Musc Flashcards by Owen Vineall

What happens physiologically in osteoarthritis

Imbalance in chondrocytes breaking down and producing cartilage due to excess stress such as obesity. Breakdown of articular cartilage leads to inflammation which triggers nerves

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Risk factors for osteoarthritis

High age
Associated inflammatory conditions like rheum and SLE
Joint injuries
Obesity
Strenuous sports

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Signs of osteoarthritis on examinations of hands

PIP- bouchards nodes
DIP- heberden nodes
Swollen first MCP

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Joints affected in osteoarthritis

Weight bearing- knees, ankles, hips, lumbar spine and wrists

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Symtpoms of osteoarthritis

Stiffness in morning of less than an hour

Sharp ache in joints worse with activity

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X ray findings of osteoarthritis

Loss of joint space
Osteophytes
Sunchondral sclerosis
Subchondral cysts

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What is eburnation

Where cartilage is lost leading to bones rubbing together

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Signs on examination of osteoarthritis joints

Crepitus
Osteophytes
Loss of motion
NO swelling

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What is another name for reactive arthritis

Reiters syndrome

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What is genetic association of reactive arthritis and what other conditions are associated with it

HLA-B27
Ankylosing Spondylitis
Psoriasis
UC

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What is reactive arthritis an example of

Seronegative spondyloarthropathy

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What joints are normally affected in reactive arthritis

Can be multiple or often just 1 affected- often the knee

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What is only organism causing reactive arthritis that doesnt cause a sterile joint

Gonorrhoea

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Common organisms associated with reactive arthritis

Shigella 
Campylobacter
Chlamydia
Gonorrhoea
Salmonella
Yersinia

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Reiters triad

Conjunctivits- painful red eye
Urethritis- pain when urinating
Arthritis

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Signs of reactive arthritis on examination

Keratoderma blenorrhagicum
Circinate balanitis
Mouth ulcers

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Other organs that can be affected in reiters syndrome but less commonly

Cervix

Pericarditis

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What is triad of feltys syndrome

Neutropenia
Splenomegaly
Associated with RA

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When is osteoarthritis pain worse

Evening

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How can osteoarthritis be classified

Generalised

Localised-often nodal

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Which joint is most commonly affected in nodal osteoarthritis

DIP

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What joints other than DIP and PIP are affected in nodal osteoarthrits

First carpometacarpal joint

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What happens to first carpometacarpal joint in osteoarthrits

Bony swelling leading to square appearance of hand

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When is polymyalgia rheumatica pain worse

Morning

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Rheumatoid x ray findings

``` Reduced joint space Soft tissue swelling Periarticular osteopenia Bony erosions Subluxation Deformity of joint ```

Most common spetic arthritis cause

S aureus

Common septic arthritis cause in young people

Gonococcus

Main investigations for septic arthritis

Aspiration and blood cultures | Then think about X ray

What in joints can reactive arthritis also affect

Entheses

Common ethesitis of reactive arthritis

Achilles tendonitis Plantar fasciitis Note aslo get dactylitis

Non joint symptom of ankylosing spondylitis

Conjunctivitis

Which joint does nodal OA affect most commonly

DIP | Then first MCP

What is seen in legs in OA

Varus or valgus deformation

What are crystals in gout

Uric acid

Physiology of uric acid

Comes from purine metabolism | Should be excreted by kidneys

What joint is most commonly affected in gout

1st MTP

Birefringe result of gout and pseudogout

Gout- negative | Pseudogout- positive

Blood test findings of gout

Raised CRP and ESR | Raised urate

Who does pseudogout occur in

Elderly

Which joints does pseudogout occur in

Knees and wrists

How does pseudogout present

Acute onset wrist or knee pain | Swelling

How does gout appear on X ray

Peri-articular erosion

Examination of gout

Swelling | Tophi present

What are soft tissue deposits of gout called

Tophi

Systemic complications of RA

``` Pericarditis Vasculitis Episcleritis Keratitis ILD RF nodules Felty syndrome Raynauds ```

What eases RA symptoms

Exercise

Joint pain that eases with exercise

Is RA symmetrical or asymmetrical

Symmetrical

Joint pain in PMR

Stiffness in neck, spine, shoulders and hips

What is only sign on X ray you see of RA early on

Soft tissue swellin

In RA which hand joint is often spared early

DIP

How can you get carpal tunnel syndrome in RA

Inflammation of flexor tendon sheath

Signs on examination of RA

Boutonniere Swan neck Ulnar deformity Carap tunnel syndrome

What percentage of psoriatic patients get arthritis

5-10%

Which joint does psoriatic arthritis tend to affect

Most commonly asymmetrical DIP

What is a good indicator psoriasis patient will get arthritis

Onochylysis

What is main risk of psoriatic arthrits

Arthritis mutilans where osteolysis occurs shortening the finger

How does dermatomyositosis present

Proximal limb weakness with skin changes too

What are crystals in gout

Monosodium urate

Risk factors for gout

High protein- red meat Alcohol Kidney dysfunction

Where are rheumatoid nodules found

Pressure points like the elbows

What do rheumatoid nodules feel like

Very firm

Why would you get recurrent infections in rheumatoid

Feltys syndrome

Associated conditions of seronegative spondyloarthropathies

Achilles tendonitis Plantar fasciitis Sacrolillitis

Presentation of ank spond

Back pain worse in morings Stiffness in morning Wake up latter half of the night

Later examination findings of ank spond

Abnormal schobers test Abnormal wall to tragus test Reduced chest expansion

Other features of ank spond

``` 6as Anterior uveitis Aortitis Aortic regurg AV conduction block from fibrosis Apical lung fibrosis IgA nephropathy ```

Investigations for ank spond

Raised ESR and CRP RF and Accp negative X ray- sacroilitis MRI- enthesitis, sacroilitis

What is bamboo spine seen in

Ank spond

Why are MRIs better than x ray in ank spond

MRIs pick up pathology earlier

5 joint psoriasis presentations

``` Symmetrical DIP and PIP arthritis Asymmetrical oligoarthritis- dactylitis DIP arthritis Arthritis mutilans Ank spond ```

Inflammatory symmetrical DIP and PIP ddx

RA | Psoriatic

Knee monoarthritis ddx

Crystal Septic Reactive arthritis

Investigations for reactive arthritis

Urethral/cervical swab for gonorrhoea PCR- chlamydia Stool sample if dysentery Joint aspiration to exclude gout and septic arthritis

Is swelling normally seen in OA

Most common cause of hip pain in elderly

Most common organ leading to clubbing

Lung

What chemical exposure is well known cause of clubbing

Asbestos

Cause of unilateral swollen leg

``` DVT Cellulitis Ruptured bakers cyst Muscular sprain Septic arthritis Allergic response to insect bite Compartment syndrome ```

Causes of bilateral swollen legs

``` Right heart failure Lymphoedema Venous insufficiency Pregnancy Vasodilators Hypoalbuminaemia Pelvic tumour compressing the IVC Fluid overload iatrogenic ```

What could cause vessel injury in virchows triad in leg

Trauma | Surgery

What would cuts and insect bites suggest about leg swelling

Insect bite- cellulitis, allergy | Cuts- cellulitis

Swelling getting bigger in unilateral leg swelling suggests what

Cellulitis

What does abdo pain and vaginal bleeding suggest about leg swelling

Ovarian mass compressing IVC

What does flaws suggest about unilateral leg swelling

Pelvic mass

What does recent surgery or radiotherapy to leg or abdo suggest about unilateral leg swelling

Lymphoedema

What does joint pain on movement suggest about unilateral leg swelling

Spetic arthritis

What are looking for in inspection of the leg in unilateral swelling

``` Cuts, punctures or insect bites- cellulitis or inflammatory response to bites Location of swelling Size Lymphadenopathy Abdominal masses Neurovascular status Pain on movement Febrile? ```

Why is location of swelling significant in unilateral leg swelling

Septic arthritis would be over a joint Bakers cyst would come out of popliteal fossa and extend downwards Compartment syndrome would be a whole muscle group

What would groin lymphadenopathy in unilateral leg swelling suggest

Infection of leg

Why is neurovascular status of limb important in unilateral leg swelling

Could be compartment syndrome

Investigations for DVT

Doppler US of leg D-dimer FBC- polycythaemia can cause it Clotting study- thrombophillia

Management of DVT

Anticoagulation Copression stockings Lifestyle advice

How can ruptured bakers cyst be diagnosed

What is Volkmanns contracture

Irreversible atrophy of the limb

Management of cellulitis

Take FBC looking for neutrophillia Flucloxacillin covering strep and staph Demarcate progression using pen Elevate leg

How to manage mosquito bite leg swelling

Topical steroids | Antihistamines

Management of bakers cyst

Elevation of limb Aspirate fluid Injection of corticosteroids into joint

What is chondrocalcinosis

Deposition of calcium pyrophosphate crystals

What arthritis is chondrocalcinosis seen in

Main diagnostic marker of PMR

ESR over 40