Week 2

Question 1

what is Rheumatoid Arthritis

Answer 1

Insidious onset.
Joint swelling.
Early morning stiffness >30mins.
Symetric.
Dramatic NSAID response.

Chronic, symmetrical, inflammatory, deforming, polyarthritis

1%.
Costly.

Question 2

Pathology of Rhuematoid Arthritis

Answer 2

Unknown.
Genetic + environmental factors.

Primary site of inflammation = synovium.

Question 3

TNFa

Answer 3

Secreted by macrophages.
Induces:
cyto/chemokines.
VEGF.
Metalloproteinase synthesis (enzymes that break down proteins - articular cartilage degradation)

Question 4

Pannus

Answer 4

Inflammation and proliferation of the synovium leads to formation of PANNUS. Thus, destruction in bones/tendons/ligaments/vessels.

Hypertrophied synovium = Pannus.

Made of macrophage and mesenchymal cells.

Question 5

Chronic Systemic Inflammation can lead to;

Answer 5

Early IHD.
Dementia.
Osteoporosis.
Pain sensitisation.
Sarcopenia (reduced muscle bulk).
Insulin resistance.

Question 6

Test for Rheumatoid Arthritis

Answer 6

Anti-CCP Antibodies.
Rheumatoid Factor (RF).
ESR.
CRP.

CCP = Cyclic Citrullinated Peptide. nr = <15.
Citrulline is an AA created from altered Arginine.
RF proteins are produced by immune system that atk healthy tissue.
nr = <15iU/mL.
ESR range 0-22 (M) 0-29(F). Increased ESR associated w/ inflammation.
CRP icnreases IL-6 secretion from macrophages. nr = <8 mg/L.

Question 7

RA Treatment

Answer 7

Disease-Modifying Anti-Rheumatic Drugs (DMARD’s).
- Methotrexate
- Leflunomide.

Methotrexate MOA: inhibits Nucleotide synthesis via DHF.

Question 8

OsteoArthritis

Answer 8

Most common Joint Disorder.
Degenerative.
DIP and PIP typically in dominant hand.
Symptoms with Activity.

Question 9

Risk Factors for OA

Answer 9

Female.
Age.
Genetic.
Obesity.
Oestrogen deficiency.

Question 10

Pain in OA

Answer 10

Prostaglandins.
Synovitis.
Cytokines.
Muscle spasm.
Venous congestion.

Question 11

Crystal Arthritis

Answer 11

Gout: Uric Acid Crystals.

Calcium Phosphate Disease: Calcium pyrophosphate Dihydrate (CPPD) crystals.

Chronic joint damage.

Most common in men.

Question 12

Gout

Patho

Answer 12

Decreased Urate excretion OR
Increased Urate production. Resulting in Hyperuricaemia, crystal formation at the joint.
Alcohol increases purine catabolism in liver, producing lactate acid which can inhibit urea secretion via renal tubules.

Masses formed = Tophaceous

Decreased Urate clearance more common.
Podagra (gout affecting big toe).

Question 13

Conditions that cause Hyperuricaemia

Answer 13

Lymphoma.
Leukaemia.
Haemolytic anaemia.
Psoriasis.

Question 14

Comorbidites in Gout

Answer 14

Renal Impairment.
Coronary Heart Disease.
Metabolic Syndrome:
- Obesity
- Dyslipidemia
- HTX
- T2D

Question 15

Contraindications in Gout

Answer 15

Furosemide.
Thiazide Diuretic.
Low-dose aspirin.
Cyclosporin.

Question 16

Septic Arthritis

Answer 16

Joint pain & swelling.
Systemic symptoms.

Trauma, recent local infection, IV drug use.

Question 17

Borders of Cubital Fossa

Answer 17

Lateral = Brachioradialis
Medial = Pronator Teres
Floor = Brachialis

Question 18

Superficial Flexors of Forearm & Innervation

Answer 18

Pronator Teres
Flexor Carpi Ulnaris
Flexor Capri Radialis
Palmaris Longus

Medial Epicondyle.

Question 19

Intermediate Flexors of Forearm

Answer 19

Flexor Digitorum Superficialis

Origin: Medial epicondyle & medial aspect of ulna.

Split attachment at the base of middle phalanx.

Question 20

Deep Flexors of Forearm

Answer 20

Flexor Digitorum Profundus
Flexor Pollicis Longus
Pronator Quadratus

FDP = attaches at base of distal phalanx.

Question 21

Innervation Forearm Flexors

Answer 21

Median nerve = All but 1/2 FDP
Ulnar Nerve = 1/2 FDP, FCU

Ulnar nerve and Artery track together and enter the wrist together.

Question 22

Superficial Forearm Extensors

Answer 22

Ext. Carpi Radialis Longus
Ext. Carpi Radialis Brevis*
Ext. Carpi Ulnaris*
Ext. Digitorum*
Ext. Digiti Minimi*
Anconeus
Brachialis

* = CEO, Lateral epicondyle

Question 23

Deep Extensors of Forearm

Answer 23

Supinator
Ext. Pollicis Brevis
Ext. Pollicis Longus
Abductor Pollicis Longus
Ext. Indicis

Question 24

Innervation of Posterior compartment muscles

Forearm Extensors

Answer 24

Radial Nerve.

Question 25

Lumbricals

Ulnar nerve.

Answer 25

Attached between Flexor Digitorum Profundus and Extensor Apparatus.

Flexion of MCP while balancing flexor and extensor function.

Question 26

Muscles of Thenar Eminence & Innervation

Answer 26

Opponens Pollicis.
Abductor Pollicis Brevis.
Flexor Pollicis Brevis.

All innervated by Median nerve.

Question 27

Deep Muscle of Thenar Eminence

Answer 27

Adductor Pollicis.

Ulnar nerve.

Question 28

Interosseous Muscles

Answer 28

Palmar: Adductor of digits towards middle finger. From metacarpal, connecting to extensor apparatus.
Dorsal: Abduct, on both sides of metacarpal, attach to extensor apparatus.

Both innervated by Ulnar nerve.

PAD = Palmar ADDuct.
DAB = Dorsal ABduct.

Question 29

Muscles of Hypothenar Eminence & Innervation

Answer 29

Opponens Digiti.
Abductor Digiti Brevis
Flexor Digiti Brevis.

Ulnar Nerve (C8-T1)

Question 30

Median Nerve innervates what hand muscles

Answer 30

Thenar eminence except ADDUCTOR pollicis.
Radial 2 lumbricals.

Ulnar does the rest.

Question 31

Blood Supply of the Hand

Answer 31

Arterial: Ulnar + Radial form Superficial and Deep Palmar Arches. Digital arteries bud off the arches.
Venous: Dorsal digital veins > Dorsal metacarpal veins > Dorsal Venous Arch > Cephalic and Basalic veins.