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MD2 Core Conditions > Bone and Joints > Flashcards

Bone and Joints Flashcards

1
Q

Paget’s disease of bone (osteitis deformans)

A

Increased bone turnover associated with increased osteoblasts and osteoclasts with resultant remodelling, bone enlargement, deformity and weakness

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2
Q

Presentation of Paget’s disease of bone

A

Asymptomatic in ~70%

Deep, boring pain and bony deformity and enlargement (typically pelvics, lumbar spine, skull, femur and “sabre tibia”)

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3
Q

Complications of Paget’s disease of bone

A 
Pathological fractures
OA
Hypercalcaemia
Nerve compression due to bony overgrowth
Osteosarcoma
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4
Q

Mx of Paget’s disease of bone

A

Analgesia

Alendronate may reduce pain and deformity

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5
Q

Ix for Paget’s disease of bone

A

Radiology: localised enlargement of bone, patchy cortical thickening with sclerosis, osteolysis and deformity
Blood chemistry: normal Ca2+ and PO4, raised ALP

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6
Q

Osteomalacia

A

Normal amount of bone but mineral content low (excess uncalcified osteoid and cartilage)
Called rickets if it occurs while bone is growing, osteomalacia if it occurs post-epiphyseal fusion

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7
Q

Presentation of osteomalacia

A

Bone pain and tenderness
Fractures (esp femoral neck)
Proximal myopathy due to low phosphate and vit D deficiency

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8
Q

Causes of osteomalacia

A 
Vit D deficiency or resistance (inherited)
Renal osteodystrophy
Liver disease
Drug-induced (e.g. anticonvulsants)
Tumour-induced
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9
Q

Mx of osteomalacia

A

In dietary insufficiency, give vit D
In malabsorption or hepatic disease, give vit D2
If due to renal disease or vit D resistance, give alfacalcidol or calcitriol
Monitor Ca2+ initially weekly, and if any N+V

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10
Q

Ix in osteomalacia

A 
Mildly decreased Ca2+, PO4
Increased ALP, PTH
Decreased vit D (except if resistance)
Bone biopsy: incomplete mineralisation
XR: loss of cortical bone, apparent partial fractures without displacement may be seen
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11
Q

Cause of gout

A

Deposition of monosodium urate crystals in and near joints
Can be precipitated by trauma, surgery, starvation, infection, diuretics
Associated with raised plasma urate

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12
Q

Complications of gout

A 
Urate deposits (tophi)
Renal disease (stones, interstitial nephritis)
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13
Q

Ix in gout

A

Polarised light microscopy of synovial fluid: negative birefrigent urate crystals
Serum urate frequently raised but can be normal
XR: only soft tissue swelling in early stages, lateral there may be well-defined “punched-out” erosions in juxta-articular bone but no sclerotic reaction

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14
Q

Mx of acute gout

A

High-dose NSAID or coxib (Sx should subside in 3-5/24)
If CI, use colchicine (NB In renal impairment, NSAID and colchicine are CI)
Steroids (oral, IM, intra-articular) may be used
RICE

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15
Q

Prevention of gout attacks

A 
Weight loss
Avoid prolonged fasts, alcohol excess, purine-rich meats, low dose aspirin (which increases serum urate)
For prophylaxis (if >1 attack in 12 months, tophi or renal stones), use allopurinol
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16
Q

SEs of allopurinol

A

Fever
Rash
Decreased WCC

17
Q

Calcium pyrophosphate deposition

A

Umbrella term used to describe different patterns of disease including:
Acute CPP crystal arthritis (pseudogout): usually spontaneous and self-limiting
Chronic CPPD: inflammatoryy RA-like (symmetrical) polyarthritis and synovitis
OA with CPPD

18
Q

Ix for pseudogout

A

Polarized light microscopy shows positive birefrigent crystals
XR: soft tissue Ca2+ deposition

19
Q

Mx of pseudogout

A

RICE
Intra-articular steroids
NSAIDs +/- colchicine

20
Q

Ankylosing spondylitis

A

Chronic inflammatory condition of the spin and sacroiliac joints of unknown aetiology

21
Q

Seronegative spondyloarthropathies

A

Ankylosing spondylitis
Enteric arthropathy
Psoriatic arthritis
Reactive arthritis

22
Q

Shared features of spondyloarthropathies

A

1) Seronegativity (RhF -ive)
2) HLA B27 association
3) “Axial arthritis”: pathology in spine and sacroiliac joints
4) Asymmetrical large-joint oligoarthritis or monoarthritis
5) Enthesitis: inflammation of site of insertion of tendon or ligament into bone, e.g. plantar fasciitis, Achilles tendonitis, costochondritis
6) Dactylitis: inflammation of entire digit (“sausage digit”) due to soft tissue oedema, and tenosynovial and joint inflammation
7) Extra-articular manifestations: iritis (anterior uveitis), psoriaform rashes, oral ulcers, aortic valve incompetence, IBD

23
Q

Ix for ankylosing spondylitis

A

Clinical Dx
MRI is most sensitive, better for early disease
XR: sacroiliitis - look for irregularities/erosions/sclerosis affecting lower half of sacroiliac joints (esp iliac side), vertebral syndesmophytes are characteristic (fuse with vertebral body above causing ankylosis)
Raised ESR/CRP
Normocytic anaemia
HLA B27 +ive

24
Q

Mx of ankylosing spondylitis

A

Exercise, not rest, for backache
NSAIDs
TNF-a blockers
Local steroid injections
Surgery: hip replacement, rarely spinal osteotomy
Increased risk of fractures (consider bisphosphonates)

25
Q

Enteric arthropathy

A

Associated with IBD, GI bypass, coeliac and Whipple’s disease
Often improves with treatment of GI Sx
DMARDs for resistant cases

26
Q

Psoriatic arthritis

A

10-40% of those with psoriasis

Can occur before skin changes

27
Q

Ix for psoriatic arthritis

A

XR: erosive changes, with “pencil-in-cup” deformity in severe cases

28
Q

Mx of psoriatic arthritis

A 
NSAIDs
Sulfasalazine
Methotrexate
Ciclosporin
Anti-TNF agents
29
Q

Reactive arthritis

A

Sterile arthritis typically affecting the lower limb ~1-4/52 after urethritis or dysentry; may be chronic or relapsing

30
Q

Reiter’s syndrome

A

Urethritis
Arthritis
Conjunctivitis

31
Q

Ix for reactive arthritis

A

Increased ESR, CRP

XR: enthesitis with periosteal reaction

32
Q

Mx of reactive arthritis

A

No specific cure
Splint affected joints acutely, give NSAIDs or intra-articular steroids
Consider sulfasalazine or methotrexate if Sx >6/12
NB Treating original infection may make little difference to arthritis

33
Q

Common sites for AVN

A

Head of femur
Neck of talus
Scaphoid

34
Q

Osteosarcoma

A

Aggressive primary cancer of bone that produces malignant osteoid (more frequently originates in metaphyseal region of long bones)
Most prevalent in children and adolescents

35
Q

Presentation of osteosarcoma

A

Pain that may be worse at night, intermittent and of varying intensity
May present with fracture (malignant bone is weaker)

36
Q

Mx of osteosarcoma

A

Complete radical surgical en bloc resection of cancer

Neoadjuvent chemotherapy

37
Q

Osteochondroma

A

Most common benign tumour of bone
Cartilage-capped bony projections or outgrowth on the surface of bones (exostoses)
Can occur anywhere cartilage forms bone (most commonly long bones, pelvis, scapula)
Mostly asymptomatic

38
Q

Mx of osteochondroma

A

Excision is curative (minimal risk of malignant transformation if not excised)

MD2 Core Conditions (12 decks)

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