General revision Flashcards
Stages of fracture repair?
Haematoma
- Cytokine and growth factor release
Inflammation
- Macrophage mediated phagocytosis of debris
Granulation tissue
- Collagen and neovascularisation
Soft callus
- in order to form cartilage in endochondral bone growth
- mesenchymal stem cells differentiate and produce fibrous cartilage
Hard callus
- cartilage into bone through chondrocyte apoptosis and osteoclast differentiation
Therapies for fracture repair?
PTH
Anti-sclerosin
BMP
- increases strength and stiffness
Where are trabecular and cortical bone?
Trabecular inside, cortical outside
What type of bone do you lose in osteoporosis?
Trabecular
How do bisphosphonates work?
Inhibit osteoclasts
What’s a bone lining cell?
Stops osteoclasts getting to bone
Osteopenia and osteoporosis T score?
Who should have a DEXA scan?
FH
Low BMI/hypogonadism/early menopause
Osteoporosis Tx?
Lifestyle
Bisphosphonates
Raloxifen
Strontium ranelate
Teriparatide - PTH, expensive
Typical areas of osteoporotic fractures?
Vertebral
Wrist
NOF
Big 5 underlying problems?
Infections
Inflammation
Malignancy
Blood flow interruption
Trauma
In what two broad situations is the ALP high?
In childhood and in liver dysfunction (and bone)
What conditions cause the ALP to be high pathologically?
Liver disease
Bone
Trauma
What conditions cause the ALT to be high pathologically?
Liver disease
Muscle disease
Drugs
Commonest cause of high calcium?
Primary hyperparathyroidism (parathyroid producing too much PTH)
Is rheumatoid factor good? whats better?
Not very specific or sensitive really, can just be raised in inflammation.
Anti-CCP is better
HLA B27 positive in 95% of people with what?
Ankylosing spondylitis - although also positive in 7% of population so not very specific
Rise in conjugated or unconjugated bilirubin indicative of biliary dysfunction?
Conjugated
Rise in conjugated bilirubin Ddx?
Liver disease or biliary obstruction.
Obstructive/cholestatic picture in LFTs?
ALP (and GGT) > ALT
Spirometry reading that define COPD?
FEV1/FVC less than 70% then COPD
Improvement of what percent in the FEV1 following bronchodilator indicates asthma?
15%
Normal treatment for TB?
Isoniazid and rifambucin (6 months)
Pyrazinamide and ethambutol (2 months)
If possibly meningeal then give steroids too
Four main groups of bacteria?
Gram positive
Gram negative
Anaerobes
Atypicals
- can’r gram stain or grow
Common examples of gram positive organisms?
Staph and strep
Common examples of gram negative organisms?
E coli
Klebsiella
pseudomonas
Haemophilis influenzae
Common examples of atypical bacteria?
Legionella
Chlamydia
Mycoplasma
What is the key structural difference between Gram-positive bacteria and Gram-negative bacteria?
Gram-negative bacteria have a double membrane
What drugs need therapeutic monitoring of levels?
Cyclosporin Valproate Carbamazepine Phenytoin Digoxin Lithium Clozapine Gentamycin Vancomycin
Stages of wound healing?
Haemostasis
- Clotting
Inflammation
- Neutrophils then macrophage, chemotaxis and pro inflammatory mediators
Proliferation
- Granulation tissue
- Fibroblasts produce collagen
- Neovascularisation
- epithelium forms over
Maturation or remodelling
- Stronger collagen
- scar tissue formed
Steps in bone healing?
Haematoma
Soft callous
- Mesh from granulation tissue
Bony callous
Bone remodelling
- Strong compact bone
- Osteoblasts
Type of pathogen in osteomyelitis, what type of bones?
Osteomyelitis - bone infection
Long bones
Staphylococcus aureus (gram +ve)
