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Revision Notes - Year 1 > Monoarthritis/Gout - 137 > Flashcards

Monoarthritis/Gout - 137 Flashcards

1
Q

What is monoarthritis? What is it most commonly due to?

A

Inflammation of 1 joint at a time. It is most commonly caused by infection

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2
Q

Name some causes of monoarthritis

A

Gout/crystal arthritis
Trauma/haemarthritis
Osteoarthritis

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3
Q

What is septic arthritis?

A

Acute inflammation of a joint caused by direct infection.

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4
Q

Name some bacterial causes of septic arthritis

A

Most commonly caused by Staph. aureus. In younger adults can be due to gonococcus. Strep. and E.coli are also causes

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5
Q

What age group does septic arthritis affect?

A

Any age

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6
Q

How might septic arthritis present?

A

Sudden onset, pain, swelling, erythema.

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7
Q

What are some predisposing factors for septic arthritis?

A

Prosthetic joint, immunosuppression, rheumatoid arthritis, existing damage, IV drug abuse.

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8
Q

How do most septic arthritis infections spread?

A

Haematogenously

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9
Q

What is the outcome for untreated septic arthritis? How is it treated?

A

Untreated: joint destruction, sinus abscess formation, septicaemia, multi organ failure. 50% morbidity.
Treated: Abx. Rapid gram stain. 2 weeks IV Abx, 4 weeks oral.

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10
Q

What is gout?

A

Clinical syndrome caused by an inflammatory response to monosodium urate monohydrate crystals.
Caused by either an overproduction of urate or underexcretion of it.

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11
Q

90% of cases of gout are caused by what?

A

Decreased urate clearance. This could be due to renal impairment

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12
Q

Name some modifiable and non-modifiable risk factors for gout

A

Modifiable: Weight, hyperuricaemia, purine-rich diet, alcohol consumption, medications (diuretics)

Non-modifiable: age, male gender, genetics, imparied renal function

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13
Q

In chronic gout what complication can arise that accounts for most of the disability?

A

Tophi -> these are firm swellings

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14
Q

What patients can have urate lowering therapy (ULT)?

A

Those who have: had a second attack within a year, has renal impairment, urate stones, tophi and tissue damage.

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15
Q

Give an example of a urate lowering drug

A

Xanthine oxidase inhibitors -> these reduce uric acid production.
Allopurinol is the main drug used -> dose must be titrated up slowly. Interacts with warfarin.

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16
Q

How is pseudogout different to gout?

A

It is caused by calcium pyropphosphate crystals, has a different demographic (elderly women). Knees and wrists most commonly affected, attacks can last much longer

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17
Q

What is the treatment for pseudogout?

A

No specific treatment

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18
Q

What other morbidities is pseudogout associated with?

A

Hyperparathyroidism, osteoarthritis, haemochromatosis, diabetes, acromegaly.

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19
Q

What are the functions of calcium within the body?

A

1) Formation of calcified tissues (bones & teeth)
2) Normal activity of nerve and muscle
3) Neurotransmitter release, hormonal & glandular secretion
4) Excitation-contraction coupling
5) Cell membranes
6) Cell adhesion
7) Blood clotting

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20
Q

What is the primary purpose of calcium homeostasis?

A

To maintain a constant blood Ca concentration

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21
Q

What organs and hormones are involved in calcium homeostasis?

A

Gut, bone, kidneys

PTH, vitamin D and Calcitonin

22
Q

Outline the process of vitamin D synthesis

A

SKIN: UV transforms 7-dehydrocholesterol into VItamin D3
LIVER: Vitamin D3 is hydroxylated into 25-hydroxyvitamin D3
KIDNEYS: hydroxylated in active form of 1, 25 (OH)2 Vitamin D3

23
Q

What regulates the action of 1-alpha hydroxylate in the kidneys?

A

PTH

24
Q

What is the function of vitamin D in the gut?

A

It stimulates transport of Ca and PO4 in the small intestine -> this increses serum calcium

25
Q

What is the function of vitamin D in the bone?

A

Stimulates terminal differentiation of osteoclasts and increases serum calcium

26
Q

What does hypercalcaemia cause?

A

Mostly causes suppression of activity -> this is because it blocks Na channels.

27
Q

Name some signs & symptoms of hypercalcaemia

A

CNS: altered mental state, lethargy, confusion, depression
Renal: dehydration, ?stones
CV: cause/exacerbate hypertension, shotened QT
Skeletal: increased fracture risk
GI: anorexia, vominting, nausea, constipation

28
Q

What is the rhyme for remembering problems associated with hypercalcaemia?

A

Stones, bones, groans, thrones and psychiatric moans

29
Q

Name some causes of hypercalcaemia

A

Primary hyperparathyroidism

Renal failure

30
Q

What must be measured in order to correctly measure total calcium levels?

A

Serum albumin

31
Q

Name some signs & symptoms of hypocalcaemia

A

Pins & needles, tetany, facial spasms, hyperactive tendon reflexes, laryngospasm, arrhythmias

32
Q

What are Rickets and osteomalacia disorders of? How are they different?

A

Disorders of calcium metabolism. Rickets is in childhood -> causes bowing of the long bones.
Osteomalacia -> in adulthood, causes decline in bone strength and fractures develop easily.

33
Q

Name a disease that can causes PTH resistance

A

Pseudohypoparathyroidism

34
Q

What type of cartilage lesion can show some spontaneous repair? Why is this?

A

Osteochondral, because the lesion penetrates through vascularised subchondral bone

35
Q

Name the 6 functions of bone

A 
Support
Movement
Protection
Calcium reservoir 
Haematopoiesis
Energy store
36
Q

Name the 5 shapes of bone

A

Long, Short, Irregular, Flat, Sesamoid

37
Q

What is the definition of a sesamoid bone?

A

A bone embedded within a tendon. Patella is the biggest in the body

38
Q

Which populations are at risk for developing vitamin D deficiency?

A
  • populations lacking sunlight

- populations with a poor diet

39
Q

What are the 2 organisational compartments the skeleton is organised into?

A

Axial & appendicular

40
Q

Embryonal bone development, longitudinal bone growth and fracture healing all make use of a process known as what?

A

Endochondral ossification

41
Q

What are the 3 cells involved in bone metabolism

A

Osteoclast, osteoblast, osteocyte

42
Q

What do tendons connect to what?

A

Bone to muscle

43
Q

What do aponeuroses connect to what?

A

Muscle to muscle

44
Q

The two sites of muscular/tendinous attachment to bone are known as what?

A

Origin and insertion

45
Q

How can bone density be measured?

A

Dexa scan. USS, qCT

46
Q

Osteocytes occupy canals called what?

A

Canaliculi

47
Q

In terms of bone metabolism - Osteocytes respond to what?

A

Mechanical loading

48
Q

What are osteocytes derived from?

A

Osteoblasts

49
Q

Why do cartilage tears heal poorly?

A

Avascular
Double diffusion system
Loss of stem cell population in older people

50
Q

What is the major proteoglycan of cartilage?

A

Aggrecan

Revision Notes - Year 1 (41 decks)

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