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Orthopaedics and rheumatology > Bone and joint pathology > Flashcards

Bone and joint pathology Flashcards

1
Q

How does low oestrogen increase bone resorption

A

In low oestrogen levels there is decreased osteoprotegerin (OPG). OPG usually acts as a decoy receptor for RANK, preventing the activation of osteoclasts by osteoblast (RANK-L) stimulation.

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2
Q

What is used for prevention of osteoporosis?

A

Calcium and Vit D3 and Bisphosphonates are first line.
Also: RANK-L inhibitors.
HRT no longer used due to increased breast and endometrial cancer risk.

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3
Q

When does peak bone mass occur?

A

20-30 years of age

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4
Q

What is the main protecting factor for osteoporosis?

A

Bone mass

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5
Q

What are the symptoms of osteoarthritis?

A

Joint pain, stiffness, functional impairment

Overall loss of quality of life

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6
Q

What causes osteoarthritis?

A

90% of cases are primary idiopathic. There are changes in proteoglycan and collagen leading to altered load bearing properties.

10% secondary: as a consequence of pre-existing joint disease.
e.g. deformity, RA, metabolic disorder, crystal deposition disease.

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7
Q

What is the pathology of Rheumatoid Arthritis?

A

Systemic autoimmune disease that manifests as synovial arthropathy (starts as sinovitis and changes spread to articular cartilage, subchondral bone and peri-articular tissue).

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8
Q

How do we treat RA?

A

Analgesics, NSAIDS and DMARDs first line.
If DMARDs don’t work use anti-TNF-alpha.
If that doesn’t work use immunotherapy (e.g. Rituximab).
Steroids are sometimes used short term for life-threatening complications or to suppress disease when DMARDs are being introduced.

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9
Q

Name 3 DMARDs

A

Methotrexate, sulfasalazine, hydroxychloroquine

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10
Q

How do we treat osteoarthritis?

A

Analgesia, exercise and bone protection (calcichew and bisphosphonates)

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11
Q

How do we treat gout?

A

NSAIDS, followed by colchicine, followed by steroids

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12
Q

What is sequestrum in osteomyeltitis

A

dead bone

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13
Q

What is involucrum in osteomyelitis

A

Layer of new bone growth surrounding the dead bone

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14
Q

Where is calcitonin produced?

A

The parafollicular (C cells) cells of the thyroid

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15
Q

What are the functions of PTH?

A

Regulates activation of vitamin D in the kidney (which then stimulates ca and P absorption in the gut and ca release from bone).
Increases resorption of Ca and decreases resorption of P in the kidney.
Releases Ca from bone.

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16
Q

What is rheumatoid factor?

A

An anti-IgG antibody

This is present in >80% of patients with RA, usually the IgM subtype.

Higher levels associated with worse prognosis

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17
Q

What method is used to detect rheumatoid factor?

A

Latex bead agglutination

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18
Q

Which autoantibodies would you expect to find in sjogren’s disease?

A

Anti-Ro (SS-A) and anti-La (SS-B) -these are ENA antibodies.

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19
Q

What is impetigo?

A

A pyogenic infection of the epidermis, usually caused by staph aureus

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20
Q

What is furunculosis?

A

Infection of sebaceous glands or sweat glands, usually causes by staph aureus.

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21
Q

What is cellulitis?

A

Infection of loose subcutaneous tissue- usually resulting from penetrating injury or local lesion. Usually strep pyogenes or staph aureus.

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22
Q

Which organism usually causes gas gangrene?

A

C. Perfringens

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23
Q

How long should antibiotics be given for in osteomyelitis? (Hint: consider acute, chronic and childhood infections)

A

Acute- 6 weeks
Chronic- 12 weeks (6 IV, 6 oral)

Acute in children- 2-4 weeks

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24
Q

Where is pain from the glenohumeral joint felt?

A

Over the upper arm

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25
Q

Where is pain from the acromioclavicuar joint felt?

A

In the joint

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26
Q

Where is rotator cuff pain felt?

A

Over the upper arm

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27
Q

What time of day is stiffness worst in inflammatory joint conditions?

A

Early morning, eases with activity

28
Q

When are pain and stiffness from non-inflammatory joint conditions worst?

A

Exacerbated by activity

29
Q

Knee pain can be felt in the knee or it can radiate- where to?

A

The hip or the ankle

30
Q

Ankylosing spondylitis affects which areas of the body most?

A

Spine and sacroiliac joints

31
Q

What is usually one of the earliest manifestations of ankylosing spondylitis?

A

Inflammation of the sacroiliac joint

32
Q

How do we treat ankylosing spondylitis

A

Same as RA!

NSAIDS, opioids, DMARDS

33
Q

What is a syndesmophyte?

A

A bony growth originating inside a ligament, commonly seen in the ligaments of the spine. Ankylosing spondylitis patients are prone to them, but also those who have had back surgery or other chronic stresses on the ligaments of the spine

34
Q

Ankylosing spondylitis affects which areas of the body most?

A

Spine and sacroiliac joints

35
Q

What is usually one of the earliest manifestations of ankylosing spondylitis?

A

Inflammation of the sacroiliac joint

36
Q

How do we treat ankylosing spondylitis

A

Same as RA!

NSAIDS, opioids, DMARDS

37
Q

What is a syndesmophyte?

A

A bony growth originating inside a ligament, commonly seen in the ligaments of the spine. Ankylosing spondylitis patients are prone to them, but also those who have had back surgery or other chronic stresses on the ligaments of the spine

38
Q

What is onycholysis?

A

Detachment of nail from nail bed. Seen in psoriasis

39
Q

What is hypertrophic pulmonary osteoarthropathy?

A

Condition combining clubbing and periostits of the small hand joints.

40
Q

What is hypertrophic pulmonary osteoarthropathy associated with?

A

Lung cancer

41
Q

How do we treat psoriatic arthritis?

A

NSAIDS, sulfasalazine, methotrexate, ciclosporin.

Anti-TNF agents may also be effective.

42
Q

What is another name for giant cell arteritis?

A

Temporal arteritis

43
Q

What are the symptoms of giant cell arteritis?

A

Aching and soreness around temples
Jaw muscle pain while eating
Vision loss

44
Q

What is enthesitis?

A

Inflammation of site of insertion of a tendon or ligament into bone e.g. Plantar fasciitis, Achilles tendonitis, costochondritis

45
Q

What are the radiographic features of RA?

A

Juxta-articular osteopenia, bony erosions, loss of joint space, soft tissue swelling

46
Q

What would you see on a pseudogout X-ray?

A

Chondrocalcinosis
Joint space narrowing
Widespread cartilage loss

47
Q

Treatments for pseudogout?

A

Just aspirate!
Colchicine
NSAIDs
Steroids

48
Q

What is the most common cause of joint effusion of the knee?

A

Osteoarthritis

49
Q

Which joints do Heberden’s nodes form in?

A

DIP joints

50
Q

Which joints do Bouchard’s nodes form in?

A

PIP joints

51
Q

What is the difference between a fixed and a flexible deformity?

A

In a flexible deformity some movement is possible.

52
Q

What does Trendellenburg’s sign suggest?

A

Weakened or paralysed abductor muscles of the hip- gluteus minimus and gluteus medius

53
Q

What is Thomas’ test used to assess?

A

Fixed flexion deformity of the hip

54
Q

Which are more likely to cause polyarthritis: viruses or bacteria?

A

Viruses

55
Q

Monoarthritis is more often caused by:
A) Bacteria
B) Virus

A

A) Bacteria

56
Q

Which virus most commonly causes polyarthritis?

A

Parvovirus

57
Q

What are the main differentials for monoarthritis? (name 6)

A 
OA
Gout
Reactive
Septic
Trauma
Avascular Necrosis
58
Q

What is podogra?

A

Gout affecting the big toe

59
Q

What kind of inflammatory cells are involved in gout?

A

Neutrophils

60
Q

Name a xanthine oxidase inhibitor used in prevention of gout.

A

Allopurinol

61
Q

What are the main systemic effects of gout?

A 
Tophi in the skin.
Renal calculi.
Systemic inflammatory response.
Fever.
Anorexia.
Metabolic syndrom.
62
Q

What are the 5 types of OA?

A

1) Nodal generalized OA
2) Erosive inflammatory OA
3) Large joint OA
4) Crystal-associated OA
5) Secondary OA

63
Q

What radiological features are seen in OA?

A 
Joint space narrowing
Sclerosis
Subchondral cysts
Bone collapse/attrition
Osseus ('loose') bodies.
64
Q

When would you use steroids for RA?

A

As a bridge therapy before the onset of action of DMARDs

65
Q

What are the most common causative organisms of reactive arthritis?

A

Gastrointestinal- e.g. Salmonella, shigella, campylobacter.

Sexually transmitted- e.g. Chlamydia trachomatis, neisseria gonorrheae

66
Q

What is the mechanism of denosumab and what is it used for?

A

RANKL inhibitor used in osteoporosis

Orthopaedics and rheumatology (5 decks)

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