Musculoskeletal Revision Lecture

Question 1

Sex Ratio- Rheumatoid vs Reactive Arthritis

Answer 1

Rheumatoid = F
Reactive = M

Question 2

Age- Rheumatoid vs Reactive Arthritis

Answer 2

Rheumatoid = all ages
Reactive = 20-40 years

Question 3

Enthesopathy- Rheumatoid vs Reactive Arthritis

Answer 3

Rheumatoid = no
reactive = yes

Question 4

Spondylitis- Rheumatoid vs Reactive Arthritis

Answer 4

Rheum = no apart from atlanto-axial
reactive = yes

Question 5

Urethritis- Rheumatoid vs Reactive Arthritis

Answer 5

Rheum = No
Reactive = yes

Question 6

Skin involvement- Rheumatoid vs Reactive Arthritis

Answer 6

Rheumatoid = subcutaneous nodules
Reactive = K.blennorhagicum
Circinate balantitis

Question 7

Rheumatoid factor - Rheumatoid vs Reactive Arthritis

Answer 7

Rheumatoid = yes 
Reactive = no

Question 8

HLA - Rheumatoid vs Reactive Arthritis

Answer 8

Rheumatoid = HLA DR4
Reactive = HLA B27

Question 9

Joint space narrowing- Rheumatoid vs Osteoarthritis

Answer 9

Yes

Yes

Question 10

Subchondral sclerosis- Rheumatoid vs Osteoarthritis

Answer 10

No

Yes

Question 11

Osteophytes- Rheumatoid vs Osteoarthritis

Answer 11

no

Yes- Bouchards nodes at PIP and Heberden nodes at DIP

Question 12

Osteopenia- Rheumatoid vs Osteoarthritis

Answer 12

yes

no

Question 13

bony erosions - Rheumatoid vs Osteoarthritis

Answer 13

yes

no

Question 14

define osteoporosis

Answer 14

reduction in total or regional bone mass

Question 15

radiological features of osteoporosis

Answer 15

osteopenia

fragility fractures

Question 16

bone chemistry of osteoporosis

Answer 16

normal

Question 17

define osteomalacia

Answer 17

soft bones due to impaired mineralisation in mature bone

Question 18

radiological features of osteomalacia

Answer 18

osteopenia

pseudofractures = looser’s zones

Question 19

define rickets

Answer 19

soft bones due to impaired mineralisation in immature bone in chilren

Question 20

radiological features of rickets

Answer 20

flared ends of bones

bowing of long bones

Question 21

biochemistry of osteomalacia and rickets

Answer 21

low calcium, low phosphate, high serum alkaline phosphate.

Question 22

define paget’s

Answer 22

disorganised bone remodelling

Question 23

radiological features of pagets

Answer 23

bone thickening = sclerosis and cortical thickening

Question 24

biochem pagets

Answer 24

high serum alkaline phosphatase

Question 25

what are the radiological findings of osteitis fibrosa cystica

Answer 25

``` sub periosteal resorption brown tumours chondrocalcinosis osteosclerosis salt and pepper skull rugger jersey spine ```

Question 26

what does sub periosteal resorption look like

Answer 26

radial aspect of ring and little fingers, tufuts of the phalanges

Question 27

what do brown tumour looks like

Answer 27

discrete lytic lesions | aggregates of osteoclasts and fibrous tissue

Question 28

what does chondrocalcinosis look like

Answer 28

calcification of articular cartilage | easily seen in menisci of knee

Question 29

what does osteosclerosis look like

Answer 29

bone thickening

Question 30

what does a salt and pepper skull look like

Answer 30

trabecular bone resorption creating a mottling appearance

Question 31

what does a rugged jersey spine look like

Answer 31

band like osteosclerosis of the superior and inferior margins of the vertebral bodies

Question 32

Key features of rheumatoid arthritis

Answer 32

``` morning stiffness rheumatoid factor symmetrical polyarthritis subcutaneous nodules joint erosions ```

Question 33

define rheumatoid factor

Answer 33

IgM anti-IgG antibody (Fc)

Question 34

what makes synovial fluid viscous

Answer 34

hylaronate = non sulphated glycosaminoglycan

Question 35

describe type a synoviocytes

Answer 35

macrophage like phagocytic

Question 36

describe type b synoviocytes

Answer 36

fibroblast like -produce hylarunoate

Question 37

what type of collagen is in the synovium

Answer 37

type 1

Question 38

define reactive arthritis

Answer 38

steril inflammation of the synovium following an infection -> enthesopathy, skin inflammation, eye inflammation

Question 39

two infections associated with reactive arthritis

Answer 39

urogenital = chlamydia Enterogenic = salmonella, shigella, campylobacter may be first manifestation of hiv or hep c

Question 40

define enthesopathy

Answer 40

inflammation where a ligament, tendon or fascia inserts into bone

Question 41

what are some examples of enthesopathy

Answer 41

plantar fascitis dactylitis spondyltitis achilles tendonitis

Question 42

what is in articular cartilage

Answer 42

type 2 collagen and aggrecan

Question 43

define proteoglycan

Answer 43

glycoproteins containing sulphated glycosaminoglycan chains

Question 44

define glycosaminoglycan

Answer 44

repeating polymers of disaccharides

Question 45

what is included in renal osteodystrophy

Answer 45

secondary and tertiary hyperparathyroidism osteomalacia soft tissue and vascular calcification

Question 46

list two infections associated with reactive arthritis

Answer 46

urogenital ie chlymadia trachomatis | enterogenic = salmonella, shigella, campylobacter

Question 47

HLA for SLE , rheumatoid and AS/Reactive

Answer 47

DR3 DR4 B 27