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PRIYA MSK BASICS > MSK rheumatology summary > Flashcards

MSK rheumatology summary Flashcards

1
Q

autoantibody for mixed CTDs

A

anti RNP

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2
Q

are ganlion cysts true cysts? why?

A

no epithelial lining

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3
Q

histology of synovial cysts

A

space with myxoid material

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4
Q

which drugs may cause dupytrens

A

anticonvulsants

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5
Q

features of embryonal rhabdomyosarcoma

A

cildhood
central tract, GI tract, GU tract, H+N, common bile duct
deletion xp11,15

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6
Q

features of alveolar skeletal muscle tumours

A

young adults
many sites eg H+ N
PAX translocation (t2,5)

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7
Q

features of pleomorphic skeletal muscle tumour

A

rarest form of older age group

IHC - myogi, myogenin

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8
Q

what is the difference between liposarcoma and lipoma

A

lipoblasts (purple blobs) in liposarcoma

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9
Q

who are rhabdomyosarcomas found in

A

children

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10
Q

where are leiomyomas found?

A

uterus

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11
Q

what is an osteoma

A

simple - cranial bones
multiple - gardners syndrome
paediatric leisons - nidus

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12
Q

what is an osteosarcoma

A

childrens long bones
codmans triangle
any malignant osteoid producing tumour is osteosarcoma until proven otherwise

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13
Q

what is ewings sarcoma

A

translocation of chromosomes 11+12

small, round, blue cells

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14
Q

describe nodular fascitis

A

a rare, non-cancerous tumour of soft tissue which mimics cancer cells

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15
Q

which cells surround the terminal bouton?

A

schwann cells

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16
Q

what are the 5 key steps of neuromuscular transmission?

A
  1. synthesis of ACH in cytoplasm of bouton
  2. uptake of ACH into synaptic vesicles for concentration + storage
  3. Ca+ dependent release of ACH INto synaptic cleft by exocytosis
  4. brief activation of nicrotinic ACH receptors by reversible binding of ACH
  5. rapid transmission of neurotransmittion action by ACHe within synaptic cleft
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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
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18
Q

what is neuromytonia / issacs syndrome?

A

cramping, stiffness + muscle twitches

prolonged epp

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19
Q

how to treat isaacs syndrome?

A

carbimazepine (blocks voltage gates Na+ channels)

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20
Q

what is lambert eaton myasthenia syndrome?

A

muscle weakness in limbs
associated with SCLC
decreased release of ACH

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21
Q

how to treat lambert eaton mtasthenia syndrome?

A

pyridostigmine (increases duration of action of ACH in synaptic cleft + K+ channel blockers

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22
Q

what is myasthenia gravis

A

increasing muscle weakness during periods of activity
weakness in eyelid and muscles
decreased epp

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23
Q

how to treat myasthenia gravis

A

pyridostigmine

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24
Q

what it botulinum toxin

A

irreversively inhibits ACh release

used to remove wrinkes

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25
Q

what is an osteochondroma

A 
most common
cartilaginous outgrowth 
local pain 
1% chance of malignancy
multiple = MEN
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26
Q

what is an enchondroma

A

intramedullary

metaphyseal cartilaginous tumour

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27
Q

what causes enchondroma

A

failure of normal enchondral ossification at the growth plate (growing cartilage is replaced by bone)

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28
Q

what does enchondroma look like

A

a leucent lesions which can undergo mineralisation –> patchy sclerotic appearance

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29
Q

what is a simple bone cyst

A

fluid fillled cyst in bone

growth defect from physis

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30
Q

where are simple bone cysts usually seen?

A

proximal humerus and femur

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31
Q

what is a giant cell tumour

A

locally agressive / painful

involves epiphysis

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32
Q

where are giant cell tumours most commonly seen

A

knee and distal radius

soap bubble appearance

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33
Q

what is the met stat for giant cell tumor?

A

5% met to lung

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34
Q

how to treat giant cell tumour

A

intralesional excision with phenol, bone cement or liquid nitrogen to destroy remaining tumour

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35
Q

what if fibrous dysplasia?

A

genetic mutation which causes lesions of fibrotic tissue + immature bone

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36
Q

what is xray sign for fibrous dysplasia?

A

extensive involvement of femur = shephards crook deformity

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37
Q

what does a bone scan show in fibrous dysplasia?

A

increased uptake during development but usually becomes inactive

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38
Q

what is the treatment for fibrous dysplasia?

A

bisphosphonates

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39
Q

what is osteoid osteoma?

A

small nidus of immature bone surrounded by an intense sclerotid halo

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40
Q

features of osteoid osteoma?

A

intense constant pain which is worse at night

NSAIDS

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41
Q

what is an osteosarcoma?

A

produced bone in adolescents
60% around knee
met spread - haematogenous

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42
Q

met stats for osteosarcoma

A

10% have pulmonary mets at diagnosis

43
Q

what is a chondrosarcoma

A

cartilagous producing bone
older ages - 45
large and slow to met
pelvis / proximal femur

44
Q

what is a fibrosarcoma

A

occurs in abnormal bone eg bone infarct

45
Q

what is ewings sarcoma

A

primitive cells in bone marrow
fever
warm swelling

46
Q

treatment of primary malignant bone tumours

A
  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
Q

describe breast bone mets

A

can be blastic /sclerotid (fills bone with extra cells)
or lytic (destroy bone material)
24-26 months survival

48
Q

describe prostate bone mets

A

sclerotic mets
more likely to hear
45% survival at one year

49
Q

describe lung bone mets

A

lytic bony mets

6 months survival

50
Q

describe renal cell carcinoma bone mets

A

vascular ‘lyric blow out’ bony mets
can bleed with biopsy / surgery
12-18 months

51
Q

what is a bursa?

A

small fluid filled sac lined with synovium around a joint which prevents friction between tenodons, muscles and bones

52
Q

causes of AVN

A

alcohol + corticosteroids (they alter metabolism > coagulation > ischaemia + Stasis)
thrombophila
caissons disease

53
Q

genetics for RA

A

HLA DR4
HLA DRB1
arginine > citrulline > protein unfolding due to loss of positive charge (anti-CPP)

54
Q

which joints are affected by RA?

A

MCP, MTP, PIP

small joints before bigger joints

55
Q

what is atlanto axial subluxation?

A

a symptom of RA

occurs due to destruction of the synovial joint between atlas + dens + rupture of transverse ligaments

56
Q

what is the occular involvement of RA?

A

keratoconjunctivitis sicca
episcleritis
uveitis
nodular scleritis (may lead to scleromalacia)

57
Q

what cytokine production is involved in RA?

A

INFg - activated synovial cells
TNF + IL1 - stimulates production of proteases from synovium
RANKL on activated T cells - stimulates bone resorption

58
Q

how does rheumatoid factor work?

A

IgM or IgG antiobody binds to Fc region of IgG

59
Q

acute vs chronic phase of RA?

A

acute - pannus formation + Destroyed cartilage

chronic - fibrosis + deformity

60
Q

can anti CPP be present before symptoms?

A

yes and remains positive during treatment

61
Q

which scoring system is used for RA?

A

das 28

62
Q

explain results of das28

A

<2.6 - remission
2.7-3.2 - decreased disease activity
3.3-5.1 - moderate disease activity
>5.1 - increased disease activity

63
Q

side effects of DMARDs

A 
bone marrow suppression
infection
liver fucntion derangements 
pneumonitis 
nausea 
takes 3 months to start working
64
Q

give example of anti TNF

A

infliximab

65
Q

give example of b cell depleter

A

rituximab

66
Q

give example of IL6 blocker

A

toclizumab

67
Q

decsribe swan neck deformity

A

volar plate of PIP joint becomes attenuated

small ligaments + lubrical tendons fall more dorsal to joint centre

68
Q

describe boutonniere button hole

A

extensor hood of PIP joint becomes attenuated

flexion of PIP

69
Q

what is the stepwise treatment for RA?

A
  1. non-opioid eg NSAID
  2. weak opioid eg codine + NSAID
  3. strong opioid (morphine) + non-opioid
70
Q

what virus is associated with SLE

A

EBV

71
Q

is ANCA + or - in SLE

A

+

72
Q

minor features of SLE

A

sclerodactylyl
atrophy or fingertips
bilateral lung fibrosis

73
Q

haematological features of SLE

A

anaemia
leukopenia (decreased WCC)
thrombocytopenia (decreased platelets)

74
Q

renal features of SLE

A

proteinuria >0.5g in 24 hours

75
Q

random features of SLE

A

jaccouds arthroplasty + serosis

76
Q

diagnosis of SLE

A

1 major and 2 micro

77
Q

management of SLE

A

HLQ (DMARD)

78
Q

3 stages of raynauds

A

blanching > acrocyanosis > reactive hyperaemia

79
Q

antibodies involved with scleroderma

A

anticentromere (limited)
anti-scl70 (diffuse)
anti-RNA polymerase

80
Q

treatment for pulmonary hypertension

A

PDE5 inhibitor

81
Q

what is pulmonary fibrosis

A

progressive SOB
bilateral crackles on chest examination
restrictive pattern

82
Q

treatment of pulmonary fibrosis

A
  1. mycophenolate mofenl

2. rituximab

83
Q

which antibody is associated with renal crisis?

A

anti RNA polymerase 3 antibody

84
Q

3 features of dermatomyositis

A 
gottrons papules (red marks on knuckles) 
helitropes rash (red/ purple rash around eyelids) 
shawl sign - rash in shawl area
85
Q

does polymyositis increase CK

A

yes

86
Q

diagnosis of poly / dermatomyositis

A
  1. perivascular inflammation + muscle necrosis

2. MRI - muscle inflammation, oedema, fibrosis + calcification

87
Q

treatmetn for poly / dermato myosiits

A
  1. corticosteroids

2. immunosuppression

88
Q

treatment of polymyalgia rheumatic

A

15mg prenisolone

89
Q

treatment of temporal arteritis / giant cell arteritis?

A

40-60mg prednisolone (gradulal reduction over 2 years)

90
Q

feature of fibromyalgia

A

widespread pain > 3 months

91
Q

grading for ankylosing spondylititis

A

modified new york critera + ASAS classification

92
Q

xray features of psoriatic arthritis

A

marginal erosions
whiskering
pencil in cup

93
Q

when does reactive arthritis occur?

A

1-4 weeks after infection

94
Q

how to treat recative arthritis ?

A

NSAIDS

95
Q

feature of enteropathic arthritis

A

pyoderma gangrenosum

96
Q

symptoms of large vessel vasculitis

A

bruit (carotid artery)
BP differences of extremities
claudication

97
Q

who gets takaysu

A

<40 asian females

98
Q

who gets giant cell arteritis

A

> 50
associated with polymyalgia rheumatic
risk of blindness

99
Q

how to treat giant cell arteritis

A

40-60mg prednisolone

100
Q

symptoms of GPA

A

nasal / oral inflammation
abnormal chest radiograph
urinary sediment
grnaulomatous inflamamtion on biopsy

101
Q

who gets GPA

A

35-55

102
Q

symptoms of EGPA

A

late onset asthma + increased eosinophil count

10% increase in peripheral blood

103
Q

symptoms of HSP

A

bloody diarrhoea
purpura
2-11 years olds after URTI

PRIYA MSK BASICS (8 decks)

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