Disease of Musculoskeletal system (1 & 2)

Question 1

What is arthritis?

Answer 1

Inflammation of joint

Pain and stiffness to joint

Not single condition - 100s of different diseases!

Question 2

How does acute arthritis present?

Answer 2

Short duration

Pain, swelling, heat, erythema

Question 3

What are the two types of chronic arthritis?

Answer 3

Osteoarthirits

Rheumatoid arthritis

Question 4

What is the clinical pathology of oesteoarthiritis?

Answer 4

Ageing phenomenon

Degeneration of articular cartilage

Formation of bony spurs and cysts in joint margins

Question 5

What are the primary and secondary causes of osteoarthritis?

Answer 5

Primary = abnormal stresses in weight bearing joints

Secondary - activity related e.g. sports; disease e,g, diabetes/obesity

Question 6

What is the cellular basis of osteoarthritis?

Answer 6

Chondrocytes (cartilage producing) produce interleukin-1 which initiates matrix breakdown

Prostaglandins - produce lytic enzymes which prevent matrix synthesis

Question 7

What occurs in osteoarthritis of the hands/fingers?

Answer 7

Herberdens and Bouchard’s nodes

Question 8

What is rheumatoid arthritis?

Answer 8

Chronic systemic disorder (principally effects joints)

Question 9

What is rheumatoid arthritis characterised by?

Answer 9

Non-Suppurative proliferative synovitis produces pannus

Pannus = abnormal fibrovascular/granulation layer

Causes progressive destruction of articular cartilage and ankylosis of joints

Question 10

What genetic genotype is associated with rheumatoid arthritis ?

Answer 10

HLA-DR4 or HLA-DR1 (one or both!)

Question 11

What virus is considered a primary arthritogen?

Answer 11

EBV

Question 12

What cytokines/factors are associated with panes formation?

Answer 12

IL1-6, cytokines, TNF-alpha and beta

Question 13

What are the diagnostic criteria for rheumatoid arthritis?

Answer 13

• Morning stiffness
• Arthritis in >3 places
• Arthritis in hands
• Rheumatoid nodules
• SYMMETRICAL ARTHRITIS
• Serum rheumatoid factors -not specific - look in synovial fluid for neutrophils!

4 of the above

Question 14

What is Gout caused by?

Answer 14

Hyperuricemia - uric acid = end product of pyrite metabolism - enzyme deficiency

Question 15

What are the clinical features of gout?

Answer 15

Crystallisation of urates in joint spaces - tophi

• chronic/acute arthritis
• Gouty neuropathy

Question 16

What is osteoporosis?

Answer 16

Increased propensity of skeleton (reduced bone mass)

Primary = age and postmenopausal

Secondary - hyperparathyroidism

Question 17

What are the clinical features of osteoporosis?

Answer 17

Kyphosis
Scoliosis
Vertebral fractures

Question 18

What infection is Pagets disease associated with>?

Answer 18

Paramyxovirus

Question 19

What is the pathogenesis of Pagets disease and clinical characteristics?

Answer 19

Osteoclastic inactivity

Osteoblastic overactivity

Rapid bone turnover but too much bone being formed - structurally unsound and disordered

Chalk break fractures

Question 20

What is osteomalacia due to?

Answer 20

Vit D deficiency

Or hyperparathyroidism (increases bone reabsorption from skeleton)

Question 21

What does soft tissue comprise?

Answer 21

• Extra skeletal non-epithelial structures
• exclusive of supportive tissue or organs/lymphoid/hamatopoietic tissue

MESODERMAL in orgin

Question 22

What are the common sites where secondary metastatic deposits originate from?

Answer 22

Prostate
Lung
Breast 
Thyroid 
Kidney

Question 23

True or false - sarcomas commonly spread through the lymph system?

Answer 23

False - mainly haematogenous