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phase2a medicine > musculoskeletal - gout and some arthritis > Flashcards

musculoskeletal - gout and some arthritis Flashcards

Questions regarding diseases that affect the musculoskeletal system and are also inflammatory.

1
Q

risk factors for osteoarthritis

A 
age
obesity (pro-inflammatory state)
high impact sports
trauma
genetics
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2
Q

is osteoarthritis more common in males or females?

A

more common in men before 45

more common in women after 55

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3
Q

non-inflammatory pathology of osteoarthritis

A

deterioration of articular cartilage by wear and tear

formation of new bone at the joint surfaces and margins

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4
Q

crepitus

A

cracking sensation when knee bends

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5
Q

inflammatory pathology of osteoarthritis

A 
proteases
metalloproteases
catabolic and anabolic cytokines
IL-1
TNF-alpha
insulin like growth factor
TGF-beta
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6
Q

joints most commonly affected by osteoarthritis

A 
knee
hip 
DIPJ
PIPJ
1st CMC
spine
1st MTPJ
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7
Q

signs of osteoarthritis

A

muscle wasting
osteophytes
Heberden’s and Bouchard’s nodes

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8
Q

symptoms of osteoarthritis

A

pain
aggravated by activity
relieved by rest

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9
Q

complications of osteoarthritis

A

poor mobility and its associated illnesses

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10
Q

where does OA of knees start?

A

starts medially and moves laterally

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11
Q

XR signs of OA

A

sclerosis
osteophytes
cysts
asymmetric loss of joint space

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12
Q

diagnostic tests for OA

A 
XR
CT
isotope bone scan
blood tests (ESR, FBC, rheumatoid factor, ALP, calcium) - should all be normal 
diagnostic injection 
arthroscopy
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13
Q

what causes the pain in OA?

A

capsular stretching and vascular congestion of the bone

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14
Q

treatment of osteoarthritis

A 
lifestyle modification and exercise
physiotherapy
walking aids
analgesics (NSAIDs and glucosamine)
capsaicin cream 
steroid injections
hyaluronic acid 
surgery
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15
Q

surgical options for osteoarthritis

A 
debridement of joint 
realignment of osteotomies
joint excision 
joint fusion (arthrodesis)
joint replacement (arthroplasty)
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16
Q

risk factors for rheumatoid arthritis

A 
female
caucasian
family history
smoking
HLA DR4 mutation
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17
Q

pathology of rheumatoid arthritis

A

inflamed synovium proliferates to form pannus –> pannus invades bone –> erosion of bone

destruction of cartilage causes release of proteinases and cytokines

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18
Q

characteristics of inflammatory joint pain

A

pain eases with use
prolonged stiffness in the morning and at rest
hot and red joint
tends to affect hands and feet

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19
Q

characteristics of degenerative joint pain

A

pain increases with use
stiffness is not prolonged
stiffness in morning and evening
tends to affect 1st CMCJ, DIPJ, and knees

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20
Q

late signs of rheumatoid arthritis

A

ulnar deviation
subluxation
Boutonierre deformity (button pressing 2nd digit)
swan neck dextrous deformity

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21
Q

complications of rheumatoid arthritis

A 
vasculitis
osteophytes
tenosynovitis
eye involvement
amyloid
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22
Q

eye involvement in rheumatoid arthritis

A

sicca
secondary Sjogrens
episcleritis
scleritis

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23
Q

what percentage of patients are negative for all rheumatoid investigations?

A

20%

24
Q

diagnosis of rheumatoid arthritis

A 
increase rheumatoid factor
high ESR
CCP increase (highly specific)
anaemia
anti-cyclic citrullinated peptide
do joint aspirate to rule out crystal disease
25
Q

treatment of rheumatoid arthritis

A

physiotherapy
surgery
anti-inflammatory drugs

26
Q

risk factors for gout

A 
genetics
diet
alcohol
male
diuretics
obesity
hypertension
27
Q

at what level does deposition of uric acid become a risk?

A

> 0.36 mmol/L

28
Q

what causes high uric acid levels in gout?

A

under excretion

over production

29
Q

pathology of gout

A

high blood monosodium urate concentration –> crystallisation and deposition in joints –> phagocyte activation –> inflammation

30
Q

what is the key enzyme in purine metabolism that prevents gout?

A

xanthine oxidase

31
Q

symptoms of gout

A

joint pain
swelling
redness
shiny looking joint (typically base of big toe)

32
Q

complications of gout

A

rate nephropathy
kidney stones
tophaceous gout (can ulcerate and get infected)

33
Q

diagnosis of gout

A

monosodium urate crystals in synovial fluid (which are blue and yellow under polarised light)
bloods: hyperuricaemia (NB: will be low in acute gout), WBCs, ESR
XR is good for chronic gout

34
Q

treatment of gout

A

hydration
NSAIDs or steroids
allopurinol and probenecid for long term reduction of symptoms
vitamin C for prevention

35
Q

differential diagnosis of gout

A

sepsis

36
Q

what should you give to gout patients who have renal problems and so can’t have NSAIDs?

A

colchicine

37
Q

risk factors for pseudogout

A 
old age
hyperparathyroidism
haemachromatosis
male gender
acromegaly
38
Q

what is usually deposited at joints in pseudo gout?

A

calcium phosphate

39
Q

pathology of acute (spontaneous) pseudogout

A

monoarthropathy usually in large joints in the elderly

40
Q

pathology of chronic pseudogout

A

inflammatory RA-like polyarthritis and synovitis

41
Q

signs of pseudogout

A

inflammation

chronic arthritis

42
Q

symptoms of pseudogout

A

pain

43
Q

complications of pseudogout

A

permanent joint damage

acute synovitis

44
Q

diagnosis of pseduogout

A

polarised light microscopy of synovial joint fluid - crystals rhomboid and not colourful
soft tissue calcium deposition

45
Q

how to treat acute pseudogout

A 
cool packs
rest
aspiratoin 
intra-articular steroids
NSAIDs
46
Q

how to treat chronic pseudogout

A

methotrexate

hydrochloroquine

47
Q

risk factors for ankylosing spondylosis

A

HLA B27 (95% patients)

48
Q

definition of ankylosing spondylosis

A

a chronic inflammatory disease of the spine and the sacroiliac joints, aetiology unknown.

49
Q

signs of spondylosing arthritis

A

SPINE ACHE

Sausage digit (dactylitis)
Psoriasis
Inflammatory back pain 
NSAIDs - responds well
Enthesitis (inflammation of tendon sheath)
Arthritis
Crohn's / colitis / elevated CRP
HLA-B27
Eye - uveitis
50
Q

symptoms of ankylosing spondylitis

A

low back pain radiating from sacro-iliac joints to hips/buttocks
pain improves towards end of day

51
Q

complications of ankylosing spondylitis

A

spine fracture

52
Q

diagnosis of ankylosing spondylitis

A

clinical diagnosis
MRI to detect bone marrow oedema
XR
bloods

53
Q

blood tests results for a patient with ankylosing spondylitis

A

increased ESR and CRP

HLA B27 positive

54
Q

X-ray results of a patient with ankylosing spondylitis

A

joint narrowing or widening
sclerosis
erosions
ankylosis/fusion

55
Q

treatment of ankylosing spondylitis

A

exercise to maintain posture and mobility
NSAIDs for symptomatic relief
TNF alpha blockers (etanercept, adalimumab)
local steroid injection

phase2a medicine (53 decks)

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