MSK rheumatology summary Flashcards
(103 cards)
1
Q
autoantibody for mixed CTDs
A
anti RNP
2
Q
are ganlion cysts true cysts? why?
A
no epithelial lining
3
Q
histology of synovial cysts
A
space with myxoid material
4
Q
which drugs may cause dupytrens
A
anticonvulsants
5
Q
features of embryonal rhabdomyosarcoma
A
cildhood
central tract, GI tract, GU tract, H+N, common bile duct
deletion xp11,15
6
Q
features of alveolar skeletal muscle tumours
A
young adults
many sites eg H+ N
PAX translocation (t2,5)
7
Q
features of pleomorphic skeletal muscle tumour
A
rarest form of older age group
IHC - myogi, myogenin
8
Q
what is the difference between liposarcoma and lipoma
A
lipoblasts (purple blobs) in liposarcoma
9
Q
who are rhabdomyosarcomas found in
A
children
10
Q
where are leiomyomas found?
A
uterus
11
Q
what is an osteoma
A
simple - cranial bones
multiple - gardners syndrome
paediatric leisons - nidus
12
Q
what is an osteosarcoma
A
childrens long bones
codmans triangle
any malignant osteoid producing tumour is osteosarcoma until proven otherwise
13
Q
what is ewings sarcoma
A
translocation of chromosomes 11+12
small, round, blue cells
14
Q
describe nodular fascitis
A
a rare, non-cancerous tumour of soft tissue which mimics cancer cells
15
Q
which cells surround the terminal bouton?
A
schwann cells
16
Q
what are the 5 key steps of neuromuscular transmission?
A
- synthesis of ACH in cytoplasm of bouton
- uptake of ACH into synaptic vesicles for concentration + storage
- Ca+ dependent release of ACH INto synaptic cleft by exocytosis
- brief activation of nicrotinic ACH receptors by reversible binding of ACH
- rapid transmission of neurotransmittion action by ACHe within synaptic cleft
17
Q
what is the role of ACHe?
A
it hydrolyses ACh to choline + acetate
- choline is taken up by choline transporter
- acetate diffuses from synaptic cleft
18
Q
what is neuromytonia / issacs syndrome?
A
cramping, stiffness + muscle twitches
prolonged epp
19
Q
how to treat isaacs syndrome?
A
carbimazepine (blocks voltage gates Na+ channels)
20
Q
what is lambert eaton myasthenia syndrome?
A
muscle weakness in limbs
associated with SCLC
decreased release of ACH
21
Q
how to treat lambert eaton mtasthenia syndrome?
A
pyridostigmine (increases duration of action of ACH in synaptic cleft + K+ channel blockers
22
Q
what is myasthenia gravis
A
increasing muscle weakness during periods of activity
weakness in eyelid and muscles
decreased epp
23
Q
how to treat myasthenia gravis
A
pyridostigmine
24
Q
what it botulinum toxin
A
irreversively inhibits ACh release
used to remove wrinkes
25
what is an osteochondroma
```
most common
cartilaginous outgrowth
local pain
1% chance of malignancy
multiple = MEN
```
26
what is an enchondroma
intramedullary
| metaphyseal cartilaginous tumour
27
what causes enchondroma
failure of normal enchondral ossification at the growth plate (growing cartilage is replaced by bone)
28
what does enchondroma look like
a leucent lesions which can undergo mineralisation --> patchy sclerotic appearance
29
what is a simple bone cyst
fluid fillled cyst in bone
| growth defect from physis
30
where are simple bone cysts usually seen?
proximal humerus and femur
31
what is a giant cell tumour
locally agressive / painful
| involves epiphysis
32
where are giant cell tumours most commonly seen
knee and distal radius
| soap bubble appearance
33
what is the met stat for giant cell tumor?
5% met to lung
34
how to treat giant cell tumour
intralesional excision with phenol, bone cement or liquid nitrogen to destroy remaining tumour
35
what if fibrous dysplasia?
genetic mutation which causes lesions of fibrotic tissue + immature bone
36
what is xray sign for fibrous dysplasia?
extensive involvement of femur = shephards crook deformity
37
what does a bone scan show in fibrous dysplasia?
increased uptake during development but usually becomes inactive
38
what is the treatment for fibrous dysplasia?
bisphosphonates
39
what is osteoid osteoma?
small nidus of immature bone surrounded by an intense sclerotid halo
40
features of osteoid osteoma?
intense constant pain which is worse at night
| NSAIDS
41
what is an osteosarcoma?
produced bone in adolescents
60% around knee
met spread - haematogenous
42
met stats for osteosarcoma
10% have pulmonary mets at diagnosis
43
what is a chondrosarcoma
cartilagous producing bone
older ages - 45
large and slow to met
pelvis / proximal femur
44
what is a fibrosarcoma
occurs in abnormal bone eg bone infarct
45
what is ewings sarcoma
primitive cells in bone marrow
fever
warm swelling
46
treatment of primary malignant bone tumours
1. bone scan / CT/ MRI -> local extent of tumour
2. biopsy - histology and grading
3. bone removed with wide margin of 3-4cm of bone + a cuff of normal muscle all around
4. adjuvant radio / chemo if indicated
47
describe breast bone mets
can be blastic /sclerotid (fills bone with extra cells)
or lytic (destroy bone material)
24-26 months survival
48
describe prostate bone mets
sclerotic mets
more likely to hear
45% survival at one year
49
describe lung bone mets
lytic bony mets
| 6 months survival
50
describe renal cell carcinoma bone mets
vascular 'lyric blow out' bony mets
can bleed with biopsy / surgery
12-18 months
51
what is a bursa?
small fluid filled sac lined with synovium around a joint which prevents friction between tenodons, muscles and bones
52
causes of AVN
alcohol + corticosteroids (they alter metabolism > coagulation > ischaemia + Stasis)
thrombophila
caissons disease
53
genetics for RA
HLA DR4
HLA DRB1
arginine > citrulline > protein unfolding due to loss of positive charge (anti-CPP)
54
which joints are affected by RA?
MCP, MTP, PIP
| small joints before bigger joints
55
what is atlanto axial subluxation?
a symptom of RA
| occurs due to destruction of the synovial joint between atlas + dens + rupture of transverse ligaments
56
what is the occular involvement of RA?
keratoconjunctivitis sicca
episcleritis
uveitis
nodular scleritis (may lead to scleromalacia)
57
what cytokine production is involved in RA?
INFg - activated synovial cells
TNF + IL1 - stimulates production of proteases from synovium
RANKL on activated T cells - stimulates bone resorption
58
how does rheumatoid factor work?
IgM or IgG antiobody binds to Fc region of IgG
59
acute vs chronic phase of RA?
acute - pannus formation + Destroyed cartilage
chronic - fibrosis + deformity
60
can anti CPP be present before symptoms?
yes and remains positive during treatment
61
which scoring system is used for RA?
das 28
62
explain results of das28
<2.6 - remission
2.7-3.2 - decreased disease activity
3.3-5.1 - moderate disease activity
>5.1 - increased disease activity
63
side effects of DMARDs
```
bone marrow suppression
infection
liver fucntion derangements
pneumonitis
nausea
takes 3 months to start working
```
64
give example of anti TNF
infliximab
65
give example of b cell depleter
rituximab
66
give example of IL6 blocker
toclizumab
67
decsribe swan neck deformity
volar plate of PIP joint becomes attenuated
| small ligaments + lubrical tendons fall more dorsal to joint centre
68
describe boutonniere button hole
extensor hood of PIP joint becomes attenuated
| flexion of PIP
69
what is the stepwise treatment for RA?
1. non-opioid eg NSAID
2. weak opioid eg codine + NSAID
3. strong opioid (morphine) + non-opioid
70
what virus is associated with SLE
EBV
71
is ANCA + or - in SLE
+
72
minor features of SLE
sclerodactylyl
atrophy or fingertips
bilateral lung fibrosis
73
haematological features of SLE
anaemia
leukopenia (decreased WCC)
thrombocytopenia (decreased platelets)
74
renal features of SLE
proteinuria >0.5g in 24 hours
75
random features of SLE
jaccouds arthroplasty + serosis
76
diagnosis of SLE
1 major and 2 micro
77
management of SLE
HLQ (DMARD)
78
3 stages of raynauds
blanching > acrocyanosis > reactive hyperaemia
79
antibodies involved with scleroderma
anticentromere (limited)
anti-scl70 (diffuse)
anti-RNA polymerase
80
treatment for pulmonary hypertension
PDE5 inhibitor
81
what is pulmonary fibrosis
progressive SOB
bilateral crackles on chest examination
restrictive pattern
82
treatment of pulmonary fibrosis
1. mycophenolate mofenl
| 2. rituximab
83
which antibody is associated with renal crisis?
anti RNA polymerase 3 antibody
84
3 features of dermatomyositis
```
gottrons papules (red marks on knuckles)
helitropes rash (red/ purple rash around eyelids)
shawl sign - rash in shawl area
```
85
does polymyositis increase CK
yes
86
diagnosis of poly / dermatomyositis
1. perivascular inflammation + muscle necrosis
| 2. MRI - muscle inflammation, oedema, fibrosis + calcification
87
treatmetn for poly / dermato myosiits
1. corticosteroids
| 2. immunosuppression
88
treatment of polymyalgia rheumatic
15mg prenisolone
89
treatment of temporal arteritis / giant cell arteritis?
40-60mg prednisolone (gradulal reduction over 2 years)
90
feature of fibromyalgia
widespread pain > 3 months
91
grading for ankylosing spondylititis
modified new york critera + ASAS classification
92
xray features of psoriatic arthritis
marginal erosions
whiskering
pencil in cup
93
when does reactive arthritis occur?
1-4 weeks after infection
94
how to treat recative arthritis ?
NSAIDS
95
feature of enteropathic arthritis
pyoderma gangrenosum
96
symptoms of large vessel vasculitis
bruit (carotid artery)
BP differences of extremities
claudication
97
who gets takaysu
<40 asian females
98
who gets giant cell arteritis
>50
associated with polymyalgia rheumatic
risk of blindness
99
how to treat giant cell arteritis
40-60mg prednisolone
100
symptoms of GPA
nasal / oral inflammation
abnormal chest radiograph
urinary sediment
grnaulomatous inflamamtion on biopsy
101
who gets GPA
35-55
102
symptoms of EGPA
late onset asthma + increased eosinophil count
| 10% increase in peripheral blood
103
symptoms of HSP
bloody diarrhoea
purpura
2-11 years olds after URTI
