Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine Year 2 5 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What does ESR stand for?

A

Erythrocyte sedimentation rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give 2 circumstances where there are false positives of ESR

A
  • ) Age
  • ) Female
  • ) Obesity
  • ) Ethnicity
  • ) Hypercholesterolaemia
  • ) Anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does CRP stand for?

A

C-reactive protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is CRP released, and in response to what?

A

Liver, IL-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of joint disease is osteoarthritis?

A

Degenerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 2 things osteoarthritis can be secondary to

A
  • ) Obesity
  • ) Occupational factors
  • ) Haemochromatosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the process of osteoarthritis mediated by?

A

Cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the main pathological features of osteoarthritis? (2)

A
  • ) Loss of cartilage

- ) Disordered bone repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give 4 risk factors for osteoarthritis

A
  • ) Age
  • ) Gender (F more after menopause)
  • ) Genetic predisposition
  • ) Obesity (low grade inflammatory state)
  • ) Occupation (manual labour)
  • ) Local trauma, inflammatory arthritis, abnormal biomechanics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 3 main symptoms that differentiate osteoarthritis from rheumatoid arthritis

A
  • ) Stiffness after rest for <30 minutes
  • ) Pain worse on exertion
  • ) Worse pain at end of day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give 3 commonly affected joints in osteoarthritis

A
  • ) DIP
  • ) Thumb CMP
  • ) Knees
  • ) Hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 symptoms of osteoarthritis

A
  • ) Pain and crepitus on movement
  • ) Background ache at rest
  • ) Worse with activity
  • ) Joint tenderness, derangement, bony swelling
  • ) Reduced range of movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 2 types of nodes in osteoarthritis?

A

Heberden’s - DIP

Bouchard’s - PIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do plain radiographs show in OA?

A 
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Give 4 treatment options for OA

A
  • ) Exercise
  • ) Analgesia
  • ) Intra-articular steroid injections
  • ) Heat/cold packs
  • ) Walking aids
  • ) Joint replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where do the majority of septic arthritis cases occur?

A

Knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give 3 risk factors for septic arthritis

A
  • ) Pre-existing joint disease (esp. RA)
  • ) DM
  • ) Immunosuppression
  • ) Chronic renal failure
  • ) Recent joint surgery
  • ) Prosthetic joints
  • ) IVDU
  • ) Age >80
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the main differential diagnosis for septic arthritis?

A

Crystal arthropathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the main investigation for septic arthritis?

A

Urgent joint aspiration for synovial fluid microscopy and culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What must we do prior to giving antibiotics in septic arthritis?

A

Blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give 3 causative organisms for septic arthritis

A
  • ) Staph aureus
  • ) Streptococci
  • ) Neisseria gonococcus
  • ) Gram negative bacilli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment for septic arthritis?

A
  • ) Empirical IV antibiotics (flucloxacillin)
  • ) Vancomycin if MRSA risk
  • ) Cefotaxine if gram negative, gonococcus
  • ) Possible washout and debridement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What do we give instead of flucloxacillin if the patient is penicillin allergic?

A

Clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is osteomyelitis?

A

Infection and inflammation of the bone and bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the 2 classifications of osteomyelitis?
- ) Acute/chronic suppurative osteomyelitis | - ) Diffuse/focal sclerosing
26
Give 3 of the most common causative organisms for osteomyelitis
- ) Staph aureus - ) Enterobacter species - ) Streptococcal species - ) H. influenzae
27
Which infection in osteomyelitis is more common in sickle cell disease?
Salmonella
28
Give 3 risk factors for osteomyelitis
- ) Behavioural factors (risk of trauma) - ) Vascular supply - ) Pre-existing bone/joint problem - ) Immune deficiency - ) IVDU - ) TB - ) Injury - ) Surgery
29
What bones are usually affected in osteomyelitis? (2)
Adult - vertebrae and pelvis | Children - long bones
30
What type of osteomyelitis usually occurs in children?
Acute haematogenous osteomyelitis (blood to bone)
31
What is the pathogenesis of osteomyelitis in children?
1) Blood flow slower in metaphysis (shaft) 2) Endothelial basement membranes absent 3) Capillaries lack/have inactive phagocytic cells 4) High blood flow in developing bones (to carry infection)
32
What type of osteomyelitis usually occurs in adults?
Contiguous osteomyelitis (infection to bone)
33
What is the pathogenesis of osteomyelitis in adults?
1) Vertebrae become more vascular with age 2) Bacterial seeding of vertebral endplate more likely 3) Lumbar > thoracic > cervical
34
Give 2 key histopathological changes that occur in osteomyelitis
- ) Necrotic bone - sequestra | - ) New bone formation - involucrum
35
Why do sequestra and involucrum occur in osteomyelitis?
Interruption of periosteal blood supply due to inflammatory exudate extending through periosteum
36
Give 2 symptoms of osteomyelitis
- ) Several day onset - ) Dull pain at site of OM - ) May be aggravated by movement
37
Give 3 signs of osteomyelitis
- ) Fevers, riggers, sweats, malaise - ) Tenderness, warmth, erythema, swelling - ) Draining sinus tract - ) Deep/large ulcers failing to heal despite several weeks treatment - ) Non-healing fractures
38
What can osteomyelitis also present as?
Septic arthritis
39
Give 3 tests we do to diagnose osteomyelitis
- ) Radiographs and CT - ) MRI - ) Bloods
40
What do radiographs and CTs show in osteomyelitis?
- ) Cortical destruction in advanced disease - ) Soft tissue swelling - ) Sclerosis - ) Sequestra - ) Periosteal reaction - ) Takes 1-2 weeks to show changes
41
What does an MRI show in osteomyelitis?
- ) Marrow oedema - ) Delineates cortical, bone marrow and soft tissue inflammation - ) Takes 3-5 days to show cahnges
42
What is the treatment for osteomyelitis?
Prolonged specific antibiotic therapy
43
What are crystals?
Homogenous solids that act to remove excess ions by surface binding
44
What is a crystal arthropathy?
Arthritis caused by crystal deposition in the joint lining
45
What type of crystals occur in gout?
Monosodium urate crystals
46
What type of crystals occur in pseudogout?
Calcium pyrophosphate crystals
47
Where does the majority of gout present?
Metatarsophalangeal joint of big toe
48
Give 3 things gout attacks may be precipitated by
- ) Trauma - ) Surgery - ) Starvation - ) Infection - ) Diuretics
49
What are long term urate deposits known as?
Tophi
50
What does severe joint inflammation present as?
Hot, red, swollen joints
51
What is uric acid produced from, and what is a key enzyme in this pathway?
Purine metabolism, xanthine oxidase
52
Give 3 causes of under excretion of uric acid
- ) Drugs (aspirin), alcohol - ) Renal impairment - ) HTN/ anti-HTNs - ) Metabolic syndrome - ) Diuretics - ) Age - ) Male - ) Post menopause
53
Give 3 causes of over production of uric acid
- ) Diet (alcohol, meat, fructose) - ) Hyperlipidaemia - ) Psoriasis - ) Chemotherapy
54
What is the amplification loop hypothesis?
The more crystals you have, there more likely you are to get more
55
Give 2 locations of tophi
- ) Pinna ear cartilage - ) Joints - ) Tendons
56
Give 3 associations of diseases with gout
- ) DM - ) CVD - ) HTN - ) Chronic renal failure
57
What is tophaceous gout?
Long term deposition without treatment
58
What is the main test for gout?
Polarised light microscopy of synovial fluid
59
What does a polarised light microscopy of synovial fluid show in gout?
Negatively birefringent urate crystals, needle shaped
60
What do radiographs show in gout?
- ) Soft tissue swelling early | - ) Well defined punched out erosions in juxta-articular bone later
61
What is the treatment of gout? (3)
- ) High dose NSAID or colchicine - ) Steroids - ) Rest and elevate joint
62
Give 3 lifestyle changes for the prevention of gout
- ) Lose weight - ) Avoid prolonged fasts - ) Avoid alcohol excess - ) Avoid purine-rich meats - ) Avoid low dose aspirin
63
When should we start prophylaxis for gout and what is it?
- ) >1 attack a year, tophi, renal stones - ) Allopurinol - ) Titrate and increase until plasma urate <0.3mmol/L - ) Wait until 3 weeks after acute episode - ) Cover with NSAID/colchicine
64
What is allopurinol?
Xanthine oxidase inhibitor
65
Give 3 risk factors for pseudogout
- ) Hyperparathyroidism - ) Haemochromatosis - ) Hypophosphataemia
66
Which joints are affected in pseudogout?
Knee > wrist > shoulder > ankle > elbow
67
What does a polarised light microscopy of synovial fluid show in pseudogout?
Weakly positive birefringent crystals, rhomboid shaped
68
What is pseudogout associated with on an XR?
Soft tissue calcium deposition
69
What is the management of pseudogout?
- ) Cool packs, rest - ) Aspiration - ) Intra-articular steroids - ) NSAIDs (+PPI) +/- colchicine may prevent acute attacks - ) Methotrexate and hydroxychloroquine for chronic
70
What should we check for if the pseudogout is early onset (<55), polyarticular, or frequent?
Metabolic disease
71
What is osteoporosis?
Reduced bone mass and micro-architectural deterioration in bone tissue
72
What can occur if trabecular bone is affected in osteoporosis?
Crushing fractures of vertebrae
73
What can occur if cortical bone is affected in osteoporosis?
Long bone fractures more likely (femoral neck)
74
Does osteoporosis occur more in men or women >50, and why?
Women, lose trabecular with age
75
Give 3 risk factors for primary osteoporosis
- ) Parental history - ) Alcohol - ) RA - ) Low BMI - ) Prolonged immobility - ) Untreated menopause
76
Give 9 other risk factors for osteoporosis (acronym)
``` SHATTERED Steroid use Hyperthyroidism, hyperparathyroidism, hypercalciuria Alcohol and tobacco Thin (low BMI <18.5) Testosterone decreased Early menopause Renal/liver failure Erosive/inflammatory bone disease (RA) Dietary calcium low, DM ```
77
What % of women will have a fracture due to osteoporosis in their lifetime?
50%
78
What is the Eular buckling theory? (osteoporosis)
Connections between horizontal trabeculae decrease, therefore decrease in overall strength
79
What are the 2 tests for osteoporosis?
XR, DEXA
80
What does DEXA stand for?
Dual energy XR absorptiometry
81
Where do we scan with DEXA?
Hip
82
What is the T-score in a DEXA scan?
The number of standard deviations the bone mineral density is from the young healthy adult average (25)
83
What does each decrease of 1SD in bone mineral density give?
2.6 times increased risk of hip fracture
84
What do the T-scores mean in osteoporosis? (5)
- ) >0, better than normal - ) 0 to -1, normal - ) -1 to -2.5, osteopenia - ) >-2.5, osteoporosis - ) >-2.5 plus fracture, severe osteoporosis
85
What is a risk assessment tool for estimating 10 year risk of osteoporotic fracture in untreated patients?
FRAX
86
Give 3 lifestyle changes to make in osteoporosis
- ) Quit smoking - ) Reduce alcohol - ) Weight bearing exercise - ) Balance exercises - ) Cacium and vitamin D diet - ) Home based fall prevention
87
How should a patient take bisphosphonates?
Plenty of water, upright for >30 minutes, wait 30 mins before eating/other drugs
88
What is denosumab and when should it be given?
Monoclonal antibody to RANK ligand, given SC twice yearly, has fast offset
89
What does RANK stand for?
Receptor Activator of Nuclear factor-Kappa B
90
What does anti-resorptive treatment do in osteoporosis?
Decreases osteoclast activity and bone turnover (allows osteoblasts to catch up)
91
What does anabolic treatment do in osteoporosis?
Increases osteoblast activity and bone formation
92
Give 3 examples of anti-resorptive treatment in osteoporosis (5)
- ) Bisphosphonates - alendronic acid - ) Strontium ranelate - only in severe intolerance and without CVD - ) HRT - ) Raloxifene - selective osterogen receptor modulator - ) Denosumab
93
Give an example of anabolic treatment in osteoporosis
Teriparatide - recombinant PTH
94
Give 3 differences between osteomalacia and osteoporosis
- ) OM serum calcium low, OP no biochemical changes - ) OM has decreased mineralisation of bone, OP no defect in mineralisation - ) OM ache and weakness, OP no symptoms
95
What is Raynaud's syndrome?
Peripheral digital ischaemia due to paroxysmal vasospasm
96
What is Raynaud's syndrome precipitated by?
Cold, emotion
97
What occurs to the fingers or toes in Raynaud's syndrome? (4)
- ) Ache and change colour - ) Pale (ischamia) - ) Blue (deoxygenation) - ) Red (reactive hyperaemia)
98
What is idiopathic Raynaud's syndrome?
Raynaud's disease
99
What is Raynaud's syndrome with an underlying cause?
Raynaud's phenomenon
100
Give 3 conditions in which Raynaud's phenomenon may be exhibited
- ) Systemic sclerosis - ) SLE - ) RA - ) Occupational, vibrating tools - ) Obstructive conditions - ) Thrombocytosis - ) Beta-blockers - ) Hypothyroidism
101
What is the treatment for Raynaud's?
- ) Keep warm - ) Stop smoking - ) Nifedipine - ) Possible sympathectomy (sympathetic nerve trunk resection)
102
What is fibromyalgia?
Syndrome with symptoms of fatigue and widespread pain
103
Give 4 risk factors for fibromyalgia
- ) Female - ) Middle age - ) Low income - ) Divorced - ) Low educational status - ) Problems at work/family - ) Anxiety
104
Give 4 psychosocial risk factor yellow flags for developing persisting chronic pain and long term disability
- ) Belief that pain and activity are harmful - ) Sickness behaviours such as extended rest - ) Social withdrawal - ) Emotional problems such as low mood, anxiety, stress - ) Problems/dissatisfaction at work - ) Problems with claims for compensation/time off work - ) Overprotective family/lack of support - ) Inappropriate expectations of treatment
105
Give 3 conditions fibromyalgia is associated with
- ) Chronic fatigue syndrome - ) IBS - ) Chronic headaches - ) RA - ) AS - ) SLE
106
Give 3 diagnostic features of fibromyalgia
- ) Chronic pain >3 months - ) Widespread pain (L, R, above, below was it, axial skeleton) - ) Profound fatigue
107
Give 3 additional features of fibromyalgia
- ) Morning stiffness - ) Paraesthesiae - ) Headaches - ) Poor concentration - ) Low mood - ) Sleep disturbance - ) Widespread and severe tender points
108
What is the treatment of fibromyalgia?
- ) Remain active - ) Keep working - ) Exclude alternative diagnosis - ) Exercise - ) Pacing of activity - ) Relaxation - ) Rehabilitation - ) Physiotherapy - ) CBT for coping strategies and achievable goals
109
What medications can we give in fibromyalgia?
- ) Low dose amitriptyline - pain and sleep | - ) Duloxetine or SSRI - anxiety and depression
110
What is vasculitis?
Inflammatory disorder of blood vessel walls
111
Give 3 things vasculitis can be secondary to
- ) SLE - ) RA - ) Hepatitis B, C - ) HIV
112
How is vasculitis categorised?
By the size of the vessel affected
113
What does vasculitis cause?
Destruction (aneurysm/rupture) or stenosis
114
Give 2 examples of each of large and medium vasculitis
Large - giant cell arteritis, Takayasu's arteritis | Medium - polyarteritis nodosa, Kawasaki disease
115
Give 4 examples of small vessel vasculitis
``` ANCA associated: -) Microscopic polyangiitis -) Granulomatosis with polyangiitis ANCA negative: -) Goodpasture's disease -) IgA vasculitis ```
116
What is the main symptom of vasculitis?
Overwhelming fatigue with increased ESR/CRP
117
Give 10 symptoms of vasculitis (think systems)
-) Systemic - fever, malaise, weight loss, etc -) Skin - purpura, ulcers etc -) Eyes - episcleritis -) ENT - epistaxis, stridor -) Pulmonary - haemoptysis and dyspnoea -) Cardiac - angina, MI, HF -) GI - pain, perforation -) Renal - HTN, renal failure -) Neuro - stroke, fits, confusion -) GU - testicular pain NOT EXHAUSTIVE LIST
118
What does ANCA stand for?
Anti-neutrophil cytoplasmic antibodies
119
What is c-ANCA?
Cytoplasmic ANCA
120
What is p-ANCA?
Perinuclear ANCA
121
What test do we do to diagnose vasculitis?
Angiography +/- biopsy
122
How do we treat vasculitis?
Large - steroids | Medium/small - immunosuppression with steroids +/- cyclophosphamide or methotrexate/azathioprine
123
What is giant cell arteritis also known as?
Temportal arteritis
124
What is giant cell arteritis associated with in 50%?
Polymyalgia rheumatic
125
What type of arteritis is giant cell?
Granulomatous
126
Give 4 symptoms for giant cell arteritis
- ) Headache - ) Temporal artery and scalp tenderness - ) Tongue/jaw claudication - ) Amaurosis fungax/sudden unilateral blindness - ) Dyspnoea, weight loss, morning stiffness, unequal/weak pulses
127
What do blood tests show in giant cell arteritis?
- ) Very increased ESR and CRP - ) Increased platelets - ) Increased ALP - ) Decreased Hb
128
Is giant cell arteritis ANCA positive or negative?
Negative
129
What is the gold standard of diagnosis in giant cell arteritis?
Temporal artery, be aware of skip lesions
130
What is the treatment of giant cell arteritis? (4)
- ) Immediate prednisolone/IV methylprednisolone - ) Reduce when symptoms resolve and ESR down - ) Balance risks of long term steroid treatment - ) PPI, bisphosphonate, calcium with colecalciferol
131
What is polyarteritis nodosa? (PAN)
Necrotising vasculitis that causes aneurysms and thrombosis in medium sized arteries
132
What does PAN lead to?
Infarction in the affected organs with severe systemic symptoms
133
What gender is giant cell arteritis more common in?
Females
134
What gender is PAN more common in?
Males
135
Give 3 symptoms of PAN
- ) Systemic features | - ) Skin, renal, cardiac, GI, GU, neuro problems
136
Is PAN ANCA positive or negative?
Negative
137
What tests are diagnostic for PAN?
- ) Renal/mesenteric angiography | - ) Renal biopsy
138
What is the treatment for PAN?
- ) Control BP - ) Steroids for mild - ) Steroid sparing agent for severe
139
What is PAN associated with?
Hep B
140
What is polymyalgia rheumatic?
Not a true vasculitis, frequently occurs with GCA
141
How does polymyalgia rheumatic present?
Subacute onset of bilateral aching, tenderness, morning stiffness in shoulders and proximal limb muscles
142
What are other symptoms of polymyalgia rheumatic?
- ) Mild polyarthritis - ) Tenosynovitis - ) Carpal tunnel syndrome - ) Systemic features
143
What is the treatment for polymyalgia rheumatic?
Prednisolone with gastric and bone protection
144
What is granulomatosis with polyangiitis also known as?
Wegener's granulomatosis
145
What is granulomatosis with polyangiitis?
Necrotising granulomatous vasculitis of arterioles, capillaries and post capillary venues
146
What is granulomatosis with polyangiitis associated with?
Anti-neutophil cytoplasmic antibodies (c-ANCA)
147
What is the classic triad that granulomatosis with polyangiitis affects?
Upper respiratory tract, lungs, kidney
148
What are the skin signs of granulomatosis with polyangiitis?
Red spots on legs and feet
149
What is the treatment for granulomatosis with polyangiitis?
- ) Corticosteroids and cyclophosphamide (or rituximab) for remission - ) Azathioprine and methotrexate for maintenance - ) Possible plasma exchange - ) Co-trimoxazole as prophylaxis
150
Give 5 red flags for back pain
- ) Aged <20 or >55 - ) Acute onset in elderly - ) Constant/progressive/nocturnal pain - ) Worse pain when supine - ) Fever, night sweats, weight loss - ) History of malignancy, abdominal mass - ) Thoracic back pain - ) Morning stiffness - ) Bilateral/alternating leg pain, leg claudication, exercise related leg pain - ) Neuro, sphincter disturbance - ) Current/recent infection - ) Immunosuppression
151
If someone was lifting something heavy, and they describe a 'popping' sensation in their back, this is what?
A slipped disc
152
What are the most likely causes of back pain according to age? (15-30)
- ) Prolapsed disc - ) Trauma - ) Fractures - ) Ankylosing spondylitis - ) Pregnancy
153
What are the most likely causes of back pain according to age? (30-50)
- ) Degenerative spinal disease - ) Prolapsed disc - ) Malignancy
154
What are the most likely causes of back pain according to age? (>50)
- ) Degererative - ) Osteoporotic vertebral colapse - ) Paget's disease - ) Malignancy - ) Myeloma - ) Spinal stenosis
155
Give 2 rarer causes of back pain
- ) Cauda equina tumours - ) Psoas abscess - ) Spinal infection
156
What is the best imaging tool for back pain, and what can it detect?
MRI, can detect disc prolapse, cord compression, cancer, infection, inflammation
157
What is the treatment for back pain?
- ) Stay active - ) Paracetamol +/- NSAIDs +/- codeine - ) Consider low dose amitriptyline if these fail - ) Physiotherapy, acupuncture, exercise programme - ) Psychosocial issues
158
What are the spondyloarthropathies? (SpA)
Group of related chronic inflammatory conditions
159
Give the 7 shared clinical features of SpA
1) Seronegativity (RF -ve) 2) HLA B27 association 3) Axial arthritis - pathology in spine and sacroiliacs 4) Asymmetrical arge joint oligo/monoarthritis 5) Enthesitis - inflammation of site of insertion of tendon/ligament into bone 6) Dactylitis - inflammation of entire digit 7) Extra-articular - iritis, psoriaform past, oral ulcers, IBD, aortic valve incompetence
160
What are the features of SpA? (acronym)
``` SPINEACHE Sausage digit (dactylitis) Psoriasis Inflammatory back pain NSAID good response Enthesitis (heel) Arthritis Crohn's/colitis/elevated CRP HLA B27 Eye (uveitis) ```
161
What is ankylosing spondylitis? (AS)
Chronic inflammatory disease of spine and sacroiliac joints
162
In which gender is AS more common?
Men
163
What is the typical patient in AS?
<30 man with gradual onset of low back pain that is worse at night with spinal morning stiffness relieved by exercise
164
Where does the pain radiate from/to in AS?
Pain radiates from sacroiliac joints to hips/buttocks, usually improves towards end of day
165
What is AS associated with? (3)
Osteoporosis, aortic valve incompetence, pulmonary apical fibrosis
166
Give 3 other symptoms of AS
- ) Progressive loss of spinal movement - ) Enthesitis in achilles tendonitis, plantar fasciitis - ) Anterior mechanical chest pain - ) Fatigue
167
What are the pathological steps of bamboo spine in AS?
1) Bony proliferations due to enthesitis between ligaments and vertebra (vertebral syndesmophytes) 2) These fuse with vertebral body above, causing ankylosis 3) Calcification of ligaments with ankylosis leads to bamboo spine
168
What is the delayed damage theory in AS?
The sequence of structural damage is 1) Inflammation 2) Erosive damage repair 3) New bone formation
169
What does an MRI show in AS?
- ) Detection of active inflammation (bone marrow oedema) - ) Erosions - ) Sclerosis - ) Ankylosis
170
What does an XR show in AS?
- ) SI joint space narrowing/widening - ) Sclerosis - ) Erosions - ) Ankylosis/fusion
171
What is the treatment for AS?
- ) Exercise - ) NSAIDs - ) TNF alpha blockers - ) Local steroid injections for pain - ) Surgery - replacement - ) Bisphosphonates
172
Give an example of a TNF alpha blocer
Etanercept, adalimumab
173
What is psoriatic arthritis?
Can occur with psoriasis and present before skin changes
174
What are the 5 patterns psoriatic arthritis can present with?
1) Symmetrical polyarthritis (like RA) 2) DIP joints only 3) Asymmetrical oligoarthritis 4) Spinal (similar to AS) - ) Psoriatic arthritis mutilans (rare, severe)
175
What radiological changes are seen in psoriatic arthritis?
Erosive changes, 'pencil in cup' deformity
176
Give 3 features of psoriatic arthritis
- ) Nail changes - ) Synovitis (dactylitis) - ) Acneiform rashes - ) Palmo-plantar pustulosis
177
What is the management of psoriatic arthritis?
- ) NSAIDs - ) Suldasalazine - ) Methotrexate - ) Anti TNF agents - ) Possible IL 12/23 blockers
178
What does DMARD stand for?
Disease modifying anti rheumatic drugs
179
What is reactive arthritis?
A condition in which arthritis and other clinical manifestations occur as an autoimmune response to infection elsewhere in the body (may have resolved)
180
What infections does reactive arthritis occur after?
- ) Urethritis (chlamydia/ureaplasma) | - ) Dysentery (campylobacter/salmonella)
181
Give 3 symptoms of reactive arthritis
- ) Iritis - ) Keratoderma blenorrhagica (brown raised plaques on soles and palms) - ) Mouth ulcers - ) Circinate balanitis (penile ulceration) - ) Enthesitis
182
What is Reiter's syndrome?
Triad of urethritis, arthritis, conjunctivitis
183
What does an XR in reactive arthritis show?
Enthesitis with periosteal reaction
184
What is the management of reactive arthritis?
- ) Splnit affected joints - ) NSAIDs/local steroid injections - ) Sulfasalazine or methotrexate if >6 months
185
What is enteropathic/enteric arthritis associated with?
IBC, GI bypass, coeliac and Whipple's disease
186
How do we treat enteropathic arthritis?
Treatment of bowel symptoms, DMARDs
187
What is rheumatoid arthritis?
A chronic systemic inflammatory disease characterised by a symmetrical, deforming, peripheral polyarthris
188
What does RA increase the risk of?
CVD
189
What is the typical presentation of RA?
Symmetrical, swollen, painful and stiff small joints of hands and feet
190
What are the 3 types of bone loss in RA?
- ) Focal erosion - ) Periarticular osteoporosis - ) Generalised osteoporosis in skeleton
191
Is the prevalence of RA increased or decreased in smokers?
Increased
192
What is RA linked to? (genetically)
HLA DR4/DR1
193
How long does stiffness last in RA?
>60 minutes
194
Is RA better or worse with use?
Better
195
Give 3 less common presentations of RA
- ) Sudden onset, widespread arthritis - ) Recurrent mono/polyarthritis of joints - ) Persistant monoarthritis - ) Systemic illness with extra articular symptoms - ) Polymyalgic onset - ) Recurrent soft tissue problems
196
Give 2 signs of early RA
- ) Inflammation - ) Swollen MCP, PIP, wrist, MTP (often symmetrical) - ) Tenosynovitis/bursitis
197
Give 2 signs of late RA
- ) Joint damage, deformities - ) Ulnar deviation - ) Subluxation of wrist and fingers - ) Boutonniere and swan neck of fingers - ) Z-deformity of thumbs - ) Hand extensor tendon rupture
198
Give 4 extra-articular manifestations of RA
-) Nodules (elbows, lungs, etc) -) Lungs (pleural disease, interstitial fibrosis etc) -) Cardiac (IHD, pericarditis, pericardial effusion etc) -) Eye (episcleritis, scleritis etc) -) Osteoporosis NOT COMPREHENSIVE
199
What is Felty's syndrome?
RA and splenomegaly and neutropenia
200
What 2 things are usually positive in RA?
RF and anti CCP (very specific)
201
What does anti CCP stand for?
Anticyclic citrullinated peptide antibodies
202
What does an XR show in RA?
Soft tissue swelling, juxta-articular osteopenia, decreased joint space
203
What are better at identifying synovitis and bone erosions than XRs in RA?
MRI and US
204
What 4 things can be found with a blood test in RA?
- ) Anaemia of chronic disease - ) Increased platelets - ) Increased ESR - ) Increased CRP
205
What is the management of RA?
- ) Treat to target - ) DMARDs and biological agents - ) Steroids - ) NSAIDs - ) Physio and occupational therapy - ) Surgery - ) Manage risk factors (CVD and cerebrovascular disease)
206
Give 2 examples of a biological DMARD used for RA
- ) TNF alpha blocker - ) IL-1 receptor blocker (anakinra) - ) Rituximab (lysis of B cells) - ) Tocilizumab (IL-6 receptor antibody) - ) Abatacept (T cell function disruption)
207
Give 2 examples of a non-biological DMARD used for RA
- ) Sulfasalazine - ) Methotrexate (CI pregnancy) - ) Leflunomide
208
Give 4 autoimmune connective tissue disorders
- ) SLE - ) Systemic sclerosis - ) Sjogren's syndrome - ) Polymyositis - ) Dermatomyositis
209
What is Sjogren's syndrome?
A chronic inflammatory autoimmune disorder
210
What is the pathology in Sjogren's?
Lymphocytic infiltration and fibrosis of exocrine glands (especially lacrimal/salivary)
211
Give 3 clinical features of Sjogren's
- ) Decreased tear production - ) Decreased salivation - ) Parotid swelling
212
Give 3 other features of Sjogren's
-) Vaginal dryness -) Dyspareunia (painful sex) -) Dry cough -) Dysphagia -) Polyarthritis -) Raynaud's -) Lymphadenopathy -) Vasculitis -) Fatigue -) Peripheral neuropathy ETC
213
Give 2 things decreased tear production in Sjogren's causes
- ) Dry eyes | - ) Keratoconjunctivitis sicca
214
How do we measure conjunctival dryness in Sjogren's?
Schirmer's test - <5mm in 5mins is positive
215
What 4 things may be present in blood tests in Sjogren's?
- ) Anti Ro antibody - ) Anti La antibody - ) RF - ) ANA
216
What does a biopsy show in Sjogren's?
Focal lymphocytic aggregation
217
What does Rose Bengal staining show in Sjogren's?
Keratitis
218
How do we treat Sjogren's?
- ) Treat sicca (artificial tears, frequent drinks) - ) NSAIDs and hydroxycholoroquine for arthralgia - ) Immunosuppressants for severe
219
What 3 things does systemic sclerosis feature?
- ) Scleroderma (skin fibrosis) - ) Internal organ fibrosis - ) Microvascular abnormalities
220
What was limited systemic sclerosis formally known as?
CREST syndrome
221
What is limited systemic sclerosis associated with?
Anticentromere antibodies (75%)
222
What parts of the body does limited systemic sclerosis involve?
Face, hands, feet
223
Give 5 features of limited systemic sclerosis
- ) Calcinosis of subcutaneous tissues - ) Raynaud's syndrome - ) Oesophageal and gut dysmotility - ) Sclerodactyly (digit inflammation) - ) Telangiectasia (spider veins)
224
What do we treat pulmonary HTN with in limited systemic sclerosis? (2)
Sildenafil, bosentan
225
What parts of the body does diffuse systemic sclerosis involve?
Whole body
226
What are 2 antibodies found in diffuse systemic sclerosis?
- ) Antitopoisomerase-1 (SCL-70, 40%) | - ) Anti-RNA polymerase (20%)
227
What 4 systems are potentially fibrosed in systemic sclerosis?
Lung, cardiac, GI, renal
228
What is the treatment for systemic sclerosis?
- ) Immunosuppression (cyclophosphamide) - ) Monitor BP and renal function - ) ACEI/ARBs (+PPIs) - ) Treat Raynaud's - ) Annual echocardiograms and spirometry
229
What can antiphospholipid syndrome cause? (4)
``` CLOTs Coagulation defect Livedo reticularis Obstetric problems Thrombocytopaenia ```
230
How do we treat antiphospholipid syndrome?
Aspirin/warfarin if recurrent
231
What are polymyositis and dermatomyositis?
Rare conditions characterised by the insidious onset of progressive symmetrical proximal muscle weakness and autoimmune mediate striated muscle inflammation (myositis)
232
What are poly/dermatomyositis associated with?
Myalgia +/- arthralgia
233
What may muscle weakness cause in poly/dermatomyositis?
- ) Dysphagia - ) Dysphonia - ) Respiratory weakness
234
Dermatomyositis features myositis plus what 3 skin signs
- ) Macular rash - ) Lilac-purple (heliotrope) rash on eyelids - ) Mailfold erythema - ) Gottron's papules (red papules over knickers)
235
What do we need to screen for in poly/dermatomyositis?
Cancers
236
Give 3 extra-muscular signs of poly/dermatomyositis
- ) Fever - ) Arthralgia - ) Raynaud's - ) Interstitial lung fibrosis - ) Myocardial involvement
237
Give 2 antibodies associated with poly/dermatomyositis
Anti-Mi2, anti-Jo1
238
What do we test for in poly/dermatomyositis? (4)
- ) Increased muscle enzymes - ) EMG shows characteristic fibrillation potentials - ) Muscle biopsy - ) MRI shows muscle oedema in acute myositis
239
Give 4 muscle enzymes
- ) ALT (alanine transaminase) - ) AST (aspartate transaminase) - ) LDH (lactate dehydrogenase) - ) CK (creatinine kinase) - ) Aldolase
240
What is the treatment for poly/dermatomyositis?
- ) Prednisolone - ) Immunosuppressives and cytotoxic if resistance - ) Hydroxychloroquine/topical tacrolimus for skin disease
241
What is systemic lupus erythematous? (SLE)
Mutisystemic autoimmnue disease
242
What are the pathogenic steps of SLE? (4)
- ) Autoantibodies made against variety of autoantigens - ) Form immune complexes - ) Inadequate clearance of immune complexes - ) Host of immune responses which cause tissue inflammation and damage
243
Which gender is SLE more common in?
Women
244
Which ethnicities is SLE more common in?
Afro-Caribbean, Asia
245
What 3 genetic associations are there in SLE?
HLA B8 HLA DR2 HLA DR3
246
Give 3 non-specific symptoms of SLE
- ) Malaise - ) Fatigue - ) Myalgia - ) Fever
247
What type of presentation does SLE have?
Remitting and relapsing illness of variable presentation and course
248
Give 5 clinical criteria of SLE
- ) Acute cutaneous lupus (malaria rash/butterfly, photosensitive rash) - ) Chronic cutaneous lupus (discoid rash) - ) Non scarring alopecia - ) Oral/nasal ulcers - ) Synovitis (2 or more joints) - ) Serositis (lung/pericardial pain) - ) Urinanalysis (proteinuria) - ) Neuro features (seizures, psychosis) - ) Haemolytic anaemia - ) Leucopenia - ) Thrombocytopenia
249
Give 3 other features of SLE
- ) Lymphadenopathy - ) Weight loss - ) Alopecia - ) Nail fold infarcts - ) Raynaud's - ) Non infective endocarditis - ) Stroke - ) Retinate exudates
250
Give 3 laboratory criteria for SLE
- ) +ve ANA - ) Anti-dsDNA - ) Anti-Smith antibodies - ) Antiphospholipid Abs - ) Low complement (C3, C4) - ) +ve Direct Coombs
251
What are ESR and CRP like in SLE?
High ESR, normal CRP
252
Give 3 causes of drug induced lupus
- ) Isoniazid - ) Hydralazine - ) Quinidine - ) Anti-TNF agents
253
What is the general treatment for SLE?
- ) Sunblock - ) Hydroxychloroquine - ) Screen for co-morbidities - ) Topical steroids for skin flares
254
How do we maintain SLE? (3)
- ) NSAIDs and hydroxychloroquine for joint and skin - ) Azathioprine, methotrexate, mycophendlate as steroid-sparing agents - ) Belimumab for autoantibody positive disease
255
What do we give for moderate flares in SLE?
DMARDs or mycophenolate
256
What do we give for severe flares in SLE? (4)
- ) Urgent high dose steroids - ) Mycophenolate - ) Rituximab - ) Cyclophosphamide
257
What do we give for lupus nephritis?
- ) Intensive immunosuppression with steroids and cyclophosphamide - ) BP control vital - ) Possible renal replacement therapy
258
What is the most common causative organism of infections?
Coagulase negative staph, then staph aureus
259
Give 3 mechanisms of infection
- ) Transient bacteraemia (e.g. from gut) - ) Pets and wounds - ) Dental work, already coloniser - ) Index surgery infection
260
What is propionibacteria?
A skin commensal involvement in upper limb (real) and lower limb (contaminant) infections
261
Give 3 risk factors for a joint prosthesis infection
- ) Male sex - ) Hybrid fixation - ) Cement without antibiotics - ) Inflammatory disease - ) Hip fracture - ) Femoral head necrosis
262
What infection is extra bone formation associated with?
Staph infection
263
Give 3 treatment options for infection of a joint prosthesis
- ) Antibiotic suppression - ) Debridement and retention of prosthesis - ) Excision/exchange arthroplasty - ) One/two stage exchange - ) Amputation
264
What can we do to make the likelihood of detecting an infection when using CRP and ESR?
Multiple sasmples
265
What is the gold standard for the diagnosis of a joint infection?
Aspiration
266
What is the limitation to aspiration when detecting an infection?
Cannot do if patient has had antibiotics in last 2 weeks
267
What inflammatory marker has a sensitivity/specificity of 95% for a joint infection?
Alpha defensin
268
What does gonococcal arthritis occur with?
Disseminated gonococcal infection
269
Give 3 features of gonococcal arthritis presentation
- ) Fever - ) Arthritis - ) Tenosynovitis - ) Polyarticular - ) Maculopapular pustular rash common in peripheries (palms, sole, painful before visible)
270
How do we detect the organism in gonococcal arthritis?
Mucosal swabs and blood cultures
271
What is a sunburst appearance on an XR indicative of? (2)
Osteosarcoma, Ewing's
272
What is a onion skin appearance on an XR indicative of?
Ewing's
273
What is the appearance of Codman's triangle on an XR indicative of? (5)
Osteosarcoma, Ewing's, OM, GCT, metastasis
274
What 3 things can a bone scan tell us?
- ) How fast blood is flowing to lesion - ) Inflammation - ) Uptake within bone (turnover rate)
275
What 4 imaging tools can we use to detect a bone tumour?
US, CT, MRI, XR
276
What system do we use to stage malignant and benign bone tumours?
Enneking
277
What are the 3 grades for a malignant tumour?
G0 - histologically benign, well differentiated, low mitotic count G1 - low grade malignant, moderate diff, local spread only, few mitoses G2 - high grade malignant, poorly diff, frequent mitoses, high risk of mets
278
What are the 3 grades for a benign tumour?
Grade 1 - latent, well defined, stops growing, may heal Grade 2 - active, growth limited by natural barriers, may expand Grade 3 - aggressive, not limited by natural barriers, mets present in 5%, high recurrence
279
What does the prefix 'osteo' relate to?
Bone
280
What does the prefix 'chondro' relate to?
Cartilage
281
What does the prefix 'rhabdomyo' relate to?
Skeletal muslce
282
What does the prefix 'lipo' relate to?
Fat
283
What does the suffix 'oma' relate to?
Benign tumour
284
What does the suffix 'sarcoma' relate to?
Malignant connective tissue tumour
285
What does the suffix 'carcinoma' relate to?
Malignant epithelial/endothelial tumour
286
What does the suffix 'blastoma' relate to?
Malignant tumour of embryonic cells
287
What does a pleomorphic soft tissue sarcoma mean?
It doesn't have a clear tissue of origin
288
Give 4 things we describe when looking at an XR with a suspected tumour
- ) Radiographic view, anatomical location - ) Epi/meta/diaphysis - ) Bone/cartilage forming - ) Bone destruction/reaction - ) Zone of transition - ) Benign/malignant
289
What mutation is osteosarcoma associated with?
p53
290
What do XRs show in osteosarcoma?
Bone formation with bone destruction
291
What is the most common type of osteosarcoma?
High grade intramedullary osteosarcoma
292
What is the treatment for osteosarcoma?
Multi-agent chemo pre-op
293
Give 3 different types of osteosarcoma
- ) Intramedullary - ) Parosteal - ) Periosteal - ) Telangiectatic
294
What does Ewing's sarcoma arise from?
Neural crest cells (neuroectodermal origin)
295
What is the genetic element of Ewing's sarcoma?
Balanced translocation t(11,22)
296
What type of lesion occurs in Ewing's sarcoma?
Diaphyseal, destructive lytic lesion
297
How do we diagnose Ewing's sarcoma?
Bone marrow biopsy (carefully!)
298
How do we treat Ewing's sarcoma?
Chemo, radio, excision/reconstruction
299
How does multiple myeloma present? (3)
- ) Bone pain - ) Pathological fractures - ) Fatigue (anaemia)
300
What proteins are seen in the urine in multiple myeloma?
Bence-Jones proteins
301
What does an XR show in multiple myeloma?
Punched out lytic lesions (pepper pot skull)
302
What does blood serum electrophoresis show in multiple myeloma?
Monoclonal bands
303
What is the treatment for multiple myeloma?
Surgical stabilisation and radiotherapy
304
What does histology show in multiple myeloma?
Plasma cells and perinuclear halo
305
What is a soft tissue sarcoma?
Malignant tumour of connective tissue
306
Give 4 factors where we would consider masses to be malignant in soft tissue sarcoma
- ) >5cm - ) Deep to fascia - ) Enlarging in size - ) Painful
307
What 5 tumours most commonly metastasise to bone?
- ) Breast - ) Lung - ) Prostate - ) Kidney - ) Thyoid
308
How is RANK-L involved in bone resorption?
Activation of osteoclasts by tumour cells, RANK-L binds to RANK receptor on osteoclasts
309
Give 3 presentations of bony mets
- ) Bone pain - ) General malaise - ) Pathological fractures
310
Give 3 management principles for bony mets
- ) Correct metabolic abnormalities (CALCIUM) - ) XRs - ) Mirel's score - ) Possible primary disease - ) Treat met as primary - ) If widespread, lease with oncology
311
What is Mirel's scoring system used for?
Diagnosing impending pathological fractures
312
What are the 4 parameters for Mirel's score?
-) Site of lesion -) Pain -) Nature of lesion -) Width of cortical destruction 3 points a parameter
313
What score gives a 33% chance of fracture?
9, give prophylactic stabilisation
314
Give 3 local complications of surgery
- ) Haematoma - ) LOF - ) Infection (silver coating of implant reduces risk) - ) Local recurrence
315
Where does the blood supply of the hip come from?
Medial and lateral femoral arteries
316
What is a significant trauma defined as?
>20mph or >20ft fall
317
Give 4 things a fracture can be
- ) Intra/extra articular - ) Associated with dislocation - ) Transverse/oblique/spiral/butterfly/comminution/segmental - ) Broken skin
318
What is the management of a fracture?
Analgesia, reduce, immboilise, rehabilitate
319
What is Paget's disease of bone?
Focal disorder of bone remodelling
320
What are the pathogenic steps of Paget's disease? (6)
1) Increase in osteoclastic bone reabsorption 2) Compensatory increase in bone formation 3) Increased local bone blood flow 4) Increased fibrous tissue deposition in adjacent bone marrow 5) Bone formation exceeds bone resorption 6) New bone is weaker and more likely to fracture
321
What is a genetic mutation that can cause Paget's?
Mutation of the gene that codes for the osteoclast mediator protein p62
322
How is Paget's often found?
Incidental finding of elevated serum alkaline phosphatase
323
Give 3 of the most commonly affected sites of Paget's disease
Pelvis, femur, lumbar spine, skull, fibia
324
Give 3 symptoms of Paget's disease
- ) Bone and joint pain - ) Deformities (e.g. bowed tibia) - ) Neurological complications - ) High output HF - ) Hypercalcaemia - ) Pathological fractures - ) Osteoarthritis, osteosarcoma
325
What is the treatment for Paget's?
Bisphosphonates, analgesia/alendronic acid
326
What is osteomalacia?
Defective mineralisation of newly formed bone matrix (osteoid)
327
What is the difference between osteomalacia and osteoporosis?
OM - normal amount of bone, low mineral content | OP - Mineralisation unchanged, overall bone loss
328
What is the difference between rickets and OM?
Rickets - during period of bone growth | OM - after fusion of epiphyses
329
Give 3 symptoms of rickets
- ) Growth retardation - ) Hypotonia - ) Apathy in infants - ) Knock-kneed - ) Bow-legged - ) Deformities of metaphyseal-epiphyseal junction - ) Ill
330
Give 3 symptoms of OM
- ) Bone pain and tenderness - ) Fractures (esp. femoral neck) - ) Proximal myopathy (waddling gait)
331
What does an XR show in Paget's disease? (4)
- ) Localised enlargement of bone - ) Patchy cortical thickening - ) Sclerosis, osteolysis, deformity - ) Hot spots
332
Give 5 causes of osteomalacia
- ) Vitamin D deficiency - ) Renal osteodystrophy (renal failure) - ) Drug induced (anticonvulsants) - ) Vitamin D resistance - ) Liver disease - ) Tumour induced osteomalacia (oncogenic hypophosphataemia)
333
Give 2 causes of vitamin D deficiency
- ) Malabsorption - ) Poor diet - ) Lack of sunlight
334
Give 4 findings in the plasma in OM
- ) Decreased Ca - ) Decreased PO4 - ) Increased ALP - ) Increased PTH - ) Decreased 25(OH)-vitamin D (except in resistance)
335
What does an XR show in OM?
- ) Loss of cortical bone | - ) Partical fractures, especially at Looser's zones (scapula, inferior femoral neck, medial femoral shaft)
336
What does an XR show in rickets?
Cupped, ragged metaphyseal surfaces
337
What is the treatment for OM?
- ) Diet - vitamin D - ) Malabsoprtion/hepatic disease - Vitamin D2 (ergocalciferol) - ) Renal/resistance - Alfacalcidol/calcitriol
338
What risk is there with aldacalcidol and calcitriol?
Hypercalcaemia! - monitor
339
What are the steps of the conversion of vitamin D into its active form? (4)
1) 7-dehydrocholestrol (from sun) 2) Cholecalciferol (vitamin D3, or from diet) 3) 25-hydroxyvitamin D3 (in liver) 4) 1,25-dihydroxyvitamin D3 (in kidneys)
340
Give 4 symptoms of granulomatosis with polyangiitis
-) Nasal obstruction, ulcers, epistaxis, destruction of nasal septum -) Sinusitis -) Glomeruloneprhtis, proteinuria, haematuria -) Cough, haemopysis, pleuritis -) Skin purpura, nodules, peripheral neuropathy, arthritis/arthralgia -) Keratitis, conjunctivitis, scleritis, episcleritis, uveitis ETC
341
What is a specific test for granulomatosis with polyangiitis?
cANCA directed against PR3
342
What does a CXR show in granulomatosis with polyangiitis?
Nodules +/- fluffy infiltrates of pulmonary haemorrhage
343
What may a CT show in granulomatosis with polyangiitis?
Diffuse alveolar haemorrhage

Medicine Year 2 5 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions