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Int Spec (Ortho) > Bone Disease > Flashcards

Bone Disease Flashcards

1
Q

What is the most common causative organism of osteomyelitis?

A

Staph aureus

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2
Q

What group of individuals are prone to developing osteomyelitis with salmonella?

A

Sickle cell anaemia patients

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3
Q

What is the imaging modality of choice for an individual with suspected osteomyelitis?

A

MRI

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4
Q

What is the gold standard investigation for osteomyelitis?

A

Bone biopsy

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5
Q

What antibiotic treatment is usually given for osteomyelitis and how long for?

A

Flucloxacillin for 6 weeks

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6
Q

What antibiotic is given for osteomyelitis if the patient is penicillin allergic?

A

Clindamycin

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7
Q

What effect does parathyroid hormone have on calcium and phosphate levels?

A

Increased calcium and decreased phosphate

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8
Q

What effect does calcitonin have on calcium and phosphate levels?

A

Decreased calcium and decreased phosphate

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9
Q

What effect does vitamin D have on calcium and phosphate levels?

A

Increased calcium and increased phosphate

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10
Q

What effect does parathyroid hormone have on osteoblastic and osteoclastic activity?

A

Increased osteoclastic activity and decreased osteoblastic activity

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11
Q

Is osteoporosis a qualitative or quantitative defect of bone?

A

Quantitative (i.e. the bone is of normal quality, there just isn’t enough of it)

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12
Q

Anybody who has a fragility fracture should be screened for what condition?

A

Osteoporosis

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13
Q

What two screening tools can be used to assess an individual’s 10-year risk of a fragility fracture?

A

Q-fracture and FRAX

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14
Q

For osteoporosis to be diagnosed, an individual’s bone density must be what?

A

< 2.5 standard deviations below the mean

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15
Q

For osteopenia to be diagnosed, an individual’s bone density must be what?

A

1 - 2.5 standard deviations below the mean

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16
Q

What is meant by a) type 1 and b) type 2 osteoporosis?

A

a) post-menopausal osteoporosis, b) osteoporosis of old age

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17
Q

The use of which medication is most likely to cause secondary osteoporosis?

A

Steroids

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18
Q

What happens to calcium, phosphate and ALP in osteoporosis?

A

They are all normal

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19
Q

What investigation is used to diagnose osteoporosis?

A

DEXA bone scan

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20
Q

What supplements should be offered to all women diagnosed with osteoporosis?

A

Calcium and vitamin D

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21
Q

What is the first line treatment for osteoporosis?

A

Oral bisphosphonate (aledronate)

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22
Q

How is zoledronic acid given?

A

Once yearly IV injection

23
Q

How is denusomab given?

A

6 monthly subcutaneous injection

24
Q

25% of patients cannot tolerate an oral bisphosphonate due to what side effects?

A

Upper GI

25
Q

How often are oral bisphosphonates given?

A

Once weekly

26
Q

How do bisphosphonates work?

A

Inhibition of osteoclastic activity

27
Q

How should patients be advised to take oral bisphosphonates?

A

On an empty stomach (at least 30 minutes before breakfast) and stand/sit upright for at least 30 minutes after taking

28
Q

Osteonecrosis of the jaw can occur as a side effect of what medication?

A

Bisphosphonates

29
Q

When should risedronate or etidronate be offered to patients with osteoporosis?

A

If they cannot tolerate aledronate

30
Q

When should strontium or raloxifene be offered to patients with osteoporosis?

A

If they cannot tolerate bisphosphonates

31
Q

When should women be given HRT as a treatment for osteoporosis?

A

Only if they also have vasomotor symptoms

32
Q

What type of drug is raloxifene?

A

Selective oestrogen receptor modulator

33
Q

Is osteomalacia a qualitative or quantitative defect of bone?

A

Qualitative

34
Q

What is the underlying cause of osteomalacia and Rickett’s?

A

Inadequate amounts of calcium and phosphate

35
Q

What are the two principle causes of osteomalacia and Rickett’s?

A

Decreased calcium absorption from the gut, and/or increased renal losses of phosphate

36
Q

What are the three main features of osteomalacia/Rickett’s?

A

Bony pain, deformities and pathological fractures

37
Q

What happens to calcium, phosphate and ALP in osteomalacia/Rickett’s?

A

Calcium and phosphate are low, ALP is high

38
Q

What happens to PTH in osteomalacia/Rickett’s?

A

High

39
Q

How is osteomalacia/Rickett’s treated?

A

Calcium and vitamin D supplementation

40
Q

What type of hearing loss can Paget’s disease cause?

A

Conductive

41
Q

Which biochemical disease of bone can result in high-output cardiac failure?

A

Paget’s disease

42
Q

What happens to calcium, phosphate and ALP in Paget’s disease?

A

Calcium and phosphate are normal, ALP is high

43
Q

How is Paget’s disease treated?

A

Bisphosphonates

44
Q

What is the commonest benign tumour of bone, producing a bony outgrowth on the external surface of bone covered with a cartilagenous cap, most commonly around the knee?

A

Osteochondroma

45
Q

Which benign tumour of bone typically occurs in the small tubular bones of the hands and feet?

A

Enchondroma

46
Q

Intense, constant pain which is worse at night but is classically greatly relieved by NSAIDs describes which benign tumour of bone?

A

Osteoid osteoma

47
Q

What is the most common primary malignant bone tumour?

A

Osteosarcoma

48
Q

60% of cases of osteosarcoma affect where?

A

The bones around the knee

49
Q

An ‘onion-skin’ pattern on plain radiography is suggestive of what malignant bone tumour?

A

Ewing’s sarcoma

50
Q

Which primary malignancy is associated with causing sclerotic bony metastases?

A

Prostate cancer

51
Q

Which primary malignancy is associated with lytic ‘blow out’ bony metastases, which bleed tremendously with biopsy or surgery?

A

Renal cell carcinoma

52
Q

How can bony metastases which are deemed not to be at risk of impending fracture be managed?

A

Radiotherapy and bisphosphonates

53
Q

How is osteosarcoma treated?

A

Surgical resection and chemotherapy

54
Q

How is Ewing’s sarcoma treated?

A

Chemotherapy +/- surgery

Int Spec (Ortho) (10 decks)

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