Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2a Basic Knowledge > MSK > Flashcards

MSK Flashcards

1
Q

Function of type 1 collagen

A

Elasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is type 1 collagen found

A

Skin, tendon, organic component of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is type 2 collagen found

A

Cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is type 3 collagen found

A

Connective tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is type 4 collagen found

A

Epithelial layer of Basement membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is type 5 collagen found

A

Hair
Placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define ligaments

A

Bone - bone attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define tendons

A

Muscle - bone attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give an example of fibrous joints

A

Skull suture

- Immoveable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give an example of cartilageneous joints

A

Intervertebral discs

- Partially moveable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give an example of synovial joints

A

Most joints in the body
Knees, hips, fingers shoulder

- Moveable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Components / anatomy of synovial joints

A

Articular cartilage - Lines the end of the periosteum (bone part with pain receptors)

Joint capsule - Inner lining of the synovial membrane

Joint cavity filled with synovial fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define osteoarthritis

A

Most common arthritis

Non-inflammatory, degenerative mechanical shearing of synovial joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for osteoarthritis

A

Increased age (50+ ; women >50 affected a lot)
Obesity
Occupation / sports
Genetics (COL2A1; genetic predisposition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathophysiology of osteoarthritis

A

Imbalanced cartilage breakdown > repair
Where you get increased chrondrocyte metaleoproteinase secretion
Degrades collagen type 2 + forms cysts
Bone attempts to overcome with type 1 collagen but get abnormal bony growths (osteophytes) + remodelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs and Sx of osteoarthritis

A

Transient (< 30/60 mins) morning pain —> worsen as day goes on

Heberdens + Bouchard’s nodes on fingers
Assymetrical, hard non-inflamed joints
No extra-articular Sx

Crepitus - crackling or grating sensation when moving a joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In which condition are heberdens nodes found and where in the body

A

Distal interphalangeal joints

Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In which condition are bouchards nodes found and where in the body

A

Found in proximal interphalangeal joints

  • osteoarthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigation and Dx of osteoarthritis

A

Xray changes:
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Bloods - normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx for osteoarthritis

A

Lifestyle management:
Weight-bearing, physio

Medical:
1st line - Paracetamol + topical NSAIDs

2nd line - Oral NSAIDS + PPIs ± topical capsaicin (chilli pepper extract)

Consider

Last resort - Arthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define rheumatoid arthritis

A

Inflammatory autoimmune symmetrical polyarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who does RA affect more

A

Women
30-50y/o

x3 more likely than males; pre menopause
Post menopause - m=f

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Risk factors for rheumatoid arthritis

A

Women >
Age
Smoking
Genetics - HLADR1 + 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pathophysiology of rheumatoid arthritis

A

Arginine —> citruline mutation in type 2 collagen
Anti-CCP (cyclic citrullinated peptide) formation against citrullinated molecules.
TNFa causes further pro-inflammatory recruitment to synovium
- synovial lining expands and tumour-like mass (pannus) grows past joint margins
- Pannus destroys subchondral bone + articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs and symptoms of rheumatoid arthritis

A

Morning stiffness > 30/60mins (eases as day goes on)
Boutenieres deformity
Swans neck deformity
Ulnar deviation
Z-thumb deformity

Remember as an anomaly; DIP joints are often spared, unlike psoriatic arthritis.

Bakers cyst might occur behind knee when the inflamed synovium moves posterior creating a cyst

Symmetrical, hot, inflamed joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What extra-articular complications are seen in rheumatoid arthritis

A

Lungs - pulmonary fibrosis
Skin - rheumatoid skin nodules
Heart - increased IHD risk
Eyes - Episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define felty syndrome

A

Triad of: rheumatoid arthritis, granulocytopenia, splenomegaly

Life-threatening; high risk of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Investigation and Dx of rheumatoid arthritis

A

Bloods:
Increased CRP & ESR (Used for monitoring disease)
Normacytic normochromic anaemia (chronic disease)

Serology:
+ve Anti-CCP (80%; specific), +ve rhematoid factor (non-specific)

Xray:
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Tx for rhematoid arthritis

A

First line is monotherapy with methotrexate (gold standard), leflunomide or sulfasalazine.
Hydroxychloroquine can be considered in mild disease and is considered the “mildest” anti rheumatic drug.

Second line is 2 of these used in combination.

Third line is methotrexate plus a biological therapy, usually a TNF inhibitor - influximab

Fourth line is methotrexate plus rituximab - B-cell inhibitor; CD20 target

Flare-up management
NSAIDs (1º care analgesia) - ibuprofen + Glucocorticoids injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Classification used to Dx rheumatoid arthritis

A

ACR
American College of Rheumatoid Arthritis

Or

EULAR
European League Against Rheumatism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Tx for RA flare ups

A

NSAIDs (1º care analgesia) - ibuprofen + Glucocorticoids injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which score is used to assess RA management

A

DAS28
Disease activity score 28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Define gout

A

Gout is an inflammatory arthritis caused by deposition of monosodium urate crystals within joints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Who does gout typically affect

A

Middle aged overweight men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which joint is most affected in gout

A

first metatarsophalangeal joint (MTP).

Base/bottom of big toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pathophysiology of gout

A

Urate is a metabolite of purine synthesis

Purines ————> uric acid ————> monosodium urate
I
I
Xanthine Oxidase

Uric acid is usually excreted via kidneys but if there’s impaired excretion (CKD) OR over-production… causes gout

Hyperuricaemia increases risk of gout but not guaranteed for getting gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Risk factors for gout

A

Purine rich diets: fish/seafood, meat, beer
Dairy can be Anti-gout

CKD
Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Signs and Sx of gout

A

Mono-articular; big toe typically (metotarsophalangeal joint)
- *sudden onset, hot, swollen red toe. Can’t put weight on it.

Gouty tophi - nodular masses of urate crystals form, usually as a late complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Differential diagnosis for gout

A

Septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Investigation and Dx of gout

A

Joint aspirate + polarised light microscopy - gold standard
* Needle-shaped, Negative bifringement monosodium urate crystals.*

Xray:
Punched out erosions
Lytic lesions - sclerotic borders with overhanging edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Tx for gout

A

1st line: NSAIDs (+ PPIs)
2nd line: Cholcicine
3rd line: corticosteroid intracellular-articular injection

Prophylaxis
Allopurinol - xanthine oxidase inhibitors - decreased uric acid conversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Define pseudogout

A

The deposition of calcium pyrophosphate crystals in long bone joint capsules

Chondrocalcinosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Who does pseudogout typically affect

A

Elderly females (> 70y/o)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Joints most affected in pseudogout

A

Knee

Shoulder
Hip
Wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Risk factors for pseudogout

A

Increasing age
Diabetes

OA
HyperPTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Signs and Sx for pseudogout

A

Often polyarticular (knee commonly affected)
- Swollen, red, hot joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Differential Dx for pseudogout

A

Septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Investigation and Dx of pseudogout

A

Joint aspiration +polarised light microscopy:
Rhomboid shaped, Positive bifringement of calcium pyrophosphate crystals
Gold standard

Xray:
Chondrocalcinosis - white line inbetween the synovial joint
LOSS - same as osteoarthritis in Xray ∆

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tx for pseudogout

A

Only Acute management :
NSAIDs, then cholcicine, then corticosteroid injection

No prevention drug here!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Give examples of connective tissue disorders

A

Marfans

Ehlers danlos syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Define marfans syndrome

A

Connective tissue disorder
- decreased connective tissue tensile strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Inheritance pattern for marfans

A

Autosomal dominant
- mutation in FBN1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Signs and Sx of marfans

A

Marfans body habitus
- Tall and thin
- Long fingers (arachnodactyly)
- Pectus excavation / cannaturn (sternum pressed in / puffed cut)

+

AORTIC COMPLICATIONS -
AAA / aortic dissection
Aortic regurgitation murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Investigation / Dx for marfans

A

Clinical Px + FBN-1 mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Define ehlers donlos syndrome

A

Autosomal dominant mutations affecting collagen proteins
13ish subtypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Signs and Sx of EDS

A

Joint hypermobility + CV complication (AAA / Aortic dissection ‘ Mitral regurgitation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Investigation / Dx for EDS

A

Clinical + collagen mutations

THESE CONNECTIVE TISSUE DISORDER WILL MEAN WEAK VALVES, WEAK VESSELS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What could cause mechanical lower back pain

A

Normal between ages 20-55
Could be trauma / work related
Signs of serious pathology:
Elderly - could indicate myeloma / neuropathic pain (spinal cord compression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Define lumbar spondylosis

A

Degeneration of intervertebral disc; loses its compliance + thins over time

Seen in older Px

Most commonly affects - L4/5 OR L5/S1

Tx: Analgesia + physiotherapy if simple mechanical pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Structure of bone: what is the hard external layer

A

Cortical bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Structure of bone: what is the internal layer of bone called

A

Spongy / trabecular bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Structure of bone: Role of trabeculae

A

Structural beams giving support to the spongy / trabecular bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Structure of bone: What is cortical bone made of

A

Small functional units - Osteons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Structure of bone: what allows blood supply to pass through hard bone

A

Osteons have a hollow canal - Haversian canal which allows blood vessels and nerve innervation to run through the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Structure of bone: what surrounds the Haversian canal?

A

Haversian canal is hole in osteon centre carrying blood supply etc….
Lamellae surrounds this and has an organic component - Collagen
And an inorganic component - hydroxyapatite (calcium phosphate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Structure of bone: what’s found inbetween lamellae

A

Inbetween lamellae we find lacunae where bones cells (Osteocytes) are found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Steps of bone remodelling

A

Bone resorption
Osteoclast break down bone
Bone formation
Osteoblast form new bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What does bone remodelling depend on

A

Serum calcium levels
- controlled by PTH, calcitonin and Vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

When is calcitonin released

A

When serum calcium is too high… calcitonin secreted by thyroid gland.

  • promotes bone formation and decreases bone resorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Define osteoporosis

A

Reduced bone density resulting in porous bone with increased fragility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Difference between osteoporosis and osteomalacia

A

Reduction in bone density but no mineralisation in osteoporosis. But there is in osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Who does osteoporosis mainly affect

A

50+ y/o postmenapausal Caucasian women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Risk factors for osteoporosis

A

Remember SHATTERED
Steroids / Smoking
Hyperparathyroid
Alcohol
Thin (reduced BMI)
Testosterone decreased
Early menopause
Renal failure
Erosive / inflammatory disease
DMT1

74
Q

Signs and Sx of osteoporosis

A

Asymptomatic

Fractures may indicate it
• Vertebrae / compression fractures (may have kyphosis)
• Proximal femurs
• Colles’ (forked wrists - fallen on outstretched wrists)

75
Q

Investigation and Dx of osteoporosis

A

DEXA scan - gold standard
Dual energy Xray Absorptiometry
- gives a T-score (comparing BMD of Px to reference)

frax tool - fracture risk assessment tool
Asses10yr fracture risk in osteoporotic Px

76
Q

Which scan is used in osteoporosis

A

DEXA

77
Q

Tx for osteoporosis

A

1st line: Bisphosphonates
Aledronate (aledronic acid)
Risondronate (Risodronic acid)

2nd line:
mAb - Denosumab
Hormone Replacement Therapy - oestrogen & testosterone
Oestrogen receptor modulator - Raloxafine

78
Q

What is the range for dexa score and what condition is it used in

A

Used for osteoporosis
T score:

Normal: > -1
Osteopenia: between -1 and -2.5
Osteoporosis: < -2.5
Severe osteoporosis: < -2.5 + fractures

79
Q

Define osteopenia

A

Osteopenia refers to a less severe reduction in bone density than osteoporosis

80
Q

Why are bisphosphonates used in osteoporosis

A

Inhibit RANK-L signalling so osteoclast activity is inhibited

81
Q

When is denosumab used

A

2nd line for osteoporosis
It’s a monoclonal antibody - inhibits RANK-L

82
Q

Give examples of autoimmune rheumatological disorders

A

Systemic lupus erythmatosis
Antiphospholipid syndrome
Sjogren syndrome
Scleroderma
Polymyositis

83
Q

A 30-year-old African-American lady presents to her GP with increasing fatigue and joint pain. On examination, she has a butterfly rash across her face. What is the Dx?

A

Systemic lupus erythmatous

84
Q

Define SLE

A

Type 3 hypersensitivity reaction - autoimmune systemic inflammation due to Antigen:Antibody complex deposition.

85
Q

Who is SLE typically seen in

A

Females
Afrocarribean descent
20-40y/o (premenopausal)

86
Q

Risk factors for SLE

A

Female (12x more than M)
HLADR2/3 or HLAB8
Drugs
Environmental factors - UV rays

87
Q

Pathophysiology of SLE

A

Damage to cells leading to impaired apoptosis. Apoptotic debris is presented to Th2 Cell Especially nuclear antibodies and double-stranded DNA
—> B cell activation —> antigen-antibody complexes deposition in tissue.

SO, SLE can be characterised by Anti-Nuclear Antibodies (ANA) and anti-dsDNA

88
Q

Signs and Sx of SLE

A

Malar butterfly rash on face + photosensitivity
Glomerulonephritis (Nephritic syndrome)
Mouth ulcers
Reynauds phenomenon
Joint pain

89
Q

Investigation and Dx for SLE

A

FBC: INCREASED ESR NORMAL CRP

Serology:
ANA +ve - v. Sensitive
Anti-dsDNA - v. Specific (Also used to monitor SLE progression)
Essentially diagnostic using these

Reduced C3+C4: Due to active disease
Prolonged APTT: in lupus Px is hypercoaguable

90
Q

Tx for SLE

A

Lifestyle changes: reduced uv ray exposure / reduce triggering drugs

1st line:
Corticosteroids - prednisolone
Then:
+ Hydroxychloroquine (DMARD)
+ NSAIDs
+ immunosuppressant if severe (Azathioprine)

Note: Aim is to taper off the other drugs so Px is left with hydroxychloroquine once stable

91
Q

Define Antiphospholipid syndrome

A

Syndrome characterised by thrombosis, pregnancy complications (recurrent miscarriages) and Antiphospholipid antibodies

Can be 1º (idiopathic ) or 2º (to other autoimmune conditions - especially SLE)

92
Q

Who’s affected in Antiphospholipid syndrome

A

Females

93
Q

Signs a and Sx of Antiphospholipid syndrome

A

CLOTS
- Px is in hyper-coaguable state
- venous thrombosis (DVT / PE)
- arterial thrombosis (stroke, MI, renal thrombosis)

Livedo reticularis - purple discolouration of skin

94
Q

Investigation and Dx of Antiphospholipid syndrome

A

Sx + Hx of thrombosis etc… + persistent antibodies presentation

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies

95
Q

Which antibodies seen in lupus

A

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies

96
Q

Tx for Antiphospholipid syndrome

A

1st line: Warfarin long-term if Px had a thrombus
If pregnant give LMWH + aspirin

Prophylaxis: Aspirin - if not had a thrombus formation yet

97
Q

Define Sjogren syndrome

A

Dry! Dry! Dry! - autoimmuneexocrine gland dysfunction

1º Sjogren’s is where the condition occurs in isolation.

2º Sjogren’s is where it occurs related to SLE or rheumatoid arthritis.

98
Q

Which antibodies is Sjogrens related to

A

It is associated with anti-Ro and anti-La antibodies.

99
Q

Signs or Sx of Sjogrens

A

Dry eyes, mouth and vagina

100
Q

What test is used in Sjögren’s syndrome

A

Schirmer test - induce tears + and place filter paper under eyes.
Measure the travel of the tear (< 10mm = sjogrens)
Should be 20mm+

101
Q

Tx for sjogrens

A

Artificial tears, saliva + lubricant for sexual activity

Sometimes can give hydroxychloroquine

102
Q

What condition does Sjogrens directly increase the risk of

A

Lymphomas

103
Q

Give examples of 1º bone tumours

A

Osteosarcoma
Ewing’s sarcoma
Fibrosarcoma
Chondrosarcoma

104
Q

SECONDARY BONE TUMOURS

A

Osteolytic: Breast and Lung

Osteosclerotic: Prostate, Thyroid, RCC
+ myeloma - can cause back pain; old CRAB

105
Q

What is the most common 1º bone malignancy

A

Osteosarcoma

Px: 15-19y/o

106
Q

What condition is osteosarcoma associated with

A

Paget’s disease

107
Q

Where does osteosarcoma most commonly metastasise to

A

Lungs

108
Q

Xray signs of osteosarcoma

A

Sunburst appearing bone

109
Q

Define ewings sarcoma

A

From mesenchymal stem cell

Affects 15y/o

110
Q

Define chondrosarcoma

A

Malignancy of cartilage

111
Q

Tx for bone tumour

A

Chemo/radiotherapy
Bisphosphonates

112
Q

Define osteomalacia

A

Defective bone mineralisation
- before epiphyseal fusion : rickets
- after epiphyseal fusion : osteomalacia

113
Q

Main cause of osteomalacia

A

Vitamin D deficiency
- reduced a calcium and phosphate
- reducing hydroxyapatite mineral of bone

114
Q

Causes of osteomalacia

A

Vit d deficiency
HyperPTH
CKD
Liver failure
Anticonvulsant drugs - increased CYP450 metabolism of Vit d

115
Q

Sx of osteomalacia

A

Fractures
Proximal weakness

Rickets:
Skeletal deformities
- bowed legs
- wide epiphysis

116
Q

Investigation and Dx of osteomalacia

A

BM biopsy (gold standard)
Incomplete mineralisation

Bloods:
Decreased 25-hydroxyVitamin D
Increased PTH (low Vit D —> low Ca2+ —> increased PTH —>2º hyperPTH)
Raised ALP

XRay:
Loser’s zones (defective mineralisation - low-density bone surrounded by sclerotic borders)

117
Q

Tx for osteomalacia

A

Calcitriol - Vit D replacement

Increase dietary intake - supplements / eggs

118
Q

Define vasculitis

A

Inflammation of the blood vessels

There’s many types affecting different sized vessels leading to different damage depending on the tissue being supplied.

119
Q

Types of vasculitis affecting small blood vessels

A

Henoch-Schonlein purpura

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)

Microscopic polyangiitis

Granulomatosis with polyangiitis (GPA - Wegerners disease)

120
Q

Types of vasculitis affecting medium blood vessels

A

Polyarteritis nodosa

Buergers disease

Kawasaki Disease

121
Q

Types of vasculitis affecting large blood vessels

A

Giant cell arteritis

Takayasu’s arteritis

122
Q

Define giant cell arteritis

A

Aka temporal arteritis

As it typically presents in temporal artery…

So Px presents with… unilateral temple headache, jaw claudication, vision ∆ leading to vision loss - affecting a 50+ y/o Caucasian female.

123
Q

Key complication of giant cell arteritis

A

Vision loss - sudden and painless

Usually in one eye

If temporary - may cause Amourosis fugax (more typically seen in TIA)
May become permanent if not treated ASAP -
High dose IV METHYLPREDNISOLONE

124
Q

Give general Sx of vasculitis

A

Fever
Weight loss
Fatigue
Muscle aches

125
Q

Investigation and Dx of GCA

A

1st line:
Raised ESR ± CRP

Diagnostic:
Temporal artery biopsy: Multinucleated giant cells (Hence its name GCA) - seen as granulomatous inflammation of intima and media.

Note: GCA presents as skip lesions so take a bigger chunk for biopsy

126
Q

Which condition presents with raised ESR normal CRP

A

SLE

127
Q

Tx of giant cell arteritis

A

Corticosteroids - Prednisolone

±

Aspirin - decreases visual loss and strokes
PPIs - for gastric damage prevention

128
Q

What’s Takayatsu disease

A

Similar to GCA but Aorta is affected more in this condition, not temporal vessels.

May get arm claudication or syncope - use Doppler USS to see carotids or CT/MRI angiography

129
Q

Define polyarteritis nodosa

A

Medium vessel vasculitis

Associated with Hep B.

Immune cells affect endothelium lining of medium vessels leading to transmural inflammation —> overtime all 3 layers die (Fibrinoid necrosis) —> wall is therefore weakened leading to Aneurysms

130
Q

Signs and Sx of polyarteritis nodosa

A

Severe systematic Sx:
GI bleeds
CKD / pre-renal AKI
Subcutaneous skin nodules + haemorrhage

Get Livedo reticularis - rash

131
Q

Investigation and Dx of polyarteritis nodosa

A

Ct angiogram- Beads on string (micro aneurysms) - looks like a tasbeeh [ -o-o-o-o- ]

Biopsy of affected area

132
Q

Tx of polyarteritis nodosa

A

Corticosteroids - prednisolone

Controls htn —> ACEi
Tx Hep B after

133
Q

Which vasculitis is c ANCA +ve

A

Granulomatosis with PolyAngitis i.e.

wegeners granulomatosis

134
Q

Classic sign for wegeners granulomatosis

A

Saddle shaped nose

  • may also cause glomerulonephritis / pulmonary renal syndrome
135
Q

Define henloch schonlein purpura

A

An IgA vasculitis
- presents with IgA antibody deposition in kidney

4 classic features: purpura (100%), joint pain (75%), abdominal pain (50%) and renal involvement (50%).

136
Q

General tx for vasculitis

A

Corticosteroids

+ PPIs
+ Bisphosphonates

137
Q

Define spondyloarthropathies

A

Assymetrical seronegative arthritis
Associated with HLAB27

An MHC-1 serotype - interacts with Tc (i.e. inflammatory)

138
Q

General features of spondyloarthropathies

A

Remember SPINE ACHE

Sausage fingers (dactylitis)
Psoriasis
Iinflammatory back pain
NSAIDs have good response
Enthesitis (inflammation at site of tendon attachment)
Arthritis
Crohn’s / collitis
HLA B27
Eyes (Uveitis)

139
Q

What are the types of spondyloarthropathies

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis
Juvenile idiopathic arthritis

140
Q

Define Ankylosing spondylitis

A

Abnormal stiffening of pints (sacroiliac + vertebral) due to new bony formation…

141
Q

Typical Px of Ankylosing spondylitis

A

Young male
HLA B27 +ve

142
Q

Pathophysiology of Ankylosing spondylitis

A

Inflammation of the spine leads to erosive damage —> repair & new bone formation —> leads to irreversible fusion of spine —> reduced mobility of the spine
Syndesmophytes formation (vertical abnormal bony growths)

143
Q

Signs and Sx of Ankylosing spondylitis

A

Back pain (stiffness in morning + at night)
Anterior uveitis
Enthesitis
Dactylitis
Decreased natural lumbar lordosis (more kyphosis)

144
Q

Investigation and Dx of Ankylosing spondylitis

A

XRay: bamboo spine + sacroiliac (squared vertebral bodies)
MRI
Bloods: raised ESR + CRP
Genetic testing: HLA B27 +ve

145
Q

Tx for Ankylosing spondylitis

A

NSAIDs

DMARDs - TNF-a blockers (Inflixamab)

146
Q

Define psoriatic arthritis

A

10-40% with psoriasis develop within 10y

147
Q

Sx of psoriatic arthritis

A

Moderate:
Inflamed distal interphalangeal joints (DIPJ)
+ nail dystrophy, dactylitis, enthesitis

Psoriatic rash on skin —> behind ears, scalp, under nails and penile

Severe:
Arthritis mutilans = pencil in cup deformity (osteolysis of bone, shortening fingers telescope in on themselves)

148
Q

Tx for psoriatic arthritis

A

NSAIDs

DMARDS - methotrexate
If fails: TNF-a blocker - infliximab
If this fails: IL 12+23 inhibitor

149
Q

Define reactive arthritis

A

Sterile inflammation of synovial membrane + tendon reacting to distant infection; usually GI or genitals

150
Q

Types of gastroenteritis causing reactive arthritis

A

Salmonella

Shigella

151
Q

Which sexual;LH transmitted organism can cause reactive arthritis

A

Chlamydia trachomatis

152
Q

Sx of reactive arthritis

A

Reiter’s triad **Cant see, can’t pee, can’t climb a tree **

Uveitis, urethritis, arthritis

+ browny discolouration g rash on sides of foot

153
Q

Main differential for reactive arthritis

A

Septic arthritis
Painful, hot, swollen and red joints + signs of infection Hx

154
Q

Investigation and Dx for reactive arthritis

A

Joint aspirate (MC+S) and polarised light microscopy
- no organism
- negative for crystal arthropathies

HLAB27 +ve genetic testing

155
Q

Tx for reactive arthritis

A

NSAIDs

DMARDS - methotrexate
± anti-TNFa (infliximab)

156
Q

Types of infective arthritis

A

Septic arthritis

Osteomyelitis

157
Q

What test is conducted for Ankylosing spondylitis

A

Do the schobers test

Measure 10 cm above and 5 cm below L5 if <20cm after bending forwards, then could be indicative of Ankylosing spondylitis

158
Q

Define septic arthritis

A

Direct bacterial infection of the joint

Could have been either by direct exposure / haematogenous spread

Medical emergency; Acutely inflamed joint with a fever, typically of the knee.
Knee could be destroyed if not Tx ≤24hrs

159
Q

Organisms that can cause septic arthritis

A

Staphylococcus aureus (most common)
H. Influenza (children; but now rare because of vaccination)
N. Gonorrhoea
Ecoli / pseudomonas (IVDU)

160
Q

Risk factors for septic arthritis

A

IVDU
Immunosuppression
Trauma
Prosthetic joints; mainly infected by S.Epidermidis

161
Q

Investigation and Dx of septic arthritis

A

URGENT JOINT ASPIRATION using MC+S & polarised light microscopy -

Septic arthritis: identified causative organism
Reactive arthritis: sterile, crystal-free
Gout: sterile, -ve birefringent Needle crystals
Pseudogout: sterile, +ve birefringent rhomboid crystals

Raised ESR + CRP in bloods

162
Q

Tx for septic arthritis

A

Do joint aspiration drainage + empirical antibiotics:

Flucloxacillin (Gram -ve; ecoli / auriginosa / staph aureus.)
… OR …
Vancomycin (MRSA)
IM Ceftriaxone + Azithromycin (Gonorrhoea)

If on DMARDS (methotrexate), stop!!!
If on steroids, double dose (to increase the stress response)
NSAIDs for analgesia

163
Q

Define osteomyelitis

A

Inflammation in a bone and bone marrow, usually caused by bacterial infection.

Spread of pathogen could have been haematogenous or direct contamination of the bones (during a fracture/surgery)

164
Q

What type of organisms could cause osteomyelitis

A

Staph Aureus (90% - most common)

Salmonella in sickle cell Px

165
Q

Risk factors for osteomyelitis

A

Immunosuppression
IVDU
Open fractures / trauma
Diabetes; especially diabetic foot ulceration
PVD

166
Q

Pathophysiology of osteomyelitis

A

Osteomyelitis (OM) is an inflammatory condition affecting any bone in the skeleton, usually as a result of bacterial infection. Infection may occur due to haematogenous spread or result from direct penetration by a causative microorganism e.g. trauma. OM can be both acute or chronic in its presentation.
The most common organisms causing OM are:
Staphylococcus aureus: most common causative organism
Coagulase-negative staphylococcus
Streptococcus pneumonia: more common in children
Haemophilus influenzae: more common in unvaccinated children
Pseudomonas aeruginosa: increased risk with intravenous drug use
Salmonella species: most common cause in sickle-cell disease patients

167
Q

Signs and Sx of osteomyelitis

A

Acute
Dull bony pain + hot swollen area (± joint ) —> worse with movement

Chronic
Above Sx + Deep ulceration - sequestrae (neotic bone embedded in pus)
Involucrum (Thick sclerotic bone placed around the sequestra to compensate for support)

168
Q

Differential Dx for osteomyelitis

A

Charcot’s joint
Damage to sensory nerves due to diabetic neuropathy
Causes progressive degeneration of weight bearing joint + bony destruction. Affects the foot, presents with diabetic foot

169
Q

Investigation and Dx of osteomyelitis

A

Bone marrow biopsy (MC+S):
Identify causative organism

Bloods: raised ESR and CRP

X-ray of affected area:
Osteopenia
Bone destruction
Periosteal reaction
Cortical breaches

170
Q

Tx of osteomyelitis

A

Immobilise area+ antibiotics:
Flucloxacillin (aureus / salmonella)
Vancomycin (MRSA)
Teicoplannin is longer-lasting than vancomycin, but increased SE: GI upset/pruritus

171
Q

Which antibiotic is longer lasting than vancomycin

A

Teicoplannin

Stronger Side effects:
GI upset
Pruritus

172
Q

What needs to be ruled out in osteomyelitis using BM biopsy

A

Rule out TUBERCULOUS OSTEOMYELITIS
(+ve for caseating granuloma)

173
Q

Define Paget’s disease

A

Focal disorder of bone remodelling (areas of patchy bone due to improper osteoblast/osteoclast function) — Areas of sclerosis + lysis

174
Q

Signs and Sx of Paget’s disease

A

Bone pain
Bone deformity
Fractures

Hearing loss -
*Nerve compression of CN8
Hydrocephalus (Sylvian aqueduct) blockage *

175
Q

Investigation and Dx of Paget’s disease

A

XRay:
Cotton-wool skull
Osteoporosis circumscripta

Urinary hydroxyproline —> protein constituents of bone collagen (marker for disease progression)

176
Q

Tx for pagets

A

1st line:
Bisphosphonates
Aledronic / zoledronic acid

2nd line:
Calcitonin

177
Q

Define fibromyalgia

A

MSK equivalent to IBS; Chronic widespread musculoskeletal pain for ≥ 3 months with all other causes ruled out

178
Q

Risk factors for fibromyalgia

A

Females
Depression + stress
Poor
60+ y/o

179
Q

Signs and Sx of fibromyalgia

A

Sleep disturbance
Morning stiffness
Esp. back and neck stiffness

Px: Stressed, depressed female 60+ and fatigue

180
Q

Investigation and dx of fibromyalgia

A

No serological markers
No ESR or CRP raised
+ pain 11/18 regions palpated… clinical dx is made!

181
Q

Tx for fibromyalgia

A

Educate Px + physiotherapy

Antidepressants for severe neuropathic pain (Amytryptyline; Tricyclic Antidepressant) + CBT

182
Q

Differential dx of fibromyalgia

A

Polymyalgia rheumatica (PMR)
Large cell vasculitis presenting as chronic pain syndrome (affects muscles and joints) - similar to fibromyalgia

Dx of PMR:
Increased ESR + CRP (diagnostic)

Tx:
Oral prednisolone

Phase 2a Basic Knowledge (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions