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CDM semester one 2018 > CDM possible exam Qs > Flashcards

CDM possible exam Qs Flashcards

1
Q

List five things in a joint that can cause pain

A
  • synovium
  • periosteum
  • joint capsule
  • ligaments
  • subchondral bone
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2
Q

List four pathological disease process of a joint

A
  • Synovitis
  • Infection
  • Crystal deposition
  • Enthesitis
  • Structural and mechanical derangement
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3
Q

List four event occurring in synovitis

A
  • Neovascularisation
  • Infiltration of synovium with lymphocytes, plasma cells and macrophages
  • Masses of proliferating syncopates and invading inflame cells leads to panes formation
  • -> pannus can destroy articular structures
  • Synovial cell hyperplasia
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4
Q

List four types of crystals

A
  • Monosodium urate (gout)
  • Calcium pyrophosphate dihydrate (pseudogout)
  • Calcium phosphate (hydroxyapatite)
  • Calcium oxalate
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5
Q

List the four key events in enthesitis

A

Inflammation of enthesis results in metaplasia of radially orientated collagen fibres giving rise to fibrous bone formation

  • > metaplasia: new set of cells developed to replace current set that was unable to handle situation
  • > new bone formation (2nd to periostitis)
  • > gradual ossification of syndesmosis
  • > syndesmophytes formation along outer fibres of vertebral discs
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6
Q

List four examples of entheseal sites

A
  • Tendons and bone
  • Ligaments and bone
  • Cortical bone and periosteum
  • Vertebral bodies and annulus fibrosis
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7
Q

Compare RA and OA joint stiffness

A

RA
- stiff upon waking, persists for more than 30-60 mins

OA
- occurs upon waking or following periods of inactivity, but is usually brief <30 mins

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8
Q

Compare RA and OA joint pain

A

RA

  • occurs with both rest and with motion
  • worse at beginning of movements and improves

OA

  • occurs mainly or only during movement
  • improves with rest
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9
Q

Compare RA and OA joint swelling

A

RA

  • synovial hypertrophy and synovial effusion
  • inflammation of periarticular structures
  • degree of swelling varies over time

OA

  • osteophyte formation and bone swelling
  • ST swelling can contribute - cysts, thickening and effusion
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10
Q

List six descriptors to help diagnose a painful joint

A 
Onset:
- abrupt 
- insidious 
Distribution
- Asymmetrical
- Symmetrical 
Duration of ssx
- Acute 
- Chronic 
Joint involvement
- migratory
- additive 
- intermittent
Number of joints affected 
- mono
- oligo
- poly 
Extra-articular manifestations 
- systemic ssx
- skin lesions
- ocular lesions
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11
Q

List six descriptors for joint pain

A
  • sharp
  • achy
  • stabbing
  • burning
  • throbbing
  • pulsating
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12
Q

List six signs of inflammatory joint disease

A
  • Synovial hypertrophy
  • Joint effusion (synovial inflammation; trauma; haemarthrosis)
  • Pain with motion
  • Limited ROM (capsular pattern)
  • Erythema (vasodilation - acute inflammatory arthritis)
  • Warmth
  • Joint tenderness
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13
Q

Define:
monoarthritis:
oligoarthritis:
polyarthritis:

A

monoarthritis:
when only one joint is affected

oligoarthritis:
between 2-4 joints are affected

polyarthritis: more than 5 joints affected

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14
Q

List three categories of joint pain

A

In true joint pain, three broad categories of joint disease must be differentiated, they may occur concurrently in the same joint;

  • Inflammatory arthritides
  • Non-inflammatory arthritides
  • Arthralgia
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15
Q

List three ssx of joint disease

A
  • pain
  • swelling
  • stiffness
  • Loss of ROM
  • fatigue
  • weakness
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16
Q

Joint involvement may be classified as

A
  • migratory
  • additive
  • intermittent
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17
Q

Manifestations of rheumatoid conditions can be arbitrarily divided into

A

Constitutional
Extra-articular
Articular

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18
Q

List four conditions in which typically present with a skin lesion/rash

A

SLE = malar rash
Dermatomyositis = Gottron’s papules
Systemic Sclerosis = dermal induration due to fibrosis
Psoriatic arthritis = psoriasis preceding inflammation

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19
Q

List three conditions presenting with ocular lesions

A 
RA = scleritis 
AS = anterior uveitis 
ReA = conjunctivitis
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20
Q

List three conditions that present with systemic manifestations

A

RA
PsA
PMDM

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21
Q

List the signs of degenerative joint disease

A
  • Bony overgrowth (bouchards nodes)
  • Limited ROM
  • Crepitus (grating sensation)
  • Joint deformity
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22
Q

Define CRP

A

C-reactive protein is an inflammatory marker produced by the liver in the presence of inflammatory cytokines (interleukin 1 & 6) when there is tissue damage, autoimmune disease or infection

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23
Q

What does CRP tell you that ESR doesn’t

A
  • more sensitive than ESR
  • rises and falls faster than ESR
  • better mirrors extent pf tissue damage than ESR
  • Is independent of factors that raise ESR
  • correlates better with disease activity
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24
Q

Define ANA testing

A

ANA testing is used to detect pathological antibodies which target specific nuclear antigens. Generally presents in those with autoimmune disorders

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25
Q

When would ANA titres be elevated?

A
  • normal people
  • in people with autoimmune conditions
  • in those with rheumatic conditions
26
Q

Name three diseases in which ANA titres would be elevated

A
  • SLE
  • Sjogren’s
  • Polymyositis
  • Mixed connective tissue disorder
  • Systemic Sclerosis
27
Q

When would you order ANA tests?

A

ANA testing is particularly useful in the diagnosis of SLE

nearly all patients with SLE have positive ANA test (93% sensitivity, 57% specificity)

28
Q

Define Alkaline Phosphatase testing

A

ALP is a group of isoenzymes produced by the liver cells and bone tissue. When these cells are destroyed serum ALP increases

29
Q

When would ALP be elevated

A

ALP is elevated in pathological conditions that increase bone turnover or destruction i.e. paget’s
Also elevated in non-musculoskeletal cases i.e. obstructive biliary cirrhosis

30
Q

Name three diseases in which ALP is elevated

When would you order ALP tests =?

A
  • Paget’s
  • Hyperparathyroid
  • Rickets
  • Osteomalacia

To aid Dx of liver and bone diseases

31
Q

Define Rheumatoid factor testing

A

Test to detect a group of autoantibodies (usually IgM) that for immune complexes that deposit in the tissues, resulting in complement activation and inflammation

32
Q

When would RF titres be elevated?

A

In normal people
People with autoimmune diseases
In rheumatic conditions

33
Q

Name three specific disease for RF

A
  • RA
  • SLE
  • SSC
  • PMDM
34
Q

when would you order RF testing

A

Support clinical diagnosis of RA

- is not pathognomonic

35
Q

Define ESR

A

Highly sensitive non-specific and inexpensive test for tissue damage and inflammation by a measure of heigh that erythrocytes fall through plasma in a westergren tube over an hour. Falling rate is slowed by acute phase proteins and immunoglobulins in the serum

36
Q

When would ESR be elevated?

A
  • Inflammatory conditions

- If extensive tissue necrosis has occurred

37
Q

Name three specific conditions ESR is associated with

A
  • infection
  • cancers
  • autoimmune diseases i.e. PMDM
38
Q

When would you order ESR?

A

to aid diagnosis of a particular disease

39
Q 
Name a test that would be used to diagnose the following: (give justification)
OA
RA
Gout
Pseudogout 
SLE
Infective Arthritis 
PMR
A

OA
- synovial fluid examination (exclude the presence of inflammatory arthritis or cystalopathy)
RA
- RF titres (80% pt have it but not diagnostic)
Gout
- synovial fluid analysis (negatively bifringent needle shaped crystals)
Pseudogout
- synovial fluid analysis (positively bifingent cuboid shaped crystals)
SLE
- ANA testing (high titres of antinuclear antibodies)
Infective Arthritis
- synovial fluid analysis (positive for presence of immune cells and initiating bacteria)
PMR
- ESR (significantly increased in this condition)

40
Q

List five indications for synovial fluid joint aspiration

A
  • Inflammatory conditions
  • Cancer
  • Autoimmune disease
  • PMR
41
Q

List five conditions which might cause increased CRP

A
  • RA
  • SLE
  • SSC
  • Polymyositis
  • Dermatomyositis
42
Q

Define arthography

A

A test performed using X-rau, CT or MRI to produce a series of images of a joint after administration of a contrast medium

43
Q

Indications of arthography

A
  • Mainly used to diagnose cause of persisitent, unexplained knee or shoulder pain
  • To visualise meniscus, cartilage and ligaments on bone
  • To visual joint derangement and synovial cysts
44
Q

Define HLA-B27

A

A test to determine the presence of human leukocyte antigen, which is a surface antigen encoded by the B locus on the major histocompatibility complex on chromosome 6. it presents antigen peptides to T cells to differentaite self from non-self

45
Q

When would HLA-B27 be elevated

A
  • AS
  • PsA
  • Juvenile AS
  • IBD
  • Spondylitis
  • ReA
46
Q

define creatine kinase

A

test used to determine the level of creatine kinase in the blood stream, it is most sensitive to mm injury

47
Q

When would CK be elevated?

A
  • crush injury
  • Rhabdomyolysis
  • muscular dystrophy
  • myositis
48
Q

List four ominous radiological findings indicating malignancy

A
  • diffuse hazy invasion of bone
  • extensive bone deformity
  • diffuse periosteal new bone formation
  • extension of tumour into neighbouring ST
49
Q

List four radiolgrahic findings of a giant cell tumour

A
  • radiolucent areas situated in the end on long bones
  • lesion is bounded by subchondral bone
  • central lesion may have soap bubble appearance
  • thinning and ballooning of cortex occurs
50
Q

List four radiographic findings of a simple bone cyst

A
  • well demarcated
  • radiolucent
  • occurring in metaphysis
  • may extend to physeal plate
  • cortical thinning and expansion
51
Q

List four lab results that would indicate malignant disease

A

FBC - anaemia
ESR - elevated in maligancy
Serum protein electrophoresis - elevated IgG
Serum acid phosphatase - elevated

52
Q

Incidence, distribution, pathology, clinical picture, radiological features, diagnostic investigations and treatment of

OSTEOSARCOMA

A

Incidence:

  • rare but highly malignant
  • primarily a malignancy of childhood/adolescence
  • possible complication of Paget’s disease

Distribution
- may affect any bone - usually the metaphysis of long bones esp. the knee or pro humerus

Pathology
- destroys and replaces bone
- results in:
> bone loss
> abnormal new bone esp. periosteal margins
- spreads towards periosteym and surrounding ST
- May cross the epiphyseal plate
- histologically arises from primitive bone forming cells
- METs occur early via blood often to the lung

Clinical picture 
- pain is the first symptom
   > constant 
   > worse at night 
   > gradually increasing in severity 
- lump or swelling 
- tenderness 
- overlying tissues may be inflamed 
Radiological features 
- hazy, osteolytic areas
- dense osteoblastic areas
- poor definition of endosteal margin 
- breaching of cortex
  > spread to adjacent tissue
  > new bone extending from cortex 
  > sunburst effect
- reactive new bone formation (periosteal elevation)
- pulmonary METs

Dx investigations

  • increased ESR
  • +/- increased serum ALP
  • blood tests show elevated WBC
  • xray
  • bone scan = increased uptake by neoplasm

Tx

  • surgery
  • chemo
53
Q

Incidence, distribution, pathology, clinical picture, radiological features, diagnostic investigations and treatment of

CHONDROSARCOMA

A

A collective term for a group of malignant mesenchymal tumours that are mainly made up of cartilage cells that produce cartilage matrix

Incidence

  • second most common bone malignancy
  • M:F = 1.5:1
  • age?

Distribution
- most common in the femur, humerus, ribs and pelvis

Pathology

  • slow growing tumour
  • can become very large
  • derived from cartilage
  • produces cartilage
  • late metastasis

Clinical picture

  • local pain (deep dull ache)
  • pain at night
  • local swelling
  • decreased ROM when tumour is near joint
  • path F#

pelvic tumour will cause additional ssx incl. -
- urinary frequency or obstruction, high groin mm pain and nerve dysfunction

Radiological findings
Primary
- usually large lesion >5cm
- radiolucent area (due to bone destruction)
- variable amounts of stippled calcification
- globular mass on surface of bone
- periosteal new bone formation
Secondary
- patches of calcification in the cartilage cap of osteochondroma

Tx:
- surgery

Lab investigations:
? Would be same as any malignancy?

54
Q

Fibrosarcoma

A

A tumour of mesenchymal origin, which is composed of malignant fibroblasts in a collagen matrix

Epidemiology/incidence

  • rare in bone (<5% of all primary bone tumours)
  • M:F = 1:1
  • most common in adults 30-60 yoa

Distribution:
- occurs in the metaphysics or diametaphyseal region of long bone. usually occur in LL, esp. femur and tibia followed by the pelvis

Pathology
Primary
- may originate in bone or invade bone from nearby connective tissue
Secondary
- can be secondary to; Paget’s, FD, GCT, bone infarct or chronic osteomyelitis

clinical picture:

  • localised painful mass
  • Path F#

Radiological features:
- osteolytic
- well-defined or ragged margin
- periosteal reaction is seen with cortical destruction
- extension into ST is common
CT & MRI are primarily used to define extent of tumour

Tx:

  • surgery
  • pre and post operative radiation

Labs:
?

55
Q

Incidence, distribution, pathology, clinical picture, radiological features, diagnostic investigations and treatment of

Ewing’s Sarcoma

A

A primary malignant bone tumour whose small round tumour cells resemble those of lymphoma or neuroblastoma

epidemiology/incidence

  • 10-15% of all bone sarcomas
  • bone tumour with youngest predilection
  • median age 15 years
  • > 50% of patients are adolescents
  • peak incidence in 2nd decade

Pathology:
?

Clinical Picture:

  • localised pain
  • palpable mass
  • path F#
  • asymmetric neuro ssx

Radiological features:
general -
- large
- poorly marginated
- >80% extend into ST
Plain xray:
- variable but usually have aggressive appearance
- common findings incl. permeative, laminated periosteum, sclerosis
MRI & CT are used to examine bone lesions MRI is best for ST

Tx:

  • chemo
  • surgery

Labs:
blood test -
- increased ALP
- hypercalcemia

56
Q

Define Antiphosphlipid Antibody testing

A

ALPA are a group of antibodies directed against phospholipid associated proteins such as

  • prothrombin
  • cardiolipin
  • beta 2 glycoprotein 1
57
Q

Who has ALPAs?

A
  • normal people have elevated levels following acute medical illness and infections
  • people suffering SLE
  • Antiphospholipid antibody syndrome
58
Q

Indications for ALPA testing

A
  • Unexplained thrombotic episodes
  • Recurrent miscarriages
  • Thrombocytopenia
  • Prolonged PTT test
  • Symptoms indicative of autoimmune disease
59
Q

Define Cryoglobulin testing

A

Cryoglobulins are a group of abnormal serum immunoglobulins that precipitate (separate) at low temperatures
Cryoglobulin particles float in the serum & precipitate at the bottom of the test tube at 4 degrees C
Particles dissolve on re-warming of serum to body temperature
Precipitated cryoglobulins can lead to;
Thrombosis → increased blood viscosity slows blood flow
Ischemic necrosis → due to small blood vessel blockage
Vasculitis → cryos activate immune system

60
Q

Who would have elevated cryoglobulins?

A 
Not specific for any conditions, produced in a number of conditions including;
•	Autoimmune diseases 
•	Infections
•	Lymphoproliferative diseases
•	Vasculitic conditions
•	Glomerulonephritis
61
Q

Indications for cryoglobulin testing

A 
Ordered in people with ssx suggestive of cryoglobulinaemia;
•	Bruising
•	Rashes
•	Joint pain
•	Weakness
•	Raynaud’s phenomenon
NOTE: All these ssx can be due to SLE

CDM semester one 2018 (4 decks)

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