kumar and clark Flashcards
articular cartilage is mainly composed of what type of cartilage
type 2
is synovial vascular
yes
neutrophilic occurs in bacterial infection but can also occur in
steriod treatment
how to detect rheumatoid factor
ELISA
Rf and ant Cp in RA is associated with what
worse prognosis
what is used as a screening test for SLE and systemic sclerosis
ANA
good thing about anti -dsDNA
used to monitor disease activity as rise and fall with disease activity
anti ro and la
Sjogrens and SLE
anti sm
SLE
anti RNA polymerase 1 and 3
systemic sclerosis
ANCAs are what antibody
IgG
normal synovial fluid is
clear and straw coloured
normal synovial fluid contains less than
3000 WBC
after joint aspirate if septic arthritis is suspected
gram stain to identify organism
good scan for inflammatory arthritis
us
what scan measures bone density and is used in monitoring of osteroporosvsis
DXA scan - dual energy x ray absorptiometry
what scan to detect large vessel vasculitis eg takaysu
PET - position emission tomography
shoulder abduction nerve root
c5
elbo flexion and extension
c5 and c6
what is rotator cuff tendonitis
pain that is worse at night and radiates to the upper arm
is the shoulder a shallow or deep joint
shallow
without impingement what glides under what
greater tuberosity slides under the acromion
rotator cuff tendonosis pain is worse when
during the middle of the range of abduction, reducing as the arm is fully raised called painful arc
passive elevation is less painful in what
rotator cuff tendonosus
what increase the risk of impingement
acromioclavicualr osteophytes
x ray is often normal in
rotator cuff tendonosis
what can distinguish, tendonitis, tears, bursitis
US
patients getting a steroid injection into the subacromial bursa should be warned that what
pain may be worse 24-48hrs after injection
shoulder feels hot and swollen and x ray shows a
diffuse opacity in the bursa in calcific tendonosis and bursitis
shoulder feels hot and swollen and x ray shows a
diffuse opacity in the bursa in calcific tendonosis and bursitis
frozen shoulder what stages are painful
initial stages but when shoulder is frozen with little pain that is not painful
pain gripping or holding a bag
tennis elbow
pain carrying a tray
golfer elbow
trigger finger is more common in
diabetics
trigger finger is more common in
diabetics
swelling under extensor reinaculum
dorsal tenosynovitis - RA
de quervains tenosynovitis has pain where
radial styloid- where abductor policies Longus tendon
splint in carpal tunnel holds the wrist in
dorsiflexion
in what 2 arthritis can a finger be swollen (dacylitis) or DIP joints affected asymmetrically
reactive or psoriatic
are scaphoid fractures seen immediately on X-ray
no
what is a ganglion because of
partial tear of the joint capsule or tendon sheath
what is first line before surgery in dupuytrens contracture
percutaenous collaganase injection
what differentiates mechanical back pain from poly myalgia rheumatica
normal CRP/ESR
most common sites for lumbar spondylosis
L4/5 L5/S1
weakest point in disc prolapse
posterolateral
below what level would cause low motor neuron disease
L2/3
straight leg raise producing radiating pain in
lower lumbar disc prolapse
hip flexion
L1/L2
plantar flexion of foot
S1/S2
spinal and root Canal stenosis characterised by
pain brought on by walking and relived by rest
what differentiates spinal stenosis from peripheral peripheral arterial caluudication
presence of pulses
a manoeuvres that helps in spinal stenosis
bending forward as opens up spinal canal
vertebrae slips
spondylolithesis- occurs in young adults
osteoporotic fractures of the spine may present as
angonizing localised pain that radiated round the abdomen and ribs
what is spared in osteoporotic vertebrae fractures
end plates and pedicels
what indicates a vertebrae fracture is recent
bone oedema
sudden onset pain in OA
effusion - treat with steriod injection
trochanteric bursitis pain is worse
going up stairs, crossing the legs
what presents similar to trochanteric bursitis but does not respond to steriod injection
gluteus medius tear
AVN occurs when
at any age
area of increased bone density at upper pole of femoral head
AVN
AVN on xray
early stage is normal but scintigraphy or MRI shows bone marrow oedema
what rarely presents with hip pain but only in severe disease
hip
slightly cloudy or blood stained fluid is likely to be
pseudo gout
meniscus are what cartilage
fibrocartilage
immediate treatment to meniscal tear
ice
what accounts for 70% of knee haemarthrosis in young people
cruciate ligaments toren
a torn ace allows what to be pulled forward
tibia
retropatellar cartilage is fibrillated
chondromalacia patallae
osteochondritis is fragment from where
medial femoral condyle
osteochonditic dissecans presents as
aching pain after activity and if fragment becomes loose then giving way occurs
what must be avoided if there is osteonecrosis of the knee
weight bearing
anserien bursitis
breast stroke swimmers
stood-schlatter particularly occurs in
teenage spots players
tenderness of upper calf of sudden onset and history of knee problems
ruptured cyst
severs disease affects
achilles tendon
painful tender swelling above achilles insertion
achilles tendonosisi
what can be injected with steriod injection at achilles
bursitis
after the hands, what joints are most commonly affected by RA
foot
flate feet puts the hind foot into what position
everted
high arched feet put pressure where
lateral border and ball of foot
common complication of ra
hallux valgus
metatarsalgia common in women who
wear high heels- ball of the foot in painful to walk on
Mortons neuroma typically occurs between the
3 and 4 metatarsal heads
Mortons neuroma typically occurs between the
3 and 4 metatarsal heads
nerve below medial malleolus
posterior tibial
difference in biochem between primary and secondary hyperparathyroidism
primary - ca is normal or high
secondary - ca is low
ALP AND PTH are both high
what is the only thing that is low in malignancy
PTH
ca is whatever but phsopahe and Alp are high in
CKD
what is the confirmatory test for osteomalacia
low vitamin D
primary hyperparathyroidism do what scan
sestamabi
main site for bone turnover
cancellous boen
what is the bone found I first few years of life, site of fracture repair and in pagets
woven boen
what forms hydroxyapatite
calciuma dn phospahet
stimulator of osteoclasts
RANKL-receptro activator of nuclear factor kappa b ligand
osteoblasts are derived from
mesenchymal cells
what are secreted when osteoclasts are working
hydrogen ions
growth occurs at what growth plate
epipihyseal
primary source of vitamin D in humans in skin is
7- dehydrocholesterol to cholecalciferol
kidneys convert cholecalciferol to 25 hydroxyvitamin D
kidneys convert 25 hydrovitamin D to 1,25 dihydroxyvitamin d which is
D3
regulation of what step is by PTH, phosphate and feedback inhibition by 1,25 dihydroxyvitamin D3
the one in the kidney - 25 to 1,25
parathyroid hormone is secreted from what cells
chief
what is the rate limiting step in PTH
1 alpha hydroxylation of vitamin D
does excess or defined calcitonin have much effect
no
what is 1,25 dihydroxycholecaliferol called
calcitriol
