Bone and Joint Disorders Flashcards
How can you find out a patient’s name?
Ask them is they are conscious
Look for ID on them e.g. in their purse / wallet
Ask a family member (if present)
What is a symptom?
What is a sign?
What the patient feels / reports to you
Something you can see or measure - e..g using equipment to look at
If presented with a patient with a history of multiple fractures, what are the possible differentials?
Unsafe home environment
Brittle bones - osteoporosis
Lack of balance
What is the difference between osteomalacia and osteoporosis?
Are they mutually exclusive?
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
How can osteoporosis (OP) be diagnosed?
How can it be distinguished from osteomalacia?
X-rays - looking for osteopenia
DEXA scan (dual energy x-ray absorptiometry) - calculates bone density and plots it on a normal distribution curve
Fill in the table below on the differences between osteoporosis and osteomalacia:
What is the difference between primary and secondary osteoporosis?
What is osteomyelitis?
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
How can people with osteoporosis reduce their risk of falls?
Lifestyle changes - less dangerous / exerting activities
Remodel home - make it safer e.g. bath mats, handrails, stair lifts etc.
Fill in this table with the different members of the MDT and their roles involved in taking care of geriatric patients:
Match the terms with the correct definitions:
What is the difference between clerking children compared to adults?
What happens in cases of suspecting child abuse?
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Look at parent-child interaction - child may be withdrawn, scared.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!
How can you build rapport with paediatric patients and their parents?
Non-verbal cues, acknowledge parent’s concerns, engaging and enthusiatic
Use toys / stickers
Simple language, explain to paediatric patient and parent
What are the important things to ask in a paediatric history?
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
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?
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
When examining the leg clinically, what is there to look for?
Swelling of the joint
Redness
Increase in temp = infection = callor
Examine movements of the joint
Pain
Look for deformities - symmetry of the legs
What investigations should be performed to narrow down the list of differentials for leg pain?
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
What is the diagnostic criteria for septic arthritis?
Kocher’s criteria:
Non-weightbearing on side affected
Fever >38.5°C
WBC count >12000/mm^3
ESR (erythrocyte sedimentation rate) >40 mm/h
How is a patient with synovitis treated?
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
Why is it often important to ask what a patient does for work?
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
What are the possible differentials for a swollen, red looking knee?
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.)
How will bacteria change the joint fluid and blood?
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
What’s the difference between ESR and CRP as inflammatory markers?
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)
What is the relevance / significance of knowing a person with an infection has diabetes?
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)
How is an infected and inflammed knee treated?
Drainage of affected joint and wash out pus, splint joint so it doesn’t move (reduces inflammation and less movement = less pain)
Analgesics
Antibiotics
