Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

JL Musculoskeletal > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is the definition of rheumatoid arthritis?

A

A chronic systemic inflammatory disease, characterised by potentially deforming symmetrical polyarthritis and extra-articular features (systemic disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What age group does rheumatoid arthritis tend to develop in and what is the female to male ration?

A

30-50

3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What genes may contribute to the cause of rheumatoid arthritis?

A

HLA, DR4 and DR1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give two factors which may contribute to rheumatoid arthritis?

A
  1. Cigarette smoking

2. Infective aetiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name two differences between a normal joint and a rheumatoid arthritis affected joint?

A
  1. Tendon sheath becomes inflamed

2. Synovial membrane is inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In relation to the pathology of rheumatoid arthritis: what does the synovium become laden with?

A

Macrophages, fibroblasts and multi-nucleated giant cells (resemble osteoclasts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In relation to the pathology of rheumatoid arthritis: what does the synovial membrane do?

A

Expands, actively invades and erodes surrounding bone and cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give four articular symptoms of rheumatoid arthritis?

A
  1. Joint pain worst on waking and improve with activity
  2. Stiffness
  3. Joint swelling
    4, malaise and fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give four signs of rheumatoid arthritis?

A
  1. Swelling
  2. Tenderness
  3. Reduced range of movement
  4. Deformities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In teh arthritis classification criteria - what is definite RA defined by (3 things)?

A
  1. Presence of synovitis in at least 1 joint
  2. Absence of alternative better diagnosis explaining synovitis
  3. Achievement of total score of 6 or more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In the arthritis classification criteria - what are the 4 point scoring systems?

A
  1. Number and site of involved joint (0-5)
  2. Serological abnormality (0-3)
  3. Elevated acute phase response (0-1)
  4. Symptom duration (0-1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give four investigations for rheumatoid arthritis?

A
  1. Anti CCP (cyclic citrullinated peptide); RF (rheumatoid factor)
  2. Inflammatory markers - PV, CRP
  3. Anaemia of chronic disease
  4. Radiology - ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give four late complications of RA?

A
  1. Infection
  2. Cervical myelopathy
  3. Interstitial lung disease
  4. Peripheral neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is it a good prognosis if you are male and young at age of RA onset?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In RA what is the window of opportunity for treatment?

A

3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the first step treatment for RA?

A

Early initiation of disease modyfyfing drugs (DMARDs) with steroids to cover ‘lag phase’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What drugs used for RA are slow avting (weeks to months), reduce rate of joint damage?

A

DMARDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give a few examples of DMARDs?

A
  1. Methotrexate
  2. Sulfasalazine
  3. Leflumamide
  4. Hydroxychloroquine
  5. Penicillamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

4 biologic approaches have achieved major impact in RA - what do infliximab, adalimumab and etanercept belongto?

A

Tumour necrosis factor alpha inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4 biologic approaches have achieved major impact in RA - what do Rituximab belong to?

A

B cell depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

4 biologic approaches have achieved major impact in RA - what do Abatacept belong to?

A

Disruption of T cell costimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4 biologic approaches have achieved major impact in RA - what do anankira and tocilizumab belong to?

A

IL-1 inhibition and IL-6 inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What four features define osteoarthritis?

A
  1. Articular cartilage failure
  2. Subchondral sclerosis
  3. Loss of joint space
  4. Subchondral cyst formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What consists of predominantly collagen type 2 fibres linked by covalent bonds, conferring tensile strength?

A

Cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In osteoarthritis what is there a loss of and release of?

A

Loss of matrix, release of cytokines (IL-1, TNF) and mixed metalloproteinases, prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What occurs once there has been a loss of matrix in OA?

A

Fibrillation of the cartilage surface and attempted repair with osteophyte formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the last stage process of OA?

A

No cartilage left so synovial fluid goes into bone causing cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can previous injury, RA, genetic elements, acromegaly and calcium crystal deposition disease all lead to?

A

Secondary OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Is OA more common in females or males?

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Name two occupations more at risk of OA?

A

Hairdressers and farmers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe the pain in OA?

A

Worse on activity and relieved by rest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the stiffness like in OA?

A

Usually morning stiffness lasting less than 30 minutes. Inactivity gelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What 4 features can be found on examination in a patient with OA?

A
  1. Crepitus
  2. Bony enlargements due to osteophytes
  3. Joint tenderness
  4. Joint effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What spine segment is OA rarely seen in?

A

Thoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Name three joints in the hand affected by OA?

A

DIP, PIP and 1st CMC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In OA of the hands - where might bony enlargements be seen?

A

DIPs (Heverdens nodes)

PIPs (Bouchards nodes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Give 2 features of OA in the knee?

A

Genu varus and valgus deformities

Bakers cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Give three features of the hip in OA?

A
  1. pain may be felt in groin or radiating to knee
  2. pain felt in hip may be radiating from the lower back
  3. hip movements restricted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

In OA of the spine - what might osteophytes impinge on and what might happen in the lumbar section?

A

Nerve roots

Can cause spinal stenosis if encroach on spinal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What three pharmacological measures are done for OA?

A
  1. Analgesia
  2. NSAIDS
  3. Pain modulators - tricyclics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Name two intra-articular mananagements for OA?

A

Steroids and hyaluronic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the most effective treatment for OA?

A

Joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is inflammation in the joint triggered by uric acid crystals?

A

Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Is gout more common in males or females?

A

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What stage in life is gout common to occur in?

A

After menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

At what level of uric acid does it become insoluble?

A

> 0.42 mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What do inherited enzyme defects, myeloproliferative disorders, psoriasis, haemolytic disorders, alcohol and high dietary purine intake (red meat, seafood, corn)?

A

Increased urate production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What does chronic renal impairment, volume depletion (heart failure), hypothyroidism, diuretics and cytotoxics (cyclosporin)?

A

Reduced urate excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What three joints does acute gout present in?

A

1st MTP > ankle > knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Does gout settle without treatment?

A

10 days without treatment

3 days with treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What condition is chronic joint inflammation, often diuretic associated and involves high serum uric acid?

A

Chronic tophaceous gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is tophi - found in chronic tophaceous gout?

A

Swelling in fingers and toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What two things are raised in chronic tophaceous gout?

A
  1. Serum uric acid raised - may be normal during acute attack
  2. Raised inflammatory markers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the key investigation for chronic tophaceous gout?

A

Polarised microscopy of synovial fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What does chronic tophaceous gout look like on an x-ray?

A

Dense shadow streching from base of DIP to middle of pharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the three treatments for acute gout?

A
  1. NSAIDs
  2. Colchicine
  3. Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What two drugs are used for the prophylaxis of gout?

A

Allopurinol

Febuxostat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When should you start prophylaxis treatment for gout?

A

2-4 weeks after acute attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What condition is commoner in the elderly, chondrocalcinosis increases with age, is related to osteoarthritis and affects fibrocartilage - knees, wrists and ankles?

A

Calcium pyrophosphate deposition disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is another name for calcium pyrophosphate deposition disease?

A

Pseudo-gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are acute attacks of pseudo-gout due to?

A

Calcium pyrophosphate crystals

62
Q

What is the difference between uric acid crystals and pseudogout crystals?

A

Pseudogout - envelope shaped

Uric acid - long, sharp, needle like

63
Q

What are four treatments of psuedogout?

A
  1. NSAIDS
  2. Colchicine
  3. Steroids
  4. Rehydration
64
Q

What condition is Milwaukee shoulder associated with?

A

Hydroxyapatite

65
Q

In hydroxyapatite what is released?

A

Collagenases, serine proteinases and IL-1

66
Q

What are four treatments for hydroxyapatite?

A

NSAIDs
Intra-articular steroid injection
Physioltherapy
Partial or total arthroplasty

67
Q

What is the general term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than either the bone or cartilage?

A

Soft tissue rheumatism

68
Q

What is the term for more generalised soft tissue pain?

A

Fibromyalgia

69
Q

Where is the commonest area for soft tissue pain?

A

Shoulder

70
Q

Where does cubital tunnel syndrome occur?

A

In elbow

71
Q

Where does de-quervains tenosynovitis occur?

A

Wrist

72
Q

Name two joint hypermobility syndromes?

A

Marfan’s

Ehlers Danlos

73
Q

What is the modified beighton score used for?

A

hyperextension and flexion

74
Q

What type of cause of muscle disease are polymyositis, dermatomyositis, inclusion body myositis, polymyalgia rheumatica?

A

Inflammatory

75
Q

What type of cause of muscle disease are hypo/hyperperthyroidism, cushings, hyperparathyroidism and diabetes mellitus?

A

Endocrine

76
Q

What type of cause of muscle disease are hypokalaemia, hypocalcaemia and hyponatraemia?

A

Electrolyte disorders

77
Q

Name a non-inflammatory cause of muscle disease?

A

Fibromyalgia

78
Q

Name two idiopathic inflammatory myopathies?

A

Polymyositis and dermatomyositis

79
Q

Are Polymyositis and dermatomyositis more common in females or males and what age group?

A

Females

40 - 50 years

80
Q

What is the most common presenting feature of polymyositis and dermatomyositis?

A

Muscle weakness - insidious onset, worsening over months, usually symmetrical and proximal muscles

81
Q

Name a cutaneous disease that has Gottrons sign, shawl sign and heliotrope rash?

A

Dermatomyositis

82
Q

Name a lung disease, oesophageal problem, cardiac disease associated with dermatomyositis?

A

Interstitial lung disease
Dysphagia
Myocarditis

83
Q

What is there a 15% incidence of in dermatomyositis?

A

Malignancy - risk greatest in men over 45 (ovarian, breast, stomach, lung etc)

84
Q

What two drugs can influence dermatomyositis?

A

Steroids and statins

85
Q

Is Raynauds indicative of dermatomyosiits?

A

Yes

86
Q

Name two examinations used to help diagnose dermatomyositis?

A

Confrontational testing - power

Isotonic testing - 30 second sit to stand test

87
Q

What investigation is mainly used for diagnosis of dermatomyositis?

A

Blood tests

88
Q

What four things are looked for in blood tests for dermatomyositis?

A

Muscle enzymes - CK
Inflammatory markers
Electrolytes, calcium, PTH, TSH
Autoantibodies

89
Q

What two autoantibodies are looked for in dermatomyositis?

A

ANA, Anti-Jo-1

90
Q

What other test (involves a probe) can be used to help diagnose dermatomyositis?

A

Electromyography - increased fibrillations, abnormal motor potentials, complex repetitive discharges

91
Q

In diagnosing dermatomyositis - what test is definitive and shows perivascular inflammation and muscle necrosis?

A

Muscle biopsy

92
Q

What investigation for dermatomyositis shows muscle inflammation, oedema, fibrosis and calcification?

A

MRI

93
Q

Give 5 treatments for dermatomyositis?

A
  1. Glucocorticoids
  2. Azathioprine
  3. Methotrexate
  4. Ciclosporin
  5. IV immunoglobulin
94
Q

What can be misdiagnosed in patients over 50 as polymyositis, is commoner in men and involves distal muscle weakness?

A

Inclusion body myositis

95
Q

Give two points on weakness in inclusion body myositis?

A
  1. Weakness wrist and finger flexors, quadriceps and anterior tibial muscles in legs
  2. Often asymmetrical weakness
96
Q

Are CK levels higher in polymyositis or inclusion body myositis?

A

Higher in PM

97
Q

What does a muscle biopsy for inclusion body myositis show?

A

Inclusion bodies and rimmed vacuoles

98
Q

What skin findigns are found in polymyositis?

A

None

99
Q

What is the difference between classic muscle biopsy findings in poly and dermatomyositis?

A

Poly - CD8 T cells

Derm - CD4 T cells

100
Q

What muscle disease occurs almost exclusively in >50s and is associated with temporal arteritis/giant cell arteritis?

A

Polymyalgia Rheumatica

101
Q

What is normal in polymyalgia rheumatica?

A

Muscle strength

102
Q

Where is ache felt in polymyalgia rheumatica?

A

In shoulder and hip girdle

103
Q

Give 5 clinical manifestations of temporal arteritis and giant cell arteritis?

A
  1. Headache
  2. Scalp tenderness
  3. Jaw claudication
  4. Visual loss
  5. Tende, enlarged, non-pulsatile temporal arteries
104
Q

What two conditions invole granulomatous arteritis of large vessels?

A

Temporal arteritis and giant cell arteritis

105
Q

What is raised in polymyalgia rheumatica?

A

Raised ESR, plasma viscosity and CRP

106
Q

How is polymyalgia rheumatica diagnosed?

A

Exclusion of other diagnoses

107
Q

How is polymyalgia rheumatica treated?

A

With low dose steroids - higher dose if temporal arteritis

108
Q

What is a common cause (more common in women) of chronic musculoskeletal pain and is not associated with inflammation?

A

Fibromyalgia

109
Q

What might fibromyalgia begin after?

A

Emotional or physical trauma

110
Q

What do fibromyalgia symptoms worsen on?

A

Exertion, fatigue and stress

111
Q

What are some clinical manifestations of fibromyalgia?

A

Pins and needles, headaches, depression, abdo pain (IBS), poor concentration anad memory

112
Q

Give two clinical findings of fibromyalgia?

A
  1. Excessive tenderness on palpitation of soft tissues

2. 11/18 tender points

113
Q

What is the definition of spondyloarthropathy?

A

Family of inflammatory arthritides characterised by involvement of both the spine and joints, principally in genetically predisposed (HLA B27) individuals.

114
Q

What are the four subgroups of spondyloarthropathy?

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Reactive arthritis (Reiter’s)
  4. Enteropathic arthritis
115
Q

What is the difference between mechanical and inflammatory back pain?

A

Mechanical - worse on activity, worse at end of day, better with rest
Inflammatory - worse with rest, better on activity, early morning stiffness

116
Q

What is dactylitis? - it is shared by all spondyloarthropathies

A

Inflammation of entire digit

117
Q

Other than dactylitis - what three other features are shared by the spondyloarthropathies?

A

Sacroiliac and spinal involvement
Enthesitis
Inflammatory arthritis

118
Q

What is enthesitis?

A

Inflammation at insertion of tendons into bones - achilles tendinitis, plantar fasciitis

119
Q

Give four shared extra-articular features of spondyloarthropathies?

A
  1. Ocular inflammation (anterior uveitis, conjuntivitis)
  2. Mucocutaneous lesions
  3. Rare aortic incompetence or heart block
  4. No rheumatoid nodules
120
Q

What is the definition of ankylising spondilitis?

A

Chronic systemic inflammatory disorder that primarily affects the spine.

121
Q

What is the hallmark of ankyolising spondilitis?

A

Sacroiliac joint involvement (sacroiliitis)

122
Q

What disorder invilves peripheral arthritis (uncommon), enthesopathy, is more common in men and occurs in late adolescence or early adulthood?

A

Ankylosing spondilytis

123
Q

What is the 5 criteria for diagnosis of ankylosing spondylitis?

A
  1. Limited lumbar motion
  2. Lower back pain for 3 months - improved with movement
  3. Reduced chest expansion
  4. Bilateral sacroiliitis
  5. Unilateral sacroillitis
124
Q

Is amyloidosis a clinical feature of ankylosing spondylitis?

A

Yes

125
Q

Ankylosing spondylitis is the ‘A’ disease - give the 7 relations.

A 
Axial arthritis
Anterior uveitis
Aortic regurgitation
Apical fibrosis
Amyloidosis
Achilles tendinitis
plAntar fasciitis
126
Q

Give three examinations for ankylosing spondylitis?

A
  1. Tragus/occiput to wall
  2. Chest expansion
  3. Modified Schober test
127
Q

What bloods are checked in ankylosing spondylitis?

A

ESR, CRP, PV

HLA B27

128
Q

What three things are looked for on an x-ray of ankylosing spondylitis?

A

Sacroiliitis
Syndesmophytes
Bamboo spine

129
Q

What four drug treatments are used for treating AS?

A
  1. NSAID
  2. Disease modifying drugs
  3. Anti TNF
  4. Corticosteroids
130
Q

What drug is used in severe AS (BASDAI>4)?

A

Etanercept

131
Q

Give the definition for psoriatic arthritis?

A

Inflammatory arthritis associated with psoriasis, but 10-15% can have PsA without it

132
Q

Is psoriatic arthritis RF negative? and does it have rhematoid nodules?

A

It is negative

No nodules

133
Q

In Psoriatic arthritis - what happens to nails?

A

Pitting

Onycholysis

134
Q

Give four x-ray features of psoriatic arthritis.

A
  1. Marginal erosions and whiskering
  2. Pencil in cup deformity
  3. Osteolysis
  4. Enthesitis
135
Q

Give four treatment options for psoriatic arthritis.

A
  1. NSAIDS
  2. Corticosteroids
  3. Disease modifying drugs
  4. Anti-TNF
136
Q

What is an infection induced systemic illness characterised primarily by an inflammatory synovitis from which viable micro-organisms cannot be cultured?

A

Reactive arthritis (Reiter’s)

137
Q

In reactive arthritis - when do the symptoms occur?

A

1-4 weeks after infection

138
Q

Name four most common infections in reactive arthritis?

A

Urogenital - chalmydia

Enterogenic - salmonella, shigella, yersinia

139
Q

What is the triad for Reiter’s syndrome?

A

Urethritis
Conjuctivitis/uveitis/iritis
Arthritis

140
Q

In reactive arthritis is it symmetrical or asymmetrical monoarthritis?

A

Asymmetrical

141
Q

Name four musculocutaneous lesions in reactive arthritis?

A
  1. Keratodema
  2. Circinate balanitis
  3. Painless oral ulcers
  4. Hyperkeratotic nails
142
Q

Name two ocular clinical features of reactive arthritis?

A
  1. Conjuntivitis

2. Iritis

143
Q

Name two visceral manifestations of reactive arthritis?

A
  1. Mild renal disease

2. Carditis

144
Q

In reactive arthritis - how is it diagnosed?

A 
Inflammatory parameters (ESR, CRP, PV)
Cultures - blood, urine, stool
Joint fluid analysis
145
Q

In what time frame can reactive arthritis spontaneously resolve?

A

6 MONTHS

146
Q

Name the main treatment for reactive arthritis?

A

NSAIDS

147
Q

What type of arthritis is associated with IBD?

A

Enteropathic arthritis

148
Q

What will 20% of patients with Crohns have in relation to enteropathic arthritis?

A

Sacroiliitis

149
Q

Give 5 ways to investigate enteropathic arthritis?

A
  1. GI endoscopy with biopsy
  2. Joint aspirate
  3. Raised CRP, PV
  4. X-rray showing sacroiliitis
  5. USS showing synovitis
150
Q

What should not be used to treat enteropathic arthritis?

A

NSAIDS

151
Q

Give three pharmacological treatments for enteropathic arthritis?

A
  1. Steroids
  2. DMRDS
  3. Anti-TNF

JL Musculoskeletal (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions