MSK

Question 1

What is Paget’s disease

Answer 1

A normal bone remodelling due to increased osteoblast and osteoclast activity
Cause unknown

Question 2

How does Paget’s disease present?

Answer 2

• usually asymptomatic and picked up due to abnormal X rays
• bone enlargement - skull enlargement (hat no longer fits)
• bowed tibia- “sabre tibia”
• pathological bone fractures
  -bone pain
• hearing loss due to nerve compression but thickened bone
• increased risk of osteosarcoma
• high ALP but calcium, phosphate and PTH normal
• cotton wool appearance of bone
  Treatment: bisphosphonates

Question 3

What is the first line treatment for osteoarthritis?

Answer 3

1st line is topical NSAID particularly for knee involvement

2nd. If topical NSAID is not effective or unsuitable then consider an oral NSAID

Paracetamol or weak opioids should be used infrequently or short term if all other pharmacological treatments are unsuitable/not tolerated/not effective

Question 4

Which age group does osteosarcoma affect?

Answer 4

10-20 years old

Question 5

Osteosarcoma clinical features

Answer 5

• 35% of primary bone malignancies
• age 10-20 years old
• typically affects distal femur
• bone pain, swelling
• Pathological fractures

occurs around the adolescent growth spurt and most frequently occurs in areas of rapid growth. The tumor is composed of osteocytes surrounded by osteoid. Radiography reveals a characteristic sunburst pattern (spiculated calcifications) and Codman triangle (raised periosteum in triangular shape

Question 6

Shoulder abduction - painful arc between 80-120 degrees indicates what condition?

Answer 6

Subacromial bursitis

Question 7

What Is Perthe’s disease?

Answer 7

Idiopathic avascular necrosis of the femoral head causing hip pain and inability to bear weight.

More common in boys, with peak presentation at age 4-6 years.

Characterised by insidious onset of a limp with or without pain.

No history of trauma

presentation is usually unilateral.

Xray may be normal in early disease - may need to do MRI

Question 8

What is Osgood Schlatter disease?

Answer 8

Avulsion of the patellar tendon causing pain and tenderness at the tibial tuberosity.

O/e
- tibial tuberosity tenderness in an adolescent boy
- may present as knee pain

Question 9

What are the symptoms of adhesive capsulitis?

Answer 9

aka frozen shoulder

• dull ace in shoulder than often disturbs sleep
• stiffness and loss of shoulder mobility
• unlikely in pts <40 and those >70
• More common in diabetes

Question 10

Slipped upper femoral epiphysis

Answer 10

• Presents in obese children aged 11-15yo
• acute onset hip pain and limp

you get slippage at the epiphyseal
plate (growth plate), in which the epiphysis remains in the acetabulum and the metaphysis becomes displaced. On AP and frog-leg lateral x-rays, this appears as a so-called ice cream scoop slipping of the cone

Treatment - surgical stabilization with pinning. If untreated, patients are at risk for avascular necrosis of the femoral head.