Loco rheumatology Flashcards
(102 cards)
1
Q
Cause of excessive thoracic kyphosis
A
Fracture of anterior part of vertebrae
Treatment = kyphoplasty
2
Q
Sheuermann’s disease
A
Adolescent kyphosis
Thoracic bones grow more posteriorly due to growth plate damage
Xray = Schmori’s nodes
3
Q
Muscles imbalances in lumbar lordosis
A
Weak lower abdominals, gluteals and hamstrings
Tight psoas major and quadriceps
–> anterior pelvic tilt
4
Q
Flat back syndrome
A
Tight hamstrings and paraspinals
5
Q
Where is disc herniation most common?
A
L4/L5 and L5/S1 as largest vertebrae
6
Q
Symptoms of cauda equina syndrome
A
Lower back pain Sciatica Saddle anaesthseia Bladder and bowel weakness Sexual dysfunction Lower limb weakness Reduced reflexes
7
Q
Treatment of cauda equina syndrome
A
Laminectomy
Discectomy
8
Q
Which area if most commonly affected by burst fracture?
A
Thoracolumbar junction
9
Q
What gives bamboo spine appearance
A
AK
10
Q
Peak age of onset of AK
A
20s
11
Q
Which gender is affected more by AK?
A
Males
12
Q
What HLA molecule is associated with AK?
A
HLA B27
13
Q
Mechanisms of septic arthritis
A
Haematogenous spread
Disseminated osteomyelitis
Spread from adjacent soft tissues
Penetrating trauma
14
Q
Septic arthritis pathogens
A
Most common = S. aureus
Common in middle age = gonococcus
Common in infants = staph, strep and haemophilus
15
Q
Reactive arthritis pathogens
A
Chlamydia
Campylobacter
Salmonella
16
Q
Reactive arthritis genetics
A
HLA B27
17
Q
Mechanisms of osteomyelitis
A
Haematogenous spread
Spread from adjacent soft tissues
Direct trauma
18
Q
Special antibiotic forms for OM
A
Vancomycin cement beads
Clindamycin foam
19
Q
Complications of OM
A
Squamous cell carcinoma
Amyloidosis
20
Q
Common sites of tendonitis
A
Lateral epicondyle
Achilles tendon
Supraspinatous
21
Q
How can inflammation lead to ossification
A
PGE2 and COX-2 though to favour chondrocyte differentiation which can lead to ossification
22
Q
How do tendons heal?
A
Within sheath = intrinsic from own fibroblasts
Outside sheath = from external fibroblasts
23
Q
Types of enthesis
A
Fibrous
- for long tendons
- weaker
- Sharpey’s fibres
Fibrocartilagenous
- for short tendons that are at strong angles
- stronger
24
Q
AS treatment
A
Sulfasalazine
Methotrexate
Anti-TNF therapies
25
De Quervain's tenosynovitis
Fibrosis and narrowing of tendon sheath surrounding extensor policis bravis and abductor pollicis
Due to rubbing over radial styloid process
26
Trigger finger
Nodule forms on finger flexor tendon and makes extension hard
27
Antibodies present in SLE
ANA
28
Presentation of SLE
Butterfly rash
Arthralgia of small joints of hands
Photosensitivity
Renal disease
29
Treatment for SLE
```
NSAIDs
Cyclophosphamide
Biologicals against B and T cells
Steroids
IV immunoglobulins
```
30
Gout pathophysiology
Purines --> uric acid
Uric acid normally insoluble or coated in apo E and B so inert
If levels rise too much --> crystals form and trigger immune reaction
Phagocytes engulf crystals --> lysis
Release of enzymes and acid content
31
Gout causes
```
Overproduction
- excessive meat, beer, red wine, shellfish intake
- tumour lysis syndrome
- Lesch-Nyhan syndrome
Under-excretion
- diuretics
- renal insufficiency
- dehydration
```
32
Common locations for tophi
```
Ear cartilage
Toes and fingers
Olecranon bursa
Achilles tendon
Kidney
```
33
Histology of tophi
Fibrous tissue
Ring of foreign body giant macrophages
Ring of lymphocytes
34
Normal uric acid level
<6.8mg/dL
35
Crystals in gout
Monosodium urate
Needle shaped
Strong negative birefringence
36
X-ray in gout
Rat bite erosions
| Soft tissue swelling
37
Gout treatment for acute attacks
Analgesics
Calchicine = anti-mitotic to prevent neutrophil proliferation
Corticosteroids
Anti-IL-1 biologicals = anakinra, rilonacept, canakinumab
38
Chronic gout treatment
Xanthine oxidase inhibitors = allopurinol, oxypurinol, febuxostat
Probenecid = increases uric acid secretion (urisuric)
Rasburicase = uric acid --> allantoin (inert)
Other urosurics = vitamin C, losartan
39
Crystals in pseudogout
Calcium pyrophosphate
Rhomboid shaped
Weak positive birefringence
40
X-ray of pseudogout
Calcification of soft tissues
| Especially menisci of the knees and wrists
41
Nodes in OA
```
DIP = Herberden's
PIP = Bouchard's
```
42
Joints affected in nodal generalised OA
```
DIP and PIP
1st CMC
Hallux valgus (1st MTP)
Hallux rigidus (1st MTP)
Knee
```
43
Apatite associated destructive arthritis
Due to hydroxyapatite crystals in joint space
Can cause severe joint erosions
Mainly affects hip and shoulder (Milwaukee shoulder)
44
Erosive OA
Cartilage destruction + synovial inflammation
Affects DIP, PIP and 1st CMC
Gull wings appearance from central erosions
Ankylosis common
45
OA of premature onset causes
Previous meniscectomy
Perthes
Haemochromatosis
46
Rate of bone loss
After 40 = 0.7% per year
| After menopause = 2-9% per year
47
T scores
> -1 = normal
-1 to -2.5 = osteopenia
< -2.5 = osteoporosis
48
Causes of secondary osteoporosis
```
Steroids
Anorexia
Chronic malabsorption diseases
Malignancy
Thyrotoxicosis
Hypogonadism
```
49
Too much Th1
Autoimmunity
50
Too much Th2
Allergy
51
Too much Th17
Chronic inflammation
52
Too much Treg
Cancer
53
Too little Treg
Autoimmunity and inflammation
54
Eye problems in RA
Keratoconjunctivitis sicca = dry eyes
Scleritis
Scleromalacia perforans
55
Complications of RA
```
Carpal tunnel
AAS
Osteoporosis
Pericarditis
Pleuritis
```
56
Signs of scleroderma
Thickened waxy appearance of skin
| Digital ischaemia
57
Signs of dermatomyositis
Purple rash on eyelids, backs of hands, chest, neck, back
| Proximal muscle weakening
58
Signs of reactive arthritis
Conjuntivitis
Skin rash
Sausage toe
Arthritis
59
Paget's disease phases
Increased rate of resorption = large numbers of osteoclasts break down bone
Compensatory phase = osteoblasts produce large amounts of disorganised bone
Sclerotic = left with hyper cellular bone with hyper vascular bone marrow
60
Which bones are affected in Paget's?
Pelvis
Femur
Skull
Vertebrae
61
Complication of Paget's disease?
Osteosarcoma
62
Paget's treatment
Bisphosphonates = slow resorption
Calcitonin = inhibits osteoclasts
Calcium and vitamin D
63
Sclerostin mAb
Romosozumab
64
How many fibres in a motor unit?
5-200
65
Which muscle fibres appear darker with ATPase staining?
Type 2 fast fibres
66
Antibody in dermatomyositis
ANA
| Anti-Jo1
67
EMG in myositis
Low grade irritability
Fibrillations
Early recruitment and low amplitude
68
Biopsy of myositis
```
Variation in fibre size with central nuclei
Necrosis
Inflammatory cell infiltration
- mainly connective tissue
- mainly CD8 T cells
```
69
Polymyositis vs dermatomyositis
```
Polymyositis = endomysium
Dermatomyositis = perimysium
```
70
Treatment for dermatomyositis
Azathioprine
Methotrexate
Rituximab
Infliximab
71
What causes death in dermatomyositis
Malignancy
| Pulmonary fibrosis
72
Inclusion body myositis muscles affected
Quads
Wrist flexors
Oesophagus
73
Biopsy of inclusion body myositis
Fibres contain empty vacuoles
Stain for beta amyloid
Variation in fibre size
Central nuclei
74
Genetics of DMD
X linked recessive
75
Presentation of DMD
Proximal muscle weakness
| Unable to walk by age 7
76
Causes of death in DMD
Respiratory failure due to diaphragm damage
| Dilated cardiomyopathy
77
Biopsy of DMD
```
Fibre size variability
Splitting of muscle fibres
Large fibres with central nuclei
Endomysial fibrosis
Muscle tissue gradually replaced by fibrous and adipose tissue in late stages
```
78
Pathophysiology of DMD
Absence of dystrophin needed to link muscle membrane and sarcomeric proteins
79
What does excessive corticosteroid use do to muscle fibres?
Degeneration of type 2 dark fibres
80
What does excessive statin use do to muscle fibres?
Rhabdomyolysis
| Myoglobin release can cause kidney problems
81
What is elevated in DMD?
Creatine kinase
82
What is raised in myositis?
Creatine kinase
83
What does excessive alcohol intake do to muscle fibres?
Type 2 fibre loss
Acute session = rhabdomyolysis
Chronic = proximal weakness
84
Antibodies in fibromyalgia
Antipolymer
85
Articular cartilage layers
```
Top = tangential
Middle = transitional
Deep = radial
```
86
Gene that increases OA risk
HMGB2
| Usually expressed in superficial zone to protect cells
87
3 macroscopic changes in OA
Fibrillation
Cracking
Eburnation
88
Microscopic changes in OA
```
Chondrocyte necrosis
Isogenic clusters of chondrocytes remaining
Hyaline --> fibrocartilage
Type II --> I collagen
Duplicated tidemark
```
89
Neutraceuticals for OA
Chondroitin sulphate
| Glucosamine
90
Capsaicin
Topical chill for analgesia
91
Microfracture vs chondrocyte graft
Microfracture --> fibrocartilage
| Chondrocyte graft --> hyaline cartilage
92
Where to perform osteotomy for varus deformity
Tibia
93
Types of synoviocytes
```
A = macrophages
B = fibroblasts
```
94
Distance between joint surfaces
50um
95
Volume of synovial fluid in knee
1-2ml
96
String test
Should be 4-6cm
97
Mucin clot test
Add 2-5% acetic acid
| Should form solid clot
98
Finkelstein's test
De Quervains tenosynovitis
99
When to avoid joint injection
Olecranon bursitis --> infection
| Achilles tendon --> rupture
100
When do you inject directly into the enthesis?
Tennis elbow
101
Which movements are limited in frozen shoulder?
External rotation > internal rotation > abduction
102
Tests for impingement
Painful arc = pain most at 90 degrees abduction
| Painful resisted abduction
