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Phase 3 > MSK > Flashcards

MSK Flashcards

1
Q

Where do osteoid Osteomas usually affect on the bone and what is a classical symptoms of them?

A

Long bones on the diaphysis area
spine

Very painful at night. Made completely better by NSAIDs

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2
Q

How is osteoid osteomas treated? why is this?

A

they have a very classic radio presentation of bony mass with hollow centre.

treated by radio destruction

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3
Q

Where do osteosarcomas present and who gets them?

A

Metaphysis of long bones.

Children mainly, but adults with Paget’s can get them too.

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4
Q

What are the typical clinical findings in osteosarcoma?

A

Large swelling around the area

pain

inability to move area

pathological fracture

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5
Q

What clinical sign is seen on the x-ray that is suggestive of osteosarcoma?

A

Codman’s triangle

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6
Q

What’s the treatment for Osteosarcoma?

A

Chemotherapy
- 8 weeks

Surgery

  • removal bone
  • check to see if itis responding

> 95% necrosis then chemo is working

if no response then change of chemo for another 8 weeks.

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7
Q

What are the stages of indirect fracture healing? give brief info on all them:

A
  1. Haematoma and inflammation
    - 6-8 hours

TGF-beta
PDGF
Osteoblasts stimulated

  1. Fibrocartilage - soft callus
    1day - 3 weeks

Pro- callus - granulation tissue.
type II collagen

  1. Bony Callus
    - 3 weeks - 4 months

Woven bone

  1. Bone remodelling
    - lamellar bone laid down
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8
Q

Highlight some of the key changes in direct fracture healing:

A

Artificial wound healing

Osteoclasts drill into the opposite bone - cutting cones

osteoblasts then fill it with osteoid

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9
Q

Name a malignant cartilage tumour:

A

Chondrosarcoma

  • middle aged people
  • men

grows within the medulla

Surgery is only option

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10
Q

Define tenosynovitis:

A

Inflammation of tendon and its overlying structures

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11
Q

What is tendinopathy and list some key features of it:

A

degeneration of the tendon, where the healing is unable to keep up with the degradation.

  • disorganisation of the collagen fibres
  • increased cellularity
  • inflammation usually around the tendon(this is minimal)
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12
Q

What cytokines are released in tendinopathy that cause pain?

A

NO
IL-1
Prostaglandins
MMPs

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13
Q

Name the type of femoral neck fractures that can occur

A

Subcapital

Transcervical

Basevericical

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14
Q

List the type of fractures that can occur:

A

Transverse

oblique

Spiral

Comminuted

Avulsion

**along with them being open or closed

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15
Q

What investigations are carried out for tendinopathy?

A

Ultrasound

  • shape of tendon
  • neovascularization

MRI
- T1 weighted

X-ray
- only useful for calcification

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16
Q

List some presenting complaints of OA:

A

Dull ache over area

Radiation
- hip radiates to knee and groin

pain worse after periods of no movement

Pain on movement

Changes in Gait

Sleep disturbance
- later on in the disease

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17
Q

What are the three broad categories of back pain?

A

Mechanical

systemic

Referred

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18
Q

List some cases of mechanical/ non specific lower back pain:

A

Lumbar sprain

Degenerative disc

Disc Prolapse

Compression fracture

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19
Q

List some symptoms of disc hernia:

A

Pain localised down the dermatome.

Myelopathy

Radiculopathy

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20
Q

What is the pain of spinal stenosis:

A

Claudication pain in both calf muscles

Pain on walking

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21
Q

What is it called when one vertebra slips over another?

A

Spondylolistheiss

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22
Q

Whats the pain described in compression fracture?

A

Sudden severe pain

Radiates around the chest like a belt
- dermatome pattern

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23
Q

What are the treatments for compression fracture?

A

Analgesics

vertebroplasty
- cement

Kyphoplasty
- baloon

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24
Q

List some key causes of referred back pain:

A

AAA

Acute pancreatitis

Peptic ulcer

Acute pyelonephritis

endometriosis

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25
Q

What is a common presenting complaint of discitis?

A

Fever
- something this is it and they are said to be pyrexia with no known origin

Back pain
- doesn’t get better

26
Q

What would usually be seen radiologically for discitis?

A

destruction to the vertebrae on both sides.

older cases the disc heals over with scarring.

27
Q

What are the symptoms of bone cancer?

A

Pain that doesn’t let up
- worse at night due to pressures and swelling

compression on nerves
- spinal cord

Systemic systems of cancers

28
Q

Whats the pathological cycle that occurs with compartment syndrome?

A

Increased pressure -

increased venous pressure -

reduced blood flow -

ischemia-

muscle swelling-

increased permeability-

increased pressure

29
Q

Describe the timeline in compartment syndrome::

A

1 hour

  • normal nerve conduction
  • muscle viable

4 hours

  • neuropraxia (lack of conduction)
  • muscle ischemia

8 hours
- nerve axontemsis (damage to shealths)

  • muscle necrosis

final stage:
- fibrotic muscle compartment

  • clawing of limbs
30
Q

What are the clinical features of compartment syndrome:

A

Pain

Pallow

Paresthesia

Paralysis

Pulseless
- this is usually last thing to occur

31
Q

What other factors must be monitored when there is compartment syndrome? and why?

A

Due to the contents of the muscle getting out:

  • fluids
  • electrolytes - K+
  • acidosis
32
Q

In gout what type of crystals are laid down?

A

Monosodium urate crystals

33
Q

What are the deposits of long standing gout called?

A

Tophi

34
Q

What medication may increase the risk of gout?

A

thiazides

35
Q

What investigations are done for gout?

A

Joint aspiration

Serum uric acid levels

U&Es

36
Q

What kind of crystals are seen on the joint aspiration of gout?

A

negative birefringent crystals

  • needle shaped
  • yellow and low
37
Q

What are the treatments for gout?

A

NSAIDs

Allopurinol

Febuoxostat

Uricosuric agents
- increase the secretion of uric acid

Rasburicase
- urate oxidase

38
Q

What is meant by arthroplasty?

and Resection of arthroplasty?

A

New artificial joint

Taking diseased out and putting in artificial one

39
Q

What is revision of arthroplasty?

A

Re-operating on artificial joint

40
Q

Describe the pathogenesis behind prosthetic joints being so susceptible to infection?

A

Material is avascular and has no immune cells on it.
bacteria easily make a biofilm on it.

the cement used, actively reduces phagocytosis and complement activation.

41
Q

What is it called when there is degeneration of the vertebral discs?

A

Spondylosis

42
Q

What is likely damaged if there is increased pain when extending (leaning backwards)?

A

Facet joint degeneration

43
Q

What is the immediate management of compartment syndrome?

A

Remove any casts or restrictions on the limb

Elevate the limb

administer IV fluids

Monitor U&Es carefully - looking for K+ rise.

Discuss with surgeons about fasciectomy

44
Q

What are normal pressures of the ABPI?

A

0.8- 1.2

45
Q

What nerves are usually first affected in compartment syndrome, and where would this manifest?

A

Deep nerves - such as deep peroneal nerve

1st interweb space on 1st.

46
Q

If someone present with late compartment syndrome >48 hours, what should your management be?

A

non- surgical as it will predispose to infection

47
Q

In bone tumours, what is it that leads to the bone destruction?

A

Osteoclast activation by the tumour cells via cytokines. Bone is not directly destroyed by tumour

48
Q

Which cancers are most likely to metastasis to the bone?

A

Breast, Lung, follicular of thyroid, prostate and kidney

49
Q

Which secondary tumours of bone are most likely to be sclerotic and not lytic?

A

Breast and prostate

50
Q

Which tumours usually appear as solitary masses?

A

Renal and thyroid

51
Q

Where do osteosarcomas usually metastasis too?

A

Lung

52
Q

What is a worse prognosis factor for osteosarcoma?

A

If it develops from Paget’s

53
Q

What sensory symptom may occur with Paget’s disease and why?

A

Deafness - due to fusion of the mallus, incus and staples

54
Q

Name the cartilaginous tumours:

A

Osteochondroma (Osseouscartilganious exotosis)

Enchondroma

Chondrosarcoma

55
Q

What mutation leads to Ewing’s Sarcoma?

A

11:22 translocation

56
Q

What radiological features does Ewing’s sarcoma have?

A

Onion layering

57
Q

What is a common radiological finding with psoriatic arthritis?

A

Pencil and Cup deformity

Dactylitis

58
Q

What tests would you do in the suggestion of Psoriatic arthritis?

A

FBC

X-ray

ESR

Rheumatoid factor

Anti CCP

Uric Acid levels - rule out gout

Lipid profile - patient often have metabolic syndrome as well

59
Q

What is the antibiotic regimen for septic arthritis, and how long is this maintained?

A

Native:
Flucloxacillin
+/-
(gentamicin) - if evidence of gram negative

2-3 weeks IV

4 weeks oral

Prosthetic:
Vancomycin
+
Gentamicin

60
Q

What is the regimen for diabetic foot infections?

A 
Flucloxacillin 
\+
Gentamicin 
\+ 
Metronidazole

6 weeks

61
Q

How long is the antibiotic regimes in endocarditis

A

4 weeks - native valve

6 weeks - prosthetic valve

62
Q

What are the three phases of pagets disease?

A

Osteolytic phase

Mixed phase

Osteoscelerotic phase

Phase 3 (50 decks)

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