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3rd year > Locomotor > Flashcards

Locomotor Flashcards

1
Q

What is osteoarthritis and how much of the joint capsule is involved?

A

Most common arthritis and the whole capital is involved. Osteoarthritis is characterised by cartilage loss followed by Periarticular a response.

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2
Q

Who is most commonly affected by osteoarthritis?

A

Over 60s
Females three times more likely than men
Some familial patterns of inheritance?

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3
Q

What joints are most commonly affected by osteoarthritis? (Two)

A

Hip and knee

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4
Q

What are some the rest factors of osteoarthritis?(7)

A 
Obesity
Lots and lots of sport
Congenital joint dysplasia
Hypermobility
Gender
Occupation
Joint congruity
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5
Q

What are the primary and secondary causes of osteoarthritis?

A

Primary cause is idiopathic/wear and tear

Secondary causes include metabolic disease,prexisting joint damage and systemic disease

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6
Q

Summarise the pathophysiology of osteoarthritis?

A

Normal balance of degradation and regeneration of cartilage is damaged.
Repair is attempted but disordered creating a surface which is fibrillated and fissured.
This exposes underlying bone to stress and microfractures and when the bonetried to repair itself it does so in a disorganised way

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7
Q

What are bony overgrowths at the joint margins called?

A

Osteophytes

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8
Q

in osteoarthritis what is a atrophied disease and what is hypertrophic disease?

A

Atrophic is cartilaginous destruction without any bony growth
Hypertrophic is cartilagineous destruction with massive new bone information.

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9
Q

What are the symptoms of osteoarthritis?

A

Primary joint pain
Morning stiffness lesson 30 minutes
Pain of stiffness better with rest worse at exercise

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10
Q

What the signs osteoarthritis?

A

Joint tenderness
Practice
Decreased range of movement
Joint instability

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11
Q

What are the hand signs of osteoarthritis?

A

Heberdens nodes at distal interphalyngeal joint

Bouchard nodes at proximal interphalangeal joint

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12
Q

Give some differentials for osteoarthritis

A 
Rheumatoid arthritis
Septic arthritis
Doubt
Anklyosing spondylitis
Bursitis
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13
Q

What investigations should you do for osteoarthritis?

A

X-ray
Bloods (crp may be up) negative ra
Joint aspiration
NB diagnosis often clinical

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14
Q

What would you see on x-ray on osteoarthritis?

A 
Loss
Loss of joint space
Osteophytes
Subchondral cyst's
Sub articular sclerosis
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15
Q

What is the go to besting treatment wise you can do for a joint with osteoarthritis?

A

Poor question but joint replacement

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16
Q

What is the overall management plan for osteoarthritis?

A 
Education
Exercises
Ànalgesia
Decrease BMI
Walking aids
Steroid injections intra-articular for short-term relief
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17
Q

What is the prognosis of osteoarthritis?

A

Most do not become completely disabled but hand and knee are bad joints to have involved

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18
Q

What is rheumatoid arthritis?

A

Auto immune disease causing chronic symmetrical polyarthritis with systemic involvement due to signovial information

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19
Q

Risk factors? For rheumatoid arthritis

A

Gender, females more likely
Genetic’s (60% of the disease susceptibility)
Immunology (V complicated) ‘immune dysregulation plays a big part on the pathophysiology of RA’

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20
Q

Tough question which two genes are heavily involved with rheumatoid arthritis?

A

HLA DR4

HLA DRB

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21
Q

Describe the pathophysiology of rheumatoid arthritis?

A

Widespread synovitis
Cause by production of rheumatoid factor and immune complexes
Synovium proliferates into folds and fronds
Vascular proliferation and increase in permeability lead to joint effusion
Panus of inflamed Sino VM damages under Lyne cartilage
Cartilage becomes thinned and underlying bone exposed
Juxtarticular bone erosions on x-ray
Bone erosions, deformities, long Term disability

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22
Q

What are the symptoms of rheumatoid arthritis?

A

Joint pain
Worse with rest better on exercise
Morning stiffness lasting longer than 30 minutes
Symmetrical pattern
Mainly hands and feet then progress to larger joints
Fatigue and weakness

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23
Q

What are the signs fairly early on the rheumatoid arthritis?

A

Muscle wasting
Slightly warmer joints
Tenderness and joint swelling
Limitation of movement

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24
Q

What are the hand signs of rheumatoid arthritis?

A 
Squaring of the hands
Ulnar deviation of the fingers
Boutienere deformity
Swan neck deformity
Z thumb deformity
And extensor tendons may rupture
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25
Q

Differentials of rheumatoid arthritis?

A 
Osteoarthritis
Gout
Septic arthritis
Polymyalgia rheumatica
Viral arthritis
26
Q

You can get extra articular signs of rheumatoid arthritis what are they?

A 
Rheumatoid nodules Albert/4 on
Vasculitis
Fibrosing
Alveolitis
Plural and pericardial if fusion
Raynolds
Carpal tunnel
27
Q

What investigations you do for rheumatoid arthritis?

A

Rheumatoid factor
Anti-CCP
Joint aspiration
X-ray

28
Q

What two serology tests are good ish for monitoring treatment/Progression?

A

ESR

CRP

29
Q

What is the main treatment for rheumatoid arthritis?

A

Dmards
First line Sulphasalazine methotrexate leflunomide
Second line TNF A blockers. Ciclosporin

30
Q

How do you DMARDS work against rheumatoid arthritis?

A

Through cytokines inhibition reduce inflammation reduce swelling and reduce development of joint erosions and irreversible damage
They are slow and their beneficial effect is not immediate

31
Q

What are some of the symptomatic treatment for rheumatoid arthritis?

A

NSAIDs and toxins

Intra-articular injections – powerful but short lived

32
Q

What is gout?

A

Inflammatory condition of joints due to deposition of mono sodium urate crystals. These and cause acute inflammation and eventual tissue damage.

33
Q

How is uric acid formed?

A

The metabolism of purines by xanthene oxidase enzyme.

Can’t break down Uric acid it is excreted by the kidneys

34
Q

Causes of gout?

A 
Things which prevent the excretion: (anything affecting kidney)
Chronic renal disease
Hypertension
Diuretics
Hyper or hypo parathyroidism
Increase lactic acid
G6P deficiency

Increased Eurich acid production:
Increased purines synthesis
Increased turnover purines

35
Q

Risk factors of gout?

A 
Mail
Alcohol seafood
Kidney problems
Anything cause kidney problems
Family history
36
Q

What is your typical presentation of gout?

A

Pain in the first metatarsal joint
9/10 pain
Often precipitated by alcohol dehydration diuretics

37
Q

Signs of gout?

A

Red swollen tender joint
Tophi
Florid Synovitis

38
Q

Investigations for gout?

A

Joint aspiration microscopy is the best
Serum uric acid
Serum uric acid and creatinine looking for signs of renal failure

39
Q

Treatment for acute gout?

A

NSAIDS/Coxibs
Corticosteroids if needed
Ice and elevate

40
Q

Prevention of gout?

A

Allopurinol
Lose weight
Avoid fatty foods and alcohol access

41
Q

What is septic arthritis?

A

Acute inflammation of a joint or Prosthetic join caused by an infection

42
Q

What are the risk factors for septic arthritis?

A 
Trauma
Surgery
Elderly
IVDU
Immunosuppressant
Obesity
Age
43
Q

Symptoms of setting of septic arthritis?

A 
Very selfish pantry
Joint pain
Swollen and read tender joint
Normally monoarticular
Irritation of movement
System upset fevers chills nice swets
44
Q

Investigation for septic arthritis?

A 
Joint aspiration from sign over your fluid for MCNS
Blood culture
Bloods wcc esr crp
X ray
Swab
45
Q

Treatment for septic arthritis?

A

Empirical antibiotics e.g. flucloxacillin
Directed abx
Infected prosthesis = remove

46
Q

What to do with an infected prosthetic joint?

A

It’s got to go
Maybe put in an antibiotic spacer for 3 to 6 weeks
Put another one in

47
Q

What actually is a prolapsed disc?

A

Nucleus pulposis herniating through annular fibrosis

48
Q

Is come place for a prolapse disk?

A

L5 S1

49
Q

Cause of prolapsed disc?

A

Trauma

Age related degeneration

50
Q

What is sciatica?

A

Pain tingling numbness that arise due to nerve entrapment of the lumbosacral spine

51
Q

Symptoms and signs of lumbosacral disc prolapse?

A 
Unilateral pain down one leg past knee
Pain often worse in leg than back
Pain better online down
Loss of tendon reflexes
Pain leg raise
52
Q

What’s in them do you need to be careful of in prolapsed disc’s?

A

Cauda equina syndrome

53
Q

Red flags for back pain?

A 
Less than 20 yo
Night pain
Supine pain
Thoracica pain
Saddle Anaesthesia
Incontinenence
Babinski or clonus reflex
54
Q

Investigations for back pain?

A

None if less than six week

MRI very specific for disc herniations

55
Q

Treatment for prolapsed disc?

A

Analgesia e.g. paracetamol ibuprofens
Add week opioid if pain continues e.g. codeine
Add amitriptyline/gabapentin if sciatic pain
Think of using diazepam if muscle spasms
If more pain go to pain clinic

56
Q

What is osteoporosis?

A

Lobo mass and deterioration of microstructure of bone. Increase bone fragility and increased risk of fractures

57
Q

Symptoms of osteoporosis?

A

Only symptom is osteoporotic fracture

58
Q

Pathogenesis of osteoporosis?

A

Increase breakdown of bone by osteoclasts
Decrease formation of osteoplast
Decrease bone density

59
Q

Risk factors for osteoporosis?

A

Postmenopausal woman lack of oestrogen
Elderly people vitamin d deficiency and consequent hypoparathyroidism
Glucocorticoids

60
Q

What are the investigations for osteoporosis?

A

X-ray

DEXA scan

61
Q

Management and treatment of osteoporosis?

A 
Vitamin D and calcium supplements
Exercise
Smoking cessation
Reduce falls
Bisphosphonates (alendronate)- lots side effects

3rd year (10 decks)

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