MSK & Rheumatology

Question 1

List structures that experience synovial joint failure in OA?

Answer 1

Cartilage

Synovium

Subchondral bone

Joint capsule

Intra-articular ligament complexes

Question 2

Function of cartilage in bones

Answer 2

Distribute load

Low contact stresses

Decrease friction (lubrication)

Question 3

Ballanitis Xerotica Obliterans (BXO) aka Lichen Schlerosis

Answer 3

A chronic condition that causes thin, white patches of skin, usually in the genital area.
This condition occurs primarily in girls who haven’t started menstruating and in postmenopausal women. Lichen sclerosus is thought to be related to genetics, immune disorders, trauma or infection.
Lichen sclerosus can cause discomfort, itching and easy bruising or tearing of the skin.

Question 4

Lymphogranuloma venereum (LGV)

Answer 4

Lymphogranuloma venereum (LGV) is an ulcerative disease of the genital area.[1] Its cause is the gram-negative bacteria Chlamydia trachomatis, especially serovars L1, L2, and L3.[2] It is an uncommon, sexually transmitted infection. It is transmittable by vaginal, oral or anal sex.

Question 5

Granuloma inguinale

Answer 5

Granuloma inguinale is a bacterial disease caused by Klebsiella granulomatis characterized by genital ulcers. It is endemic in many less-developed regions

Question 6

List causes of genital ulcers

Answer 6

Syphilis

Herpes Simplex Virus

Chancroid

Malignancy (penile cancer)

Premalignant conditions

Carcinoma in sito

Ballanitis Xerotica Obliterans (BXO) aka Lichen Schlerosis

Lymphogranuloma venereum

Granuloma inguinale

Question 7

What organism causes syphilis?

Answer 7

Treponema pallidum (organism)

Question 8

What are the stages of syphilis, and latent syphilis is dived into what based on?
Also how long does it take for an infection to happen?

Answer 8

Primary, secondary, latent and tertiary infection (stage of untreated infection)

Latent is subdivided into early and late latent (based on if infection occurred within the last 12m)

Time from transmission to primary lesion varies widely:

21 days (10-90 days)

May present decades later

Question 9

What does gummatous mean?

Answer 9

: a tumor of gummy or rubbery consistency that is characteristic of the tertiary stage of syphilis. g

Question 10

Causes of phimosis (physiologicalthen pathological)

Answer 10

Physiological:

Normal in babies
Loosen up as boy grow:
- 50% @ 1 Year
- 89% @ 3 Years
- 92% @ 8 Years
(Do not retract the foreskin of a baby_
Pathological

Causes:
- Balanitis
- Dermatitis / posthitis (DM)
- Retracting foreskin of a baby
- Lichen Sclerosis (BXO)

Question 11

Pathogenesis pof paraphimosis

Answer 11

Narrow (relatively) foreskin forms tight band behind glans
 Venous & lymphatic drainage of glans  swelling of inner prepuce and glans Reduced perfusion of glans with eventual necrosis

Question 12

2 causes of paraphimosis

Answer 12

Doctors / medical students after catheterization

Incomplete phimosis: foreskin pulled back and left there with relatively tight foreskin

Question 13

Urethral discharge

Answer 13

Urethral discharge usually caused by urethritis (inflammation of urethra)

Most urethritis caused by sexually transmitted diseases

Other causes (rare):

Urethral cancer

Foreign bodies

Stones

Urethral strictures

Instrumentation (cystoscopy)

Chemical irritation

Systemic illness (Reiter’s syndrome)

Question 14

Organism of Gonococcal urethritis and occurence

Answer 14

Neisseria gonorrhoeae
2nd most reported infectious disease in USA

Underestimated (70% of infected women asymptomatic)

Question 15

List organisms of non-gonococcal urethritis (NGU)

Answer 15

Chlamydia trachomatis (50-60%)
Ureaplasma urealyticum (20%)
Mycoplasma genitalium
Trichomonas vaginalis

Question 16

With NGU, there is 2 big causes - name and describe

Answer 16

Chlamydia trachomatis is causative organism in 50-60% of cases

Most common STI

Often asymptomatic

Spread easily

Undiagnosed

CDC recommends annual screening for sexually active women under the age of 26
Reiter’s syndrome:

Systemic illness due to Chlamydia Trachomatis (and other infections)

1-3% of patients

Reactive arthritis

Urethritis

Conjunctivitis

“Can’t see, can’t pee, can’t climb a tree”

Question 17

Local complications of urethritis

Answer 17

Urethral stricture (on average 20 years later!)

Epididymitis

Infertility (secondary to bilateral epididymal obstruction in men and fallopian tube obstruction in females)

Pelvic inflammatory disease (PID) causing chronic pelvic pain in females

Question 18

Systemic complicayions

Answer 18

Perihepatitis

Fitz-Hugh-Curtis syndrome

Right upper quadrant pain

Adhesions between the liver, anterior abdominal wall and diaphragm

Arthritis

Dermatitis

Meningitis

Myopericarditis

Question 19

Primary syphilis

Question 20

Secondary syphilis

Question 22

Tertiary syphilis

Question 23

Chancroid

Question 24

Lymphogranuloma venereum

Question 25

Granuloma inguinale

Question 26

Necrotising fascitis (fornier's gangrene) and pathogenesis

Question 27

Azoospermia

Answer 27

Azoospermia is the medical term used when there are no sperm in the ejaculate. It can be “obstructive,” where there is a blockage preventing sperm from entering the ejaculate, or it can be “nonobstructive” when it is due to decreased sperm production by the testis.

Question 28

Which cells secrete testosterone?

Answer 28

Leydig cells from LH

Question 30

FSH is secreted through which cells and provides sperm incubators

Answer 30

Sertoli cells

Question 31

If you have Sertoli Cell only Syndrome, what happens?

Answer 31

No germ cells Azoospermia

Question 32

GnRH

Answer 32

Gonadotropin hormone-releasing hormone (GnRH) is the key regulator of the reproductive axis. Its pulsatile secretion determines the pattern of secretion of the gonadotropins follicle stimulating hormone and luteinizing hormone, which then regulate both the endocrine function and gamete maturation in the gonads

Question 33

Define male infertility

Answer 33

No pregnancy after 12 months of unprotected sex

Question 34

Causes of infertility

Answer 34

Pre-testicular: General factors: - Virus infections - Stress - Smoking - Age - Nutrition - Alcohol, dagga - Chronic illness Endocrine: - Hypothalamus - Pituitiary -Adnrenal -Thyroid - Prolactin Then testicular causes: - Varicocele (Reflux of renal- and adrenal metabolites, heat, hypoxia): most common reversable cause - Undescended testis - Previous torsion / trauma - Mumps orchitis (Immunologic) - Radiotherapy Post-testicular:Post-testicular: - Congenital bilateral absence of vas deferens (Needs genetic evaluation) -Tubal obstruction (infection) - Retrograde ejaculation - Coitus-related problems: ED, PE Peyronie’s Hypospadias - Inflammatory conditions of prostate - Urethral stricture -Immunological – Antisperm antibodies - Previous surgery (inguinal hernia)

Question 35

Detumescence

Answer 35

the subsidence of a swelling, esp the return of a swollen organ, such as the penis, to the flaccid state

Question 36

Peyronie's disease and aetiology

Answer 36

Peyronie's disease is a disorder in which scar link tissue, called plaque, forms under the skin of the penis—the male organ used for urination and sex. The plaque builds up inside the penis, in the thick elastic membrane called the tunica albuginea. The tunica albuginea helps keep the penis stiff during an erection. Causes curved, painful erections!! 1% of males Onset: 40-60 years (same as erectile dysfunction) 15-20% also have dupuytren’s contracture What is the natural history of it?Active phase: painful erections, and worsening curve (lasts 12-18 months) Chronic or stable phase: no more pain, stable curve severity, might have erectile dysfunction In some patients the curve in stable phase might not be bothersome (usually if <30 degrees)

Question 37

Priaprism

Answer 37

Priapism is a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation. Definitions vary regarding duration, but any erection lasting four hours or longer is generally considered priapism.