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MBChB YR2 MSK > Disease Profiles: Bone and Joint Disorders > Flashcards

Disease Profiles: Bone and Joint Disorders Flashcards

1
Q

List one way corticosteriods indirectly impact bone density

A

Inhibition of gonadal and adrenal steroid production

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2
Q

Which forms of malignancy are patients with Paget’s disease of bone at increased risk of?

A

Osteosarcoma, fibrosarcoma

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3
Q

The following organisms most commonly cause what type of prosthetic joint infection?

Coagulase-negative staph (e.g. Staph. epiderdimis), cutibacterium, corynebacterium, S. aureus

A

Chronic prosthetic joint infection (3 weeks + after operation)

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4
Q

How does vitamin D deficiency cause osteomalacia/rickets?

A

Vitamin D deficiency increases calcium absorption, osteoclastic activity, and release of Ca2+ from bone → impairs mineralisation of newly formed osteoid

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5
Q

What are Bouchard’s nodes?

A

Osteophytes of the PIP joints (can be seen in OA but more commonly seen in RA)

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6
Q

What is osteomyelitis?

A

Infection of the bone and/or bone marrow

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7
Q

The following organisms most commonly cause what type of

prosthetic joint infection?

Staph. aureus, coagulase-negative staph (e.g. Staph. epiderdimis)

A

Early prosthetic joint infection (within 2-3 weeks of operation)

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8
Q

Which patient group is most likely to develop primary osteoarthritis?

A

> 50 years, more common in females

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9
Q

How does chronic osteomyelitis develop?

A

From an untreated acute osteomyelitis

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10
Q

When would you prescribe an osteoporotic patient oral bisphonates?

A

Normal patients: T score = -2.5

If ongoing steroid requirement >/= 7.5mg prednisolone for 3 months or more or if there is a prevalent vertebral fracture, consider treatment with T score < -1.5

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11
Q

When would you refer a patient for a DEXA scan?

A

Anyone with a 10 year risk assessment for any OP fracture of at least 10%

Any patient over 50 years with a low trauma fracture

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12
Q

Which patient group is most likely to develop joint hypermobility syndrome?

A

Higher incidence in females, usually presents in childhood or 3rd decade

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13
Q

Why does acute osteomyelitis in children commonly localise to the metaphyses of long bones?

A

The metaphyses of children’s long bones contain abundant tortuous vessels with sluggish flow which can result in accumulation of bacteria

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14
Q

Which patient group is most likely to develop Paget’s disease of bone?

A

> 50

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15
Q

Describe the clinical presentation of hypocalcaemia

A

Paraesthesiae, muscle cramps, irritability, fatigue, seizures, brittle nails

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16
Q

The following organisms most commonly cause osteomyelitis in which patient group?

S. aureus, Enterobacter sp., and group A and B Strep

A

Newborns (<4 months)

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17
Q

What is the diagnostic investigation for osteomyelitis?

A

Bone biopsy

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18
Q

When should rifampicin be added to patients with a prosthetic joint infection?

A

If culture is positive for rifampicin-sensitive staphlococci

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19
Q

Define primary osteoarthritis

A

Osteoarthritis due to normal ‘wear and tear’ of joints as people age

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20
Q

Which type of fractures are common in patients with type II osteoporosis?

A

Femoral neck fractures and vertebral fractures

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21
Q

What is tertiary hyperparathyroidism?

A

Seen in patients with chronic secondary hyperparathyroidism (usually CKD) who develop an adenoma which will continue to produce PTH despite biochemical correction

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22
Q

Which patient groups would you assess with a 10-year osteoporotic fracture risk calculator?

A

Anyone over 50 years with risk factors

Anyone under 50 years with very strong clinical risk factors - early menopause, glucocorticoids

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23
Q

Which organism is associated with septic arthritis in the elderly, IV drug users and the seriously ill?

A

Escherichia coli

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24
Q

Define diffuse osteomyelitis

A

Segment of bone is infected resulting in skeletal instibility e.g. infected non-union

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25
Q

What is SAPHO and CRMO?

A

Conditions which cause chronic non-bacterial osteomyelitis, chest wall commonly affected

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26
Q

The following organisms commonly cause what type of prosthetic joint infection?

S. aureus, GNB

A

Haematogenous (chronic-late onset)

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27
Q

How can the risk of developing osteoporosis be reduced?

A

Building up peak bone mineral density by way of exercise, good diet and healthy levels of sunlight exposure before bone density starts to decline

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28
Q

What is secondary hyperparathyroidism?

A

Hyperparathyroidism due to physiological overproduction of PTH secondary to hypocalcaemia, usually caused by vitamin D deficiency or CKD

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29
Q

Why are post-menopausal women more likely to develop osteoporosis?

A

There is an increase in osteoclastic bone resorption with the loss of protective effects of oestrogen after menopause

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30
Q

Name two consequences of a vertebral neck fracture due to osteoporosis

A

Result in thoracic kyphosis → loss of height

Once patient has had one vertebral body fracture they are at increased risk of additional fractures

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31
Q

What is rickets?

A

Qualitative defect of bone IN CHILDREN with abnormal softening of the bone due to deficient mineralization of osteoid secondary to inadequate amounts of calcium and phosphorus

This affects the growing skeleton

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32
Q

Define joint hypermobility syndrome

A

Patient with hypermobile joint(s) develops chronic pain lasting 3 months or longer

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33
Q

What is osteoarthritis?

A

Chronic disease involving the imbalance between wear and repair of articular (hyaline) cartilage leading to progressive cartilage loss and accompanying periarticular change

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34
Q

How would you manage a patient with osteomalacia/rickets?

A

Vit D therapy with calcium and phosphate supplementation

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35
Q

The following organisms most commonly cause osteomyelitis in which patient group?

S. aureus, occasionally Enterobacter or Streptococcus sp

A

Adults

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36
Q

What is a sequestrum and what is its clinical significance in osteomyelitis?

A

A sequestrum is a dead fragment of bone that usually breaks off

Once a sequestrum is present antibiotics alone will not cure the infection

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37
Q

List some aspects of lifestyle advice with a patient with osteoporosis

A

Increase calcium intake - postmenopausal women aim 1000 mg calcium per day

Exercise - high intensity strength training and low-impact weight-bearing exercise

Avoidance of excess alcohol and smoking

Fall prevention

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38
Q

Where does chronic osteomyelitis tend to occur in adults?

A

Axial skeleton (spine or pelvis) with haematogenous spread from pulmonary or urinary infections, or from infection of the intervertebral disc

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39
Q

Describe the pharmacological management of osteoarthritis

A

Analgesia as needed (paracetamol, NSAIDs, avoid opiates)

Local intra-articular steroid injections for flare-up up to 3x year

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40
Q

Which organisms most commonly cause osteomyelitis in sickle cell anaemia patients?

A

S. aureus the most common, Salmonella species common and fairly unique to sickle cell patients

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41
Q

Describe the examination findings of a patient with septic arthritis

A

Reduced ROM +/- swelling

May have systemic fever

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42
Q

Describe the clinical presentation of spinal osteomyelitis

A

Insidious onset of back pain which is constant and unremitting

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43
Q

What is the quantitative definition of osteoporosis?

A

Bone density is 2.5 standard deviations below the mean peak value of young adults of the same race and sex

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44
Q

Describe the clinical presentation of acute osteomyelitis

A

Gradual onset pain at site of infection, point tenderness, swelling, redness, warmth

Systemic findings: malaise, fever, chills

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45
Q

When would HRT be indicated in osteoporosis?

A

Not indicated for osteoporosis except in early postmenopausal women who also have significant perimenopausal symptoms

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46
Q

When would you empirically treat a patient with septic arthritis?

A

If they are septic

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47
Q

Define localised osteomyelitis

A

OM affecting cortex and medullary bone

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48
Q

Which type of fractures are common in patients with type I osteoporosis?

A

Colles fractures and vertebral insufficiency fractures

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49
Q

What investigations would you perform in suspected prosthetic joint infection?

A

Culture of perioperative tissue

Bloods - CRP, blood culture

X-ray

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50
Q

How would you manage a patient with early or haematogenous prosthetic joint infection?

A

DAIR - debridement, antibiotics (12 weeks), implant retention

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51
Q

What is type I osteoporosis?

A

Exacerbated loss of bone in the post‐menopausal period

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52
Q

What is Brodie’s abscess?

A

Subacute osteomyelitis found in children with a more insidious onset; bone reacts by walling off the abscess with a thin rim of sclerotic bone

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53
Q

Why does osteoporosis increase fracture risk?

A

The reduced density and increased porosity increases the fragility of bone

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54
Q

Why does the formation of pus make osteomyelitis difficult to treat?

A

Impairs local blood flow

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55
Q

What blood test results would indicate osteomalacia/rickets?

A

↓ calcium and serum phosphate, ↑ serum ALP

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56
Q

How would you manage a normal patient with chronic prosthetic joint infection?

A

Stage 2 exchange - removal of joint and 6 weeks of aggressive antibiotic therapy, once infection under control perform a revision joint replacement

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57
Q

What is the average bone loss per year once peak bone mass has been reached?

A

0.7%

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58
Q

Define superficial osteomyelitis

A

OM affecting the outer surface of bone

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59
Q

What are brown tumours?

A

Osteoporotic bone prone to fracture

Associated haemorrage elicits macrophage reaction and processes of organisation and repair → mass of reactive tissue ‘brown tumour’

60
Q

When would testosterone be indicated in osteoporosis?

A

Men with clinical and biochemical evidence of hypogonadism

61
Q

Describe the clinical presentation of septic arthritis

A

Single warm, red, painful joint with pain whenever the joint moves

62
Q

Describe the examination findings of a joint with osteoarthritis

A

Joint line tenderness, crepitus, deformity, stiff on testing ROM

63
Q

What is an involucrum in osteomyelitis?

A

The formation of new bone around the area of necrosis

64
Q

What is DEXA scanning?

A

Measure of bone mineral density - predicts fracture risk independently of other risk factors

65
Q

What is the first line treatment for the majority of patients with osteoporosis?

A

Oral bisphosphonates e.g. alendronate, risedronate

66
Q

Define secondary arthritis

A

Osteoarthritis that affects an unexpected site due to overuse, previous injury or previous arthritis

67
Q

Describe the management of joint hypermobility syndrome

A

Patient eduction, physio, analgesia as required

68
Q

When does peak bone mass occur?

A

Young adulthood

69
Q

What is a prosthetic joint infection (PJI)?

A

Periprosthetic infection involving the joint prosthesis and adjacent tissue

70
Q

How would you diagnose osteoarthritis?

A

Clinical diagnosis

71
Q

What is type II osteoporosis?

A

Osteoporosis of old age with a greater decline in bone mineral density than expected

72
Q

Define medullary osteomyelitis

A

OM affecting medullary bone

73
Q

What causes contagious osteomyelitis?

A

Spread of infection from adjacent tissue e.g. injuries, infected foot ulcer or pressure sore, PJI etc.

74
Q

What is Gaucher’s disease?

A

Lysosomal storage disorder which can mimic osteomyelitis

75
Q

Describe the classical x-ray findings seen in osteoarthritis

A

Loss of joint space, marginal osteophytes, sclerosis (subchondral), subchondral cysts

76
Q

What is the second most common cause of septic arthritis in adults?

A

Streptococci

77
Q

What is sessile bacteria?

A

Phenotypic transformation of planktonic bacteria to form a biofilm encased in an extracellular matrix

Occurs in chronic deep infections

Antibiotics cannot penetrate the biofilm - removal of infected prosthesis needed

78
Q

What does ‘squaring of the thumb’ indicate?

A

1st CMC joint OA

79
Q

The following organisms most commonly cause osteomyelitis in which patient group?

S. aureus, group A Strep, H. influenzae, Enterobacter sp

A

Children (4 months to 4 years)

80
Q

Describe the surgical management of osteoarthritis

A

Joint replacements

Arthroscopic sugary e.g. to remove loose bodies

81
Q

When would you perform imaging in suspected osteoarthritis?

A

If there is doubt over diagnosis

82
Q

Describe the clinical presentation of osteomalacia/rickets

A

Bone pain of the pelvis, spine and femora, deformities from soft bones (particularly in rickets), pathological fractures, S+S of hypocalcaemia

83
Q

What is osteoporosis?

A

Quantitative defect of bone characterised by reduced bone mineral density and increased porosity

84
Q

What empirical antibiotic would you give for an adult septic patient who has septic arthritis?

A

Flucloxacillin

85
Q

Why must you always aspirate any hot, red and tender joint?

A

Septic until proven otherwise - emergency due to rapid irreversible cartilage damage

86
Q

What x-ray results would indicate osteomalacia/rickets?

A

Pseudofractures (aka Looser’s zones), particularly of the pubic rami, proximal femora, ulna and ribs

87
Q

Describe the clinical presentation of chronic osteomyelitis

A

Recurrent pain usually following a prior episode of osteomyelitis, swelling, redness

88
Q

What are subchondral cysts?

A

Accumulation of synovial fluid in a joint with OA

89
Q

Which investigations would you perform in suspected osteomyelitis?

A

Probe to bone test, blood CRP, imaging (x-ray then consider others e.g. MRI)

Gold standard - bone biopsy to confirm

90
Q

How would you manage a patient with septic arthritis?

A

1-2 weeks IV antibiotics to cultured organism, may require joint washout, if good progress PO antibiotics til 6 weeks antibiotics completed

91
Q

Where does osteomyelitis that has travelled from another site (haematogenous) commonly localise in children?

A

Long bone metaphysis

92
Q

What investigations would you perform in suspected septic arthritis?

A

Aspiration of joint fluid

Bloods - CRP, blood culture if pyrexic

X-ray, consider MRI

93
Q

How would you manage chronic osteomyelitis?

A

Can be suppressed with antibiotics but may be unsuccessful

Surgery - take bone cultures, remove sequestrum and debride infected/non-viable bone

IV antibiotics for several weeks after surgery

94
Q

Acute osteomyelitis in the absence of recent surgery usually occurs in which age group?

A

Children

95
Q

What is fibrosa cystica?

A

The result of unchecked hyperparathyroidism, which results in an overproduction of PTH

Continued osteoclasis → osteoporosis, brown tumours and osteitis

96
Q

Describe the clinical presentation of Paget’s disease of bone

A

Can be asymptomatic

Pain - micro-fracture or nerve compression

Enlargement and abnormal shape of bone

Increased metabolism can cause warm skin, AV shunt

97
Q

What are the 3 stages of Paget’s disease of bone

A
  1. Osteolytic
  2. Mixed osteoclasis and osteoblastic activity
  3. Osteosclerotic
98
Q

When would teriparatide be indicated in a patient with osteoporosis?

A

Recommended over oral bisphosphate in postmenopausal women with at least 2 moderate or 1 severe low trauma vertebral fracture to prevent vertebral fracture

99
Q

What is sickle cell osteomyelitis?

A

OM that occurs during a sickle cell crisis

100
Q

What are Heberden’s nodes?

A

Osteophytes of the DIP joints (only seen in OA)

101
Q

Describe the clinical presentation of joint hypermobility syndrome

A

Joint pains especially after exercise/physical work, frequent sprains and dislocations, thin stretchy skin

102
Q

How would you manage acute osteomyelitis?

A

‘Best guess’ antibiotics IV unless there is an abscess which requires drainage

If infection fails to resolve - second line antibiotics, surgery to take a sample for culture and remove infected bone/tissue

103
Q

What causes localised osteoporosis?

A

Osteoporosis which develops through disuse of particular bones

104
Q

What is the most common mechanism of spread for a septic arthritis?

A

Haematogenous

105
Q

What is eburnation?

A

The surface of a joint with OA becomes ‘polished’ - subchondral sclerosis

106
Q

Define localised osteoarthritis

A

Osteoarthritis affecting a single joint e.g. hips, knees, finger interphalangeal joints, facet joints of lower cervical and lower lumbar spines

107
Q

The following organisms most commonly cause osteomyelitis in which patient group?

S. aureus (80%), group A Strep, H. influenzae, and Enterobacter sp.

A

Children/adolescents (4 years to adult)

108
Q

When would calcium and/or vitamin D supplements be indicated in a patient with osteoporosis?

A

If dietary intake is poor/limited sunlight exposure

109
Q

What are the most common causative organisms for prosthetic joint infection?

A

Staph. aureus and staph. epiderdimis

110
Q

Where does osteomyelitis that has travelled from another site (haematogenous) commonly localise in adults?

A

Vertebrae

111
Q

Define severe osteoporosis

A

Bone density is 2.5 standard deviations below the mean peak value of young adults of the same race and sex WITH a fragility fracture

112
Q

What is hyperparathyroidism?

A

Involves overactivity of the parathyroid glands with high levels of parathyroid hormone (PTH)

113
Q

How would you manage a frail patient with chronic prosthetic joint infection?

A

Stage 1 exchange - removal of joint and antibiotics

114
Q

SERMS (selective estrogen receptor modulators) are rarely used in the management of osteoporosis, they only reduce the risk of which type of fractures?

A

Vertebral

115
Q

Describe the effect of Paget’s disease on the bone structure

A

Thick excess bone with abnormal reversal lines (mosaic pattern)

Bone matures but is soft and porous

116
Q

What causes osteomalacia/rickets?

A

Either insufficient calcium absorption (which can be caused by lack of vitamin D), or phosphate deficiency caused by increased renal losses

117
Q

Which clinical features suggest post-traumatic osteomyelitis?

A

Non-union and poor wound healing

118
Q

What is the modified Beighton score?

A

Measures hypermobility on a 9 point scale

119
Q

What is the most common cause of septic arthritis in children?

A

Haemophilus influenzae (however now uncommon in areas where Haemophilus vaccination is practiced)

120
Q

When would romosozumab be indicated in osteoporosis?

A

Recommended for postmenopausal women with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture (24 months)

121
Q

Which joints are affected in primary arthritis?

A

Weight-bearing or active joints - most commonly the knees, hands and hips

122
Q

What is Paget’s disease of bone?

A

Chronic condition condition involving cellular remodeling and deformity of one or more bones

123
Q

In intra-articular metaphases found in neonates and children (e.g. proximal femur), what co-existent condition can develop from osteomyelitis?

A

Septic arthritis

124
Q

What empirical antibiotic would you give for a septic patient under 5 who has septic arthritis?

A

Flucloxacillin and ceftrioxine

125
Q

Define generalised osteoarthritis

A

OA at either the spinal or hand joints and in at least 2 other joint regions

126
Q

Describe the pathophysiology of osteoarthritis

A

Localised loss of hyaline cartilage and remodeling of adjacent bone with osteophyte formation at joint margins

Causes increased pressure and inflammation → pain, swelling, stiffness

127
Q

How is a subperiosteal abscess able to form in infants?

A

Infants have loosely applied periosteum

128
Q

Name an organism associated with prosthetic joint infection in upper limb prostheses

A

Cutibacterium acnes

129
Q

What is secondary osteoporosis?

A

Osteoporosis that occurs secondary to other conditions e.g. corticosteroid use, alcohol abuse, malnutrition, endocrine disorders

130
Q

Which bones are usually affected by Paget’s disease of bone?

A

Usually axial bones (small bones less commonly affected)

131
Q

What is the most common cause of septic arthritis in adults?

A

Staph. aureus

132
Q

Describe the non-pharmacological management of osteoarthritis

A

Exercise, weight loss, walking aids, physio, activity modification

133
Q

What is the quantitative definition of osteopenia?

A

Intermediate stage before osteoporosis where bone mineral density is between 1 to 2.5 standard deviations below mean peak value

134
Q

Describe the clinical presentation of osteoarthritis

A

Pain worse with activity, morning stiffness < 30 mins, night pain, inactivity gelling, instability

135
Q

Name 3 risk factors for the development of primary osteoarthritis

A

Genetic predisposition, constitutional factors (e.g. female), biomechanics factors (e.g. occupational use)

136
Q

What is osteomalacia?

A

Qualitative defect of bone with abnormal softening of the bone due to deficient mineralization of osteoid secondary to inadequate amounts of calcium and phosphorus

137
Q

List three ways by which corticosteroids directly impact bone density

A

Reduction of osteoblast activity and lifespan

Suppression of replication of osteoblast precursors

Reduction in calcium absorption

138
Q

What is primary hyperparathyroidism?

A

Hyperparathyroidism due to a benign adenoma, hyperplasia or rarely a malignant neoplasia

139
Q

Which patient group is most likely to develop osteoporosis?

A

Post-menopausal women

140
Q

Which investigations would you perform in suspected osteomalacia/rickets?

A

X-ray, bloods

141
Q

What is septic arthritis?

A

Inflammation of the joint space caused by infection

142
Q

What is the clinical marker of generalised osteoarthritis?

A

The presence of multiple Herbeden’s nodes

143
Q

Neisseria gonorrhoea is a common cause of septic arthritis in which patient group?

A

Young adults

144
Q

Name two second-line treatments used in osteoporosis

A

Zoledronic acid, desunomab

145
Q

Why is a vertebral body fracture in a patient with osteoporosis often not identified at the time of injury?

A

Stress can be minimal e.g. coughing

146
Q

Which investigation would you perform to exclude a malignancy from a patient presenting with vertebral fractures where you suspect osteoporosis?

A

Protein electrophoresis and Bence Jones proteins - to rule out multiple myeloma

MBChB YR2 MSK (36 decks)

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