Musculoskeletal and rheumatology Flashcards

Question

What causes the pain in osteochondritis dissecans?

Answer 1

separation of bone and cartilage from the medial femoral condyle following avascular necrosis

Answer 2

Complete separation of articular fragments can cause loose body formation and symptoms of knee locking or giving way

Answer 3

Rest and quadriceps exercises; surgery occasionally needed

Answer 4

Type 1 collagen

Answer 5

4 types - 1 mildest

Answer 6

``` Increased fragility of bones, but fracture healing process is unaffected Short stature Scoliosis Defective dentinogenesis Conductive deafness Ligamentous laxity Blue sclerae and tympanic membranes ```

Answer 7

Avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of blood supply, followed by revascularisation and reossification over 18-36 months

Answer 8

Boys age 5-10

Answer 9

Insidiously Limp, hip or knee pain Bilateral in 10-20%

Answer 10

XR of both hips including frog views - May show increased density in the femoral head which then becomes fragmented and irregular

Answer 11

Bed rest and traction If severe, may need to maintain the hip in abduction with plaster or calipers Femoral or pelvic osteotomy

Answer 12

displacement of the epiphysis of the femoral head postero-inferiorly - Needs prompt treatment to avoid avascular necrosis

Answer 13

1-15 year old obese boys

Answer 14

Restricted abduction and internal rotation of the hip

Answer 15

Usually surgically

Answer 16

``` Oligo Polyarthritis: RF -ve and RF +ve Systemic Enthesitis-related Psoriatic ```

Answer 17

=4 or fewer joints involved within the first 6 months

Answer 18

females between 12 months and 5 years

Answer 19

Chronic uveitis (almost always symptomatic but can cause blindness) Associated with ANA positivity Knees most commonly affected

Answer 20

Exacerbations and remissions but long term prognosis is good unless develops into polyarthritis

Answer 21

= 5 or more joints during the first 6 months | RF must be positive on at least 2 occasions 3 months apart to be RF positive

Answer 22

``` Involves large and small joints, cervical spine, temporomandibular joints Can be symmetrical or asymmetrical Can remit in late childhood ANA may be positive Requires screening for uveiti ```

Answer 23

Females | Late childahoodearly teens

Answer 24

Symmetrical polyarthritis affecting upper and lower limbs | Also features subcutaneous rheumatoid nodules and early erosive radiological changes

Answer 25

Unremitting severe disease and poor functional outcome in over 50%

Answer 26

1-4 year olds most often, equal sex incidence

Answer 27

Fever - typically single or double quotidian pattern with high spikes daily, at similar times every day Rash - evanescent, coming and going with fever spikes, discrete salmon pink macules usually around upper trunk and axillae; show Koebner phenomenon, rarely pruritic Polyarticular arthritis - can be a late feature

Answer 28

``` Lymphadenopathy Hepatosplenomegaly Serositis (pericarditis, pleuritis) Inflammatory ascites Haematological changes (anaemia, leucocytosis, macrophage activation syndrome) Occasional myocarditis ```

Answer 29

Systemic features can precede by months

Answer 30

Approx 50% remit in 2-3 years Untreated, joint destruction occurs in most cases Most mortality is in this subgroup - Death is due to infection, myocardial involvement or macrophage activation syndrome

Answer 31

Pre teenage males

Answer 32

Lower limb involvement, especially hips and sacroiliac joints Many show features common to spondyloarthropathies e.g. enthesitis, decreased lumbar flexion Involvement of the spine is uncommon in childhood Can get uveitis, but is usually symptomatic with red eye with pain and photophobia, in contrast to other forms

Answer 33

HLA-B27 in 80% | ANA and RF negative

Answer 34

``` Anterior uveitis Aortitis Aortic incompetence Muscle weakness Low grade fever ```

Answer 35

Females, mid childhood

Answer 36

Arthritis is asymmetrical and can be oligoarticular or polyarticular Dactylitis is seen in younger patients and DIP joint involvement is common Inflammation can involve tendon sheaths- If severe is called arthritis mutilans, which is very destructive Often a family history of psoriasis Nail changes - pitting, onycholysis Psoriasis Uveitis

Answer 37

>4 years of age, males and females equal

Answer 38

Usually after onset of bowel symptoms | Usually oligoarticular

Answer 39

Benign peripheral arthritis coinciding with active bowel disease In older patients in spondylitic group, joint activity doesn't necessarily link with bowel activity

Answer 40

``` Erythema nodosum Pyoderma gangrenosum Mucosal ulcers Fever Weight loss Growth retardation Acute iritis in the spondylitic group ```

Answer 41

HLA-B27 in many | RF and ANA negative

Answer 42

``` Painless swelling of joints Marked tenosynovitis Rash Panuveitis Renal disease ```

Answer 43

ACE - in 50%

Answer 44

Inflammatory reaction in joints, skin, heart and CNS following group A haemolytic strep infection

Answer 45

Girls, >3 years

Answer 46

Revised jones criteria

Answer 47

``` Carditis Polyarthritis Subcutaneous nodules Chorea Erythema marginatum ```

Answer 48

``` Fever Arthralgia Previous rheumatic fever and rheumatic heart disease Raised acute phase reactants Prolonged P-R ```

Answer 49

Bed rest Penicillin Salicylates Corticosteroids with significant carditis Prophylactic oral or IM penicillin after an attack required into adult life

Answer 50

small-vessel vasculopathy involving arterioles and capillaries

Answer 51

Bohan and peter

Answer 52

Characteristic rash Plus 3/4 of: Symmetrical proximal muscle weakness Elevated muscle-derived enzymes: E.g. CK, aldolase, LDH, transaminases Muscle histopathology confirming the typical pattern of myofibre atrophy and drop out necrosis with fibre regeneration, and chronic inflammatory infiltrate involving blood vessels EMG changes of inflammatory myopathy: Fasciculations at rest, bizarre high-frequency discharges

Answer 53

``` Gottron's papules Heliotrope rash Scaly red rash on sunexposed areas Shawl sign Rash on extensor tendons - can be mistaken for psoriasis ```

Answer 54

``` Generalised tissue oedema Skin ulceration Fever Hypernasal voice GI involvement Cardiopulmonary involvement including myocarditis and dilated cardiomyopathy Pulmonary fibrosis Respiratory muscle weakness CNS vasculitis Ophthalmological complications e.g. retinopathy, glaucoma, cataracts Renal failure Raynaud's Lipodystrophy ```

Answer 55

Muscle enzymes ESR CRP ``` Autoantibodies ANA Anti-ds-DNA Anti-Sm Anti-RNP Anti-Jo1 Myositis specific antibodies ``` ``` Imaging Pulmonary function tests ECG Nail fold capillaroscopy +/- biopsy ```

Answer 56

dysregulation of the innate and adaptive immune system including production of autoantibodies and hypergammaglobulinaemia

Answer 57

``` ANA Anti-ds-DNA Anti-U1 RNP Antibodies Anti-cardiolipin Complement ```

Answer 58

Clinical triad of: Recurrent oral aphthous ulcers Recurrent genital ulcers Uveitis - severe and can lead to glaucoma and blindness

Answer 59

Male predominance, Japan, Middle East and Mediterranean

Answer 60

Arthritis Rash - skin hypersensitivity Bowel involvement Meningoencephalitis, brainstem lesions and dementia

Answer 61

Steroids Thalidomide Anti TNF

Answer 62

Dry eyes (keratoconjunctivitis sicca) Dry mouth and carious teeth Parotitis

Answer 63

May occur alone or in association with other rheumatological conditions Occasional complication of renal disease or lymphoreticular malignancy

Answer 64

Localised and diffuse/CREST

Answer 65

Morphea: thickened shiny pale skin then darkens as resolves with loss of subcutaneous tissue, Can be single or multiple Linear: thickened plaque which causes loss of subcutaneous tissues and contractures over joints and loss of bone growth: Face, forehead and scalp (en coup de sabre) Limb (en bande)

Answer 66

``` Calcinosis cutis Raynaud phenomenon Oesophageal hypomobility Sclerodactyly Telangiectasia Systemic problems include respiratory, gastrointestinal, and renal disease ```

Answer 67

Small vessel vasculitis that can be precipitated by infection

Answer 68

Haemolytic strep

Answer 69

Boys >3 years

Answer 70

Petechiae Rash: urticarial lesions evolving into purpuric macules, usually on legs, feet and buttocks Cutaneous nodules over the elbows and knees Localised areas of subcutaneous oedema that affect the forehead, spine, genitalia, hands and feet Arthritis: transient, involving large joints GI involvement: colicky abdominal pain and/or GI bleeding Renal involvement: nephritis, occasionally nephrosis

Answer 71

Episodes usually self limiting but can occur Long term morbidity is related to renal involvement Severe disease may need corticosteroids

Answer 72

polymorph leucocytosis, raised platelets

Answer 73

``` ≥5 days fever Bilateral conjunctival injection Changes in lips and oral cavity Changes in extremities: reddening and oedema of palms and soles followed by desquamation Polymorphous erythematous rash Cervical lymphadenopathy ```

Answer 74

``` Irritability Pericarditis Valvular dysfunction Coronary artery disease Arthritis and/or arthralgia GI symptoms Urethritis Aseptic meningitis Iritis ```

Answer 75

Acute and convalescent stage lasts up to 10 weeks

Answer 76

Coronary aneurysms or widening in 20% | Death due to coronary vasculitis causing MI or aneurysm rupture occurs in about 1%

Answer 77

``` Supportive care Careful observation Salicylates IV gamma globulin Steroids Anti-TNF ```

Answer 78

Small to medium vessel vasculitis

Answer 79

3-16 years

Answer 80

``` Fever Abdo pain Arthralgia/myalgia Rash: -Petechiae/purpura in generalised form -Tender subcutaneous nodules and livedo reticularis in the cutaneous form Hypertension Renal involvement Neurological disease ```

Answer 81

``` High ESR Low Hb Leucocytosis ASOT elevated in some Focal necrosis in small and medium sized arteries ```

Answer 82

Cutaneous form usually benign but can relapse | Prognosis is worse in generalised form depending on organ involvement

Answer 83

High dose steroids Immunosuppression Penicillin prophylaxis if streptococcal aetiology proven

Answer 84

aka giant cell arthritis: a panarteritis of the aorta and its large branches leading to thrombosis, stenosis or occlusion

Answer 85

Primarily affects young adult women, more common in East Asian and Black people

Answer 86

``` Claudication Myalgia Hypertension Malaise Fever ```

Answer 87

Steroids +/- cytotoxic and reconstructive surgery when the disease is inactive

Answer 88

Systemic necrotising vasculitis of small arteries and veins, accompanying asthma and eosinophilia

Answer 89

Lungs: asthma and transient pulmonary infiltrates Rash: palpable purpuras and tender subcutaneous nodules Peripheral neuropathy Renal involvement

Answer 90

Necrotising granulomatous vasculitis of the upper and lower respiratory tracts, accompanied by glomerulonephritis

Answer 91

``` Pulmonary granulomas Destructive granulomas of the ears, nose and sinuses Rash Glomerulonephritis Eye lesions ```

Answer 92

Anti neutrophil cytosolic antibodies

Answer 93

Steroids and cyclophosphamide

Answer 94

``` Absent or hypoplastic pectoral muscle Shoulder abnormalities Limb abnormalities Hypoplasia or aplasia of the breast or nipple Aplasia of ribs Syndactyly/bradydactyly Absent fingers Short middle phalanges ```

Answer 95

Dextrocardia

Answer 96

Moebius Klippel Fiel Non Hodgkins lymphoma Acute leukaemia

Musculoskeletal and rheumatology Flashcards

(124 cards)