Disease And Disorders Of Msk

Front 1

What are the red flags of spine disorders?

Back 1

o History of cancer
o Significant trauma
o Minor trauma >50, osteoporosis, steroids
o Neurological deficit
o Infection:
 Immunocompromised
 Weight loss
 Febrile, raised ESR, CRP
o Failure to improve >4 weeks

Front 2

Which one is more common: mechanical back pain or inflammatory back pain?

Back 2

Mechanical back pain is more common.

Front 3

What is spondyloarthropathies?

Back 3

Spondyloarthropathies -> inflammatory joint disease of the vertebrae, associated with HLA-B27, involving both synovium and entheses. The most likely cause is infection.

Front 4

What are the characteristics of mechanical LBP?

Back 4

- Sudden onset
- age 20 - 55
- Asymmetry
- Non-radiating
- Relieved by bed rest
- Worsen of physical activity

Front 5

what are the 2 classifications of back pain?

Back 5

Mechanical or inflammatory.

Front 6

What are the compositions of intervertebral disc?

Back 6

Inner Nucleus pulposus = collagen II + PG + water
Outer annulus fibrosis = colagen

Front 7

What are the 5 ligaments of the vertebrae? Describe the anatomical position.

Back 7

Anterior longitudinal ligament - anterior to the vertebrae
Posterior longitudinal ligament - posterior to the vertebrae
Ligamentum flavum - between lamina
Interspinous ligament - between transverse process
Supraspinous ligament - linking tips of transverse process

Front 8

What is the ACR criteria for diagnosing SLE?

Back 8

o SLE if the person has 4 out of 11 symptoms (SOAP BRAIN MD), BUT diagnosis of SLE can be made in a patient having fewer than 4 symptoms.
1. Serositis
• Pleuritis (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart);
2. Oral ulcers (includes oral or nasopharyngeal ulcers).
3. Arthritis
• Nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion.
4. Photosensitivity (exposure to ultraviolet light causes skin rash, or other symptoms of SLE flareups);
5. Blood—hematologic disorder—
• hemolytic anemia
• leucopenia
• lymphopenia
• orthrombocytopenia in the absence of offending drug;
• Hypocomplementemia is also seen, due to either consumption of C3 and C4 by immune complex-induced inflammation or to congenitally complement deficiency, which may predispose to SLE.
6. Renal disorder: More than 0.5g per day protein in urine or cellular cas;ts seen in urine under a microscope.
7. Antinuclear antibody test positive;
8. Immunologic disorder:
• Positive anti-Smith (sm)
• anti-ds DNA
• antiphospholipid antibody, and/or false positive serological test for syphilis; sensitivity = 85%; specificity = 93%.
• Presence of anti-ss DNA in 70% of cases (though also positive with rheumatic disease and healthy persons)
9. Neurologic disorder: Seizures or psychosis.
10. Malar rash (rash on cheeks);
11. Discoid rash (red, scaly patches on skin that cause scarring)

ACR takes both clinical and lab findings into account.

Front 9

What are the available treatments for SLE?

Back 9

• Treatment:
o Paracetamol, NSAIDs, anti-malarials (hydroxychloroquine), methotrexate, tricyclic antidepressants, calcium, vitamin D, limit steroid use, weight bearing exercise.

Front 10

What is Myastenia Gravis?

Back 10

MG is an autoimmune disorder of the neuromuscular system leading to muscle weakness and fatiguability. It is due to autoantibodies to Ach receptors at post synaptic junction.

Front 11

Is the weakness associated with MG constant or fluctuating?

Back 11

MG is fluctuating muscle weakness. This is the characteristics of MG from others neuromuscular disorders.

Front 12

What is the initial clinical presentation of myasthenia gravis?

Back 12

Ocular weakness - ptosis or diplopia

Front 13

What are the treatments for MG?

Back 13

- Cholinesterase inhibitors - pyridostigmine
- Coticosteroids
- Azathioprine
- Plasmapheresis
- IVIG

Front 14

What are some characteristics of inflammatory back pain?

Back 14

Inflammatory back pain is typically:
o Insidious in onset
o Typically lasts for at least 3 months
o Is associated with early morning stiffness
o Is improved by exercise
o Has an onset before 40 years
o Responds to NSAIDs
o Is associated with alternating buttock pain

Front 15

What are the 4 zones of an enthesis?

Back 15

1. Tendon or ligament
2. Unmineralised cartilage
3. Mineralised fibrocartilage
4. Bone

Front 16

What is the underlying pathology of 'bamboo spine'?

Back 16

Bamboo spine’ refers to the condition caused by ossification of the annulus fibrosus in the lumbar spine which results in the formation of marginal syndesmophytes in a gradually ascending pattern.
(A syndesmophyte is a ligamentous bone deposit producing fine bony bridging between adjacent vertebral bodies at the margin of the vertebrae, common in ankylosing spondylitis).

Front 17

What is the significance of HLA type with regards to inflammatory back disorders?

Back 17

There is a very strong link between HLA B27 and ankylosing spondylitis, which suggests a pathogenic role for HLA B27. This naturally binds viruses such as influenza, HIV and EBV. Theories to explain the association include binding of an ‘arithogenic’ peptide and/or the formation of an antigen, possibly the homodimer of B27 itself. More than 90% of patients with ankylosing spondylitis have HLA B27.

Front 18

What history might you elicit from a patient with a suspected case of ankylosing spondylitis?

Back 18

Patients are typically male, aged 15 to 30 years. They may report buttock pain radiating to the proximal thigh and early morning stiffness that lasts more than 30 minutes. Patients also often have low thoracic pain radiating around the lower ribs and heel pain due to enthesitis.

Front 19

How is psoriatic arthritis treated?

Back 19

Psoriatic arthritis is treated in a similar manner to Rheumatoid arthritis. DMARDs (disease modifying anti-rheumatic drugs) such as sulfasalazine, methotrexate, cyclosporine and leflunomide are all used which improve both skin and joint manifestations of the disease. Biologic DMARDs such as infliximab are also finding a place in treatment. NSAIDs may help with swelling, pain and morning stiffness. Exercise is important to preserve strength and range of motion, and rehabilitation or physiotherapy may also be used. Surgery is an option in severe disease.

Front 20

What is reactive arthritis? How is it treated?

Back 20

Reactive arthritis is sterile synovitis following an infection in the last month. Infectious agents implicated include shigella, salmonella, yersinia and campylobacter enteric infections as well as urogenital Chlamydia. Reactive arthritis may have features of synovitis, enthesitis, tendonitis and osteitis. It is a systemic illness and may present with psoriatic skin features, sterile urethritis and conjunctivitis.