Musculoskeletal Flashcards Preview

CMS! > Musculoskeletal > Flashcards

Flashcards in Musculoskeletal Deck (100)
1

Define musculoskeletal disease

disorders of joints and bones that may or may not also affect other bodily systems

2

name the two categories of joint disease

1. osteoarthritis
2. connective tissue diseases

3

name 3 types of connective tissue diseases

- rheumatoid arthritis
- systemic sclerosis
- systemic lupus erythematosus (SLE)

4

name 4 types of bone disease

- hyperparathyroidism
- paget's disease
- osteomalacia
- osteoporosis

5

general symptoms for joint disease is.. 6 things

inflammation
- hot
- red
- swollen
- painful
destruction
- deformity
- instability

6

list the 4 joints that are most likely to be affected by osteoarthritis

- hands
- hips
- knees
- ankles

7

3 things that predispose a person to osteoarthritis

- genetics
- obesity
- previously damaged joints

8

which part of the joint does osteoarthritis affect (or all of it)?

whole joint affected

9

what are 3 pathophysiological changes that occur in osteoarthritis?

- cartilage worn away
- cartilage fragments in synovial fluid
- bone spurs (overgrowth)

10

what is the full definition of osteoarthritis

progressive destruction of the cartilage due to inflammation which can go on to affect the whole joint

11

who is most at risk of having osteoarthritis?

women over 60

12

what % of patients have no symptoms of osteoarthritis?

50% (25% of the 50% of over 60s who have radiographic evidence)

13

what are 4 symptoms of osteoarthritis

- pain that is worsened by movement and eased by rest
- immobility which is worse in the morning
- deformity
- swelling

14

which nodes on the hands are closer to where a ring would sit?

heberden's nodes

15

what are the nodes closest to your finger nails called?

bouchards nodes

16

what are 5 ways to manage osteoarthritis

- lose weight
- physiotherapy
- analgesia
- steroid injection (temporary relief)
- joint replacement

17

what type of disease is rheumatoid arthritis

autoimmune disease with unknown aetiology

18

what does the immune system do to give rheumatiod arthritis?

makes antibodies against bodies own antibodies - commonly IgM

19

which part of the joint experiences the most inflammation in rheumatoid arthritis?

synovial inflammation leads to joint destruction

20

what 3 changes occur to a joint with rheumatoid arthritis?

- inflammed synovium
- generalised bone loss/erosion
- cartilage loss

21

what % of the population is affected by rheumatoid arthritis

1-3%

22

rheumatoid arthritis - how many times more common is it in female?

3x

23

when is the usual onset of rheumatoid arthritis?

30 - 50 years old

24

what parts of the body are usually initially affected by RA?

hands and feet

25

what areas are then affected later on by RA?

- cervical spine
- knees
- ankles
- elbows
- shoulders

26

what are 2 symptoms of established RA?

deformity (restriction)
sub-luxation

27

give the 5 signs of RA in the hands

1. ulnar deviation
2. rheumatoid nodule(s)
3. Z thumb
4. swan neck deformity
5. boutonniere deformity

28

what are 7 systemic issues with RA?

- kidney failure
- nervous system issues
- heart disease
- lung issues
- systemic inflammation
- eye issues
- sjogrens syndrome

29

what are the 2 nervous system complications with RA?

- peripheral neuropathy
- cervical cord compression (paralysis)

30

what lung complications can occur with RA?

pulmonary fibrosis

31

what systemic inflammatory associated issues can occur with RA?

- malaise
- anaemia

32

what can occur to the eyes in RA pt?

inflammation

33

what is sjogrens syndrome defined as?

an autoimmune chronic inflammatory condition where the WBCs attack the bodies moisture producing glands (eg salivary & lacrimal)

34

what 3 ways can RA be diagnosed?

Clinically
- ulnar deviation
- Z-thumb
- rheumatoid nodules
- swan neck deformity
- boutonniere deformity

Blood tests

Radiology (destructive arthritis)

35

what is the management of RA?

1. pharmacologically
2. surgery
3. physio (to optimise joint function)
4. occupational therapy (optimise functional abilities)

36

name the 3 groups of drugs that will be given to a patient with RA?

- analgesics
- corticosteroids
- disease modifying anti-rheumatic drugs

37

what 2 ways can corticosteroids be administered?

1. systemically
2. local injection into joints

38

name 6 DMARDs

1. sulphasalazine
2. penicillamine
3. methotrexate
4. gold
5. hydrochloroquine
6. azathioprine

39

what surgery options are there for RA?

joint replacement

40

dental aspects of RA?

- reduced dexterity
- TMJ disease
- Sjogrens syndrome
- drug side effects

41

what are some orally relevant side effects of DMARDs?

- oral ulceration
- stomatitis
- taste loss/disturbance
- vomiting

42

systemic sclerosis is also called?

scleroderma

43

systemic sclerosis pathophysiology is...

- autoimmune disease
- multi organs
- skin mainly effected (thickened and bound to underlying structures)

44

how common is systemic sclerosis?

rare

45

how many times more is a woman likely to be affected with systemic sclerosis?

3-5 x more

46

when will systemic sclerosis present itself?

middle age

47

what are 7 symptoms of systemic sclerosis?

- sclerodactyly
- telangiectasia
- calcinosis
- beaked nose
- fixed expression
- limited mouth movements
- radial furrowing of lips

48

what is sclerodactyly?

- thickening/tightness of the skin in fingers and toes

49

what is telangiestasia?

dilation of capillaries giving spider like appearance (small red or purple blisters

50

2 ways that systemic sclerosis is diagnosed?

- clinically
- blood tests

51

what does SLE stand for?

systemic lupus erythematousus

52

what is SLE?

- an autoimmune multi system disease that has unknown aetiology.

- widespread vascular immune complex deposition

53

what are antibodies formed against in SLE?

cell nuclear components

54

how common (in %) is SLE?

0.1%

55

which 2 groups are at higher risk of SLE?

1. african origin
2. women aged 20-40

56

what are the 6 main areas affected by SLE?

1. Joints
2. Heart
3. Skin
4. Nervous system
5. Lungs
6. Kidneys (failure)

57

what condition can be associated with SLE?

Raynauds in 20% of cases

58

what kind of joint issue is associated with SLE?

small joint arthritis (90%)

59

what kind of heart issues are associated with SLE?

- valve disease
- endocarditis (aseptic)

60

what kind of skin issues are associated with SLE?

- photosensitivity
- butterfly rash

61

what kind of nervous system issues are associated with SLE?

- fits
- neuropathy
- psychosis
- paralysis

62

what kind of respiratory issue can be associated with SLE?

- pleural effusions (fluid in pleural space)

63

2 ways of diagnosing SLE?

- clinical
- specific auto-antibodies

64

what is the management of SLE?

1. pharmacological (as RA)
- analgesic
- corticosteroids
- DMARDs
2. psychological/practical support

65

what is gout?

a form of arthritis caused by the accumulation of urate (uric acid) crystals in joints

66

which category of people are most likely to have gout?

older men

67

what is the main symptom of gout in an acute attack?

extremely painful joints

68

what can cause a gout attack?

-starvation
-alcohol excess
-certain foods (high in uric acid)

69

how is gout managed?

- drugs
- surgery

70

what is the chronic symptom of gout?

trophic deposition - usually painless but can get in the way

71

what is psoriatic arthritis?

arthritis associated with psoriasis

72

what is hyperparathyroidism?

- excess parathyroid hormone

73

what is usually the cause of hyperparathyroidism?

adenoma of the parathyroid glands

74

what % of the population is affected with hyperparathyroidism?

0.1%

75

what is the 2 main symptoms of hyperparathyroidism?

hypercalcaemia & bone pain

76

what does hypercalcaemia cause?

- malaise
- depression
- constipation
- abdominal pain
- kidney stones

77

what is the common saying about hyperparathyroidism symptoms?

"bones, stones and abdominal groans"

78

what is the management of hyperparathyroidism?

drugs

79

what are the dental aspects of hyperparathyroidism?

- giant cell lesions
- loss of lamina dura around roots on radiographs

80

what is the pathophysiology of pagets disease?

- abnormal bone remodelling
- abundant new bone formation

81

what is the abundant new bone formation like in pagets disease?

- structurally normal
- prone to fracture

82

what is pagets disease closely related to?

age

83

what are the possible symptoms of pagets disease?

- bone deformities (skull enlargement/nerve compression)
- fractures

84

what are the two possible outcomes of nerve compression?

- deafness
- spinal cord compression (paralysis)

85

define osteomalacia?

a vitamin D deficiency

86

what are 3 causes of Vit D deficiency?

1. lack of sunshine
2. poor intake
3. malabsorption in intestine (it is a fat soluble vitamin)

87

what are the 2 at risk groups for osteomalacia?

- asian origin
- frail elderly

88

what are 2 symptoms of osteomalacia?

- diffuse bony pains
- proximal muscle weakness

89

what is the treatment fot osteomalacia?

vitamin D replacement

90

what is the dental relevance of osteomalacia?

affects tooth development in children

91

what is the definition of osteoporosis?

loss of bone mass with increased fracture risk

92

what is the % of women affected by osteoporosis aged 50?

15%

93

what is the % of women affected by osteoporosis aged 80?

70%

94

where are the 3 most common places to get an osteoporotic fracture?

- vertebral
- hips
- wrist/humerus neck

95

what will be associated with vertebral fractures?

- pain
- loss of height
- kyphosis

96

what will be associated with hip fractures?

- disability
- high mortality/morbidity

97

what are 11 risk factors for osteoporosis?

- female
- white
- smoking
- alcohol
- lack of exercise
- steroids
- thin
- short menstrual history
- malabsorption
- hyperthyroidism
- hypogonadism

98

what are the 3 treatments of osteoporosis?

- drugs
- calcium and vit d
- risk factor modification

99

what can be a side effect of bisphosphonates?

osteonecrosis of the jaw

100

what advice should be given to patients on bisphosphonates?

- good OH to avoid extraction
- new recommended dental assessment pre prescription