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Phase 2A HT > MSK > Flashcards

MSK Flashcards

1
Q

cardinal signs of inflammation

A 
rubor = redness
callor = hot
dolor = pain
tumour = swelling
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2
Q

what deformities do you see in RA

A

boutonniere
swan neck
ulnar deviation

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3
Q

which cells can act as APCs

A

macrophages
dendritic cells
b cells

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4
Q

give some examples of extra-articular symptoms/involvement in RA

A

eyes - scleritis and sicca (esp secondary to sjogrens)
skin - nodules and vasculitis
soft tissue - bursitis, tenosynovitis and muscle wasting
kidneys - amyloidosis
lungs - pleural effusions
CVS - pericarditis, pericardial rub
neuro - polyneuropathy
haematological - anaemia and splenomegaly

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5
Q

difference in morning stiffness in OA and RA

A

OA 60 mins

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6
Q

difference in joint involvement in OA and RA

A

OA - weight bearing joints, CMCJ and DIPJ
RA - NEVER DIPJ
–> symmetrical involvement of small joints of hands and feet, common in wrists, MCP and PIPs

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7
Q

examples of TNF-a inhibitors used in RA and explain mechanism of action

A

etanercept, infiliximab, adalimumab

  • -> bind to TNF and prevent its interaction with receptors (remove it from inflam sites and prevent it reaching its receptors)
  • -> prevents its effects of mediating/stimulating release of other cytokines
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8
Q

what is tocilizumab and how does it work

A

= DMARD - IL-6 inhibitor

  • -> binds to IL receptor therefore prevents IL-6 from binding and inhibiting cell communication
  • -> inhibits production of more T and B cells and therefore reduces inflam at joints
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9
Q

what is anakinra

A

IL-1 inhibitor

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10
Q

what is rituximab and how does it work

A

= B cell inhibitor
targets CD20 and prevents the release of cytokines and inflam mediators
also prevents B cells acting as APCs

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11
Q

what is abatacept and what is its mechanism of action

A

= t cell inhibitor
decreases t cell activation and prolif
decreases release of pro-inflam cytokines
upstream modulation (preventing downstream changes)
decreases autoAb production
regulates function of CD4+ cells

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12
Q

what triad of features do you see in Felty’s syndrome

A

seropositive RA
splenomegaly
neutropenia

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13
Q

why are women at higher risk of osteoporosis post-menopause

A

because bone turnover occurs more rapidly in the absence of oestrogen –> more bone resorbed than reformed –> bone loss

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14
Q

how does cortisol lead to osteoporosis

A

it increases bone resorption and induces osteoblast apoptosis (–> decreased bone formation)

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15
Q

composition of bone

A

70% mineral cortex - mostly HYDROXYAPATITE = ca and phosphate
30% organic cortex - mostly type 1 collagen fibres

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16
Q

actions of PTH leading to increased serum Ca

A

increased osteoclastic resorption of bone
increased interstitial absorption of Ca
increased synthesis of 1,25 dihydroxy-vit D
increased renal tubular reabsorption

17
Q

4 secondary causes of sjogrens

A

SLE
systemic sclerosis
primary biliary cirrhosis
RA

18
Q

Main clinical features of sjogrens

A 
SICCA COMPLEX =
dry eyes
dry mouth
enlarged parotid/salivary glands
(plus systemic features)
19
Q

systemic features of sjogrens

A 
fatigue
vasculitis
arthritis
raynauds
lymphadenopathy
dysphagia/abnormal oesophagus
20
Q

what auto-Abs might you see in sjogrens

A

Anti-Ro, anti-La, RF, and ANA

21
Q

Ix for sjogrens

A

schirmer’s test
gland bx –> rose bengal stainign –> keratinitis
Immunology - Anti-Ro, anti-La, RF, and ANA
lab abnormalities - raised Ig levels, raised immune complexes etc

22
Q

define polymyositis

A

= progressive symmetrical proximal weakness and AI muscle inflam, ± myalgia ± arthralgia

23
Q

what is antiphospholipid syndrome characterised by

A

thrombosis
&/or recurrent miscarriages
& persistent +ve blood tests for antiphospholipid antibodies

24
Q

How do you treat APS and how does this differ in pregnancy

A

in pt with history of thrombosis give long term warfarin
in pregnant give aspirin and heparin –> decrease risk of miscarriage, but pre-eclampsia and poor foetal growth still common

25
Q

What are the common features in the seronegative spondyloarthropathies

A

Asymmetrical large joint mono/oligoarthritis
Enthesitis
Dactylitis
Extra-articular features e.g. anterior uveitis
Strong association with HLA B27

26
Q

two types of crystals that account for most of the crystal arthritis

A

sodium urate

calcium pyrophosphate

27
Q

where are tophi in tophaceous gout most likely to form

A

ear, fingers and achilles tendon

28
Q

what are some associated disorders of fibromyalgia

A 
depression
chronic headache
IBS
chronic fatigue syndrome
myofascial pain syndrome
29
Q

What is an important complication in juvenile idiopathic arthritis

A

chronic uveitis due to inflam can –> to loss of sight

If JIA dx = REFER TO OPTHALMOLOGIST

30
Q

define a fracture

A

soft tissue injury in which there is also a break in continuity of surface/sub-structure of a bone

Phase 2A HT (11 decks)

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