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CMS > Week 8 - Musculoskeletal Disease > Flashcards

Week 8 - Musculoskeletal Disease Flashcards

(54 cards)

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1
Q

general signs and symptoms of joint disease?

A
  • inflammation: hot, red, swollen, painful

- destruction: immobility, deformity, instability

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2
Q

osteoarthritis: what joints affected? associated with?

A
  • hands
  • weight bearing joints (hips, knees, ankles)
  • genetic
  • obesity
  • previously damaged joints or bones
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3
Q

osteoarthritis - pathophysiology?

A
  • inflammation in the joint,
  • body tries to remodel bone back to original state, but does more damage than benefit
  • joint space reduced
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4
Q

osteoarthritis - symptoms?

A
  • pain: worse on movement, relieved by rest
  • immobility: worse in morning
  • swelling
  • deformity
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5
Q

osteoarthritis - how is it diagnosed?

what are the physical landmarks of osteoarthritis?

A
  • clinical: history & examination
  • radiology: plain x-rays
  • heberden’s and bouchard’s nodes
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6
Q

what is the difference between heberden and bouchard nodes?

A
  • heberden nodes located on distal interphalangeal joints

- bouchard’s nodes are located at distal interphalangeal nodes

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7
Q

osteoarthritis - management?

surgical management?

A
  • lose weight
  • physiotherapy
  • analgesia
  • steroid injection: temporary relief only
  • joint replacement. but difficult to repair if goes wrong. dont do on young pts.
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8
Q

osteoarthritis - dental considerations?

A
  • reduced dexterity
  • reduced mobility
  • associated medication?
  • recognition
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9
Q

rheumatoid arthritis - pathophysiology?

A
  • autoimmune disease of unknown aetiology
  • joint destruction, due to synovial inflammation
  • multi-system disease
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10
Q

rheumatoid arthritis - signs and symptoms?

presentation in acute and in established RA?

A

on joints: hands and feet initially, later cervical spine, knees, ankles, elbows, shoulders

presentation:
- acute - hot, swollen, tender
- established: deformity, restriction, sub-luxation (veers off to one side)

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11
Q

rheumatoid arthritis - physical deformities in those affected?

A
  • ulnar deviation
  • rheumatoid nodule
  • Z thumb
  • Boutonniere deformity
  • swan neck deformity
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12
Q

rheumatoid arthritis - signs and symptoms?

A
  • nervous system: peripheral neuropathy, cervical cord compression - paralysis
  • lungs: pulmonary fibrosis
  • heart disease
  • kidney failure
  • eyes: inflammation
  • sjogren’s syndrome: dry mouth & eyes
  • systemic inflammation: malaise, anaemia
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13
Q

rheumatoid arthritis - methods of diagnosis?

A
  • clinical exam
  • blood tests
  • radiology
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14
Q

rheumatoid arthritis - medical management?

A
  • analgesia
  • disease modifying anti-rheumatic drugs
  • corticosteroids: systemic & local (for joint infection)
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15
Q

examples of disease modifying anti-rheumatic drugs?

A
  • sulphasalazine
  • penicillamine
  • methotrexate
  • gold (?)
  • hydrochloroquine
  • azathioprine

biologicals: adalimumab, infliximab

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16
Q

rheumatoid arthritis - what do the following help with?

  • surgery?
  • physiotherapy?
  • occupational therapy?
A
  • joint replacements
  • optimise joint function
  • optimise functional abilities
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17
Q

rheumatoid arthritis - dental considerations for making diagnosis?

A
  • TMJ disease?
  • sjogren’s syndrome?
  • hands?
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18
Q

rheumatoid arthritis - dental considerations for those with established disease?

A
  • reduced manual dexterity
  • managing the patient’s sjogren’s syndrome
  • c-spine vulenrability: lying back?
  • drug side effects
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19
Q

systemic sclerosis/scleroderma - pathophysiology? describe the condition

A
  • autoimmune disease: mainly affecting the skin.
  • thickening and bound to underlying structures
  • multi-organ disease
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20
Q

systemic sclerosis/scleroderma - physical signs and symptoms?
characteristic appearance?

A
  • sclerodactyly
  • telangiectasia
  • calcinosis
  • beaked nose, fixed expression, radial furrowing of lips, limitation of mouth movements
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21
Q

systemic sclerosis/scleroderma - diagnosis?

A
  • clinical
  • blood test: specific auto-antibodies
  • management: symptomatic
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22
Q

systemic sclerosis/scleroderma - dental considerations about diagnosis and management?

Study These Flashcards
A

diagnosis: dentist may suspect from oral findings

mouth care:

  • limitation of opening
  • atrophic mucosa
  • loss of dexterity for OH
  • side effects of medication
23
Q

systemic lupus erythematous -
pathophysiology?
antibodies against?
widespread deposition of?

Study These Flashcards
A
  • autoimmune + multi-system disease
  • aetiology unknown
  • antibodies against cell nuclear components
  • widespread vascular complex deposition
24
Q

systemic lupus erythematous - signs and symptoms?

Study These Flashcards
A
  • skin: photosensitivity, butterfly rash
  • joints: small joint arthritis
  • raynaud’s syndrome
25
what is raynaud's syndrome?
temporary spasm of blood vessels, blocking the flow of blood - affected experience pain, numbness, pins and needles
26
SLE - signs and symptoms?
- nervous system: fits, paralysis, neuropathy, psychosis - heart: valve disease, endocarditis - lungs: effusions - kidney failure
27
systemic lupus erythematous - diagnosis?
- clinical exam | - test for specific auto-antibodies
28
systemic lupus erythematous - management?
- pharmacological same as rheumatoid arthritis | - psychological, for practical support
29
systemic lupus erythematous - dental considerations? (diagnosis & established)
- recognition of orofacial features (butterfly rash) -> diagnosis diagnosed disease: - drug side effects - reduced anxiety - secondary sjogren's syndrome
30
gout - what is it? caused by? more common in?
- accumulation of urate crystals in joints (overnourished + change in metabolism + high protein diet) - common in older men
31
gout - acute presentation? precipitated by?
- extremely painful joints | - starvation, alcohol excess, certain foods, operations, drugs
32
gout - chronic presentation?
tophi deposition (crystalline uric acid at joints)
33
psoriatic arthritis: psoriasis associated with? can rarely affect where?
- destructive arthritis associated with psoriasis | - can rarely affect TMJs
34
name 4 bone disorders?
- hyperparathyroidism - paget's disease - osteomalacia - osteoporosis
35
hyperparathyroidism: pathophysiology?
- excess thyroid hormone | - usually adenoma in parathyroid gland
36
hyperparathyroidism - hypercalcaemia associated with what symptoms?
- malaise and depression - constipation - abdominal pains - bone pain - kidney stones
37
hyperparathyroidism: untreated hypercalcaemia leads to?
cardiac disrhythmia and death
38
hyperparathyroidism: diagnosis?
- blood tests | - xrays: look for sub-periosteal erosions
39
hyperparathyroidism: management?
- parathyroidectomy | - drugs
40
hyperparathyroidism: dental considerations?
- consider the effect of bone resorption: giant cell lesions, loss of lamina dura around roots - may have had treatment with bisphosphonates
41
paget's disease: pathophysiology?
- abnormal bone remodelling: abundant bone formation. | bone formed is structurally abnormal and prone to fracture
42
paget's disease: signs and symptoms?
- most is asymptomatic - bone deformities - enlargement of skull - nerve compression (due to the narrowing of foramina in skull). leading to deafness & spinal cord compression - fractures
43
paget's disease: diagnosis?
- clinical exam: presence of gross deformities, can't bear weight - xray characteristics: cotton wool deposits on mandible? hypercementosis, possible ankylosis of teeth
44
paget's disease: dental considerations - initial and established diagnosis?
initial: - recognition of radiological features & dental changes established diagnosis: - care with surgery to bone, risk of infection and fracture - awareness of osteosarcoma risk - may be treated with bisphosphonates
45
osteomalacia - deficiency in? due to? what is it called in children?
vitamin D deficiency - due to lack of sunlight - poor intake (lack oily fish, eggs, red meat, fortified cereal/margarine) - malabsorption in intestine - rickets -> typical deformity
46
osteomalacia - epidemiology in UK: - what increases risk? - who is it also likely to affect?
- darker skin increases risk - frail/elderly/institutionalized patients - increased demand (babies, children, pregnancy, breastfeeding)
47
osteomalacia - symptoms?
- diffuse bony pains | - proximal muscle weakness
48
osteomalacia - diagnosis and treatment?
diagnosis: - history - investigations: x-rays, blood tests. looser's zone fracture: pseudofracture, area of radiolucency treatment: replacement, change in diet: Healthy Start
49
osteoporosis - pathophysiology?
- loss of bone mass | - increased fracture risk
50
osteoporosis: characteristics in: - vertebrae? - hip? - wrist/neck or humerus?
- pain, loss of height, kyphosis - disabling, high mortality, moribidity - less disabling, but marker of underlying osteoporosis
51
osteoporosis: risk factors?
- white, female, smoking, alcohol - lack of exercise - steroids - thin - short menstrual history: less abundance of protective hormones - malabsorption - hyperthyroidism - hypogonadism
52
osteoporosis: diagnosis?
DEXA (dual energy x-ray absorptiometry)
53
osteoporosis : treatment?
- calcium & vitamin D | - treat risk factors
54
osteoporosis: dental considerations?
- bisphosphonates: risk of MRONJ

CMS (16 decks)

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