iBSc: Question 5 By Alan McLeod

Getting the best marks Read the whole question – a latter section may give you a clue about an earlier one. To see how many points you need look at the marks allocated – for example a 3 point question is generally looking for 3 salient points If giving a list answer put the best answers first – examiners will not usually mark answers too far down a list Always write something – it may get you part of a mark and is anonymised so no one will think you are stupid! If you genuinely have no clue then re-write the question to see if this sparks some ideas. If not then move on and come back at the end. And remember – always write something. Good luck!

Question 5 Mrs McCartney, a 52 year old woman has been getting pains in her finger joints. She think it may be ‘arthritis, like my mum had’ Q5.1 Outline the gate- control theory of pain (6) Q5.2 Compare rheumatoid and osteoarthritis in terms of the joints affected (5)

Question 5 This disease affects synovial joints Q5.3 What part of the joint does Rheumatoid arthritis affect (1) Q5.4 Draw and label a synovial joint (5)

Question 5 One of the essential components of a synovial joint is cartilage which is made from collagen Q5.5 Describe how collagen is formed (8)

Question 5 The pain is inflammatory in cause in rheumatoid arthritis Q5.7 List four other symptoms / signs of inflammation (2)

Question 5 Rheumatoid factor has prognostic value in patients with rheumatoid arthritis. It is an antibody against the Fc portion if IgG Q5.8 Draw and label the structure of an IgG molecule including the Fc portion (6)

The Answers View these on ‘note view’ rather than on full screen – additional notes are provided for some slides

Gate Control Theory A , C AA Anxiety Worry Depression Etc. Happiness Optimism Relaxation Etc. Meds

Gate Control Theory vbvb vbvb vbvb vbvb Red: Red: A  /C ‘small’ fibre Black: A  ‘large’ fibre Blue: Interneurone Yellow: Yellow: Projection neurone BRAIN

Opening and Closing the Gate OpenClose PhysicalInjuryMedication Emotional Anxiety Worry Tension Depression Happiness Relaxation Optimism Behavioural Focussing on pain boredom Distraction Concentration Other activities

Osteo and Rheumatoid Osteoarthritis Disease of cartilage No immune component –M=F –Rheumatoid factor -ve Assymetric joints Large > small joints DIP Joints Rheumatoid arthritis Disease of synovium Autoimmune –M<F (approx 1 : 3-4) –Rheumatoid factor 80% Symmetrical Small > large joints MCP + PIP Joints

Video Link Synovial Joint

Collagen Synthesis ton.edu/bonebio/AS BMRed/collagen/col lagen.swf

Inflammation Features Rubor (redness) Calor (heat) Dolor (pain) Tumor (swelling) Loss of Function

IgG Heavy chain Lightchain FAB Hinge region Fc Variable region

The End The slides here should allow you to mark your own work – remember 1 mark per answer* up to the maximum for the question. Multiply by 3 to get percentage points. I assume a 60% pass mark. Sorry but I am unable to give further advice on answers due to time constraints.