Bone and Joint Disorders Flashcards

1
Q

How can you find out a patient’s name?

A

Ask them is they are conscious

Look for ID on them e.g. in their purse / wallet

Ask a family member (if present)

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2
Q

What is a symptom?

What is a sign?

A

What the patient feels / reports to you

Something you can see or measure - e..g using equipment to look at

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3
Q

If presented with a patient with a history of multiple fractures, what are the possible differentials?

A

Unsafe home environment

Brittle bones - osteoporosis

Lack of balance

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4
Q

What is the difference between osteomalacia and osteoporosis?

Are they mutually exclusive?

A

Osteomalacia = reduced mineralisation of the bone, there is laying down of collagen but insufficient Ca2+ to mineralise the bone –> results in rickets in children

Osteoporosis = reduced bone density and bone mass, resulting in fragility

No - both can occur within a patient

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5
Q

How can osteoporosis (OP) be diagnosed?

How can it be distinguished from osteomalacia?

A

X-rays - looking for osteopenia

DEXA scan (dual energy x-ray absorptiometry) - calculates bone density and plots it on a normal distribution curve

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6
Q

Fill in the table below on the differences between osteoporosis and osteomalacia:

A
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7
Q

What is the difference between primary and secondary osteoporosis?

What is osteomyelitis?

A

Primary = typically age related, loss of bone mass / density from the bone

Secondary - loss of bone due the presence of another disease / condition / environmental factor e.g. medications, hyperparathyroidism, other endocrine conditions etc.

Inflammation of the bone

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8
Q

How can people with osteoporosis reduce their risk of falls?

A

Lifestyle changes - less dangerous / exerting activities

Remodel home - make it safer e.g. bath mats, handrails, stair lifts etc.

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9
Q

Fill in this table with the different members of the MDT and their roles involved in taking care of geriatric patients:

A
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10
Q

Match the terms with the correct definitions:

A
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11
Q

What is the difference between clerking children compared to adults?

What happens in cases of suspecting child abuse?

A

Child = difficulty verbalising symptoms, involve parent / carer as well as the child, treat anxiety of the patient, use simplistic language for the child, child trusts parent more than dr so will say more to the parent, parent-child interaction important because of abuse

Look at parent-child interaction - child may be withdrawn, scared. Full skeletal x-ray / scan, often find many bruises / fractures with different timelines. Suspicions must be reported!

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12
Q

How can you build rapport with paediatric patients and their parents?

A

Non-verbal cues, acknowledge parent’s concerns, engaging and enthusiatic

Use toys / stickers

Simple language, explain to paediatric patient and parent

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13
Q

What are the important things to ask in a paediatric history?

A

All the regular points - lifestyle, previous health conditions etc.

But also:

Birth history - natural or c-section, any complications?

Did they reach their milestones okay? Are they equal in school in terms of P.E. and running?

History of development - what were their siblings like? Often siblings and patients have similar issues

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14
Q

What are the possible differentials for a pediatric patient case presenting with leg pain, a limp and refusing to put weight on the leg that has been ongoing for 3 days?

A

Top 3 most common = Synovitis, fracture, infection:

Fallen over / tripped

Fevers and infection = could be in the leg / bone. If in joint = eaten up v. quickly or inflammed synovium (synovitis)

OA secondary to infection

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15
Q

When examining the leg clinically, what is there to look for?

A

Swelling of the joint

Redness

Increase in temp = infection = callor

Examine movements of the joint

Pain

Look for deformities - symmetry of the legs

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16
Q

What investigations should be performed to narrow down the list of differentials for leg pain?

A

Blood test - inflammatory markers, CRP, ESR (long term marker for inflammation), WBC count etc.

X-ray = to look for a fracture

Examine movements of the joint, blood vessels and nerves

Ultrasound = looks for inflammation of soft tissues

Joint aspiration = look for infection

17
Q

What is the diagnostic criteria for septic arthritis?

A

Kocher’s criteria:

Non-weightbearing on side affected

Fever >38.5°C

WBC count >12000/mm^3

ESR (erythrocyte sedimentation rate) >40 mm/h

18
Q

How is a patient with synovitis treated?

A

Joint aspiration to take away fluid from the inflammed membrane - grow the bacteria and see what medications / antibiotics they are susceptible to, then offer antibiotics

19
Q

Why is it often important to ask what a patient does for work?

A

To look at environmental factors that could be contributing to the issue

Affects on mental health - stressful? Long hours?

Level of detail to explain to patients - v. educated Vs not a fluent speaker = diff. approaches to explaining the same condition / treatment

20
Q

What are the possible differentials for a swollen, red looking knee?

A

Repetitive stress on knee, heavy lifting, blood borne infection, trauma to the knee, allergic reaction, wound that got infected

Inflammation / synovitis (inflamed synovial membrane)

Bursitis = inflammed bursae (sacs of fluid found in joints)

Infection from small pore, cut, sting etc. bug in the blood seeding on bone / joint. Infection in the bone = osteomyelitis - travel from the bone into the joint

Trauma - falls, injury, accident = fracture

Whether they have a previous history of repeated infections = immunocompromised (HIV, diabetes etc.)

21
Q

How will bacteria change the joint fluid and blood?

A

Alteration to colour, consistency, volume and makeup

More joint fluid, more cytokines, raised WBC, CRP, ESR

Bacteria produce enzymes and cytokines that digest tissues - raised WBC to counteract this - so specifcally, raised neutrophil count (neutrophilia)

Bugs can infect bone that eventually infects the joint, travel through blood, or directly infect skin

22
Q

What’s the difference between ESR and CRP as inflammatory markers?

A

ESR (erythrocyte sedimentation rate) - more long term inflammatory marker as it requires longer time for the sedimentation / deposition of the erythrocytes

CRP (C-reactive protein) - released by liver, short-term (goes up within hours)

23
Q

What is the relevance / significance of knowing a person with an infection has diabetes?

A

Compromised immune function

Wound healing = slower, therefore more likely to get infected

More sugar in blood = more resources / fuel for bacteria to grow in the blood

Tissues dont heal as well

Infection can sometimes induce a diabetic state (particularly in obese patients)

24
Q

How is an infected and inflammed knee treated?

A

Drainage of affected joint and wash out pus, splint joint so it doesn’t move (reduces inflammation and less movement = less pain)

Analgesics

Antibiotics