Diseases of MSK 1

Question 1

The group of diseases causing pain, stiffness and inflammation of the MSK system

Answer 1

Arthritides

Question 2

2 different types of arthritides

Answer 2

Acute and Chronic

Question 3

2 different types of chronic arthritis

Answer 3

Osteoarthritis

Rheumatoid arthritis

Question 4

Commoneste type of joint disease aka degenerative joint disease, Progressive erosion of articular cartilage.

Answer 4

Osteoarthritis

Question 5

What forms at the margins of joints in osteoarthritis

Answer 5

Bony spurs and cysts

Question 6

Underlying systemic diseases in OA

Answer 6

Diabetes

Obesity

Question 7

Which joints are affected by OA in men and women?

Answer 7

Men-hip

Women- knees and hands

Question 8

Pathogenesis of OA

Answer 8

Deterioration or loss of cartilage
Bone forms spurs and cysts
Results in pain and limitaiton of movements

Question 9

Cells which form the cartilage around bone

Answer 9

Chondrocytes

Question 10

How do chondrocytes contribute to OA

Answer 10

-Produce interleukin 1- initiates matrix breakdown. -Prostaglandin derivative induces the release of lytic enzymess- prevents matrix synthesis

Question 11

Abnormal stresses in weight bearing joints

Answer 11

Primary OA

Question 12

What joints are commonly affected in OA

Answer 12

Fingers, knees and cervical and lumbar spines

Question 13

What forms in the fingers in primary OA

Answer 13

Herbeden’s or Bouchard’s nodes

Question 14

Chronic systemic disorder-principally affecting the joints

Answer 14

Rheumatoid arthritis

Question 15

Pathogenesis of RB

Answer 15

Production of a non suppurative proliferative synovitis-destruction of articular cartilage and ankylosis of joints

Question 16

Who is more at risk of RA- emn or women?

Answer 16

Women

Question 17

What happens to the synovium in RB

Answer 17

Polypoid fibrovascular thickening of the synovium, forms a pannus that invades into the articular cartilage- penetrates subchondral bone and cyst formation

Question 18

Clinical features of RB

Answer 18

Malaise, fatigue and generalised MSK pain
Joints are swollen, warm, painful and stiff in the morning or after activity
Small joints of the hands and feet are frequently affected

Question 19

Mutations in which genes predispose you to RA

Answer 19

HLA
DR4
DR1

Question 20

Name 2 primary exogenous arthritogens

Answer 20

EBV

Borrelia

Question 21

Describe the pathogenesis of RA

Answer 21

Autoimmune reaction within the synovial membranes- CD4 positive T cells.
Release of cytokines- IL1,6, TNF alpha and beta

Question 22

Criteria for diagnosis

Answer 22

Morning stiffness
Arthritis in 3 or more joint areas
Arthritis of hand joints
Symmetric arthritis
Rheumatoid nodules
Serum Rheumatoid factor
Typical radiographic changes-narrowing of joint space, loss of articular cartilage

Question 23

What 2 main things are required for the diagnosis of RB

Answer 23

Rheumatoid factor- present in most

Analysis of synovial fluid- presence of neutrophils

Question 24

RA- other systems involvement

Answer 24

Skin- rheumatoid nodules

Lung, spleen, heart and other viscera

Question 25

What do you call arthitis which lacks rheumatoid factor

Answer 25

Sero-negative arthritides

Question 26

4 sero negative arthritides

Answer 26

Ankylosing spondylitis Reiter's syndrome Psoriatic arthritis Enteropathic arthritis

Question 27

End point of a group of disorders producing hyperuricaemia- uric acid is the end product of purine metabolism

Answer 27

Gout

Question 28

4 clinical features of gout

Answer 28

Acute arthritis Chronic arthritis Tophi in various sites Gouty nephropathy

Question 29

Pathogenesis of gout

Answer 29

Transient attacks of acute arthritis- crystallization of urates within and about joints, leading to chronic gouty arthritis and deposition of masses of urates in joints and other sites - tophi

Question 30

deposition of masses of urates in joints and other sites

Answer 30

Tophi

Question 31

Sytemic illness and marked pain over the affected region is typical of what condition?

Answer 31

Pyogenic (bacterial) osteomyelitis

Question 32

What shows up on the X-ray for pyogenic osteomyelitis

Answer 32

Lytic focus of bone destruction surrounded by zone of sclerosis

Question 33

3 mechanisms of cause of pyogenic osteomyelitis

Answer 33

Haematogenous Contiguous Direct implantation

Question 34

Acutely painful and swollen joints with restricted movements, with fever, leucocytosis and elevated ESR

Answer 34

Infective arthritis

Question 35

Common bacterial causes of infective arthritis

Answer 35

Staph, strep, gonococcus, mycobacteria

Question 36

Predisposing conditions for infective arthritis

Answer 36

Trauma IVDU debilitating illness

Question 37

What are the d2 types of osteoporosis

Answer 37

Primary or secondary

Question 38

Primary osteoporosis risk factors

Answer 38

Age and postmenopausal

Question 39

Increased porosity of the skeleton, reduction in bone mass, localised or entire skeleton

Answer 39

Osteoporosis

Question 40

3 clinical features of osteoporosis

Answer 40

Vertebral fractures Kyphosis Scoliosis

Question 41

3 causes of secondary osteoporosis

Answer 41

Endocrine disorders neoplasm e.g. multiple myeloma Malnutrition

Question 42

2 examples of ednocrine disorders that predispose you to secondary osteoporosis

Answer 42

Hyperparathyroidism, Type 1 diabetes

Question 43

Paget's disease

Answer 43

Osteoclast dysfunction- matrix madness. Histological hallmark-mosaic pattern

Question 44

Cause of paget's disease

Answer 44

Paramyxovirus

Question 45

Pathogeneisis of osteoclast dysfunction e.g. paget's disease

Answer 45

Pred. osteoblastic activity- gain in bone mass. Newly formed bone is disordered and architecturally unsound

Question 46

Who is most at risk of Paget's disease

Answer 46

5th decade, males

Question 47

What bones are most commonly affected by paget's disease

Answer 47

Axial skeleton and proximal skeleton

Question 48

Most common symptom of pagets

Answer 48

Pain

Question 49

What type of fractures do you get in Paget's disease?

Answer 49

Chalk stick type fractures

Question 50

3 causes of paget's disease

Answer 50

Giant cell tumour- benign | Malignant-osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma

Question 51

Defects in matrix mineralisation, related to lack of vit. D.

Answer 51

Ostomalacia

Question 52

Decreased bone density

Answer 52

Osteopenia

Question 53

Are skeletal deformities seen in osteomalacia?

Answer 53

No

Question 54

Excessive secretion of parathyroid hormone

Answer 54

Hyperparathyroidism