25/1

Question 1

OA

• define
• age/ sex
• patho
• RF
• symptoms
• signs
• Ix
• DDx
• Dx
• Mx
• complications

Answer 1

define

• non-inflam synovial disease
• IN periarticular bone formation

age/ sex
- female, >65Y

patho

• genes, overuse, injury
• imbalance between cartilage wearing down and chondrocytes reparing it

RF

• trauma
• obesity
• metabolic, anatomical issues
• female, post-meno
• > 65Y

symptoms

• pain
• joint gelling
• enlargement of joint
• DE ROM
• crepitus
• effusion around joint
• referred pain e.g. lower back or knee from hip OA

signs

• DIPJ - heberden´s
• PIPJ - bouchard’s
• thumb - squaring of base at carpo-metacarpal J
• weak grip
• DE ROM
• hallux valgus

Ix

• FBC - Hb, uric acid, TFT, bone profile, ANA, ESR
• xray - LOSS: loss joint space, osteophytes, subarticular sclerosis, subchondral cyst
• MRI - cartilage erosion

DDx
- septic, crystal arthropathy, seronegative, RA

Dx
- >45Y + stiff<30M, activity related

Mx

• conserve - physio, exercise, OT, orthotics
• meds - paracetamol and topical NSAID&raquo_space; oral NSAID and PPI&raquo_space; opiate e.g. codeine
• intraarticular steroids
• surgery - replacement arthroscopy for hip, knee, ankle; arthrodesis for DIPJ, ankle, foot and spine; realignment osteotomy for hip and knee; excision arthroplasty for 1st MCPJ and thumb base

comp - surgery

• replacement arthroscopy - dislocation, leg length discrepency, infection
• major - dislocation 2-3%, infection, DVT/ PE, wear and tear, nvsc damage
• minor - clicking, stiff after sitting, numbness at scar
• advice - early mobilisation, remove stitches at 7-14D, no driving for 6W and no active work for 12W, follow-up at 6W

Question 2

bone cancer - types

Answer 2

primary - osteosarcoma, chondrosarcoma, ewing´s sarcoma
secondary - BLT KP (breast and bowel, thyroid, lung, kidney, prostate)
benign - leimyeloma, lipoma, schwanomma
malignant - sarcoma

Question 3

osteosarcoma

• define
• age/ sex
• patho
• symptoms
• Ix
• Mx
• prognosis

Answer 3

define
- most common primary bone cancer

age/ sex

• M>F
• paeds, elderly

patho

• metaphysis
• prox humerus/ tibia
• distal femur

symptoms
- pain, swelling, enlarging mass

Ix

• sunburst lesions on xray
• ass - lung mets, CXR

Mx
- chemo and sx

prog
- no mets - 60%, mets 20%

Question 4

chondrosarcoma

• define
• age/ sex
• patho
• symptoms
• Ix
• Mx
• prognosis

Answer 4

define
- cancer of cartilage cells

age/ sex
- >50Y

patho
- flat bones - pelvis, ribs, scapula

symptoms
- mech sx, patho fracture, pain

Mx

• surg
• no responsive to chemo

prog

• high severity - 60%
• low - 90%

Question 5

Ewing´s sarcoma

• define
• age/ sex
• patho
• symptoms
• Ix
• Mx
• prognosis

Answer 5

define
- cancer of bone and soft tissues

age/ sex
- paed, teen

patho
- diaphysis

symptoms

• pain, swelling, enlarging mass
• wt loss, sweat

Ix

• onion periosteal reaction - xray
• IN ESR

Mx
- chemo and radio

prog
- 50%

Question 6

glomerulonephritis

• define
• patho
• symptoms
• types
• age/ sex
• Ix
• Mx
• prognosis

Answer 6

define
- inflam of nephron and glomerulus

patho

• endothelial cells proliferate&raquo_space; capillary wall necrosis&raquo_space; glomerulosclerosis&raquo_space; fenestra and capillaries pulled apart
• tubules - deposition of cells
• BM prolif&raquo_space; DE filtration

symptoms

• nephritic - proteinuria (<3g/24hrs), haematuria, oliguria, fluid retention
• nephrotic - proteinuria (>3g/24hrs), hypercholesterolaemia, de serum albumin (<25g/L)

types

• focal segmental
• IgA nephropathy/ berger’s
• goodpasture’s
• minimal change
• membranoproliferative
• systemic vasc
• HSP
• post-strep
• membranous nephropathy
• rapidly progressive glomerulonephritis

age/ sex

• IgA nephropathy - young males
• minimal change - paeds
• HSP - 3-15Y

Ix

• FBC - Hb, urea, UE, LFT, CRP, ESR
• ASTO, anti-dsDNA, ANCA
• immunofluorescence
• light microscopy
• renal uss
• renal biopsy - dx

types - Ix

• focal segmental - IgM, C3
• IgA nephropathy - IgA, C3,
• goodpasture’s - anti-GBM, CXR with pulmonary shadowing, linear IgG along GBM (renal biopsy)
• minimal change - normal light microscopy, -ve immunofluorescent, loss of feet of podocytes
• membranoproliferative - mesangial prolif, tramline biopsy
• systemic vasc - ANCA, p/c
• HSP - +ve immuno in renal/ skin biopsy, IgA
• post-strep - ASTO, anti-dsDNA, IgG and c3
• membranous nephropathy - diffuse global glomeruloneph, IgG and C3, thick BM
• rapidly progressive glomerulonephritis

Mx

• general - ACEi and immunosuppression with steroids
• focal segmental - none
• IgA neph - steroids if RF, supportive
• goodpasture’s - plasma exchange, corticosteroids, cytotoxics
• minimal change - oral steroids, cyclophosphamide if relapse
• membranoproliferative - none
• systemic vasc
• HSP - steroids if DE renal function
• post-strep - none
• membranous nephropathy - alternating steroids/ chlorambucil to reverse DE in RF
• rapidly progressive glomerulonephritis - aggressive immunosuppression (high dose po steroids and cyclophosphamide)

prognosis

• IgA nephropathy - 20% ESRF within 20Y
• goodpasture’s - depending on stage of dx
• minimal change - 1% ESRF
• membranoproliferative - 50% ESRF in 10Y, high reoccurence in trasplants
• membranous nephropathy - 25% ESRF in 10yr
• rapidly progressive glomerulonephritis - depends on how early treatment started