LOCOMOTOR Flashcards
(127 cards)
1
Q
what is the prevalence of gout?
a) 1%
b) 5%
c) 20%
d) 50%
A
a) 1%
2
Q
which gender is most commonly affected by gout
A
male
3
Q
what are the name of the deposits in gout and what are they made of?
A
crystalised uric acid (tophi) forming sodium monourate crystals
4
Q
which joint is most commonly affected by gout?
A
first metatarsalphalyngeal joint
5
Q
what is the cause of primary gout?
A
diet - chronic hyperuricaemia
6
Q
give 3 causes secondary gout?
A
alcohol excess renal impairement polycythaemia leukemia cytotoxic drugs Chemotherapy = break down of tumour causes increase in uric acid low dose of aspirin
7
Q
how long do gout attacks normally last?
A
1 week
8
Q
what 2 symptoms often accompany pain in gout?
A
swelling
redness
9
Q
give 5 factors which may precipitate an attack of gout
A
excess alcohol excess food or starvation dehydration starting a diuretic trauma/surgery infection
10
Q
what kind of microbiological analysis might you carry out on a patient with gout?
A
synovial fund microscopy
11
Q
which of these blood markers would NOT be raised in a patient with gout?
a) uric acid
b) creatinine
c) eGFR
d) urea
A
c) eGFR - would be LOWERED
12
Q
why should allopurinol be started with naproxen at the start of gout treatment?
A
may cause an attack at the start
13
Q
give a complication of gout
A
kidney stones
Recurrent and advanced attacks of gout
14
Q
what is the most common joint condition in the UK?
A
osteoarthritis
15
Q
what is the classic phrase to describe the damage which causes osteoarthritis?
A
wear and tear
16
Q
what structures are inflamed in osteoarthritis?
A
whole structure including synovium
17
Q
what familial gene mutation can contribute to the formation of osteoarthritis?
A
collagen type 2
18
Q
which ethnicity is more likely to get hip and knee osteoarthritis?
a) black
b) caucasian
c) asian
d) native american
A
c) asian
19
Q
give 4 risk factors for development of osteoarthritis
A
age occupation previous joint injury obesity family history congenital joint dysplasia osteoporosis
20
Q
at what point in the day is the pain of osteoarthritis worse?
A
end of day
21
Q
where are bouchard’s nodes?
A
PIPJs
22
Q
where are heberden’s nodes?
A
DIPJs
23
Q
does osteoporosis normally affect just one or multiple joints?
A
one
24
Q
give an audible sign present on examination of joints with osteoarthritis
A
crepitus
25
give 2 things that can cause the loss of bone space characteristic of osteoarthritis?
subcondral growths/cysts
osteophytes
infective inflammation
26
give 2 examples of blood markers that could be raised in inflammatory osteoarthritis
ESR
| CRP
27
what type of microbiological investigation might you perform if a patient suspected osteoarthritis?
synovial fluid microscopy
28
give 2 types of drug which might be given for the pain in osteoarthritis
Topical NSAIDs
Topical Capsaicin cream for knee and hip
Corticosteriod injection
29
how common is prolapsed disc in the UK?
a) 1-3%
b) 8-10%
c) 25-30%
d) 40-50%
a) 1-3%
30
what is the pathophysiology of a prolapsed disc?
tear in annulus fibrosis (outer ring) of vertebral disc with herniation of the nucleus polposus
31
What part of the spine is most commonly involved in prolapsed disc?
Lumbar region, larger disc greater inflammation and pressure on surrounding nerves
32
give 3 causes of prolapsed disc
age-related degeneration
abnormal lifting/twisting/straining
trauma
33
give 2 risk factors for prolapsed disc
age
occupation
sedentary lifestyle
34
describe the onset pain of a prolapsed disc
sudden
35
where does the pain of prolapsed disc radiate?
down legs
36
what is the name of prolapsed disc pain if it is pressing on nerves L4-S3?
sciatica
37
which of these is not a symptom of prolapsed disc
a) numbness
b) weakness
c) tingling
d) twitching
e) paralysis
d) twitching
38
what organ can be affected by a prolapsed disc?
bladder (incontinence)
39
give 3 symptoms of cauda equina syndrome
saddle anaesthesia
incontinence
sex dysfunction
40
give 3 imaging techniques you could use to diagnose a prolapsed disc
X-Ray
CT
MRI
41
what physical examination could be used to diagnose sciatica?
raise leg to 90 degrees when lying on back and dorsiflex.
| pain = sciatica
42
what cause of a prolapsed disc is a medical emergency and requires urgent surgery?
cauda equina syndrome
43
what organisms are normally responsible for causing septic arthritis?
bacteria
44
what is the most common bacterial organism to cause septic arthritis?
s. aureus
45
give 3 other bacterial causes of septic arthritis
h influenza
strep
n gonorrhoea
e coli
46
gonorrhoea is most likely to be the cause of septic arthritis in which age group?
young, sexually active
47
which of these group of people are at risk of e coli causing septic arthritis?
Elderly
IVDU
Immunocompromised
48
give 3 non-bacterial causes of septic arthritis
viral
fungal
mycobacteria
49
what type of onset is septic arthritis?
a) rapid
b) crescendo
c) slow
a) rapid
50
give 3 symptoms of septic arthritis
pain
swelling
redness
stiffness
51
when in the day is the joint pain/stiffness worse in septic arthritis?
morning
52
does the pain of septic arthritis last a longer or shorter time than osteoarthritis?
longer
53
give 7 risk factors for the development of septic arthritis
```
Joint trauma
previous joint problems (RA, Gout)
rheumatoid arthritis medication
skin fragility
Immunocompromised
DM
Increase AGE
```
54
What blood markers are indications of septic arthritis?
```
Raised :
WCC
ESR
CRP
Lactate
```
55
why is septic arthritis a medical emergency?
can destroy the whole joint in a matter of days
56
what antibiotic is given IV in bacterial septic arthritis?
flucloxacillin IV for 4-6 weeks
57
when in the day is the pain of rheumatoid arthritis worse?
morning, after rest
58
give 3 symptoms of rheumatoid arthritic joints
```
warm
swollen
painful
stiff
synovitis
```
59
what distinguishes the distribution of osteoarthritis and rheumatoid arthritis?
rheumatoid is bilateral
| affects hands & wrists
60
name 4 deformities associated with rheumatoid arthritis
z-neck deformities
swan neck deformities
boutonniere
ulnar deviation
61
give 2 systemic symptoms of rheumatoid arthritis
fever
| fatigue
62
what can occur to the skin in rheumatoid arthritis?
rheumatoid nodules
63
what kind of disorder is rheumatoid arthritis?
autoimmune
64
which of these is not a stage of rheumatoid arthritis?
a) initiation phase
b) amplification phase (T cells)
c) chronic inflammatory and tissue injury stage
d) necrotic stage
d) necrotic stage
65
what genetic factor is associated with rheumatoid arthritis?
MHC HLA antigen
66
give a lifestyle risk factor for rheumatoid arthritis
smoking
Eating a lot of red meat
Drinking a lot of coffee
67
give two herpes type viruses linked to development of rheumatoid arthritis
herpes 6
| EBV
68
deficiency of what vitamin is linked to development of rheumatoid arthritis?
D
69
what antibody can be tested for in diagnosis of rheumatoid arthritis?
rheumatoid factor antibody
70
what are the 3 types of drugs given to treat rheumatoid arthritis?
analgesia (NSAIDs)
steroids
DMARDs
71
give 2 examples of DMARDs
hydroxychloroquine
| metotrexate
72
what haematological condition can be a complication of rheumatoid arthritis?
anaemia
73
give a respiratory complication of rheumatoid arthritis
lung inlammation and fibrosis= SOB and chest pain
74
give 3 circulatory complications of rheumatoid arthritis
atherosclerosis
pericarditis
vasculitis
Increase risk of CVD
75
give a renal complication of rheumatoid arthritis
renal amyloidosis
76
give an ophthalmic complication of rheumatoid arthritis
Inflammation leading to
Scleritis= eye pain and redness
or
Sjogren's syndrome= dry eyes
77
give a neurological complication of rheumatoid arthritis
peripheral neuropathy
78
give the most common symptom of osteoporosis
bone breakage
79
which group are most likely to experience osteoporosis
a) young men
b) old men
c) young women
d) old women
d) old women
80
what occurs to bone mass and bone loss in osteoporosis?
lower bone mass
| higher bone loss
81
what factor that occurs after menopause can contribute to higher bone loss?
low oestrogen
82
What thyroid abnormality leads to osteoporosis?
Hyperthyroidism
83
give 3 lifestyle risk factors associated with osteoporosis
alcoholism
smoking
lack of exercise
poor childhood diet
84
give 3 drugs that can contribute to development of osteoporosis
```
anti seizure medication
chemotherapy
PPIs
SSRIs
steroids
```
85
what mental illness can contribute to development of osteoporosis?
anorexia
86
what conditions precedes osteoporosis?
osteopenia--> protein and mineral content of the bone is reduced but not as severely
87
what type of medication can be given for osteoporosis?
bisphosphonates
| Vitamin D and calcium supplements
88
which only two bone conditions result in decreased calcium and phosphate?
osteomalacia
| rickets
89
what would alkaline phosphatase show in blood tests for osteoporosis, osteomalacia and rickets?
raised
90
which bone condition is characterised by thick dense bones (marble bones)
osteopetrosis
91
What food specifically increase your risk of gout?
Food that have high levels of purine such as red meat and sea food
92
What is the prophylaxis for gout?
Reduced the amount of purine rich food, reduce alcohol intake, reduce weight, drink more water
Allopurinol
93
What is the alternative treatment if allopurinol is not tolerated?
Febuxostat
94
What is the treatment of acute Gout?
NSAIDS --> naproxen or declofenac
95
what treatment do you give for gout if their is a contradiction in the use of naproxen (peptic ulcer)
Colchine then last choice is corticosteriods
96
In what group of people does primary osteoarthritis occur in?
Over >50 years olds with wear and tear
97
What group of people does secondary osteoarthritis occur in?
Younger people who have had previous bone fractures, injury or deformity
98
What deformities occur to bones and muscles in osteoarthritis around the affected joint?
Muscle wasting, joint effusion and bone instability and enlargement
99
What is the most common surgical treatment for hip and knees osteoarthritis?
Arthroplasty (Surgical joint replacement)
100
What are alternative surgical treatment to arthroplasty? Explain each one
Arthrodesis --> fusing two bones into a fixed position
| Osteotomy --> removal or adding small bits of bone above or below your knee
101
What is Sciatica?
It is compression of the sciatica nerve (L4-S3) causing pain and numbness from the lower back down one leg to the feet and ankles.
Also weakness in the calf muscles of the effected leg
102
What test can be done to see the speed of nerve transmission after a prolapsed disc?
Nerve conduction test
103
What is the treatment and duration of prolapsed disc?
```
1-3 months duration
NSAIDS or epidural
Physiotherapy
Weight loss
Education
```
104
For nerve pain seen in sciatica what unusual treatment can be givin?
Amitriptyline and sertryline ( antidepressants)
| gabapentin and pregabalin --> anticonvulsants
105
What tool is used for definitive diagnostic of the cause of septic arthritis?
Join aspiration and culture to identify the cause of the infection.
MRI and CT are used in difficult cases
106
If the patient is penicillin resistant what abx is given for septic arthritis?
Iv clindamycin 4-6 weeks
107
If MRSA is suspected what abx is used for septic arthritis?
IV Vancomycin 4-6 weeks
108
What are DD of septic arthritis?
```
Primary rheumatoligical disease (RA, OA, gout)
Viral arthritis
Drug induced arthritis
Reactive arthritis
Lyme disease
Infective endocarditis
```
109
What two factors can reduce the risk of getting RA?
High intake of vitamin C
| Drinking moderate amount of alcohol
110
What triggers the autoimmune condition RA?
External trigger such as infection, trauma or smoking
111
Give DD for RA?
Gout, OA, SLE, Ankylosing spondylitis, psoariatic arthritis. lyme disease and hep c
112
What are the non medical treatment are their for RA?
Life style changes
| Splinters and braces
113
What eye complication can you get from rheumatoid arthritis?
Episcleritis
114
What surgery can increase chance of osteoporosis?
Hysterectomy
115
What is Paget disease of the bone?
Abnormal bone architecture
116
What are the function of
a) Osteoclast
b) Osteoblast
a) cells that absorb old bone
| b) cells that make new bones
117
What occurs in Paget disease in terms of osteoclast and osteoblast?
Osteoclast absorbs bone quicker than normal
| Osteoblast therefore makes bone quicker than normal but the bones are weaker and longer
118
Why do you look at biomarkers for osteoporosis?
Took look at the different types of bone pathology
119
Complications of osteoporosis?
Chronic pain
| Inability to do daily activity
120
What is a DEXA scan used for?
To diagnose osteoporosis by looking at bone density
121
Name 3 drugs that can cause gout?
Low does aspirin
Chemotherapy drugs
Indapamide (diuretics)
122
How does chemotherapy drugs cause gout?
Uric acid is produced by the breakdown of tumours
123
How does indapamide cause gout?
The thiazide like diuretic reduces the excretion of uric acid by th`e kidney's
124
What is ankylosing spondylitis?
Chronic condition affecting the back and the joints causing inflamation
125
What is the symptoms of ankylosing spondylitis?
Pain in the back and stiffness
Inflammation in the affected joints (arthritis) and in the tendons joining the bone (enthesiits) = causing pain and swelling
Fatigue
126
Is there a cure for ankylosing spondylitis?
No just symptomatic relief
127
What is the cause of ankylosing spondyltitis?
Thought to be linked to the HLA-B27 gene
