LOCO2 Flashcards

1
Q

Define volkman contracture [1]

A

Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.

The condition is also called Volkmann ischemic contracture.

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2
Q

How would a S. aureus infection appear in culture? [1]

A

Appears as grape like clusters, on trypticase soy agar plate produces yellow pigment: staphlyoxanthin

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3
Q

Common consequences of osetomeylitis? [2]
Rare consequences of osetomeylitis? [2]

A

Common:
* Local bone loss
* Persistent drainage through sinuses

Rare
* Squamous cell carcinoma
* Amyloidosis

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4
Q

Risk factors for osteomyelitis? [6]

A

Age
Malnutrition
Impairment of local vascular blood supply:
* Diabetes mellitus
* Venous stasis
* Radiation fibrosis (radiation therapy damaging blood vessels)
* Sickle cell disease (due to crisis)

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5
Q

Describe how you diagnose osteomyelitis [4]

How does it appear on ultrasound? [2]

A

(same as SA)
Local non-specific pain
Elevated neutrophil count (< 50% of cases)
Elevated ESR

Ultrasound:
* Cortical thinning
* Inflamation
* Periosteal lifiting: abscess lifting it off

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6
Q

How do you treat chronic osteomyelitis? [5]

A

Puncture drainage if abscessed

Surgical debridement

Reconstruct bone (allograft/ autograft)

Antibiotics (4-6wks, at least 2 IV):
* Vancomyocin cement beads
* Flucoxallin (gram +ve)
* Clindamycin
* Piperacillin
* Ciprofloxacilin

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7
Q

Describe the pathophysiology of scalded skin syndrome [2]

A

Exotoxins are proteases that destroy desmosomes holding keratinocytes in granulosum and spinosum layers together:

Causes widespread fluid filled blisters that easily break

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8
Q

Therapy for Necrotising fascitis? [3]

A

Treatment:
* Surgical debridement
* Empiric antibiotics
* Hyperbaric oxygen (Add on therapy)

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9
Q

Treatment for HPV: viral warts and veruccas? [5]

A

Topical salicylic acid
**Fluorouracil cream **
Cryosurgery
Surgical curettage
Laser treatment (CO2 laser 582nm)

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10
Q

Describe what Postherpetic neuralgia (PHN) is [2]

A

Unpredictable complication of varicella zoster virus- (VZV-) induced herpes zoster (HZ) which often occurs in elderly and immunocompromised persons

The main symptom of post-herpetic neuralgia is intermittent or continuous nerve pain in an area of your skin previously affected by shingles.

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11
Q

Treatment for leprosy? [3]

A

Rifampicin, dapsone and clofazimine

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12
Q

State what the acetabular angle should be for each of the following ages?

0 - 1 year old < []
1 > 4 year old < []
> 4 year old < []

A

The acetabular angle should decrease with age:

0 - 1 year old < 34
1 > 4 year old < 28
> 4 year old < 25

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13
Q

Explain the pathophysiology of heterotopic bone [3]

A

Fibroblasts, osteoblasts and chondroblasts come from same precursors

Tendon fibroblast differentiate into chondrocytes / hypertrophic chondrocyte and osteoblasts via COX-2

Pro-inflammtory cytokines like prostaglandin E2 induces osteoblasts to differentiate

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14
Q

Describe enthesitis pathogenesis:

Normal enthesitis insertion occurs at a location with lots of which structure? [1]

How does this influence enthesitis pathogenesis? [3]

A

Normal enthesis inserts into porous bone at a location with lots of small transcortical vessels (TCV)

Mechanical trauma; TCVs become inflammed:
* Vasodilation
* Efflux of immune cells (neutrophils)
* Osteoblasts form bone at enthesis - causes bone to be formed

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15
Q

Enthesitis is associated with which three conditions? [3]

A

Ankylosing spondylitis
Psoriatic arthritis
IBD

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16
Q

How do you treat enthesitis:

  • If mechanical? [2]
  • If Inflammatory [5]
A

Mechanical:
* RICE
* NDSAIDs

Inflammatory:
* Sulfasalazine
* Methotrexate
* Anti-TNF therapy (restricted use for severe autoimmune enthetitis)
* Local radiotherapy
* Corticosteroid injection
* Hyperosmolar dextrose (initiates proliferation of intrinsic fibroblasts - race to repair damage c.f. osteoblasts)

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17
Q

DMARD treatments for SLE? [4]

A

Cylcophosphamide
Mycophenolate mofetil
Methotrexate
Tacrolimus

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18
Q

Describe two biological DMARDs for SLE? [2]

A

Belimubab: inhibits BAFF (B cell activating factor)
Rituximab: CD20 blocker

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19
Q

How can you treat resistant urticaria and asthma?

A

Omalizumab: binds free IgE in the serum, forming trimers and hexamers

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20
Q

Treatment of Pemphigus Vulgaris? [3]

A

Oral steroids

Immunosuppresion: mycophenolate mofetil or azathioprine

Rituximab (targeting CD20 on B cells)

21
Q

Describe the features of Immune Complex Mediated Vasculitis [4]

A

Antigen and antibody form an immune complex

This causes production of proteins and aggregation of platelets into micro thrombi

This results in:
* Deposition of fibrin
* Leaky vessel and extravasation of blood and oedema.
* The proteases degrade vessel BMZ
* Necrosis of the vessel wall

22
Q

Allergic Contact Dermatitis pathogenesis? [3]

A

Promotion of Th1 response:

  • Secretion of IL2, IL3, GM-CSF, IFNg and TNF
  • This promotes a macrophage rich response
  • Causes inflammation to the skin around 48 hours to 72 hours after the challenge
23
Q

New drug class treatments for AA and Vitiligo? [1]

Name an example drug [1]

A

JAK Inhibitors

E.g Ruxolitinib

24
Q

Pemphigus Vulgaris occurs due to autoantibodies directed at a cadherin-type epithelial cell adhesion molecule called what? [1]§

A

Desmoglein 3

25
Q

Oral steroids; mycophenolate mofetil or azathioprine and / or Rituximab would be used to treat which skin condition? [1]

A

Pemphis vulgaris

26
Q

Granuloma formation is a which type of hypersensitivity reaction?

Type 1
Type 2
Type 3
Type 4

A

Type 4

27
Q

Which nerves [2] and muscles [2] are at risk of from axillary lymph node clearance? [2]

A

Injury to thoracodorsal nerve; Latissimus dorsi

Injury to long thoracic nerve; serratus anterior - causes winging scapula

28
Q

Which of the following is the glenoid labrum?

A
B
C
D
E

A

Which of the following is the glenoid labrum?

A
B
C
D
E

29
Q

Which of the following is the acromion?

A
B
C
D
E

A

Which of the following is the acromion?

A
B
C
D
E

30
Q

Which of the following is the scapula?

A
B
C
D
E

A

Which of the following is the scapula?

A
B
C
D
E

31
Q

Which of the following is the supraspinatus muscle?

A
B
C
D
E

A

Which of the following is the supraspinatus muscle?

A
B
C
D
E

32
Q

Which of the following is the glenoid labrum

A
B
C
D
E

A

Which of the following is the glenoid labrum

A
B
C
D
E

33
Q

Which of the following is the glenoid cavity

A
B
C
D
E

A

Which of the following is the glenoid cavity

A
B
C
D
E

34
Q

Label A-C

A

A: Coracobrachialis muscle
B: Teres major
C: Medial head of triceps brachii muscle

35
Q

Which of the following drug treatment causes muscle damage by creating lysosomes in muscle tissue

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

A

Hydroxychloroquine

36
Q

Which of the following drug treatment causes dose dependent type 2 atrophy

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

A

Corticosteroids

37
Q

Which of the following is treatment for DMD

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

A

Which of the following is treatment for DMD

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

38
Q

This sign tests which nerve

Radial
Median
Axillary
Ulnar

A

Median

39
Q

How does a patient with dermatoymositis present? [4]

A

Rash around eyes
Peri-orbital oedema
V sign of neck due to increased photosynsetivity
Gottron’s sign

40
Q

Which muscular dystrophies are the most common? [2]

Describe their inheritance [1]

A

Duchenne & Becke Muscular Dystrophies;

X-linked - recessive

41
Q

Which muscle groups are most at risk in Duchenne MD? [2]

What does this mean clinically? [2]

A

Respiratory muscles & diaphragm; die from resp. failure

Dilated cardiomyopathy occurs; heart failure

42
Q

How does early DMD appear histologically? [3]

A

Fibre size variation
endomysial & perimysium fibrosis
Degenerating muscle fibres undergoing myophagocytosis

43
Q

How does late DMD appear histologically? [2]

A

Loss of muscle; atrophy of fibres and death - replaced with fibrotic material and fat

44
Q

Treatment for DMD? [2]

A

Prednisilone
Gene alterations

45
Q

How do statins affect 10% muscle? [2]

A

Rhabdomyolysis; get vacuoles in type 2 muscle fibres

46
Q

Name and describe how two therapeutic drugs cause myopathy [2]

A

Corticosteroids; cause dose dependent type 2 atrophy

Hydroxychloroquine: not dose dependent atrophy; lysosomes damaged

Hydroxychloroquine causing lysosome damage

47
Q

Treatment options for fibromyalgia? [4]

A

Amitriptyline (TCA)
Fluxetine (SSRI)
Exercise
Complementary therapy

48
Q

What type of fracture causes superior gluteal nerve damage? [1]

A

sacroiliac joint disruption