master document Pt1 Flashcards
what do bisphophonates do?
reduce osteoclast resorption
what muscles attach to the clavicle
deltoid and trapezius
what does strontium do
increases osteoblast replication and reduces resorption
describe an osteoclast
breaks up bone – multinucleate
describe an osteoblast
builds bone
what increases during acute illness
ferritin
how is an osteosarcoma seen on an X-ray
as the Codman triangle which is due to periosteum elevation by tumour formation
what inserts onto the lesser trochanter
Psoas major
what can cause hypercalcaemia and how
lithium by resetting the set point of PTH
describe skeletal muscle
striations and peripheral nuclei
Osteoprogenitor cells:
located on bone surfaces, for example under the periosteum, these cells serve as a pool of reserve osteoblasts
osteoblasts:
bone forming cells found on the surface of developing bone. They have plentiful RER and prominent mitochondria.
osteocytes:
a bone cell trapped within the bone matrix.
osteoclasts:
large multinucleated cells. They are found on the surface of bone and are responsible for bone resorption
Pernicious anaemia –
not enough B12
where can Musculocutaneous nerve injury present as weakness
in elbow flexion as it innervates biceps brachii
where is the sternal angle located
at the lower border of T4 vertebrae
where does the middle meningeal artery go through
foramen spinosum
Non-painful flexion contracture which is not correctable in elderly patient –
Dupuytrens
pain and numbness
Carpal tunnel syndrome
pain and inflammation
deQuervain tenosynovitis
pain and clicking or trigger sign
flexor tendinitis
well circumcised without causing rigid contractures
tendon sheath ganglia
radial nerve palsy is normally caused by fractures involving
the distal 1/3 of the humerus
atraumatic c spine injury can occur in
Down syndrome and RA
polio:
affects motor anterior horn cell in the spinal cord, flu like illness
what may predispose to SUFE
Hypothyroidism or renal disease
Sufe:
patients can present with pain purely in the knee Loss of internal rotation of the hip
apophysitis:
inflammation of a growing tubercle where a tendon attaches
Talipes Equinovarus (clubfoot):
boys, forefoot supination, forefoot varus alignment, ankle equinus (plantarflexion), Ponseti technique of splintage, loosen Achilles tendon
Spondylolisthesis is
slippage of one vertebra over another and usually occurs at the L4/L5 or L5/S1 level
Ankylosing spondylosis:
male, age 20-40, bamboo spine, can have fusion of sacroiliac joints
what doesn’t have any effect on spinal disease
DMARDs
onycholysis:
lifting of the nail from the nail bed (nail fungus or psoriasis)
Reactive arthritis: in response to GU or GI infection
Large joints (knees) swell 1-3 weeks after infection
Reiter’s syndrome:
uveitis/conjunctivitis, urethritis, arthritis
treat raynauds
calcium channel blockers (nifedipine)
what is the final product of the breakdown of purines (adenosine & guanine)
uric acid
gout
Needle shaped negative birefringence (change from yellow to blue when lined across the direction of polarisation
gout treatment
use colchicine or NSAIDs
what is pseudogout caused by
by calcium pyrophosphate crystals
Polymyalgia rheumatica:
HLA-DR4 & exposure to adenovirus/parvovirus B19
ENT symptoms are common in
GPA
polymyalgia reumatica is associated with
GCA
GPA associated with
cANCA and PR3
olfer’s elbow –
medial condyle
tennis elbow –
lateral condyle
Total knee replacement:
cobalt chrome or stainless steel or titanium with a high density polyethylene bearing surface or ceramic
Meniscal injuries:
twisting force on a loaded knee
ie turning in football
- Joint line pain and effusion the next day
- Locking
ACL rupture –
- higher rotational force, turning upper body laterally on a planted foot
- Rugby, skiing
- Pop felt or heard
- Haemarthrosis – due to vascular bleeding of ACL within 1 hour
- Anterior drawer test and Lachman test positive
Hip pathology produces pain in the
groin
hip replacement early complications
infection, dislocation, nerve injury, MI, chest infection, DVT, PE
hip replacement late complications
loosening, late infection and late dislocation
Gold standard for hallux rigidus is
arthrodesis (surgical immobilisation of a joint by fusion)
Morton’s neuroma:
- Irritated nerves can become inflamed and swollen and form a neuroma
- Burning pain and tingling radiating into the affected toes
- Women and high heels are a cause
- Third interspace nerve is most commonly affected
- Planter interdigital nerves (from medial and lateral plantar nerves)
- Mulder’s click test: squish the forefoot together
- US for diagnosis (of swollen nerve)
Metatarsal pad/offloading insole/steroid and local anaesthetic insole
