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MSK Flashcards

1
Q

Types of in utero bone development

A

Intramembranous ossification(flat bones)

Endochondrial ossification(long bones)

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2
Q

Intramembranous ossification process

A

Condensation of mesenchymal cells
Osteoblasts secrete osteoid->osteocyte
Trabecular matrix & periosteum form

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3
Q

Endochondrial ossification process

A

Hyaline cartilage precursor
Perichondrium forms around it
Calcified matrix forms around POC
POC is at centre, SOC at end of long bones

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4
Q

Bone cells and function

A

Osteogenic cell: stem cell

Osteoblast: build bone, secrete osteoid

Osteoclast: consume bone(phagocytosis)

Osteocyte: mature bone cell

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5
Q

What is an osteon

A

Unit of cortical bone
Concentric lamellae around a central Haversian canal
Transverse canals: Volksmans canals

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6
Q

Structure of long bones

A

Epiphysis
Physis
Metaphysis
Diaphysis

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7
Q

Types of bone growth

A 
Interstitial(lengthening):
Happens at physis
Contains hyaline cartilage
Epiphysis: hyaline cartilage divides
Diaphysis: cartilage calcifies into bone

Appositional(thickening):
Periosteum ridges->groove for blood vessels
Ridges fuse into endosteum lined tunnel
Osteoblast in endosteum form osteon

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8
Q

Stabilising factors for synovial joints

A

Ligament
Tendon
Bone surface congruity

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9
Q

Differences between children bones and adult bones

A

Elasticity: high density of Haversian canals, bones bend before breaking
Physis
Speed of healing
Remodelling

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10
Q

Congenital paediatric conditions

A

Developmental dysplasia of hip
Clubfoot
Achondroplasia
Osteogenesis imperfecta

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11
Q

What is developmental dysplasia of hip and risk factors

A

HoF is unstable/incongruous with acetabulum

Female
Family history
Breech
Oligohydramnios

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12
Q

Developmental dysplasia of hip investigations and treatment

A

Range of motion->limited abduction
Ultrasound(<4m)
X ray(>4m)

Pavlik harness->reducible hip & <6m
MUA and closed reduction and spica

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13
Q

Clubfoot risk factors

A

Hawaiian

M2:1F

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14
Q

Clubfoot deformities

A

C- cavus: high arch
A- adductus of foot: tight tib ant.&post.
V: varus: tight ach tendon
E: equinos: tight ach tendon

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15
Q

Clubfoot treatment

A

Ponseti method:
Series of casts
Many require operative treatment
Foot orthosis brace

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16
Q

What is achondroplasia

A

Most common skeletal dysplasia
Autosomal dominant
Inhibition of chondrocytic proliferation in physis

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17
Q

Achondroplasia signs

A

Humerus shorter than forearm
Femur shorter than tibia
Normal trunk
Adult height 125cm

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18
Q

What is osteogenesis imperfecta

A

Decreased type 1 collagen due to low production or abnormal collagen
Insufficient osteoid production

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19
Q

Osteogenesis imperfecta manifestations

A

Short stature
Fragility fractures
Scoliosis

Blue sclera
Brown, soft teeth

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20
Q

Classification of paeds fractures(PAEDS)

A 
P- pattern
A- anatomy: prox/mid/dist 1/3
E- extra-intraarticular: pri/sec bone heal
D- displacement: angulated, rotated etc
S- Salter-Harris
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21
Q

Salter-Harris types

A 
Physeal separation
Transverses physis, exits metaphysis
Transverses physis, exits epiphysis
Passes through meta, dia and physis
Crush injury to physis
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22
Q

Types of growth arrest

A

Whole physis: limb length discrepancy

Partial physis: angulation

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23
Q

Growth arrest treatment

A

Limb length: shorten long side vice versa

Angulation: stop growing unaffected side/reform bone(osteotomy)

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24
Q

3 causes of a limping child

A

Septic arthritis

Perthes disease

Slipped upper femoral epiphysis(SUFE)

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25
Q

Septic arthritis diagnosis and management

A

Non-weight bearing
ESR>40
WCC>12,000
Temp>38

Joint aspiration->MS&C
Surgical washout
Transient synovitis once SA excluded

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26
Q

What is perthes disease

A

Idiopathic necrosis of proximal femur epiphysis
4-8 years old
Commonly male
Supportive treatment

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27
Q

What is SUFE

A

Proximal epiphysis slips in relation to metaphysis
Commonly obese adolescent male
Hypothyroidism/Hypopituitarism
Operative fixation with screws

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28
Q

What makes up a sarcomere

A

A band: myosin(dark)
I band: actin(light)
Z disc separates sarcomeres

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29
Q

What is actin made of

A

Actin twisted into helix
Each molecule has myosin binding site
Also has troponin and tropomyosin

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30
Q

Muscle fibre types

A

Type 1: slow
Type 2a: fast fatigue resistant
Type 2b: fast fatiguable

31
Q

Regulation of muscle fibres

A

Recruitment: smaller units recruited first

Rate coding: slow units fire at lower frequency

32
Q

2 examples of muscle plasticity

A

Ageing: from type 2 to type 1
Microgravity: type 1 to type 2

33
Q

What happens to microfilament during muscle contraction

A

Ca binds to troponin
Tropomyosin moves
Myosin binding site on actin exposed
Actin-myosin crossbridges form

34
Q

Clinical signs of a fracture

A 
Pain
Swelling
Crepitus
Deformity
Adjacent structural injury
35
Q

Fracture healing process

A

Bleeding
Inflammation
Proliferation
Remodelling

Haematoma forms
Cytokine release, angiogenesis
Soft callus formation(type2 collagen)
Converts to hard callus(type1 collagen)

36
Q

Fracture management

A

Reduction
Hold
Rehabilitation

37
Q

Types of fracture reduction

A

Open

Closed

38
Q

Types of hold fracture management

A

Closed: plaster, traction(skin/skeletal)

Fixation:
External(mono/multiplanar)
Internal(intra/extramedullary)

39
Q

Fracture complications

A 
General:
Fat embolus
DVT
Infection
Prolonged immobility
Specific:
Neurovascular injury
Muscle/tendon injury
Nonunion
Degenerative change
40
Q

NoF fracture causes and important history features

A

Osteoporosis
Trauma

Age
Comorbidities
Pre-injury mobility
Social history

41
Q

NoF fracture classification

A

Near head of femur: intracapsular

Below head of femur: extracapsular ->transcervical, intertrochanteric, subtrochanteric

42
Q

NoF management

A

Extracapsular: internal fixation
Intracapsular:
Undisplaced(fixation with screws)
Displaced-> <55y(reduce and fixation) or >65y(total hip replacement if fit, hemiarthroplasty if unfit)

43
Q

Distal radius fracture management

A

Check for angulation
Minimal displacement->cast
Extraarticular unstable->MUA & K wire
Intraarticular->ORIF(open reduction, internal fixation)

44
Q

Shoulder dislocation symptoms, investigations and name of defect

A

Direct trauma
Pain
Restricted movement
Loss of normal shoulder contour

Test axillary nerve
X ray
Scapular Y view

Hill Sachs defect

45
Q

Types of tendinopathy

A

Tendinosis
Tendinitis
Rupture

46
Q

What is osteomalacia

A

Bone demineralisation due to low vit D
Muscle weakness and fragile bones
Treat with vit D injections

47
Q

Gout causes, common joint and medications

A

Urate crystal deposition->inflammation
Caused by purine rich food and kidney problems
Commonly big toe

Colchicine
NSAIDs
Steroids
Allopurinol

48
Q

What is pseudogout

A

Calcium pyrophosphate dihydrate crystal deposition

49
Q

Pseudogout vs gout

A

Gout: negative birefringence, needle shaped crystals
PG: positive birefringence, rhomboid shaped crystals

50
Q

Rheumatoid arthritis symptoms

A

Symmetrical polyarthritis

Early morning stiffness, better after movement

51
Q

Rheumatoid arthritis autoantibodies

A

Rheumatoid factor: igM against IgG

Antibodies to citrullinated protein antigen(ACPA): specific for RA

52
Q

RA treatment

A

DMARDs:
Methotrexate+sulfasalazine/hydroxychloroquine

Janus kinase inhibitors
Biological therapy: TNF inhibition, B cell depletion, IL-6 inhibition

53
Q

RA complications

A

Osteopenia
Bony erosions
Joint space narrowing

54
Q

What is psoriatic arthritis

A

Asymmetrical arthritis

Skin manifestations present as well

55
Q

What is ankylosing spondylitis

A

Chronic inflammation of sacroiliac joint
Causes spinal fusion
Commonly 20-30y male
Associated with HLA-B27

56
Q

Ankylosing spondylitis investigations

A

Bloods: normocytic anaemia, high CRP&ESR, HLA-B27
X ray
MRI: squaring vertebral bodies, erosion/sclerosis/narrowing, bamboo spine

57
Q

Side effect of DMARDs

A

Liver damage: bilirubin, ALT, ALP, albumin

58
Q

What does high ALP indicate?

What does low calcium/phosphate indicate?

A

ALP: Paget’s disease of bone

Calcium/phosphate: osteomalacia

59
Q

SLE diagnosis

A

ANA->sensitive but not specific

dsDNA antibody->specific for SLE

60
Q

X ray findings for gout, OA, RA

A

Gout: rat bites
OA: joint space narrowing, osteophytes, subchondral sclerosis, subchondral cyst
RA: bony erosions

61
Q

Ultrasound findings RA

A

Synovial hypertrophy
Increased blood flow
May detect erosions not on x ray

62
Q

Osteoarthritis symptoms

A

Pain related to use
Minimal morning stiffness
Swelling
Low range of motion

63
Q

Osteoarthritis finger manifestations

A

Bouchard nodes-> PIP

Heberdens nodes-> DIP

64
Q

Types of connective tissue disorder

A 
SLE
Sjorgen’s syndrome
Inflammatory muscle disease
Systemic sclerosis
Overlap syndrome
65
Q

Connective tissue disease symptoms

A

Serum antibodies
Non erosive arthritis
Raynaud’s phenomenon: intermittent vasospasm of digits when cold(white to blue to red)

66
Q

SLE management

A

Hydroxychloroquine and methotrexate

B cell targeted therapy

67
Q

What is Sjogren’s syndrome and presentations

A

Autoimmune exocrinopathy

Dry eyes
Dry mouth
Parotid gland enlargement

68
Q

What is inflammatory muscle disease and what antibodies are present

A

Dermatomyositis(rash) or polymyositis

Anti-tRNA

69
Q

What is systemic sclerosis

A

Scleroderma
Thickened skin
CREST syndrome

70
Q

What is overlap syndrome

A

More than 1 CTD present

Mixed connective tissue disease: anti-U1-RNP antibody

71
Q

Lower back pain red flags

A

Weight loss
Fever
Night pain
<19 y

72
Q

Leg pain red flags

A

Bowel/bladder dysfunction
Saddle anaesthesia
Profound neurological deficit

73
Q

Osteopenia vs osteoporosis

A

Penia: DEXA scan between -1 and -2.5
Porosis: DEXA scan < -2.5

Osteoblast activity low
Commonly female

Y2 (10 decks)

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