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Y1&2 Medicine Zoe Veary > ORTHO 137 Monoarthritis and Gout > Flashcards

ORTHO 137 Monoarthritis and Gout Flashcards

1
Q

Define Gout

A

An inflammatory response to monosodium urate monohydrate crystals in the joint

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2
Q

How does gout typically present?

A

As an acute monoarthritis: joint inflammation

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3
Q

What joint is gout most common in?

A

the metatarsophalangeal joint - big toe

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4
Q

What are tophi?

A

Solid lumps of uric acid that may develop in those with chronic gout

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5
Q

What are some of the causes of gout?

A

Purine rich diet e.g. beer, cider (alcohol excess0

Diuretics and renal impairment

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6
Q

How would you investigate gout?

A

Joint fluid: crystals
Blood: check for metabolic syndrome (blood sugar, fasting lipids, LFT’s); urea, urate and creatinine
Urinalysis: blood and protein

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7
Q

How would you manage and treat gout?

A

Lifestyle changes
Pain relief
Correct hyperuricaemia

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8
Q

What pain relief would you give in gout?

A

NSAID’s
Colchicine (NSAID but without GI SE’s)
Steroids: oral or intraarticular

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9
Q

How would you correct the hyperuricaemia in gout?

A

Xanthine oxidase inhibitors e.g. allopurinol & febuxostat

Uricosurics: increase secretion of uric acid

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10
Q

What is Septic Arthritis?

A

Invasion of a joint by a pathogenic organisms causing joint inflammation

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11
Q

What are differential diagnoses for a monoarthritis?

A

Septic arthritis
Crystal Arthritis
Trauma

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12
Q

What are the normal physiological roles of calcium?

A

Formation of calcified tissues
Normal activity of nerve and muscle
NT release, hormonal and glandular secretions
Excitation/contraction coupling
Integrity and permeability of cell membranes
Cell adhesion
Blood clotting

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13
Q

What 3 organs tightly regulate blood calcium?

A

Gut, kidenys and bone

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14
Q

What 3 hormones contro blood calcium?

A

PTH, Calcitonin and Vitamin D3

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15
Q

Where is PTH released from?

A

Chief cells in the paraythyroid glands

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16
Q

What does PTH stimulate?

A

Bone resorption
Renal tubular reabsorption of Calcium
1-alpha hydroxylation of 25 (OH)D3

17
Q

What does PTH respond to?

A

Falling calcium levels

18
Q

What is the precursor to Vitamin D3 and how is it converted?

A

7 dehydrocholesterol converted to vitamin D3 in the skin

19
Q

What happens to vitamin D3 in the liver?

A

It is hydroxylated to 25(OH)D3

20
Q

What happens to 25(OH)D3 in the kidneys?

A

It is hydroxylated to 1,25(OH)D3 = active metabolite

21
Q

What are the actions of 25(OH)D3?

A

Gut: transepithelial transport of calcium and phosphate (increase Calcium uptake)
Bone: terminal differentiation of osteoclasts (increased bone resorption)
PTH: -ve feedback to inhibit transcription of PTH

22
Q

Where is calcitonin synthesised?

A

C cells of thyroid gland

23
Q

What is the general action of calcitonin?

A

Decrease calcium levels in blood

24
Q

Why does articular cartilage have a limited capacity for repair?

A

As it is avascular - nutrients only move in an out slowly through synvovium

25
Q

What is a focal lesion?

A

Small area of cartilage damage

26
Q

What is a chondral lesion?

A

Lesion within the cartilage but no subchondral bone penetration

27
Q

What is an osteochondral defect?

A

Lesion in cartilage that penetrates to the subchondral bone

28
Q

Why can osteochondral defects repair better than condral lesions?

A

As OC defects have access to subchondral blood supply and chondroprojenitor cells whereas chondral lesions do not

29
Q

What is a Grade 1 articular cartilage defect?

A

fissures into superficial cartilage

30
Q

What is a Grade 2 articular cartilage defect?

A

multiple fissures extending hald the depth of cartilage

31
Q

What is a Grade 3 articular cartilage defect?

A

fissures extending full depth of cartilage

32
Q

What is a Grade 4 articular cartilage defect?

A

complete cartilage loss and subchondral bone exposure

33
Q

What are the 5 current options for treating a small/interediate articular cartilage defect?

A 
Debridement
Microfracture
Osteotomy
Osteochondral grafting
Autologous chondrocye implantation
34
Q

Describe debridement for an articular cartilage defect?

A

Shave off frayed edged to reduce pain and swelling - no repair but pain relief

35
Q

Describe what microfracturing is in the treatment of an AC defect

A

Make holes in bone surface to stimulae bleeding and clotting response
Fibrocartilage usually forms which is less effective than hyaline

36
Q

When would an osteotomy be performed?

A

In response to deformed/malaligned joint to avoid wear and tear and re-establish normal loading and gait

37
Q

What is osteochondral grafting?

A

Taking good cartilage from another siter and adding it to the defect site - can be autograft or allograft

38
Q

What is autologous chrondrocyte implantation?

A

A regenerative cell based therapy: chondrocytes grown in lab and placed into focal lesion using periostal flap

Y1&2 Medicine Zoe Veary (60 decks)

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