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Medicine Phase 2a MSK and Rheumatology > Lectures > Flashcards

Lectures Flashcards

1
Q

Categories of joint pain

A

Inflammatory

Non-inflammatory

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2
Q

Non-inflammatory causes of joint pain

A

Degenerative e.g. osteoarthritis

Non-degenerative e.g. fibromyalgia

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3
Q

Inflammatory causes of joint pain

A

Autoimmune
Crystal arthritis
Infection

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4
Q

Autoimmune causes of inflammatory joint pain

A

Rheumatoid arthritis
Spondylo-arthropathy (HLA B27)
Connective tissue disease

Vasculitis related to all of these

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5
Q

What is inflammation

A

Reaction of microcirculation
Movement of fluid and white blood cells into extra-vascular tissues
Pro-inflammatory cytokines

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6
Q

4 cardinal signs of inflammation

A

Rubour (red)
Calor (heat)
Tumour (swelling)
Dolor (pain)

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7
Q

Presentation of crystal disease and infection

A

Rapid onset
Very hot and red joints
Relevant clinical Hx - gout and infection

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8
Q

Hx suggestive of gout

A

Diuretics
Obesity
Hypertension
Alcohol

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9
Q

Hx suggestive of infection (relating to crystal disease)

A

Bacteraemia
Age
Immunosuppressed

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10
Q

Differences in pain presentation between inflammatory and degenerative joint pain

A

Inflammatory - pain eases with use

Degenerative - pain increases with use (clicks/clunks)

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11
Q

Differences in stiffness presentation between inflammatory and degenerative joint pain

A

Inflammatory - more stiff; significant (>60 mins); early morning/at rest (evening)

Degenerative - stiff; not prolonged (<30 mins); morning/evening

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12
Q

Differences in pain presentation between inflammatory and degenerative joint pain

A

Inflammatory - pain eases with use

Degenerative - pain increases with use (clicks/clunks)

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13
Q

Differences in stiffness presentation between inflammatory and degenerative joint pain

A

Inflammatory - more stiff; significant (>60 mins); early morning/at rest (evening)

Degenerative - stiff; not prolonged (<30 mins); morning/evening

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14
Q

Differences in swelling presentation between inflammatory and degenerative joint pain

A

Both show swelling
Inflammatory = synovial with or without bony
Degenerative = none, bony

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15
Q

Differences in joint distribution between inflammatory and degenerative joint pain

A 
Inflammatory = hands and feet
Degenreative = 1st CMCJ, DIPJ, knees
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16
Q

Differences in patient demographics between inflammatory and degenerative joint pain

A 
Inflammatory = young, psoriasis, family Hx
Degenerative = older, prior occupation/sport
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17
Q

Differences in joint distribution between inflammatory and degenerative joint pain

A 
Inflammatory = hands and feet
Degenreative = 1st CMCJ, DIPJ, knees
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18
Q

Differences in effect of NSAIDs on inflammatory and degenerative joint pain

A 
Inflammatory = responds to NSAIDs
Degenerative = less convincing response
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19
Q

Describe normal synovial joint

A

2 articulating bone surfaces covered with hyaline cartilage
Fibrous capsule lined with synovium
Joint space filled with synovial fluid
Inflammation of these structures=arthritis

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20
Q

Micro types of bone structure

A

Woven bone - made quickly, disorganised, no clear structure

Lamellar bone - made slowly, organised, layered structure

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21
Q

Macro types of bone structure

A

Cortical - compact, dense, solid, only spaces are for cells and blood vessels (more outer layer)
Trabecular - cancellous (spongy), network of bony struts (trabeculae), looks like sponge, many holes filled with bone marrow, cells reside in trabeculae and blood vessels in holes
(more centre bit)

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22
Q

How hollow long bone structure contributes to its function

A

Keep mass away from the neutral axis and minimised deformation

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23
Q

How trabecular bone structure contributes to its function

A

Give structural support while minimising mass

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24
Q

Function of wide ends structure of bones

A

Spreads load over weak, low friction surface

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25
Adult bone composition
50-70% mineral - hydroxyapatite (crystalline form of calcium phosphate) 20-40% organic matrix - Type 1 collagen (90% of all protein) and non-collagenous protein (10% of all protein) 5-10% water
26
What % of all protein in organic matrix is Type 1 collagen
90%
27
What is function of mineral part of bone composition
hydroxyapatite crystals | STIFFNESS
28
What is function of collagen in bone composition
ELASTICITY
29
3 functions of a joint
Allow movement in 3 dimensions Bear weight Transfer load evenly to the MSK system
30
Types of joint
Fibrous Cartilaginous Synovial
31
Example of fibrous joint
Teeth sockets
32
Example of cartilaginous joint
Intervertebral discs
33
Examples of synovial joints
Metacarpophalangeal | Knee
34
What is a synovial joint
Articulating bones separated by a fluid filled cavity (most joints of the body fit this category)
35
Main features of a synovial joint
Articular cartilage Joint capsule - inner layer is the synovial membrane Joint (synovial) cavity - space filled with synovial fluid Synovial fluid Reinforcing ligaments
36
Some synovial joints like the knee also contain bursae and menisci, what are these
``` Bursae = fluid filled sacs lined by synovial membrane Menisci = discs of fibrocartilage ```
37
What is ESR
Erythrocyte Sedimentation Rate - Rises with inflammation/infection - Increased fibrinogen makes RBCs ‘stick together’ and thus fall faster - Thus if ESR rises the rate of fall is faster - ESR rises and falls SLOWLY (days to weeks) (- can have false positives/high results)
38
What is ESR
Erythrocyte Sedimentation Rate - Rises with inflammation/infection - Increased fibrinogen makes RBCs ‘stick together’ and thus fall faster - Thus if ESR rises the rate of fall is faster - ESR rises and falls SLOWLY (days to weeks)
39
What is CRP
C-reactive protein - Acute phase protein - Released in inflammation/infection - Prodcued by the liver in response to IL-6 (pro-inflammatory cytokine) - Rises and falls RAPIDLY
40
What are different parts of bone called (long bone)
Ends of bone are Epiphysis Then after epiphyseal line (where growth plate is) is Metaphysis or just Physis Main middle part of bone is Diaphysis
41
What are the different zones of the growth plate
``` (Epiphysis) Germinal zone with stem cells Proliferative zone Zone of maturation Hypertrophic zone (Diaphysis with osteoblasts, bone and invading capillaries) ```
42
Which people most commonly have proximal epiphysis of femur broken off and where do they present pain
Young adolescents Overweight children Black Afro-caribean Present with knee pain Growth plate can be broken off preventing growth of bone
43
Developmental dysplasia of the hip aka CDH - what is it and what should it be in a normal hip
In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally.
44
How does sepsis quickly cause arthritis
Chondrolytis - almost immediate chondral destruction
45
Investigations of septic arthrits
Investigate: Bloods - White cell count, CRP (ESR) Radiographs *Joint aspirate - gram stain (poor sensitivity = may have infection but test may still be negative) and culture Do NOT give ABx (antibiotics) before sample sent to micro (joint aspirate)
46
Bones of hand/ carpal bones
https://teachmeanatomy.info/upper-limb/bones/bones-of-the-hand-carpals-metacarpals-and-phalanges/ From next to little and ring finger to thumb: Hamate Capitate Trapezoid Trapezium From proximal (next to wrist) of Trapezoid and Trapzeium round to small finger again: Scaphoid Lunate Triquetrum Pisiform (circular bone next to Triquetrum)
47
Examination of median nerve
Ask patient to make ok sign with hand
48
Where is sensation of median nerve in hand:
Front/palm of hand: Radial 3.5 digits (includes thumb) and palm of hand below these digits Back of hand: Top/distal half of index and middle finger Top/distal half and radial half of that of ring finger (see diagram if dont understand)
49
Where is sensation of ulnar nerve in hand
Front and back of hand: | Ulnar 1.5 digits and palm or non digit part of hand below these digits
50
Where is sensation of radial nerve in hand
Back of hand: Back of/posterior thumb Back of hand below half of 3.5 digits supplied by median nerve
51
Test function of ulnar nerve
Abduct fingers: Ask patient to first turn hand prone and spread fingers apart to a maximal distance. Then, ask the patient to resist your attempts to squeeze the fingers together.
52
Test function of median nerve
Ask patient to touch the distal tip of the thumb to the distal tip of the fifth finger and hold it
53
Test function of radial nerve
Ask patient to extend the wrist (i.e. as if trying to stop traffic) and push back against you attempting to push the hand into the flexed position
54
Blood supply of thigh
Femoral artery | Give branch to Medial circumflex, lateral circumflex and lesser trochanter in thigh
55
Types of fracture or head of femur
Partly displaced Fully displaced (management changes depending on which e.g. dynamic hip screw as one example of replacement)
56
What 3 things need to be done in general with any hip or knee or any other injury
Reduce Stabilise Rehabilitate
57
4 stages of fracture healing
Haematoma formation (inflammatory phase and granulation tissue is formed) Fibrocartilaginous (soft) callus formation Bony (hard) callus formation Bone remodelling
58
Important cytokines produced in haematoma formation
IL-1, 6, 10, 12 TGF-beta Platelet derived growth factor
59
Why should you not give NSAIDs to patients with fractures
NSAIDs inhibit COX2 pathway | COX2 essential for osteoblast differentiation
60
What cells secrete cartilage
Chondrocytes
61
Where does cauda equina form from
Spinal cord ends with conus which ends at L1, at which the cauda equina starts
62
What can result from cauda equina disease on bladder
Compression means parasympathetic control is inhibited. Outer sphincter cant relax (and detrusor muscles cant contract) so get retention - overflow incontinence (cant feel need to go)
63
Cinical presentation of cauda euqina syndrome
``` Low back pain. Bilateral sciatica. Lower limb motor weakness and sensory deficit (saddle anaesthesia). Bowel and/or bladder dysfunction. Sexual dysfunction. ```
64
Causes of cauda equina syndrome
Herniation of a lumbar disc (usually L4,L5 / L5,S1). Tumour. Trauma. Infection.
65
Diagnostic tests of cauda equina syndrome
Clinical MRI PRE: sphincter tone
66
Treatment of cauda equina syndrome
Immediate surgical decompression, removal of causative agent
67
Main treatment of osteoporosis
Bisphosphonates - inhibit osteoclasts
68
Types of bisphosphonates
Nitrogen containing | Non-nitrogen containing
69
How do nitrogen containing bisphosphonates work
Inhibit formation of a brush border so osteoclasts can't function as well to resorb bone
70
How do non-nitrogen containing bisphosphonates work
Produce toxic ATP which induces apoptosis
71
Name treatment of osteoporosis except bisphosphonates
Denosumab - binds to/inhibits RANKL | Osteobalsts secrete RANK Ligand which activate osteoclasts

Medicine Phase 2a MSK and Rheumatology (18 decks)

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