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Flashcards in LOCOMOTOR Deck (127):
1

what is the prevalence of gout?
a) 1%
b) 5%
c) 20%
d) 50%

a) 1%

2

which gender is most commonly affected by gout

male

3

what are the name of the deposits in gout and what are they made of?

crystalised uric acid (tophi) forming sodium monourate crystals

4

which joint is most commonly affected by gout?

first metatarsalphalyngeal joint

5

what is the cause of primary gout?

diet - chronic hyperuricaemia

6

give 3 causes secondary gout?

alcohol excess
renal impairement
polycythaemia
leukemia
cytotoxic drugs
Chemotherapy = break down of tumour causes increase in uric acid
low dose of aspirin

7

how long do gout attacks normally last?

1 week

8

what 2 symptoms often accompany pain in gout?

swelling
redness

9

give 5 factors which may precipitate an attack of gout

excess alcohol
excess food or starvation
dehydration
starting a diuretic
trauma/surgery
infection

10

what kind of microbiological analysis might you carry out on a patient with gout?

synovial fund microscopy

11

which of these blood markers would NOT be raised in a patient with gout?
a) uric acid
b) creatinine
c) eGFR
d) urea

c) eGFR - would be LOWERED

12

why should allopurinol be started with naproxen at the start of gout treatment?

may cause an attack at the start

13

give a complication of gout

kidney stones
Recurrent and advanced attacks of gout

14

what is the most common joint condition in the UK?

osteoarthritis

15

what is the classic phrase to describe the damage which causes osteoarthritis?

wear and tear

16

what structures are inflamed in osteoarthritis?

whole structure including synovium

17

what familial gene mutation can contribute to the formation of osteoarthritis?

collagen type 2

18

which ethnicity is more likely to get hip and knee osteoarthritis?
a) black
b) caucasian
c) asian
d) native american

c) asian

19

give 4 risk factors for development of osteoarthritis

age
occupation
previous joint injury
obesity
family history
congenital joint dysplasia
osteoporosis

20

at what point in the day is the pain of osteoarthritis worse?

end of day

21

where are bouchard's nodes?

PIPJs

22

where are heberden's nodes?

DIPJs

23

does osteoporosis normally affect just one or multiple joints?

one

24

give an audible sign present on examination of joints with osteoarthritis

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