MSK III Flashcards

1
Q

How does CKD cause osteomalacia?

A

Reduced phosphate excretion and inactive activation of vitamin D results in secondary hyperparathyroidism with subsequent osteomalacia, sclerosis of bone and calcification of soft tissues

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2
Q

Shepherd’s hook deformity =

A

Fiberous dysplasia

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3
Q

Where does fiberous dysplasia typically affect?

A

Proximal femur

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4
Q

Which malignant primary bone tumour tends to occur in abnormal bone?

A

Fibrosarcoma

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5
Q

Briefly describe the steps involved at the NMJ

A
  1. Resting potential of end bulb is negative
  2. AP coming along makes it positive
  3. This opens up voltage gated calcium channels, and calcium flows into the end bulb
  4. This causes vesicles containing ACh to release ACh into the synaptic cleft
  5. This causes activation of Na channels on the muscle, causing Na influx
  6. This generated an AP in the skeletal muscle
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6
Q

Describe the process of sliding filament theory

A
  1. An AP from the NMJ propagates along the sarcolemma, and down T tubules
  2. This causes opening of voltage gated Ca channels, and Ca2+ flows out of the terminal cisternae
  3. Ca2+ bind to troponin, causing tropomyosin to unwind and the myosin binding site on actin to become free
  4. ATP binds to the myosin, and myosin binds to actin
  5. Myosin pulls actin towards the M line of the sarcomere
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7
Q

Name and briefly describe the three types of skeletal muscle fibre

A
Type 1
- Slow contracting 
- Abundant mitochondria
- Resistant to fatigue
- Produce relatively less force 
Type IIA
- Intermediate between the other two 
- Fast contracting 
- Resistant to fatigue 
- Uncommon 
Type IIB
- Fast contracting 
- Few mitochondria
- Fatigue relatively easily
- Produce relatively greater force
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8
Q

Which type of bone does not contain Haversian canals?

A

Trabecular (cancellous)

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9
Q

What is the difference between lamellar and woven bone?

A

Woven is layed down after trauma in a hap hazard fashion
Woven bone is remodelled to lamellar bone
Lamellar bone has collagen fibres all running in one direction

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10
Q

What is the basic multicellular unit (BMU) in bone?

A

The collection of osteoclasts and osteoblasts that participate in bone remodelling

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11
Q

What is the functional unit of bone?

A

Osteon

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12
Q

What are each of the following

  • A band
  • I band
  • H zone
  • M line
A
  • A band - runs the length of thick filaments (remember A band is dArk)
  • I band - runs the length of thin filaments (remember I band is thIn)
  • H zone - lighter area within middle of A band, where thin filaments don’t reach
  • M line - extends vertically down middle of A band
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13
Q

In skeletal muscle contraction, what is the contractile component and what is the series-elastic component?

A

Contractile component = sarcomeres

Series-elastic component = connective tissue + tendon

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14
Q

What are the two types of skeletal muscle contraction

A

Isotonic contraction: -
- Used for (1) body movements and for (2) moving objects
- Muscle tension remains constant as the muscle length changes.
Isometric contraction:
- Used for (1) supporting objects in fixed positions and for (2) maintaining body posture
- Muscle tension develops at constant muscle length

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15
Q

When are each of the skeletal muscle fibre types used?

A
Type I (slow oxidative) - maintenance of posture, walking 
Type II (fast oxidative) - jogging 
Type II (fast glycolytic) - jumping
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16
Q

What are muscle spindles?

A

Sensory receptors for stretch reflex
They are a collection of specialised muscle fibres
Found in the belly of muscles and run parallel to ordinary muscle fibres
They have their own efferent nerve supply

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17
Q

Why do muscle spindles have their own nerve supply?

A

To adjust their sensitivity so that they remain sensitive to stretch

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18
Q

What are the four broad types of collagen and where are they found?

A

Type I - bone, fascia, dermis of skin
Type II - cartilage (hyaline)
Type III - skin, vessels, granulation tissue
Type IV - basement membrane -> important in Alport syndrome

19
Q

What should you treat MRSA with?

A

Vancomycin

20
Q

Asymmetrical huge joint swelling which isn’t as painful as it looks = ?

A

Lyme disease

21
Q

Tennis shoe on, step on a nail = ?

A

Pseudomonas

22
Q

Needle lickers bug = ?

A

Eikenella corrodens

23
Q

Bugs in Sickle cell osteomyelitis?

A

Salmonella

Staph aureus

24
Q

What does SAPHO and CRMO stand for?

A

Synovitis Acne Pustolosis Hyperostosis Osteitis (adults)

Chronic Recurrent Multifocal Osteomyelitis (kids)

25
Q

What is Pott’s disease?

A

Vertebral TB

26
Q

What is the classic triad of prosthetic joint infection?

A
  1. Severe skin infections
  2. Necrotizing pneumonia
  3. Invasive infections e.g. bacteraemia, septic arthritis
27
Q

Antibiotic for open # prophylaxis?

A

IV co-amoxiclav

28
Q

Which antibiotic is important in biofilm?

A

Rifampicin

29
Q

Upper limb prosthesis infection bug?

A

Propionibacterium acnes

30
Q

Antibiotic for septic arthritis <5 y?

A

Flucloxacillin + Ceftriaxone

31
Q

Treatment of Clostridium tetani pyomyositis?

A

Surgical debridement + botulism antitoxin + penicillin/metronidazole + toxoid booster vaccination

32
Q

Antibodies for Kawasaki?

A

Anti-endothelial

33
Q

Funny rash + GI symptoms + renal failure = ?

A

Polyarteritis nodosa

34
Q

Apple green birefringence with congo red staining = ?

A

Amyloid - found in multiple myeloma

35
Q

Secondary malignancy in Paget’s?

A

Osteosarcoma

36
Q

Mets of which cancer cause sclerosis (opacity) in bone?

A

Prostate

37
Q

Kid born with tumour that looks like grapes coming out of the vagina = ?

A

Embryonal Rhabdomyosarcoma

38
Q

List some side effects of methotrexate

A

Leukopeania, thrombocytopenia
Hepatitis/cirrhosis - lower alcohol consumption
Pneumonitis
Nausea
Teratogenic - males and females should stop 3 months before trying to conceive

39
Q

Importance of Leflunomide?

A

V similar to methotrexate but longer half life

Either have to do a full washout or not get pregnant for 2 years after if you just stop it

40
Q

Side effects of sulphasalazine?

A
Neutropenia
Turns pee red
Reversible infrtility in men
Nausea
Hepatitis
SAFE IN PREGNANCY
41
Q

Side effect of hydroxychloroquine?

When is this drug used?

A

Irreversible retinopathy

Used in palindromic RA

42
Q

Side effects of gold?

A
Bone marrow suppression
Glomerulonephritis
Rash
Mouth ulcers
FBCs and proteinuria
43
Q

Which is the only biologic you can use in connective tissue disease?

A

Rituximab

44
Q

Treatment of ANCA associated vasculitis?

A

If organ involvement localized to resp or without organ threatening: MTX + steroids
If organ threatening: IV steroids + cyclophosphamide