MSK 2 Flashcards

Question

how is osteomalacia managed?

Answer 1

calcium plus vitamin D - ergocalciferol or colecalciferol and calcium carbonate or calcium citrate

Answer 2

it is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites.

Answer 3

``` chronic pain - at multiple sites, sometimes pain all over lethargy cognitive impairment - fibro fog sleep disturbances headaches dizziness ``` on examination there may be diffuse tenderness

Answer 4

``` family history rheumatological conditions age between 20 and 60 female sex associated conditions - IBS, tension headaches, chronic fatigue syndrome, temporomandibular joint disorder ```

Answer 5

``` RA osteoarthritis SLE chronic fatigue syndrome ankylosing spondylitis polymyalgia rheumatica ```

Answer 6

diagnosis is usually clinical | - you would do investigations to rule out differential diagnosis

Answer 7

American College of Rheumatology (ACR) criteria for fibromyalgia syndrome The criteria include: > Generalised pain, defined as pain in at least 4 of 5 regions. > Symptoms have been present at a similar level for at least 3 months. > Widespread Pain Index (WPI) ≥7 and symptom severity scale (SSS) score ≥ 5 or WPI 4-6 and SSS score ≥ 9. > A diagnosis of fibromyalgia is valid irrespective of other diagnosis. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.

Answer 8

management is often difficult and needs to be tailored to individual patients explanation aerobic exercise - good evidence to help symptoms CBT Medication 1st line = amitriptyline or cyclobenzaprine 2nd line - pregabalin, duloxetine or gabapentin Analgesia such as naproxen or tramadol can be added

Answer 9

infection in the bone

Answer 10

haematogenous osteomyelitis - results from bacteraemia - is usually monomicrobial - most common form in children - vertebral osteomyelitis is the most common form of haematogenous osteomyelitis in adults - risk factors include: sickle cell anaemia, intravenous drug user, immunosuppression due to either medication or HIV, infective endocarditis non-haematogenous osteomyelitis: - results from the contiguous spread of infection from adjacent soft tissues to the bone or from direct injury/trauma to bone - is often polymicrobial - most common form in adults - risk factors include: diabetic foot ulcers/pressure sores, diabetes mellitus, peripheral arterial disease

Answer 11

S-aureus = most common in children other causes - GBS, aerobic gram -ve bacilli, strep pyogenes, H influenzae drug users - pseudomonas aeruginosa sickle cell disease - salmonella species

Answer 12

- non-specific pain at the site of infection - malaise and fatigue - local inflammation, erythema or swelling - low grade fever

Answer 13

``` WBC count ESR CRP plain x-ray - in acute disease - osteopenia appears and evidence of bone destruction and cortical breaches and periosteal reaction follow qucikly MRI ```

Answer 14

antibiotics usually flucloxacillin for 6 weeks clindamycin if penicillin allergy

Answer 15

it is where infection occurs in a joint | it can be in a native joint but is also a common and important complication of joint replacement

Answer 16

usually just one single joint (most commonly in the knee) Hot, red, swollen and painful joint Stiffness and reduced range of motion Systemic symptoms such as fever, lethargy and sepsis

Answer 17

Staphylococcus aureus is the most common causative organism. Other bacteria: Neisseria gonorrhoea (gonococcus) in sexually active individuals Group A Streptococcus (most commonly Streptococcus pyogenes) Haemophilus influenza Escherichia coli (E. coli)

Answer 18

Gout (fluid shows urate crystals that are negatively birefringent of polarised light) Pseudogout (fluid shows calcium pyrophosphate crystals that are rod-shaped intracellular crystals positively birefringent of polarised light) Reactive arthritis typically triggered by urethritis or gastroenteritis and associated with conjunctivitis Haemarthrosis (bleeding into the joint)

Answer 19

``` synovial fluid microscopy, gram stain and polarising microscopy synovial fluid culture and sensitivities synovial fluid WCC blood cultures and sensitivities WCC ESR and CRP U&E LFTs plain X-ray USS ```

Answer 20

Empirical IV antibiotics should be given until the sensitivities are known. Antibiotics are usually continued for 3 – 6 weeks in total. Choice of antibiotic depends on the local guidelines. Example regimes are: Flucloxacillin plus rifampicin is often first line Vancomycin plus rifampicin for penicillin allergy, MRSA or prosthetic joint Clindamycin is an alternative

Answer 21

osteomyelitis | joint destruction

Answer 22

Behcet's syndrome is a complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins.

Answer 23

triad - oral ulcers, genital ulcers, anterior uveitis other features - thrombophlebitis and DVT - arthritis - aseptic meningitis - abdo pain, diarrhoea, colitis - erythema nodosum - retinal haemorrhage - headaches and migraines - memory impairment

Answer 24

Behçet’s disease is a clinical diagnosis based on the features of the condition. The only particular investigation to be aware of is the pathergy test. The pathergy test involves using a sterile needle to create a subcutaneous abrasion on the forearm. This is then reviewed 24 – 48 hours later to look for a weal 5mm or more in size. It tests for non-specific hypersensitive in the skin. It is positive in Behçet’s disease, Sweet’s syndrome and pyoderma gangrenosum.

Answer 25

Management involves a combination of: Topical steroids to mouth ulcers (e.g. soluble betamethasone tablets) Systemic steroids (i.e. oral prednisolone) Colchicine is usually effective as an anti-inflammatory to treat symptoms Topical anaesthetics for genital ulcers (e.g. lidocaine ointment) Immunosuppressants such as azathioprine Biologic therapy such as infliximab

Answer 26

Discoid lupus erythematosus is a non-cancerous chronic skin condition. It is more common in women and usually presents in young adults between ages 20 to 40. It is more common in darker-skinned patients and smokers. It is associated with an increased risk of developing systemic lupus erythematosus, however this risk is still below 5%. Rarely the lesions can progress to squamous cell carcinoma (SCC) of the skin.

Answer 27

The lesions typically occur on the face, ears and scalp. They are photosensitive, meaning that they are made worse by exposure to sunlight. They are associated with scarring alopecia (hair loss in affected areas that does not grow back) and hyper-pigmented or hypo-pigmented scars. ``` The appearance of the lesions are: Inflamed Dry Erythematous Patchy Crusty and scaling ```

Answer 28

Skin biopsy can be used to confirm the diagnosis. Treatment is with Sun protection Topical steroids Intralesional steroid injections Hydroxychloroquine

Answer 29

Antisynthetase syndrome is caused by autoantibodies against aminoacyl-tRNA synthetase e.g. anti-Jo1. ``` It is characterised by myositis interstitial lung disease thickened and cracked skin of the hands (mechanic's hands) Raynaud's phenomenon ```

Answer 30

``` They inhibit osteoclasts by reducing recruitment and promoting apoptosis. Clinical uses prevention and treatment of osteoporosis hypercalcaemia Paget's disease pain from bone metatases ```

Answer 31

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate) osteonecrosis of the jaw increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate acute phase response: fever, myalgia and arthralgia may occur following administration hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant

Answer 32

an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions may be idiopathic or associated with connective tissue disorders or underlying malignancy (typically ovarian, breast and lung cancer, found in 20-25% - more if patient older). Screening for an underlying malignancy is usually performed following a diagnosis of dermatomyositis polymyositis is a variant of the disease where skin manifestations are not prominent **usually ANA positive

Answer 33

Skin features photosensitive macular rash over back and shoulder heliotrope rash in the periorbital region Gottron's papules - roughened red papules over extensor surfaces of fingers 'mechanic's hands': extremely dry and scaly hands with linear 'cracks' on the palmar and lateral aspects of the fingers nail fold capillary dilatation ``` Other features proximal muscle weakness +/- tenderness Raynaud's respiratory muscle weakness interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia dysphagia, dysphonia ```

Answer 34

Most common causes procainamide hydralazine Less common causes isoniazid minocycline phenytoin

Answer 35

an autosomal dominant connective tissue disorder that mostly affects type III collagen. This results in the tissue being more elastic than normal leading to joint hypermobility and increased elasticity of the skin. Features and complications elastic, fragile skin joint hypermobility: recurrent joint dislocation easy bruising aortic regurgitation, mitral valve prolapse and aortic dissection subarachnoid haemorrhage angioid retinal streaks

Answer 36

autosomal recessive type V glycogen storage disease caused by myophosphorylase deficiency this causes decreased muscle glycogenolysis ``` Features muscle pain and stiffness following exercise muscle cramps myoglobinuria low lactate levels during exercise ```

Answer 37

Lateral epicondylitis typically follows unaccustomed activity such as house painting or playing tennis ('tennis elbow'). It is most common in people aged 45-55 years and typically affects the dominant arm.

Answer 38

pain and tenderness localised to the lateral epicondyle pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks

Answer 39

advice on avoiding muscle overload simple analgesia steroid injection physiotherapy

Answer 40

Supraspinatus - abducts the arm before deltoid Infraspinatus - rotates arm laterally teres minor - adducts and rotates arm laterally Subscapularis - adducts and rotates arm medially

MSK 2 Flashcards

(64 cards)