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Year 1 Medicine > Week 137 - Arthritis/Gout > Flashcards

Week 137 - Arthritis/Gout Flashcards

1
Q

What are the clinical features of Reactive Arthritis?

A

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

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2
Q

What type of arthritis is associated with IBD?

A

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

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3
Q

What is gout?

A

Inflammatory arthritis associated with hyperuricaemia

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4
Q

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

A

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

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5
Q

What are the clinical features of acute gout?

A

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

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6
Q

Name two xanthine oxidase inhibitors

A

Allopurinol ( first line)

Febuxostat

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7
Q

What is chronic tophaceous gout?

A

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

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8
Q

What is psedogout?

A

Calcium pyrophosphate deposits in hyaline and fibrocartilage

Crystals are shed resulting in acute synovitis which resembles gout

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9
Q

What are the clinical features of Septic Arthritis?

A

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

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10
Q

The hip joint is an articulation between…

A

Head of femur and acetabulum of hip

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11
Q

What muscles are responsible for flexion of the hip?

A

Iliopsoas
Rectus Femoris
Sartorius
Adductor muscles

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12
Q

What muscles are responsible for extension of the hip?

A

Gluteus maximus

Hamstring muscles

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13
Q

What muscles are responsible for abduction of the hip?

A 
Gluteus medius
Minimus
Sartorius
Tensor fascie latae
Piriformis
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14
Q

What muscles are responsible for adduction of the hip?

A

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

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15
Q

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

A

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

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16
Q

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

A

Posterior division of obturator nerve supplies both hip and knee joints

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17
Q

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

A

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

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18
Q

What structures pass through the greater sciatic foramen?

A

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

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19
Q

Femoral Nerve - Origin + Innervation

A

L2-L4

All muscles of anterior compartment of thigh

20
Q

Obturator Nerve - Origin + Innervation

A

L2-L4

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

21
Q

Sciatic Nerve - Origin + Innervation

A

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

22
Q

What does the Gluteal Nerve innervate?

A

Superior gluteal nerve

Inferior gluteal nerve

23
Q

Lateral Cutaneous Nerve - Origin + Innervation

A

L2-L3

Supplies skin on lateral side of thigh

24
Q

Nerve to quadratus femoris - Origin + Innervation

A

L4-S1

gemellus inferior + quadratus femoris

25
Q

Nerve to obturator internus - Origin + Innervation

A

L5-S2

gemellus superior + obturator muscle

26
Q

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

A

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

27
Q

Which myotome is tested during knee flexion?

A

S2

28
Q

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

A

S1

29
Q

What are the clinical signs of tarsal tunnel syndrome?

A

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

30
Q

What are the clinical signs of peroneal nerve injury?

A

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

31
Q

What are the features of osteoarthritis on X-ray?

A

Joint space narrowing
Sclerosis
Subchondral cysts
Osteophytes

32
Q

Who do cartilage focal lesions most commonly affect?

A

Younger Sporty People

Either by repetitive or traumatic impact

33
Q

Describe the grading of cartilage defects

A

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

34
Q

What are the treatments available for cartilage damage?

A

Debridement
Microfracture
Autologous chondrocyte implantation (ACI)

35
Q

What is Vitamin D made from?

A

7-Dehydrocholesterol (+ light)

36
Q

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

A

1-α-hydroxylase

37
Q

What effect does vitamin D have in the GUT?

A

↑transepithelial transport of Ca and PO4

↑serum [Ca]

38
Q

What effect does vitamin D have in the BONE?

A

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

39
Q

What effect does vitamin D have in the Parathyroid?

A

Inhibit PTH production

40
Q

What effect does PTH have on the body?

A

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

41
Q

What is the effect of calcitonin?

A

↓OC bone resorption

42
Q

What drugs decrease excretion of urate?

A

Aspirin (Low Dose)
Thiazine Diuretics
Furosemide
Ethambutol

43
Q

What is an apophysis?

A

Separate growth centre/ossification centre

Forming a lump (e.g. greater trochanter)

44
Q

When does the iliac crest growth plate fuse?

A

about 25 yrs

45
Q

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

A

Stress Fracture - repeated microtrauma on NORMAL bone

Insufficiency Fracture - NOT normal bone

46
Q

What is Perthes’ disease?

A

Femoral head softens and breaks down due to avascular necrosis

Year 1 Medicine (12 decks)

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