Week 137 - Arthritis/Gout

Question 1

What are the clinical features of Reactive Arthritis?

Answer 1

Acute, Asymmetrical, lower-limb arthritis
Occuring a few days/couple weeks after infection
Enthesitis is common

Question 2

What type of arthritis is associated with IBD?

Answer 2

Enteropathic arthritis
Symmetrical + lower limbs
Occurs in 10-15% of pt with UC/Crohn’s

Question 3

What is gout?

Answer 3

Inflammatory arthritis associated with hyperuricaemia

Question 4

What do uricouric drugs block (e.g. probenecid)?

Answer 4

GLUT9 and URAT-1 = ↑excretion of uric acid in urine

Question 5

What are the clinical features of acute gout?

Answer 5

Sudden onset + agonizing pain, swelling, redness of first MTP joint

Question 6

Name two xanthine oxidase inhibitors

Answer 6

Allopurinol ( first line)

Febuxostat

Question 7

What is chronic tophaceous gout?

Answer 7

Individuals with very high levels of uric acid can present with this
Sodium urate forms smooth white deposits (tophi) in skin

Question 8

What is psedogout?

Answer 8

Calcium pyrophosphate deposits in hyaline and fibrocartilage

Crystals are shed resulting in acute synovitis which resembles gout

Question 9

What are the clinical features of Septic Arthritis?

Answer 9

Joint hot, red, swollen
Agonizingly painful
Held immobile by muscle spasm
In 20% >1 joint affected

Question 10

The hip joint is an articulation between…

Answer 10

Head of femur and acetabulum of hip

Question 11

What muscles are responsible for flexion of the hip?

Answer 11

Iliopsoas
Rectus Femoris
Sartorius
Adductor muscles

Question 12

What muscles are responsible for extension of the hip?

Answer 12

Gluteus maximus

Hamstring muscles

Question 13

What muscles are responsible for abduction of the hip?

Answer 13

Gluteus medius
Minimus
Sartorius
Tensor fascie latae
Piriformis

Question 14

What muscles are responsible for adduction of the hip?

Answer 14

Adductor longus & brevis
Adductor fibers of adductor magnus
Pectineus & gracilis

Question 15

Hip joint pain can be referred to front+medial side of thigh, why?

Answer 15

Femoral nerve not only supplies the hip joint but also supplies medial + front of thigh

Question 16

Why would hip joint disease sometimes give rise to pain in knee joint?

Answer 16

Posterior division of obturator nerve supplies both hip and knee joints

Question 17

What are the four major routes by which structures pass from the abdomen into the lower limb?

Answer 17

Obturator canal
Greater Sciatic Foramen
Lesser Sciatic Foramen
Gap between inguinal ligament & pelvic bone

Question 18

What structures pass through the greater sciatic foramen?

Answer 18

Split by piriformis muscle
Superior gluteal nerve & vessels
Inferior gluteal nerve & vessels, Sciatic Nerve, pudendal nerve, internal pudendal vessels

Question 19

Femoral Nerve - Origin + Innervation

Answer 19

L2-L4

All muscles of anterior compartment of thigh

Question 20

Obturator Nerve - Origin + Innervation

Answer 20

L2-L4

All muscles of medial compartment of thigh (except part of adductor magnus muscle)

Question 21

Sciatic Nerve - Origin + Innervation

Answer 21

L4-S3 of sacral plexus
All muscles of posterior compartment of thigh
Nerve divides into common fibular nerve and tibial nerve

Question 22

What does the Gluteal Nerve innervate?

Answer 22

Superior gluteal nerve

Inferior gluteal nerve

Question 23

Lateral Cutaneous Nerve - Origin + Innervation

Answer 23

L2-L3

Supplies skin on lateral side of thigh

Question 24

Nerve to quadratus femoris - Origin + Innervation

Answer 24

L4-S1

gemellus inferior + quadratus femoris

Question 25

Nerve to obturator internus - Origin + Innervation

Answer 25

L5-S2 | gemellus superior + obturator muscle

Question 26

Name the myotomes and joint movements involved in "kicking down a door"

Answer 26

L2 - hip flexion L3 - knee extension L4 - ankle dorsi-flexion

Question 27

Which myotome is tested during knee flexion?

Answer 27

S2

Question 28

Which myotome is tested during ankle-plantar flexion/ankle eversion/hip extension?

Answer 28

S1

Question 29

What are the clinical signs of tarsal tunnel syndrome?

Answer 29

Vague discomfort or pain (burning, tingling) in plantar foot Prolonged standing & walking usually exacerbate the symptoms ?Night pain, improved with massage/walking

Question 30

What are the clinical signs of peroneal nerve injury?

Answer 30

Paretic/Paralyzed ankle dorsiflexors (i.e. foot drop) Loss of sensation Tapping on nerve at fibular head -> may produce Tinnel's sign

Question 31

What are the features of osteoarthritis on X-ray?

Answer 31

Joint space narrowing Sclerosis Subchondral cysts Osteophytes

Question 32

Who do cartilage focal lesions most commonly affect?

Answer 32

Younger Sporty People | Either by repetitive or traumatic impact

Question 33

Describe the grading of cartilage defects

Answer 33

Grade I - superficial cartilage Grade II - 1/2 depth of cartilage Grade III - down to subchondral bone Grade IV - exposure of subchondral bone

Question 34

What are the treatments available for cartilage damage?

Answer 34

Debridement Microfracture Autologous chondrocyte implantation (ACI)

Question 35

What is Vitamin D made from?

Answer 35

7-Dehydrocholesterol (+ light)

Question 36

What enzyme is stimulated in the kidney by PTH affecting the vitamin D levels?

Answer 36

1-α-hydroxylase

Question 37

What effect does vitamin D have in the GUT?

Answer 37

↑transepithelial transport of Ca and PO4 | ↑serum [Ca]

Question 38

What effect does vitamin D have in the BONE?

Answer 38

Stimulate terminal differentiation of OC Directly + via OB ↑serum [Ca]

Question 39

What effect does vitamin D have in the Parathyroid?

Answer 39

Inhibit PTH production

Question 40

What effect does PTH have on the body?

Answer 40

↑Bone Resorption ↑Renal Tubular Reabsorption ↑1-α-hydroxylase ↑serum [Ca]

Question 41

What is the effect of calcitonin?

Answer 41

↓OC bone resorption

Question 42

What drugs decrease excretion of urate?

Answer 42

Aspirin (Low Dose) Thiazine Diuretics Furosemide Ethambutol

Question 43

What is an apophysis?

Answer 43

Separate growth centre/ossification centre | Forming a lump (e.g. greater trochanter)

Question 44

When does the iliac crest growth plate fuse?

Answer 44

about 25 yrs

Question 45

What is the difference between a stress fracture and insufficiency fracture?

Answer 45

Stress Fracture - repeated microtrauma on NORMAL bone | Insufficiency Fracture - NOT normal bone

Question 46

What is Perthes' disease?

Answer 46

Femoral head softens and breaks down due to avascular necrosis