Musculoskeletal station Flashcards
(36 cards)
back pain red flags
Age < 20, Age >55, Sphincter disturbance, Infection, Malignancy, Stiffness morning, Neurological disturbance, FLAWS
rheumatoid arthritis signs
MCP swelling, swan neck deformity = flexed DIP, boutonniere = extended DIP, Z-thumb deformity, ulnar deviation, MCP subluxation, nodules on elbows, reduced function
rheumatoid additional signs
No nail changes. If nail changes = psoriatic
Scar = carpel tunnel syndrome
Cushingoid appearance = steroids
Features of RA
Improves with use
Bilateral
Systemic symptoms XRAY - LESS
rheumatoid extra–articular manifestations
Pulmonary = effusions, fibrosis, bronchiectasis
Eyes = sjogren’s, scleritis
Haem = anaemia, felty’s syndrome
Neurological = carpal tunnel, atlanto-axial subluxation
Other = amyloidosis, nephrotic syndrome, pericarditis
rheumatoid arthritis investigations
RF = 80% sensitive
Anti-CCP
management of rheumatoid arthritis
NSAIDs for symptoms
Steroids for flare ups
DMARDS = methotrexate, Sulfasalazine, hydroxychloroquine
Biologicals - Anti-TNFs = interferon gamma test + CXR first
rheumatoid arthritis xray changes
Loss of joint space Erosions periarticular Soft tissue swelling Subluxation + deformity
OA signs
Bony swelling, heberdon’s nodes, bouchard’s nodes (before = proximal), fixed flexion deformity in the knee following knee replacement, midline knee scar, unable to fully extend, weight bearing joints more likely affected
Features of OA
Pain following use
Improves with rest
Unilateral
OA management
Conservative = Weight loss and exercise
Medical = Analgesia = NSAID’s + PPI, Intra-articular steroids
Surgical = Total joint replacement
xray changes in OA
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Psoriatic arthritis signs
Rash, arthritis, nail pitting, extensor plaques with scales, nail onycholysis, hyperkeratosis, psoriatic arthritis mutilans
Psoriatic arthritis diagnostic criteria
CASPAR criteria
= skin psoriasis, nail changes, dactylitis, negative rheumatoid factor, new bone formation on xray
Psoriatic arthritis nail signs
Pitting
Onycholysis
Subungual hyperkeratosis
Ridging
Psoriatic arthritis management
Conservative = stop precipitants e.g. smoking, beta blockers, stress, alcohol
Medical = calcipotriol + steroids + tar
Surgical = UV light
Gout investigations
Polarised light microscopy = negatively birefringent needle shaped crystals
Serum urate = can be normal
Monosodium urate crystals
Gout treatment
1st = Colchicine, NSAIDs
PO steroids if renal impairment
Chronic prevent = WL, EToh, allopurinol
pseudogout investifations
Polarised light microscopy = positive birefringent rhomboid shaped crystals
pseudogout treatment
Analgesia
NSAIDS
Steroids
Ankylosing spondylitis features
Back pain
Relieved by exercise
Costochondritis
SOB
Ankylosing spondylitis investigations
Schober’s test
<5cm increase = positive
Xray spine
Ankylosing spondylitis treatment
Conservative = Exercise/ physio
Medical = NSAID
Surgical = hip replacement
Reactive arthritis
Sterile arthritis after 1-4 weeks after urethritis or dysentery (Chlamydia
Campylobacter)
NSAID’s
PO steroids
Sulfasalazine