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MSK + Rheumatology Flashcards

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1
Q

What are the risk factors for developing mechanical back pain?

A 
Heavy manual handling 
Female
Older age 
Fibromyalgia
Stress
Smoking
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2
Q

What are the clinical features of mechanical back pain?

A

Pain that starts suddenly
Pain relieved by rest
Precipitated by injury
Stiff back

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3
Q

What are the red flags of back pain?

A 
Acute onset in elderly
Nocturnal pain
Worse pain on being supine
Fever
Night sweats
Weight loss
Abdominal mass
History of malignancy 
Neurological disturbance
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4
Q

How would you manage mechanical back pain?

A

Avoid prolonged inactivity
Analgesia
Physiotherapy

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5
Q

Name the three key signs of cauda equina compression.

A
  1. Alternating or bilateral root pain in legs
  2. Bladder + bowel incontinence
  3. Saddle anaesthesia
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6
Q

Fibromyalgia is a chronic condition that causes pain, fatigue and muscle ache. What are the psychosocial risk factors for this?

A 
Divorced
Female sex
Sickness behaviours
Social withdrawal
Stress
Lack of social support
Low household income
Low educational status
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7
Q

Which medical conditions are associated with fibromyalgia?

A

IBS

Depression

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8
Q

What are the symptoms of fibromyalgia?

A 
Sleep disturbance 
Chronic widespread pain with no inflammation
Severe fatigue
Low mood
Headache
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9
Q

How would you manage fibromyalgia?

A

Amitriptyline
CBT
Exercise programmes

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10
Q

What are the crystals in gout made out of?

A

Monosodium urate

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11
Q

What are the risk factors for developing gout?

A 
Obesity
High dietary purines
Alcohol excess
Diuretics
Hypertension
DM
Chronic renal failure - kidneys fail to excrete uric acid
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12
Q

What are the signs of gout?

A

Monoarthritis - tends to be one joint
Swollen joint
Red shiny joint
Tophi - onion like aggregates of urate crystal

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13
Q

What investigations can you do to diagnose gout?

A

Serum urate
Polarized light microscopy - negatively birefringent urate needle shaped crystals
X-ray

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14
Q

What are the features of gout on an X-ray?

A

Soft tissue swelling

Erosions in juxta-articular bone

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15
Q

How would you manage gout?

A

NSAIDs
Colchicine - can cause diarrhoea
Steroids

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16
Q

Outline prophylaxis for gout.

A

Allopurinol
Lose weight
Cut down alcohol and purine reach foods

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17
Q

What type of crystals manifest in pseudo-gout?

A

Calcium pyrophosphate

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18
Q

What are the risk factors for developing pseudo-gout?

A

Old age
Hyperparathyroidism
Haemachromatosis

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19
Q

How would pseudo-gout appear on light microscopy?

A

Positive birefringent rhomboid shaped crystals

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20
Q

Which gene is rheumatoid arthritis associated with?

A

HLA-DR4/DR1

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21
Q

In RA, there is chronic inflammation of the joints, leading to joint space narrowing. What are the symptoms of RA?

A 
Swollen painful joints - worse in morning 
Morning stiffness >30 mins
Pain improves with activity 
Fatigue
Fever 
Weight loss
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22
Q

What are the signs of RA?

A 
Rubor = redness
Calor = Heat
Tumour = swelling 
Dolor = pain

Symmetrical polyarthritis
Ulnar deviation of fingers
Boutonniere and swan-neck deformities

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23
Q

What are the extra-articular signs of RA?

A 
Sicca = dry eyes
Nodules on elbows
Lymphadenopathy 
Vasculitis 
Carpal tunnel syndrome 
Peripheral neuropathy
Scleritis
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24
Q

What investigations would you do to diagnose RA?

Study These Flashcards
A

FBC: anaemia of chronic disease
ESR/CRP
Rheumatoid factor
anti-CCP antibodies

25
How would RA appear on an x-ray?
Soft tissue swelling Loss of joint space Juxta-articular osteopenia Bony erosions
26
How would you manage RA?
``` Methotrexate Sulfasalazine Hydroxychloroquine Gold injections TNF-a inhibitors Intra-articular steroid injections Rituximab (anti-CD20) Physiotherapy Surgery in severe cases ```
27
A DMARD is a disease-modifying anti-rheumatic drug. What is the major side effect of these drugs?
Immunosuppression
28
Which drug needs to be prescribed with methotrexate?
Folic acid 5mg
29
What are the adverse effects of methotrexate?
Mouth ulcers Pulmonary fibrosis Leukopenia Teratogenic
30
What are the adverse effects of sulfasalazine?
Male infertility
31
What are the adverse effects of rituximab?
Night sweats | Thrombocytopenia
32
Polymyalgia rheumatica is an inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck. Which condition is this associated with?
Giant cell arteritis
33
What are the symptoms of polymyalgia rheumatica?
``` Bilateral shoulder pain that may radiate to elbow Bilateral pelvic girdle pain Pain worse on movement Pain interferes with sleep Morning stiffness >45 mins Weight loss Fever Pitting oedema Carpel tunnel ```
34
Polymyalgia rheumatica is usually diagnosed after excluding other conditions. Along with routine bloods and x-ray, how would you confirm polymyalgia rheumatica?
Assess response to steroids
35
Outline the Don't STOP plan for patients on long term steroids.
Don't: - Patients should not stop taking steroids due to risk of adrenal crisis S - sick day - increase steroids if patient becomes sick T - treatment card O - osteoporosis prophylaxis with bisphosphonates, calcium and Vitamin D P - proton pump inhibitor
36
What are the risk factors for osteoarthritis?
``` Obesity Age Occupation Trauma Female FH ```
37
Why is obesity a risk factor for osteoarthritis?
Obesity is a low grade inflammatory state, with the release of IL-1 and TNF. Both of these cytokines mediate OA
38
What are the symptoms of osteoarthritis?
Joint pain on movement Stiffness Functional impairment n ADLs Pain worse at end of day
39
What are the signs of osteoarthritis?
``` Asymmetrical joint Gait alteration Crepitus Tenderness Morning stiffness <15 mins Herderden's nodes at DIP joints Bouchard's nodes at PIP joints Cyst formation Reduced range of movement ```
40
What are the signs of osteoarthritis on x-ray?
``` LOSS: L - loss of joint space O - osteophytes S - subchondral sclerosis S - subchondral cysts ```
41
What is the non-medical management of osteoarthritis?
Exercise Weight loss Physio Walking aids
42
What is the pharmacological management of osteoarthritis?
NSAIDs Opiates Intra-articular steroid injections
43
What is the surgical management of osteoarthritis?
Joint replacement
44
What is osteoporosis?
Decreased bone density
45
What are the risk factors for osteoporosis?
``` SHATTERED S - steroid use H - hyperthyroidism, hyperparathyroidism A - alcohol + tobacco T - thin, BMI <22 T - testosterone low (female) E - early menopause R - renal or liver failure E - erosive bone disease - RA D - dietary low calcium ```
46
Which hormone protects against osteoporosis?
Oestrogen
47
What does the FRAX tool predict?
Risk of fragility fracture over next 10 years
48
Which scan is used to measure bone mineral density?
DEXA scan
49
What T scores would you expect for someone with normal BDM, osteopenia and osteoporosis?
``` Normal = > -1 Osteopenia = -1 to -2.5 Osteoporosis = < -2.5 ```
50
Which medical conditions are asked about in the FRAX score?
``` RA Kidney failure Cushing's Coeliac disease MS Hyperthyroidism Hyperparathyroidism Diabetes Previous fracture ```
51
Which medications are asked about in the FRAX score?
Glucocorticoids Lithium Barbiturates
52
Which FH is asked about in the FRAX score?
Parental fractured hip
53
What social history is asked about in the FRAX score?
Smoking status | Alcohol units
54
Which personal information is asked about in the FRAX score?
``` Age Sex Weight Height Femoral neck BMD ```
55
Which lifestyle changes would you advise for someone with osteoporosis?
``` Exercise Quit smoking Reduce alcohol Maintain healthy weight Adequate calcium and vitamin D ```
56
What is the first line medical treatment for osteoporosis and how does this work?
Bisphosphonates - reduce osteoclast activity, preventing reabsorption of bone
57
What are the side effects of bisphosphonates?
Reflux | Oesophageal erosions
58
What second line medications can be given for osteoporosis?
Denosumab - monoclonal antibody to RANK ligand Strontium ranelate Teriparatide HRT

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