LOCOMOTOR Flashcards
what is the prevalence of gout?
a) 1%
b) 5%
c) 20%
d) 50%
a) 1%
which gender is most commonly affected by gout
male
what are the name of the deposits in gout and what are they made of?
crystalised uric acid (tophi) forming sodium monourate crystals
which joint is most commonly affected by gout?
first metatarsalphalyngeal joint
what is the cause of primary gout?
diet - chronic hyperuricaemia
give 3 causes secondary gout?
alcohol excess renal impairement polycythaemia leukemia cytotoxic drugs Chemotherapy = break down of tumour causes increase in uric acid low dose of aspirin
how long do gout attacks normally last?
1 week
what 2 symptoms often accompany pain in gout?
swelling
redness
give 5 factors which may precipitate an attack of gout
excess alcohol excess food or starvation dehydration starting a diuretic trauma/surgery infection
what kind of microbiological analysis might you carry out on a patient with gout?
synovial fund microscopy
which of these blood markers would NOT be raised in a patient with gout?
a) uric acid
b) creatinine
c) eGFR
d) urea
c) eGFR - would be LOWERED
why should allopurinol be started with naproxen at the start of gout treatment?
may cause an attack at the start
give a complication of gout
kidney stones
Recurrent and advanced attacks of gout
what is the most common joint condition in the UK?
osteoarthritis
what is the classic phrase to describe the damage which causes osteoarthritis?
wear and tear
what structures are inflamed in osteoarthritis?
whole structure including synovium
what familial gene mutation can contribute to the formation of osteoarthritis?
collagen type 2
which ethnicity is more likely to get hip and knee osteoarthritis?
a) black
b) caucasian
c) asian
d) native american
c) asian
give 4 risk factors for development of osteoarthritis
age occupation previous joint injury obesity family history congenital joint dysplasia osteoporosis
at what point in the day is the pain of osteoarthritis worse?
end of day
where are bouchard’s nodes?
PIPJs
where are heberden’s nodes?
DIPJs
does osteoporosis normally affect just one or multiple joints?
one
give an audible sign present on examination of joints with osteoarthritis
crepitus
give 2 things that can cause the loss of bone space characteristic of osteoarthritis?
subcondral growths/cysts
osteophytes
infective inflammation
give 2 examples of blood markers that could be raised in inflammatory osteoarthritis
ESR
CRP
what type of microbiological investigation might you perform if a patient suspected osteoarthritis?
synovial fluid microscopy
give 2 types of drug which might be given for the pain in osteoarthritis
Topical NSAIDs
Topical Capsaicin cream for knee and hip
Corticosteriod injection
how common is prolapsed disc in the UK?
a) 1-3%
b) 8-10%
c) 25-30%
d) 40-50%
a) 1-3%
what is the pathophysiology of a prolapsed disc?
tear in annulus fibrosis (outer ring) of vertebral disc with herniation of the nucleus polposus
What part of the spine is most commonly involved in prolapsed disc?
Lumbar region, larger disc greater inflammation and pressure on surrounding nerves
give 3 causes of prolapsed disc
age-related degeneration
abnormal lifting/twisting/straining
trauma
give 2 risk factors for prolapsed disc
age
occupation
sedentary lifestyle
describe the onset pain of a prolapsed disc
sudden
where does the pain of prolapsed disc radiate?
down legs
what is the name of prolapsed disc pain if it is pressing on nerves L4-S3?
sciatica
which of these is not a symptom of prolapsed disc
a) numbness
b) weakness
c) tingling
d) twitching
e) paralysis
d) twitching
what organ can be affected by a prolapsed disc?
bladder (incontinence)
give 3 symptoms of cauda equina syndrome
saddle anaesthesia
incontinence
sex dysfunction
give 3 imaging techniques you could use to diagnose a prolapsed disc
X-Ray
CT
MRI
what physical examination could be used to diagnose sciatica?
raise leg to 90 degrees when lying on back and dorsiflex.
pain = sciatica
what cause of a prolapsed disc is a medical emergency and requires urgent surgery?
cauda equina syndrome
what organisms are normally responsible for causing septic arthritis?
bacteria
what is the most common bacterial organism to cause septic arthritis?
s. aureus
give 3 other bacterial causes of septic arthritis
h influenza
strep
n gonorrhoea
e coli
gonorrhoea is most likely to be the cause of septic arthritis in which age group?
young, sexually active
which of these group of people are at risk of e coli causing septic arthritis?
Elderly
IVDU
Immunocompromised
give 3 non-bacterial causes of septic arthritis
viral
fungal
mycobacteria
what type of onset is septic arthritis?
a) rapid
b) crescendo
c) slow
a) rapid
give 3 symptoms of septic arthritis
pain
swelling
redness
stiffness
when in the day is the joint pain/stiffness worse in septic arthritis?
morning
does the pain of septic arthritis last a longer or shorter time than osteoarthritis?
longer
give 7 risk factors for the development of septic arthritis
Joint trauma previous joint problems (RA, Gout) rheumatoid arthritis medication skin fragility Immunocompromised DM Increase AGE
What blood markers are indications of septic arthritis?
Raised : WCC ESR CRP Lactate
why is septic arthritis a medical emergency?
can destroy the whole joint in a matter of days
what antibiotic is given IV in bacterial septic arthritis?
flucloxacillin IV for 4-6 weeks
when in the day is the pain of rheumatoid arthritis worse?
morning, after rest
give 3 symptoms of rheumatoid arthritic joints
warm swollen painful stiff synovitis
what distinguishes the distribution of osteoarthritis and rheumatoid arthritis?
rheumatoid is bilateral
affects hands & wrists
name 4 deformities associated with rheumatoid arthritis
z-neck deformities
swan neck deformities
boutonniere
ulnar deviation
give 2 systemic symptoms of rheumatoid arthritis
fever
fatigue
what can occur to the skin in rheumatoid arthritis?
rheumatoid nodules
what kind of disorder is rheumatoid arthritis?
autoimmune
which of these is not a stage of rheumatoid arthritis?
a) initiation phase
b) amplification phase (T cells)
c) chronic inflammatory and tissue injury stage
d) necrotic stage
d) necrotic stage
what genetic factor is associated with rheumatoid arthritis?
MHC HLA antigen
give a lifestyle risk factor for rheumatoid arthritis
smoking
Eating a lot of red meat
Drinking a lot of coffee
give two herpes type viruses linked to development of rheumatoid arthritis
herpes 6
EBV
deficiency of what vitamin is linked to development of rheumatoid arthritis?
D
what antibody can be tested for in diagnosis of rheumatoid arthritis?
rheumatoid factor antibody
what are the 3 types of drugs given to treat rheumatoid arthritis?
analgesia (NSAIDs)
steroids
DMARDs
give 2 examples of DMARDs
hydroxychloroquine
metotrexate
what haematological condition can be a complication of rheumatoid arthritis?
anaemia
give a respiratory complication of rheumatoid arthritis
lung inlammation and fibrosis= SOB and chest pain
give 3 circulatory complications of rheumatoid arthritis
atherosclerosis
pericarditis
vasculitis
Increase risk of CVD
give a renal complication of rheumatoid arthritis
renal amyloidosis
give an ophthalmic complication of rheumatoid arthritis
Inflammation leading to
Scleritis= eye pain and redness
or
Sjogren’s syndrome= dry eyes
give a neurological complication of rheumatoid arthritis
peripheral neuropathy
give the most common symptom of osteoporosis
bone breakage
which group are most likely to experience osteoporosis
a) young men
b) old men
c) young women
d) old women
d) old women
what occurs to bone mass and bone loss in osteoporosis?
lower bone mass
higher bone loss
what factor that occurs after menopause can contribute to higher bone loss?
low oestrogen
What thyroid abnormality leads to osteoporosis?
Hyperthyroidism
give 3 lifestyle risk factors associated with osteoporosis
alcoholism
smoking
lack of exercise
poor childhood diet
give 3 drugs that can contribute to development of osteoporosis
anti seizure medication chemotherapy PPIs SSRIs steroids
what mental illness can contribute to development of osteoporosis?
anorexia
what conditions precedes osteoporosis?
osteopenia–> protein and mineral content of the bone is reduced but not as severely
what type of medication can be given for osteoporosis?
bisphosphonates
Vitamin D and calcium supplements
which only two bone conditions result in decreased calcium and phosphate?
osteomalacia
rickets
what would alkaline phosphatase show in blood tests for osteoporosis, osteomalacia and rickets?
raised
which bone condition is characterised by thick dense bones (marble bones)
osteopetrosis
What food specifically increase your risk of gout?
Food that have high levels of purine such as red meat and sea food
What is the prophylaxis for gout?
Reduced the amount of purine rich food, reduce alcohol intake, reduce weight, drink more water
Allopurinol
What is the alternative treatment if allopurinol is not tolerated?
Febuxostat
What is the treatment of acute Gout?
NSAIDS –> naproxen or declofenac
what treatment do you give for gout if their is a contradiction in the use of naproxen (peptic ulcer)
Colchine then last choice is corticosteriods
In what group of people does primary osteoarthritis occur in?
Over >50 years olds with wear and tear
What group of people does secondary osteoarthritis occur in?
Younger people who have had previous bone fractures, injury or deformity
What deformities occur to bones and muscles in osteoarthritis around the affected joint?
Muscle wasting, joint effusion and bone instability and enlargement
What is the most common surgical treatment for hip and knees osteoarthritis?
Arthroplasty (Surgical joint replacement)
What are alternative surgical treatment to arthroplasty? Explain each one
Arthrodesis –> fusing two bones into a fixed position
Osteotomy –> removal or adding small bits of bone above or below your knee
What is Sciatica?
It is compression of the sciatica nerve (L4-S3) causing pain and numbness from the lower back down one leg to the feet and ankles.
Also weakness in the calf muscles of the effected leg
What test can be done to see the speed of nerve transmission after a prolapsed disc?
Nerve conduction test
What is the treatment and duration of prolapsed disc?
1-3 months duration NSAIDS or epidural Physiotherapy Weight loss Education
For nerve pain seen in sciatica what unusual treatment can be givin?
Amitriptyline and sertryline ( antidepressants)
gabapentin and pregabalin –> anticonvulsants
What tool is used for definitive diagnostic of the cause of septic arthritis?
Join aspiration and culture to identify the cause of the infection.
MRI and CT are used in difficult cases
If the patient is penicillin resistant what abx is given for septic arthritis?
Iv clindamycin 4-6 weeks
If MRSA is suspected what abx is used for septic arthritis?
IV Vancomycin 4-6 weeks
What are DD of septic arthritis?
Primary rheumatoligical disease (RA, OA, gout) Viral arthritis Drug induced arthritis Reactive arthritis Lyme disease Infective endocarditis
What two factors can reduce the risk of getting RA?
High intake of vitamin C
Drinking moderate amount of alcohol
What triggers the autoimmune condition RA?
External trigger such as infection, trauma or smoking
Give DD for RA?
Gout, OA, SLE, Ankylosing spondylitis, psoariatic arthritis. lyme disease and hep c
What are the non medical treatment are their for RA?
Life style changes
Splinters and braces
What eye complication can you get from rheumatoid arthritis?
Episcleritis
What surgery can increase chance of osteoporosis?
Hysterectomy
What is Paget disease of the bone?
Abnormal bone architecture
What are the function of
a) Osteoclast
b) Osteoblast
a) cells that absorb old bone
b) cells that make new bones
What occurs in Paget disease in terms of osteoclast and osteoblast?
Osteoclast absorbs bone quicker than normal
Osteoblast therefore makes bone quicker than normal but the bones are weaker and longer
Why do you look at biomarkers for osteoporosis?
Took look at the different types of bone pathology
Complications of osteoporosis?
Chronic pain
Inability to do daily activity
What is a DEXA scan used for?
To diagnose osteoporosis by looking at bone density
Name 3 drugs that can cause gout?
Low does aspirin
Chemotherapy drugs
Indapamide (diuretics)
How does chemotherapy drugs cause gout?
Uric acid is produced by the breakdown of tumours
How does indapamide cause gout?
The thiazide like diuretic reduces the excretion of uric acid by th`e kidney’s
What is ankylosing spondylitis?
Chronic condition affecting the back and the joints causing inflamation
What is the symptoms of ankylosing spondylitis?
Pain in the back and stiffness
Inflammation in the affected joints (arthritis) and in the tendons joining the bone (enthesiits) = causing pain and swelling
Fatigue
Is there a cure for ankylosing spondylitis?
No just symptomatic relief
What is the cause of ankylosing spondyltitis?
Thought to be linked to the HLA-B27 gene
