GEP (Life Structure) Week 4

Question 1

Bone Overview of the hand and wrist

Answer 1

Question 2

Bones of the Carpel

Answer 2

Question 2

What are the 4 main muslce of the Hand

Answer 2

4 main muscle groups:
Thenar muscles
Hypothenar muscles
Interossei
Lumbricals

Question 3

Overview of the Thenar Muscles

Answer 3

Question 4

Muscles of the hypothenar

Answer 4

Question 5

What are the muscles of the lumbiricals and interossie

Answer 5

Question 6

Ligaments of the wrist

Answer 6

Question 7

The movement of the wrists

Answer 7

Question 8

What is the proximal radio-ulna joint

Answer 8

Question 9

What is the distal radio-ulna joint

Answer 9

Question 10

Muscles of the anterior forearm

Answer 10

Question 11

Muscles of the posterior Forearm

Answer 11

Question 12

What is the sensory innervation of the hand

Answer 12

Question 13

What are the brachial plexus palsies

Answer 13

Question 14

Summary of anterior compartment of forearm

Answer 14

Question 15

Summary of the posterior compartment of the forearm

Answer 15

Question 16

Summary of the muslces of the hand

Answer 16

Question 17

Overview of Rhuematoid artheritis

Answer 17

Rheumatoid arthritis is an autoimmune inflammatory form of arthritis.
Immune complexes form in the joints, which leads to triggering of the immune response through complement activation or direct activation of immune cells leading to secretion of chemokines and cytokines.
This leads to inflammation of the synovium and synovial membranes.
Primarily affects small joints of hands and feet.

Risk factors:
Family history -> 2-4x increased risk (HLA)
Smoking
Female -> as for all autoimmune disease

Question 18

Presentation of RA

Answer 18

Symmetrical arthritis lasting >6 weeks
Female
Age 50-55
Joint pain and swelling
Morning stiffness lasting >1 hour
Systemic symptoms (fatigue, muscle aches, weight loss, flu like symptoms)
Spares DIPs

Joint deformities
Swan neck
Boutonniere’s
Ulnar deviation
Rheumatoid nodules

Severe disease
Vasculitic lesions (rashes)
Pleuritic chest pain (pleuritis or pericarditis)
Scleritis
Uveitis

Question 19

What is the pathophysiology of RA

Answer 19

Question 20

Investigations of RA

Answer 20

Question 21

What is DAS 28

Answer 21

The DAS28 is a measure of disease activity in rheumatoid arthritis (RA). DAS stands for ‘disease activity score’, and the number 28 refers to the 28 joints that are examined in this assessment.

Number of swollen joints -> out of 28
Number of tender joints -> out of 28
Measure ESR or CRP
Ask patient to make global assessment of health

Question 22

Management of RA

Answer 22

Question 23

Biologics as treatment

Answer 23

Biological drugs, commonly referred to as biologics, are a class of drugs that are produced using a living system, such as a microorganism, plant cell, or animal cell

Used in moderate-to-severe and refractory disease
Target points in the inflammatory system

Question 24

Overview of Psoriatic Artheritis

Answer 24

Inflammatory arthritis associated with psoriasis. Occurs in about 20% of those with psoriasis. Shares many clinical features with spondyloarthropathies and rheumatoid arthritis. Usually seronegative, but can can be positive for anti-CCP and RF. Clinical manifestations are varied. Management is similar to RA Risk factors Psoriasis Family history of psoriasis or psoriatic arthritis History of tendon or joint trauma Infection Smoking

Question 25

Presentation of Psoriatic artheritis

Answer 25

Joint pain and stiffness Prolonged morning stiffness >30 mins Peripheral arthritis Early PsA may just involve a few lower extremity joints e.g. knees Dactylitis History of scalp or nail problems (in patients without known diagnosis of psoriasis) Enthesitis Spinal stiffness Reduction of cervical spine mobility Uveitis Inflammatory bowel disease

Question 26

Investigations of psoriatic artheritis

Answer 26

Question 27

Inflammatory compared to non-inflammatory

Answer 27

Question 28

Inflammatory and Non-inflammatory of the hand

Answer 28

Question 29

Overview of Gout

Answer 29

Question 30

Overview of septic artheritis

Answer 30

Question 31

Overview of reactive artherisit

Answer 31

Question 32

Overview of carpel tunnel syndrome

Answer 32

Question 33

MICRA DMARDs

Answer 33

Disease-modifying antirheumatic drugs (DMARDs) are a class of drugs indicated for the treatment of inflammatory arthritides, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS

Question 34

What are the key side effects of DMARDs

Answer 34