MSK

Question 1

Qn – joint destruction is typicall seen in all of these arthritis EXCEPT:

• JIA
• Ankylosing spondylitis
• Lyme disease
• Gonococcal arthritis
• Staphylococcal septic arthritis

Answer 1

Gonococcal arthritis

Question 2

Story to remember risk factors of RA?

Answer 2

Fat nulliparous middle aged female who smokes

Question 3

What is Felty Syndrome?

What is the acronym to remember it?

Answer 3

Rare autoimmune disorder (females), genetic association
Serious - predispose to severe infection
SANTA acronym:
SPLENOMEGALY
ANEMIA - HAEMOLYTIC --> ULCERS LEGS
NEUTROPENIA
THROMBOCYTOPENIA
Rheumatoid ARTHRITIS

Question 4

What does limited mobility of a joint indicate, anatomically (pathology)?

Answer 4

Limited mobility = Irregularity within the joint/ankylosis

Question 5

Triad of features in Reactive arthritis? Thus, what epidemiology?

Answer 5

• Reactive asymmetric polyarthritis predom lower limb - migratory
• Non-gonococcal urethritis***
• Conjunctivitis
  Dactylitis!

***epidemiology in young men who get chlamydia, and are HLAB27 positive

Question 6

Who gets MSK tumours (epidem)?

Answer 6

MSK tumours

• Rare in adults
• Common in kids. 40% thigh cancers children

Question 7

Top 3 most common benign soft tissue tumours + their histology
Top 3 most common malignant soft tissue tumours + their histology

Answer 7

Benign soft tissue tumours: 1) lipoma 2) angioma 3) leiomyoma - well-demarcated
Malignant soft tissue tumours - 1) liposarcoma, 2) malignant fibrous histiocytoma 3) angiosarcoma
- poorly demarcated, infiltrative

Question 8

What is the commonest bone and soft tissue CT tumour?

Answer 8

OSTEOSARCOMA

Question 9

TCP osteosarcoma

Answer 9

• 18yo boy presents with leg pain, swelling and mild fever for 2 weeks
• A hx of falling over is quite possible

Question 10

Osteosarcoma classification + aetiology

Answer 10

Primary (10-20y olds)
Secondary – in elderly, secondary to other diseases in the bone

Rb gene mutations in >60% - huge genetic component in it

Question 11

Most common site of mets for osteosarcoma?

Answer 11

Pulmonary

Question 12

95% of Ewings patients have which mutations?

Answer 12

95% of pts with Ewings have 5(11;22) or t(21;22)

Question 13

3 medications that cause osteoporosis?

Answer 13

STEROIDS
Anticoagulants
PPIs

Question 14

Pharmacological treatment of osteoporosis outline

Answer 14

1st line treatment = bisphosphonates – inhibit osteoclastic action.
Alternatives where bisphosphonates contraindicated:
- Denosumab (monoclonal Ab against RANKL): for pts with impaired renal function, or no success with 1st line
- Teriparatide (PTH analog): severe OP
- Raloxifene (SERM) for pts with contraindications to bisphosphates or those who require breast cancer prophylaxis. Warning: this increases risk of thromboembolism.

Question 15

Definition of spondylosis

Spondylolisthesis

Answer 15

Spondylosis = general term for age-related wear + tear of spinal discs
Spondylolisthesis = degenerative condition where one vertebra slips forward under the vertebra beneath it

Question 16

What is myopathy? Most common aetiology - name some examples

Answer 16

Myopathy - non-inflammatory muscle abnormality. Viral aetiology most common, caused by STATINS MYOPATHY or thyrotoxicosis