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Y3 CORE CONDITIONS > LOCOMOTOR > Flashcards

LOCOMOTOR Flashcards

1
Q

what is the prevalence of gout?

a) 1%
b) 5%
c) 20%
d) 50%

A

a) 1%

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2
Q

which gender is most commonly affected by gout

A

male

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3
Q

what are the name of the deposits in gout and what are they made of?

A

crystalised uric acid (tophi) forming sodium monourate crystals

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4
Q

which joint is most commonly affected by gout?

A

first metatarsalphalyngeal joint

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5
Q

what is the cause of primary gout?

A

diet - chronic hyperuricaemia

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6
Q

give 3 causes secondary gout?

A 
alcohol excess
renal impairement
polycythaemia
leukemia
cytotoxic drugs
Chemotherapy = break down of tumour causes increase in uric acid
low dose of aspirin
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7
Q

how long do gout attacks normally last?

A

1 week

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8
Q

what 2 symptoms often accompany pain in gout?

A

swelling

redness

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9
Q

give 5 factors which may precipitate an attack of gout

A 
excess alcohol
excess food or starvation
dehydration
starting a diuretic
trauma/surgery
infection
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10
Q

what kind of microbiological analysis might you carry out on a patient with gout?

A

synovial fund microscopy

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11
Q

which of these blood markers would NOT be raised in a patient with gout?

a) uric acid
b) creatinine
c) eGFR
d) urea

A

c) eGFR - would be LOWERED

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12
Q

why should allopurinol be started with naproxen at the start of gout treatment?

A

may cause an attack at the start

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13
Q

give a complication of gout

A

kidney stones

Recurrent and advanced attacks of gout

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14
Q

what is the most common joint condition in the UK?

A

osteoarthritis

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15
Q

what is the classic phrase to describe the damage which causes osteoarthritis?

A

wear and tear

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16
Q

what structures are inflamed in osteoarthritis?

A

whole structure including synovium

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17
Q

what familial gene mutation can contribute to the formation of osteoarthritis?

A

collagen type 2

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18
Q

which ethnicity is more likely to get hip and knee osteoarthritis?

a) black
b) caucasian
c) asian
d) native american

A

c) asian

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19
Q

give 4 risk factors for development of osteoarthritis

A 
age
occupation
previous joint injury
obesity
family history
congenital joint dysplasia
osteoporosis
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20
Q

at what point in the day is the pain of osteoarthritis worse?

A

end of day

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21
Q

where are bouchard’s nodes?

A

PIPJs

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22
Q

where are heberden’s nodes?

A

DIPJs

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23
Q

does osteoporosis normally affect just one or multiple joints?

A

one

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24
Q

give an audible sign present on examination of joints with osteoarthritis

A

crepitus

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25
Q

give 2 things that can cause the loss of bone space characteristic of osteoarthritis?

A

subcondral growths/cysts
osteophytes
infective inflammation

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26
Q

give 2 examples of blood markers that could be raised in inflammatory osteoarthritis

A

ESR

CRP

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27
Q

what type of microbiological investigation might you perform if a patient suspected osteoarthritis?

A

synovial fluid microscopy

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28
Q

give 2 types of drug which might be given for the pain in osteoarthritis

A

Topical NSAIDs
Topical Capsaicin cream for knee and hip
Corticosteriod injection

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29
Q

how common is prolapsed disc in the UK?

a) 1-3%
b) 8-10%
c) 25-30%
d) 40-50%

A

a) 1-3%

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30
Q

what is the pathophysiology of a prolapsed disc?

A

tear in annulus fibrosis (outer ring) of vertebral disc with herniation of the nucleus polposus

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31
Q

What part of the spine is most commonly involved in prolapsed disc?

A

Lumbar region, larger disc greater inflammation and pressure on surrounding nerves

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32
Q

give 3 causes of prolapsed disc

A

age-related degeneration
abnormal lifting/twisting/straining
trauma

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33
Q

give 2 risk factors for prolapsed disc

A

age
occupation
sedentary lifestyle

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34
Q

describe the onset pain of a prolapsed disc

A

sudden

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35
Q

where does the pain of prolapsed disc radiate?

A

down legs

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36
Q

what is the name of prolapsed disc pain if it is pressing on nerves L4-S3?

A

sciatica

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37
Q

which of these is not a symptom of prolapsed disc

a) numbness
b) weakness
c) tingling
d) twitching
e) paralysis

A

d) twitching

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38
Q

what organ can be affected by a prolapsed disc?

A

bladder (incontinence)

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39
Q

give 3 symptoms of cauda equina syndrome

A

saddle anaesthesia
incontinence
sex dysfunction

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40
Q

give 3 imaging techniques you could use to diagnose a prolapsed disc

A

X-Ray
CT
MRI

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41
Q

what physical examination could be used to diagnose sciatica?

A

raise leg to 90 degrees when lying on back and dorsiflex.

pain = sciatica

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42
Q

what cause of a prolapsed disc is a medical emergency and requires urgent surgery?

A

cauda equina syndrome

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43
Q

what organisms are normally responsible for causing septic arthritis?

A

bacteria

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44
Q

what is the most common bacterial organism to cause septic arthritis?

A

s. aureus

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45
Q

give 3 other bacterial causes of septic arthritis

A

h influenza
strep
n gonorrhoea
e coli

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46
Q

gonorrhoea is most likely to be the cause of septic arthritis in which age group?

A

young, sexually active

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47
Q

which of these group of people are at risk of e coli causing septic arthritis?

A

Elderly
IVDU
Immunocompromised

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48
Q

give 3 non-bacterial causes of septic arthritis

A

viral
fungal
mycobacteria

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49
Q

what type of onset is septic arthritis?

a) rapid
b) crescendo
c) slow

A

a) rapid

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50
Q

give 3 symptoms of septic arthritis

A

pain
swelling
redness
stiffness

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51
Q

when in the day is the joint pain/stiffness worse in septic arthritis?

A

morning

52
Q

does the pain of septic arthritis last a longer or shorter time than osteoarthritis?

A

longer

53
Q

give 7 risk factors for the development of septic arthritis

A 
Joint trauma
previous joint problems (RA, Gout)
rheumatoid arthritis medication
skin fragility
Immunocompromised
DM
Increase AGE
54
Q

What blood markers are indications of septic arthritis?

A 
Raised :
WCC
ESR
CRP
Lactate
55
Q

why is septic arthritis a medical emergency?

A

can destroy the whole joint in a matter of days

56
Q

what antibiotic is given IV in bacterial septic arthritis?

A

flucloxacillin IV for 4-6 weeks

57
Q

when in the day is the pain of rheumatoid arthritis worse?

A

morning, after rest

58
Q

give 3 symptoms of rheumatoid arthritic joints

A 
warm
swollen
painful
stiff
synovitis
59
Q

what distinguishes the distribution of osteoarthritis and rheumatoid arthritis?

A

rheumatoid is bilateral

affects hands & wrists

60
Q

name 4 deformities associated with rheumatoid arthritis

A

z-neck deformities
swan neck deformities
boutonniere
ulnar deviation

61
Q

give 2 systemic symptoms of rheumatoid arthritis

A

fever

fatigue

62
Q

what can occur to the skin in rheumatoid arthritis?

A

rheumatoid nodules

63
Q

what kind of disorder is rheumatoid arthritis?

A

autoimmune

64
Q

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

A

d) necrotic stage

65
Q

what genetic factor is associated with rheumatoid arthritis?

A

MHC HLA antigen

66
Q

give a lifestyle risk factor for rheumatoid arthritis

A

smoking
Eating a lot of red meat
Drinking a lot of coffee

67
Q

give two herpes type viruses linked to development of rheumatoid arthritis

A

herpes 6

EBV

68
Q

deficiency of what vitamin is linked to development of rheumatoid arthritis?

A

D

69
Q

what antibody can be tested for in diagnosis of rheumatoid arthritis?

A

rheumatoid factor antibody

70
Q

what are the 3 types of drugs given to treat rheumatoid arthritis?

A

analgesia (NSAIDs)
steroids
DMARDs

71
Q

give 2 examples of DMARDs

A

hydroxychloroquine

metotrexate

72
Q

what haematological condition can be a complication of rheumatoid arthritis?

A

anaemia

73
Q

give a respiratory complication of rheumatoid arthritis

A

lung inlammation and fibrosis= SOB and chest pain

74
Q

give 3 circulatory complications of rheumatoid arthritis

A

atherosclerosis
pericarditis
vasculitis
Increase risk of CVD

75
Q

give a renal complication of rheumatoid arthritis

A

renal amyloidosis

76
Q

give an ophthalmic complication of rheumatoid arthritis

A

Inflammation leading to
Scleritis= eye pain and redness
or
Sjogren’s syndrome= dry eyes

77
Q

give a neurological complication of rheumatoid arthritis

A

peripheral neuropathy

78
Q

give the most common symptom of osteoporosis

A

bone breakage

79
Q

which group are most likely to experience osteoporosis

a) young men
b) old men
c) young women
d) old women

A

d) old women

80
Q

what occurs to bone mass and bone loss in osteoporosis?

A

lower bone mass

higher bone loss

81
Q

what factor that occurs after menopause can contribute to higher bone loss?

A

low oestrogen

82
Q

What thyroid abnormality leads to osteoporosis?

A

Hyperthyroidism

83
Q

give 3 lifestyle risk factors associated with osteoporosis

A

alcoholism
smoking
lack of exercise
poor childhood diet

84
Q

give 3 drugs that can contribute to development of osteoporosis

A 
anti seizure medication
chemotherapy
PPIs
SSRIs
steroids
85
Q

what mental illness can contribute to development of osteoporosis?

A

anorexia

86
Q

what conditions precedes osteoporosis?

A

osteopenia–> protein and mineral content of the bone is reduced but not as severely

87
Q

what type of medication can be given for osteoporosis?

A

bisphosphonates

Vitamin D and calcium supplements

88
Q

which only two bone conditions result in decreased calcium and phosphate?

A

osteomalacia

rickets

89
Q

what would alkaline phosphatase show in blood tests for osteoporosis, osteomalacia and rickets?

A

raised

90
Q

which bone condition is characterised by thick dense bones (marble bones)

A

osteopetrosis

91
Q

What food specifically increase your risk of gout?

A

Food that have high levels of purine such as red meat and sea food

92
Q

What is the prophylaxis for gout?

A

Reduced the amount of purine rich food, reduce alcohol intake, reduce weight, drink more water
Allopurinol

93
Q

What is the alternative treatment if allopurinol is not tolerated?

A

Febuxostat

94
Q

What is the treatment of acute Gout?

A

NSAIDS –> naproxen or declofenac

95
Q

what treatment do you give for gout if their is a contradiction in the use of naproxen (peptic ulcer)

A

Colchine then last choice is corticosteriods

96
Q

In what group of people does primary osteoarthritis occur in?

A

Over >50 years olds with wear and tear

97
Q

What group of people does secondary osteoarthritis occur in?

A

Younger people who have had previous bone fractures, injury or deformity

98
Q

What deformities occur to bones and muscles in osteoarthritis around the affected joint?

A

Muscle wasting, joint effusion and bone instability and enlargement

99
Q

What is the most common surgical treatment for hip and knees osteoarthritis?

A

Arthroplasty (Surgical joint replacement)

100
Q

What are alternative surgical treatment to arthroplasty? Explain each one

A

Arthrodesis –> fusing two bones into a fixed position

Osteotomy –> removal or adding small bits of bone above or below your knee

101
Q

What is Sciatica?

A

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

102
Q

What test can be done to see the speed of nerve transmission after a prolapsed disc?

A

Nerve conduction test

103
Q

What is the treatment and duration of prolapsed disc?

A 
1-3 months duration
NSAIDS or epidural
Physiotherapy
Weight loss
Education
104
Q

For nerve pain seen in sciatica what unusual treatment can be givin?

A

Amitriptyline and sertryline ( antidepressants)

gabapentin and pregabalin –> anticonvulsants

105
Q

What tool is used for definitive diagnostic of the cause of septic arthritis?

A

Join aspiration and culture to identify the cause of the infection.
MRI and CT are used in difficult cases

106
Q

If the patient is penicillin resistant what abx is given for septic arthritis?

A

Iv clindamycin 4-6 weeks

107
Q

If MRSA is suspected what abx is used for septic arthritis?

A

IV Vancomycin 4-6 weeks

108
Q

What are DD of septic arthritis?

A 
Primary rheumatoligical disease (RA, OA, gout)
Viral arthritis
Drug induced arthritis
Reactive arthritis 
Lyme disease
Infective endocarditis
109
Q

What two factors can reduce the risk of getting RA?

A

High intake of vitamin C

Drinking moderate amount of alcohol

110
Q

What triggers the autoimmune condition RA?

A

External trigger such as infection, trauma or smoking

111
Q

Give DD for RA?

A

Gout, OA, SLE, Ankylosing spondylitis, psoariatic arthritis. lyme disease and hep c

112
Q

What are the non medical treatment are their for RA?

A

Life style changes

Splinters and braces

113
Q

What eye complication can you get from rheumatoid arthritis?

A

Episcleritis

114
Q

What surgery can increase chance of osteoporosis?

A

Hysterectomy

115
Q

What is Paget disease of the bone?

A

Abnormal bone architecture

116
Q

What are the function of

a) Osteoclast
b) Osteoblast

A

a) cells that absorb old bone

b) cells that make new bones

117
Q

What occurs in Paget disease in terms of osteoclast and osteoblast?

A

Osteoclast absorbs bone quicker than normal

Osteoblast therefore makes bone quicker than normal but the bones are weaker and longer

118
Q

Why do you look at biomarkers for osteoporosis?

A

Took look at the different types of bone pathology

119
Q

Complications of osteoporosis?

A

Chronic pain

Inability to do daily activity

120
Q

What is a DEXA scan used for?

A

To diagnose osteoporosis by looking at bone density

121
Q

Name 3 drugs that can cause gout?

A

Low does aspirin
Chemotherapy drugs
Indapamide (diuretics)

122
Q

How does chemotherapy drugs cause gout?

A

Uric acid is produced by the breakdown of tumours

123
Q

How does indapamide cause gout?

A

The thiazide like diuretic reduces the excretion of uric acid by th`e kidney’s

124
Q

What is ankylosing spondylitis?

A

Chronic condition affecting the back and the joints causing inflamation

125
Q

What is the symptoms of ankylosing spondylitis?

A

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

126
Q

Is there a cure for ankylosing spondylitis?

A

No just symptomatic relief

127
Q

What is the cause of ankylosing spondyltitis?

A

Thought to be linked to the HLA-B27 gene

Y3 CORE CONDITIONS (15 decks)

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