LOCO2 Flashcards
Define volkman contracture [1]
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.
How would a S. aureus infection appear in culture? [1]
Appears as grape like clusters, on trypticase soy agar plate produces yellow pigment: staphlyoxanthin
Common consequences of osetomeylitis? [2]
Rare consequences of osetomeylitis? [2]
Common:
* Local bone loss
* Persistent drainage through sinuses
Rare
* Squamous cell carcinoma
* Amyloidosis
Risk factors for osteomyelitis? [6]
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)
Describe how you diagnose osteomyelitis [4]
How does it appear on ultrasound? [2]
(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
How do you treat chronic osteomyelitis? [5]
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
Describe the pathophysiology of scalded skin syndrome [2]
Exotoxins are proteases that destroy desmosomes holding keratinocytes in granulosum and spinosum layers together:
Causes widespread fluid filled blisters that easily break
Therapy for Necrotising fascitis? [3]
Treatment:
* Surgical debridement
* Empiric antibiotics
* Hyperbaric oxygen (Add on therapy)
Treatment for HPV: viral warts and veruccas? [5]
Topical salicylic acid
**Fluorouracil cream **
Cryosurgery
Surgical curettage
Laser treatment (CO2 laser 582nm)
Describe what Postherpetic neuralgia (PHN) is [2]
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.
Treatment for leprosy? [3]
Rifampicin, dapsone and clofazimine
State what the acetabular angle should be for each of the following ages?
0 - 1 year old < []
1 > 4 year old < []
> 4 year old < []
The acetabular angle should decrease with age:
0 - 1 year old < 34
1 > 4 year old < 28
> 4 year old < 25
Explain the pathophysiology of heterotopic bone [3]
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
Describe enthesitis pathogenesis:
Normal enthesitis insertion occurs at a location with lots of which structure? [1]
How does this influence enthesitis pathogenesis? [3]
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
Enthesitis is associated with which three conditions? [3]
Ankylosing spondylitis
Psoriatic arthritis
IBD
How do you treat enthesitis:
- If mechanical? [2]
- If Inflammatory [5]
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)
DMARD treatments for SLE? [4]
Cylcophosphamide
Mycophenolate mofetil
Methotrexate
Tacrolimus
Describe two biological DMARDs for SLE? [2]
Belimubab: inhibits BAFF (B cell activating factor)
Rituximab: CD20 blocker
How can you treat resistant urticaria and asthma?
Omalizumab: binds free IgE in the serum, forming trimers and hexamers
Treatment of Pemphigus Vulgaris? [3]
Oral steroids
Immunosuppresion: mycophenolate mofetil or azathioprine
Rituximab (targeting CD20 on B cells)
Describe the features of Immune Complex Mediated Vasculitis [4]
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
Allergic Contact Dermatitis pathogenesis? [3]
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
New drug class treatments for AA and Vitiligo? [1]
Name an example drug [1]
JAK Inhibitors
E.g Ruxolitinib
Pemphigus Vulgaris occurs due to autoantibodies directed at a cadherin-type epithelial cell adhesion molecule called what? [1]§
Desmoglein 3
Oral steroids; mycophenolate mofetil or azathioprine and / or Rituximab would be used to treat which skin condition? [1]
Pemphis vulgaris
Granuloma formation is a which type of hypersensitivity reaction?
Type 1
Type 2
Type 3
Type 4
Type 4
Which nerves [2] and muscles [2] are at risk of from axillary lymph node clearance? [2]
Injury to thoracodorsal nerve; Latissimus dorsi
Injury to long thoracic nerve; serratus anterior - causes winging scapula
Which of the following is the glenoid labrum?
A
B
C
D
E
Which of the following is the glenoid labrum?
A
B
C
D
E
Which of the following is the acromion?
A
B
C
D
E
Which of the following is the acromion?
A
B
C
D
E
Which of the following is the scapula?
A
B
C
D
E
Which of the following is the scapula?
A
B
C
D
E
Which of the following is the supraspinatus muscle?
A
B
C
D
E
Which of the following is the supraspinatus muscle?
A
B
C
D
E
Which of the following is the glenoid labrum
A
B
C
D
E
Which of the following is the glenoid labrum
A
B
C
D
E
Which of the following is the glenoid cavity
A
B
C
D
E
Which of the following is the glenoid cavity
A
B
C
D
E
Label A-C
A: Coracobrachialis muscle
B: Teres major
C: Medial head of triceps brachii muscle
Which of the following drug treatment causes muscle damage by creating lysosomes in muscle tissue
Statins
Hydroxychloroquine
Corticosteroids
Prednisilone
Hydroxychloroquine
Which of the following drug treatment causes dose dependent type 2 atrophy
Statins
Hydroxychloroquine
Corticosteroids
Prednisilone
Corticosteroids
Which of the following is treatment for DMD
Statins
Hydroxychloroquine
Corticosteroids
Prednisilone
Which of the following is treatment for DMD
Statins
Hydroxychloroquine
Corticosteroids
Prednisilone
This sign tests which nerve
Radial
Median
Axillary
Ulnar
Median
How does a patient with dermatoymositis present? [4]
Rash around eyes
Peri-orbital oedema
V sign of neck due to increased photosynsetivity
Gottron’s sign
Which muscular dystrophies are the most common? [2]
Describe their inheritance [1]
Duchenne & Becke Muscular Dystrophies;
X-linked - recessive
Which muscle groups are most at risk in Duchenne MD? [2]
What does this mean clinically? [2]
Respiratory muscles & diaphragm; die from resp. failure
Dilated cardiomyopathy occurs; heart failure
How does early DMD appear histologically? [3]
Fibre size variation
endomysial & perimysium fibrosis
Degenerating muscle fibres undergoing myophagocytosis
How does late DMD appear histologically? [2]
Loss of muscle; atrophy of fibres and death - replaced with fibrotic material and fat
Treatment for DMD? [2]
Prednisilone
Gene alterations
How do statins affect 10% muscle? [2]
Rhabdomyolysis; get vacuoles in type 2 muscle fibres
Name and describe how two therapeutic drugs cause myopathy [2]
Corticosteroids; cause dose dependent type 2 atrophy
Hydroxychloroquine: not dose dependent atrophy; lysosomes damaged
Hydroxychloroquine causing lysosome damage
Treatment options for fibromyalgia? [4]
Amitriptyline (TCA)
Fluxetine (SSRI)
Exercise
Complementary therapy
What type of fracture causes superior gluteal nerve damage? [1]
sacroiliac joint disruption
