kumar and clark Flashcards
1
Q
articular cartilage is mainly composed of what type of cartilage
A
type 2
2
Q
is synovial vascular
A
yes
3
Q
neutrophilic occurs in bacterial infection but can also occur in
A
steriod treatment
4
Q
how to detect rheumatoid factor
A
ELISA
5
Q
Rf and ant Cp in RA is associated with what
A
worse prognosis
6
Q
what is used as a screening test for SLE and systemic sclerosis
A
ANA
7
Q
good thing about anti -dsDNA
A
used to monitor disease activity as rise and fall with disease activity
8
Q
anti ro and la
A
Sjogrens and SLE
9
Q
anti sm
A
SLE
10
Q
anti RNA polymerase 1 and 3
A
systemic sclerosis
11
Q
ANCAs are what antibody
A
IgG
12
Q
normal synovial fluid is
A
clear and straw coloured
13
Q
normal synovial fluid contains less than
A
3000 WBC
14
Q
after joint aspirate if septic arthritis is suspected
A
gram stain to identify organism
15
Q
good scan for inflammatory arthritis
A
us
16
Q
what scan measures bone density and is used in monitoring of osteroporosvsis
A
DXA scan - dual energy x ray absorptiometry
17
Q
what scan to detect large vessel vasculitis eg takaysu
A
PET - position emission tomography
18
Q
shoulder abduction nerve root
A
c5
19
Q
elbo flexion and extension
A
c5 and c6
20
Q
what is rotator cuff tendonitis
A
pain that is worse at night and radiates to the upper arm
21
Q
is the shoulder a shallow or deep joint
A
shallow
22
Q
without impingement what glides under what
A
greater tuberosity slides under the acromion
23
Q
rotator cuff tendonosis pain is worse when
A
during the middle of the range of abduction, reducing as the arm is fully raised called painful arc
24
Q
passive elevation is less painful in what
A
rotator cuff tendonosus
25
what increase the risk of impingement
acromioclavicualr osteophytes
26
x ray is often normal in
rotator cuff tendonosis
27
what can distinguish, tendonitis, tears, bursitis
US
28
patients getting a steroid injection into the subacromial bursa should be warned that what
pain may be worse 24-48hrs after injection
29
shoulder feels hot and swollen and x ray shows a
diffuse opacity in the bursa in calcific tendonosis and bursitis
30
shoulder feels hot and swollen and x ray shows a
diffuse opacity in the bursa in calcific tendonosis and bursitis
31
frozen shoulder what stages are painful
initial stages but when shoulder is frozen with little pain that is not painful
32
pain gripping or holding a bag
tennis elbow
33
pain carrying a tray
golfer elbow
34
trigger finger is more common in
diabetics
35
trigger finger is more common in
diabetics
36
swelling under extensor reinaculum
dorsal tenosynovitis - RA
37
de quervains tenosynovitis has pain where
radial styloid- where abductor policies Longus tendon
38
splint in carpal tunnel holds the wrist in
dorsiflexion
39
in what 2 arthritis can a finger be swollen (dacylitis) or DIP joints affected asymmetrically
reactive or psoriatic
40
are scaphoid fractures seen immediately on X-ray
no
41
what is a ganglion because of
partial tear of the joint capsule or tendon sheath
42
what is first line before surgery in dupuytrens contracture
percutaenous collaganase injection
43
what differentiates mechanical back pain from poly myalgia rheumatica
normal CRP/ESR
44
most common sites for lumbar spondylosis
L4/5 L5/S1
45
weakest point in disc prolapse
posterolateral
46
below what level would cause low motor neuron disease
L2/3
47
straight leg raise producing radiating pain in
lower lumbar disc prolapse
48
hip flexion
L1/L2
49
plantar flexion of foot
S1/S2
50
spinal and root Canal stenosis characterised by
pain brought on by walking and relived by rest
51
what differentiates spinal stenosis from peripheral peripheral arterial caluudication
presence of pulses
52
a manoeuvres that helps in spinal stenosis
bending forward as opens up spinal canal
53
vertebrae slips
spondylolithesis- occurs in young adults
54
osteoporotic fractures of the spine may present as
angonizing localised pain that radiated round the abdomen and ribs
55
what is spared in osteoporotic vertebrae fractures
end plates and pedicels
56
what indicates a vertebrae fracture is recent
bone oedema
57
sudden onset pain in OA
effusion - treat with steriod injection
58
trochanteric bursitis pain is worse
going up stairs, crossing the legs
59
what presents similar to trochanteric bursitis but does not respond to steriod injection
gluteus medius tear
60
AVN occurs when
at any age
61
area of increased bone density at upper pole of femoral head
AVN
62
AVN on xray
early stage is normal but scintigraphy or MRI shows bone marrow oedema
63
what rarely presents with hip pain but only in severe disease
hip
64
slightly cloudy or blood stained fluid is likely to be
pseudo gout
65
meniscus are what cartilage
fibrocartilage
66
immediate treatment to meniscal tear
ice
67
what accounts for 70% of knee haemarthrosis in young people
cruciate ligaments toren
68
a torn ace allows what to be pulled forward
tibia
69
retropatellar cartilage is fibrillated
chondromalacia patallae
70
osteochondritis is fragment from where
medial femoral condyle
71
osteochonditic dissecans presents as
aching pain after activity and if fragment becomes loose then giving way occurs
72
what must be avoided if there is osteonecrosis of the knee
weight bearing
73
anserien bursitis
breast stroke swimmers
74
stood-schlatter particularly occurs in
teenage spots players
75
tenderness of upper calf of sudden onset and history of knee problems
ruptured cyst
76
severs disease affects
achilles tendon
77
painful tender swelling above achilles insertion
achilles tendonosisi
78
what can be injected with steriod injection at achilles
bursitis
79
after the hands, what joints are most commonly affected by RA
foot
80
flate feet puts the hind foot into what position
everted
81
high arched feet put pressure where
lateral border and ball of foot
82
common complication of ra
hallux valgus
83
metatarsalgia common in women who
wear high heels- ball of the foot in painful to walk on
84
Mortons neuroma typically occurs between the
3 and 4 metatarsal heads
85
Mortons neuroma typically occurs between the
3 and 4 metatarsal heads
86
nerve below medial malleolus
posterior tibial
87
difference in biochem between primary and secondary hyperparathyroidism
primary - ca is normal or high
secondary - ca is low
ALP AND PTH are both high
88
what is the only thing that is low in malignancy
PTH
89
ca is whatever but phsopahe and Alp are high in
CKD
90
what is the confirmatory test for osteomalacia
low vitamin D
91
primary hyperparathyroidism do what scan
sestamabi
92
main site for bone turnover
cancellous boen
93
what is the bone found I first few years of life, site of fracture repair and in pagets
woven boen
94
what forms hydroxyapatite
calciuma dn phospahet
95
stimulator of osteoclasts
RANKL-receptro activator of nuclear factor kappa b ligand
96
osteoblasts are derived from
mesenchymal cells
97
what are secreted when osteoclasts are working
hydrogen ions
98
growth occurs at what growth plate
epipihyseal
99
primary source of vitamin D in humans in skin is
7- dehydrocholesterol to cholecalciferol
100
kidneys convert cholecalciferol to 25 hydroxyvitamin D
101
kidneys convert 25 hydrovitamin D to 1,25 dihydroxyvitamin d which is
D3
102
regulation of what step is by PTH, phosphate and feedback inhibition by 1,25 dihydroxyvitamin D3
the one in the kidney - 25 to 1,25
103
parathyroid hormone is secreted from what cells
chief
104
what is the rate limiting step in PTH
1 alpha hydroxylation of vitamin D
105
does excess or defined calcitonin have much effect
no
106
what is 1,25 dihydroxycholecaliferol called
calcitriol
107
for critical measures of total plasma calcium should do what
fasting g state and use a tourniquet
108
high levels of phosphate are found when
CKD and hypoparathyroidism
109
PTh are raised in
in familial hypocalcuric hypercalcaemia, PTH may be
hyperparathyroidism
normal or marginally elevated
110
vitamin d status is best asssessed using
25 hydroxyvitamin d as 1,25 has a short half life and doe s not accurately reflect vitamin D
111
hypercalaemia means there is increased calcium is urine but one excpetion to where there is hypecalcaemia but reduced calcium excretion is in
familial hypocacliuric hypercalcemai
112
what reflects bone turnover
uptake of 99m technetium labelled biphosphonate
113
what reflects bone turnover
uptake of 99m technetium labelled biphosphonate
114
best test for osteomyelitis
MRI
115
what is given before bone biopsy
tetracycline
116
dexa scan is measured at
hip or spine
117
what factors are the most important in determining peak bone mass
genetic factors
118
what can increase risk of osteoporosis
oestrogen deficiency
119
vitamin d deficiency consequently causes
hyperparathyroidism
120
2/3 of vertebrae fractures are
asymptomatic
121
what is the strongest risk for another fracture
previous fracture
122
frax is a
fracture risk calculator
123
biphosphonates adheres to what and inhibits osteoclasts
hydroxyapatite
124
how should biphosphonates betaken
fasting, standing upright - after stay upright and avoid drinks dn food for 30 mins
125
what is a rare complication of biphosphobates
osteonecrosis of the jaw
126
what is an antibody to RANKL
denosumab
127
bad thing about denosumab in comparison to biphosponages
when denosumab stopped all good benefits are gone so need to replace with something else
128
what stimulates bone formation
teriaratide
129
teriparatide only reduces fractures where
vertebrae
130
when can you give treatment without doing dexa scan
poste menopausal woman, men over 50 any anyone who has already sustained fragility fracture
131
over 80% of osteonecrosis ar due to
steriods or alcohol
132
bone marrow oedema
osteonecoris
133
most common site of pagets
pelvis
134
what defiency is often seen in pagets
vitamin d
135
what is characteristic of pagets in the skull
osteoporosis circumscripta
136
cortical thickening and coarsening of trabecular network
paget s
137
bisphosphonate treatment of pagets the new bone is
lamellar instead of woven
138
what is the most commonly sued iV biphosphonate for pagets
zoledronate
139
common symptoms after zoledronae
flu like so give paracetemol
140
what is the most common cause of osteomalacia
low phosphate due to hyperparathyroidism secondary to vit d deficiency
141
gastro diseases can result in malabsorption of vitamin d as it is a
fat soluble vitamin
142
if symptomatic osteomalacia classical causes
muscle weakness and widespread bone pain
143
if symptomatic osteomalacia classical causes
muscle weakness and widespread bone pain
144
waddling gait with difficulty climbing stairs and getting out of a chair
osteomalacia
145
neonatal rickets may present as
craniotabes ( thin deformed skull)
146
widened epiphyses, beading of the costochondral junctions producing rickety rosary or a groove in ribcage
rickets
147
characteristic finding in rickets
losers pseduofractures - narrow radiolucent lines with sclerotic borders running perpendicular to the cortex
148
what is the gold standard in rickets but rarely used
tetracycline labelled bone biopsy
149
,mainstay treatment of osteomalacia and rickets
vit d
150
organism accountable for 90% of osteomyelitis
staphylococci
151
classic presentation of osteomyelitis
fever with localised bone pain with overlying tenderness and erythema
152
treatment of osteomyelitis
iv antibiotics can switch to oral after 2 weeks
153
subacute osteomyelitis associated with
brodeis abscess
154
Potts disease related to
tuberculosis osetomyeltiis
155
hot areas of boney metastasis shown on what scan
skeletal isotope scan
156
osteosclerotic regions are characteristic of
prostatic carcinoma
157
progressive dorsal kyphossiois in the thoracic region in adolescent boy
scheurmanns
158
retention of urea does not alter
distribution of total body water
159
Na is reabsorbed where
collecting ducts
160
Na is reabsorbed where
collecting ducts
161
where reabsorbs NaCl without water
ascending loop of henle
162
in the absence of adh, little water is reabsorbed in the collecting ducts and a
dilute urine is excreted
163
decline in water reabsorption in collecting ducts
diabetes insipidus
164
hyponatraemia is seen in
siadh
165
what is a common clinical finding in hypoalbuminaeia
interstitial oedema
166
things that can cause too much sodium
oestrogen
aldosterone
nsaids
tzds
167
drug that can cause peripheral oedema
amlodipine
168
loop stimulate excretion of what
sodium chloride and water
169
loops act where
thick ascending loop of henle
170
loops good with patients with
left ventricular failure
171
loops unwanted effects
urate retention causing gout, hypokalaemia, hypercalcuria stimulating calcium stoen s
172
loop that can particularly cause ototoxicity
furosemide
173
thiazides like loop cause urate rendition, hypoakalemia but they also cause
hyponatraemia
174
as thiazides can cause hyponatraemia this is good for
diabetes insipidus
175
thiazide diuretic in renal impairment
metolazone
176
thiazide diuretic in renal impairment
metolazone
177
aldosterone is reabsorbed where
collecting ducts
178
carbonic anhydrase inhibitors cause what
metabolic acidosis and hypoakalemia
179
carbonic anhydrase inhibitors cause what
metabolic acidosis and hypoakalemia
180
what may be needed alongside sglt2i at first
loops
181
what diuretic cause more urate retention, glucose intolerance and hypokalaemia
thiazides more so than loops
182
excessive diuresis can cause what renal failure
pre renal
183
what leads to loss of skin elasticity
loss of interstitial fluid
184
what causes postural hypotension
loss of extracellular fluid
185
what is a stimulus to sodium and water retention
surgery
186
what is a stimulus to sodium and water retention
surgery
187
hyponatraemia with euvolaemia
SIADH
188
hyponatraemia with euvolaemia
SIADH
189
hyponatraeic encephalopathy shows what on MRI
cerebral oedema
190
mostly how is hypnatraemia managed
restrict water with review of diuretics
191
things that can cause hypokalaemia
insulin, theophylline
192
effects that aldosterone has a potassium
renal excretion is increased
193
aldosterone secretion is increased by
hyperkalaemia and angiotensin II
194
how does vomitting cause hypokalemai
sodium loss, aldosterone is released causing hypokalaemia
195
most common causes of hypokalaemia
diuretics particularly thiazides and hyperaldsteronism
196
acute hypokalaemia in hospitals the most common cause of
diuretic or iv fluids (particularly in DKA) - as use on insulin and iv fluids without potassium can casue
197
most cases how to treat hypoakalemai
withdraw diuretics
Iv K is only needed in cardiac arrhythmia, muscle weakness or severe DKA
198
failure to treat hypokalaemia may be due to
hypomagnaesemai
199
failure to treat hypokalaemia may be due to
hypomagnaesemai
200
physiological cause of acute hyperkalemai
vigorous exercise
201
what is a particularly dangerous cause of hyperkalaemia
acei with NSAIDs or potassium sparing diuretic
202
muscle weakness can be the only cause in
hyperkalaemai
203
hyperkalaemia can be associate with what causing kassmauls breathing
metabolic acidosis
204
what brings down the potassium in hyperkalemai
insulin- must be with glucose to prevent hypoglycaemia
205
what drugs have been associated with hypomagnesium
PPIs
206
flattened t waves
hypomagensium
207
what is decreased by parathyroid hormone
phosphate
208
causes of metabolic acidosis with a high anion gap
CKD, lactic acidosis , ketoacidosis
209
all the glomeruli are where in the kidney
cortex
210
renal capsule are urters are innervated by
T10-L1
211
foot process of podocytes prevents
albumin getting through
212
what can contract and relax to control blood flow
mesangial cells
213
distal tubule has what epithelium
cuboidal
214
loop of heel has what cells
squamous
215
what epithelium in the macula densa
columnar
216
what is constructed in response to salt
afferent arteriole to reduce gfr so renin is secreted which allows aldosterone
217
sglt2i works where
proximal tubule and absorbs na and glucose
218
what is used to monitor deterioration in GFR
creatinine
219
what is used to monitor deterioration in GFR
creatinine
220
as a diabetics renal function decrease what change is made
reduced insulin as kidneys not functioning as well so clearance of insulin is reduced and insulin half life is greater
220
as a diabetics renal function decrease what change is made
reduced insulin as kidneys not functioning as well so clearance of insulin is reduced and insulin half life is greater
221
what apparatus regulates flow and filtration of each individual nephron
juxtaglomerular
222
renin is stored where
JCA
223
angiotensin II causes what in the kidney
zona glomerulosa to release alodsteron
vasoconstriction of efferent arteriole
224
sodium absorption from aldosterone occurs where
collecting duct
225
polycythaemia may occur in
polycystic kidney disease
benign renal cyst
rcc
226
cox 1 is where
cox 2 is where
collecting duct
macula densa
227
high specific gravity can suggest
pre renal AKI
228
urinary pH is only helpful for invesiogating
renal tubular acidosis
229
red cell casts always indicates
glomerular disease
230
dipstick that is positivity for haematuria but no red cells on microscopy suggest haemoglobinuria or myoglobin uria
231
blood only at the end of peeing suggest
bleeding from prostate or baldder base
232
when will women commonly have a dipstick positive haematuria during
period
233
electrolytes is unhelpful in
CKD
234
enzyme specific for neutrophils
leukocytes esterase
235
white cell casts are characteristic of
acute pyelonephritis
236
what cells indicate active renal disease
granular cast
237
antistreptolysin 0 titre
post streptococcal glomerulonephritis
238
membranous nephropathy and polyarteritis linked with hep
B - memBranous
239
why is MR angiography to not be used in renal disease
risk of nephrogenic systemic fibrosis
240
podocyte attach to GBM by
foot processes
241
where can mixed nephrotic/ nephritic be seen
lupus., henoch schonlein purpura
242
thromboembolism is paritucalrly common n what neohripajty
membranous
243
loss of immunoglobulin in the urine in nephritic patients can cause what major cause of death
sepsis
244
what can trigger the nephrotic syndrome in minimal change disease
allergic reactions
245
can minimal change lead to CKD
no
246
increased alpha feto protein in amniotic fluid
congenital nephrotic syndrome
247
glowmruli where are affected by focal segmental glomerulosclerosis first
corticomedullay junction
248
if foot process effacement is present is present in normal and sclerosed glomeruli glomerular then it is
primary figs as opposed to secondary
249
collapsing FGS seen in
HIV
250
mainstay of treatment of post transplant fgs
plasmapheresis
251
glomeruli are typically what in hiv associate nephriapthy
collapsed
252
plat 2
membranous
253
silver spikes
membranous nephropathy
254
what is predomominant in idiopathic membranous nephropathy
IgG4
255
1/3 of membranous nephraphty
will cgo into remission after 6-12 month s
256
tretament for membranous nephropathy
acei, anticoagualtion, diuretics and a statin
257
amyloidosis may be seen in
myeloma
258
what can be an early feature of amyloidosis
carpal tunnel
259
heart failure and autonomic neuopathy are common in
amyloidosis
260
imaging of amyloidosis kidneys are often
large
261
what measures progression of amyloid
scintigraphy with radiolabelled amyloid P
262
widespread eosinophilic deposits
amyloidosis
263
fibrils
amyloidosis
264
light chain associated amyloidosis treatment
rituximab
265
amylin
diabetic nephropathy
266
gym thicken and maesagnium expands
diabetic nephroapthy
