General

Question 1

reduced bone mass normal mineralisation

Answer 1

osteoporosis

Question 2

risk factors osteoporosis

Answer 2

female
oestrogen deficiency (early menopause) 
FH hip fracture
low dietary calcium when young
reduced mobility

Question 3

causes of osteoporosis? mnemonic?

Answer 3

RACISM 
Rheumatoid arthritis
Alcohol
Corticosteroids
Immobility
Smoking
Multiple myeloma

Question 4

features of osteoporosis

Answer 4

asymptomatic until low trauma fracture

Question 5

investigations osteoporosis

Answer 5

bone profile - all normal
x ray - normal until >30% bone mass lost
BMD via DEXA - gold

Question 6

treatment osteoporosis

Answer 6

vitamin D3 + Calcium 1g
bisphosphonates - alendronic acid + risedronate once weekly (reduce resorption)
teriparatide (increase bone mass)

Question 7

low mineralisation normal bone mass

Answer 7

osteomalacia

Question 8

cause of osteomalacia

Answer 8

vitamin D deficiency

Question 9

3 causes of osteomalacia

Answer 9

lack of dietary vitamin D3 / malabsorption (after gastrectomy)
lack of sunlight exposure (isolation, immobility)
chronic renal failure

Question 10

osteomalacia investigations

Answer 10

bone profile - low Ca, PO4. raised ++ ALP. low urinary Ca
x ray - rarefaction, pseudo fractures, transverse lucencies
bone biopsy - diagnostic. wide osteoid seams

Question 11

treatment osteomalacia

Answer 11

vitamin D3 + calcium supplements

Question 12

wide osteoid seams on bone biopsy

Answer 12

osteomalacia

Question 13

increased multinucleate osteoclasts
increased osteoblasts
increased fibrosis
disorganised bone matrix

Answer 13

pagets disease

Question 14

presentation pagets disease

Answer 14

asymptomatic

deformity, throbbing, fracture, deafness due to CNVIII compression

Question 15

investigations pagets disease

Answer 15

bone profile - Ca, PO4 normal. ALP raised

x ray - cortical thickening + thickened trabecular pattern

BONY EXPANSION ON X RAY!!!!! PATHOGNOMIC

Question 16

bony expansion on xray

Answer 16

pagets disease

Question 17

treatment pagets disease

Answer 17

bisphosphonates
PO risedronate OD 2 months
IV zoledronic acid 5mg single dose

Question 18

polymyalgia rheumatica symptoms

Answer 18

inflammation of blood vessels

stiffness arms, shoulder, hips, neck

Question 19

risk factors poly myalgia rheumatic

Answer 19

FHx
female
viral / bacterial illness
>65yo

Question 20

investigations polymyalgia rheumatica

Answer 20

bloods - increased ESR, CRP

temporal artery biopsy - giant cells

Question 21

treatment polymyalgia rheumatica

Answer 21

40mg PO steroids 1 week

maintain low dose steroids 12-18m

Question 22

osteoarthritis presentation

Answer 22

older people 
gradual onset 
large joints 
MCP, DIP
herbedens and Bouchard nodes 
bony swelling 
morning stiffness <1h 
pain ++ in evening 
if painful, improves with rest

IMPROVES WITH REST

Question 23

investigations osteoarthritis

Answer 23

x ray hands - LOSS
 loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis

Question 24

osteoarthritis management

Answer 24

no cure
analgesia and anti inflammatory
don’t give NSAID if renal impairment or on diuretics
steroid injections. NOT systemic steroids

Question 25

rheumatoid arthritis features

Answer 25

younger patient
bilateral and symmetrical
quicker onset eg weeks, months 
smaller joints eg PIP, DIP
systemic symptoms!!! and extra articular features 
stiffness improves with use 
stiffness >30mins 
pain >6 weeks 

IMPROVES WITH USE