Quick facts 9 Flashcards
What is being tested in this photo? [1]
True leg length: anterior superior iliac spine (ASIS) to the medial malleolus.
What measurement is being recorded? [1]
Apparent leg length
Most prostaglandins cause relaxation of vascular smooth muscle as part of the normal homeostatic role.
What role in the inflammatory process would this have in an osteoarthritic joint?
Cause joint to become hot and red
Cause loss of function of the joint
Cause pain
Increase number of immune cells
Increase production of synovial fluid
Most prostaglandins cause relaxation of vascular smooth muscle as part of the normal homeostatic role.
What role in the inflammatory process would this have in an osteoarthritic joint?
Cause joint to become hot and red
Cause loss of function of the joint
Cause pain
Increase number of immune cells
Increase production of synovial fluid
A 14 year old body presents with fever and knee pain of sudden onset over 12 hrs. The knee is swollen and there is limited knee flexion. The gadolinium fat supressed T1 weighted image is shown.
What is the name of this region of bone
Diaphysis
Epiphysis
Epiphyseal growth plate
Metaphysis
Periosteum
A 14 year old body presents with fever and knee pain of sudden onset over 12 hrs. The knee is swollen and there is limited knee flexion. The gadolinium fat supressed T1 weighted image is shown.
What is the name of this region of bone
Diaphysis
Epiphysis
Epiphyseal growth plate
Metaphysis
Periosteum
Define metaphysis [1]
neck portion of a long bone between the epiphysis and the diaphysis. It contains the growth plate, the part of the bone that grows during childhood, and as it grows it ossifies near the diaphysis and the epiphyses.
What region of the skin is most responsible for the heat retention thermoregulation function
Dermis
Epidermis
Sebaceous gland
Subcutaneous tissue
Sweat gland
What region of the skin is most responsible for the heat retention thermoregulation function
Dermis
Epidermis
Sebaceous gland
Subcutaneous tissue
Sweat gland
Melanocytes are found in which layer of the skin? [1]
stratum basalis
What colour do eumelanin and pheomelanin produce? [2]
Eumelanin (black and brown), pheomelanin (red)
Where is Neuromelanin produced? [1]
Brain
The arrow is pointing to which type of cell in the skin? [1]
Merkel cells
What type of hypersensitivity reaction is urticarial classed as?
Hypersensitivity type I
Hypersensitivity type II
Hypersensitivity type III
Hypersensitivity type IV
Hypersensitivity type V
What type of hypersensitivity reaction is urticarial classed as?
Hypersensitivity type I
Hypersensitivity type II
Hypersensitivity type III
Hypersensitivity type IV
Hypersensitivity type V
Describe the difference in action of HLAs corresponding to MHC class A,B & C compared to DP,DM,DOA,DOB,DQ, andDR [2]
HLAs corresponding to MHC class I (A,B, andC) present peptides from inside the cell. For example, if the cell is infected by a virus, the HLA system brings fragments of the virus to the surface of the cell so that the cell can be destroyed by the immune system.
HLAs corresponding to MHC class II (DP,DM,DOA,DOB,DQ, andDR) present antigens from outside of the cell to T-lymphocytes
Which ligaments are commonly implicated in DISH [1]
anterior longitudinal ligaments
What is DISH? [1]
Which side of the spine does it commonly occur on and why? [2]
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by characteristic ossification patterns that can occur in the spine and peripheral entheses. DISH most commonly affects the spine and often presents as back pain and stiffness
DISH in the spine most commonly occurs on the right side of the thoracic region. The literature supports the original theory of the protective effect and mechanical barrier preventing DISH formation on the contralateral (i.e., left) side of the thoracic spine secondary to the pulsatile descending aorta
Why is bone formation more likely to occur at enthesis when injured compared to synovial fluid? [1]
At the enthesis there are more chances to form bone than in a joint, as you have mesenchymal fibroblasts that can convert to chondrocyte, whereas in the joint you have synovial macrophages that can become an osteoclast.
A 70 year old man presented with pain in his upper back for many months and gradually progressive weakness in lower limbs with inability to walk. MRI of the vertebral column revealed epidural abscess with vertebral body involvement of the thoracic 3 to 5th vertebra.
What is the most likely diagnosis
DISH
Osteoarthritis
Osteomyelitis
Osteoporosis
Rheumatoid arthritis
A 70 year old man presented with pain in his upper back for many months and gradually progressive weakness in lower limbs with inability to walk. MRI of the vertebral column revealed epidural abscess with vertebral body involvement of the thoracic 3 to 5th vertebra.
What is the most likely diagnosis
DISH
Osteoarthritis
Osteomyelitis
Osteoporosis
Rheumatoid arthritis
Infection from TB
Why is avascular necrosis of the femoral head a posibility with a femoral neck fracture? [2]
In approximately 80% of the adult population the acetabular artery from obturator has become closed and fibrotic. (1 mark)
The femoral head receives a retrograde blood supply from the medial and lateral circumflex and femoral neck fractures may disrupt this blood supply. (1 mark)
Robert is an 87-year old man who has osteoporosis with co-morbid osteomalacia.
Explain why these two conditions are often co-morbid.
Both conditions are linked to low vitamin D. (1 mark), If you have low Vit D that will also cause less Ca2+ and so less good bone is formed ((1 mark)
Low vitamin D is linked to poorer diet (1/2 mark) and not being as active or going outside as much. (1/2 mark)
State SIX histological changes that you will find in the articular cartilage of Mrs Fox’s knees?
Chondrocyte necrosis (more marked in the superficial layers) (1/2 mark)
Large isogenic clusters of the remaining chondrocytes (1/2 mark)
Cracks and fissures in the cartilage (1/2 mark)
Duplication of the tidemark (1/2 mark)
More collagen type I (1/2 mark)
Fewer proteoglycans (1/2 mark)
State the effect of more ACPA being produced in RA [1]
(ii) ACPA causes monocytes to differentiate as osteoclasts and they produce IL8 that creates the autocrine loop. (1 mark)
Mary is a 63- year old woman who has a 22 year history of rheumatoid arthritis. She is presently taking methotrexate (MTX) and infliximab was added 5 years previously but the efficacy of the infliximab has started to wane.
Briefly explain why the efficacy of the infliximab is starting to wane?
Infliximab is a chimeric anti-TNF alpha antibody designed against the mouse binding site of TNF alpha and the remaining 75% is mouse meaning that the body will see it as foreign and mount an immune response against the drug (1 mark). With time both neutralising and non-neutralising antibodies will be produced (1 mark). These will directly interfere, form immune complexes and increase clearance of the infliximab. (1 mark)
Name the FOUR stages of fracture healing.
Fracture hematoma
Soft callus (fibrocartilage callus)
Bony callus
Bone remodelling
The initial management of osteoarthritis is the use of NSAIDs, these drugs antagonise the COX2 enzyme in the joint.
How and what leads to the induction of COX2 in the affected joint?
Inflammatory signals (TNFalpha, IL1 and IL17) can directly induce the expression of COX2 in the joint (1 mark)
but the inflammatory stimuli can also indirectly activate COX2 by inducing iNOS that where the free radicals induce COX2. (1 mark).
An eight year old boy is diagnosed with Blounts disease.
Briefly explain why children are at risk of developing this condition?
Blounts disease is damage to the epiphyseal growth plate (squashing) (1 mark) both the cartilage of the epiphyseal growth plate and the woven bone it makes are softer and more deformable than and adults lamellar bone. (1 mark).
Which nerves control each movement? [3]
Median
Ulnar
Radial
Left hip abductors
Tibial
A 4-year old boy is brough to the GP as he is showing delayed motor milestones. When the boy is asked to get up from a seated position on the floor he goes through the following stages to stand. He also has a waddling gait.
What you would expect to see on a Quadricep muscle biopsy?
Degenerating and regenerating fibres, fibrosis and fat infiltration
Hypertrophy of the fast twitch fibres
Loss of fast twitch fibres
Loss of slow twitch fibres
Normal biopsy, but overall loss of muscular tissue
A 4-year old boy is brough to the GP as he is showing delayed motor milestones. When the boy is asked to get up from a seated position on the floor he goes through the following stages to stand. He also has a waddling gait.
What you would expect to see on a Quadricep muscle biopsy?
Degenerating and regenerating fibres, fibrosis and fat infiltration
Hypertrophy of the fast twitch fibres
Loss of fast twitch fibres
Loss of slow twitch fibres
Normal biopsy, but overall loss of muscular tissue
Septic arthritis
Weakness in wrist extension
Weakness in DIP flexion
Weakness in thumb flexion
No functional deficit
Weakness in PIP flexion
Weakness in wrist extension
Weakness in DIP flexion
Weakness in thumb flexion
No functional deficit
Weakness in PIP flexion
Describe the defining charactersitic of osteomalacia with regards to bone structure [2]
Osteomalacia the amount of bone is normal but the ratio of matrix to mineral is increased (1 mark)
3 What substance provides the skin with its waterproofing and where is it produced and give 2 sites where this substance is not produced on the body.
(2 marks)
Sebum (0.5 marks)
Produced by the sebaceous gland (0.5 marks)
Palm, soles, lips (0.5 marks each)
Which circumflex artery provides the majority of the retinacular arteries of the hip joint? [1]
The medial circumflex provides the majority of the retinacular arteries of the hip joint and enters through the neck of the femur so are affected here (1 mark)
Describe biochemical changes to OA bone [3]
- Biochemically
- increase in water in cartilage
- decreased proteoglycans
- loss of collagen network
Describe microscopic changes in bone in OA [2]
chondrocyte necrosis with focal clonal proliferation (1 mark) so patchy repair change in properties from hyaline to fibrocartilage change from type II collagen to type I (1 mark).
11 Explain briefly, why the hip is more commonly affected by OA than the shoulder. (2 marks)
The hip is a weight bearing joint and is so subjected to more stress and wear and tear than the shoulder (1). OA is most likely to affect the weight bearing joints first (1).
Describe how subchondral sclerosis occurs in OA [2]
When bone is exposed there are microfractures of the bone as bone does not have the same resilience as the cartilage. (1 mark)
In response there is increased osteoblastic activity and new bone formation leading to sub-chondral scerlosis of the bone. (1 mark)
Describe how subchondral cysts occur in OA [1]
There may be focal pressure necrosis of the bone that leads to the formation of sub-chondral cysts. (1mark)
There is vascular engorgement, slowing of blood flow through the sub-chondral bone. (1 mark)
State two non-dietary causes of rickets / osteomalacia [4]
- Malabosorption of vitamin D3 from malabsorption syndromes such as coeliac disease.
- Chronic renal failure, with reduced 1-a-hydroxylation of 25-hydroxy vitamin D3 to active metabolic 1,25-(OH)2-D3.
- Renal tubular acidosis
- Tumours
What are Loosers zones on x-rays? [1]
Pseudofractures - Linear areas of low density surrounded by sclerotic borders
19 What does the C-reactive protein measure, what induces its production and what is its function? (3 marks)
C-reactive protein is a direct measure of inflammation (1 mark). The C-reactive protein owes its name to the ability of this protein to precipitate pneumococcal C-polysaccharide in the presence of calcium.
CRP production is induced by the liver under the influence of IL-1 and IL-6 (1 mark).
Its function in-vivo is to assist the immune system by activation of the complement system, influence phagocytic cell function, and augmenting cell mediated cytotoxicity (1mark).
Describe the pattern of CRP release [2]
It reaches peak levels quickly, approximately 50 hours and also falls rapidly once the stimulus is removed.
Thus the CRP provides a more immediate picture of the level of inflammation than does the ESR i
State a common complication of being RF positive [1]
Vasculitis
If left un-diagnosed and untreated this can lead to the formation of a new acetabulum in the ilium. There is a shortening of the leg because of this and there would be a positive Trendelenburg’s sign.
A. Blount’s disease
B. Congenital hip dysplasia
C. Osgood-Schlatter disease
D. Perthes disease
E. Slipped upper femoral epiphysis
If left un-diagnosed and untreated this can lead to the formation of a new acetabulum in the ilium. There is a shortening of the leg because of this and there would be a positive Trendelenburg’s sign.
A. Blount’s disease
B. Congenital hip dysplasia
C. Osgood-Schlatter disease
D. Perthes disease
E. Slipped upper femoral epiphysis
The x-ray changes include periarticular osteoporosis and bone erosions.
A. Gout
B. Osteoarthritis
C. Psoriatic arthritis
D. Reactive arthritis
E. Rheumatoid arthritis
The x-ray changes include periarticular osteoporosis and bone erosions.
A. Gout
B. Osteoarthritis
C. Psoriatic arthritis
D. Reactive arthritis
E. Rheumatoid arthritis
Myopathic infantile hypotonia
What would be the effect on bone mass for the patients using teripartide?
Less bone mass and less mineralisation
Less bone mass with normal mineralisation
More bone mass and normal mineralisation
More bone mass but unmineralised
No effect
What would be the effect on bone mass for the patients using teripartide?
Less bone mass and less mineralisation
Less bone mass with normal mineralisation
More bone mass and normal mineralisation
More bone mass but unmineralised
No effect
A 35 year old woman reports a 6 week history of symmetrical swelling and pain in the carpals. On examination there is “boggyness” in the metacarpal phalangeal joints as well as the carpals. Rheumatoid arthritis is diagnosed and she is started on methotrexate. 6 months later she has a synovectomy.
What is the most common immune cell in the synovial membrane?
* B-lymphocyte
* CD8 cytotoxic T-lymphocyte
* Histocyte
* Neutrophil
* TH17 CD4 T-lymphocyte
A 35 year old woman reports a 6 week history of symmetrical swelling and pain in the carpals. On examination there is “boggyness” in the metacarpal phalangeal joints as well as the carpals. Rheumatoid arthritis is diagnosed and she is started on methotrexate. 6 months later she has a synovectomy.
What is the most common immune cell in the synovial membrane?
* B-lymphocyte
* CD8 cytotoxic T-lymphocyte
* Histocyte
* Neutrophil
* TH17 CD4 T-lymphocyte
Which cell type would be most prominent in A and B in a patient with RA? [2]
A - synovial membrane: Th17 lymphocytes
B - synovial fluid: Neutrophils
A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips. Which muscle and tendon could be transferred to help this individual walk better?
Fibularis longus
Flexor hallucis longus
Gastrocnemius
Tibialis anterior
Tibialis posterior
A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips. Which muscle and tendon could be transferred to help this individual walk better?
Fibularis longus
Flexor hallucis longus
Gastrocnemius
Tibialis anterior
Tibialis posterior
Blount’s disease is characterised by what abnormality to which bone? [2]
irreversible tibia varus is the pathophysiology behind
osgood-schlatter
blounts disease
SUFE
Perthes
CDH
Describe the pathophysiology of Osgood Schlatters [2]
The patella tendon inserts into the tibial tuberosity. In patients with Osgood-Schlatter disease, multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially, this lump is tender due to inflammation. As the bone heals and inflammation settles, the lump becomes hard and non-tender.
A hard, non-tender lump is then permanently present at the tibial tuberosity.
Osgood schlatters is characterised by which type of fractures to the tibia?
multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone.
What are the arrrows pointing to? [1]
Schmorl’s nodes
Where is Klines line? [1]
How can you use this to diagnose SUFE? [1]
Klein’s line is drawn along superior border of femoral neck should cross at least a portion of the femoral head. When SUFE the femoral head drops below this line.
What is the best way to treat genu varum in an adult?
What is the procedure they have done to correct this deformity?
Distal femoral osteotomy
Proximal femoral osteotomy
Proximal fibular osteotomy
Proximal tibial closing wedge osteotomy
Proximal tibial open wedge osteotomy
Proximal tibial open wedge osteotomy
Harrington rods
OA or degenerative disc disease blocking the vertebral artery causes what pathology? [1]
Vertebral-basilar artery insufficiency
Describe the signs / symptoms of cauda equina syndrome [5]
Cauda equina syndrome results in lower motor neurone signs and symptoms:
- reduced or absent lower extremity reflexes
- reduced lower limb sensation (often bilateral)
- bladder or bowel dysfunction
- lower limb motor weakness
- severe back pain
- impotence.
Describe pathophsiology of Diffuse idiopathic skeletal hyperostosis (DISH) [2]
Unilateral ossification of anterior longitudinal ligament (+/- osteophytes)
Not complete ossification: looks like candle wax
Disc height maintained
ID where the femoral head is
Affected side will be more lateral to the side
Unaffected side: femoral head more medial
Describe shape of babies feet and how this changes with age [2]
How can this process be pathological? [1]
Flat foot: fat pad present for energy reserves. As they grow this dissapears
In some children the arch never fully develops: presents as weak ankles and turn inwards
Describe the treatment of Talipes equinovarus [2]
Ponseti method – manipulative technique to correct clubfoot without invasive surgery
Wear in night everyday
Places the foot in abduction / valgum: as the skeleton continues to grow don’t have the deformity come back
Explain how you can interpret ultrasound to determine CHD level [4]
Ultrasound interpretation of CHD can also be done by interpretation of the alpha-angle, which is an angle formed by the acetabular roof to the vertical cortex of the ilium and thus reflects the depth of the bony acetabular roof.
The normal value is greater than or equal to 60 degrees. Less than 60 degrees suggests dysplasia of the acetabulum
- Grade 1 > 60 degrees
- Grade IIa,b 50-59 degrees
- Grade IIc 43-49 degrees
- Grasde IIIa, b, IV < 43 degrees
Describe the points that Perkins line is found [1]
How is it used for assessment for CHD? (affected v unaffected)
Top of the acetabulum going down: ID where the femoral head is
Affected side will be more lateral to the side
Unaffected side: femoral head more medial
Describe the movement of the joint that occurs in SUFE [2]
Epiphysis actually stays in place it’s the neck and shaft of the femur that moves
Epiphysis moves posteriorly and medially
Consequences of not treating CDH? [2]
Head of femur will form a new acetabulum on the back of pelvis: creating a leg length discrepancy due to the moving of the femur further onto the back of the ilium.
The acetabulum also forms of fibrocartilage rather than hyaline, further affecting the joint properties.
Visceral pleura
Parietal pleura
Papillary muscle
Skeletal muscle
stomach
‘Weeping lubrication’ is a process by which nutrients and excretory materials are respectively absorbed and removed from articular cartilage. What is the macromolecule that provides the backbone for the aggrecan proteoglycan that facilitates this process?
hyalouronic acid,
Pulmonary trunk
Superior lobar bronchus
Facial (VII)
Antrum
Abduction of the arm
Abduction of the digits
Extension of the elbow
Flexion of the elbow
Flexion of the digits
Abduction of the arm
Abduction of the digits
Extension of the elbow
Flexion of the elbow
Flexion of the digits
Hamstrings
Conscious proprioception
Subconscious proprioception
Pain
Motor to upper limbs
Motor to lower limbs
On the image of an epiphyseal growth plate below, identify the zone indicated A
proliferation
sertoli
Primordial follicle
Primary follicle
Secondary follicle
Graffian follicle
Oocyte
Primordial follicle
Primary follicle
Secondary follicle
Graffian follicle
Oocyte
