Musculoskeletal Disease

Question 1

What parts of the body does osteoarthritis affect?

Answer 1

Hands and weight bearing joints

Question 2

What is osteoarthritis associated with?

Answer 2

Obesity
Genetics
Previously damaged joint or bone

Question 3

Does oteoarthritis affect part of a joint or the whole joint?

Answer 3

Whole joint

Question 4

Is osteoarthritis more common in men or women?

Answer 4

Women

Question 5

What are the symptoms of osteoarthritis?

Answer 5

Pain that is worse on movement
Immobility
Swelling
Deformity

Question 6

How is osteoarthritis diagnosed?

Answer 6

Clinical exam
Radiology if disease is advanced
MRI scan

Question 7

How is osteoarthritis managed?

Answer 7

Lose weight
Physio
Analgesics
No symptoms = no treatment
Steroid injections
Joint replacement

Question 8

What is rheumatoid arthritis?

Answer 8

An auto immune disease of unknown aetiology

Joint destruction due to synovial inflammation

Question 9

Compared to osteoarthritis, rheumatoid arthritis is…?

Answer 9

More localised

Question 10

How common is rheumatoid arthritis and who does it affect more?

Answer 10

1-3% of population

3x more women

Question 11

What is the peak onset for rheumatoid arthritis?

Answer 11

30-50

Question 12

What are the signs and symptoms of rheumatoid arthritis?

Answer 12

Joint pain initially with hands and feet
Later cervical spine, knees, ankles, elbows and shoulders
Acute = Hot, swollen and tender
Established = Deformity, and restriction 
Heart disease
Lung problems 
Kidney failure
Sjogrens syndrome
Systemic inflammation

Question 13

What do 1/4 of cases of rheumatoid arthritis show?

Answer 13

Symmetrical onset

Question 14

What effects can rheumatoid arthritis have on the nervous system?

Answer 14

Peripheral neuropathy

Cervical cord compression - paralysis

Question 15

How is rheumatoid arthritis diagnosed?

Answer 15

Clinical exam
Blood tests - full blood count
Anti CCP test

Question 16

How is the disease severity established with rheumatoid arthritis?

Answer 16

Radiographically

Question 17

What makes the prognosis of rheumatoid arthritis worse?

Answer 17

If pt is a woman

If they are diagnosed as anaemic within 3 months of diagnosis of rheumatoid arthritis

Question 18

How is rheumatoid arthritis managed?

Answer 18

Analgesia 
Disease modifying anti rheumatic drugs
Corticosteroids 
Surgery - joint replacement
Physic
Occupational therapy

Question 19

Why patients with rheumatoid tend to have better dexterity than patients with osteo?

Answer 19

Rheumatoid progresses slowly over time so give pts a change to get used to it

Question 20

What is systemic sclerosis?

Answer 20

An auto immune disease that affects mainly the skin - thickened skin that is bound to underlying structures

Question 21

Does systemic sclerosis occur more in men or women?

Answer 21

3-5x more in women

Question 22

What age does systemic sclerosis present?

Answer 22

Middle age

Question 23

What are the signs and symptoms of systemic sclerosis?

Answer 23

Sclerodactyly
Telangiectasis
Characterised appearance - beaked nose, fixed expression, radial furrowing of lips and limitation in mouth movement

Question 24

How is systemic sclerosis diagnosed?

Answer 24

Clinical exams

Blood tests

Question 25

What is systemic lupus erythematous?

Answer 25

A multi system auto immune disease

Question 26

What % of the population does systemic lupus erythematous affect and is it more common in men or women?

Answer 26

0.1% | 9x more common in women

Question 27

What is the average age onset for systemic lupus erythematous?

Answer 27

20-40 years

Question 28

What are the symptoms of systemic lupus erythematous?

Answer 28

``` Photosensitivity of skin Butterfly rash on face Small joint arthritis Raynaulds disease Heart problems Lung problems Kidney failure Nervous system problems ```

Question 29

How is systemic lupus erythematous diagnosed?

Answer 29

Clinical exam | Test for specific ago antibodies

Question 30

How is systemic lupus erythematous managed?

Answer 30

``` Analgesia Disease modifying anti rheumatic drugs Corticosteroids Surgery - joint replacement Physic Occupational therapy Psychological practical support ```

Question 31

What is gout?

Answer 31

Accumulation of rate crystals in joints

Question 32

Who is gout most common in?

Answer 32

Older men

Question 33

What is psonatic arthritis associated with?

Answer 33

Psoriasis

Question 34

What is hyperparathyroidism?

Answer 34

Excess of parathyroid hormone

Question 35

What are the symptoms of hyperparathyroidism?

Answer 35

``` Hypercalcaemia - malaise - depression - constipation - abdominal pains - kidney stones Bone pain ```

Question 36

How is hyperparathyroidism diagnosed and managed?

Answer 36

Diagnosed - blood tests and X-rays | Management - Parathyroidectomy or drugs

Question 37

What does hyperparathyroidism affect dentally?

Answer 37

Bone resorption | Loss of lamina dura around roots

Question 38

What is pagets disease?

Answer 38

Abnormal bone remodelling and abundant new bone formation

Question 39

What are patients with pagets disease prone to?

Answer 39

Fractures

Question 40

In pagets disease, what is the bone resorption initially replaced with?

Answer 40

Fibro-vascular tissue

Question 41

What eventually happens to the bone remodelling and bone resorption?

Answer 41

They level off

Question 42

What are the signs and symptoms of pagets?

Answer 42

``` Most completely asymptomatic Bone deformities - enlargement of skull - nerve compression - fractures ```

Question 43

How is pagets diagnosed?

Answer 43

Clinical exam Xrays Hypercementosis of roots of teeth

Question 44

How is pagets managed?

Answer 44

With bisphosphonates

Question 45

What is osteomalacia?

Answer 45

Vitamin D deficiency

Question 46

What are the symptoms of osteomalacia?

Answer 46

Diffuse bone pain | Proximal muscle

Question 47

How is osteomalacia diagnosed?

Answer 47

Xrays and blood tests

Question 48

What does osteomalacia affect in children?

Answer 48

Development of teeth

Question 49

What is osteoporosis?

Answer 49

Loss of bone mass

Question 50

What are patients who suffer osteoporosis prone to?

Answer 50

Fractures

Question 51

What are the risk factors for developing osteoporosis?

Answer 51

``` Female Alcohol Thin White Lack of exercise Short menstrual cycle history Malabsorption Hyperthyroidism Hyopgonadism ```

Question 52

How is osteoporosis managed?

Answer 52

Diagnosis with a DEXA scan Pharmacological Calcium and vitamin D