Disease Profiles 6 Flashcards
1
Q
Simple Bone Cyst
A
Single cavity benign fluid filled cyst in a bone
2
Q
Simple Bone Cyst: Aetiology
A
Growth defect in the bone physis
3
Q
Simple Bone Cyst: Normal locations
A
Metaphysis of long bones - proximal humerus and femur
Talus
Calcaneus
4
Q
Simple Bone Cyst: Clinical Presentation
A
Weakened bone can lead to pathological fracture
5
Q
Simple Bone Cyst: Investigations (2)
A
X-ray
MRI scan
6
Q
Simple Bone Cyst: Management
A
Curettage and bone grafting +/- stabilisation
7
Q
Aneurysmal Bone Cyst
A
Chambers in the bones filled with blood or serum
8
Q
Aneurysmal Bone Cyst: Aetiology
A
Small arteriovenous malformation
9
Q
Aneurysmal Bone Cyst: Location
A
Metaphyses of long bones, flat bones and vertebral bodies
10
Q
Aneurysmal Bone Cyst: Pathophysiology
A
Locally aggressive lesion causes cortical expansion and destruction
11
Q
Aneurysmal Bone Cyst: Clinical presentation
A
Painful mass or swelling that may cause a pathological fracture
12
Q
Aneurysmal Bone Cyst: Investigation
A
X-ray
13
Q
Aneurysmal Bone Cyst: Management
A
Curettage and grafting
Use of bone cement
14
Q
Fibrous Dysplasia
A
Benign developmental disorder of bone that causes normal skeletal tissue to be replaced by fibrous tissue
15
Q
Fibrous Dysplasia: Aetiology
A
Genetic mutation
16
Q
Fibrous Dysplasia: Presents in what age?
A
Adolescents
17
Q
Fibrous Dysplasia: Pathophysiology
A
Genetic mutation results in lesions of fibrous tissue and immature bone
18
Q
Fibrous Dysplasia: Defective mineralisation may result in what?
A
Angular deformities causing wider bone with thinned cortices
19
Q
Fibrous Dysplasia: Clinical Presentation (3)
A
Bone pain
Deformity
Pathological fractures
20
Q
Fibrous Dysplasia: Investigation
A
Bone scan
21
Q
Fibrous Dysplasia: What does the bone scan show?
A
Intense increase in uptake during development but the lesion become inactive
22
Q
Fibrous Dysplasia: Presentation of Femur on bone scan
A
Shepherd’s crook deformity on X-ray
23
Q
Fibrous Dysplasia: Management Options (3)
A
Bisphosphonates
Stabilise pathological fractures with internal fixation and cortical bone graft
Simple intralesional excision
24
Q
Henoch-Schlonlein Purpura
A
IgA-mediated generalised vasculitis involving small vessels of the skin, GI tract, kidneys, joints, the lungs and CNS
25
Henoch-Schlonlein Purpura: Most common age range
2-11 years old
26
Henoch-Schlonlein Purpura: This is preceded by what in 75% of cases?
Infection - mainly Group A Streptococcus 1-3 weeks before
27
Henoch-Schlonlein Purpura: Clinical presentation (5)
Purpuric rash over the buttocks and lower limbs
Colicky abdominal pain
Bloody diarrhoea
Joint pain
Renal involvement
28
Henoch-Schlonlein Purpura: Test for definitive diagnosis
Tissue biopsy
29
Henoch-Schlonlein Purpura: Management
Usually self-limiting - 8 weeks
Urinalysis and BP should be monitored due to risk of renal failure
30
Scaphoid Fractures: What is the most common fracture?
Of the carpal bone
31
Scaphoid Fractures: Mechanism of injury
Fall on an outstretched hand
32
Scaphoid Fractures: Clinical presentation
Pain and tenderness in the anatomical snuffbox
33
Scaphoid Fractures: Investigations
X-ray - AP, Lateral and Two obliques (should be repeated after 10 days)
MRI
34
Scaphoid Fractures: Conservative management
Cast
35
Scaphoid Fractures: Operative management options (2)
Percutaneous screw fixation
Open reduction with internal fixation
36
Scaphoid Fractures: Complications - What blood supply is at risk?
Dorsal branch of the radial artery in the distal pole of the scaphoid
37
Scaphoid Fractures: Complications (4)
Damage to the dorsal branch of the radial artery
Non-union
AVN
Early wrist Osteoarthritis
38
Pelvic Soft Tissue Injury: Acute causes due to what?
Muscle tear or tendon avulsion
39
Pelvic Soft Tissue Injury: Can occur secondary to what?
Pelvic fracture
40
Pelvic Soft Tissue Injury: Investigations (2)
US
MRI
41
Pelvic Soft Tissue Injury: Management
RICE
42
Bone Marrow Oedema: Pathophysiology
Impaction to the articular surface leads to microscopic fracture of the trabecular bone with bleeding and impaction
43
Bone Marrow Oedema: Clinical presentation - Major source of pain
Meniscal or Ligament injuries
44
Bone Marrow Oedema: Investigation
MRI
45
Bone Marrow Oedema: Management - Self resolves within what time line?
3 months to one year
46
Bone Marrow Oedema: Complication
Hyaline cartilage may deteriorate to leave a full thickness chondral defect
47
Claw and Hammer Toes
Conditions that deform the shape of the four smaller toes leaving them in a curved position
48
Claw and Hammer Toes: Aetioogy
Acquired imbalance between the flexor and extensor tendons
49
Claw and Hammer Toes: Claw toes have what pathophysiology?
Hyperextension at the MTP joint with flexion in the PIP and DIP joints
50
Claw and Hammer Toes: Hammer toes have what pathophysiology?
Flexion of the PIP joint, Extension of the DIP joint and neutral MTP joint
51
Claw and Hammer Toes: Management - for skin problems
Toe sleeves or corn plasters
52
Claw and Hammer Toes: Surgical management options (4)
Tenotomy - division of an overactive tendon
Tendon transfer
Arthrodesis of the PIP joint
Toe amputation
53
Cerebral Palsy
A persisting qualitative motor disorder appearing before the age of three years due to non-progressive damage to the brain before the growth of the CNS is complete
54
Cerebral Palsy: Aetiology (6)
Insult to the brain before, during or after birth
Genetics
Hypoxia
Prematurity
Brain malformation
Meningitis or intrauterine infection
55
Obstetric Brachial Plexus Palsy: Incidence
2 in 1000 vaginal deliveries
56
Obstetric Brachial Plexus Palsy: Most commonly arises in what cases? (3)
Large babies - macrosomia in diabetes
Twin deliveries
Shoulder dystocia
57
Obstetric Brachial Plexus Palsy: Most common type
Erb's Palsy
58
Obstetric Brachial Plexus Palsy: Erb's Palsy - Aetiology
Injury to C5 and C6 nerve roots
59
Obstetric Brachial Plexus Palsy: Erb's Palsy - Pathophysiology
Causes loss of motor innervation to the deltoid, supraspinatus, infraspinatus, biceps and brachialis muscles
60
Obstetric Brachial Plexus Palsy: Erb's Palsy - Clinical presentation
Injury leads to internal rotation of the humerus - due to unopposed subscapularis
61
Obstetric Brachial Plexus Palsy: Erb's Palsy - Management first and second line
Physiotherapy - prevents contractures early on
Surgical release of contractures and tendon transfers
62
Obstetric Brachial Plexus Palsy: Klumple's Palsy - Aetiology
Injury to the lower brachial plexus - C8 + T11 roots due to forceful adduction
63
Obstetric Brachial Plexus Palsy: Klumple's Palsy - Clinical presentation (2)
Paralysis of the intrinsic hand muscles +/- finger and wrist flexors
Fingers typically flexed
64
Obstetric Brachial Plexus Palsy: Klumple's Palsy - Why are fingers typically flexed?
Paralysis of the interossei and lumbricals which assist extension at the PIP joints
65
Obstetric Brachial Plexus Palsy: Klumple's Palsy - What syndrome may occur and why?
Horner's Syndrome - due to disruption of the first sympathetic ganglion from T1
66
Obstetric Brachial Plexus Palsy: Klumple's Palsy - Management
None
67
Mechanical Back Pain
Recurrent relapsing and remitting back pain with no neurological symptoms
68
Mechanical Back Pain: Mean age
20-55 years old
69
Mechanical Back Pain: Risk Factors - Modifiable (5)
Obesity
Poor posture
Poor lifting technique
Lack of physical activity
Depression
70
Mechanical Back Pain: Non-modifiable risk factors (3)
Facet joint osteoarthritis
Degenerative disc prolapse
Spondylosis
71
Spondylosis
Intervertebral disc lose water content with age resulting in less cushioning and increased pressure on the face joint
72
Mechanical Back Pain: Clinical Presentation (2)
Pain in the lumbosacral region, buttocks and thighs - dull pain above the knee
Mechanical pain - varies with activity
73
Discogenic Back Pain
An acute tear of the outer fibrosis of an intervertebral disc
74
Discogenic Back Pain: Clinical presentation
Pain is worse on coughing - as increases disc pressure
75
Discogenic Back Pain: Investigation
MRI
76
Discogenic Back Pain: Management
Analgesia
Physiotherapy
Symptoms take 2-3 months to settle
77
Sciatica
Characteristic pain felt in the lower back, buttocks and the posterior of the lower leg
78
Sciatica: Aetiology
Compression of a nerve root of the Sciatic nerve - most commonly L5/S1
79
Intervertebral Disc Prolapse: Intervertebral discs consist of what
Concentric collagenous fibres surrounding a central nucleus of degenerated collagen
80
Intervertebral Disc Prolapse: Healthy discs contain what?
Water
81
Intervertebral Disc Prolapse: Ageing causes what to happen to the discs?
Dehydrated
Weakening of the disc
82
Intervertebral Disc Prolapse: When does prolapse occur?
When there is a defect in the annulus fibrosus that allows the nucleus to herniate
83
Intervertebral Disc Prolapse: Herniation of the nucleus occurs due to what?
Strenuous physical activity involving the lumbar spine
84
Intervertebral Disc Prolapse: Prolapsed disc material can impinge on nerve roots causing what?
Pain and altered sensation in a dermatomal distribution as well as reduced power in a myotomal distribution
85
Intervertebral Disc Prolapse: Most common site
Lower lumbar spine in L4, L5 and S1 nerve roots
86
Sciatica: Aetiology - Examples of root compressions by degenerative disease (4)
Bone spurs
Canal stenosis
Spondylolisthesis
Facet arthropathy
87
Sciatica: Aetiology - Examples of sinister causes (3)
Tumour
Fractures
Tuberculosis
88
Sciatica: Aetiology - Examples of root compression from outside of the spine (4)
Piriformis syndrome
Endometriosis
Pelvic disease
Peroneal compression
89
Sciatica: Aetiology - Causes without root compression (2)
Arachnioditis
Peripheral neuropathy
90
Sciatica: Classic description
Sharp, shooting electric unilateral leg pain that radiates to the foot
91
Sciatica: Management - Management
NSAIDs and Analgesia
92
Bony Nerve Root Entrapment
Osteoarthritis of the facet joints
93
Bony Nerve Root Entrapment: Complications
Osteophytes impinge on exit nerve roots
94
Bony Nerve Root Entrapment: Management
Surgical decompression with trimming of impinging osteophytes
95
Spinal Stenosis and Claudication
Narrowing of the central spinal canal, intervertebral foramen and lateral recess causing progressive nerve root compression
96
Spinal Stenosis and Claudication: Aetiology - Main cause
Degenerative joint disease
97
Spinal Stenosis and Claudication: Aetiology - Common age
Middle aged to elderly
98
Spinal Stenosis and Claudication: Pathophysiology - What may cause the lumbar spine to have less space?
Sponylosis
Bulging discs
Bulging ligamentum flavum
Osteophytosis
99
Spinal Stenosis and Claudication: Clinical Presentation - Main symptom
Claudication - pain in legs on walking
100
Spinal Stenosis and Claudication: Clinical Presentation - Differential diagnosis from vascular claudication
Claudication distance is inconsistent
Burning pain - instead of cramping
Spinal extension (standing or walking downhill) exacerbates symptoms whilst flexion improves symptoms
Pedal pulses are preserved
101
Spinal Stenosis and Claudication: Management - Conservative
Analgesia
Physiotherapy
Weight loss
102
Spinal Stenosis and Claudication: Management - MRI evidence of stenosis
Surgical decompression of the spin to increase space for the cauda equina
103
Cauda Equina Syndrome
Compression of the nerve roots caudal to the level of spinal cord termination
104
Cauda Equina Syndrome: Most common aetiology
Compression arising from large lumbar disc herniation at the L4/5 and L5/S1 level
105
Cauda Equina Syndrome: Clinical Presentation (4)
Bilateral leg pain
Loss of motor or sensory function of the bowel and bladder
Perineal anaestheiae
Progressive motor weakness in the legs or gait
106
Cauda Equina Syndrome: Signs
PR exam shows loss of anal sphincter tone
107
Cauda Equina Syndrome: Investigation
Urgent MRI to determine level of prolapse
108
Cauda Equina Syndrome: Management
Urgent disectomy
109
Cauda Equina Syndrome: Complications - prolonged compression can cause what? This requires what management?
Permanent nerve damage - colostomy and urinary diversion
110
Cervical Spondylosis: Clinical presentation
Slow onset stiffness and pain in the neck that radiates to the shoulders and occiput
111
Cervical Spondylosis: Management
Physiotherapy and analgesics
112
Cervical Disc Prolapse
Acute and degenerative disc prolapse in the cervical spine to cause neck pain and nerve root compression
113
Cervical Disc Prolapse: Nerve root compression clinical presentation
Shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes
114
Cervical Disc Prolapse: Most common affected nerve
Lower nerve root - C7 root for C6/7 disc or C8 root for C7/T1 disc
115
Cervical Disc Prolapse: Large central prolapse can have what impact?
Compress the cord leading to myelopathy with upper motor neurone symptoms
116
Cervical Disc Prolapse: Investigation
MRI
117
Cervical Disc Prolapse: Management (3)
Analgesia
Physiotherapy
Surgery
118
Atlanto-Axial Subluxation: Aetiology
In RA destruction of the synovial joint between the atlas and dens and rupture of the transverse ligament
119
Atlanto-Axial Subluxation: Management
Collar to prevent flexion
If more severe requires surgical fusion
120
Lower Cervical Subluxation: Aetiology
Destruction of the synovial facet joints and uncovertebral joints due to RA
121
Lower Cervical Subluxation: Measurements are taken from what?
Flexion-Extension X-rays
122
Lower Cervical Subluxation: Management - When is conservative management (analgesia and physiotherapy) used?
If instability does not involve or threaten neurological structures
123
Lower Cervical Subluxation: Management - Severe casses
Stabilisation and fusion
