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Year 2 Loco > LOCO2 OVERVIEW > Flashcards

LOCO2 OVERVIEW Flashcards

1
Q

Osteoclasts

A

Cell that breaks down the bone - secrete digestive enzymes

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2
Q

How to recognise osteoclast from image

A

Sits in a depression
LARGE cells
Multinucleated

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3
Q

NB NOT LOCO - where is collagen type III found?

A

Reticular fibres - supporting network of tissues for e.g. liver, bone marrow

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4
Q

Collagen type found in bone

A

Collagen I

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5
Q

Components of ECM of bone

A

Collagen I and proteoglycans

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6
Q

Osteoclast is a relative of which cell type?

A

Macrophage

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7
Q

Osteoprogenitor cells

A

Can differentiate into osteblasts

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8
Q

Osteoprogenitor cells - cell type

A

Mesenchymal cells

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9
Q

Where are osteoprogenitor cells found?

A

Endosteum

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10
Q

What is the endosteum?

A

Thin, vascular membrane of connective tissue lining the inner component of the bone

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11
Q

Recognise osteoblast from image

A

Cuboidal like cell

Sat at the surface of the bone matrix

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12
Q

Recognise osteocyte from image

A

Little black dots - look like pits

Sat within lacunae (surrounds the black dot)

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13
Q

Types of bone

A

Lamellar (mature) - have the cortical and the cancellous/spongy/trabecuale
Woven - immature bone

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14
Q

What is found within trabeculae bone?

A

Bone marrow - important for production of RBCs

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15
Q

Why is woven bone weak?

A

Mechanically weak due to random organisation of the collage fibres
Laid down very quickly - lack of organisation

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16
Q

Organic vs. inorganic components of bone

A

35-40% organic ECM - proteoglycans, collagen I, cytokines
60% - inorganic salt - calcium hydroxyapatite
5% - water

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17
Q

Canaliculi - what are they and what cell are they found on?

A

Little black processes present osteocytes - these sense the surrounding environment for any signs of stress that the surrounding bone may be under

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18
Q

‘Scerostin’

A

Secreted by happy osteocytes that are under no stress

Prevents production of new bone by osteoblasts

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19
Q

Effect of PTH on sclerostin

A

PTH - stress hormone released by osteocyte
Inhibits secretion of sclerostin
Induces bone production

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20
Q

RANKL

A

Ligand that stimulates bone resorption

Produced by osteocytes and osteoblasts

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21
Q

RANK

A

Receptor for RANK found on osteclasts and precursors

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22
Q

‘Osteoid’

A

Unmineralised bone matrix

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23
Q

How is osteoid mineralised and when?

A

By calcium hydroxyapatite - about one week after it is laid down

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24
Q

How long does bone remodelling take from start to finish?

A

About three months

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25
Q

Normal serum calcium levels

A

2.2-2.6mmol/L

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26
Q

What is the recommended daily intake of calcium?

A

500-1300mg

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27
Q

Normal plasma concentration of phosphate

A

0.8-1.5mmol/L

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28
Q

PTH receptor found on which cell?

A

Osteoblast

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29
Q

Action of PTH on osteoblast?

A

Release of RANKL - acts of onsteoclasts

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30
Q

Action of 1,25-dihydroxyvitamin D in calcium regulation

A

Increases calcium reabsorption from the gut

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31
Q

Calcitonin

A

Released from thyroid gland when calcium levels are too high (>2.6mmol/L)

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32
Q

‘Osteoporosis’

A

Reduced bone density due to reduced levels of tissue resulting from calcium or vitamin D deficiency

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33
Q

What does a DEXA scan measure?

A

Bone density/bone mass

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34
Q

Mechanism of action of bisphosphonates

A

Drug incorporated into the bone when taken
Taken up into osteoclasts as they break down the bone
Promotes apoptosis of the osteoclasts

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35
Q

Teriparatide

A

Short term PTH - increases action of osteoblasts - so builds up bone for osteoporosis
NB. PTH activates osteoblasts in short term and osteoclasts in long term

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36
Q

Denozumab

A

Antibody for osteoporosis treatment

Binds to RANKL to prevent it from binding to osteoclasts - reduces the action of osteoclasts

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37
Q

‘Osteomalacia’

A

Lack of bone mineralisation due to insufficient levels of vitamin D
Insufficient calcium and phosphate to mineralise the bone

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38
Q

Define pseudofractures

A

Regions of unmineralised bone (osteoid)

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39
Q

How much sun exposure should an individual have to get sufficient levels of vitamin D?

A

15 minutes of sun on the hands and face 2-3 times a week

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40
Q

Treatment of osteoporosis

A

Vitamin D and calcium supplements
HRT for menopausal women
Bisphosphonates
Antibodies

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41
Q

Five foods high in calcium

A 
Bread
Leafy green veg
Beans and pulses
Milk 
Dried fruit
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42
Q

Osteosarcoma and Paget’s disease

A

Osteosarcoma is a rare complication of Paget’s - due to the high stage of compensatory proliferation of woven bone

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43
Q

‘Paget’s disease’

A

Disruption to the cycle of bone renewal and repair

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44
Q

Type a vs. Type b synoviocytes

A

a

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45
Q

Tissue type of the subintima

A

a

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46
Q

Composition of synovial fluid

A

a

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47
Q

Leucocytes present in RA

A

Lymphocytes - infiltrate the synovial membrane

Neutrophils - enter the synovial fluid

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48
Q

Leucocytes present in RA

A

Lymphocytes - infiltrate the synovial membrane

Neutrophils - enter the synovial fluid

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49
Q

Components responsible for the viscosity of hyaluronic acid

A

a

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50
Q

Function of synovial fluid

A

a

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51
Q

Antibodies produced in RA and their action?

A

Anti-citrullinated protein antibodies (ACPA)

Stimulates osteoclast differentiation and proliferation

52
Q

DKK-1 and their actions

A

Produced by Th17 where there are no osteoclasts - induces production of sclerostin - osteoblasts are switched off

53
Q

Action of neutrophils in synovial fluid

A

Respiratory burst - production of free radicals - damage to hyaluronic acid, synovial fluid, subchondral exposed bone, articular cartialge

54
Q

Action of neutrophils in synovial fluid

A

Respiratory burst - production of free radicals - damage to hyaluronic acid, synovial fluid, subchondral exposed bone, articular cartialge

55
Q

Prevalence of RA

A

1%

56
Q

RA symmetrical or non-symmetrical?

A

Symmetrical

57
Q

Joints affected in the hands in RA?

A

MCP and PIP joints

58
Q

First line management for RA

A

Pain relief - analgesic ladder

59
Q

First line management for RA

A

Pain relief - analgesic ladder

60
Q

Gold standard conventional DMARD

A

Methotrexate

61
Q

Mechanism of action of conventional DMARDs

A

Immune suppressants

62
Q

Mechanism of action of methotrexate

A

Folic acid/folate inhibitor - NOT to be used in pregnant women
Targets any proliferating cells - not just the proliferating immune cells SO has systemic effects

63
Q

How long before methotrexate has an effect?

A

3-12 weeks

64
Q

Adverse effects of methotrexate

A

Hepatic problems - liver failure

Stem cell problems

65
Q

Direct action of methotrexate

A

Dihydrofolate synthetase

66
Q

Indirect action of methotrexate

A

Thymidate synthetase

67
Q

Indirect action of methotrexate

A

Thymidate synthetase

68
Q

Main site of action of sulfasalazine and why?

A

a

69
Q

Metabolite of sulfasalazine and site of action of this

A

a

70
Q

Hydroxychloroquine and mechanism of action

A

Animalarial
Accumulates in lysosomes to reduce pH - reduces protein modifications
Blocks toll-like receptor 9 - reduced activation of dendritic cells

71
Q

Hydroxychloroquine should be avoided in who?

A

In patients with psoriatic arthritis - makes their skin condition worse

72
Q

Patients that cannot take methotrexate should be given what?

A

Leflunomide

73
Q

How long for gold to have an effect in the treatment of RA?

A

4-6 months

74
Q

Name three biological TNFa blockers

A

Entanercept
Infliximab
Adalumumab

75
Q

Name a biological that has an action of B cells nad what is the target?

A

Rituximab

CD20 on B cells

76
Q

Name a biological that has an action on T cells and what is the target?

A

Abatacept

CD28 on T cells

77
Q

Nerve roots of the femoral nerve

A

L2, L3, L4

78
Q

Nerve roots of the obturator nerve

A

L2, L3, L4

79
Q

Nerve roots of the sciatic nerve

A

L5, S1, S2

80
Q

Order of nerves in the lumbar plexus

A 
Subcostal 
Iliohypogastric
Ilioinguinal 
Genitofemoral
Lateral cutaneous
Obturator 
Femoral
81
Q

Nerve roots of the lumbar plexus

A

L1-L4

82
Q

Borders of femoral triangle

A

Inguinal ligament
Sartorius
Adductor longus

83
Q

Three bones involved in the ankle joint

A

Tibia
Fibula
Tallus

84
Q

Name of heel bone

A

Calcaneus

85
Q

On which side of the arm are the cephalic and basilic veins located?

A

Cephalic - radial side

Basilic - ulnar side

86
Q

Muscles responsible for abduction of the arm

A

Supraspinatous - first ten degrees

Deltoid - rest of the movement

87
Q

Nerve roots of the brachial plexus

A

C5-T1

88
Q

Two nerves that can cause winging of the scapula and what do these innervate?

A

Long thoracic nerve - serratous anterior

Spinal accessory nerve - trapezius

89
Q

Presentation of radial nerve damage

A

Wrist drop

90
Q

Presentation of median nerve damage

A

Hand of bennidiction

91
Q

Define osteoid

A

Unmineralised organic component of bone

92
Q

Presentation of Duputren’s contracture vs. trigger finger

A

Trigger finger closer to the palm of the hand

93
Q

Dupuytren’s contracture is common in who?

A 
Men 
Heavy drinkers
Diabetes
Smokers 
Classically: HEAVY DRINKERS
94
Q

What is Dupuytren’s contracture?

A

Palmar aponeurosis

95
Q

Protein involved in genetic aspect of OA

A

HMGB2 - early onset OA

96
Q

Chondromalacia and how does this occur in OA?

A

Softening cartilage
Lack of proteoglycans
Increased water moves into the collagen and causes chondromalacia
NB. water than moves out again due to lack of proteoglycans to hold the water in place

97
Q

What happens following chondromalacia of the cartilage

A

Chondromalacia followed by fibrilation (and then erosion and cracking and then eburnation)

98
Q

Collagen type found in bone

A

Collagen type I

99
Q

Collagen type found in articular hyaline cartilage of synovial joint?

A

Mainly collagen type II

Deeper radial layer - collagen type X

100
Q

Main proteoglycan in the body?

A

Aggrecan

101
Q

Function of proteoglycans in articular cartilage?

A

Negative side chains - attracts water from the synovial fluid

102
Q

OA bilateral or unilateral and why?

A

OA can be either - starts of as unilateral - person uses joints on the other side of the body to compensate for their weakening joints - becomes bilateral

103
Q

OA or RA more common?

A

OA

104
Q

Age of onset OA vs. RA

A

OA - rare prior to 45 years

RA - peak age of onset between 20 and 40 years

105
Q

Almost everyone develops OA or RA?

A

OA

106
Q

Morning joint stiffness presentation in OA

A

Tender and aching joints - don’t tend to be that swollen
Morning stiffness lasting less than one hour
Stiffness returns at the end of the day/after periods of activity

107
Q

Morning joint stiffness presentation in RA

A

Very stiff, swollen, inflamed joints
Morning stiffness lasting more than one hour
Due to lack of movement in the night and formation of gel in the synovial fluid

108
Q

Systemic symptoms of OA vs. RA

A

OA - no systemic symptoms

RA - feeling ill and fatigue

109
Q

Heberden’s vs. Bouchard’s nodes

A

Both are osteophyte formation in OA
Bouchard’s - PIP
Heberden’s - DIP

110
Q

Four signs of OA on x-ray

A

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Trabeculae fractures

111
Q

Effect of IL17 on synovial macrophages

A

IL17 causes a switch in the phenotype of synovial macrophages to osteotype macrophages

112
Q

Primary curves

A

Kyphoses - thoracic and sacral

113
Q

Secondary curves

A

Lordoses - lumbar and cervical

114
Q

Increased thoracic kyphoses - three causes

A

Osteoporosis
Erosion
Fracture

115
Q

Treatment of osteoporotic kyphosis

A

Vertebral augmentation

116
Q

Scheurmann’s disease + presentation

A

Thoracic kyphosis present in adolescants

Pain in the back and difficulty breathing

117
Q

Cause of lumbar lordosis x2

A

Weakness of the trunk muscles

Psoas dysfunction

118
Q

Dermatomes of sciatic nerve

A

L5 and S1

119
Q

Other than at the back - common presentation of flat back syndrome

A

Slight bend in the knees (due to internal rotation of the thigh)

120
Q

Schmall’s does and condition in which these are present?

A

Depression in the vertebra at the nucleus propulsus due to Scheurmann’s disease

121
Q

Most common region for scoliosis

A

Thoraco-lumbar region - thoracic abnormal curve and this then compensated for by lumbar curve

122
Q

Different stages of scoliosis and when you treat these

A

<20 degrees - do nothing
20 - 40 degrees - wear a brace
>40 degrees - surgical options

123
Q

‘Syndesmophyte’

A

Osteophyte present at the verterbral column

NB. Osteophyte technically only present at synovial joints

124
Q

‘Cauda equina syndrome’

A

Posterior dislocation of vertebral body - compression of the cauda equina - multiple nerve endings

125
Q

‘Discectomy/

A

Removal of the IV disc

126
Q

‘Laminectomy’

A

Removal of lamina of the spinous process

127
Q

‘DISH’

A

Diffuse idiopathic skeletal hyperostosis

Ossification of the anterior longitudinal ligament

Year 2 Loco (31 decks)

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