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Medicine > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Mechanism of SMOOTH MUSCLE contraction

A

Depolarisation caused by action potential and OPENING of voltage gated Ca2+ channel

Ca2+ ions bind to CALMODULIN

Myosin light kinase chain ACTIVATED

The role of myosin:actin coupled with MYOSIN P causes contraction

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2
Q

Mechanism of SKELETAL and CARDIAC MUSCLE contraction

A

Depolarisation caused by action potential and OPENING of voltage gated Ca2+ channel

  • NEUROTRANSMITTER released

Spread of depolarisation down the T TUBULES to DIHYDROPYRIDINE RECEPTORS in skeletal muscle

In CARDIAC muscle- it involves calcium-induced calcium release

  • Increased calcium ions from calcium-induced calcium release- calcium ions bind to TROPONIN C

Myosin head binds to actin when TROPOMYOSIN moves

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3
Q

Cause of Rheumatoid Arthritis

A

Hypersensitivity III reaction

Involves HLA DR4 and HLA DR1

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4
Q

6 Hand signs of Rheumatoid Arthritis

A
  • Z deformity
  • Boutonniere deformity
  • Swan neck deformity
  • Ulnar deviation
  • Subluxation of fingers
  • Raynaud’s phenomenon (decreased blood flow to fingers and sometimes ears, nose, nipples, toes, knees)
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5
Q

Feet and Skin signs of Rheumatoid Arthritis

A

Feet-

  • Hammer toe deformity
  • Subluxation of toes

Skin-

  • Rheumatoid nodule
  • Vasculitis
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6
Q

Respiratory, Cardiovascular and Wrist signs of Rheumatoid Arthritis

A

Respiratory-
- Pulmonary Fibrosis

Cardiovascular-
- Atherosclerosis increased in RA

Wrist-
- Carpal Tunnel syndrome

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7
Q

Investigations in Rheumatoid Arthritis

A

Blood-

  • Rheumatoid factor
  • Cyclic Cytrullinated Peptides (CCP) antibodies

Radiology-

  • Subluxation
  • Periarticular osteoporosis
  • Bony erosion
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8
Q

Treatment of Rheumatoid Arthritis

A

Physiotherapy

Medical-
- GLUCOCORTOIDS

  • DMARDS (Gold salts, Methotrexate, Sulfasalazine)
  • Anticytokine therapy considered if patient is intolerant to METHOTREXATE

Surgery- if severely affected- EXCISION arthroplasty

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9
Q

Complications of Rheumatoid Arthritis

A

PERICARDITIS

Sjogren’s Syndrome (dry eyes and mouth)

Cervical myopathy

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10
Q

Pain worse in the morning vs in the night

A

Morning- Rheumatoid Arthritis

Night- Osteoarthritis

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11
Q

Risk factors of Osteoarthritis

A
  • Increased age
  • Conditions such as Haemochromatosis and Ehlers-Dalos Syndrome
  • Obesity
  • Trauma to joint
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12
Q

Signs and Symptoms of Osteoarthritis

A
  • Pain and stiffness
  • Swelling around joints
  • Crepitus (crackles)
  • HEBERDEEN’s nodes at DIP (remember outer hebrides)
  • BOUCHARD’s nodes at PIP
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13
Q

Investigations in Osteoarthritis

A

Bloods- relevant is OS is linked to another condition such as HAEMOCHROMATOSIS

Radiology (LOSS)

  • Loss of joint space
  • Osteophytes
  • Subchondrial cysts
  • Sclerosis
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14
Q

Treatment of Osteoarthritis

A

Encourage exercise and weight loss

Medical-
- Analgesia (paracetamol or NSAIDs)

  • Gels such as CAPSAICIN
  • Steroidal injections
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15
Q

Complications of Osteoarthritis

A
  • Increased risk of GOUT

- CHONDROCALCINOSIS (calcium phosphate deposition in joints)

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16
Q

Types of Spondyloarthropathies

A

Psoriatic arthritis
Enteropathic arthropathies
Ankylosing spondylitis
Reactive arthritis

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17
Q

Reactive arthritis symmetrical or asymmetrical and causes of it

A

ASYMMETRICAL

Occurs after GASTROINTESTINAL or UROGENITAL infection

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18
Q

4 signs and symptoms of Reactive arthritis

A

Urethritis
Uveitis- eye infection
Conjuctivitis- eye infection
Arthritis- pain and stiffness

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19
Q

Investigations in Reactive arthritis

A

Make sure it is SERONEGATIVE for Rheumatoid arthritis

Blood cultures- look for infectious cause

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20
Q

Treatment of Reactive arthritis

A

Physiotherapy

Analgesia (NSAIDs)

DMARDs (sulphasalazine)

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21
Q

Complications of Reactive arthritis

A

Arrhythmia

Aortic insufficiency

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22
Q

Psoriatic arthritis, Enteropathic arthritis and Ankylosing spondylitis associated with which gene?

A

HLA B27

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23
Q

Causes of Psoriatic arthritis

A

Inflammatory process coupled with HLA B27 gene

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24
Q

THREE signs and symptoms of Psoriatic arthritis

+3 points about psoriasis
(+4 nail changes)

A

Psoriasis-
- Salmon pink plaques with evidence of scaling

  • usually present on the EXTENSOR SURFACES but can occur in RAINDROP PATTERN over torso
  • GUTTATE PSORIASIS preceded by UPPER RESP INFECTION caused by STREPTOCOCCUS

Nail changes (pitting, yellowing of nail, onycholysis (painless detachment of nail from nail bed), subungual hyperkeratosis (scaling under skin))

Swelling of affected joint and swelling of affected joints

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25
Q

Investigations in Psoriatic arthritis

A

Make sure bloods are seronegative for RHEUMATOID ARTHRITIS

Radiology-
- pencil-in-cup deformity on hand xray

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26
Q

Treatment for Psoriatic arthritis and Ankylosing spondylitis

A

Explain that Psoriasis has NO CURE

ANALGESIA (NSAIDs)
DMARDS (Methotrexate)

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27
Q

Where does chronic inflammation happen in Ankylosing Spondylitis

A

Spine and Sacroiliac joints

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28
Q

Signs and symptoms of Ankylosing spondylitis

A

Question mark posture

Bamboo spine- due to CALCIFICATION OF LIGAMENTS

Pain and stiffness which gets BETTER with EXERCISE

29
Q

Enteropathic arthritis associated with which condition?

A

IBD

30
Q

4 Signs and Symptoms of Enteropathic arthritis

A

IBD symptoms

Spondylitis (inflammation of spine)
Sacroilitis
Peripheral Arthritis (usually of large joints)

31
Q

Which joint does Gout present in? and what is deposited?

A

Metatarsophalangeal joint

URATE crystals

32
Q

Causes of GOUT

A

Horrific DELAY

Hyperuricaemia, Hereditary

Diuretics (thiazide)
Ethanol
Leukemia
renAl impairment
lesch-nYhan syndrome
33
Q

Signs and Symptoms of GOUT

A

inflammation of affected joint

Tophi (urate deposits) may be present on tendon surfaces (elbow or ear)

Patient may have symptoms of RENAL CALCULI

34
Q

Investigations in GOUT

A

Serum URATE levels
CREATININE

GFR- assess kidney function

SYNOVIAL FLUID ANALYSIS (positive if birefringement monosodium urate crystals seen)

35
Q

Treatment of GOUT

A

Low PURINE diet

Stop causative agents- thiazide diuretics

ANALGESIA

Acute- COLCHICINE and STEROIDS

Chronic- ALLOPURINOL and FEBUXOSTAT may be used if allopurinol is not tolerated

36
Q

Complications of GOUT

A

Renal calculi

Tophi formation

37
Q

Risk factors of OSTEOPOROSIS

A
  • Prolonged STEROID use
  • Diet deficient in CALCIUM
  • Increasing age
  • Excessing alcohol and smoking
  • Loss of protective oestrogen in postmenopausal women
  • Endocrine disorders such as DIABETES MELLITUS and HYPERTHYROIDISM
38
Q

Signs and Symptoms of OSTEOPOROSIS

A
  • often asymptomatic until pathological fracture
  • Loss in height
  • Back pain
  • Dowager’s hump (hyperkyphosis)
39
Q

Investigations in OSTEOPOROSIS

A

PTH
Serum calcium
Serum phosphatase
Alkaline phosphatase

DEXA scan- T score>2.5 is diagnostic

40
Q

Treatment of OSTEOPOROSIS

A

Selective Oestrogen Receptor Modulators (SORM/ SERM)

Calcitonin and Bisphosphonates

41
Q

The ONLY BONE DISEASE where Serum Calcium and Serum Phosphate are low

And PTH is high

A

Osteomalacia

42
Q

Two bone diseases where Alkaline Phosphatase is high

A

Osteomalacia and Osteopetriosis

43
Q

Axillary Nerve NERVE ORIGIN

A

C5-C6

44
Q

Musculocutaneous NERVE ORIGIN

A

C5-C7

45
Q

Median NERVE ORIGIN

A

C5-T1

46
Q

Ulnar NERVE ORIGIN

A

C8-T1

47
Q

Radial NERVE ORIGIN

A

C5-C8

48
Q

Axillary nerve LESION

A

Deltoid muscle paralysis

49
Q

Musculocutaneous LESION (rare)

A

Paralysis of biceps, brachialis and coracobrachialis

50
Q

4 LESIONS of Median nerve

A

Above antecubital fossa
At wrist
Below antecubital fossa
Within the wrist

51
Q

Ulnar LESION

A

Ulnar clawing

52
Q

Radial LESION

A

Wrist drop

53
Q

C5-C6 LESION

A

Erb-Duchenne Palsy

54
Q

C8 and T1 LESION

A

Klumpke’s Palsy

55
Q

Two causes of Deltoid muscle paralysis (AXILARY LESION)

A

Shoulder dislocation

Humerus neck fracture

56
Q

Two causes of Paralysis of biceps, brachialis and coracobrachialis (MUSCULOCUTANEOUS LESION)

A

Complication of surgery

Dislocation

57
Q

Complication of Musculocutaneous lesion

A

DECREASED sensation of lateral forearm

58
Q

TWO causes of LESION above antecubital fossa (MEDIAN LESION)

A

Supracondylar fractures

Neuropathy

59
Q

Cause of LESION at wrist (MEDIAN LESION)

A

LACERATION of wrist

60
Q

3 complication of LESION above antecubital fossa AND at the wrist

A

Papal sign of benediction

Ape hand deformity

Loss of sensation over THENAR EMINENCE

61
Q

Cause of LESION below antecubital fossa (MEDIAN LESION)

A

Injury to the ANTERIOR interosseous branch of the MEDIAN NERVE

62
Q

Two complications of LESION below antecubital fossa

A

Anterior interosseous syndrome

Inability to PRONATE the forearm

63
Q

Cause of LESION within the wrist (MEDIAN LESION)

A

Carpal Tunnel Syndrome

64
Q

Carpal Tunnel Syndrome-

Where is the PARAESTHESIA?
When is the pain worse?
What tests are done to diagnose Carpal Tunnel Syndrome?
What 7 things is Carpal Tunnel Syndrome associated with?

A
  • Paraesthesia in LATERAL 2.5 fingers
  • Pain is worse at night (like OSTEOARTHRITIS)
  • Phalen’s and Tinel’s Test done to diagnose Carpal Tunnel Syndrome
  • Pregnancy
  • Oral Contraceptive Pill
  • Diabetes
  • Rheumatoid arthritis
  • Heart failure
  • GOUT
  • ACROMEGALY
65
Q

2 causes of Ulnar clawing (ULNAR LESION)

A

Cubital Tunnel Syndrome

Ganglion cyst in the Guyon canal

66
Q

What is the Ulnar paradox?

A

Ulnar clawing is more PRONOUNCED, the more DISTAL the lesion

67
Q

Erb-Duchenne Palsy (C5 and C6 lesions) and Klumpke’s Palsy (C8 and T1 lesions) are both caused by what?

A

DYSTOCIA (difficult childbirth)

68
Q

2 causes of Wrist drop (RADIAL LESION)

A

Trauma: fracture of the HUMERUS

Lead poisoning

69
Q

What four things are seen in C5 and C6 LESIONS?

A

Paralysis of infraspinatus, teres minor

Paralysis of supraspinatus, deltoid

Paralysis of biceps

Paralysis of brachialis

Medicine (15 decks)

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