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Musculoskeletal > Pathology and Disease > Flashcards

Pathology and Disease Flashcards

1
Q

bone enlargement, thickened cortices, thickened trabeculae with mixed areas of lysis and sclerosis

A

Paget’s Disease

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2
Q

Signs of Osteoarthritis

A 
Crepitus
Restricted movement 
Bony enlargement 
Joint effusion 
Bony instability
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3
Q

Symptoms of Osteoarthritis

A

Short lived morning joint stiffness
Joint pain with movement and weight bearing
May have inflammatory flare ups

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4
Q

Joints Affected:
Hands
Knee
Spine

A

Hands = DIP, PIP, 1st CMC
Knee = may see Baker’s cyst in the popliteal fossa
Spine =
Cervical region - pain and reduced ROM
Lumbar - osteophytes may produce spinal stenosis

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5
Q

Pathophysiology of Osteoarthritis (Key Cell)

A

Osteophytes

Attempt to repair the damage to the bone surface

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6
Q

Investigations for Osteoarthritis (2)

A

Bloods - inflammatory markers NORMAL

X-ray - classic signs

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7
Q

X-ray features of Osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Formation of cysts

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8
Q

Management
Physical
Pharmacological

A 
Physical = weight loss, low impact exercise 
Pharmacological = pain control, NSAIDs
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9
Q

Seronegative Inflammatory Arthritis (4)

A

Ankylosing Spondylitis
Reactive Arthritis
Enteropathic Arthritis
Psoriatic Arthritis

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10
Q

HLA type in Rheumatoid Arthritis

A

HLA-DR4

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11
Q

Pathophysiology of Rheumatoid Arthritis

A

Autoimmune response to the synovium
Inflammatory layer forms which attacks and degrades the cartilage
TNF-a is produced and contributes to joint destruction

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12
Q

Complications of Rheumatoid Arthritis

A

Atlanto-axis subluxation

Cervical cord compression

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13
Q

Clinical Presentation of Rheumatoid Arthritis

A

Prolonged morning stiffness
Usually starts in the small joints of the hand
Boggy swelling
DIP joint usually spared
Affected: elbows, shoulders, knees, ankles

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14
Q

Autoantibodies present in RA

A

Anti-CCP - more specific, present before disease onset

- Also have rheumatoid factor, used less now

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15
Q

Investigations in RA

A

Bloods - inflammatory markers RAISED
Autoantibodies - anti-CCP, rheumatoid factor
X-ray - won’t show any joint abnormality until later

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16
Q

Polymyalgia Rheumatica

- Presentation

A

Presentation:

  1. Reduced movement
  2. Aching joints (not from weakness of muscles)
    - Usually shoulder and hip girdle
    - Accompanied by morning stiffness >1 hour
  3. General symptoms
    e. g. fatigue, anorexia, fever, weight loss
17
Q

Polymyalgia Rheumatica

- Investigations

A

No specific test

Inflammatory markers are raised

18
Q

Polymyalgia Rheumatica

- Management

A

Prednisolone 15mg

See dramatic improvement in symptoms

19
Q

Polymyalgia Rheumatica

- Associations

A

= giant cell arteritis

  • Temporal artery biopsy
  • Increase prednisolone to 40mg (don’t wait for biopsy)
20
Q

Inflammatory Myopathies (2)

A

Dermatomyositis

Polymyositis

21
Q

Difference between dermatomyositis and polymyositis

A

Clinically similar EXCEPT

  • Dermatomyositis is just the skin and muscles
  • Dermatomyositis has an increased risk of malignancy
22
Q

Aetiology of Inflammatory Myopathies

A

Idiopathic

More likely to occur in females

23
Q

Dermatomyositis

- Skin Features

A

Heliotrope Rash = purplish colours around the eyes
Gottron’s Sign = red/purplish papules on finger joint area
Shawl Sign = rash where a shawl would have traditionally sat

24
Q

Dermatomyositis and Polymyositis

  • Muscle Features
  • Antibodies
A
  1. Muscle weakness (hip and shoulders)
  2. Insidious onset
  3. Usually symmetrical
  4. Worsens over a few months
  5. Proximal weakness - struggle washing/brushing hair, climbing stairs
    Antibody: anti-Jo-1
25
Q

Polymyositis

- Histology

A

= muscle biopsy

- Muscle fibre necrosis, degeneration, inflammatory cell infiltrate

26
Q

Polymyositis

- Other Clinical Features

A

Generalised = fever, weight loss, Raynaud’s
Lung = ILD
Oesophageal = dysphagia, oesophageal muscle weakness
Poor prognostic sign
Cardiac = myocarditis

27
Q

Polymyositis

  • Investigations
  • Antibodies
A

Raised inflammatory markers
Increased CK levels (often extreme increase)
Electromyography = almost always abnormal in polymyositis
Muscle Biopsy = DEFINITIVE
(MRI)
Antibodies: anti-Jo-1

28
Q

Polymyositis and Dermatomyositis

- Management

A

Prednisolone 40mg
Combined with immunosuppressive drugs e.g. methotrexate, azathioprine
How: add in steroid initially as immunosupressant takes 4-6 weeks to be effective

29
Q

Giant Cell Arteritis

- Management

A

Prednisolone

  • 40mg
  • 60mg if visual impairment
  • Start as soon as diagnosis is suspected
30
Q

Kawasaki Disease

A

= medium vessel vasculitis
- Usually seen in children
WARY: coronary artery affected > aneurysm

31
Q

Small Vessel Vasculitis

- General Features

A

Fever, weight loss, arthralgia/arthritis

Rash = raised, non-blanching, purpuric

32
Q

pANCA

- Vasculitis which are +VE

A

MPA

EGPA

33
Q

cANCA

- Vasculitis which are +VE

A

GPA

34
Q

Investigations for Small Vessel Vasculitis

A

U&E to check renal involvement
Inflammatory markers raised
Urinalysis
Chest x-ray

35
Q

EGPA

- Other features

A

Asthma, rhinitis, high peripheral blood eosinophils

36
Q

MPA

- Complications

A

= necrotising vasculitis

Complication: glomerulonephritis

37
Q

GPA

  • Aetiology
  • Presentation
  • Associations
A
  • More common in those of N European descent, typically 35-55
    ENT: deafness, nosebleeds, recurrent sinusitis, nasal crusting
    Associations: cANCA
38
Q

HSP

  • Aetiology
  • Pathogenesis
  • Presentation
  • Disease Course
A

Aetiology: usually occurs in children
Pathogenesis: IgA mediated
1. Purpuric rash - buttocks and the lower limbs
2. Abdominal pain, joint pain, vomiting
- Usually a preceding illness e.g. URTI, pharyngeal, GI

Musculoskeletal (7 decks)

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