MSK/rheum Flashcards
(142 cards)
1
Q
What is gout
A
- Crystal arthropathy
- Chronically high blood uric levels
- Gouty tophi= subcutaneous deposits of uric acid
2
Q
Gout S+S
A
- Severe pain
- Heat
- Swelling
- Redness
- Rapid onset
-Tophi
3
Q
Gout RF
A
- Male
- Obesity
- High purines = meat, seafood
- Alcohol
- Diuretics
- Cardio or kidney disease
- FHx
4
Q
Joints affected in gout
A
- Base of big toe = metatarso-phalangeal joint
- Wrists
- Base of thumb = carpometacarpal
5
Q
Gout Ix
A
- serum urate = >360 micromol
- Aspiration = needle shaped crystals, negatively bifringent, monosodium urate crystals
6
Q
Gout Mx
A
Acute flare
- NSAIDs 1st line
- Colchicine 2nd line
7
Q
Gout prophylaxis
A
- Allopurinol
- Lifestyle changes
8
Q
Psudogout S+S
A
- Older adult
- Hot
- Swollen
- Stiff joint = knee, shoulders, wrists, hips
9
Q
Pseudogout aspiration
A
- Calcium pyrophosphate crystals
- Rhomboid shaped
- Positively bifringent
10
Q
Mx pseudogout
A
- NSAIDs
- Colchicine
- Aspiration
- Steroid injections
- Oral steroids
11
Q
why is osteoarthritis thought to occur
A
imbalance between cartilage damage and chondrocyte response
12
Q
XR changes OA
A
LOSS
- Loss joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cysts
13
Q
S+S OA
A
- joint pain and stiffness
- Worse with activity and end of day
- bulky enlargement
- Resitrcted ROM
- Crepitus and effusions
14
Q
Hand signs OA
A
- Heberdens = DIP
- Bouchards = PIP
- squaring base of thumb
15
Q
Dx OA
A
- > 45, typical pain and no morning stiffness = OA
16
Q
Mx OA
A
- Self care
- Topical and oral NSAIDs
- Weak opiates for short term
- Injections
- replacement
17
Q
pattern of RA
A
symmetrical polyarthritis
18
Q
gene assocaited with RA
A
HLA DR4
19
Q
how many RA pateitns in RF seen in
A
70%
20
Q
antibodies that are more specific than RF
A
- Anti CCP antibodies = 80% of patients
21
Q
S+S RA
A
- pain, stiffness and swelling
- tender and synovial thickening
- systemic symptoms
- worse in morning, better on activity
22
Q
when to refer for RA
A
- Small joints of hands or feet
- More than 1 joint affected
- Delay of 3 months or longer between onset and advice seek
23
Q
Hand signs in RA
A
- Z shaped thumb
- Swan neck
- Boutonniere
- Ulnar deviation
24
Q
eye manifestations related to RA
A
- dry eye syndrome
- episcleritis
- scleritis
- keratitis
- cataracts
- retinopathy
25
Dx RA
- RF
- Anti CCP
- Inflam markers
- X rays
26
XR changes RA
- Periarticular osteopenia
- Bony erosions
- Soft tissue swelling
- Joint destruction and deformity
27
Mx RA
1. monotherapy with methotrexate, leflunomide, sulfasalazine and short course pred
- Combo with multiple cDMARDs
- Biologics = methotrexate
28
RA tx in pregnancy
- hydroxycholorquine and sulfasalazine safest
29
SE methotrexate
- bone marrow suppression, teratogenic, leukopenia
30
SE leflunomide
- HTN and peripheral neuropathy
31
SE sulfasalazine
- orange urine and male infertitlity
32
SE hydroxychloroquine
- retinal toxicity, blue grey skin pigmentation, hair bleaching
33
what are the seronegative spoldyloarthopathies
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
HLA B27
34
Signs of psoriatic arthrtis
- symmetrical polyarthritis
- Psoriatic plaques
- Nail pitting
- Oncholysis
- Dactylitis
- Enthesitis
35
XR psoriatic
- Erosive changes = pencil in cup
- periostitis
- ankylosis
- osteolysis
- dactylitis
36
Mx psoriatic arthritis
- NSAIDs
- Steroids
- DMARDs = methotrexate
- Anti TNF
- monoclonal abs = ustekinumab
37
RF for reactive arthritis
- preceeding chlamydia or GI infection
38
S+S Reactive
- acute synovitis in 1 or more joints
- typically knee
- conjunctivitis
- urethritis
- circinate balanitis
- cant see cant pee cant climb a tree
39
Ix and Mx reactive
- Rule out septic = joint aspiration
- Treat infection
- NSAIDs
- Steroids
40
Main joints affected in AS
- Sacroiliac joints
- Vertebral column joints
41
S+S AS
- Young men in 20s
- Pain and stiffness in lower back
- Sacroiliac pain
- Improves with movement
- worse at night
- >30 mins to improve in morning
- enthesitis, dactylitis, SOB
42
AS associations
- Anterior uveitis
- Aortic regurgitation
- AV block
- Apical lung fibrosis
- Anaemia chronic disease
43
Schobers test
- 10cm above L5 and 5 cm below this
- Length <20cm when touching toes = AS
44
Ix AS
- Inflammatory markers
- HLA B27
- X ray
- MRI
45
AS XR changes
- Bamboo spine
- Squaring vertebral bodies
- Subchondral sclerosis
- Syndesmophytes
- Ossification
- Fusion
46
AS Mx
- NSAIDs 1st line
- Anti TNF 2nd line
- 3rd line = IL17 monoclonal abs or JAK inhibs
47
Patho of SLE
- ANA generate a chronic inflammatory response
- ANA = autoantibodies against proteins within the nucleus
48
S+S SLE
- fatigue
- weight loss
- arthralgia and myalgia
- non-erosive arthritis
- photosensitive malar rash
- LN
- hair loss
- Raynauds
- SOB
49
Ix SLE
- Autoantibodies = ANA and Anti dsDNA
- FBC
- CRP and ESR
- Urinalysis
- Renal biopsy
50
Complications SLE
- Cardiovascular disease
- Infection
- Anaemia
- Pericarditis
- Pleuritis
- ILD
- Lupus nephritis
51
Mx SLE
- Hydroxychloroquine
- NSAIDs
- Steroids
- Severe = DMARDs and biologics
52
presentation PMR
- rapid onset
- 2 weeks before diagnosis consideres
- pain and stiffness in shoulders, pelvic girdle, neck
- worse in morning and rest
- >45 mins to ease
- some imprvement on activity
53
associated features PMR
- systemic
- muscle tenderness
- carpal tunnel
- peripheral oedema
54
IX for PMR before steroids
- FBC
- U+E
- LFT
- Calcium
- Serum protein electrophoresis
- TSH
- CK
- RF
- urine
55
Mx PMR
- 15mg prednisolone daily
- follow up after 1 week
- 15 mg until fully controlled
- 12.5mg for 3 w then
- 10mg for 4-6w then
- reduce by 1mg every 4-8 w
56
Dont STOP for steroids
- Dont = dont stop immediate = adrenal crisis
- Sick day rules = increase
- Treatment card
- Osteoporosis prevention
- PPI
57
presentation GCA
- unilateral headache
- Scalp tenderness
- jaw claudication
- blurred or double vision
- Loss of vision
58
Dx GCA
- Clinical presentation
- Raised inflammatory markers
- TA biopsy
- duplex USS
59
Mx GCA
- 40-60mg prednisolone if no vision or jaw, 500-1000mg if visual or jaw
- aspirin
- PPI
- bone protection
60
T scores for OP
Normal = > -1
Openia = -1 to -2.5
Oporosis = <-2.5
Severe = -2.5 + fracture
61
Mx OP
- Reversible RF
- Calcium 1000mg and Vit D 400-800
- Bisphosphonates = alendronate, zole
-
62
SE Bisphosphonates
- reflux and oesophageal erosions
- atypical fractures
- osteonecrosis jaw or auditory canal
63
S+S osteomalacia
- fatigue
- bone pain
- musle weakness and aches
- pathological fractures
64
Ix osteomalacia
- Serum 25-hydroxyvitamin D = <25 def
- Low Ca and P, high ALP and PTH
- XR = osteopenia
- DEXA
65
Tx omalacia
- colecalciferl
- 50,000IU once weekly for 6 w or 4000 IU daily for 10
66
Pagets patho
- Excessive bone turnover
- increased osteoclast and blast activity
- patchy areas of sclerosis and lysis
67
S+S pagets
- bone pain
- deformity
- fractures
- hearing loss
- raised ALP
68
XR pagets
- bone enlargement
- OP curcumscripta
- cotton wool skull
- V shaped osteolytic defects in long bones
69
Mx pagets
- Bisphosphonates
- NSAIDs
70
complications pagets
- hearing loss
- HF
- osteosarcoma
- spinal stenosis
71
Polymyositis
- no skin features
- proximal weakness, symmetrical
- dermatomyositis
- CK raised
- steroids
72
Dermatomyositis
- same as pol but skin
- Gottron papules
- helitrope rash
- periorbital eodema
- photosensitive rash on back
73
Antiphospholipid syndrome
- increase risk of thrombosis
- pregnancy complications
- mx = APL antibodies
- long term warfarin
- pregnancy = LMWH and aspirin
74
Sjogrens
- dry eyes, dry mouth, dry vagina
- joint pain and stiffness
- Anti Ro and anti La
- artificial tears etc
75
main feature bechets
- recurrent oral and genital ulcers
- HLA B51
- pathergy test
- steroids
76
ehlers danlos
- joint pain and hypermobility
- beighton score
77
what is a colles fracture
- transverse fracture of distal radius
78
what is compartment syndrome
- pressure within fascial compartment is abnormally elevated = cut off blood flow
79
5 Ps of acute compartment syndrome
- Pain
- Paraesthesia
- Pale
- Pressure high
- Paralysis
80
Mx compartment syndrome
needle naometry
-remove dressings, elevate lef, maintain BP
- fasciotomy
81
most common bug in osteomyelitis
- staphylococcus aureus
82
S+S omyelitis
- fever
- pain
- red
- swelling
83
Ix and mx omyelitis
- XR = periosteal reaction, osteopenia, destruction
- MRI
- cultures
Mx
- debridement
- 6w flucloxacillin
84
trochnteric bursitis
- inflammation of bursa over trochanter on outer hip
- gradual onset outer hip pain, aching or burning, worse activity, hard to lie
85
special tests fot troncharic bursitis
- trendelenburg
- resisted abduction
- resisted internal rotation
- resisted external rotation
86
mx trochanteric bursitis
- rest
- ice
- anaglesia
- physio
- steroid injections
87
olecranon bursitis
- bony lump at elbow
- repetitive movements
- swollen, warm, tender, fluid filled
- aspirate if think infection
- rest, ice, compression, analgesia
88
what is a compound fracture
skin is broken and bone exposed to the air
89
what is a stable fracture
sections of bone remain in alignment at the fracture
90
pathological fracture
bone breaks due to an abnormality within the bone
91
what is a colles fracture
transverse fracture of the distal radius near the wrist
- distal portion displaces upwards
92
which bones have vulnerable blood supplies (risk avascular necrosis)
- Scaphoid bone
- Femoral head
- Humeral head
- Talus
- Navicular
- 5th metatarsal foot
93
weber classification of fractures to lateral malleolus
- A = below ankle joint
- B = at level of ankle joint
- C = above the ankle joint = syndesmosis disrupted
94
gurds major criteria for fat embolism
- resp distress
- petechial rash
- cerebral involvement
95
Intracapsular hip fracture
- Break in femoral neck within capsule of hip joint
- 1 = incomplete and non-displaced
- 2 = complete fracture and non-displaced
- 3 = partial displacement
- 4 = full displacement
96
extracapsular
- leave head of femur intact
97
surgery for intertrochanteric fractures
- dynamic hip screw
98
subtrochanteric fractures surgery
- intramedullary nail
99
presentation hip fracture
- pain in groin or hip
- not able to weight bear
- shortened, abducted and externally rotated leg
100
F1 mx hip fracture
- analgesia
- X rays
- VTE proph
- pre-op assessment
- orthogeris
101
septic arthritis common bacteria
- staph aureus most
- n gonorrhoea
102
Mx septic arthritis
- joint aspiration
- empirical antibiotics IV
- 4-6w abx
- fluclox 1st line, clindamycin in pen allergy
103
GCA presentation
- unilateral headache
- scalp tenderness
- jaw claudication
- blurred/loss vision
104
dx GCA
- presenttion
- raised inflam markers
- temporal artery biopsy
- duplex USS = halo sign
105
GCA biopsy finds
multinucleated giant cells
106
Mx GCA
- 40-60mg pred if no vision or jaw claud
- 500-1000mg pred if visual or jaw
- aspirin
- PPI
- bisphosphonates
107
skin changes in dermatomyositis
- gottron papules
- heliotrope rash
108
presentation myositis
- muscle weakness, gradual onset and symmetrical
- pain
109
test in myositis
creatinine kinase = high due to inflammation = in thousands
110
polymyositosis antibody
anti-jo 1
111
antiphospholipid syndrome
- antip antibodies = cause inflammation and increase thrombosis
- VTE and pregnancy complications
112
specific signs antiphospholipid
- livedo reticularis = lace rash
- libmann sacks endocarditis
- thrombocytopenia
113
Mx antip
- warfarin long term
- LMWH and aspirin pregnancy
114
antip antibodies
- lupus anticoagulant
- anticardiolipin
- anti b2 glycoprotein
115
sjogrens
- dry eyes, mouth and vagina
- joint pain
- dry skin
anti ro and anti la
116
presentation polymyalgia rheumatica
- shoulder pain and stiffness
- pelvic girdle pain and stiffness
- neck pain and stiffness
- worse in morning and after rest, interferes sleep
117
tx PMR
- 15mg prednisolone daily
- follow up 1 week
118
limited cutaneous systemic sclerosis
- Calcinosis
- Raynauds
- Esophageal dysmotility
- Sclerodactyly
- Telangiectasia
119
diffuse cutaneous systemic sclerosis
- cardio problems = systemic and pul htn
- lung problems = fibrosis
- kidney problems
120
anti centromere bodies in
limited cutaneous ss
121
anti scl 70 antibodies in
diffuse cutaneous ss
122
ottawa rules ankle fracture
Ankle XR only needed if pain in malleolar zone and 1 of
- Bony tenderness at lateral malleolar zone
- Bony tenderness at medial malleolar zone
- inability to walk 4 weight bearing steps immediately after injury and in ED
123
Colles fracture
- transverse fracture of radius
- 1 inch proximal to radio-carpal joint
- dorsal displacement and angulation
- Complications = median nerve injury, compartment syndrome
124
anterior cruciate ligament
- lateral blow to the knee
- pop
- swollen
- instability
- anterior draw
- lachmans
125
medial epicondylitis
- pain worse with wrist flexion and pronation
- pain and tenderness localised to medial epicondyle
126
Garden classification hip fractures
1 = incomplete and non displaced
2 = complete and non-displaced
3 = partial displacement (angle)
4 = full displacement (parallel)
127
SE displaced intracapsular fractures
- disrupt blood supply = avascular necrosis
- no disruption in extra = heal well
128
how does a displaced hip fracture look
- short leg
- externally rotated
129
posterior dislocated femur with no fracture looks
short leg
internal rotation
130
Mx undisplaced IC fracture
- early mobilisation
- internal fixation
- cannulated screw
131
Mx displaced IC frcture
- hemiarthroplasty or tota hip replacement
132
Mx intertrochanteric extracapsular
- sliding or dynamic screw
133
mx subtrochanteric EC fracture
Intramedullary nail
134
all ankle fractures should be...
promptly reduced to remove pressure and necrosis
135
marfans genetics
autosomal dominant = affects gene responsible for creating fibrillin
136
features marfans
- tall
- long neck
- arachnodactyly
- high arch palate
- hypermobile
- pectus carinatum or exavatum
137
associated conditions marfans
- pneumothorax
- GORD
- mitral valve prolapse with regurgitation
- aortic valve prolapse with regurgitation
- aortic aneurysms
- scoliosis
138
marfans preventative meds
- bb
- angiotensin 2 receptor antagonists
139
most common type ehlers danlos
- hypermobile ED = joint hypermobility and stretchy soft skin
- AD
140
presentation ed
- joint pain
- hypermobile
- dislocations
- soft stretchy skin
- poor wound healing
141
score for hypermobility
beighton
142
