joint replacement
108
Septic arthirits management
Emperical - Flucloxacillin Immobolisation Joint drainge NSAIDs
109
What do you do if a patient with R.A develops septic arthiritis
Stop immunosuppresion - DMARDs
110
What should you do if a patient currently taking steroids develops septic arthirits
Double the dose
111
Ankylosing spondylitis presentation
``` Lower back pain Pain worse at night Spinal morning stiffness >30mins stiffness relieved by excercise Sacroiliatic pain Pain wakes from sleep ```
112
Ankylosing sponylitis manageemnt
1st - Excercise 2nd - NSAIDs 3rd - Anti-TNF alpha blockers 4th - steroid injections
113
Presentation of fracture of the surgical neck of humerus
Axillary nerve - Teres minor weakness - Deltoid weakness - Loss of sensation of regimaental patch
114
Rotator cuff movements
``` Subscapularis - Internal rotation Suprascapularis - Abduction External rotation - teres minor - Infraspiantus ```
115
Shoulder abduction - muscles involved
0 - 15 = Supraspinatus 15 - 90 = Deltoid 90 - 180 = Deltoid + serrartus anterior
116
Nerve assesed when adducting and abducting the fingers
Ulnar
117
Nerve assessed with thumb abduction against resistance
Median

Disease summaries (9 decks)

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