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MSK Flashcards

1
Q

What are the types of bone tumours?

A

Metastatic disease

Primary bone tumours

Benign

Haematological

Soft tissue bone tumours

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2
Q

Which cancers most likely metastasise to bone?

A 
BLT KP
Breast
Lung
Thyroid-TFTs
Kidney-U&E, Ca2+ and Phosphate
Prostate-PSA and DRE
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3
Q

What could be seen on x-ray of bone malignancy?

A 
- Locatoion 
Epiphysis?
Metaphysis?
Diaphysis?
- Size
- Lytic or scleroitic?
Sclerotic: prostate as increased osteoclast action
Lytic: Lung, Kdney and Thyroid
Breast is mixed
- Zone of transition
Narrow: slow-growing tumours have well defined demarcated sclerotic margin
Wide: tumour grows too fast for bone to respond-looks moth-eaten
- Periosteal reaction?
- Soft tissue involvement?
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4
Q

What are the primary bone sarcomas?

A 
Bone-forming tumours
Cartilage forming tumours
Giant-cell tumour
Marrow tumour
Vascular tumours
CT tumours
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5
Q

What are the characteristics of malignant bone tumours?

A

Poorly defined borders

Wide zone transition

Moth eaten pattern of bone destruction

Periosteum shows interrupted sunburst or onion skin reaction

Adjacent soft tissue mass

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6
Q

What are the characteristics of benign bone tumours?

A

Well-defined sclerotic borders

Geographic bone destruction

Periosteal reation is uninterrupted (solid)

No soft tissue mass

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7
Q

What is osteosarcoma?

A

Malignancy of osteoblasts producing osteoid (immature bone)

Aggressive

Often at end of long bones e.g. the knee

Pain and swelling, may be reluctant to bear weight

Males > females
Teenagers
Paget’s disease
MCC primary bone cancer

Chemo/Radio/Resect

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8
Q

What is Ewing’s sarcoma?

A

Malignant small, round, blue cell tumour of neural tube
Mixed lysis and sclerosis
Pariosteal reaction with lamellated bone growth

Genetic

Fevers, anaemia, systemic illness
May mimic osteomyelitis

55% in axial skeletonPelvis, femur, humerus, ribs and claical and spine
- Spine stenosis, back pain and cauda equina

Teenagers 10-20
Males>females

Chemo/Radio/Surgery

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9
Q

What is chondrosarcoma?

A

Cancer of cartilage producing cells.

Any age-middle and olver

Axial skeleton, pelvis and proximal femur

Xray shows invasion and soft tissue extension

Back or thigh pain, sciatic, bladder problems

Surgical resection (C&R not effective)

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10
Q

What is osteochondroma?

A

MC benign tumour of bone

Cartilage-capped boney projections

Remove if iminging on vessles or nerves and affecting movement

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11
Q

Define: sarcoma

A

Cancer arising from transformed cells fo mesenchymal origin e.g. cancellous bone, cartilage, fat, muscle, vessles or haemopoetic tissue

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12
Q

What may a mid-humeral shaft fracture damage?

A

Radial nerve in the radial groove

Reduced sensation of the dorsal hand and extensor disfunction

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13
Q

Which carpal bone dislocates most commonly?

A

Lunate bone dislocates anteriorly into the carpal tunnel and compresses the median nerve resulting in wrist pain and altered sesnation in the palmar aspect of the lateral fingers and weakness in thumb opposition

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14
Q

Describe a Hamate fracture

A

Usually the hook

Foosh

Damage to the ulnar nerve - claw hand

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15
Q

Describe an Ulnar Collateral Ligament tear

A

‘Skier’s thumb’

Tearing: pain along ulnar side of the MCP thumb joint

Laxity: ‘gamekeeper’s thumb’

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16
Q

What are the risk factors for AVN of the femoral hip?

A

Chronic corticosteroids
Alcohol
SLE

Not many xray changes

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17
Q

What is Septic Arthritis?

A

Pain at rest and movement
Joint (unilateral) tenderness and swelling
Fevere

Systemic problems

Xray: joint effusion

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18
Q

Osteoporosis

A

Osteopenia: reduced bone mass but ratio of bone mineral to matrix is normal

Poor diet
Low oestrogen

Normal levels of calcium, phosphat, PTH and ALP

Treat with bisphosphonates

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19
Q

Osteomalacia

A

Decreased bone mineralisation so low mineral to matrix ratio

Insufficient Ca2+ due to low Vitamin D or increased phosphate loss in kidneys

Ca2+ low
Vitamin D low

Phosphate high
ALP high

Diffuse pain particularly femur, pelvis and spine
Bone bowing and difficulty walking

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20
Q

What is Hammer toe?

A

Flexion and PIJ and Extension at DIJ in 2nd 3rd 4th toes

Can be rigid or flexible

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21
Q

Supracondylar humeral fractures

A

Damage

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22
Q

What is Compartment syndrome?

A

Pressure build up in a closed space (compartment) causing severe pain

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23
Q

What causes Compartment Syndrome?

A

Fluid in the compartment

  • Blood in trauma
  • Pus in infection

Trauma- long bone especially

  • Fractures
  • Crush
  • Haematoma
Burns
Infection
Prolonged compression
Muscle hypertrophy e.g. athletes
Severe ascites
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24
Q

How does Compartment syndrome present?

A

Early:

  • Burning, deep and aching PAIN, builds as pressure increases
  • Worsened by passive stretching of muscles
  • Paraesthesia
  • Swelling of compartment
Late:
- Loss of distal Pulses  (cap refill reduced)
- Ischaemia: rest of 6 Ps
Pallor 
Paralysis
Perishingly cold
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25
Where are the common sites for Compartment syndrome?
MC: Lower limb Also Forearm Gluteal-sciatic nerve palsy Abdomen: major organ injury
26
How is Compartment Syndrome investigated?
Intracompartmental pressure measurements​ Wick catheters, pressure transducers, needle manometry, etc.​ (Nasogastric tube can be used in abdominal compartment syndrome​) MRI may help in ambiguous cases​
27
How is Compartment Syndrome managed?
urgent decompression to prevent ischaemia - Remove casts/bandage - Elevate the limb Fasciotomy-skin and deep fascia are cut along length of compartment and left open until pressure is releived Abx, analgesia, phsio after
28
What are the complications of Compartment Syndrome?
Tissue necrosis. In muscles this leads to fibrosis, shorteining, ischaemic contracture and reduced function
29
What structures may be affected in Anterior Lower Leg Compartment Syndrome?
Deep fibular Nerve Anterior Tibial Artery
30
What structures may be affected in Superficial Posterior Lower Leg Compartment Syndrome?
Tibial nerve
31
What structures may be affected in Deep Posterior Lower Leg Compartment Syndrome?
Tibial nerve and vessels Fibualr artery
32
What structures may be affected in Later Lower Leg Compartment Syndrome?
Deep and Superficial fibular nerves
33
What structures may be affected in Anterior (ventral) forearm Syndrome?
Median and ulnar nerves Radial and ulnar arteries
34
What structures may be affected in Posterior (dorsal) forearm Compartment Syndrome?
Posterior Interosseus nerve (deep branch of radial)
35
What is Osteomyelitis?
Infection of bone marrow leading to bone destruction and necrosis It can spread to cortex and periosteum (causes necrosis) via the Haversian canals
36
What are the causative organsims in Osteomyelitis?
Staph Aureus H. Influenzae Streps Ceftreiaxone or penicillins Vancomycin for MRSA
37
What are the risk factors for Osteomyelitis?
Trauma​ - Open fracture​ - Surgery​ Prosthetics – more likely to become infected as bacteria can easily form a biofilm​ Diabetes → ulcer formation → infection spread to exposed bone​ IV drug abuse​ Immunosuppression​ Chronic steroid use​ Tuberculosis​ Sickle-cell anaemia
38
How does Osteomyelitis present?
``` Fever Tenderness over bone Imobility Pain, redness and swelling Joint pain when associated with Septic Arthritis ``` Back pain, worse at rest and nerve patterns of pain when in spine
39
What are the investigations for Osteomyelitis?
Bloods MRI Biopsy is definitive XRAY: - periosteal reaction and necrosis ~1 week later - sequestrum-dead bone isolated from live bone by necrosis looks like a white circle with black ring - involucrum:new layer of normal bone growth from periosteum
40
What are the depths of Osteomyelitis?
Medullary Superficial – Localised to one area of cortex​ Localised – Cortex breached, medulla infiltrated​ Diffuse – Cortex breached, medulla infiltrated, cortex on the OTHER SIDE also breached
41
How is Osteomyelitis managed?
Depride and saline washout Remove prosthesis Bone graft or antibiotic implants 6 weeks of antibiotics Hyperbaric O2 therapy if recurrent
42
What is Septic Arthritis?
invasion of a joint by an infectious agent resulting in joint inflammation Most often in hip or knee Pus in joints will erode the cartialge
43
How does Septic Arthritis present?
``` Rubor Tumor Calor Dolor Loss of function ESPECIALLY IF SYSTEMICALLY UNWELL ```
44
What are the causative organisms of Septic Arthritis?
Staph Aureus- Flucloxacillin or Clindamycin MRSA-Vancomycin May enter via Inocculation (directly) or blood stream
45
What are the risk factors for Septic Arthritis?
RA or OA Joint prosthesis​ Low socioeconomic status​ IV drug abuse​ Alcoholism​ Diabetes​ Puncture wound to the joint​ - Traumatic​ - Iatrogenic from surgery or injections such as steroids for arthritis relief​ Cutaneous Ulcers
46
How is Septic Arthritis investigated?
Bloods Synovial aspiration: gram stain and culture and check for Gout MRSA swabs MRI will show inflammation
47
How is Septic Arthritis manged?
Abx immediately Surgical washout-2 incisions, one pump saline in other suck it out Flush until all pus has gone
48
What is Kocher's criteria?
``` Suspecting SA in children: NEWT Non weight bearing ESR >40, CRP >20 WCC >12 Temperatur >38.5 ``` 1 feature = 3% 2 = 40% 3 = 93% 4 = 99%
49
What are Newman's 4 points?
Suspecting Septic Arthritis: - Pathogen isolated from joint - Pathogen isolated from blood in context of hot red joint - Typical features and turbid joint fluid in context of previous Abx - Post mortem
50
What is Paget's disease of the bone?
Chronic excessive breakdown and formation of bone due to increased osteoclast and blast action which leads to remodelling There is more bone but it is non-lamellar and so weaker
51
What causes Paget's disease?
Genetic-AD Viral
52
How does Paget's disease present?
Often asymptomatic RAISED ALP Pathological fractures - Non-mechanical bone pain - Bone deformity - Riased skin temp
53
Which bones are often affected by Paget's disease?
Axial skeleton Long bones and skull most often affected: - Pelvis - Lumbar spine - Femur - Tibia - Skull
54
What are the complications of Paget's disease?
- Increased risk of pathological fractures as weaker and highly vascular so risk of bleeding
55
What are the complications of Paget's disease?
Increased risk of pathological fractures as weaker and highly vascular so risk of bleeding and increased TPR which can lead to heart failure Bone deformities: - Spine curvatures: hypohosis and spinal stenosis/nerve compression such as sciatica or Corda Equina - Tibia bowing - Frontal bossing of skull and increased head size: may cause deafness and tinnitus due to CN8 compression and/or ear ossicle remodelling - Enlarged maxilla Osteoarthritis if near a joint
56
How is Paget's disease investigated?
Bone-specific ALP (maybe raised caclium and phosphate) X-ray: - Osteolysis (lucency) - Lots of bone - V shape between healthy and diseased bone - Cotton wool on skull May biopsy to rule out malignancy
57
How is Paget's disease managed?
``` Analgesia Monitor for osteosarcoma Walking aides Bisphosphonates Relieve nerve compression ALENDRONATE to reduce pain and deformity ```
58
What are the causes of pathological fractures?
Atypical locations or very low trauma - Osteoporosis - Osteomalacia - Bone cancers and tumours - Bone cysts - Paget's disease
59
What are the causes of pathological fractures?
Atypical locations or very low trauma - Osteoporosis - Osteomalacia - Bone cancers and tumours - Bone cysts - Paget's disease
60
How can Myeloma be detected?
Bence-Jones proteins
61
How are bone-cancers managed?
Debarking: removal of metaplastic soft tissue from around bone Chemo and radio Replace joint if near joint Prophylactic fixation: Mirel's scoring system Bisphosphonates reduce weakening
62
What antibiotics are used prohpylactically in surgeru?
Leicester uses 1.2g of co-amoxiclav on induction followed by 600mg over 8 hours post-op and then 600mg over 16 hours post-op Teicoplanin is easier-one dose on induction Swab for MRSA
63
What antibiotics are given for Open Fractures?
1.2g co-amoxiclav on A&E presentation Or clandamycin/cefuroxamime
64
What are the antibiotics given for Bite Wounds?
Debride and leave in sterile dressing rather than close Tetanus risk Swab the wound Dog Bites: Pasturella, strep, staph and Neisseria Cat Bites: Human bites: Give co-amoxiclav 5 days OR doxycycline + metronidazole if penicllin allergic
65
What are the antibiotics given for Bite Wounds?
Debride and leave in sterile dressing rather than close Tetanus risk Swab the wound Dog Bites: Pasturella, strep, staph and Neisseria Cat Bites: Pasturella, strep, Neisseria Human bites: Give co-amoxiclav 5 days OR doxycycline + metronidazole if penicllin allergic
66
How are open fractures treated?
BOAST - IV antibiotics within 3 hours of injury and continued until debridement 1. 2g co-amoxiclav or 1.5 cefuroxime 1. 2 g co-amoxiclav 1.5mg/kg from debirdement and 72 hours after/closure of wound - Assess neurovascular status (vascular damage and compartment syndrome require immediate surgery) - Splint limb
67
What types of joint surgeries are there?
Replacement: give function back Fusion: prevent further pain where replacements are not usually sucessful e.g. ankle Removal: e.g. toe joints or trapezium in OA
68
CAUSES OF A SWOLLEN JOINT
CHRIST ``` Crystal arthropathies Haemophilia Rheumatoid arthritis (and other inflammatory) Infection Synovial pathology Trauma ```

FINALS (13 decks)

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