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Phase 4 > MSK > Flashcards

MSK Flashcards

1
Q

What is ankylosing spondylitis?

A

a chronic progressive inflammatory arthropathy associated with HLA-B27 gene which ultimately may lead to radiographical changes in the spine and sacroiliac joints.

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2
Q

what percentage of patents with AS have HLA-B27 gene? what chromosome is it found on?

A

90%

autosomal dominant on chromosome 6

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3
Q

what are 3 risk factors for AS?

A

HLA-B27
FHx
male

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4
Q

what are 5 presentations of AS?

A 
severe inflammatory (improved by NSAIDs) back/ butt pain and stiffness
worse in morning (>30 mins)
bamboo spine on X-ray
uvitis and systemic symptoms
enthesitis
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5
Q

what age group most commonly presents with AS?

A

late teens to 20s

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6
Q

what are 4 investigations for AS?

A

spine and sacral Xray
FBC - normocytic anaemia
CRP and ESR - elevated
HLA-B27 gene testing

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7
Q

what are 7 radiological signs of AS?

A 
bamboo spine 
squaring of vertebral bodies 
subchondral sclerosis 
subchondral erosions
syndesmophtes
ossifications 
fusions
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8
Q

what are 3 differentials for AS?

A

osteoarthritis
psoriatic arthritis
reactive arthritis

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9
Q

what is the treatment for AS? (in order)

A

NSAIDs
steroids - flare ups
anti-TNF - infliximab or etancercept
IL-7 MAB - secukinumab

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10
Q

what are 3 complications of AS?

A

osteoporosis
vertebral fractures
anaemia

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11
Q

what are the 5 seronegative spodyloarthropathies?

A 
psoriatic 
ankylosing spondylitis
reactive arthitis
IBD associated arthritis
juvenile idiopathic arthritis
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12
Q

what are the 8 common symptoms of the seronegative spodyloarthropathies?

A 
SPINE ACHE
sausage digits - dactylitis
psoriasis
inflammatory back pain 
NSAID responsive
enthesitis - inflammation at point tendon attaches to bone 
Arthritis
Crohn's/Colitis/CRP elevated
HLA-B27
eyes - uveitis
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13
Q

what is fibromyalgia?

A

a chronic pain syndrome diagnosed by the presence of widespread body pain

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14
Q

does fibromyalgia affect more men or women?

A

women

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15
Q

what are the overlapping pain conditions with fibromyalgia?

A 
IBS
TMJD
interstitial cystitis
vulvodynia
tension headaches
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16
Q

what are 3 risk factors for fibromyalgia?

A

FHx
rheumatic conditions
age 30-60

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17
Q

what are 5 clinical manifestations of fibromyalgia?

A 
chronic pain
diffuse tenderness of examination
fatigue unrelieved by rest/sleep disturbance
morning stiffness
headaches
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18
Q

what are 3 differentials for fibromyalgia?

A

rheumatoid arthritis
vitamin D deficiency
chronic fatigue syndrome

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19
Q

what is the treatment for fibromyalgia?

A 
education
exercise
CBT
antidepressants - amitriptyline, SNRIs 
analgesia - naproxen/tramadol
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20
Q

what is the criteria for a fibromyalgia diagnosis?

A

widespread pain (front back left right both sides of diaphragm), 3+ months, tenderness of at least 11/18 designated tender point sites

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21
Q

What is giant cell arteritis?

A

a granulomatous vasculitis of large and medium-sized arteries. It primarily affects branches of the external carotid artery, and it is the most common form of systemic vasculitis in adults

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22
Q

Who does giant cell arteritis usually affect?

A

females 50+

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23
Q

what are 3 risk factors for giant cell arteritis?

A

genetics
smoking
atherosclerosis

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24
Q

what are 5 presentations of giant cell arteritis?

A 
severe headache - temporal pounding 
scalp pain/tenderness
aching and stiffness - neck, shoulders, hips
extreme limb, tongue or JAW claudication
loss of vision
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25
Q

what are 3 investigations of giant cell arteritis?

A

CRP/ESR - raised
FBC - may have normochromic, normocytic anaemia, normal WBCs and elevated platelets
temporal artery biopsy - gold

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26
Q

what are 3 differentials for giant cell arteritis?

A

polymyalgia rheumatica
solid organ cancers and haematological malignancies
SLE

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27
Q

what is the management of giant cell arteritis?

A

high dose corticosteroids - prednisolone
tocilzumab - biological and Glucocorticoid
aspirin

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28
Q

what are 3 complications of giant cell arteritis?

A

blindness
aortic aneurysm
large vessel stenosis

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29
Q

what are the histological features of giant cell arteritis?

A

cellular infiltrate - CD4+ T lymphocytes, macrophages and giant cells in vessel wall

granulomatous inflammation of intimacy and media

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30
Q

What is gout?

A

an inflammatory arthritis caused by deposition of monosodium urate crystals within joints

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31
Q

what are grout crystals like?

A

monosodium urate - negatively bifringent

needle shaped

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32
Q

what are 4 triggers of gout?

A

CKD
diuretics - thiazide and loop
purine rich diet
obesity

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33
Q

what joints does gout usually affect?

A 
big toe - MTP (metatarsophalangeal)
foot
ankle
fingers
knee
wrist 
elbow
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34
Q

what is gout most commonly caused by?

A

renal under excretion of urate - 90%

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35
Q

what are 3 risk factors for gout?

A

older age
consumption of meat, seafood and alcohol
use of diuretics

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36
Q

what is the pathophysiology of gout?

A

High urate levels result in super saturation and crystal formation leading to gout => uric acid crystals in joint interact with undifferentiated phagocytes and trigger acute inflammation by inducing TNF-alpha and activating signalling pathways

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37
Q

what are 4 clinical manifestations of gout?

A

rapid onset of severe joint pain in few joints
joint stiff, red, hot
tophi

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38
Q

what are 3 investigations for gout?

A

joint aspiration - gold
serum uric acid levels
joint X-ray

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39
Q

what are 3 differentials for gout?

A

reactive arthritis
septic arthritis
rheumatoid arthritis

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40
Q

what is the management of an acute gout attack?

A

NSAID - not in renal problems
colchicine
corticosteroids - 2
IL-1 inhibitors

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41
Q

what is an adverse effect of colchicine?

A

causes diarrhoea

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42
Q

what is the mangement of chronic gout?

A

lifestyle advise
uric acid lowering drugs - allopurinol or febuxostat
uricosuric agent - sulfinpyrazone

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43
Q

what are 3 complications of gout?

A

joint destruction
kidney disease - acute uric acid nephropathy
urate nephrolithiasis

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44
Q

what is osteoarthritis?

A

a non-inflammatory degenerative arthritis characterised by progressive synovial joint damage

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45
Q

what are 3 risk factors for osteoarthritis?

A

older age - 50+
obesity
physically demanding job/sport

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46
Q

what are the 5 X-ray manifestations of osteoarthritis?

A 
JOSSA
joint space narrowing
osteophyte formation
subchondral sclerosis
subchondral cysts
abnormalities of bone contour
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47
Q

what is the pathophysiology of osteoarthritis?

A

there is a failure in maintaining the homeostatic balance of the cartilage matrix synthesis and degradation, resulting from reduced formation or increased catabolism

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48
Q

what are 5 presentations of osteoarthritis?

A 
pain 
functional difficulty
crepitus 
bony deformaties 
effusions
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49
Q

what joints does osteoarthritis usually affect?

A

weight bearing joints asymmetrically

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50
Q

what are 3 investigations for osteoarthritis?

A

X-ray
RF and anti-CCP antibody - negative
serum CRP/ESR - may be slightly elevated

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51
Q

what are 3 differentials for osteoarthritis?

A

bursitis
Gout/pseudogout
rheumatoid arthritis

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52
Q

what is the management for osteoarthritis?

A

1 - oral paracetamol + topical NSAID + topical capsaicin

+ PPI (stomach protection)
+ opiates

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53
Q

what are 3 complications of osteoarthritis?

A

functional decline
spinal stenosis
NSAID related GI bleeding

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54
Q

what are heberden’s node?

A

osteoarthritic nodes of the DIP joints

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55
Q

what are Bouchard’s nodes?

A

osteoarthritic nodes of the PIP joints

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56
Q

what kind of appearance does erosive OA have on Xray?

A

gulls wing

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57
Q

What is osteomyelitis?

A

an inflammatory condition of bone caused by an infecting organism

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58
Q

what is the most common cause of osteomyelitis?

A

S. Aureus

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59
Q

what are the 3 paths of infection in osteomyelitis?

A

direct innoculation
contiguous spread from adjacent tissues
haematogenous spread

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60
Q

who is mainly affected by osteomyelitis?

A

extremes of age

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61
Q

what organisms mainly cause osteomyelitis in infants?

A

S. Aureus
group B strep
aerobic gram -ve bacili
candida albicans

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62
Q

what organisms mainly causes osteomyelitis in children?

A

S. Aureus

group B strep

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63
Q

what organisms mainly cause osteomyelitis in adults?

A

S. Aureus
coagulase negative staph
aerobic gram negatives
anaerobic gram +ve peptostreptococci

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64
Q

what organisms mainly cause osteomyelitis in the elderly?

A

gram negative bacili

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65
Q

what organisms usually cause osteomyelitis in IVDU?

A

S. Aureus

Pseudomonas aeruginosa - most likely in clavicle and pelvis

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66
Q

what are 3 risk factors for osteomyelitis?

A

pHx of osteomyelitis
penetrating injury
IVDU

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67
Q

what re 5 manifestations of osteomyelitis?

A 
limp/reluctance to weight bear
systemic symtoms
local inflammation 
limb deformity
spinal cord/nerve root compression
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68
Q

what are 3 investigations for osteomyelitis?

A

blood cultures
ESR/CRP
plain film X-ray

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69
Q

what is the gold standard for osteomyelitis?

A

bone biopsy, cultures and histopathology

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70
Q

what are 3 differentials for osteomyelitis?

A

septic arthritis
juvenile idiopathic arthritis
reactive arthritis

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71
Q

what is the treatment of osteomyelitis?

A

debridement - surgery to remove necrotic bone

antibiotics - IV for up to 6 weeks

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72
Q

what re 3 complications of osteomyelitis?

A

drug reactions
amputation
recurrence

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73
Q

what is osteoporosis?

A

Systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue with consequent increase in bone fracture and fragility

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74
Q

what is the numerical categorisation of osteoporosis?

A

bone mineral density (BMD) MORE than 2.5 standard deviations BELOW the gender matched young adult mean value (T score < -2.5)

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75
Q

who is osteoporosis most common is?

A

post menopausal women

especially caucasian and Asian

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76
Q

what is the cause of osteoporosis?

A

Low bone mass and abnormal bone architecture => size and shape of bone, bone turn over, micro-architecture, bone mineralisation => can be due to low peak bone mass, loss of bone mass with age, poor bone architecture

mismatch between bone resorption and formation

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77
Q

what are 5 risk factors for osteoporosis?

A 
FHx
low BMI/weight
androgen deprivation (men) and aromatase inhibitors (women)
corticosteroid use
smoking
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78
Q

what are 5 presentations of osteoporosis?

A 
kyphosis
impaired vision
impaired gait
back pain
imbalance and lower extremity weakness
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79
Q

what is the gold standard investigation for osteoporosis?

A

dual energy X-ray absorpitometry - DXA scan

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80
Q

what are 3 differentials for osteoporosis?

A

multiple myeloma
osteomalacia
CKD-bone mineral disorder

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81
Q

what is the treatment for osteoporosis?

A

bisphosphonates - alendronic acid

HRT
denosumab
teriparatide
calcium + vitamin D

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82
Q

how do bisphosphonates work?

A

slow down osteoclast activity => reduce bone breakdown

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83
Q

how does Denosumab work?

A

anti-resorbative - inhibits osteoclast activity

84
Q

how does teriparatide work?

A

anabolic - synthetic parathyroid hormone, increases osteoblastic activity

85
Q

what are 3 complications of osteoporosis?

A

fracture
chronic pain syndrome
jaw necrosis associated with bisphosphonates

86
Q

what is a T-score?

A

standard deviation score using DXA scan

87
Q

what are the T score ranges?

A

> -1 = normal
-1 - -2.5 = osteopenia
< -2.5 = osteoporosis
< -2.5 + a fracture = severe osteoporosis

88
Q

What is pseudo gout?

A

an acute inflammatory arthritis of one or more joints due to calcium pyrophosphate deposition on joint surfaces

89
Q

what are 3 risk factors for pseudo gout?

A

advanced age >65
injury/trauma
hyperparathyroidism

90
Q

what kind of crystals are deposited in psudogout?

A

calcium pyrophosphate crystals

positively bifringent rhomboid shaped crystals

91
Q

what are 5 manifestations of pseudogout?

A 
red painful and tender joints 
sudden worsening of osteoarthritis
joint effusion
fever
malaise
92
Q

what are 3 investigations for pseudogout?

A

synovial fluid aspirate analysis - gold
joint X ray - chondrocalcinosis
serum calcium + PTH

93
Q

what are 3 differentials for pseudogout?

A

gout
septic arthritis
osteoarthritis

94
Q

what is the management for pseudogout?

A

NSAIDs or Colchicine
corticosteroid intra-articular

DMARDs - methotrexate and hydroxchloroquine
joint replacement

95
Q

what is the general order of affected joints in pseudogout?

A

Knee > wrist > shoulders > ankles >elbows

96
Q

What is psoriatic arthritis?

A

a seronegative chronic inflammatory joint disease associated with psoriasis

97
Q

what are 3 risk factors for psoriatic arthritis?

A

psoriasis
FHx
Hx of joint/tendon trauma

98
Q

what are two features of psoriatic arthritis that distinguish it from RhA?

A

Dactylitis - sausage fingers

DIP joint involvement

99
Q

what are 5 manifestations of psoriatic arthritis?

A 
painful stiff joints - DIP
dactylitis
spinal stiffness
psoriasis 
enthesitis
100
Q

what are 3 investigations for psoriatic arthritis?

A

X-ray hands and feet
ESR/CRP - normal
PEST screening tool

101
Q

What are 4 X-ray features of psoriatic arthritis?

A 
Pencil in cup deformity
periostitis
ankylosis 
osteolysis
dactylitis
102
Q

what are 3 differentials for psoriatic arthritis?

A

rheumatoid arthritis
gout
errosive osteoarthritis

103
Q

what is the mangement for psoriatic arthritis?

A

NSAIDs
Intraarticular corticosteroids
DMARDs - methotrexate, sulfasalazine

TNF-alpha inhibitors
ustekinumab

104
Q

what are 3 complications of psoriatic arthritis?

A

CVD
aortitis
methotrexate hepatotoxicity

105
Q

What is reactive arthritis?

A

A sterile inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections.

106
Q

what is the classic triad of reactive arthritis? what is the way to remember it?

A

Post-infective arthritis
non-gonococcal urethritis
conjunctivitis

Can’t see, can’t wee, can’t climb up a tree

107
Q

is reactive arthritis usually asymmetrical?

A

YES - also usually only affects one joint - mono arthritis

108
Q

who is reactive arthritis most common in?

A

Men with HLA-B27

109
Q

what are 5 causative organisms for reactive arthritis?

A

GU - chlamydia trachomatis, gonorrhoea

GI - salmonella, shingella, yersinia enterocoliti

110
Q

what are 3 risk factors for reactive arthritis?

A

HLA-B27
male
chlamydial/GI infection

111
Q

what are 5 symptoms of reactive arthritis?

A

can’t see, can’t wee, can’t climb up a tree

warm swollen joint
iritis/conjunctivitis
circinate balantis - head of penis dermatitis
mouth ulcers

112
Q

what are 3 investigations for reactive arthritis?

A

ESR/CRP - elevated
joint aspiration
infectious serology

113
Q

what are 3 differentials for reactive arthritis?

A

gout
pseudogout
septic arthritis

114
Q

what is the management of reactive arthritis?

A

PRESUME SEPTIC UNTIL PROVEN OTHERWISE

NSAIDs - naproxen/ibruprofen
corticosteroids injections
DMARDs - methotrexate

115
Q

what are 3 complications of reactive arthritis?

A

circinate balanitis
uveitis
keratoderma blennorhagicum

116
Q

What is rheumatoid arthritis?

A

An autoimmune chronic inflammatory erosive arthritis primarily affecting the small joints of the hands and feet

117
Q

what percentage of the population have rheumatoid arthritis and who is it most common in?

A

1%
most common in women
50-55 years

118
Q

what are 2 risk factors for RhA?

A

genetics

smoking

119
Q

what are 5 manifestations of RhA?

A 
Active symmetrical arthritis > 6 weeks
morning stiffness lasting >30 mins
rheumatoid nodules 
rheumatoid deformities
pleuritic chest pain
120
Q

what are the 3 types of RhA deformity?

A

Swan’s neck
Boutonniere - pip always bent
Ulnar deviation

121
Q

what are 3 investigations for RhA?

A

Rheumatoid factor - positive
anti-CCP - positive in 70%
X-ray - erosions

122
Q

what are 3 differentials for RhA?

A

psoriatic arthritis
infective arthritis
gout

123
Q

What is the management of RhA?

A

DMARDs - methotrexate, sulfasalazine, hydroxychloroquine
corticosteroids
NSAIDs

124
Q

what are 3 complications of RhA?

A

work disability
increased coronary artery disease
increased joint replacement surgery

125
Q

What is septic arthritis?

A

the acute infection of 1 or more joints caused by pathogenic inoculation of microbes. It occurs either by direct inoculation or via haematogenous spread and can destroy a joint in under 24 hours.

126
Q

what is the most common joint to be infected with septic arthritis?

A

knee

127
Q

what is the most common causative organism for septic arthritis?

A

S. Aureus

128
Q

who 2 gram negative bacteria cause septic arthritis? what patients in?

A

E. COLI and PSEUDOMONAS AERUGINOSA

IVDU
immunosuppressed
neonates
elderly

129
Q

what are 2 gram positive causative bacteria of septic arthritis? what patients affected?

A

Strep group A (pyogenes) - <5yrs

Staph epidermis - prosthetic joints

130
Q

what are 4 risk factors for septic arthritis?

A

underlying joint disease/prosthetic joint
IVDU
immunosuppression

131
Q

what are 5 manifestations of septic arthritis?

A 
hot, swollen, painful, red
restricted and acute
fever
affecting single joint (90%)
erythema migrans
132
Q

what are 3 investigations for septic arthritis?

A

joint aspiration - gold

FBC - leukocytosis
CRP and ESR - high
blood cultures

133
Q

what are 3 differentials for septic arthritis?

A

osteoarthritis
pseudogout
Gout

134
Q

what is the management of septic arthritis?

A 
IV antibiotics
STOP methotrexate and anti-TNF alpha
double steroids (if on)
aspiration and joint wash out
rest and splint
135
Q

what are 3 complications of septic arthritis?

A

sepsis
osteomyelitis
joint destruction

136
Q

What is systemic lupus erythramatosus?

A

a chronic systemic autoimmune condition caused by a type 3 hypersensitivity reaction

137
Q

who most commonly presents with SLE?

A

women in their childbearing years

most commonly of African or asian descent

138
Q

What are 5 environmental triggers for SLE?

A 
UV light
Smoking
Medications
Sex hormones
EBV
139
Q

What is the pathophysiology of SLE?

A

Environmental triggers cause cell death creating apoptotic bodies. There is reduced clearance or these apoptotic bodies and cellular and the immune system of these patients doesn’t recognise the cellular debris as self and so attack the cell material, forming nuclear antigen-antibody complexes. These complexes can deposit in different tissues and activate complement causing inflammation and damage - a type III hypersensitivity reaction

140
Q

what are 10 manifestations of SLE?

A 
malar (butterfly)/ photosensitive /discoid rash
lupus nephritis
fever and fatigue
arthralgia/arthritis
Raynaud's disease
pericarditis and myocarditis
anaemia 
pleuritis and peritonitis 
psychosis, seizures, migraine
141
Q

what are 4 blood tests for SLE?

A

FBC - may have anaemia, thrombocytopaenia and leukopaenia
U+E - check for lupus nephritis
ESR - raised
CRP - normal

142
Q

what are 3 antibody tests for SLE?

A

ANA (anti-nuclear antibodies) - most sensitive
Anti-dsDNA - most specific
Anti-smith antibodies - most specific, not sensitive
Rheumatic factor - 20% positive

143
Q

what are 3 differentials for SLE?

A

Rheumatoid Arthritis- SLE less symmetrical
antiphospholipid syndrome
mixed connective tissue disease

144
Q

what is the treatment for SLE?

A

hydroxychloroquine (anti-malarial)
NSAIDs
corticosteroids - prednisolone
immunosuppressants - methotrexate

145
Q

what are 4 complications of SLE?

A

anaemia
osteoporosis
kidney failure - lupus nephritis
pericarditis

146
Q

how long does morning stiffness in OA last?

A

<30 mins

147
Q

what is FRAX?

A

predicts risk of fragility fracture over the next 10 years

age, BMI, smoking, alcohol

148
Q

what group of people does N. Gonorrhoea cause septic arthritis in?

A

sexually active young adults

149
Q

what antibiotics are used in septic arthritis?

A

IV flucoxacillin - gram pos
(clindamycin in allergy)
IV cefotaxime - gram neg

150
Q

what are 4 risk factors for SLE?

A

female
FHx
middle aged

151
Q

what are 4 benign bone caners?

A

osteochondroma
giant cell tumour
osteoblastomas
osteoid osteomas

152
Q

what are 3 malignant bone cancers?

A

osteosarcoma
Ewing sarcoma
chondrosarcoma

153
Q

what are the 5 most common secondary bone tumour metastasis?

A 
breast 
prostate
lungs
thyroid
kidneys
154
Q

what are 4 manifestations bone cancer?

A

bone pain, swelling and fractures
generally worse at night
constitutional symptoms
lung metastasis

155
Q

what are 3 investigations for bone cancer?

A

ALP - from bone elevated
X-ray
hypercalcaemia

156
Q

what are 4 X-ray signs of bone cancer?

A

giant cell - soap bubbles lessions
osteosarcoma - sunburst
Ewing - onion skin
chondrosarcoma - moth-eaten

157
Q

what is mechanical back pain?

A

the source of the pain is in the spinal joints, discs, vertebrae, or soft tissues.

158
Q

what are 3 risk factors for mechanical back pain?

A

female
increasing age
fibromyalgia

159
Q

what is the imaging of choice for mechanical back pain?

A

MRI

160
Q

what is the gold standard investigation of osteomalacia?

A

iliac bone biopsy with double tetracycline labelling

rare as invasive

161
Q

what is osteomalacia?

A

a metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix (osteoid) following growth plate closure in adults.

soft bones - rickets in children

162
Q

what causes osteomalacia?

A

vitamin D deficiency

calcium or phosphate deficiency

163
Q

what are 3 investigations for osteomalacia?

A

serum calcium and phosphate
serum 25-hydroxyvitamin D
PTH level

164
Q

what do you give in osteomalacia if deficiency in malabsorption?

A

vitamin D2 or IM calcitrol

165
Q

which disks are most commonly affected in vertebral disc degeneration?

A

lower lumbar spine

166
Q

what age group get disc prolapse?

A

young people - 20-40 years

167
Q

what are 4 manifestations of acute vertebral disc disease ?

A

sudden onset sever back pain with trigger
decreased range of motion
tingling, numbness, paresthesia
muscle weakness and atrophy

168
Q

what is Paget’s disease?

A

A chronic bone disorder that is characterised by focal areas of increased bone remodelling, resulting in overgrowth of poorly organised bone.

169
Q

what are 3 risk factors for Paget’s disease?

A

FHx
50+
infection

170
Q

what are the 3 stages of Paget’s disease?

A

lytic phase - excessive osteoclasts
mixed phase - excessive resorption and disorganisation of bone formation
sclerotic phase – osteoblast lay down excessive disorganised bone

171
Q

what are 5 manifestations of Paget’s disease?

A

pain
growth of bones in face - leontiasis, hearing loss, vision loss
kyphosis
lower limb muscle weakness

172
Q

what disease can cause cotton wool appearance of skull on x-ray?

A

Paget’s disease

173
Q

what chromosome is the mutation that causes Marfan’s on?

A

chromosome 15

174
Q

what is the inheritance pattern of marfans?

A

autosomal dominant

175
Q

what are 10 symptoms of Marfan’s?

A 
tall, long arms, long legs
long fingers and toes
pigeon chest or intruding chest 
scoliosis 
inability to extend allows to 180 degrees
hypermobility
downward slant of eyes 
crowded teeth 
stretch marks 
flat feet
176
Q

where is type 1 collagen found?

A

skin, tendons, organs, bones

177
Q

where is type 2 collagen found?

A

cartilage

178
Q

where is type 3 collagen found?

A

supporting mesh of soft organs

179
Q

where is type 4 collagen found?

A

basal lamina (basement membranes)

180
Q

where is type 5 collagen found?

A

cells surfaces, hair, placenta

181
Q

what are 6 manifestations of Elher’s Danlos syndrome?

A 
hyper mobility and joint pain
recurrent dislocation
scoliosis and spine pain
hyper elastic skin
easy bruising 
atrophic skin
182
Q

what is antiphospholipid syndrome?

A

antiphospholipid antibodies which cause clinical features characterised by thromboses and pregnancy related morbidity

183
Q

what other condition is antiphospholipid syndome associated with?

A

SLE in 20-30% of cases

184
Q

what sex is antiphospholipid syndrome more common in?

A

females

185
Q

what are 4 signs of antiphospholipid syndrome?

A

CLOTs

Coagulation defects
Livedo reticularis - lace lie purple discolouration of skin
Obstetric issues - miscarriage
Thrombocytopenia

186
Q

what are 3 investigations of antiphospholipid syndrome?

A

anticardiolipin test - IgG or IgM antibodies
lupus anticoagulant test
Anti-B2-glycoprotein test

187
Q

what is the management of antiphospholipid syndrome?

A

warfarin

pregnancy - aspirin and SC heparin

188
Q

what is salter-harris classification?

A

fractures in children affecting the growth plate

189
Q

what is the Z score?

A

bone density compared to average for their age and gender

190
Q

what drug class is allopurinol and what is its MOA?

A

Xanthine oxidase inhibitor

Xanthine oxidase metabolises xanthine into uric acid => inhibits metabolism so therefore lowers plasma uric acid

191
Q

where is hidden psoriasis found?

A

genitals
soles
scalp
ears

192
Q

what is the name of 1 bisphosphonate?

A

Alendronate

193
Q

how do you take bisphosphonates?

A

take on empty stomach once a week and remain upright for at least half an hour afterwards

194
Q

What are the bloods like in Paget’s disease?

A

ALP - high
Calcium - normal
Phosphate - normal

195
Q

what is the 1st line treatment of Paget’s disease?

A

bisphosphonates - alendronate

196
Q

what are 3 complications of Paget’s disease?

A

osteosarcoma
leontiasis
fractures

197
Q

what are 5 of the diagnostic criteria for giant cell arteritis?

A

50+
temporal artery abnormality
abnormal temoral artery biopsy
elevated ESR

198
Q

what is the name of the blotchy skin pattern in antiphospholipid syndrome?

A

Livedo reticularis

199
Q

what disease can antiphospholipid syndrome be mistaken for due to positive antibody test?

A

Syphilis

200
Q

what reflex comes from S1?

A

Ankle jerk

201
Q

what is Sjogren’s syndrome?

A

autoimmune disorder of diminished lacrimal and slivery gland secretions

presents with fatigue, dry eyes, dry mouth, dry vagina

202
Q

what antibodies are in sjogren’s syndrome?

A

anti-Ro (SS-A) and anti-La (SS-B) antibodies
rheumatoid factor - RF
antinuclear antibodies - ANA

203
Q

what is a key eponymous test for sjorgren’s syndrome and what is it?

A

Schirmer’s test

filter paper placed in corner of eye to measure secretions

204
Q

what is the treatment for Sjögren’s syndrome?

A

1 - artificial tears, salivary substitutes, paracetamol, IVIg

2 - ophthalmic ciclosporin drops, cholinergic drugs NSAIDs

205
Q

what is felty’s triad?

A

complication of RhA

RhA
Splenomegally
neutropenia

206
Q

what are the 5 extra-articular manifestations of AS?

A

5 As

Anterior uveitis 
Autoimmune bowel disease
Apical lung fibrosis 
Aortic regurgitation 
Amyloidosis
207
Q

what test is used to determine spinal motility?

A

Schober’s test

find L5 and make mark 10cm above, ask patient to bend over as far as possible and mark 5cm below L5 => if distance between 2 marks <20cm =. reduced lumbar movement

Phase 4 (19 decks)

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