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msk mid tier Flashcards

1
Q

what do all autoimmune connective tissue disorders share

A
  • All linked by ANA antibody +(antinuclear antibody)
  • All relate to immunosuppression
  • Can affect any organ
  • All relate to inflammation
  • Scarring as a result
  • Damage is irreversible
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2
Q

sjorgens pathophysiology and symptoms

A

Lymphocytic infiltration → Exocrine glands (salivary and lacrimal) destroyed → fewer secretions

Symptoms

  • Dry eyes
  • Dry mouth
  • Arthritis
  • Vasculitis
  • Rash
  • Neurological
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3
Q

marfan’s symptoms

A 
Tall
Arm span greater than height
Long fingers
Lens dislocation
High arched palate (mouth)
Aneurysm -- Collagen in vessels
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4
Q

ehler danos symptoms

A

Genetic collagen defect
vascular/skeletal types
Joint hypermobility
Skin elasticity

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5
Q

which connective tissue disorders are NOT autoimmune

A

ehler danos

marfans

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6
Q

sjorgen’s

- investigations

A

Shermer’s test = paper dipped in eye

Raised ESR and immunoglobulins

Antibodies

  • antiRO
  • antiLA
  • ANA
  • RF
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7
Q

sjorgen’s treatment

A

Replace saliva and tears

Immunosuppression for systemic complications

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8
Q

scleroderma pathophysiology

A

Increased fibroblast activity → abnormal growth of connective tissue

systemic sclerosis

collagen depsotion, inflammation, autpimmune
vascular damage

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9
Q

scleroderma symptoms

A

CREST (limited disease)

  • Calcinosis = calcium deposition sub-cut (white lumps)
  • Raynaud’s (vasculopathy)
  • Esophageal dysmotility and strictures and dilated (reflux)
  • Sclerodactly = thickened skin
  • Telangiectasia = widened venules - spider naevi
\+ tight skin (restriction)
ulcers (esp digits)
watermelon belly
short history of raynauds
pulmonary hypertension

more diffuse disease

  • Rapid and widespread onset
  • Heartburn
  • Reflux oesophagitis
  • Delayed gastric emptying
  • Pulmonary fibrosis and hypertension
  • Skin involvement, also proximal - trunk
  • Raynaud’s history shorter
  • Increased risk of CV
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10
Q

scleroderma investigations

A
  • ACA anticentromere antibodies
  • ANA +
  • Spirometry and echo to detect pulmonary and arterial hypertension
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11
Q

scleroderma treatment

A
  • PPIs (GORD)
  • ACEi - prevent renal crisis
  • Vasodilators (raynauds) — CCB
  • Monitor for pulmonary hypertension
  • Treat skin oedema
  • UV protection
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12
Q

dermatomyotis
polymyotis

what is the symptoms and treatment for these both

A
  • skin rash - eyelids, knuckles(Derm)
  • muscle weakness (polymyo)
  • breathlessness (both)

steroids
immunosuppression

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13
Q

antiphospholipid syndrome =

  • pathophys
  • who
  • presentation
  • management
  • compli
A

autoimmune
arterial and venous thrombosis (antiphospholipid antibodies are hypercoaguable)

fertile-age women + if black

presentation = clot-y

management = heparin

compl = clot-y (MI,stroke, miscarriage, DVT etc)

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14
Q

primary bone tumours

  • commonness
  • age group
A

rare (secondary more com)

young patients

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15
Q

most common primary bone tumour in children / adults

A

children - osteosarcoma

adults - chrondrosarcoma

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16
Q

primary bone cancer types

A 
multiple myeloma
lymphoma
osteosarcoma
fibrosarcomas
chondrosarcome
ewings tumour
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17
Q

osteosarcoma

  • age
  • where
  • disease progression
A
  • 15-19
  • knees mainly (humerus, femur)
  • destroys bone and spreads to surrounding tissues + metastasises to lung rapidly
  • but relatively painless
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18
Q

what bloods might be interesting for bone tumours

A
  • Serum alkaline phosphatase (from bone) raised
  • Hypercalcemia occurs in 10-20% of those with metastatic malignancies
  • FBC (low something - bone makes stuff?)
  • u/e
  • PSA = prostate specific antigen. May be raised with prostatic metastases
19
Q

mirel’s score=

A

likelihood of fracture

  • based on site
  • pain
  • lesion nature (blastic, lytic, mixed)
  • lesion size
20
Q

enneking system for grading

A

for primary bone tumours

1A : low grade- intracompartmental
1B: low grade- extracompartmental
2A: high grade -intracompartmental
2B : high grade - extracompartmental 
3: metastases
21
Q

how much bone density must be lost before lytic areas to be seen

22
Q

onion skinning

A

layers on edge - periosteum lifted off then bone calcifies sequentially

bone tumours

23
Q

sunburst spicules

A

calcification of capillaries supplying tumour

bone tumour

24
Q

codman’s triange

A

periosteum lifted off bone

bone tumour

25
what does the periosteum reveal on a bone tumour scan
- periosteum covers bone. - comes off with tumour, infection, trauma - indicates tumour speed of growth - slow -- callus - fast -- interputs process causing layers. may burst through periosteum. (onion skinning, sunburst spicules, codman's triangle)
26
secondary bone tumours - metastasise from where to bone - nature of these tumours
``` Lungs, bronchus Breast Prostate - often osteosclerotic too Rarer - Thyroid - kidney ``` osteolytic (bone resoprption via osteoclast activation by tumour cells (RANK-L binds to RANK…))
27
chondrosarcoma - what - symptoms - where
cancer of the cartilage dulll, deep pain swollen tender pelvis also - femur, humerus, scapula, ribs
28
red flags for bone tumours
- Suspected infection - Systemically unwell inc weight loss - Night pain / rest pain - -- Non-mechanical - -- Constant - Rapid deterioration - Structural deformity - Loss of movement/function - Lump present - -- Tender, enlarging, deep to fascia, large - Neurological symptoms
29
bone tumour presentation
- tender at site - systemic - weight loss, malaise, fever, - aches, pains - ewing's sarcoma can be associated with paralysis, numbness, incontinence
30
primary/ secondary tumours sclerotic/lytic
``` primary = lytic secondary = i think depends on from where ```
31
is a well/ill defined zone of transition more optimistic for bone tumours
well defined = more benign | ill defined = malignant, or could be infection
32
fibromyalgia - age - gender - other risk factors - assocaited with what - triggers
- 30-60 - female - low household income, divorced, low education status - chronic fatigue, IBS, chronic headaches, depression - physical trauma, PTSD, infection, distress, hormone alteration
33
fibromyalgia presentation
- Chronic pain - Responds poorly to analgesia - Soft tissue tenderness - Usually at multiple sites - Depression , anxiety - Fatigue - Poor concentration - Sleep disturbance - Altered bowel habit - Headache - parasthesia
34
fibromyalgia management
- Address social stressors and depression - Education --- Not “in their head” --- Not destructive arthritis → exercise will not harm joint. Not degenerative like OA - Exercise/ strength programmes- may reduce pain and fatigue - CBT - physiotherapy - accupuncture - Tricyclic antidepressants eg amitriptyline may help pain and improve sleep - Anticonvulsants eg pregabalin, gabapenlin (If amitriptyline ineffective) - Dual reuptake inhibitors eg duloxetine-- Good for anxiety/depression - Antiinflammatory ones have no use - analgesia but poor response
35
fibromyalgia investigations
Examination of tender trigger points (need teens of them) Exclude other diagnoses - all other investigations are normal
36
mechanical lower back pain - age - common - where
- 20-55 - common - back :lumbrosacral. buttock/thigh
37
mechanical back pain
``` back pain - lumbrosacral buttock/ thigh varies with physica; activity and time normally resolves in 6w may persist/ relapse ```
38
mechanical back pain management
``` Conservative management - Education - Exercise Analgesia NSAIDs Muscle relaxants ```
39
osteomalacia treatment
Vitamin D replacement= calciferol
40
osteomalacia symptoms
- Rickets - bowed legs, knock knees - Proximal Muscle weakness + pain - Widespread bone pain (diffuse but esp hips) + tenderness - Bone weakness--Fractures, esp femoral neck - Muscle spasm and numbness -- due to hypocalcaemia
41
osteomalacia pathophysiology
- Normal amount of bone but its mineral content is low - Defective mineralisation - Excess uncalcified osteoid and cartilage - Bone mineralisation needs adequate calcium and phosphate - so bones are soft and weak
42
how does vit d play a part in osteomalacia
Vitamin d promotes calcium absorption in the intestines and promotes bone resorption (by increasing osteoclast number) - so more for bones so vit d deficiency is common cause
43
osteomalacia causes (inc epidemiology!)
Vitamin D def - Lack of sunlight - -- Dark skin * - -- Elderly * - -- institutionalised - Poor diet (not enough oily fish /egg yolk) - Renal disease - Liver disease - Some drugs eg anticonvulsants breakdown vit D precursor Calcium def Phosphate def * GI malabsorption
44
osteomalacia investigations
Blood - Low calcium and phosphate - Raised serum alkaline phosphatase - Elevated parathyroid hormone - Low 25-hydroxy vitamin D Biopsy = gold standard - Incomplete mineralisation in bone X ray - Psuedo fractures, low BMD, osteopenia

phase 2a mine (38 decks)

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