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Year 2 > Locomotor > Flashcards

Locomotor Flashcards

1
Q

If abducting the shoulder 180 degrees how much of the movement is from which joint?

A

120 degrees is from glenohumeral joint and 60 from the scapulothoracic joint

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2
Q

What nerve is affected if there is injury to the lattimus dorsi?

A

Thoracodorsal

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3
Q

What nerve is most at risk in fractures of the medial epicondyle?

A

Ulna

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4
Q

What sign do you get in ulna injuries?

A

Claw hand (clawing and flexion of 4th and 5th fingers)

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5
Q

In what nerve injury would you get loss of thenar muscles

A

median

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6
Q

What is the name of the test for collateral circulation in hand

A

Allan test

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7
Q

What does a disruption to Shenton’s line show?

A

NOF

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8
Q

What is the strongest ligament in the hip joint?

A

The ilio-femoral ligament (anterior)

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9
Q

What does a positive Tredelenburg test show?

A

Damage to superior gluteal nerve

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10
Q

What are the borders of the femoral triangle?

A

Inguinal ligament, sartorius, adductor longus

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11
Q

What is the unhappy triad?

A

PCL, ACL and medial meniscus

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12
Q

What nerve wraps around neck of fibula?

A

common peroneal

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13
Q

What does the common peroneal innervate and what do you get if its damaged?

A

Muscles of anterior and lateral compartment of the leg = foot drop.
And sensory to the dorsum of the foot

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14
Q

What nerve passes through the tarsal tunnel?

A

Tibial nerve

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15
Q

What type of collagen is bone?

A

Type 1

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16
Q

What is a romosozumab?osteoporosis

A

A monoclonal antibody inhibiting sclerostin (treats osteoporosis)

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17
Q

How do osteoclasts absorb bone?

A

They acidify a matrix area and the hydroxyapatite dissolves setting free Calcium

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18
Q

What do osteoblasts fill lacuna with?

A

Osteoid

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19
Q

How does calcitonin regulate calcium?

A

It lowers plasma ca2+ by directly inhibiting osteoclast activity, increasing excretion from kideny and inhibiting absorption from intestines

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20
Q

how does Cinacalcet work for secondary hyperparathyroidism?

A

It binds to allosteric site of calcium sensing receptor of parathyroid which increases the sensitivity of the receptor to calcium. Therefore reduces PTH

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21
Q

What does calcitrol do?

A

It is the active form of vit D and binds to Vit D receptor and induces genes necessary to maintain calcium reserves. It mainly increases uptake of calcium from intestines

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22
Q

What hormone counters PTH affect on vit D?

A

Fibroblast growth factor 23

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23
Q

When and where is FGF23 secreted?

A

By osteocytes and osteoblasts in response to increased calcitrol and dietary phopshate

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24
Q

A mutation in what gene causes x linked hypophosphatemia?

A

PHEX gene (causes rickets/osteomalacia)

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25
Q

What hormone does Growth Hormone stimulate release of?

A

IGF-1

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26
Q

What does IGF1 do to chondrocytes

A

Stimulates chondrocytes in epiphyseal plate to divide

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27
Q

What effect does oestrogen have on bone?

A

It directly stimulates bone formation and reduces the number and activity of osteoclasts

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28
Q

What is tendinosis?

A

Chronic injury of a tendon

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29
Q

For tendon healing, when is passive motion beneficial as opposed to cast immobilisation?

A

Beneficial for flexor tendon healing, detrimental for tendon to bone healing

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30
Q

What connecting fibres do you find in fibrous enthesis?

A

Sharpey fibers

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31
Q

When are fibrocartilage enthesis better than that fibrous enthesis?

A

In joints where theres going to be angle changes

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32
Q

What HLA is enthesitis associated with?

A

HLA B27

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33
Q

What co-morbid conditions are associated with enthesitis?

A

inflammatory bowel disease, psoriatic arthritis, ankylosing spondylitis

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34
Q

What’s the difference between enthesophytes and osteophytes?

A

Enthesophytes originate from insertion of ligament and tendons
Osteophytes originate from border of articular cartilage

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35
Q

What could be used for severe autoimmune enthesitis?

A

Anti TNF therapy

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36
Q

What is a treatment for De Quervian’s?

A

Shave down the radial styloid as it is caused by tendon sheath rubbing over styloid

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37
Q

What is an undifferentiated connective tissue disease?

A

Systematic Lupus Erythematosus

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38
Q

What type of hypersensitivity is lupus?

A

Type 3 - anti nuclear antigens against intra-nuclear proteins

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39
Q

What treatment inhibits B cell activating factor and is a treatment for SLE?

A

Belimumab

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40
Q

How does rituximab work for SLE?

A

It is a CD20 blocker (suppresses B cells)

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41
Q

Difference between a T score and a Z score?

A

T score = number of standard dev of the mean health 30 year old of same age
Z score = number of standard devs from someone of same age, gender and ethnicity

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42
Q

What type of bone is most affected by osteoporosis?

A

Trabecular bone eg vertebral bodies and femoral neck

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43
Q

How can teriparatide treat osteoporosis?

A

It is a portion of PTH. Intermittent PTH activates osteoblasts more than osteoclasts (once daily injections)

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44
Q
A
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45
Q

What are some complications of bisphosphonates?

A

Osteonecrosis of the jaw, atypical fractures eg subtrochanteric and femoral shaft fractures

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46
Q

How does romosozumab work for osteoporosis?

A

It is an antibody against sclerostin which leads to increased osteoblast activity

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47
Q

What would you find in lab results for osteomalacia (rickets)?

A

Low serum calcium and phosphate
High alkaline phosphotase

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48
Q

What is a characteristic finding of osteomalacia on xray?

A

Looser zones - pseudo fractures (areas of unmineralised bone)

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49
Q

What can you label bone with to check for mineralisation?

A

Tetracycline

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50
Q

What type of cartilage is the meniscus?

A

Fibrocartilage

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51
Q

What is the tide mark?

A

The line in which the cartilage changes from calcified to uncalcified

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52
Q

Articular cartilage is mainly type II collagen, but what is the other main type of collagen present particularly in the deep layers?

A

Collagen type X

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53
Q

A loss of expression of what can cause osteoarthritis?

A

HMGB2 = high mobility group protein 2 which is normally prominent in superficial zone and supports chondrocyte survival

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54
Q

Loss of what causes water to move in an out of the joint faster and leads to osteoarthritis

A

Proteoglycans

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55
Q

What are type A and type B synoviocytes?

A

Type A = bone mArrow derived macrophages
Type B = fibroBlast like connective tissue

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56
Q

How long would a normal string of synovial fluid be?

A

4-6cm

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57
Q

What is a key interleukin in RA that induces more osteoclasts, sensitises noiceptors and attracts neutrophils?

A

IL8

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58
Q

What CD4+ cells infiltrate in RA and what do they secrete?

A

Th17 and they secrete IL-17

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59
Q

What are the most numerous cells in synovial effusion in RA

A

neutrophils

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60
Q

What does seropostive RA mean?

A

They are ACPA positive

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61
Q

What are the strongest risk alleles for seropositive RA?

A

HLA-DRB1
PTPN22

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62
Q

What interleukins and cytokines are produced by macrophages and leak into blood stream in RA?

A

IL-1 and IL-6 and TNF alpha. TNF alpha important to remember

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63
Q

What type of anemia does RA usually cause?

A

Normochromic, normocytic anemia but can progress to hypochromic

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64
Q

What does citrullination mean?

A

It is when arginine is converted into citrulline and then the immune system might not recognise them as self antigens

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65
Q

What type of Ig is rheumatoid factor?

A

IgM antibody that targets the Fc domain of altered IgG

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66
Q

What does anti-CCP target?

A

Citrullinated proteins

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67
Q

What protein can cause scelrostin to be released which inhibits osteoblast differentiation?

A

DKK-1

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68
Q

What antibodies are associated with severe, erosive RA despite treatment with TNF inhibitors?

A

PAD4

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69
Q

What is carbamylation?

A

Conversion of lysine into homocitrullines by chemical reaction with cyanate

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70
Q

How can smoking lead to RA?

A

It increases the levels of cyanate and so increases amount of carbamylation

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71
Q

What does a histological section of a classic infantile myopathic hypotonia look like?

A

The type 1 slow fibres (paler) are a lot smaller

(the other way around for non classic)

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72
Q

What might you see on biopsy for the myositis?

A

Variation in fibre size, central nuclei, necrosis and regeneration and infiltrate of lymphocytes (CD8 cytotoxic T cells)

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73
Q

What is the most common ANA in myositis that gives a worse outcome?

A

Anti-Jo1

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74
Q

What muscles are affected more in inclusion body myositis?

A

Finger and wrist flexors
Knee extensors (loss of quadricep reflex)

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75
Q

What is inheritance pattern of Duchenne and Becker muscular dystrophy?

A

X-linked recessive

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76
Q

How many points on the ACR/EULAR score do you need for an RA diagnosis?

A

6 or more out of 10

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77
Q

What are the standard treatment concepts for mild, moderate and severe RA?

A

Mild - methotrexate + second line DMARD
Moderate -methotrexate and TNF alpha inhibitor
Severe - methotrexate + rituximab

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78
Q

How does methotrexate work?

A

It is a folic acid antagonist- limiting RNA and DNA synthesis and it is an anti-cytokine inhibiting production of IL1 and NF-kB

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79
Q

What is sulfasalazine a combination of?

A

Sulfapyridine and 5-amino salicyclic acid. (5-ASA stays in the gut)

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80
Q

What RA drug also treats ulcerative collitis?

A

Sulfasalazine

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81
Q

How does hydroxychloroquine work?

A

It increases the lysosomal pH in antigen presenting cells and blocks TLR9

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82
Q

What pro drug efficacy is similar to methotrexate?

A

Leflunomide

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83
Q

How does leflunomide work?

A

Inhibits pyrimidine biosynthesis

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84
Q

Name some TNFalpha blockers

A

Infliximab - monoclonal antibody against TNFalpha
Etanercept- binds to TNFalpha and stops signal transduction
Adalimub -monoclonal antibody

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85
Q

How do you measure the Q angle?

A

Draw a line from ASIS to centre of patella
Draw a line from tibial tuberosity to patella.
Normal Q angle = 15-20 degrees

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86
Q

What are the nodes that grow on the distal interphalangeal joint in OA?

A

Herberden’s node

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87
Q

What are the nodes that grow on the proximal interphalangeal joint in OA?

A

Bouchard’s node

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88
Q

What spinal joint is most often damaged in RA?

A

Atlanto-axial (misalignment of 1st and 2nd vertebrae). You get subluxation

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89
Q

What infections can go on to result in reactive arthritis?

A

Urethritis / cervicitis /infectious diarrhea

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90
Q

What can sausage toe be a sign of?

A

Reactive arthritis

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91
Q

What prostaglandin inhibits gastric secretion?

A

PGE2

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92
Q

What kind of drug is diclofenac?

A

Preferential COX-2 inhibitor

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93
Q

What is an example of an irreversible non selective NSAID?

A

Aspirin

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94
Q

What is basement membrane composed of?

A

Laminin 332, collage IV, collagen VII

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95
Q

What type of collagen is papillary dermis?

A

Type III collagen

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96
Q

What type of collagen is reticular dermis?

A

Type I

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97
Q

What are the two types of hair follicles?

A

Vellus - body hair, Terminal - scalp and secondary sexual hair

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98
Q

What are the three main phases of hair cycle?

A

Anagen -active
Catagen - regressive
Telogen -resting

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99
Q

What hip replacement material has least wear and tear?

A

Ceramic on ceramic

100
Q

What muscles are often used for free muscle transfer?

A

Gracilis muscle and rectus femoris

101
Q

What does a Colles fracture refer to?

A

Dorsal displacement of distal fragment of radius - dinner fork look. Think fallen with wrist extended

102
Q

What is a torus fracture?

A

A buckle fracture, happens in kids, axial loading causes trabecular compression on one side

103
Q

In bone healing, how long does fibrocartilaginous callus last?

A

About 3 weeks

104
Q

What are the cells involved in fibrocartilaginous callus formation?

A

Fibroblasts and osteogenic cells invade procallus and make collagen
Chondroblasts begin to produce fibrocartilage

105
Q

How long does the bony callus last?

A

from week 3 to about 3-4 months (woven bone)

106
Q

What is neurotmesis?

A

Complete transection of a peripheral nerve

107
Q

What is a common bacteria that can cause septic arthritis in children?

A

Haemophilus influenza

108
Q

What is talipes equinovarus?

A

Club foot - fixed varus and equinus deformity

109
Q

What are associated with club foot?

A

Breech, connective tissue disorders eg Ehlers Danlos, oligohydramnios, genetic syndromes

110
Q

What is the Ponseti method?

A

Use of multiple manipulative casts to correct club foot

111
Q

What is Perthes disease?

A

Avascular necrosis of femoral head (normally self limiting)

112
Q

What does SUFE stand for?

A

Slipped upper femoral epiphysis
(more common in boys and in the left hip)

113
Q

What type of fracture is a SUFE?

A

Salter Harris type 1

114
Q

How do you detect SUFE on XRAY?

A

No femoral head above Klein’s line

115
Q

What is Blount’s disease?

A

A growth problem of medial part of proximal tibia, causes tibial varus (knees bow outwards)

116
Q

What risk factors are associated with Blount’s disease?

A

Obesity and walking early

117
Q

What is sever’s disease

A

Calcaneal apophysis

118
Q

What causes Kohler’s disease?

A

Avascular necrosis to navicular bone often associated with infection

119
Q

What causes Kienbock disease?

A

Interruption of blood supply to the lunate, cause not known.
maybe think KienBOCK like BOX, think Boxing to remember its in the hand

120
Q

What crystals get deposited in gout?

A

Monosodium urate crystals

121
Q

What is podagra?

A

Inflammation of 1st MTP joint (big toe)

122
Q

Eating a diet high in what substance can lead to gout?

A

Purine

123
Q

What cells would you see in the synovial fluid in gout?

A

Polymorphonuclear neutrophils (PMNS), would have a high WBC too

124
Q

How does colchicine work for gout?

A

It stops microtubule polymerisation hence stopping neutrophils

125
Q

What’s the MAO of Allopurinal?

A

It inhibits xanthine oxidase hence reducing generation of uric acid

126
Q

What is pseudogout?

A

It is the deposition of calcium pyrophosphate, you often get it in OA

127
Q

What are the spinal changes in osteoporosis kyphosis?

A

Increased thoracic curvature (kyphosis) and then a compensatory increase in cervical lordosis

128
Q

What is Sheuermann’s disease?

A

A disease of adolescence (epiphyseal growth plates of vertebral bodies) that causes hyper kyphosis

129
Q

What muscle dysfunction is associated with excessive lumbar lordosis

A

Shortened Psoas muscle

130
Q

How great a curve in scoliosis before you do surgery?

A

50 degrees

131
Q

What are the most common levels for herniated disc?

A

L4/L5, L5/S1

132
Q

What does DISH stand for?

A

Diffuse idiopathic skeletal hyperostosis (ossification of anterior longitudinal ligament, looks like candle wax dripping)

133
Q

What radiographic signs do you get on MRI of ankylosing spondylitis?

A

Dagger sign and bamboo shoot spine

134
Q

If impetigo is just in one place how should you treat it?

A

1% hydrogen peroxide cream

135
Q

What is the pathophysiology behind scalded skin syndrome?

A

Exotoxins to staph aureus are produced which destroy the desmosomes holding together keratinocytes so you get detachment of epidermal cells

136
Q

What does molluscum contagiosum cause?

A

water warts

137
Q

What is pityriasis versicolour an example of?

A

Yeast infection

138
Q

What are permethrin, ivermectin and crotamiton examples of?

A

Anti parasite medications, used to treat scabies

139
Q

What bacteria is spread by ticks causing Lyme disease?

A

Borrelia

140
Q

What causes lupus vulgaris?

A

TB infection

141
Q

What causes Leishmaniasis?

A

Sandflies

142
Q

What does type 1 hypersensitivity refer to?

A

IgE mediated hypersensitvity. IgE bound to mast cells, when allergen binds causes degranulation

143
Q

What is type 2 hypersensitivity?

A

IgG mediated cytotoxic hypersenstivity eg blood transfusion RBCs destroyed

144
Q

What is type 3 hypersensitivity?

A

Immune complex mediated, eg antigen-antibody complexes desposited in tissues causing activation of complement
eg RA, systemic lupus erythematosus

145
Q

What is type 4 hypersensitivity?

A

Cell mediated hypersensitivity. Th1 cells secreting cytokines etc eg contact dermatitis, tuberculin reaction, MS

146
Q

What type of hypersensitivity is uticaria (hives)?

A

Type 1

147
Q

What common allergens do dust mites release?

A

Der P1

148
Q

What is a new biological treatment for urticaria and asthma (IgE mediated)?

A

Omalizumab (binds to IgE decreasing cell bound IgE)

149
Q

What antibodies cause pemphigus vulgaris? (blisters on mucus membranes)

A

antibodies to desmoglein 3 (an epidermal desmosomal adhesion protein)

150
Q

What are new treatments for alopecia and vitiligo?

A

JAK inhibitors - Ruxolitinib

151
Q

What cell is the link between adaptive and innate immunity?

A

APCs

152
Q

What do hybrid hip replacements involve?

A

The use of a cemented femoral stem with an uncemented acetabular cup

153
Q

In what injury do you get loss of rounded profile?

A

anterior dislocation
(normally from deltoid muscle)

154
Q

What nerve is damaged in winging of the scapula?

A

long thoracic

154
Q

What are the signs of deltoid paralysis?

A

loss of roundness of shoulder, numbness over regimental badge and weakness in abduction

155
Q

What palsy do you see shoulder falling?

A

trapezius palsy (spinal accessory)

156
Q

What do radius and ulna articulate with in the hand?

A

radius articulates with scaphoid and lunate
ulna doesnt articulate with any carpals (fibrocartilage fills the gap)

157
Q

What nerve passes through the carpal tunnel?

A

median nerve

158
Q

What artery runs through ligamentum teres?

A

obturator

159
Q

What nerve palsy would result in paralysis of plantar flexors and sensory loss back of leg and sole of foot?

A

tibial nerve palsy

159
Q

Nerve roots of femoral nerve?

A

L2, L3, L4

160
Q

What nerve provides sensation to the skin between big and second toe?

A

deep peroneal nerve

161
Q

What is the inorganic part of bone?

A

Calcium hydroxyapatite

162
Q

Where is preferred for bone marrow transplantation?

A

iliac crest

163
Q

What cells sense mechanical strain on the bone?

A

osteocytes

164
Q

What is sclerostin secreted by and what inhibits its secretion?

A

produced by osteocytes
inhibited by PTH, and mechanical strain

165
Q

What regulates elimination of phosphate via kidneys?

A

Fibroblast growth factor 23

166
Q

What essentially has the opposite effect to PTH?

A

Calcitonin

167
Q

Where does the final step of hydroxylation of vit D to active form take place?

A

Proximal tubule via 1-alpha hydroxylase

168
Q

What is the central target organ of calcitrol/ activated vit d?

A

Duodenum

169
Q

How can chronic kidney disease have affect on bones?

A

Increased FGF23 and decreased calcitrol, leads to increased PTH and therefore bone disorder

170
Q

What is FSH effect on bone?

A

stimulates osteoclast activity but is compensated by actions of oestrogen

171
Q

What are centrally located nuclei a sign of?

A

muscle repair

172
Q

What can be given prophylactically to prevent heterotopic ossification?

A

NSAIDs (inhibit COX2)

173
Q

How would you control loading for ruptured achilles?

A

Cast immobilisation, as it is tendon to bone

174
Q

When does intrinsic tendon healing occur?

A

In any tendon that is covered by a tendon sheath

175
Q

What essentially is ankylosing spondylitis?

A

Enthesitis of IV disc and anterior longitudinal ligament

176
Q

What is a surgical treatment for trigger finger?

A

cut the annular ligament

177
Q

What are more than 95% patients with SLE positive for?

A

ANA - anti-nuclear antigens

178
Q

What is raloxifene? (used for osteoporosis)

A

it is a selective oestrogen receptor modulator (estrogenic effects on bone)

179
Q

During which part of ovulatory cycle does bone resorption decrease?

A

Decreases during luteal phase bc of high progesterone

180
Q

How does denosumab work for osteoporosis?

A

It is a monoclonal antibody to RANK L
(RANKL is what binds to RANK receptor on osteoclasts)

181
Q

What do you see on osteomalacia bone biopsies?

A

wide seams of unmineralised osteoid

182
Q

What type of collagen is the ECM of cartilage?

A

II, IX, X and XI

183
Q

How do collagen fibre orientations change as you move down the articular layers?

A

superficial - parallel, highest tensile strength
intermediate - criss-crossed oblique allows compression
deep zone - perpendicular

184
Q

What is presence in cartilage and can hold up to 50x their dry weight in water?

A

proteogylacans

185
Q

What is synovial fluid?

A

The ultrafiltrate of blood with added hyaluronic acid

186
Q

What is added to synovial fluid in mucin clot test?

A

2-5% acetic acid

187
Q

What is produced by osteoclasts that leads to more osteoclasts, attracts neutrophils and sensitises nociceptors increasing pain?

A

IL8

188
Q

Which autoantibodies do not seem to play a major pathogenic role in RA?

A

Rheumatoid factor autoantibodies

189
Q

What is polymyositis and dermatomyositis?

A

They are inflammatory myopathies, autoimmune and associated with microbial infection

190
Q

When in dermatomyositis or polymyositis would you need long term immunosuppression?

A

If there are anti Jo-1 antibodies

191
Q

What do you see on a biopsy for inclusion body myositis?

A

fibres contain empty vacuoles and clumps of cellular material that contain amyloid like material ( congo red)

192
Q

What is Duchenne’s a problem of?

A

Dystrophin (responsible for connecting cytoskeleton of muscle fibre to basal lamina)

193
Q

Which muscle fibres get more affected by corticosteroids and statins?

A

type 2

194
Q

Foods rich in this could help improve osteoarthritis symptoms?

A

Omega-3 (oily fish)

195
Q

What is used in mosaicplasty?

A

undamaged cartilage from less weight bearing regions

196
Q

What are future options for biological treatments for OA?

A

IL-1 blockage, TNF inhibition

197
Q

What do you need to check at least every three months in methotrexate patients?

A

complete blood count and liver function tests

198
Q

What drugs aren’t really used much anymore for RA?

A

D-pencillamine and gold salts

199
Q

Anakinra, canakinumab and rilonacept all work on what?

A

IL-1 (for gout)

200
Q

What is the first oral biological option?

A

JAK inhibitors (tofacitinib, barcitinib and upadacitinb)

201
Q

When might you see gull-wing or saw-tooth appearance?

A

In erosive OA, post-menopausal women more affected

202
Q

What effects can NSAIDs have on kidney?

A

They can leads to Na and water retention = hypertension and kidney injury

203
Q

Where is the only place that both COX1 and COX2 are found under resting conditions?

A

CNS

204
Q

What links keratin cytoskeleton to basement membrane?

A

Hemidesmosomes

205
Q

What is the most abundant cell in the dermis?

A

fibroblast

206
Q

Which layer of skin contains many blood vessels?

A

Papillary layer (directly below epidermis and BM)

207
Q

What antibody activates osteoclast in RA?

A

ACPA causes monocytes to differentiate

208
Q

What does reverse hybrid hip replacement mean?

A

That the cemented version is the bit in the acetabulum and not in femur

209
Q

What tendons are often used for ACL?

A

semitendinosous or gracilis tendon

210
Q

Neck of fibula fractures what nerve is at risk?

A

common peroneal

211
Q

What are you looking for on xrays of stress fractures and why?

A

Periosteal lifting as they are fractures of the trabeculae network within the bone

212
Q

What are the stages of bone healing?

A

1) fracture haematoma
2) fibrocartilaginous callus
3) soft callus
4) bony callus lasts about 3-4 months
5) bone remodelling

213
Q

In pelvic fractures where is the majority of the haemorrhage coming from?

A

posterior venous plexus

214
Q

What is a complication of fractures that can lead to deterioration in consciousness and petchiae rash?

A

Fat embolism - fat getting into blood stream

215
Q

What is normal compartment pressure and at what pressure would it be an emergency?

A

normal = 0-10
emergency = 30 plus

216
Q

What is the most common organism causing septic arthritis?

A

staphylococcus aureus

217
Q

What is a common lab finding in septic arthritis particularly in children?

A

neutrophilia

218
Q

What is i can’t see, can’t pee, can’t climb a tree about?

A

reactive arthritis bc it affects eye, urinary system and hands and feet

219
Q

What is the name for necrotic bone?

A

sequestrum

220
Q

What can be used to treat gram pos osteomyelitis?

A

flucloxacilin

221
Q

How do you test for congenital hip dysplasia?

A

Barlow test - adduct and push downwards
Ortolani - abduct and push forwards with fingers
Galeazzi sign - leg length discrepency

222
Q

complications of congenital hip dysplasia?

A

Avascular necrosis and femoral nerve palsies

223
Q

What are the four stages of Perthes?

A

1) necrosis - up to one year
2) fragmentation - dead cells absorbed and replaced, variable femoral head shapes
3) reossification - femoral head continues to grow
4) remodelling - continues

224
Q

What age does Perthes frequently occur?

A

between 4-8 years

225
Q

What are the steps to a gout attack?

A

proteins lower Ph making more crystals form
white blood cells attack
crystals pop the cell
cell releases proteins
proteins call in more white blood cells

226
Q

What is inside the tophi in gout?

A

urate crystals surrounded by lymphocytes, macrophages and foreign body cells

227
Q

How high does serum uric acid need to be before it should definitely be treated?

A

11mg/dL

228
Q

What biologicals can be used for gout?

A

IL1 biologicals - rilonacept, canakinumba, anakinra

229
Q

How does probenecid work for gout?

A

It increases uric acid excretion

230
Q

How does rasburicase work for gout?

A

it catalyses the conversion of uric acid to allantoin

231
Q

What can acute pseudogout be triggered by?

A

trauma, rapid reduction of serum calcium

232
Q

What direction would gout and pseudogout crystals face?

A

gout - yellow diagonally up, blue diagnonally down
pseudo-gout - other way around

233
Q

What crystals might you find in a rare case of RA?

A

cholestrol crystals / lipid spherules

234
Q

What is a treatment for osteoporosis kyphosis?

A

kyphoplasty - inserting and inflating balloon into bone to make it less wedge shaped

235
Q

What are Schmorl’s nodes?

A

They are herniated discs bulging upwards or downwards - common in Sheuermann’s disease

236
Q

How do you treat Sheuermann’s disease?

A

physio - increase strength of paraspinals
bracing - if less than 65 degree angle
surgical if greater than 65 degrees

237
Q

What type of collagen is annulus fibrosus?

A

type 1

238
Q

What bacteria tend to cause folliculitis (carbuncles, boils)

A

stayphyloccous aureus

239
Q

Difference between cellulitis and erysipelas?

A

cellulitis - infection in subcut tissuess
erysipelas - superficial cellulitis (infection just in dermis and not the sub cut fat)

240
Q

what is Scrofuloderma?

A

tuberculous involvement of skin from TB infection in underlying lymph nodes

241
Q

What causes leprosy?

A

mycobacterium leprae or mycobacterium leptomatosis

242
Q

What is the treatment for leprosy?

A

rifampicin, dapsone and clofazimine

243
Q

How do you treat pemphigus vulgaris?

A

immunosuppression with c mycophenolate motefil or azathioprine
rituximab - targeting CD20 on b cells

244
Q

What are five types of salter harris fracture

A

S - straight across type 1
A - Above type 2
L - lower type 3
T - two or through type 4
ER - erasure type 4

245
Q

What kind of injury will lead to hand of benediction when asked to make a fist?

A

a high median injury (common in supracondylar fractures of humerus). results from paralysis of flexor digitorum superficialis, and pollicis longus

Year 2 (10 decks)

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