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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
Q

Adult bone composition

A

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

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26
Q

What % of all protein in organic matrix is Type 1 collagen

A

90%

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27
Q

What is function of mineral part of bone composition

A

hydroxyapatite crystals

STIFFNESS

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28
Q

What is function of collagen in bone composition

A

ELASTICITY

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29
Q

3 functions of a joint

A

Allow movement in 3 dimensions
Bear weight
Transfer load evenly to the MSK system

30
Q

Types of joint

A

Fibrous
Cartilaginous
Synovial

31
Q

Example of fibrous joint

A

Teeth sockets

32
Q

Example of cartilaginous joint

A

Intervertebral discs

33
Q

Examples of synovial joints

A

Metacarpophalangeal

Knee

34
Q

What is a synovial joint

A

Articulating bones separated by a fluid filled cavity (most joints of the body fit this category)

35
Q

Main features of a synovial joint

A

Articular cartilage
Joint capsule - inner layer is the synovial membrane
Joint (synovial) cavity - space filled with synovial fluid
Synovial fluid
Reinforcing ligaments

36
Q

Some synovial joints like the knee also contain bursae and menisci, what are these

A 
Bursae = fluid filled sacs lined by synovial membrane
Menisci = discs of fibrocartilage
37
Q

What is ESR

A

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
Q

What is ESR

A

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
Q

What is CRP

A

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
Q

What are different parts of bone called (long bone)

A

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
Q

What are the different zones of the growth plate

A 
(Epiphysis)
Germinal zone with stem cells
Proliferative zone
Zone of maturation
Hypertrophic zone
(Diaphysis with osteoblasts, bone and invading capillaries)
42
Q

Which people most commonly have proximal epiphysis of femur broken off and where do they present pain

A

Young adolescents
Overweight children
Black Afro-caribean

Present with knee pain

Growth plate can be broken off preventing growth of bone

43
Q

Developmental dysplasia of the hip aka CDH - what is it and what should it be in a normal hip

A

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
Q

How does sepsis quickly cause arthritis

A

Chondrolytis - almost immediate chondral destruction

45
Q

Investigations of septic arthrits

A

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
Q

Bones of hand/ carpal bones

A

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
Q

Examination of median nerve

A

Ask patient to make ok sign with hand

48
Q

Where is sensation of median nerve in hand:

A

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
Q

Where is sensation of ulnar nerve in hand

A

Front and back of hand:

Ulnar 1.5 digits and palm or non digit part of hand below these digits

50
Q

Where is sensation of radial nerve in hand

A

Back of hand:
Back of/posterior thumb
Back of hand below half of 3.5 digits supplied by median nerve

51
Q

Test function of ulnar nerve

A

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
Q

Test function of median nerve

A

Ask patient to touch the distal tip of the thumb to the distal tip of the fifth finger and hold it

53
Q

Test function of radial nerve

A

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
Q

Blood supply of thigh

A

Femoral artery

Give branch to Medial circumflex, lateral circumflex and lesser trochanter in thigh

55
Q

Types of fracture or head of femur

A

Partly displaced
Fully displaced
(management changes depending on which e.g. dynamic hip screw as one example of replacement)

56
Q

What 3 things need to be done in general with any hip or knee or any other injury

A

Reduce
Stabilise
Rehabilitate

57
Q

4 stages of fracture healing

A

Haematoma formation (inflammatory phase and granulation tissue is formed)
Fibrocartilaginous (soft) callus formation
Bony (hard) callus formation
Bone remodelling

58
Q

Important cytokines produced in haematoma formation

A

IL-1, 6, 10, 12
TGF-beta
Platelet derived growth factor

59
Q

Why should you not give NSAIDs to patients with fractures

A

NSAIDs inhibit COX2 pathway

COX2 essential for osteoblast differentiation

60
Q

What cells secrete cartilage

A

Chondrocytes

61
Q

Where does cauda equina form from

A

Spinal cord ends with conus which ends at L1, at which the cauda equina starts

62
Q

What can result from cauda equina disease on bladder

A

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
Q

Cinical presentation of cauda euqina syndrome

A 
Low back pain. 
Bilateral sciatica. 
Lower limb motor weakness and sensory deficit (saddle anaesthesia). 
Bowel and/or bladder dysfunction. 
Sexual dysfunction.
64
Q

Causes of cauda equina syndrome

A

Herniation of a lumbar disc (usually L4,L5 / L5,S1). Tumour. Trauma. Infection.

65
Q

Diagnostic tests of cauda equina syndrome

A

Clinical
MRI
PRE: sphincter tone

66
Q

Treatment of cauda equina syndrome

A

Immediate surgical decompression, removal of causative agent

67
Q

Main treatment of osteoporosis

A

Bisphosphonates - inhibit osteoclasts

68
Q

Types of bisphosphonates

A

Nitrogen containing

Non-nitrogen containing

69
Q

How do nitrogen containing bisphosphonates work

A

Inhibit formation of a brush border so osteoclasts can’t function as well to resorb bone

70
Q

How do non-nitrogen containing bisphosphonates work

A

Produce toxic ATP which induces apoptosis

71
Q

Name treatment of osteoporosis except bisphosphonates

A

Denosumab - binds to/inhibits RANKL

Osteobalsts secrete RANK Ligand which activate osteoclasts

Medicine Phase 2a MSK and Rheumatology (18 decks)

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