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2a mid tier > MSK > Flashcards

MSK Flashcards

1
Q

Name four primary bone tumours

A

Osteosarcomas, fibrosarcoma, chondromas, Ewing’s tumour

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2
Q

What are the most common primary sites for secondary bone tumours?

A

Bronchus, breast and prostate

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3
Q

What is the presentation of bone tumours?

A
  • Related to anatomical position of the tumour with local bone pain:
  • Systemic symptoms e.g. malaise and pyrexia
  • Aches and pains are occasionally related to hypercalcaemia
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4
Q

How are bone tumours diagnosed?

A
  • Skeletal isotope scan show bony metastases
  • X-rays show metastases as osteolytic areas
  • MRI used for vertebral lesions
  • Serum alk phos raised
  • Hypercalcaemia
  • PSA is raised if prostatic metastases
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5
Q

How are bone tumours managed?

A
  • Analgesics and anti-inflammatory drugs
  • Local radiotherapy to bone metastases
  • Some tumours response to chemotherapy
  • Some tumours are hormone-dependent and respond to hormonal therapy
  • Bisphosphonate e.g. alendronate can help symptomatically
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6
Q

What are the most common osteosarcoma sites?

A

Knee and proximal humerus (long bones)

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7
Q

What is the presentation of osteosarcoma?

A
  • Often presents as a painless tumour

- Rapidly metastasised to the lung

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8
Q

How is osteosarcoma diagnosed?

A
  • XR: bone destruction and formation, soft tissue calcification produces a sunburst appearance
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9
Q

How was osteosarcoma managed?

A
  • Cut the tumour and some of the healthy tissue around it from the affected bone (doesn’t always require amputation)
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10
Q

What is a Ewing’s sarcoma?

A
  • Rare cancer that affects bones/ soft tissues around bones
  • Much more common in children and young people
  • Thought to arise from mesenchymal stem cells
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11
Q

What is the presentation of a Ewing’s sarcoma?

A
  • Presents with a mass/swelling, most commonly in the long bones of the arms, legs, pelvis and chest
  • Can present in the skill and flat bones of the trunk
  • Painful swelling
  • Redness around the tumour site
  • Malaise
  • Anorexia
  • Weight loss
  • Fever
  • Paralysis and/or incontinence (only if affecting the spine)
  • Numbness in affected limb
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12
Q

What is a chondrosarcoma?

A
  • Cancer of the cartilage
  • Most common adult sarcoma
  • Commonly affects the pelvis, femur, humerus, scapula and ribs
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13
Q

What is the presentation of chondrosarcoma?

A
  • Dull, deep pain

- Affected area is swollen and tender

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14
Q

How are you chondrosarcomas diagnosed?

A
  • XR
  • MRI
  • CT
  • Biopsies
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15
Q

How will chondrosarcomas managed?

A
  • Chemotherapy/ stem cell transplant

- Localised therapy with radiotherapy or surgery

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16
Q

What is the aetiology of fibromyalgia?

A
  • Associated with depression, chronic headache, IBS, chronic fatigue and myofascial pain syndrome
17
Q

What is the definition of fibromyalgia?

A
  • Widespread MSK pain after other diseases have been excluded
  • Symptoms present for >3m
  • Pain at 11 of 18 tender point sites on palpation
18
Q

What are the risk factors of fibromyalgia?

A
  • Female
  • Middle age
  • Low household income
  • Divorced
  • Low educational status
19
Q

What is the presentation of fibromyalgia?

A
  • Widespread chronic pain lasting >3m
  • Aggravated by stress, cold and activity
  • Associated with generalised morning stiffness
  • Tingling hands and feet
  • Pain usually focuses on: lower neck in front, base of skull, upper edge of breast, neck and shoulder, below side bone at elbow, upper outer buttock, hip bone, inside just above knee
  • Fatigue is often extreme and occurs after minimal exertion
  • Non-restorative sleep: frequent waking in the night, waking unrefreshed, poor concentration and forgetfulness, low mood, irritable, weepy, function pain from lack of non-REM sleep
20
Q

What are the differential diagnosis of fibromyalgia?

A
  • Hypothyroidism
  • SLE
  • Polymyalgia rheumatica (PMR)
  • High calcium
  • Low vitamin D
  • Inflammatory arthritis
21
Q

How is fibromyalgia diagnosed?

A
  • Pain at 11 of 18 tender points on digital palpation

No diagnostic test, so can only exclude things:

  • Thyroid function test (to exclude hypothyroidism)
  • ANA and DsDNA (to exclude SLE)
  • ESR and CRP (to exclude polymyalgia rheumatica)
  • Ca2+ and electrolytes (to exclude high calcium)
  • Vit D (to exclude low vit D)
  • Examine patient and CRP (to exclude inflammatory arthritis)
22
Q

How is fibromyalgia managed?

A
  • Educate patient and family
  • Avoid unnecessary investigations
  • Reset pain thermostat: correct non-restorative sleep, improve aerobic fitness (tires them so they sleep better)
  • Low dose antidepressants and anticonvulsants
  • NSAIDs and steroids rarely work
23
Q

What is the aetiology of mechanical lower back pain?

A
  • Often trauma or work related
  • Main causes: lumbar disc prolapse, osteoarthritis, fractures, spondylolisthesis, heavy manual handling, stooping and twisting whilst lifting, exposure to whole body vibration
  • Need to be aware of more sinister causes: malignancy, infection, inflammatory causes
24
Q

What are the red flags for serious spinal pathology?

A
  • Age of onset <20y or >55y
  • Violent trauma (e.g. fall from height or road traffic accident)
  • Constant, progressive, non-mechanical pain
  • Thoracic pain
  • Systemic steroids, drug use or HIV
  • Systemically unwell, weight loss
  • Persisting severe restriction of lumbar flexion
  • Widespread neurology
  • Structural deformity
25
Q

What are the risk factors of mechanical low back pain?

A
  • Psychosocial distress
  • Smoking and dissatisfaction with work
  • Risk factors for recurrent back pain: female, increasing age, pre-existing chronic widespread pain (fibromyalgia), psychosocial factors
26
Q

What is the presentation of mechanical low back pain?

A
  • Stiff back that may present with scoliosis when standing
  • Visible muscular spasm, palpable and causes local pain/tenderness (relieved by sitting or lying)
  • Pain is often unilateral
  • Episodes are generally short-lived and self-limiting
  • Sudden onset
  • Pain worse in evening
  • No morning stiffness
  • Aggravated by exercise
27
Q

What is the differential diagnoses of mechanical low back pain in elderly patients?

A
  • Polymyalgia rheumatica
28
Q

How is mechanical low back pain diagnosed?

A
  • Spinal XR if red flags present
  • MRI > CT
  • Bone scans
29
Q

How is mechanical low back pain managed?

A
  • Urgent neurosurgical referral if any neuro deficit
  • Analgesia to allow normal mobility
  • Combined with physiotherapy, back muscle training regimens and manipulation
  • Acupuncture can help
  • Avoid excessive rest
  • Re-education in lifting and exercises to prevent further attacks of pain
  • Comfortable sleeping position using a medium firm mattress
30
Q

What is the aetiology of osteomalacia?

A
  • Most common cause is hypophosphataemia due to hypoparathyroidism
  • Vitamin D deficiency
  • Renal disease
  • Drug induced
  • Liver disease
31
Q

What is the pathophysiology of osteomalacia?

A
  • Normal amount of bone, but mineral content is low (excess uncalcified osteoid and cartilage)
  • Defective mineralisation after fusion of epiphyses (i.e. in adults)
32
Q

What is the presentation of osteomalacia?

A
  • Muscle weakness leading to waddling gait and difficulty climbing stairs/ getting out of a chair
  • Widespread bone pain (dull ache worse on weight-bearing and walking)
  • Bone pain and tenderness
  • Fractures especially of the femoral head
33
Q

How is osteomalacia diagnosed?

A

Bloods:

  • Low Ca2+ and phosphate
  • Raised serum alk phos
  • Elevated PTH
  • Low 25-hydroxy vit D

Biopsy:

  • Shows incomplete mineralisation
  • Gold standard, but not practical

XR:
- Shows defective mineralisation

34
Q

How is osteomalacia managed?

A
  • Vit D replacement

2a mid tier (10 decks)

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