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3rd year > Locomotor > Flashcards

Locomotor Flashcards

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1
Q

What is osteoarthritis and how much of the joint capsule is involved?

A

Most common arthritis and the whole capital is involved. Osteoarthritis is characterised by cartilage loss followed by Periarticular a response.

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2
Q

Who is most commonly affected by osteoarthritis?

A

Over 60s
Females three times more likely than men
Some familial patterns of inheritance?

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3
Q

What joints are most commonly affected by osteoarthritis? (Two)

A

Hip and knee

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4
Q

What are some the rest factors of osteoarthritis?(7)

A 
Obesity
Lots and lots of sport
Congenital joint dysplasia
Hypermobility
Gender
Occupation
Joint congruity
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5
Q

What are the primary and secondary causes of osteoarthritis?

A

Primary cause is idiopathic/wear and tear

Secondary causes include metabolic disease,prexisting joint damage and systemic disease

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6
Q

Summarise the pathophysiology of osteoarthritis?

A

Normal balance of degradation and regeneration of cartilage is damaged.
Repair is attempted but disordered creating a surface which is fibrillated and fissured.
This exposes underlying bone to stress and microfractures and when the bonetried to repair itself it does so in a disorganised way

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7
Q

What are bony overgrowths at the joint margins called?

A

Osteophytes

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8
Q

in osteoarthritis what is a atrophied disease and what is hypertrophic disease?

A

Atrophic is cartilaginous destruction without any bony growth
Hypertrophic is cartilagineous destruction with massive new bone information.

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9
Q

What are the symptoms of osteoarthritis?

A

Primary joint pain
Morning stiffness lesson 30 minutes
Pain of stiffness better with rest worse at exercise

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10
Q

What the signs osteoarthritis?

A

Joint tenderness
Practice
Decreased range of movement
Joint instability

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11
Q

What are the hand signs of osteoarthritis?

A

Heberdens nodes at distal interphalyngeal joint

Bouchard nodes at proximal interphalangeal joint

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12
Q

Give some differentials for osteoarthritis

A 
Rheumatoid arthritis
Septic arthritis
Doubt
Anklyosing spondylitis
Bursitis
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13
Q

What investigations should you do for osteoarthritis?

A

X-ray
Bloods (crp may be up) negative ra
Joint aspiration
NB diagnosis often clinical

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14
Q

What would you see on x-ray on osteoarthritis?

A 
Loss
Loss of joint space
Osteophytes
Subchondral cyst's
Sub articular sclerosis
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15
Q

What is the go to besting treatment wise you can do for a joint with osteoarthritis?

A

Poor question but joint replacement

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16
Q

What is the overall management plan for osteoarthritis?

A 
Education
Exercises
Ànalgesia
Decrease BMI
Walking aids
Steroid injections intra-articular for short-term relief
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17
Q

What is the prognosis of osteoarthritis?

A

Most do not become completely disabled but hand and knee are bad joints to have involved

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18
Q

What is rheumatoid arthritis?

A

Auto immune disease causing chronic symmetrical polyarthritis with systemic involvement due to signovial information

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19
Q

Risk factors? For rheumatoid arthritis

A

Gender, females more likely
Genetic’s (60% of the disease susceptibility)
Immunology (V complicated) ‘immune dysregulation plays a big part on the pathophysiology of RA’

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20
Q

Tough question which two genes are heavily involved with rheumatoid arthritis?

A

HLA DR4

HLA DRB

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21
Q

Describe the pathophysiology of rheumatoid arthritis?

A

Widespread synovitis
Cause by production of rheumatoid factor and immune complexes
Synovium proliferates into folds and fronds
Vascular proliferation and increase in permeability lead to joint effusion
Panus of inflamed Sino VM damages under Lyne cartilage
Cartilage becomes thinned and underlying bone exposed
Juxtarticular bone erosions on x-ray
Bone erosions, deformities, long Term disability

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22
Q

What are the symptoms of rheumatoid arthritis?

A

Joint pain
Worse with rest better on exercise
Morning stiffness lasting longer than 30 minutes
Symmetrical pattern
Mainly hands and feet then progress to larger joints
Fatigue and weakness

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23
Q

What are the signs fairly early on the rheumatoid arthritis?

A

Muscle wasting
Slightly warmer joints
Tenderness and joint swelling
Limitation of movement

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24
Q

What are the hand signs of rheumatoid arthritis?

A 
Squaring of the hands
Ulnar deviation of the fingers
Boutienere deformity
Swan neck deformity
Z thumb deformity
And extensor tendons may rupture
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25
Differentials of rheumatoid arthritis?
``` Osteoarthritis Gout Septic arthritis Polymyalgia rheumatica Viral arthritis ```
26
You can get extra articular signs of rheumatoid arthritis what are they?
``` Rheumatoid nodules Albert/4 on Vasculitis Fibrosing Alveolitis Plural and pericardial if fusion Raynolds Carpal tunnel ```
27
What investigations you do for rheumatoid arthritis?
Rheumatoid factor Anti-CCP Joint aspiration X-ray
28
What two serology tests are good ish for monitoring treatment/Progression?
ESR | CRP
29
What is the main treatment for rheumatoid arthritis?
Dmards First line Sulphasalazine methotrexate leflunomide Second line TNF A blockers. Ciclosporin
30
How do you DMARDS work against rheumatoid arthritis?
Through cytokines inhibition reduce inflammation reduce swelling and reduce development of joint erosions and irreversible damage They are slow and their beneficial effect is not immediate
31
What are some of the symptomatic treatment for rheumatoid arthritis?
NSAIDs and toxins | Intra-articular injections – powerful but short lived
32
What is gout?
Inflammatory condition of joints due to deposition of mono sodium urate crystals. These and cause acute inflammation and eventual tissue damage.
33
How is uric acid formed?
The metabolism of purines by xanthene oxidase enzyme. | Can't break down Uric acid it is excreted by the kidneys
34
Causes of gout?
``` Things which prevent the excretion: (anything affecting kidney) Chronic renal disease Hypertension Diuretics Hyper or hypo parathyroidism Increase lactic acid G6P deficiency ``` Increased Eurich acid production: Increased purines synthesis Increased turnover purines
35
Risk factors of gout?
``` Mail Alcohol seafood Kidney problems Anything cause kidney problems Family history ```
36
What is your typical presentation of gout?
Pain in the first metatarsal joint 9/10 pain Often precipitated by alcohol dehydration diuretics
37
Signs of gout?
Red swollen tender joint Tophi Florid Synovitis
38
Investigations for gout?
Joint aspiration microscopy is the best Serum uric acid Serum uric acid and creatinine looking for signs of renal failure
39
Treatment for acute gout?
NSAIDS/Coxibs Corticosteroids if needed Ice and elevate
40
Prevention of gout?
Allopurinol Lose weight Avoid fatty foods and alcohol access
41
What is septic arthritis?
Acute inflammation of a joint or Prosthetic join caused by an infection
42
What are the risk factors for septic arthritis?
``` Trauma Surgery Elderly IVDU Immunosuppressant Obesity Age ```
43
Symptoms of setting of septic arthritis?
``` Very selfish pantry Joint pain Swollen and read tender joint Normally monoarticular Irritation of movement System upset fevers chills nice swets ```
44
Investigation for septic arthritis?
``` Joint aspiration from sign over your fluid for MCNS Blood culture Bloods wcc esr crp X ray Swab ```
45
Treatment for septic arthritis?
Empirical antibiotics e.g. flucloxacillin Directed abx Infected prosthesis = remove
46
What to do with an infected prosthetic joint?
It's got to go Maybe put in an antibiotic spacer for 3 to 6 weeks Put another one in
47
What actually is a prolapsed disc?
Nucleus pulposis herniating through annular fibrosis
48
Is come place for a prolapse disk?
L5 S1
49
Cause of prolapsed disc?
Trauma | Age related degeneration
50
What is sciatica?
Pain tingling numbness that arise due to nerve entrapment of the lumbosacral spine
51
Symptoms and signs of lumbosacral disc prolapse?
``` Unilateral pain down one leg past knee Pain often worse in leg than back Pain better online down Loss of tendon reflexes Pain leg raise ```
52
What's in them do you need to be careful of in prolapsed disc's?
Cauda equina syndrome
53
Red flags for back pain?
``` Less than 20 yo Night pain Supine pain Thoracica pain Saddle Anaesthesia Incontinenence Babinski or clonus reflex ```
54
Investigations for back pain?
None if less than six week | MRI very specific for disc herniations
55
Treatment for prolapsed disc?
Analgesia e.g. paracetamol ibuprofens Add week opioid if pain continues e.g. codeine Add amitriptyline/gabapentin if sciatic pain Think of using diazepam if muscle spasms If more pain go to pain clinic
56
What is osteoporosis?
Lobo mass and deterioration of microstructure of bone. Increase bone fragility and increased risk of fractures
57
Symptoms of osteoporosis?
Only symptom is osteoporotic fracture
58
Pathogenesis of osteoporosis?
Increase breakdown of bone by osteoclasts Decrease formation of osteoplast Decrease bone density
59
Risk factors for osteoporosis?
Postmenopausal woman lack of oestrogen Elderly people vitamin d deficiency and consequent hypoparathyroidism Glucocorticoids
60
What are the investigations for osteoporosis?
X-ray | DEXA scan
61
Management and treatment of osteoporosis?
``` Vitamin D and calcium supplements Exercise Smoking cessation Reduce falls Bisphosphonates (alendronate)- lots side effects ```

3rd year (10 decks)

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