Podcast
Questions and Answers
What should be done if sepsis is suspected in a large joint?
What should be done if sepsis is suspected in a large joint?
- Administer oral antibiotics immediately
- Check serum uric acid levels
- Conduct a physical examination only
- Perform arthroscopic washout and send fluid for culture (correct)
Which test can help assess the response to treatment in suspected sepsis or arthritis?
Which test can help assess the response to treatment in suspected sepsis or arthritis?
- C-reactive protein (CRP) levels and ESR (correct)
- Thyroid function tests
- Complete blood count (CBC)
- Liver function tests
Which condition typically shows symmetrical involvement of small joints and may include a rash?
Which condition typically shows symmetrical involvement of small joints and may include a rash?
- Viral arthritis (correct)
- Rheumatoid arthritis
- Osteoarthritis
- Psoriatic arthritis
Which option describes the characteristics of osteoarthritis?
Which option describes the characteristics of osteoarthritis?
What is a common presentation for polyarthritis?
What is a common presentation for polyarthritis?
In the context of arthritis, which condition is associated with dactylitis?
In the context of arthritis, which condition is associated with dactylitis?
What is the implications of having normal serum uric acid levels in the diagnosis of gout?
What is the implications of having normal serum uric acid levels in the diagnosis of gout?
What is essential to rule out in cases of pseudogout?
What is essential to rule out in cases of pseudogout?
What does a normal serum uric acid level indicate regarding gout during an acute attack?
What does a normal serum uric acid level indicate regarding gout during an acute attack?
In which scenario might an elevated serum C-reactive protein (CRP) be misleading?
In which scenario might an elevated serum C-reactive protein (CRP) be misleading?
Which arthritis is characterized by symmetrical involvement of the small joints of the hands and feet?
Which arthritis is characterized by symmetrical involvement of the small joints of the hands and feet?
What is a limitation of serum creatine phosphokinase (CPK) levels in diagnosing myopathy?
What is a limitation of serum creatine phosphokinase (CPK) levels in diagnosing myopathy?
Which condition is strongly associated with enthesitis?
Which condition is strongly associated with enthesitis?
Which autoimmune connective tissue disease may present with a normal CRP but an elevated ESR in active disease?
Which autoimmune connective tissue disease may present with a normal CRP but an elevated ESR in active disease?
What does an elevated rheumatoid factor (RF) indicate?
What does an elevated rheumatoid factor (RF) indicate?
Nail pitting and dystrophy are clinical features specifically associated with which type of arthritis?
Nail pitting and dystrophy are clinical features specifically associated with which type of arthritis?
Which of the following conditions is NOT typically associated with extra-articular features of SLE?
Which of the following conditions is NOT typically associated with extra-articular features of SLE?
Which condition is NOT typically associated with elevated serum creatine phosphokinase (CPK) levels?
Which condition is NOT typically associated with elevated serum creatine phosphokinase (CPK) levels?
What does the presence of alkaline phosphatase (ALP) indicate in the context of osteoporosis post-fracture?
What does the presence of alkaline phosphatase (ALP) indicate in the context of osteoporosis post-fracture?
Which feature is commonly associated with systemic sclerosis?
Which feature is commonly associated with systemic sclerosis?
Which biochemical abnormality is normal in renal osteodystrophy?
Which biochemical abnormality is normal in renal osteodystrophy?
Which of the following is a common feature of spondyloarthritis (SpA)?
Which of the following is a common feature of spondyloarthritis (SpA)?
In which type of arthritis may you find involvement of proximal and distal interphalangeal joints?
In which type of arthritis may you find involvement of proximal and distal interphalangeal joints?
Which condition can present with photosensitivity as an extra-articular feature?
Which condition can present with photosensitivity as an extra-articular feature?
What is a common precipitating factor for a fragility fracture?
What is a common precipitating factor for a fragility fracture?
Which imaging method should be used first to investigate a suspected vertebral fracture when X-rays show no evidence of a fracture?
Which imaging method should be used first to investigate a suspected vertebral fracture when X-rays show no evidence of a fracture?
What type of fracture is particularly associated with non-union and avascular necrosis?
What type of fracture is particularly associated with non-union and avascular necrosis?
What should be included in X-ray evaluations for suspected fractures?
What should be included in X-ray evaluations for suspected fractures?
For patients over the age of 50 with fragility fractures, what screening should be performed?
For patients over the age of 50 with fragility fractures, what screening should be performed?
What is a key component of the management approach for managing an acute fracture?
What is a key component of the management approach for managing an acute fracture?
What kind of treatment is typically required after healing from a fracture?
What kind of treatment is typically required after healing from a fracture?
Which of the following conditions may be detected on X-rays that reveal a vertebral fracture?
Which of the following conditions may be detected on X-rays that reveal a vertebral fracture?
What is a key benefit of education for patients with rheumatic diseases?
What is a key benefit of education for patients with rheumatic diseases?
Which type of exercise is most beneficial for patients with chronic arthritis?
Which type of exercise is most beneficial for patients with chronic arthritis?
Which intervention can help in managing pain and improving flexibility in patients with rheumatic diseases?
Which intervention can help in managing pain and improving flexibility in patients with rheumatic diseases?
Which of the following is NOT a core intervention for patients with rheumatic diseases?
Which of the following is NOT a core intervention for patients with rheumatic diseases?
What role does the inclusion of a patient's partner or carer play in managing chronic conditions?
What role does the inclusion of a patient's partner or carer play in managing chronic conditions?
Which of the following is a physical treatment option for patients with rheumatic diseases?
Which of the following is a physical treatment option for patients with rheumatic diseases?
Which of the following has been shown to produce long-term pain reduction in patients with rheumatic diseases?
Which of the following has been shown to produce long-term pain reduction in patients with rheumatic diseases?
What is one of the advantages of non-pharmacological treatments in managing rheumatic diseases?
What is one of the advantages of non-pharmacological treatments in managing rheumatic diseases?
What effect do weight-bearing exercises have on patients with osteoporosis?
What effect do weight-bearing exercises have on patients with osteoporosis?
Which strategy is recommended to minimize joint strain in patients with arthritis?
Which strategy is recommended to minimize joint strain in patients with arthritis?
What is the role of orthoses in patient care?
What is the role of orthoses in patient care?
How do local heat and ice packs benefit patients with rheumatic diseases?
How do local heat and ice packs benefit patients with rheumatic diseases?
What is a temporary measure to support painful joints?
What is a temporary measure to support painful joints?
Which of the following assists patients with daily living activities to maintain independence?
Which of the following assists patients with daily living activities to maintain independence?
What recommendation is made regarding prolonged rest for patients with chronic pain?
What recommendation is made regarding prolonged rest for patients with chronic pain?
What effect does hydrotherapy have on patients with chronic pain conditions?
What effect does hydrotherapy have on patients with chronic pain conditions?
Flashcards
Gout Serum Uric Acid
Gout Serum Uric Acid
Elevated serum uric acid levels are often seen in gout, but a normal level doesn't rule out gout, especially during acute attacks where levels temporarily drop. High uric acid levels don't definitively confirm gout, as many with high uric acid never develop it.
C-Reactive Protein (CRP)
C-Reactive Protein (CRP)
C-reactive protein (CRP) is a good marker for infection and inflammation, more specific than ESR (erythrocyte sedimentation rate).
ESR vs. CRP (autoimmune diseases)
ESR vs. CRP (autoimmune diseases)
In autoimmune conditions like lupus and systemic sclerosis, CRP might be normal, while ESR is elevated during active disease. Elevated CRP in these situations suggests a secondary infection, not the underlying disease.
Serum Creatine Phosphokinase (CPK)
Serum Creatine Phosphokinase (CPK)
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CPK Elevated Causes
CPK Elevated Causes
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Rheumatoid Factor (RF)
Rheumatoid Factor (RF)
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Biochemical tests interpretation
Biochemical tests interpretation
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Biochemical Abnormalities (Skeletal Diseases)
Biochemical Abnormalities (Skeletal Diseases)
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Septic Arthritis
Septic Arthritis
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Arthroscopic Washout
Arthroscopic Washout
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Blood Cultures
Blood Cultures
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CRP and ESR
CRP and ESR
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Gout
Gout
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Pseudogout
Pseudogout
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Polyarthritis
Polyarthritis
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Rheumatoid Arthritis
Rheumatoid Arthritis
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Viral Arthritis
Viral Arthritis
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Osteoarthritis
Osteoarthritis
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Intra-articular glucocorticoid injection
Intra-articular glucocorticoid injection
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Inflammatory Arthritis
Inflammatory Arthritis
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Psoriatic Arthritis (PsA)
Psoriatic Arthritis (PsA)
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Rheumatoid Arthritis (RA)
Rheumatoid Arthritis (RA)
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Enthesitis
Enthesitis
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Spondyloarthritis (SpA)
Spondyloarthritis (SpA)
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Inflammatory Small Joint OA
Inflammatory Small Joint OA
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Proximal and Distal Interphalangeal (PIP and DIP) Joints
Proximal and Distal Interphalangeal (PIP and DIP) Joints
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Metacarpophalangeal (MCP) Joints
Metacarpophalangeal (MCP) Joints
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Nail Pitting
Nail Pitting
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Onycholysis
Onycholysis
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Symmetrical Joint Involvement
Symmetrical Joint Involvement
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Fragility fracture
Fragility fracture
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Vertebral fracture
Vertebral fracture
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Stress fracture
Stress fracture
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High-energy fracture
High-energy fracture
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Pathological fracture
Pathological fracture
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X-ray investigation
X-ray investigation
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MRI (Magnetic Resonance Imaging)
MRI (Magnetic Resonance Imaging)
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DXA scan
DXA scan
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Fracture management (acute stage)
Fracture management (acute stage)
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Femoral neck fracture
Femoral neck fracture
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Rehabilitation
Rehabilitation
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Suspected Vertebral Fracture
Suspected Vertebral Fracture
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Rheumatic Disease Interventions
Rheumatic Disease Interventions
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Patient Education
Patient Education
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Aerobic Conditioning
Aerobic Conditioning
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Muscle Strengthening
Muscle Strengthening
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Simple Analgesics
Simple Analgesics
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Disease-Modifying Therapy
Disease-Modifying Therapy
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Pacing of Activities
Pacing of Activities
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Education for Children and Adolescents
Education for Children and Adolescents
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Exercise for Chronic Arthritis
Exercise for Chronic Arthritis
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Exercise Frequency
Exercise Frequency
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Weight-bearing exercise in osteoporosis
Weight-bearing exercise in osteoporosis
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Joint protection
Joint protection
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Impact loading
Impact loading
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Repetitive use
Repetitive use
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Local heat/ice
Local heat/ice
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Hydrotherapy
Hydrotherapy
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Splints
Splints
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Orthoses
Orthoses
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Aids & appliances
Aids & appliances
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Self-help/coping strategies
Self-help/coping strategies
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Study Notes
Musculoskeletal System Disorders
- Affect all ages and ethnic groups
- Account for 25% of new consultations in general practice in the UK
- Manifestations include pain and impairment of locomotor function
- More common in women and increase with age
- Common cause of physical disability in older people
Bone Structure
- Two main types:
- Flat bones (skull) formed by intramembranous ossification
- Long bones (femur, radius) formed by endochondral ossification
- Components:
- Cortical bone: dense, forms outer layer
- Trabecular bone: inner meshwork, contains bone marrow
- Cell types:
- Osteoclasts: resorb bone
- Osteoblasts: form bone
- Osteocytes: sense and respond to mechanical stimuli
- Bone marrow stromal cells: produce RANKL and M-CSF
Bone Remodelling
- Cyclical process: quiescence, resorption, reversal, formation
- Osteoclasts remove old bone
- Osteoblasts replace with new bone
- Mediators:
- RANKL: stimulates osteoclast formation
- RANK: receptor for RANKL (activates osteoclast formation)
- OPG: decoy receptor for RANKL (inhibits osteoclast formation)
- Sclerostin (SOST): inhibits bone formation
- Wnt family members: stimulate bone formation
Joint Structure
- Types: fibrous, fibrocartilaginous, synovial
- Synovial joints contain:
- Synovial fluid: lubricates the joint
- Articular cartilage: covers bone ends
- Synovial membrane: lines the joint capsule
- Ligaments: strengthen the joint capsule
- Bursae: cushion tendons and muscles
- Synovial cells:
- Type A: phagocytic, remove debris
- Type B: fibroblast-like, secrete synovial fluid
Musculoskeletal Disease Investigations
- Clinical history and examination often sufficient for diagnosis
- Joint aspiration: used for septic arthritis, crystal arthritis or bleeding
- X-rays: diagnosis and monitoring of many bone and joint diseases
- Bone scintigraphy: useful for metastatic bone disease, Paget's, etc
- MRI: detailed images of bone and soft tissues in musculoskeletal diseases
- Ultrasound: detect early synovitis, evaluating tendon lesions
- Blood tests: assess metabolic bone disease, muscle diseases, gout
- Immunological tests: used in rheumatic diseases (e.g., rheumatoid factor, anti-CCP antibodies, ANAs)
- Tissue biopsy: can confirm diagnosis, assess tissue samples for infection or other issues
Gout
- One of the most common inflammatory arthritides
- Sudden onset of pain in a joint (typically first metatarsophalangeal joint)
- Characterized by inflammation, redness, and swelling.
- Caused by increased serum uric acid (hyperuricemia):
- either overproduction or underexcretion
- Characterized by formation of monosodium urate (MSU) crystals in joints
- Can be treated with colchicine, NSAIDs, corticosteroids, and/or urate-lowering medications (e.g., allopurinol).
Septic Arthritis
- Infection within a joint
- Red Flag: do not miss
- Sepsis
- Infection in one area causes a whole body response.
- Can be diagnosed via blood tests (ESR, CRP), blood cultures, X-rays and joint fluid analysis.
- Treatment includes antibiotics administered intravenously, joint drainage, monitoring
- Prevention:
- Avoid procedures that could introduce microorganisms into the joint
Rheumatoid Arthritis
- Chronic autoimmune inflammatory disorder
- Characterized by:
- Early morning stiffness (lasts > 30 minutes)
- Fatigue and tired easily
- Painful and swollen joints
- Inflammation of the lining of the joints (synovium)
- Common sites are hands (small joints of the wrist and fingers)
- Treatment includes NSAIDs, corticosteroids, DMARDs (methotrexate) and biologics
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