29.7 - 29.11 Ex 29.10!

Question 1

The febrile response is a survival mechanism to increase the activity of ___ - their optimal operating temperature is ___ degrees C.

Answer 1

Enzymes

39.5

Question 2

Cytokines from macrophages active ___ in inflammatory cells. ___ acts on the ___ region of the hypothalamus to increase heat gaining mechanisms.

Answer 2

COX-2
PGE2
Preoptic region

Question 3

There may be exhaustion after rigors with high fever (usually > ___ degrees C).

Answer 3

39

Question 4

For an acute fever ___ ___ antibiotics are used if a ___ infection is suspected. But for a prolonged fever, these are NOT used.

Answer 4

Empirical intravenous

Bacterial

Question 5

PUO can be due to ___ e.g. subacute bacterial endocarditis (viridans strep.), TB, HIV, etc; due to ___ tissue diseases (e.g. polymyalgia rheumatica, vasculitis), or ___ (e.g. lymphoma, carcinoma).

Answer 5

Infection
Connective tissue diseases
Malignancy

Question 6

___ cause 80% of PUO post-transplantation or in HIV e.g. due to Mycobacterium avium complex, TB, CMV, fungi.

Answer 6

Infections

Question 7

At the inner margin of the pelvis at the level of the hip joint is the ___ plate. What is on the other side of the quadrilateral plate? What are the borders of the pelvic brim/inlet, starting from the sacral promontory?

Answer 7

Quadrilateral plate
Acetabulum
Sacral promontory -> arcuate line -> pectineal line -> superior margin of pubic symphysis

Question 8

The acetabulum points ___ i.e. anterior margin is more medial than posterior margin.

Answer 8

Forwards/anteriorly

Question 9

The position of the ___ trochanter is useful to figure out the position of the hip because when the hip externally rotates, it moves to the side more.

Answer 9

Lesser

Question 10

S___ and part of t___ f___ l___ attach to the ASIS. R___ f___ attaches to the AIIS. ___ muscles attach to the greater trochanter. ___ attaches to the lesser trochanter. The ___ (group) attach to the ischial tuberosity.

Answer 10

ASIS – sartorius and part of tensor fascia latae
AIIS – rectus femoris
Greater trochanter – gluteal muscles
Lesser trochanter – iliopsoas
Ischial tuberosity – adductors

Question 11

The femoral head appears (i.e. starts to ossify) at ___-___ months. At 10 years you can see an epiphysis for the ___ trochanter and the capital ___ epiphysis.

Answer 11

6-9 months
Greater trochanter
Capital femoral epiphysis

Question 12

It can be difficult to diagnose ___ ___ of the hip in infants because the centres of ossification are not ossified until 6-9 months.

Answer 12

Congenital dislocation of the hip

Question 13

Gerdy’s tubercle is a lateral tubercle of the tibia where the ___ tract attaches.

Answer 13

Iliotibial tract

Question 14

The ___ femoral condyle is larger than the ___ femoral condyle.

Answer 14

Medial larger than lateral

Question 15

On T1 AND T2 weighted images, fat is ___. On T1, fluid is ___ but on T2, fluid is ___! In MSK imaging, fat suppression is often used. Therefore, on fat suppressed T2, fat/bone marrow is ___ and fluid is ___.

Answer 15

T1 and T2 – fat is bright
T1 – fluid is dark
T2 – fluid is bright
Fat suppressed T2 - fat/bone marrow is dark and fluid is bright

Question 16

The ___ ___ ligament attaches from the medial epicondyle of the femur to the tibia, deep to the ___ ___ tendons.

Answer 16

Medial collateral ligament (MCL)

Deep to pes anserinus tendons

Question 17

The anterior horn of the ___ meniscus is a smaller width than the posterior horn.

Answer 17

Medial meniscus

In lateral meniscus, similar width of anterior and posterior horns

Question 18

The most common illness in travellers is travellers’ ___. ___ is the most common vaccine preventable infection, and ___ ___ is the second most vaccine preventable infection. ___ is the most important mosquito-borne infection, and ___ is the second most important mosquito-borne infection.

Answer 18

Diarrhoea
Most common vaccine preventable - flu
2nd most common vaccine preventable - hepatitis A
Most common mosquito - malaria
2nd most common mosquito - dengue

Question 19

In Victoria (VIDS data), for patients presenting with fever after travel, ___ is the most common diagnosis, ___ infections are 2nd and ___ infections are 3rd.

Answer 19

Malaria (insect/vector) most common
Gut infections 2nd most
Respiratory infections 3rd most

Question 20

___ is very common but ___ is rare in Thailand.

___ is very common, but ___ is rare in sub-Saharan Africa and Melanesia.

Answer 20

Dengue common, malaria rare in Thailand

Malaria common, dengue rare in sub-Saharan Africa and Melanesia

Question 21

Most malarial infections are due to P. ___ - type that causes severe disease and is most commonly resistant to drugs. 35% of malaria in travellers occurs in people ___ ___/___ (VFRs).

Answer 21

P. falciparum

Visiting friends/relatives (often no travel health advice)

Question 22

If malaria is suspected or possible, time is very important! Treatment with ___ hours is essential because the range of mortality is between 3 and 7 days.

Answer 22

48 hours

Question 23

___ lines the joint space, joined to the capsule. It secretes ___ fluid - a plasma filtrate with hyaluronic acid, lubricin, etc. It is NOT an ___ because it has no ___ ___ and no junctional complexes (freely allows fluid from capillaries in and out of joint space). There are 2 types of cells: type A (“___-like) composing 25% for uptake of fragments in joint space, and type B (“___-like”) composing 75% for production of ECM.

Answer 23

Synovium
Synovial fluid
Epithelium
Basement membrane
Type 1 - macrophage-like, 25% for uptake of fragments
Type 2 - fibroblast-like, 75% for ECM production

Question 24

Osteophytes occur when cartilage growths change into bone by ___ ossification - an adaptation to increase joint stability.

Answer 24

Endochondral