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Medicine MBBS year 2 > MSK > Flashcards

MSK Flashcards

1
Q

What are the different types of bone ultrastructure of bone?

A
  1. woven/primary bone

2. lamellar/secondary bone - contact and spongy bone

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2
Q

what are the ECM components of bone?

A
  1. Collagen (type 1 mainly, and type 5)

2. Mineral salts -calcium hydroxyapatite

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3
Q

what are osteoclasts derived from?

A

monocytes

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4
Q

describe the 2 ways in which bones undergo ossification

A

Endochondral - provides length

Intramembranous - provide
width

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5
Q

what is a fracture?

A

a discontinuity of bone

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6
Q

How could you describe a fracture to a person? What do you need to think about?

A

Orientation - transverse, oblique, spiral, comminuted

Location - epiphysis, metaphysis, diaphysis OR Proximal ⅓, Middle ⅓, Distal 1/3

Displacement - displaced or undisplaced

Skin penetration - open or closed

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7
Q

What are the 2 types of fracture healing?

A

Direct - Intramembranous healing. Minimal fracture gap. No movement.

secondary/indirect - Results in callous formation (fibrocartilage). It is endochondral healing

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8
Q

what are some risks that affect fracture healing?

A

Age
Diabetic
Smoker

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9
Q

Bones adapt to forces placed upon it by remodelling. This is ___ law

A

wolfs

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10
Q

what are the two main types of fracture healing complications?

A

Non union - bone does not heal within expected time frame

Malunion - bone healing occurs but outside the normal parameters of alignment

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11
Q

State and describe the different types of Non-union fracture healing complications.

A

Atrophic - healing completely stopped with no XR changes

Hypertrophic - too much movement causing callus healing - horse hoof vs elephant hoof

Oligotrophic

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12
Q

how do you manage a fracture?

A

Resuscitation
Reduction of fracture - casts
Rest - hold the fracture in a position
Rehabilitation

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13
Q

state 3 types of conservative management of fractures

A

Rest and ice
Casts
Traction

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14
Q

state types of surgical management of fractures.

A

Internal fixation - MUA + K-wire, ORIF, IM nail

External fixation - mono/biplanar, multiplanar(ring)

Arthroplasty

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15
Q

__ is a condition where there is a decrease in bone density. Types include post-menopausal, senile and secondary.

A

osteoporosis

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16
Q

Rickets/osteomalacia results from _ or _ deficiency

A
  • vitamin D

- calcium

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17
Q

____ ___ is a disorder that results from abnormal collagen synthesis. fragile bones, bone deformities and blue sclera are common signs/symptoms.

A

osteogenesis imperfecta

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18
Q

how do you diagnose a fracture

A

History and examination – tenderness/limb pain/swelling

Obtain X-ray of affected region, ensure in at least two planes

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19
Q

what are the symptoms and signs of shoulder dislocation?

A

loss of normal shoulder contour, pain, restricted movement.

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20
Q

how do you manage a shoulder dislocation?

A

asses to see if there is axillary nerve damage. Vigorous manipulation or twisting should be avoided.

Use traction-counter traction +/- gentle internal rotation. Ensure patient relaxation (benzodiazepines)

If alone could use stimson’s method.

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21
Q

3 types of shoulder dislocation are?

A

Anterior
Posterior
Inferior

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22
Q

A _ shoulder dislocation is associated with seizures/shocks and has a light bulb sign on XR

A

posterior

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23
Q

A __ shoulder dislocation results from arm being held abducted above head

A

inferior

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24
Q

A __ shoulder dislocation is the most common type.

A

anterior

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25
Q

Damage to humeral head in shoulder dislocation is known as a __ lesion

A

Hill-Sachs

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26
Q

Damage to the labrum and/or glenoid in shoulder dislocation is known as a __ lesion

A

Bankart

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27
Q

what is a common cause of a proximal humerus fracture?

A

Fall onto an outstretched hand. Typically in elderly with osteoporosis

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28
Q

describe how proximal humerus fractures are classified

A

2 part - neck vs greater tuberosity fracture
3 part
4 part

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29
Q

what are the different management options for a proximal humerus fracture?

A
  • Collar and cuff - 2-part fracture, minimally displaced, high surgical risk
  • ORIF - fracture with displacement but not highly comminuted
  • Arthroplasty - fracture with large displacement and high risk of non-union
  • Reverse arthroplasty
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30
Q

describe how distal radius fractures are classified

A

Extra articular:

  • Dorsal angulation - colles fracture
  • Volar angulation - smith fracture

Intra articular:

  • Dorsal angulation - dorsal barton
  • Volar angulation - Volar/reverse barton
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31
Q

how do you manage a distal radius fracture?

A

cast/splint - minimally displaced
MUA & K-WIRE - extra-articular but with instability
ORIF- fractures not suitable for K-wires or with intra-articular involvement.

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32
Q

What 3 things does management of a distal radius fracture aim to restore?

A

Radial inclination
Radial height
Volar tilt

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33
Q

label the carpal bones of the wrist

A

refer to notes

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34
Q

what is the most common carpal bone injury?

A

scaphoid fracture

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35
Q

what examinations and investigations are required if a scaphoid fracture is suspected?

A

Scaphoid exam + scaphoid view X-ray

Always check if carpal bones are articulating well and if they have fractures

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36
Q

how is a scaphoid fracture managed?

A

undisplaced - cast

displaced - ORIF

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37
Q

what is the difference between a lunate and perilunate dislocation?

A

Perilunate = disruption of articulation of lunate with capitate only

Lunate = disruption of articulation with capitate AND radius

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38
Q

how is perilunate instability managed?

A
  • Acute injury (<8 weeks): Open reduction, ligament repair and fixation
  • Non-acute (>8 weeks): Proximal row carpectomy (converts wrist into simple hinge type)
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39
Q

Other than imaging X rays and radiographs, what other investigation is important if a pelvic fracture is suspected?

A

urethrogram

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40
Q

AN _____ exam and ATLS protocol is important in pelvic fractures and femoral shaft fractures

A

ABCDE

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41
Q

what are the 3 types of pelvic fractures

A

Lateral compression
Anterior-posterior compression
Vertical shear

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42
Q

how do you manage a NOF fracture?

A 
Pain relief 
Catheterise 
Blood tests 
ECG/Chest X-ray if >55
Rule out other injury/pathology causing fall
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43
Q

how can you treat a femoral shaft fracture?

A

intramedullary nail

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44
Q

state 3 different types of lower back pain

A

Non-specific

Mechanical

Nerve root pain (sciatica) - pain radiating to lower limb with or without neuralgic symptoms

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45
Q

what are some general causes of lower back pain?

A 
Tumour including myeloma
Infection -> e.g. due to tuberculosis 
Spondyloarthropathy
Pars interarticularis injury
Compression fracture
Visceral
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46
Q

Give 2 examples of lower back MECHANICAL pain

A 
Disc degeneration
Disc herniation
Annular tears
Facet joint OA
Instability
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47
Q

what are indicators for sciatica?

A

Unilateral leg pain greater than low back pain

Pain radiating to foot or toes

Numbness and paraesthesia in the same distribution

Straight leg raising test induces more leg pain

Localised neurology—that is, limited to one nerve root

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48
Q

Do you offer imaging in a non-specialist setting for people with low pack pain with or without sciatica?

A

No. treat first, if pain doesn’t go away, imaging

Or do specialist referral if needed

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49
Q

name some treatments for lower back pain

A 
Paracetamol, NSAIDS
Manipulation 
Acupuncture 
TNS 
Disc replacement
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50
Q

What are some red flags for malignancy in patients with lower back pain?

A

Weight loss
Fever
Night pain
Under 19 years

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51
Q

What are some red flags for spinal cord compression in patients with leg pain?

A

Bowel or bladder dysfunction
Saddle anaesthesia
Profound neurological deficit

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52
Q

what is the primary investigation for lower back pain?

A

MRI

Radiographs can miss lesions

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53
Q

identify some lower back conditions from the MRIs provided.

what condition can cause shiny corners on vertebral bodies of MRI

what condition can cause collapse of vertebral bodies?

A
  1. inflammatory arthropathy

2. tuberculosis of spine

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54
Q

what are the different types of epidural anaesthetic?

A

Interlaminar
Transforaminal
Caudal

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55
Q

state a non-surgical treatment for a slipped disc

A

nerve root block

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56
Q

The ankle joint is composed of the _ articulating with tibia and fibula.

A

talus

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57
Q

what are the 3 classes for ankle fractures?

A

Weber A - below the level of the syndesmosis, ligament disruption and joint stability unlikely

Weber B - at the level of the syndesmosis, ligament disruption and joint stability possible

Weber C - fractures occur above the level of the syndesmosis, therefore ligament disruption and joint instability likely

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58
Q

With ankle fractures, always check for ____ tenderness as a high fibula fracture may be present

A

proximal

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59
Q

___ refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus.

A

Maisonneuve fracture

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60
Q

How is compact/cortical bone organised?

A

Osteons - lamellae surrounding haversians canals
Volksman canals - transverse perforating canal
lacunae - small spaces containing osteocytes

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61
Q

What is the connective tissue covering bone called?

A

periosteum

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62
Q

describe the steps in fracture healing

A

Hematoma formation -> soft callus -> hard callus -> remodeling

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63
Q

3 mechanisms of bone fracture?

A

Trauma
Stress
Pathological - abnormal bone

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64
Q

different pathological causes of bone fracture?

A 
Osteoporosis 
Malignancy 
Vit D deficiency 
Osteomyelitis 
Osteogenesis imperfecta 
Pagets disease
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65
Q

which type of test checks for metastases?

A

bone scan

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66
Q

what key things do you consider when describing a fracture radiograph?

A

Location: which bone and which part of bone?

Pieces: simple/multifragmentary?

Pattern: transverse/oblique/spiral

Displaced/undisplaced?
Describing displacement: Translation (proximal vs distal, medial vs lateral, anterior vs posterior) and angulation (internal vs external rotation, dorsal vs volar, varus vs valgum) including X/Y/Z plane for both

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67
Q

how would you manage a fracture?

A

Reduce/ hold /rehabilitate

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68
Q

under hold, what options are there for fixation of a fracture?

A

Internal fixation - internal intra/extramedullary

External fixation - monoplanar, multiplanar

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69
Q

how would you reduce an open vs closed fracture?

A

Closed - manipulation, traction

Open - mini incision/full exposure

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70
Q

what are some general fracture complications?

A 
Fat embolus - hours 
DVT - days-weeks 
PE 
Infection/sepsis 
Prolonged immobility - UTI, chest infections, sores
71
Q

what are some urgent local fracture complications?

A 
visceral, vascular or nerve injury 
compartment syndrome
hemarthrosis 
infection 
gas gangrene
72
Q

what are some less urgent local fracture complications?

A 
sores 
fracture blisters 
nerve entrapment 
myosistis ossificans 
joint stiffness 
algodystrophy 
ligament injury, tendon lesions
73
Q

what are some late local fracture complications?

A 
union problems 
avascular necrosis 
muscle contracture 
joint instability 
osteoathritis
74
Q

what are the main causes of NOF fracture?

A

Osteoporosis - older

Trauma - younger

75
Q

When would a NOF fracture require total hip replacement?

A

Intracapsular fracture that is displaced and patient >65 years

76
Q

how do you classify joints?

A

Fibrous- e.g. sutures
Cartilaginous - e.g. spine, pubic symphysis
Synovial

77
Q

what are the key differences in X-ray findings in osteoarthritis vs RA

A

differences:
- OA has subchondral sclerosis
- OA has ostophytes
- MCP is spared. involvement of DIP (and PIP and 1st CMC)

  • RA has osteopenia
  • RA has bony erosions
  • RA can have ulnar finger deviation
  • involvement of MCP, wrist, (and PIP)
78
Q

what condition is degenerative. and starts in articular cartilage

A

OA

79
Q

which condition starts in synovium and an example is RA

A

Inflammatory Arthritis

80
Q

what are the risk factors for OA?

how does OA typically present?

A

Age
Weight
Menopause/estrogen deficiency
Trauma - e.g meniscus removal

pain in weight bearing joint with use -> improves after rest.
asymmetric joint involvement
no systemic symptoms

81
Q

how do you examine a patient in orthopeadics?

A

Look - e.g. scars, valgus alignment
Feel - e.g. for effusions
Move - range of movement possible e.g. knee flexion
Special tests - e.g. anterior drawer tes

82
Q

What 4 radiographic changes in knee are common in OA?

A

Loss of space
Osteophytes - new bone production
Sclerosis
Subchondral cysts

83
Q

how do you manage osteoarthritis?

A

Conservative - analgesic, steroid injections

Operation - e.g. knee replacement, ankle fusion

84
Q

What causes septic arthritis? What are the risk factors?

A

Bacterial infection of joint

Immunosuppressed, pre-existing damage, IV drug use

85
Q

What are the symptoms of septic arthritis? How do you diagnose it?

A

Acute painful, Red, hot, swollen joint, fever, usually only one joint involved
Diagnosis - joint aspiration -> gram stain and culture

86
Q

How do you treat Septic arthritis?

A

surgical wash out and IV antibiotics

87
Q

What organisms are usually responsible for septic arthritis?

A

Staphylococcus aureus, streptococci, gonococcus

88
Q

How do you treat osteomyelitis? (bacteria not in the joint, they are on the shaft of bones)

A

antibiotics

Surgical drainage

89
Q

distinguish between the 2 ways in which bones grow

A

Intramembranous: mesenchymal cells -> bone (flat bones)
Endochondral: mesenchymal -> cartilage -> bone (long bones)

90
Q

There are more bones in a __ skeleton, with __ bones

A

child

270

91
Q

Primary ossification centres occur ____ and form the ____ part of the bone. Secondary ossification centres are _____. There are often several and they are ____.

A

Prenatally
Central
Post-natal
Physes

92
Q

state 3 differences between children and adult bones

A

More elastic - can bend more due to increased density of haversian canals

They have physes - growth

Speed of healing and remodelling

93
Q

state 3 presentations you can get in children due to elasticity of bones

A

Plastic deformity - bends before breaking

Buckle fracture - taurus like column

Greenstick - one side snaps but other side buckles

94
Q

state some presentations you can get in children due to physeal injuries

A

Growth arrest

Deformity

95
Q

state locations where physis grows quickly in children

A

extreme upper limb

knee

96
Q

state 4 common congenital orthopedic conditions

A
  1. Developmental dysplasia of hip
  2. Club foot/ congenital Talipes Equinovarus
  3. Achondroplasia
  4. Osteogenesis
    imperfecta
97
Q

what is DDH?

A

Spectrum with dysplasia - subluxation - dislocation

98
Q

what are the risk factors for DDH?

A 
Female
First born 
Breech 
FH 
Oligohydramnios 
Native american
99
Q

how do you investigate and treat DDH?

A

Ultrasound up until 4 months
X ray after 4 months
Treatment = pavlik harness

100
Q

how does club foot present?

A

C avus- high arch
A dductus of foot
V arus
E quinous

101
Q

risk factors for club foot?

A

Male
Hawaiin
PITX1 gene

102
Q

treatment for club foot

A

Ponseti method - sequential casts

May require operative treatment - soft tissue release

Foot orthosis brace

103
Q

___ is the most common skeletal dysplasia

A

achondroplasia

104
Q

what causes achondroplasia?

A
  • G380 mutation of FGFR3

- Inhibition of chondrocyte proliferation in the physis -> defect in endochondral bone formation

105
Q

how does achondroplasia present?

A
  1. Rhizomelic dwarfism:
    - Humerus shorter than forearm
    - Femur shorter than tibia
    - Normal trunk
  2. Normal cognitive
    development
  3. Significant spinal issues
106
Q

what causes OI?

A

Decreased secretion of OR abnormal collagen production -> insufficient osteoid production

107
Q

effects of OI?

A
  1. Bones - fragility fracture, short stature, scoliosis
  2. Non orthopedic:
    - Heart
    - Blue sclera
    - Dentiogenesis imperfecta - brown soft teeth
    - Wormian skull
    - Hypermetabolism
108
Q

If a fracture affects the physis in children, the fracture description must include the _____ classification.

A

Slater-harris

109
Q

In primary bone healing, there is no ___ formation.

A

callus

110
Q

how would you describe a pediatric fracture x ray?

A

P attern - transverse, oblique, spiral, comminuted, avulsion
A natomy - location
I ntra/extra articular
D displacement - displaced, angulated, shortened, rotated
S alter-Harris

111
Q

describe the Salter-Harris classification system

A

Type 1 - physeal Separation

Type 2 - fracture traverses physis and exits metaphysis Above

Type 3 - fracture traverses physis and exits physis Lower

Type 4 - fractire passses Through epiphysis, physis and metaphysis

Type 5 - crush injury to physis

Risk of growth arrest increases from type 1-5
Type 2 is the most common

112
Q

How would a whole physeal injury differ from partial?

A

Whole physis - limb length discrepancy

Partial - angulation

113
Q

how do you treat growth arrest?

A

Limb length correction - shorten long side, lengthen short side

Angular deformity correction - stop growth of unaffected side OR reform the bone (osteotomy)

114
Q

Pediatric fractures are often managed by ___ reduction. An example of a traction method used is ___ traction

A

closed

Gallows

115
Q

state 4 causes of a limp in a child

A
  1. Septic arthritis - kocher’s classification can help diagnose - requires surgical washout
  2. Transient synovitis - diagnosis of exclusion after ruling out septic arthritis - can be managed with antibiotics
  3. Perthes
  4. SUFE (slipped upper femoral epiphysis)
116
Q

To diagnose limp in a child, you must always rule out __ ___ first

A

septic arthritis

117
Q

what is perthes?

A

Idiopathic necrosis of the proximal femoral epiphysis

More common in men

118
Q

how do you diagnose perthes?

A

Won’t see temp or inflammatory markers

Plain film radiograph

119
Q

risk factors for SUFE?

A

Obese adolescent male

12-13 during rapid growth

Associated with hypothyroidism/hypopituitarism

120
Q

How do you treat SUFE?

A

Fixation with screw

121
Q

Describe 3 causes of joint inflammation and give examples of related diseases

A

1) Crystal arthritis
Gout
Pseudogout

2) Immune-mediated(“autoimmune”)
- Rheumatoid arthritis
- Seronegative spondyloarthropathies
- Connective tissue diseases

3) Infection
Septic arthritis
Tuberculosis

122
Q

what is gout?

A

syndrome caused by deposition of urate (uric acid) crystals -> inflammation

123
Q

risk factors for gout?

A
  • Genetic tendency
  • Increased intake of purine rich foods
  • Reduced excretion (kidney failure)
  • Hyperuriceamia
124
Q

what is pseudogout?

A

a syndrome caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystal deposition crystals -> inflammation

125
Q

risk factors for psuedogout?

A

background osteoarthritis, elderly patients, intercurrent infection

126
Q

Acute arthritis occurs as a result of _____. It can lead to ___ and gouty arthritis

A 
hyperuricemia 
tophy (external ear, olecranon bursa, achilles tendon)
127
Q

Gouty arthritis commonly affects the 1 MTP joint. This can be described as ____. X-ray shows “rat bite’ ___.

A

podagra

erosions

128
Q

What investigations and management is carried out for crystal arthritis?

A

Joint aspiration
- synovial fluid analysis

Management
- Acute attack – colcihine, NSAIDs, Steroids

  • Chronic – allopurinol
129
Q

Distinguish between the shape and birefringence in gout and pseudogout

A

gout - needle shaped, negative

Pseudogout - brick-shaped, -Positive

130
Q

describe how RA (rheumatoid arthritis) presents

A

Polyarthritis

Symmetrical joint involvement

Early morning pain and stiffness -> improves with use

systemic symptoms -> fever fatigue, weight loss.

131
Q

State some extra-articular manifestations that occur in RA

A

Rheumatoid nodules - common on elbow

Rare: vasculitis (can cause digital ischemia), occular inflammation e.g. episcleritis, neuropathies, Amyloidosis, Lung disease, Felty’s syndrome (triad of splenomegaly, leukopenia and RA)

132
Q

What is the Rheumatoid ‘factor’ that may be detected in the blood in RA.

A

IgM antibody against IgG Fc region

133
Q

The primary site of pathology in RA is the ____ . It becomes a mass of tissue due to Neovascularisation, Lymphangiogenesis and inflammatory cells. ______ is a key inflammatory cytokine in this condition.

A

Synovium (can also get bursitis, extensor tenosynovitis)

TNF-alpha

134
Q

What are the treatment options for RA?

A

1st line - methotrexate (DMARD. folic acid analog that inhibits DHFR and decreases DNA synthesis) in combination with hydroxychloroquine or sulfasalazine

2nd line - biologics:

  • anti TNFs antibodies - infliximab, adalimumab, golimumab
  • antibodies against B cell CD20 - Rituximab
  • receptor fusion proteins - entanercept - binds TNF and prevents it from binding to IgG
  • interleukin 6 receptor antagonists (tocilizumab, sarilumab)

glucocorticoids (prednisolone)

135
Q

What are some key features of seronegative spondyloarthritis?

A

Arthritis without Rheumatoid factor

Strong association with HLA-B27

Subtypes show variable inflammatory back pain(early morning, IMPROVES with exercise), peripheral arthritis, enthesitis, dactylitis, uveitis.

ASSYMETRICAL arthritis

136
Q

Name the 4 subtypes of seronegative spondyloarthritis

A

P - psoriatic arthritis
A - ankylosing spondylitis
I - Inflammatory bowel disease
R - reactive arthritis

137
Q

Ankylosing spondylitis is inflammation of spine and ___ ___. It results in ___ __. Typical finding on imaging is ___ ____. Patients may have loss of lumbar lordosis and hyperextended neck.

A 
Sacroiliac joint. (can narrow)
Spinal fusion 
Bamboo spine (vertebral fusion)
138
Q

What are the features and findings in psoriatic arthritis?

how do you treat it?

A

ASYMMETRICAL arthritis involving IPJs

Pencil in cup deformity of DIP on X-Ray

Psoriasis association

dactylitis

treat with methotrexate, avoid steroids

139
Q

What are the features of reactive arthritis?

A

Sterile inflammation in joints following infection

GI infections - salmonella, shigella, campylobacter

Urogenital - chlamydia

Triad; conjunctivitis, urethritis, arthritis

self limiting

140
Q

____ is an example of a connective tissue disease that causes joint inflammation. Clinical tests show ANA (highly sensitive but not specific) and anti-dsDNA (specific).

A

SLE

141
Q

What 3 investigations are usually carried out in rheumatology?

A
  • blood tests
  • joint (synovial) fluid analysis
  • Imaging tests - X-rays,etc
142
Q

when looking at the full blood count. what would the WCC be in:

  1. inflammatory arthritis
  2. osteoathritis (degenerative arthritis)
  3. septic arthritis
A

inflammatory arthritis - usually normal

osteoathritis - normal

septic arthritis - leucocytosis

143
Q

A patient complains of painful joints in front of you.

go through this long list to see the order in which you should order tests.

A

May not need if diagnosis is clear from history and examination e.g. osteoarthritis of knee

Start with basic blood tests: 
FBC 
U&E 
LFT
Bone profile 
ESR 
CRP

If ESR/CRP elevated then move on to do specialist tests for conditions causing inflammatory arthritis:

  1. RF - non-specific. anti -CPP - more specific for RA
  2. ANA - non-specific. In combination with correct clinical features may indicate an autoimmune connective tissue disease (SLE, Sjrogren’s syndrome, scleroderma, polymyositis)

If ANA is positive, do an ENA test(panel of 5 autoantibodies)

  1. Ro - lupus or sjogrens syndrome
  2. La - lupus or sjogrens syndrome
  3. RNP - lupus or mixed connective tissue disease
  4. Smith - lupus
  5. Jo-1 - polymyositis

If ANA is positive, also order dsDNA - highly specific for lupus. Associates with renal involvement, useful for tracking lupus activity. Can also look at C3 and C4 with decrease in active lupus

144
Q

Give examples of how rheumatological diseases can impair kidney function

A

SLE - lupus nephritis

Vasculitis - nephritis

Poorly controlled chronic inflammatory disease -> high

SAA protein -> SAA deposits in organs (AA amyloidosis)

NSAIDS can impair kidney

145
Q

Why are LFTs important in rheumatology?

A

DMARDs e.g. methotrexate can cause liver damage.
Regular blood tests required

Low albumin can reflect liver synthesis problem or problem of leak from kidney (e..g in lupus nephritis)

146
Q

What is pagets disease and what will a bone profile show?

A

Abnormality of high bone turnover

bone pain, excessive bony growth, fracture through abnormal bone

ELEVATED ALP

147
Q

What does a bone profile show for ostoeomalacia?

A

Elevated calcium

Others usually normal

148
Q

What does a bone profile show for osteoporosis

A

Normal values usually

Diagnosis made with DEXA scan

149
Q

ESR and CRP are useful markers of _____. However ___ can be up for other reasons. ___ more specific.

A

Inflammation
ESR
CRP

150
Q

What do ESR and CRP values show in SLE?

A

ESR usually high. CRP usually normal

High CRP - first suspect infection

151
Q

How do you interpret an ANA test?

A

1:80 means it is the furthest dilution at which the ANA was still detectable. It is weak
Therefore 1:1280 is strong

Negative test rules out SLE
Positive test doesn’t mean SLE. only if other clinical and lab features

152
Q

State 2 reasons for joint aspiration

A

Diagnostic - septic arthritis, crystal arthritis

Therapeutic to relieve symptoms +/- steroid injection

153
Q

State 3 key differences between septic and reactive arthritis

A

Synovial fluid culture is negative in reactive arthritis

No antibiotic therapy is given in reactive arthritis

No joint lavage in reactive arthritis

154
Q

State the types of imaging used in rheumatology and when they will be appropriate

A

X rays - first line
CT scans - more detailed bony imaging
MRI - visualization of soft tissues like tendons and ligaments. Best for spinal imaging
Ultrasound - can visualise soft tissues. Good for small joints

155
Q

early RA is best detected with ___ imaging. what might you see?

A

Ultrasound

  • synovial hypertrophy
  • increased blood flow -> doppler signal

*a normal x-ray doesnt rule out RA

156
Q

What is the key antibody in systemic vasculitis?

A

ANCA

157
Q

What antibodies are associated with RA?

A

Rheumatoid factor- not specific

Anti-cyclic citrullinated peptide (CCP) antibodies - more specific

158
Q

Where are the key sites of inflammation in SLE?

A

joints, skin, kidney

159
Q

What antibodies are associated with SLE? How do you interpret their findings?

A

Antinuclear antibodies - always seen, not specific for SLE

Anti-double stranded DNA antibodies- specific, level correlated with disease activity

Antiphospholipid antibodies - associated with risk of venous and arterial thrombosis. Can occur in absence of SLE

anti-SM - specific

Also Low C3 and C4 (they are not antibodies)

160
Q

How do you treat SLE?

A

Ibuprofen

Hydroxychloroquine

persistently active or severe disease -> B cell targeted therapies (rituximab and belimumab)

161
Q

what are the connective tissue disorders?

A

Systemic Lupus Erythematosus (SLE)

Sjögren’s syndrome

Autoimmune inflammatory muscle disease: Polymyositis, Dermatomyositis

Systemic sclerosis (scleroderma): Diffuse cutaneous, Limited cutaneous

Overlap syndromes

162
Q

what are the key features of connective tissue disorders

A

Arthralgia and arthritis is typically non-erosive

Raynaud’s phenomenon may be present

163
Q

What is sjogrens syndrome? What are the features? what antibodies are associated with it?

A 
Autoimmune exocrinopathy (lymphocytic infiltration) 
Non-erosive arthritis 
Dry eyes 
Dry mouth 
Parotid gland enlargement
Raynaud's phenomenon

anti-Ro and/or anti-La antibodies (can also be seen in SLE)

164
Q

what is inflammatory muscle disease?

A

Progressive symmetric proximal muscle weakness
With rash = dermatomyositis
Without rash = polymyositis

165
Q

Which antibody is specific for dermato or polymyositis?

A

anti-tRNA transferase e.g anti-Jo-1

166
Q

what are the findings in inflammatory muscle disease?

A

Elevated CK
anti-Jo-1 antibodies
CD8+ T cells in muscle biopsy = polymyositis
CD4+ T cells in muscle biopsy = dermatomyositis

Dermatomyositis: 
Gottron's papules 
Heliotrope rash on eyelids
Malar rash 
Mechanics hands 
Shawl sign
167
Q

state 2 conditions associated with dermatomyositis

A

Malignancy

Interstitial lung disease

168
Q

What antibody is specific for a mixed connective tissue disease?

A

anti-U1 RNP

169
Q

what is systemic sclerosis/scleroderma

A

Noninflammatory vasculopathy and collagen deposition with fibrosis

key findings:

  • Sclerosis of skin - puffy taught skin, thickened skin without wrinkles, fingertip pitting
  • Raynauds phenomena

May involve other body systems
Diffuse and limited type

170
Q

what are the features of limited systemic sclerosis?

A

Limited skin involvement - fingers and face

Anticentromere antibodies

CREST syndrome: Calcinosis cutis(calcium deposits on elbows knees and fingers that leak white fluid), Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly (claw like hands), Telangiectasia (dilated capillaries beneath skin of face and lips)

Raynauds

Severe complication -> pulmonary disease-> Hypertension, fibrosis

171
Q

What are the features of diffuse systemic sclerosis?

A

Widespread skin involvement

anti-SCL-70 antibody

Visceral involvement - pulmonary disease, renal, GI,

raynauds

172
Q

How do you treat gout?

A

Acute = NSAIDS (not including aspirin) glucocorticoids, colchicine (inhibits microtuble polymerisation impairing neutrophil chemotaxis)

Chronic = allopurinol (Xanthine oxidase inhibitor)

173
Q

swan neck and boutonniere are findings in what arthritic condition?

A

Rheumatoid arthritis

174
Q

state 3 conditions in rheumatoid arthritis that can develop from synovial inflammation

A
  1. Extensor tenosynovitis - due to inflammation of tenosynovium surrounding tendons
  2. bursitis e.g. olecranon bursitis
  3. joint synovitis

Medicine MBBS year 2 (11 decks)

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