MSK Flashcards
Where do osteoid Osteomas usually affect on the bone and what is a classical symptoms of them?
Long bones on the diaphysis area
spine
Very painful at night. Made completely better by NSAIDs
How is osteoid osteomas treated? why is this?
they have a very classic radio presentation of bony mass with hollow centre.
treated by radio destruction
Where do osteosarcomas present and who gets them?
Metaphysis of long bones.
Children mainly, but adults with Paget’s can get them too.
What are the typical clinical findings in osteosarcoma?
Large swelling around the area
pain
inability to move area
pathological fracture
What clinical sign is seen on the x-ray that is suggestive of osteosarcoma?
Codman’s triangle
What’s the treatment for Osteosarcoma?
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.
What are the stages of indirect fracture healing? give brief info on all them:
- Haematoma and inflammation
- 6-8 hours
TGF-beta
PDGF
Osteoblasts stimulated
- Fibrocartilage - soft callus
1day - 3 weeks
Pro- callus - granulation tissue.
type II collagen
- Bony Callus
- 3 weeks - 4 months
Woven bone
- Bone remodelling
- lamellar bone laid down
Highlight some of the key changes in direct fracture healing:
Artificial wound healing
Osteoclasts drill into the opposite bone - cutting cones
osteoblasts then fill it with osteoid
Name a malignant cartilage tumour:
Chondrosarcoma
- middle aged people
- men
grows within the medulla
Surgery is only option
Define tenosynovitis:
Inflammation of tendon and its overlying structures
What is tendinopathy and list some key features of it:
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)
What cytokines are released in tendinopathy that cause pain?
NO
IL-1
Prostaglandins
MMPs
Name the type of femoral neck fractures that can occur
Subcapital
Transcervical
Basevericical
List the type of fractures that can occur:
Transverse
oblique
Spiral
Comminuted
Avulsion
**along with them being open or closed
What investigations are carried out for tendinopathy?
Ultrasound
- shape of tendon
- neovascularization
MRI
- T1 weighted
X-ray
- only useful for calcification
List some presenting complaints of OA:
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
What are the three broad categories of back pain?
Mechanical
systemic
Referred
List some cases of mechanical/ non specific lower back pain:
Lumbar sprain
Degenerative disc
Disc Prolapse
Compression fracture
List some symptoms of disc hernia:
Pain localised down the dermatome.
Myelopathy
Radiculopathy
What is the pain of spinal stenosis:
Claudication pain in both calf muscles
Pain on walking
What is it called when one vertebra slips over another?
Spondylolistheiss
Whats the pain described in compression fracture?
Sudden severe pain
Radiates around the chest like a belt
- dermatome pattern
What are the treatments for compression fracture?
Analgesics
vertebroplasty
- cement
Kyphoplasty
- baloon
List some key causes of referred back pain:
AAA
Acute pancreatitis
Peptic ulcer
Acute pyelonephritis
endometriosis
What is a common presenting complaint of discitis?
Fever
- something this is it and they are said to be pyrexia with no known origin
Back pain
- doesn’t get better
What would usually be seen radiologically for discitis?
destruction to the vertebrae on both sides.
older cases the disc heals over with scarring.
What are the symptoms of bone cancer?
Pain that doesn’t let up
- worse at night due to pressures and swelling
compression on nerves
- spinal cord
Systemic systems of cancers
Whats the pathological cycle that occurs with compartment syndrome?
Increased pressure -
increased venous pressure -
reduced blood flow -
ischemia-
muscle swelling-
increased permeability-
increased pressure
Describe the timeline in compartment syndrome::
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
What are the clinical features of compartment syndrome:
Pain
Pallow
Paresthesia
Paralysis
Pulseless
- this is usually last thing to occur
What other factors must be monitored when there is compartment syndrome? and why?
Due to the contents of the muscle getting out:
- fluids
- electrolytes - K+
- acidosis
In gout what type of crystals are laid down?
Monosodium urate crystals
What are the deposits of long standing gout called?
Tophi
What medication may increase the risk of gout?
thiazides
What investigations are done for gout?
Joint aspiration
Serum uric acid levels
U&Es
What kind of crystals are seen on the joint aspiration of gout?
negative birefringent crystals
- needle shaped
- yellow and low
What are the treatments for gout?
NSAIDs
Allopurinol
Febuoxostat
Uricosuric agents
- increase the secretion of uric acid
Rasburicase
- urate oxidase
What is meant by arthroplasty?
and Resection of arthroplasty?
New artificial joint
Taking diseased out and putting in artificial one
What is revision of arthroplasty?
Re-operating on artificial joint
Describe the pathogenesis behind prosthetic joints being so susceptible to infection?
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.
What is it called when there is degeneration of the vertebral discs?
Spondylosis
What is likely damaged if there is increased pain when extending (leaning backwards)?
Facet joint degeneration
What is the immediate management of compartment syndrome?
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
What are normal pressures of the ABPI?
0.8- 1.2
What nerves are usually first affected in compartment syndrome, and where would this manifest?
Deep nerves - such as deep peroneal nerve
1st interweb space on 1st.
If someone present with late compartment syndrome >48 hours, what should your management be?
non- surgical as it will predispose to infection
In bone tumours, what is it that leads to the bone destruction?
Osteoclast activation by the tumour cells via cytokines. Bone is not directly destroyed by tumour
Which cancers are most likely to metastasis to the bone?
Breast, Lung, follicular of thyroid, prostate and kidney
Which secondary tumours of bone are most likely to be sclerotic and not lytic?
Breast and prostate
Which tumours usually appear as solitary masses?
Renal and thyroid
Where do osteosarcomas usually metastasis too?
Lung
What is a worse prognosis factor for osteosarcoma?
If it develops from Paget’s
What sensory symptom may occur with Paget’s disease and why?
Deafness - due to fusion of the mallus, incus and staples
Name the cartilaginous tumours:
Osteochondroma (Osseouscartilganious exotosis)
Enchondroma
Chondrosarcoma
What mutation leads to Ewing’s Sarcoma?
11:22 translocation
What radiological features does Ewing’s sarcoma have?
Onion layering
What is a common radiological finding with psoriatic arthritis?
Pencil and Cup deformity
Dactylitis
What tests would you do in the suggestion of Psoriatic arthritis?
FBC
X-ray
ESR
Rheumatoid factor
Anti CCP
Uric Acid levels - rule out gout
Lipid profile - patient often have metabolic syndrome as well
What is the antibiotic regimen for septic arthritis, and how long is this maintained?
Native:
Flucloxacillin
+/-
(gentamicin) - if evidence of gram negative
2-3 weeks IV
4 weeks oral
Prosthetic:
Vancomycin
+
Gentamicin
What is the regimen for diabetic foot infections?
Flucloxacillin \+ Gentamicin \+ Metronidazole
6 weeks
How long is the antibiotic regimes in endocarditis
4 weeks - native valve
6 weeks - prosthetic valve
What are the three phases of pagets disease?
Osteolytic phase
Mixed phase
Osteoscelerotic phase
