1
Q
What are the 4 pillars of inflammation?
A
- Rubor (red)
- Dolor (pain)
- Calor (hot)
- Tumor (swollen)
2
Q
How might joint inflammation present?
A
- Hot, painful, red swollen joint
- Stiffness
- Poor mobility/function
- Deformity
3
Q
Describe inflammatory pain
A
- Eases with use
- Stiffness > 60 mins
- Synovial swelling
- Young pt.
4
Q
Describe degenerative pain
A
- Increases with use
- Stiffness < 30 mins
- Bony swelling
- Old pt.
5
Q
Where is a common place for osteoarthritis (OA) to present?
A
Base of thumb
6
Q
Describe rheumatoid arthritis (RA)
A
- Symmetrical
- Polyarthritis
- Deformity
- Erosion on X-ray
7
Q
What are the hallmarks of RA?
A
- Ulnar drift
2. Erosion of bone
8
Q
What are proximal nodes in OA called?
A
Bouchard’s nodes
9
Q
What are distal nodes in OA called?
A
Heberden’s node
10
Q
What is the pathophysiology of Raynaud’s?
A
Capillaries clamp down causing hypoxia in fingers
11
Q
What is the colour changes in Raynaud’s?
A
White > blue > red
12
Q
What inflammatory markers are used for MSK?
A
- ESR (erythrocyte sedimentation rate)
2. CRP
13
Q
What markers are used to test for rheumatoid arthritis?
A
- Rheumatoid factor
2. Cyclic citrullinated peptide (CCP)
14
Q
What markers are used to test for SLE?
A
- Anti nuclear antibody (ANA)
2. dsDNA
15
Q
Which tissue type is associated with spondyloarthritis (SpA)?
A
HLA B27
16
Q
What is the prevalence of HLA B27?
A
Further from equator is higher prevalence; 9% in UK
17
Q
What are the theories for why B27 is linked with SpA?
A
- Molecular mimicry
- Mis-folding theory
- HLA B27 heavy chain homodimer hypothesis
18
Q
What are the important therapeutic targets in HLA-B27 misfolding?
A
IL17 and IL23
19
Q
What are the clinical features of SpA?
A
- Stooped posture
- Achilles inflamed
- Swollen knee
- Psoriasis
- Inflammation of eye
20
Q
What are the other features of SpA?
A
SPINE ACHE
- Sausage digit (dactylitis)
- Psoriasis
- Inflammatory back pain
- NSAID good response
- Enthesitis (heel)
- Arthritis
- Crohn’s
- HLA B27
- Eye (uveitis)
21
Q
What is axial spondyloarthritis (AS)?
A
Inflammatory arthritis of spine and rib cage
22
Q
When does AS usual onset?
A
Late teens - 20s
23
Q
What increases risk of AS?
A
- Male
- Smokers
- B27 +ve
- Syndesmophytes
- High CRP
24
Q
What features are seen in AS?
A
- Syndesmophytes
2. Sacroiliitis
25
How is AS diagnosed?
Bone marrow oedema on MRI
26
What is the progression of disease in AS?
1. Inflammation
2. Erosive damage
3. Repair
4. New bone formation
27
What is the progression of AS?
Back pain with:
1. Sacriliitis on MRI
2. Radiographic sacroiliitis
3. Syndesmophytes
28
What are the classifications for AS?
1. >3m back pain
2. Onset <45 years old
3. Sacroiliitis on imagine plus >1 AS feature
4. HLA B27 plus >2 AS features
29
What is the Rx for AS?
1. NSAIDs
2. Physiotherapy
3. Anti-TNF drugs
30
What are the patterns for psoriatic arthritis?
1. DIPJ only
2. RA like
3. Large joint oligoarthritis
4. Axial
5. Arthritis mutilans
31
What is the presentation of psoriatic arthritis?
1. Patches of psoriasis incl. in the nail
2. Telescoping
3. Pencil in cup X-ray changes
4. Dactylitis
5. Pitting
6. Oncolysis
32
What is the Rx for psoriatic arthritis?
1. DMARDs e.g. MTX
2. Anti-TNF drugs e.g. etanercept, infliximab
3. IL-12/23 blockers e.g. ustekinumab
33
What is reactive arthritis?
Sterile inflammation of synovial membrane, tendons and fascia triggered by an infection at a distant site, usually GI or genital
34
Name 3 infections related to reactive arthritis
1. Salmonella
2. Shigella
3. Chlamydia
35
What are the features of reactive arthritis?
1. Arthritis (2 days to 2 weeks post infection)
2. Conjunctivitis
3. Urethritis
36
What is the DDx for reactive arthritis?
1. Septic arthritis
| 2. Gout
37
What is the investigation for reactive arthritis?
1. Raised ESR/CRP
2. Aspirate joint to exclude infection/ crystals
3. Urethral swab
4. Stool culture
38
What is the Rx for reactive arthritis?
1. Physiotherapy
2. NSAIDs e.g. indomethacin
3. Anti-TNF e.g. etanercept
4. Abx if indicated
39
What is osteoporosis?
A systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture
40
How many osteoporotic fracture are there in the UK each year?
230,000
41
How does menopause increase risk of osteoporosis?
1. Peak bone mass reduces with age
2. Bone resorption decreases due to remodelling imbalance
3. Loss of restraining effects of oestrogen on bone turnover
42
How can postmenopausal osteoporosis be prevented?
Oestrogen replacement
43
How is postmenopausal osteoporosis characterised?
1. High bone turnover (resorption > formation)
2. Predominantly cancellous bone loss
3. Microarchitecture disruption
44
What is the result of increased bone turnover?
Less trabeculae so less strength to withstand fracture
45
What are the changes to trabecular with ageing?
1. Decrease in trabecular thickness
2. Decrease in connections between horizontal trabeculae
3. Decrease in trabecular strength and increased fractures
46
How is osteoporosis diagnosed?
1. Bone densitometry
2. DXA (measures fracture sites)
3. T-score (comparative bone loss)
47
What DXA score defines osteoporosis?
1.
48
What are the disease risk factors for osteoporosis?
1. Inflammatory disease e.g. RA
2. Endocrine disease e.g. hyperthyroidism, Cushing's
3. Reduced skeletal load e.g. immobility
49
What medications increase risk of osteoporosis?
1. Glucocorticoids
2. Aromatase inhibitor
3. GnRH analogues
50
What Hx risk factors increase risk of osteoporosis?
1. Previous fracture
2. FHx of osteoporosis or fracture
3. Alcohol
4. Smoking
51
What is the risk assessment tool for fracture?
FRAX
52
What types of osteoporosis drugs are there?
1. Anti-resorptive
| 2. Anabolic
53
What is the mechanism of anti-resorptive drugs?
Decrease osteoclast activity and bone turnover
54
Give examples of anti-resorptive Rx
1. Biphosphonates
2. HRT
3. Denosumab
55
What is the mechanism of anabolic osteoporotic drugs?
Increase osteoblast activity and bone formation
56
Give an example of an anabolic drug
Teriparatide
57
What are the risks of HRT?
1. Breast cancer
2. Stroke
3. CVD
4. Venous thromboembolic disease
5. Vaginal bleeding
58
Give 3 examples of biphosphonates
1. Alendronate
2. Risedronate
3. Ibandronate
59
What are the common vasculitis diseases in the UK?
1. Giant cell arteritis
2. Polymyalgia rheumatica
3. ANCA associated vasculitis (AAV)
60
How is vasculitis characterised?
1. Vessel size
| 2. Consensus classification
61
How does giant cell arteritis (GCA) present?
1. Stroke
| 2. Blindness
62
What are the clinical patterns of GCA?
1. Cranial GCA (headache)
| 2. Large vessel GCA (malaise, weight loss)
63
What is the pathogenesis of GCA?
1. Activation of dendritic cells in adventitia
2. Recruitment and activation of T cells
3. Recruitment of CD8 cells and monocytes
4. Vascular damage and remodelling
64
What are the symptoms of cranial GCA?
1. New headache
2. Scalp tenderness
3. Visual symptoms e.g. loss, amarosis
4. Jaw claudication
65
Describe GCA headache
1. Abrupt
2. Unilateral
3. Temporal
66
What are the symptoms of LV-GCA?
1. Constitutional symptoms e.g. malaise, fever
2. Polymyalgia
3. Limb claudication
67
What are the signs of GCA?
1. Scalp tenderness
2. Temporal artery tenderness
3. Reduced/absent pulsation
68
What are the complications of GCA?
1. Visual loss
| 2. Strokes
69
What are the investigations for GCA?
1. Temporal artery biopsy
2. USS
3. PET-CT scan (LV-GCA)
70
What is the Rx for GCA?
1. Glucocorticoids - promptly (prednisolone)
| 2. DMARD e.g. MTX
71
What are the side effects of GCA Rx?
1. Osteoporosis
| 2. DM
72
What are AAV?
Rare life-threatening, multi-system diseases causing damage to predominantly small vessels
73
What are the 3 key AAV conditions?
1. Granulomatosis with polyangiitis (GPA)
2. Eosinophilic granulomatosis with polyangiitis
3. Microscopic polyangiitis
74
What is vasculitis?
Neutrophil driven necrotising inflammation causing direct vessel wall damage
75
What is the pathogenesis of AAV?
1. Pathogenic anti-neutrophil cytoplasmic antibodies (ANCA)
2. Vasculitis
3. Granulomatous inflammation
76
What are the 2 patterns of AAV?
1. PR3-ANCA (C-ANCA pattern)
| 2. MPO-ANCA (P-ANCA pattern)
77
Give 5 symptoms of GPA
1. Epistaxis
2. Hearing loss
3. Hoarseness
4. Iritis
5. Cough
78
What are the investigations for GPA?
1. ANCA testing
2. Tissue biopsy (renal)
3. CT thorax
4. CRP/U&E
5. CT head
79
What is the Rx for GPA?
1. Cyclophosphamide or rituximab
2. Glucocorticoids
3. Plasma exchange
4. DMARD e.g. azathioprine
80
What joints does OA affect?
Synovial joints
81
How many people in the UK have OA?
8.75m people
82
What is OA?
An age-related, dynamic reaction pattern of a joint in response to insult or injury
83
Which joint type is most affected by OA?
Articular cartilage
84
What are the main pathological features of OA?
1. Loss of cartilage
| 2. Disordered bone repair
85
What is the pathogenesis of OA?
1. Wear and tear
2. Mechanical forces
3. Metabolically active mediated by cytokines
86
What are the risk factors for OA?
1. Age
2. Female
3. Genetic pre-disposition
4. Caucasian
5. Obesity
6. Occupation - manual labour
87
Why is age a risk factor for OA?
1. Cumulative effect of traumatic insult
| 2. Decline in neuromuscular function
88
What are the symptoms of OA?
1. Pain
| 2. Functional impairment
89
What are the signs of OA?
1. Alteration in gait (valgus)
2. Joint swelling
3. Limited ROM
4. Crepitus
5. Tenderness
90
What are the radiological features of OA?
1. Joint space narrowing
2. Osteophyte formation
3. Subchondral sclerosis
4. Subchondral cysts
5. Abnormalities of bone contour
91
Describe nodal OA
1. Early inflammatory phase in joint - red, swelling
2. Bone swelling and cyst formation
3. Reduced hand function
92
What compartment of the knee is most commonly affected by OA?
Medial
93
What is a key feature of OA of the hip?
Groin pain
94
What is the additional management for inflammatory OA?
DMARDs
95
What is loose body in the knee associated with?
Locking of knee
96
What is the non-medical management for OA?
1. Weight loss
2. Physiotherapy
3. Occupational therapy
4. Footwear
5. Walking aids
97
What is the pharmacological management for OA?
1. NSAIDs
2. Capsaicin
3. Opioids - tramadol
4. Puprenorphine
Intra-articular steroid injections
98
What is the surgical management for OA?
1. Arthroscopy
2. Osteotomy
3. Arthroplasty
4. Fusion
99
What are the indications for arthroplasty?
1. Uncontrolled pain
| 2. Significant limitation of function
100
What are the features of Marfan's syndrome?
1. Tall with wide arm span
2. Dislocations
3. High arches palate
4. Arachnodactyly
5. Aneurysms
101
What are the features of Ehler Danlos syndrome?
Hyperflexibility and hyperelasticity
102
What is the pathology of autoimmune connective tissue disorders (CTD)?
Inflammation leading to scarring in organs affected
103
Which group is most at risk for Systemic Lupus Erythematosus (SLE)?
Afro-Caribbeans
104
What genes are associated with SLE?
HLA DR2/3
105
What is the pathogenesis of SLE?
1. Immune complex mediated inflammation -> tissue damage
| 2. Phospholipid antibodies cause thrombosis
106
What are the skin features of SLE?
1. Malar butterfly rash
2. Generalised erythema
3. Bullous LE
4. Annular
5. Discoid
107
How doe arthritis present in SLE?
1. Symmetrical
2. Deforming
3. Non-erosive
108
What are the features of lupus nephritis?
1. Hypertension
2. Proteinuria
3. Renal failure
109
What are the haematological features of SLE?
1. Anaemia
2. Thrombocytopenia
3. Neutropenia
4. Lymphopenia
110
What is the Dx for SLE?
1. Anti-nuclear antibody
2. Double stranded DNA antibody
3. Rheumatoid factor
111
What is the management for SLE pt.?
1. UV protection
2. Assess lupus activity
3. Screen for major organ involvement
112
What drugs are used to treat SLE?
1. Topical e.g. sunscreen
2. NSAID
3. Antimalaria - HCQ
4. Steroids
5. Azathioprine or MTX
6. Rituximab
113
What are the features of systemic sclerosis?
1. Vasculopathy
2. Excessive collagen deposition
3. Inflammation
4. Auto-antibody production
114
What are the subsets of systemic sclerosis (SSc)?
1. Limited cutaneous
2. Diffuse cutaneous
3. Sine scleroderma
4. Overlap syndromes
115
What are the features of limited cutaneous SSc?
1. Sclerodactyly
2. Long Hx Raynaud's phenomenon
3. Late-stage complications
4. Pulmonary arterial HTN
116
What are the features of diffuse cutaneous SSc?
1. Proximal scleroderma and trunk involvement
2. Short Hx of Raynaud's
3. Increased risk renal crisis, cardiac involvement, ILD
117
What are the symptoms of SSc?
1. Strictures
2. Ulceration in chronic ischaemia
3. Capillaries in nailfolds
4. Calcification in fingers
5. Telaugioctasia
6. Oesophageal dysmotility
118
What is the Rx for SSc?
1. Treat symptoms
| 2. Early detection of pulmonary arterial hypertension - annual ECG and pulmonary function tests
119
What is the Rx for Raynaud's?
1. Physical protection
2. Vasodilators e.g. nifedipine
3. Fluoxetin
120
What are the causes of secondary Sjögren's syndrome?
1. SLE
2. RA
3. Scleroderma
4. Primary biliary cirrhosis
121
What are the symptoms of primary Sjögren's syndrome?
1. Dry eyes
2. Dry mouth
3. Arthritis
4. Rash
122
What are the lab features of primary Sjögren's syndrome?
1. ANA +
2. RF +
3. Ro and La +
4. dsDNA -
123
What is the Rx for Sjögren's syndrome?
1. Tear and saliva replacement
2. HCQ
3. Corticosteroids/ immunosuppressants
4. Biological therapies
124
What are the features of dermatomyositis?
1. Rash and muscle weakness
| 2. ILD
125
What is the investigation for dermatomyositis?
1. Increase creatinine kinase
2. Antibody screen
3. EMG
4. Muscle/skin biopsy
5. PET
6. CXR
126
What is the Rx for dermatomyositis?
1. Steroids
| 2. Immunosuppressants
127
When does CRP suggest infection rather than inflammation?
>100
128
How is joint infection diagnosed?
Joint aspirate
129
When does joint aspirate indicate infection?
1. Turgid fluid (yellow and cloudy)
2. Leucocytes
3. Gram stain
130
What is the management for joint infection?
1. Stop DMARD and anti-TNF
2. Abx e.g. flucloxacillin
3. Prednisolone double
4. Analgesia
5. Splinting
131
What is the most common age for septic arthritis?
>65
132
Name 3 organisms that commonly cause joint infection
1. S. aureus
2. Streptococci
3. Neisseria gonorrhoea
133
Why do immunocompromised need synovial lining biopsy when joint infection is suspected?
To check for unusual organisms as causes
134
When does gonococcal arthritis occur?
With disseminated gonococcal infection
135
What are the symptoms of gonococcal arthritis?
1. Fever
2. Arthritis
3. Tenosynovitis
4. Maculopapular-pustular rash
136
What are the risk factors for septic joint?
1. Any cause for bacteraemia
2. Direct/penetrating trauma
3. Local skin breaks/ulcers
4. Damaged joints
137
What people are at risk for septic joint?
1. Immunosuppression
2. Elderly
3. RA
4. DM
138
What is the typical presentation of a septic joint?
1. Painful, red, swollen, hot joint
2. Fever
3. Monoarthritis (90%)
4. Knee > hip > shoulder
139
What is the management for septic joint?
1. Aspiration
2. Long course Abx
3. Joint washout
4. Rest/splint/physio
5. Analgesia
6. Stop immunosuppressant therapy
140
Where can listeria infection come from?
Soft cheese
141
Why is propionibacteria more of a problem in upper limbs?
1. Colonises humans above the waist
| 2. Can be shed by blinking
142
Why are propionibacteria difficult to treat?
1. Slow growing therefore hard to diagnose
2. Seldom cause acute infections
3. Don't significantly raise inflammatory markers
143
What is the incidence of osteomyelitis?
10-100 per 100,000 pa
144
Why is there an increasing prevalence of chronic osteomyelitis?
Due to increasing prevalence of predisposing conditions e.g. DM, PVD
145
Describe acute osteomyelitis
1. Associated with inflammatory bone changes caused by pathogenic bacteria
2. Symptoms typically present within 2 weeks
146
Describe chronic osteomyelitis
1. Involves bone necrosis
| 2. Symptoms may not occur until 6w after onset of infection
147
What is direct inoculation?
Direct inoculation into bone via trauma or surgery
148
What is contiguous spread?
Spread of infection to bone from adjacent soft tissues and joints, or conditions e.g. DM, chronic ulcers
149
What is haematogenous seeding?
Children (long bones) > adults (vertebrae)
150
What are the host factors for osteomyelitis with an example?
1. Behavioural factors e.g. risk of trauma
2. Vascular supply e.g. DM
3. Pre-existing bone or joint problem e.g. inflammatory arthritis
4. Immune deficiency e.g. drugs
151
Where does most haematogenous OM occur?
Long bone metaphysis
152
Why is metaphysis more common for haematogenous OM?
Slower blood flow which allows bacteria to penetrate BM
153
What bacteria is most commonly associated with haematogenous OM?
S. aureus
154
What bacteria often cause OM?
1. S. aureus
2. Coagulase-negative staphylococci
3. Aerobic gram-negative bacilli
155
What is the histopathology in OM?
1. Inflammatory exudate in marrow
2. Increase intramedullary pressure
3. Extension of exudate into bone cortex
4. Rupture through periosteum
5. Interruption of periosteal blood supply causing necrosis
6. Leaves pieces of separated dead bone sequestra
7. New bone forms here - involucrum
156
What are the symptoms for OM?
1. Dull pain at site of OM
2. Aggravated by movement
3. Malaise
4. Fever
5. Sweats
157
What are the signs of acute OM?
1. Tenderness
2. Warmth
3. Erythema
4. Swelling
158
What are the signs of chronic OM?
1. Signs of acute OM
2. Draining sinus tract
3. Deep ulcers that fail to heal
4. Non-healing fractures
159
What is the Dx of OM?
1. High WCC (acute)
2. High ESR/CRP (acute)
3. X-ray of joint
4. MRI
5. CT
6. Nuclear bone scan
7. Bone biopsy
160
What is the DDx for OM?
1. Soft tissue infection
2. Charcot joint
3. Avascular necrosis of bone
4. Gout
5. Fracture
161
What is the Rx for OM?
1. Debridement
2. Hardware replacement
3. Abx
162
How long is Abx treatment usually in OM?
2-6 weeks
163
What guides stopping OM Abx Rx?
ESR/CRP levels
164
How are septic joint infections diagnosed?
1. Hx
2. Examination
3. X ray
4. FBC, ESR, CRP
5. Microbiology culture
165
How is septic joint infection confirmed?
Aspiration with pt. OFF Abx for 2 weeks
166
What is the Rx for septic joint infection?
1. Abx suppression
2. Debridement and retention of prosthesis
3. Excision arthroplasty
4. 1-/2-stage exchange arthroplasty
5. Amputation
167
When is Abx suppression done?
1. Pt. unfit for surgery
2. Multiple prosthetic joint infections
3. Poor distal tissues
168
What are the risk factors for primary bone cancer (PBC)?
1. Previous radiotherapy
2. Previous primary bone cancer
3. Paget's disease of bone
4. Childhood cancer
5. Germline abnormalities
6. Benign bone lesions
169
What are the red flag symptoms of PBC?
1. Bone pain worse at night
2. Atypical bony of soft tissue swelling/masses
3. Pathological fractures
170
Describe bone pain in PBC
1. Worse at night
2. Constant or intermittent
3. Resistant to analgesia
4. May increase in intensity
171
What are the other symptoms of PBC?
1. Easy bruising
2. Mobility issues e.g. stiff, limp
3. Inflammation and tenderness over bone
4. Systemic symptoms
172
What are the investigations for PBC?
1. Plain X-ray
2. ESR, ALP, LDH, FBC, U&E, Ca
3. 40+ -> CT chest, abdo, pelvis
4. Biopsy
173
What is the management of PBC?
1. Neoadjuvant and adjuvant chemo
2. Radiotherapy
3. Surgery (limb sparing or amputation)
174
What are the radiological features in PBC?
1. Bone destruction
2. New bone formation
3. Soft tissue swelling
4. Periosteal elevation
175
What are the most common types of PBC?
1. Chondrosarcoma
2. Osteosarcoma
3. Ewing sarcoma
176
When is the highest incidence for chondrosarcoma?
30-60 years
177
What are the common sites for chondrosarcoma?
1. Rubs
2. Long bones
3. Pelvis
178
What is the typical radiology for chondrosarcoma?
Popcorn calcification
179
What is the Rx for chondrosarcoma?
Excision only (chemo and radiotherapy resistant)
180
When is the incidence peak in osteosarcoma?
1. 15-19
| 2. 70-89
181
What are the common sites for osteosarcoma?
Long bones, eps. around the knee
182
What is the typical radiology for osteosarcoma?
1. Sunday spiculation
| 2. Codman's triangle
183
What is the Rx for osteosarcoma?
Surgery, chemo
184
What cells does Ewing sarcoma effect?
Neural crest cells
185
What age is highest incidence for Ewing sarcoma?
10-20
186
What bones are commonly affected by Ewing sarcoma?
1. Long bones
2. Pelvis
3. Ribs
4. Vertebrae
187
What is the typical radiology for Ewing sarcoma?
Onion ring sign
188
What is the Rx for Ewing sarcoma?
1. Chemo
2. Surgery
3. Radiotherapy
189
What is a cardinal sign of malignancy on imaging?
Wide zone of transition (ill-defined border)
190
What is the management for hip fractures?
1. Reduction
2. Immobilisation
3. Rehabilitation
191
What are the stages in fracture healing?
1. Haematoma formation
2. Fibrocartilaginous callus formation
3. Bony callus formation
4. Bone remodelling
192
Give 5 early complications of fracture
1. Infection
2. Compartment syndrome
3. Fat embolus
4. Shock
5. Crush syndrome
193
Give 5 late complications of fracture
1. Delayed union
2. Avascular necrosis
3. Stiffness
4. Arthritis
5. Osteomyelitis
194
What are the features of compartment syndrome?
1. Pain disproportionate to injury
2. Paresthesia
3. Tense compartment
195
What are the symptoms of compartment syndrome?
5 Ps
1. Pain
2. Pallor
3. Perishing cold
4. Paralysis
5. Pulselessness
196
What is the Rx for compartment syndrome?
Fasciotomy then leave for 24hr to see if still viable and remove dead tissue
197
What is the presentation of ACL injuries?
1. Swelling
2. Knee giving way
3. Pain
198
What is the Dx of ACL injuries?
1. Positive Lachman's
2. Anterior draw test
3. MRI
199
What is the Rx for ACL injury?
1. RICE - rest
2. Conservative - physiotherapy
3. Surgical - tendon repair, artificial graft
200
What are the red flags of cauda equine syndrome?
1. Bilateral sciatica
2. Severe neurological deficit of legs
3. LUTS
4. Loss of sensation of rectal fullness
5. Perianal, perineal or genital sensory loss
6. Laxity of anal sphincter
201
What is the Rx for cauda equine syndrome?
Urgent decompression and discectomy
202
What is the initial management for trauma fractures?
1. Analgesia
2. Examination (neurovascular)
3. Reduce
4. Immobilise
5. Rehabilitate
203
What can be used to immobilise a fracture?
1. Cast
2. Splint
3. Brace
4. Halo
5. Traction
6. Internal fixation e.g. screws
7. Excision and arthroplasty
8. External fixation (frames)
204
What is crystal arthropathy?
Arthritis caused by crystal deposition in joint lining
205
What crystal is in gout?
Urate
206
What crystal is in pseudogout?
Pyrophosphate
207
How do crystal arthropathies present?
Hot, swollen joints
208
How are crystal arthropathies diagnosed?
1. Hx
2. Pattern
3. Aspiration of joint
4. Blood tests
5. XR
209
Describe the crystals found in gout
Negatively birefringent needles
210
Describe the crystals found in pseudogout
Positively birefringent rhomboids
211
Where is uric acid produced from?
Nucleic acids and purine metabolism
212
What is the key enzyme in uric acid production?
Xanthine oxidase
213
Where is urate found in the diet?
1. Shellfish
2. Red meat
3. Liver
4. Fizzy drinks
214
What is the pathogenesis of gout?
1. Renal, diet, drugs
2. Excessive urate
3. Urate crystals
4. Phagocyte activation
5. Inflammation
215
What are the risk factors for gout?
1. OA
2. Trauma
3. Age
4. Hereditary
5. Metabolic disease
216
What is a major risk factor for gout?
Hyperuricaemia
217
Name 3 things that cause under-excretion of urate
1. Alcohol
2. Low dose aspirin
3. HTN
218
Name 3 things that cause over-excretion of urate
1. Psoriasis
2. Yeast extract
3. Alcohol
219
What can cause a sudden change in uric acid concentration?
1. Hypouricaemic therapy
2. Alcohol or shellfish binge
3. Sepsis
4. Trauma
220
What is the Rx for gout attack?
1. Anti-inflammatories
2. NSAIDs
3. Colchicine
4. Steroids
221
What are tophi?
Onion like aggregates of urate crystals with inflammatory cells
222
How long does it take to treat tophi?
6-9 months
223
What is the aim in long term treatment for gout?
Urate < 300umol/L
224
What is the long term Rx for gout?
1. Xanthine oxidase inhibitors e.g. allopurinol
| 2. Colchicine
225
What are the side effects of allopurinol?
1. Rash
2. Headache
3. Myalgia
226
What causes pseudogout?
Deposition of calcium pyrophosphate crystals on joint surface
227
Where does pseudogout tend to occur?
Wrists, knees
228
What is seen on pseudogout XR?
Chondrocalcinosis
229
What are the symptoms of pseudogout?
1. Severe pain
2. Stiffness
3. Swelling
4. Synovitis
5. Fever
230
What can trigger pseudogout attack?
1. Trauma
2. Intercurrent illness
3. Surgery
4. Blood transfusion
5. T4 replacement
231
When should pseudogout pt. be screened for metabolic diseases?
1. Early onset <55
2. Polyarticular
3. Frequent recurrent attack
4. Additional clinical or radiographic clues
232
What is the acute management for pseudogout?
1. NSAIDs
2. Analgesia
3. Aspiration
4. Injection
5. Physiotherapy
233
What is the long term management for pseudogout?
1. Anti-rheumatic Rx e.g. MTX, HCQ
2. Synovectomy
3. Surgery
234
What are the symptoms of RA?
1. Tender, warm, swollen joints
2. Joint stiffness worse in morning and after inactivity
3. Fatigue
4. Fever
5. Anorexia
235
What are the investigations for RA?
1. Raised ESR
2. Raised CRP
3. Rheumatoid factor
4. Anti-CCP
5. XR
236
What are the Rx for RA?
1. Ibuprofen
2. Prednisone
3. MTX
4. Rituximab
237
What is the pathophysiology of fibromyalgia?
Abnormalities in neuroendocrine and autonomic nervous systems
238
What are the symptoms of fibromyalgia?
1. Widespread pain
2. Extreme sensitivity
3. Stiffness
4. Fatigue
5. Cognitive problems
239
What is the Ix for fibromyalgia?
1. FBC
2. CCP test
3. Rheumatoid factor
5. TFTs
240
What is the Rx for fibromyalgia?
1. Analgesia
2. Duloxetine
3. Gabapentin
4. Physical therapy
5. Occupational therapy
241
What is the source of pain in mechanical lower back pain?
1. Spinal joints
2. Discs
3. Vertebrae
4. Soft tissues
242
What are the symptoms of mechanical lower back pain?
1. Pain in lower back
2. Pain radiates to buttocks and thighs
3. Spasms
4. Noticeable with flexion and when lifting
243
What are the Ix for lower back pain?
1. XR
2. MRI or CT
3. Bloods
4. Nerve studies
244
What are the Rx for mechanical lower back pain?
1. Stay active
2. Back exercise and stretches
3. Ibuprofen
4. Diazepam
245
What is the pathophysiology of osteomalacia?
1. Softening of bones
2. Impaired bone metabolism
3. Inadequate P, Ca, Vitamin D, resorption of Ca
246
What are the symptoms of osteomalacia?
1. Diffuse joint and bone pain
2. Muscle weakness
3. Waddling gait
4. Hypocalcaemia
5. Compressed vertebrae
247
What is the Ix for osteomalacia?
1. Vitamin D levels
2. Ca and P levels
3. XR - cracks
4. Bone biopsy
248
What is the Rx for osteomalacia?
Vitamin D supplements
249
What is the pathology of vertebral disc degeneration?
One or more discs between vertebrae of spinal cord deteriorate or break down leading to pain
250
What are the symptoms of vertebral disc degeneration?
1. Low grade continuous pain around disc
2. Pain on exertion
3. Giving out sensation
4. Muscle spasms
5. Radiating pain
251
What are the Ix for vertebral disc degeneration?
1. XR
2. MRI
3. Physical exam
252
What is the Rx for vertebral disc degeneration?
1. Aspirin
2. Ibuprofen
3. Physical therapy
4. Steroids
5. Discectomy
253
What is the pathophysiology of Paget's disease?
1. Increased and disorganised bone remodelling
| 2. Dense but fragile and expanding bones
254
What are the symptoms of Paget's disease?
1. Bone pain
2. Joint pain
3. Sciatica
4. Peripheral neuropathy
255
What is the Ix of Paget's disease?
1. XR
2. Bloods - Alk Phos
3. Bone biopsy
4. Scintigraphy
256
What is the Rx for Paget's disease?
1. Alendronate
2. Calcitonin
3. Surgery
