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MSK > MSK 3b > Flashcards

MSK 3b Flashcards

1
Q

resorption ?

A

osteoclasts break down bone tissue

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2
Q

bone formation ?

A

osteoblasts form a matrix to replace resorbed bone with new bone

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3
Q

Majority of vertebral fractures (…. %) …. come to clinical attention

A

50 - 70 % , don’t

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4
Q

With ageing there is progressive loss of ..1.. leading to ….2… and an increased likelihood of ….3…

A
  1. physiological integrity
  2. functional impariment
  3. death
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5
Q

ageing biologically results from the imapct of the accumulation of a wide variety of …. over time

A

molecular and cellular damage

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6
Q

In ageing what are interconnected ?

A
  • Immune system
  • endocrine system
  • haemopoietic & clotting systems
  • brain
  • skeletal muscle
  • nutritional status
  • respiratory
  • cardiovascular
  • renal
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7
Q

Physical changes of MSK related problems ?

A
  • sarcopenia
  • decreased bone mineral density
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8
Q

consequences of MSK related problems:
* loss of …. x 2
* increased risk of …. x 2
* reduction in ….

A
  • loss of muscle strenght & endurance
  • loss of bone strength
  • increased fall risk
  • increased fracture risk
  • reduction in ability to perform ADL (activities of daily living)
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9
Q

3 clinical consequences of ageing

A
  • osteoporosis
  • fractures
  • osteoarthritis
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10
Q

Fragility fractures result from…

A

mechanical forces that wouldn’t ordinarily result in a fracture (low-level trauma)

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11
Q

How has WHO quantified the forces equivalent to of fragility fractures ?

A

a fall from a standing height or less

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12
Q

What is a major risk factor for fragility fracture ?

A

reduced bone density

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13
Q
A
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14
Q

Other risk factors apart from reduced bone density for fragility fractures ?

A
  • oral or systemic glucocorticoids
  • age
  • sex
  • previous fractures
  • family history of osteoporosis
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15
Q

Osteoporosis is what disease ?

A

systemic skeletal disease

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16
Q

what is osteoporosis characterised by ?

A

low bone mass and microarchitectural deterioration of bone tissue causing:
* increased bone fragility & risk of fracture

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17
Q

In osteoporosis:

there is increased …1… with excessive …2… that exceeds ….3.. e.g. due to ….4.. deficiency following menopause

A
  1. bone turnover
  2. bone resorption (destruction)
  3. bone formation
  4. oestrogen
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18
Q

In osteoporosis what can been seen in microscopic views of cancellous bone ?

A
  • thinning of trabecular elements
  • destruction of interconnecting elements weakens the strength of bone
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19
Q

With hip fractures what is there increased of …?

relative mortality risk varies from ….. greater in the 12 month following hip fracture

A
  • increased disability
  • increased mortality
  • 2 - 10 x
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20
Q

Vertebral factures include:
* ….. of the spine
* …. of height

A
  • curvature
  • loss
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21
Q

Symptoms of vertebral fractures include ?

A
  • pain
  • breathing difficulties
  • GI problems
  • difficulties in performing activities of daily living
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22
Q

Non-modifiable risk factors for osteoporosis ?

A
  • Age
  • Female sex
  • Ethnicity (Caucasians)
  • Previous fracture
  • Family History
  • Late menarche (>16 y.o.), early
    menopause (<47 y.o.)
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23
Q

modifiable risk factors for osteoporosis ?

A

B WASP

  • Bone Mineral density
  • Weight (BMI < 20)
  • Alcohol (>3.5 units/day).
  • Smoking
  • Physical inactivity
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24
Q

National
recommended levels of alcohol in men &
women ?

A

< 14 units/week

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25
Q

Medications : risk factors for osteoporosis ?

A
  • long-term antidepressants
  • antiepileptics
  • aromatase inhibitors
  • long-term DMPA
  • GnRH agonists (in men with prostate cancer)
  • PPIs
  • oral glucocorticoids
  • Thiazolidinedione for DM TZDs
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26
Q

Name some endocrine conditions associtated with increased risk of osteoporosis

A
  • diabetes mellitus
  • hyperthyroidism
  • hyperparathyroidism
  • hyperprolactinaemia
  • Cushing’s
  • menopause
  • treatment with aromatase inhibitors
  • androgen deprivation therapy
  • hypogonadism
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27
Q

Name some neurological conditions associate with increased risk of osteoporosis

A
  • Alzehimer’s
  • parkinson’s
  • multiple sclerosis
  • stroke
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • infalmmatory bowel disease
  • malabsorption
  • cystic fibrosis
  • epilepsy
  • HIV
  • depression
  • asthma
  • chronic kidney disease
28
Q

What value of eGFR (estimated Glomerular Filtration Rate) indicates chronic kidney disease ?

A

less than 60 ml/min/1.73 m² for three months or more

29
Q

What score is bone mineral density expressed as ?

A

T-score

30
Q

what is the T-score which is how bone mineral density is expressed ?

A

the standard deviations (SD) below the mean BMD of young adults at their peak bone mass

31
Q

What does the T-score measurement provide with bone mineral densities ?

A

valuable information about an individual’s bone density relative to their age-matched peers and helps identify the presence of low bone mass or osteoporosis

32
Q

T-score for normal BMD ?

A

-1 SD or above

33
Q

T-score for osteopenia BMD ?

A

between -1 and -2.5 SD

34
Q

T-score for osteoporosis BMD ?

A

-2.5 SD or below

35
Q

T-score for established (severe) osteoporosis BMD ?

A

-2.5 SD or below with one or more associated fractures

36
Q

DEXA scan stands for ?

A

Dual energy X-ray absorptiometry

37
Q

DEXA scan assess ?

A

bone mineral density

38
Q

DEXA scan :
1. uses …
2. aimed at…

A
  1. X-rays of 2 different energies
  2. femur and L-spine
39
Q

Lifestyle interventions in osteoporosis invloves ?

A

exercise & diet

40
Q

Exercise as a lifestyle intervention in osteoporosis may involve what ?

A
  • variety of weight-bearing and muscle strengthening exercises
  • muscle resistance training and balance
41
Q

Diet as a lifestyle intervention in osteoporosis may involve what ?

A
  • Supplementation with 10 micrograms/day of Vitamin D (400 IU)
  • Dietary calcium
  • VitB,VitK
  • Reduce salt
  • Balanced diet
42
Q

What type of sources / food / drinks does vitamin D come from

A
  • sun
  • oily fish
  • dairy
  • eggs
  • fortified milks
  • cereals
  • mushrooms
  • fortified tofu
  • orange juice
43
Q

What are bisphosphonates ?

A
  • anti-resorptive agents, absorved into bone matrix
44
Q

What do bisphosphonates effect ?

A
  • effects osteoclasts (bone resorption)
  • effect on bone: decrease bone turnover, increase bone mineralisation
45
Q

Name 2 types of bisphosphonates

A
  • simple
  • nitrogen-containing
46
Q

Name 2 very important examples of side effects that may be because of bisphosphonate use

A
  • osteonecrosis of jaw
  • gastric ulcers
47
Q

consequences of hip fractures

A
  • High mortality rate
  • High morbidity rate
  • PE/DVT/CVA/MI
  • Pressure sores
  • Chest infections/UTIs
  • Confusion
48
Q

Orthogeriactrician ensures what ?

A
  • patients receive highest standard geriatric care
  • proved holistic care
  • co-ordinates the MDT team and discharge plan
49
Q

NICE definition of osteoarthritis :
1. disorder of…
2. characterised by : focal areas of …., remodelling of …., mild…

A
  1. synovial joints
  2. damage to articular cartilage, underlying bone and the formation of osteophytes - new bone at joint margins, synovitis
50
Q

Name 4 clinical features of osteoarthritis

A
  • pain
  • stiffness
  • deformity
  • joint swelling
51
Q

What stiffnes is not present in osteoarthritis but is in RA ?

A
  • not prolonged stiffness which can last for hours in inflammatory arthritis
52
Q

In OA:
1. Knee…
2. in hand….

A
  1. swelling
  2. Heberdens nodes in DIP & bouchard in PIP
53
Q

In OA there is shiny foci on the articular surface known as ….

A

eburnation

54
Q

In OA there is shiny foci on the articular surface known as eburnation

how does this happen ?

A
  • continuous loss of articular cartilage which leads to exposure of subchondrial bone
55
Q

What results in formation of osteophytes ( nodules at bony edges) ?

A

progressive loss of articular cartilage stiumlates new bone formation,

56
Q

radiological features of OA ?

A
  • Loss joint space
  • Osteophytes
  • Sclerosis
  • Subchondral cysts: fluid filled spaces in joints which may require aspiration
57
Q

Non-operative treatment of OA ?

A
  • weight loss
  • exercise/ physiotherapy
  • analgesia/NSAIDs
  • joint injection
58
Q

Why perform a hip replacement ?

A
  • relieve pain and sitffness from damaged or diseased hip joint
  • improve function of hip joint (ROM)
  • increase mobility
59
Q

Hip replacement with increase mobility , what helps to restore mobility and return to activities with less pain ?

A

recovery & rehabilitation

60
Q

Local complications of hip replacement ?

A
  • leg length inequality
  • dislocation (3%)
  • infection (2-3%)
  • loosening (usually after 10-15 yrs)
  • neurovascular damage
61
Q

What nerves are involved in neurovascular damage as local complications of hip replacement ?

A
  • sciatic/femoral nerve
  • common peroneal nerve TKRs
62
Q

Systemic complications of hip replacement ?

A
  • UTIs/chest infections
  • clinical DVT
  • non-fatal PE (Pulmonary Embolism)
  • fatal PE (Pulmonary Embolism)
  • mortality
63
Q

Other nerves injured as common peroneal nerve (total knee replacements) as neurovascular damage of local complications of hip replacement ?

A

inferior/Superior Gluteal Nerves

64
Q

Frailty in the muscular skeletal system is often correlated with other what ?

A

2 major geriatric syndromes
* sarcopenia
* cachexia

65
Q

sarcopenia ?

A

loss of muscle mass and function associated with aging

66
Q

cachexia ?

A

weight loss due to an underlying illness

MSK (25 decks)

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