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Musculoskeletal Flashcards

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1
Q

Mechanism of SMOOTH MUSCLE contraction

A

Depolarisation caused by action potential and OPENING of voltage gated Ca2+ channel

Ca2+ ions bind to CALMODULIN

Myosin light kinase chain ACTIVATED

The role of myosin:actin coupled with MYOSIN P causes contraction

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2
Q

Mechanism of SKELETAL and CARDIAC MUSCLE contraction

A

Depolarisation caused by action potential and OPENING of voltage gated Ca2+ channel

  • NEUROTRANSMITTER released

Spread of depolarisation down the T TUBULES to DIHYDROPYRIDINE RECEPTORS in skeletal muscle

In CARDIAC muscle- it involves calcium-induced calcium release

  • Increased calcium ions from calcium-induced calcium release- calcium ions bind to TROPONIN C

Myosin head binds to actin when TROPOMYOSIN moves

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3
Q

Cause of Rheumatoid Arthritis

A

Hypersensitivity III reaction

Involves HLA DR4 and HLA DR1

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4
Q

6 Hand signs of Rheumatoid Arthritis

A
  • Z deformity
  • Boutonniere deformity
  • Swan neck deformity
  • Ulnar deviation
  • Subluxation of fingers
  • Raynaud’s phenomenon (decreased blood flow to fingers and sometimes ears, nose, nipples, toes, knees)
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5
Q

Feet and Skin signs of Rheumatoid Arthritis

A

Feet-

  • Hammer toe deformity
  • Subluxation of toes

Skin-

  • Rheumatoid nodule
  • Vasculitis
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6
Q

Respiratory, Cardiovascular and Wrist signs of Rheumatoid Arthritis

A

Respiratory-
- Pulmonary Fibrosis

Cardiovascular-
- Atherosclerosis increased in RA

Wrist-
- Carpal Tunnel syndrome

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7
Q

Investigations in Rheumatoid Arthritis

A

Blood-

  • Rheumatoid factor
  • Cyclic Cytrullinated Peptides (CCP) antibodies

Radiology-

  • Subluxation
  • Periarticular osteoporosis
  • Bony erosion
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8
Q

Treatment of Rheumatoid Arthritis

A

Physiotherapy

Medical-
- GLUCOCORTOIDS

  • DMARDS (Gold salts, Methotrexate, Sulfasalazine)
  • Anticytokine therapy considered if patient is intolerant to METHOTREXATE

Surgery- if severely affected- EXCISION arthroplasty

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9
Q

Complications of Rheumatoid Arthritis

A

PERICARDITIS

Sjogren’s Syndrome (dry eyes and mouth)

Cervical myopathy

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10
Q

Pain worse in the morning vs in the night

A

Morning- Rheumatoid Arthritis

Night- Osteoarthritis

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11
Q

Risk factors of Osteoarthritis

A
  • Increased age
  • Conditions such as Haemochromatosis and Ehlers-Dalos Syndrome
  • Obesity
  • Trauma to joint
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12
Q

Signs and Symptoms of Osteoarthritis

A
  • Pain and stiffness
  • Swelling around joints
  • Crepitus (crackles)
  • HEBERDEEN’s nodes at DIP (remember outer hebrides)
  • BOUCHARD’s nodes at PIP
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13
Q

Investigations in Osteoarthritis

A

Bloods- relevant is OS is linked to another condition such as HAEMOCHROMATOSIS

Radiology (LOSS)

  • Loss of joint space
  • Osteophytes
  • Subchondrial cysts
  • Sclerosis
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14
Q

Treatment of Osteoarthritis

A

Encourage exercise and weight loss

Medical-
- Analgesia (paracetamol or NSAIDs)

  • Gels such as CAPSAICIN
  • Steroidal injections
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15
Q

Complications of Osteoarthritis

A
  • Increased risk of GOUT

- CHONDROCALCINOSIS (calcium phosphate deposition in joints)

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16
Q

Types of Spondyloarthropathies

A

Psoriatic arthritis
Enteropathic arthropathies
Ankylosing spondylitis
Reactive arthritis

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17
Q

Reactive arthritis symmetrical or asymmetrical and causes of it

A

ASYMMETRICAL

Occurs after GASTROINTESTINAL or UROGENITAL infection

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18
Q

4 signs and symptoms of Reactive arthritis

A

Urethritis
Uveitis- eye infection
Conjuctivitis- eye infection
Arthritis- pain and stiffness

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19
Q

Investigations in Reactive arthritis

A

Make sure it is SERONEGATIVE for Rheumatoid arthritis

Blood cultures- look for infectious cause

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20
Q

Treatment of Reactive arthritis

A

Physiotherapy

Analgesia (NSAIDs)

DMARDs (sulphasalazine)

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21
Q

Complications of Reactive arthritis

A

Arrhythmia

Aortic insufficiency

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22
Q

Psoriatic arthritis, Enteropathic arthritis and Ankylosing spondylitis associated with which gene?

A

HLA B27

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23
Q

Causes of Psoriatic arthritis

A

Inflammatory process coupled with HLA B27 gene

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24
Q

THREE signs and symptoms of Psoriatic arthritis

+3 points about psoriasis
(+4 nail changes)

A

Psoriasis-
- Salmon pink plaques with evidence of scaling

  • usually present on the EXTENSOR SURFACES but can occur in RAINDROP PATTERN over torso
  • GUTTATE PSORIASIS preceded by UPPER RESP INFECTION caused by STREPTOCOCCUS

Nail changes (pitting, yellowing of nail, onycholysis (painless detachment of nail from nail bed), subungual hyperkeratosis (scaling under skin))

Swelling of affected joint and swelling of affected joints

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25
Investigations in Psoriatic arthritis
Make sure bloods are seronegative for RHEUMATOID ARTHRITIS Radiology- - pencil-in-cup deformity on hand xray
26
Treatment for Psoriatic arthritis and Ankylosing spondylitis
Explain that Psoriasis has NO CURE ANALGESIA (NSAIDs) DMARDS (Methotrexate)
27
Where does chronic inflammation happen in Ankylosing Spondylitis
Spine and Sacroiliac joints
28
Signs and symptoms of Ankylosing spondylitis
Question mark posture Bamboo spine- due to CALCIFICATION OF LIGAMENTS Pain and stiffness which gets BETTER with EXERCISE
29
Enteropathic arthritis associated with which condition?
IBD
30
4 Signs and Symptoms of Enteropathic arthritis
IBD symptoms Spondylitis (inflammation of spine) Sacroilitis Peripheral Arthritis (usually of large joints)
31
Which joint does Gout present in? and what is deposited?
Metatarsophalangeal joint URATE crystals
32
Causes of GOUT
Horrific DELAY Hyperuricaemia, Hereditary ``` Diuretics (thiazide) Ethanol Leukemia renAl impairment lesch-nYhan syndrome ```
33
Signs and Symptoms of GOUT
inflammation of affected joint Tophi (urate deposits) may be present on tendon surfaces (elbow or ear) Patient may have symptoms of RENAL CALCULI
34
Investigations in GOUT
Serum URATE levels CREATININE GFR- assess kidney function SYNOVIAL FLUID ANALYSIS (positive if birefringement monosodium urate crystals seen)
35
Treatment of GOUT
Low PURINE diet Stop causative agents- thiazide diuretics ANALGESIA Acute- COLCHICINE and STEROIDS Chronic- ALLOPURINOL and FEBUXOSTAT may be used if allopurinol is not tolerated
36
Complications of GOUT
Renal calculi Tophi formation
37
Risk factors of OSTEOPOROSIS
- Prolonged STEROID use - Diet deficient in CALCIUM - Increasing age - Excessing alcohol and smoking - Loss of protective oestrogen in postmenopausal women - Endocrine disorders such as DIABETES MELLITUS and HYPERTHYROIDISM
38
Signs and Symptoms of OSTEOPOROSIS
- often asymptomatic until pathological fracture - Loss in height - Back pain - Dowager's hump (hyperkyphosis)
39
Investigations in OSTEOPOROSIS
PTH Serum calcium Serum phosphatase Alkaline phosphatase DEXA scan- T score>2.5 is diagnostic
40
Treatment of OSTEOPOROSIS
Selective Oestrogen Receptor Modulators (SORM/ SERM) Calcitonin and Bisphosphonates
41
The ONLY BONE DISEASE where Serum Calcium and Serum Phosphate are low And PTH is high
Osteomalacia
42
Two bone diseases where Alkaline Phosphatase is high
Osteomalacia and Osteopetriosis
43
Axillary Nerve NERVE ORIGIN
C5-C6
44
Musculocutaneous NERVE ORIGIN
C5-C7
45
Median NERVE ORIGIN
C5-T1
46
Ulnar NERVE ORIGIN
C8-T1
47
Radial NERVE ORIGIN
C5-C8
48
Axillary nerve LESION
Deltoid muscle paralysis
49
Musculocutaneous LESION (rare)
Paralysis of biceps, brachialis and coracobrachialis
50
4 LESIONS of Median nerve
Above antecubital fossa At wrist Below antecubital fossa Within the wrist
51
Ulnar LESION
Ulnar clawing
52
Radial LESION
Wrist drop
53
C5-C6 LESION
Erb-Duchenne Palsy
54
C8 and T1 LESION
Klumpke's Palsy
55
Two causes of Deltoid muscle paralysis (AXILARY LESION)
Shoulder dislocation Humerus neck fracture
56
Two causes of Paralysis of biceps, brachialis and coracobrachialis (MUSCULOCUTANEOUS LESION)
Complication of surgery Dislocation
57
Complication of Musculocutaneous lesion
DECREASED sensation of lateral forearm
58
TWO causes of LESION above antecubital fossa (MEDIAN LESION)
Supracondylar fractures Neuropathy
59
Cause of LESION at wrist (MEDIAN LESION)
LACERATION of wrist
60
3 complication of LESION above antecubital fossa AND at the wrist
Papal sign of benediction Ape hand deformity Loss of sensation over THENAR EMINENCE
61
Cause of LESION below antecubital fossa (MEDIAN LESION)
Injury to the ANTERIOR interosseous branch of the MEDIAN NERVE
62
Two complications of LESION below antecubital fossa
Anterior interosseous syndrome Inability to PRONATE the forearm
63
Cause of LESION within the wrist (MEDIAN LESION)
Carpal Tunnel Syndrome
64
Carpal Tunnel Syndrome- Where is the PARAESTHESIA? When is the pain worse? What tests are done to diagnose Carpal Tunnel Syndrome? What 7 things is Carpal Tunnel Syndrome associated with?
- Paraesthesia in LATERAL 2.5 fingers - Pain is worse at night (like OSTEOARTHRITIS) - Phalen's and Tinel's Test done to diagnose Carpal Tunnel Syndrome - Pregnancy - Oral Contraceptive Pill - Diabetes - Rheumatoid arthritis - Heart failure - GOUT - ACROMEGALY
65
2 causes of Ulnar clawing (ULNAR LESION)
Cubital Tunnel Syndrome Ganglion cyst in the Guyon canal
66
What is the Ulnar paradox?
Ulnar clawing is more PRONOUNCED, the more DISTAL the lesion
67
Erb-Duchenne Palsy (C5 and C6 lesions) and Klumpke's Palsy (C8 and T1 lesions) are both caused by what?
DYSTOCIA (difficult childbirth)
68
2 causes of Wrist drop (RADIAL LESION)
Trauma: fracture of the HUMERUS Lead poisoning
69
What four things are seen in C5 and C6 LESIONS?
Paralysis of infraspinatus, teres minor Paralysis of supraspinatus, deltoid Paralysis of biceps Paralysis of brachialis

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