MSK & Rheumatology Flashcards
(104 cards)
1
Q
Osteoporosis vs osteopenia
A
- Osteoporosis: significant reduction in bone density.
- Osteopenia: less severe decrease in bone density.
2
Q
Why is oestrogen protective against osteoporosis?
A
Reduces bone resorption by inhibiting osteoclast activity.
3
Q
How does tamoxifen prevent osteoporosis?
A
It’s a selective oestrogen receptor modulator (SERM) that blocks oestrogen receptors in breast tissue, but stimulates oestrogen receptors in the uterus and bones.
4
Q
Name 2 investigations for osteoporosis
A
- DEXA scan of hip and spine.
- Lateral lumbar and thoracic vertebral radiographs.
5
Q
Name the sero-negative inflammatory arthritises
A
- Psoriatic arthritis
- Ankylosing spondylitis
- Reactive arthritis
Related to HLA B27
6
Q
Describe the NSAIDs response to inflammatory arthritis compared to OA
A
Inflammatory arthritis has a better response to NSAIDs compared to OA.
7
Q
Which joints are commonly affected in RA?
A
Wrist, MCP, PIP, MTP
Symmetrical, polyarthritis.
8
Q
Which joints are commonly affected in OA?
A
Weight bearing joints (hips, knees, cervical & lumbar spine), 1st MCP (thumb), 1st MTP (big toe).
9
Q
Describe the link between arthritis and eye disease
A
- Scleritis - RA
- Uveitis - sero-negative arthropathies
- Conjunctivitis - reactive arthritis
10
Q
Hand changes in RA?
A
- Ulnar deviation
- Rheumatoid nodules
- Swan neck deformity
- Boutonniere deformity
11
Q
Management for RA
A
- NSAIDs
- Steroids
- DMARDs (methotrexate, sulfasalazine, hydroxychloroquine)
- Biologic therapies (anti-TNF, rituximab, anti IL-6)
- Physio/OT
12
Q
Palpable purpura
A
Vasculitic rash.
If non-palpable - thrombocytopenia.
13
Q
Name 2 types of ANCA positive vasculitis
A
- Granulomatosis with polyangiitis (GPA, Wegener’s) - also PR3.
- Microscopic polyangiitis (MPA) - also MPO.
14
Q
Where does GPA most commonly affect?
A
- Head and shoulders
- Also commonly affects kidneys
15
Q
Palpable purpuric a rash and abdominal pain
A
Polyarteritis nodosa (PAN)
16
Q
Asthma and vasculitis symptoms
A
Eosinophilic granulomatosis with polyangiitis (EGPA)
17
Q
Describe the rash in SLE
A
Facial ‘butterfly’ rash across the cheeks, that spares the nasolabial folds.
18
Q
Which cancers metastasise to bone?
A
Breast, thyroid, prostate, lung
19
Q
Where does the sciatic nerve originate?
A
L5-S1
20
Q
Causes of back pain
A
- Sciatica
- Ankylosing spondylitis
- Mechanical
- Cauda equina
- Tumours
- Infection e.g. discitis, osteomyelitis
- Disc herniation
- Degenerative e.g. OA
21
Q
Gout synovial fluid?
A
Negatively birefringent crystals
22
Q
Name one important risk factor for osteoporosis
A
Previous fragility fracture
23
Q
What is the staining like in SLE?
A
Speckled
24
Q
What is the staining like in scleroderma?
A
Nucleolar (diffuse) or centromere (limited)
25
Scl 70
Scleroderma
26
RNP
Mixed connective tissue disease (MCTD) or overlapping RA/SLE (RUPUS)
27
Ro
Rash - SLE/Sjogren’s
28
La
Sjogrens
29
Sm
SLE
30
Jo 1
Polymyositis
31
dsDNA
SLE
32
Outline CREST syndrome
- Calcinosis
- Raynauds
- Oesophageal dysmotility
- Sclerodactyly
- Telangiectasia
33
What is the most common cause of heel pain in adults?
Plantar fasciitis
34
Which meniscus tear can cause a locked knee?
Bucket handle tear
35
XR findings for OA?
- Osteophytes
- Loss of joint space
- Sclerosis
- Cysts
36
What factors may predict worse disease in RA?
Disease activity, +ve Abs and erosions on XR.
37
What is the most common cause of death in RA?
Accelerated atherosclerosis and associated IHD.
38
What test should be performed prior to starting biologics in RA?
CXR - due to risk of TB reactivation.
39
What is the most widely used DMARD?
Methotrexate
40
What monitoring is required with methotrexate?
- FBC - myelosuppression.
- LFTs - liver cirrhosis.
41
Haemochromatosis is a risk factor for what?
Pseudogout
42
'Can't see, pee or climb a tree' are features of what condition?
Reactive arthritis
43
Name 2 skin conditions associated with reactive arthritis
- Circinate balanitis (painless vesicles on the coronal margin of the prepuce).
- Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles).
44
Anti-centromere antibodies
Limited (central) systemic sclerosis
45
What is the initial management for RA?
Conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid.
46
Old man, bone pain, raised ALP
Paget's disease
47
What is a useful rule out test for SLE?
ANA
48
Which test is useful to rule in SLE?
Anti-dsDNA
49
A raised CRP in a patient with SLE may indicate what?
An underlying infection (as during active disease CRP may be normal).
50
Which tool screens for psoriatic arthritis in patients with psoriasis?
Psoriasis Epidemiological Screening Tool (PEST)
51
Name the seronegative spondyloarthropathies
- Ankylosing spondylitis.
- Psoriatic arthritis.
- Reactive arthritis.
- IBD-associated spondyloarthropathy.
‘Seronegative’ refers to both the lack of rheumatoid factor positivity and the absence of specific antibodies for each disease. They’re associated with the HLA-B27 gene.
52
Abs for Antiphospholipid syndrome
- Anticardiolipin antibodies
- Anti-beta2 glycoprotein I antibodies
- Lupus anticoagulant
53
Diagnosis of ankylosing spondylitis can be best supported by what?
Sacro-ilitis on a pelvic X-ray
54
Describe the adverse effects of methotrexate
Mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, liver fibrosis.
55
Which drugs are used in for the management of pathological fractures?
Bisphosphonates and denosumab
56
Patients receiving IV bisphosphonates in the treatment of cancer have a greater risk of which side effect?
Osteonecrosis of jaw
57
List the poor prognostic features for RA
- Rheumatoid factor positive
- Anti-CCP antibodies
- Poor functional status at presentation
- X-ray: early erosions (e.g. after < 2 years)
- Extra articular features e.g. nodules
- HLA DR4
- Insidious onset
58
Low serum calcium, low serum phosphate, raised ALP and raised PTH
Osteomalacia
59
When is the pain worst for lateral epicondylitis?
On resisted wrist extension/supination whilst elbow extended.
60
Malignancy + raised CK
Polymyositis
61
Management of psoriatic arthropathy
- Mild - NSAIDs
- Moderate/severe - methotrexate
62
What blood test should be checked before starting Azathioprine?
Thiopurine methyltransferase deficiency (TPMT)
63
Azathioprine may interact with which drug causing bone marrow suppression?
Allopurinol
64
Blood test values in osteoporosis?
Normal blood test values (e.g. normal ALP, normal calcium, normal phosphate, normal PTH).
65
What is the differential diagnosis for gout?
Septic arthritis
66
What is the gold standard investigation for gout?
Joint aspiration - needle-shaped monosodium urate crystals that are negatively birefringent under plane-polarised light.
67
Management of patients >= 75 years following a fragility fracture?
Start alendronate without waiting for a DEXA scan.
68
Management of patients < 75 following a fragility fracture?
DEXA scan
69
What Schober's test value is indicative of ankylosing spondylitis?
< 5cm
70
Normal calcium, normal phosphate, raised ALP and normal PTH
Paget’s disease
71
What should be used whilst starting allopurinol?
NSAID or colchicine cover
72
Marfan’s syndrome is caused by a mutation in which protein?
Fibrillin
73
Outline the features of Marfan’s syndrome
- Tall stature
- High-arched palate
- Arachnodactyly
- Pectus excavatum
- Pes planus
- Aortic sinus dilation - aortic aneurysm, aortic dissection, aortic regurgitation
- Mitral valve prolapse
- Pneumothorax
- Upwards lens dislocation
- Dural ectasia
74
Raised serum calcium, low serum phosphate, raised ALP and raised PTH
Primary hyperparathyroidism (e.g. parathyroid adenoma - most common)
75
When is the pain worse for medial epicondylitis?
Wrist flexion and pronation
76
Name the risk factors for pseudogout
- Haemochromatosis
- Hyperparathyroidism
- Low magnesium, low phosphate
- Acromegaly, Wilson's disease
77
Describe the T and Z scores for osteoporosis
- T-score is a comparison of a person's bone density with that of a healthy 30-year-old of the same sex.
- Z-score is a comparison of a person's bone density with that of an average person of the same age, sex, and race.
78
Management of Raynaud's phenomenon
Nifedipine
79
Name the adverse effects of Azathioprine
- Bone marrow suppression
- N+V
- Pancreatitis
- Increased risk of non-melanoma skin cancer
80
What are the triad of features in Still’s disease
Fever, polyarthralgia and salmon-pink rash.
Also elevated serum ferritin.
81
Bone pain, tenderness and proximal myopathy (→ waddling gait)
Osteomalacia
82
Management of antiphospholipid syndrome
- Primary thromboprophylaxis: low-dose aspirin.
- Secondary thromboprophylaxis: lifelong warfarin.
83
What is the most common cause of lateral knee pain in athletes?
Iliotibial band syndrome
84
Osteosarcoma vs Ewing’s sarcoma
- Osteosarcoma: most common primary malignant bone tumour, metaphyseal region of long bones, Colman triangle and sunburst pattern on XR.
- Ewing’s sarcoma: diaphysis of pelvis and long bones, onion skin appearance on XR.
85
If a patient is allergic to sulfasalazine, which other drug will they be allergic to?
Aspirin
86
Which drugs can cause drug-induced lupus?
- Procainamide
- Hydralazine
- Isoniazid
- Minocycline
- Phenytoin
87
Describe the features of Osteogenesis imperfecta
Presents in childhood with features such as bone fractures and deformities, blue sclera and hearing/visual problems.
88
Outline the management of patients at risk of corticosteroid-induced osteoporosis
1. Patients > 65 years or those who've previously had a fragility fracture should be offered bone protection.
2. Patients under < 65 years should be offered a bone density scan (DEXA).
89
What is the treatment choice for SLE?
- Hydroxychloroquine.
- If internal organ involvement e.g. renal, neuro, eye, then consider prednisolone, cyclophosphamide.
90
Risk factors for Dupuytren’s contracture
- Manual labour
- Phenytoin treatment
- Alcoholic liver disease
- Diabetes mellitus
- Trauma to the hand
91
List the red flags for back pain
- Age < 20 years or > 50 years
- History of previous malignancy
- Night pain
- History of trauma
- Systemically unwell e.g. weight loss, fever
- Thoracic pain
- Non-mechanical pain
- Pain worse when supine
- Presence of neurological signs
- Past medical history of HIV
- Immunosuppression or steroid use
- IV drug use
- Structural deformity
92
Causes for avascular necrosis
- Long-term steroid use
- Chemotherapy
- Alcohol excess
- Trauma
93
What findings are most consistent with frozen shoulder (adhesive capsulitis)?
Active and passive movement limited & external rotation most affected.
94
Treatment of Paget’s disease
Bisphosphonates
95
Name one adverse effect of Hydroxychloroquine
Retinopathy
96
In osteoporosis, when should the 10 year fracture risk be reassessed for patients taking alendronate?
After 5 years
97
Name the most common ocular complication from temporal arteritis
Anterior ischaemic optic neuropathy - fundoscopy shows a swollen pale disc and blurred margins.
98
Treatment for temporal arteritis
- No visual loss : high-dose prednisolone.
- Visual loss: IV methylprednisolone, urgent ophthalmology review.
99
Knee pain after exercise, locking and ‘clunking’
Osteochondritis dissecans
100
How can nerve root pain be distinguished from other pain in the leg?
By the dermatomal distribution and associated neurological deficit
101
CK level in PMR
Normal
102
What drug should be avoided when taking methotrexate?
Trimethoprim - may cause bone marrow suppression and severe or fatal pancytopaenia.
103
First line management for back pain
NSAIDs
104
RA, splenomegaly and low white cell count
Felty's syndrome
