CDM 2017 Exam Flashcards
List 5 sources of pain within a joint
- synovium
- periosteum
- ligaments
- joint capsule
- subchondral bone
List 4 basic pathophysiological types of joint disease
- synovitis
- crystal deposition disease
- enthesitis
- infection
- structural and mechanical derangement
List 4 key events occurring in synovitis
- Neovascularisation
- Infiltration of synovium by lymphocytes, plasma cells and macrophages
- Mass proliferation of synoviocytes and invasion by inflammatory cell leads to pannus formation
- pannus can cause destruction of bone and cartilage - Synovial hyperplasia = thickening of synovium
Differentiate between RA and OA joint stiffness
RA
- worse in the AM
- lasts 30-60mins
OA
- worse in AM and after periods of inactivity
- lasting <30 mins
List 6 descriptors to help diagnose a painful joint
Onset (abrupt/insidious)
Duration (acute/chronic)
Distribution (symmetric/asymmetrical)
Number of joints involved (mono/poly)
Category of involvement (additive/migratory)
Extra articular manifestations (ocular lesions/skin lesions)
Briefly define
Mono
Oligo
Poly
Mono: arthritis affecting one joint
Oligo: affecting 2-4 joints
Poly: affecting >5 joints
List three constitutional manifestations seen in systemic conditions
- fever
- malaise
- LOW
- fatigue
List four conditions commonly presenting with skin manifestations
Dermatomyositis
- gottrons papules (raised plaques mainly seen on bony prominences)
Psoriatic arthritis
- psoriasis (scaly rash seen on back of hands and on scalp for example)
SLE
- Malar rash (butterfly rash - red passing over nose and cheeks)
Ssc
- dermal insuration (hardening of the skin)
List three inflammatory arthritides resulting in monoarthritis
- septic arthritis
- crystal deposition disease
- PsA (subtype - unilateral asymmetrical)
- JIA
- monoarticular RA
Define CRP
What does CRP tell us that ESR doesn’t
C-reactive protein is an inflammatory market produced by the liver in the presence of inflammatory cytokines (IL 2&6) when there is tissue damage, infection or an autoimmune disease present
- more sensitive than ESR
- mirrors the extent of tissue damage better than ESR
- rises and falls quicker than ESR
- Independant if factors influencing ESR
- correlated better with disease activity
Define ANAs
Who has it?
Which conditions is it elevated in?
Indicated?
Test used to detect pathological autoantibodies which target specific nuclear antigens. Generally ANAs present in autoimmune diseases
Occur in
- normal people
- people with autoimmune disease
- people with rheumatic conditions
Conditions associated
- SLE
- Sjogrens
- PM
Indications
- Helpful in the diagnosis of SLE - specific ANA against double stranded DNA
Name one lab test for each of the following conditions Mm injury AS Myositis Mm weakness Mm dystrophy Pagets
Muscle injury
- creating kinase (most sensitive indicator of mm injury)
AS
- HLAB27 (80-90% of patients with AS will have this gene)
Myositis
- myositis specific antibodies (appear in autoimmune antibodies)
Mm weakness
- mm biopsy ( used to do mm disease, can be tested against antibody reagents)
Mm dystrophy
- creatine kinase or mm biopsy
Pagets
- ALP (increased in diseases that have an elevated bone turn over or destruction)
List 5 indications for joint aspiration
Aid dx it gout/pseudogout
To detect presence of gonococci, major cause of joint infection
To establish dx of infection, arthritis, synovitis etc
To evaluate disease progression
To identify cause of joint effusion
Name four conditions where serum alkaline phosphotase is elevated
- pagets
- FD
- Hyperparathyroidism
- osteosarcoma (malignancy)
Define HLAB27
List 2 conditions in which it’s positive
- AS
- PsA
- ReA (axial subtypes)
- IBD
List four ominous manifestations on X-ray that would indicate malignancy
- diffuse, hazy invasion
- wide ZOT
- extensive deformity
- periosteal response (spiculated)
- diffuse periosteal new bone formation
- extension into neighbouring tissues
- METs
List 4 lab test results indicative of malignancy
- increased ALP
- increase ESR
- increased serum acid phosphatase
- FBC = anaemic
Write notes on osteosarcoma
Incidence:
- children/adolescents 2nd/3rd decades
- rare
- can be complication of Pagets
- highly malignant
Distribution:
- any bone but mainly metaphysis of long bones (prod humerus and around knee)
Pathology
- Histologically arises from primitive bone forming cells
- lytic and blastic in nature leading to bone loss and abnormal bone formation
- spreads to periosteum and neighbouring ST
- may cross epiphyseal plate
- Mets occur early ( via blood to lungs)
Clinical presentation
- pain (constant, worse at night, progressive)
- lump or swelling
- tenderness
- inflammation of surrounding/overlying ST
Dx investigations Serum - elevated ESR - +/- elevated ALP X-ray FBC - anaemia - increase WBCs Bone scan - increased uptake by neoplasm
Tx
- surgery (amputation)
- chemo
