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MSK cortext Flashcards

1
Q

what is a lipoma

A

neoplastic proliferation of fast which usually occurs in subcutaneous tissue but can grow in fat

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2
Q

GCT of tendon sheet what do they look like histologically and microscopically?
what are they called when in a joint

A

pigmented and contain multinucleate giant cells and haemosiderin
pigmented villonodular synovitis (PVN)

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3
Q

what are some rare causes of AVN

A

sea diving

decompression sickness

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4
Q

what are the two types of osteoporosis

A

type 1 - post menopausal increase in osteoclastic bone resorption with loss of protective effects of oestrogen
type 2 - osteoporosis of old age

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5
Q

what do bisphosphonates do and give some examples

A

reduce osteoclast production

alendronate, risedronate, etidronates

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6
Q

what type of drug is zoledronic and how often is it given

A

IV bisphosphonate

once yearly

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7
Q

what kind of drug is desunomab and what does it do

A

monoclonal AB

decreases osteoclast activity

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8
Q

what does strontium do

A

increases osteoblast production and decreases absorption

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9
Q

what is osteomalacia

A

abnormal softening of the bone due to deficient mineralisation of osteoid secondary to inadequate amounts of calcium and phosphate

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10
Q

what is the presentation of osteomalacia

A

bone pain, deformity, pathological fracture, symptoms of hypocalcaemia, pseudo fractures (loosers zones)

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11
Q

what is brittle bone disease and what causes it

A

osteogenesis imperfecta

defect in type 1 collagen

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12
Q

is osteogensis imperfect autosomal dom or recessive
what are the symptoms/signs
what do the bones look like

A

dominant
fragility fractures, blue sclera, loss of hearing
thin (gracile) with thin cortices and osteopenic

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13
Q

why does skeletal dysplasia occur

A

genetic error - abnormal development of bone and connective tissue

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14
Q

what type of skeletal dysplasia is the commonest - give the occurrence/cause, what does it present like, what are the joints like and does it have an effect on mental development

A

achondroplasia
autosomal dom but 80% are sporadic
disproportionally short limbs with prominent forehead and widened nose
joints are lax and mental development is normal

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15
Q

how does marfans syndrome occur
what does it look like
other signs

A

autosomal dominant or sporadic mutation of fibrillin gene
tall stature with disproportionally long limbs and ligamentous laxity
high arched palate, scoliosis, flattening of chest, eye problems, aortic aneurysm, cardiac valve incompetence

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16
Q

what is ehlers-danlos syndrome
how does it occur
wha are the signs

A

abnormal collagen and elastin formation
autosomal dom
joint hyper mobility, joint instability, scoliosis

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17
Q

commonest type of CP

A

spastic 80% - injury to motor cortex

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18
Q

Ataxic CP what does it affect and what are the signs

A

cerebellum

decreased co ordination and balance

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19
Q

what does athetoid CP affect and what are the signs

A

extra pyramidal motor system, pyramidal triangle, basal ganglia
uncontrolled writhing motion, sudden changes in tone and difficulty controlling speech

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20
Q

monoplegic
hemiplegic
diplegia
total body involvement

A

one limb
one ipsilateral upper and lower limb
both legs
all 4 limbs

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21
Q

treatment of CP

A

physio
orthotics
baclofen - injection intrathecally in the subarachnoid space to reduce spasticity

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22
Q

what is spina bifida

A

congenital disorder where the two halves of the posterior vertebral arch fail to fuse

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23
Q

spina bifida occult is what kind of form
what can some patients develop
when do neurological symptoms occur
what are some characteristics of this condition

A

mildest form
tethering of spinal cord and roots which leads to claw toes and pes cavus
neurological symptoms can occur at any age
tell tale sign of tuft of hair in skin overlying defect

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24
Q

spina bifida cystica is what form

what happens

A

severe form
contents of vertebral canal herniate through defect with either herniation of meninges alone (meningocele) or with the spinal cord or caudal equina

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25
is meningocele associated with neurological effects | but
no | but myelomeningocele has neurological defects below lesion
26
what is spina bifida cystia associated with
hydrocephalus (excess CSF around increase intracranial pressure)
27
how is spina bifida cystia treated
defect usually closed within 48 hours of birth
28
what is polio and what does it affect
viral infection | affects motor anterior horn cells in the spinal cord or brain stem resulting in lower motor neurone deficit
29
how does the virus in polio enter and what does it lead to
vie GIT with a flu like illness leading to a variable degree of paralysis usually affecting a group of muscles within 2-3 days
30
what is the treatment of residual paralysis of polio
splint age | shortening of leg can be treated with a shoe raise
31
what is syndactyly
2 digits fused together due to failure of separation of skin/soft tissues or pahalnges of adjacent digits
32
what is polydactyl
extra digit formed
33
what is fibular hemimelia
partial or complete loss of fibula leading to a shortened limb
34
what does an absence or hypoplasia of radium lead to
absence of thumb | radial clubhand
35
how does tarsal coalition occur and what is it
congenital fusion | painful flat feet in later childhood
36
what is Erbs palsy and what does it lead to what are the signs treatment
inquiry to C6 and C7 motor neurones loss of motor innervation to deltoid, supra, infra, biceps, brachialis internal rotation of humerus, classic waters tip posture physio
37
what is klumpke's palsy cause leads to what sign
c8 and T1 roots damage forceful adduction paralysis of intrinsic hand muscles and finger and wrist flexors fingers are flexed
38
when do bow legs (virus knees) become normal aligned and what does this then progress to
``` 14 months knock knees (valgus) ```
39
what are valgus knees
knock knees 10-15 degrees at the age of 3 and progresses to 6 degrees by 6-9
40
test for mobile flat feet
jacks test - medial arch is formed with dorsiflexion of great toe
41
what happens when jacks test for flat feel is negative | and what are the causes of this
rigid flat feet | underlying bone abnormality (tarsal coalition), underlying inflam disorder or neurological disorder
42
what is developmental dysplasia of the hip (DDH)
dislocation or subluxation of the femoral head in the perinatal period which affects development of the hip joint
43
who does DDH occur where and both sides or just one?
females more than men left hip commoner only 20% bilateral
44
what are the risk factors for DDH?
FH first born Downs other congenital disorders
45
what are the signs of DDH
limb shortening, assym groin/thick skin creases | click/clunk on ortolani or barlow manoeuvre
46
describe ortolani and barlow manœuvres
O - reducing dislocated hip with abduction and anterior displacement B - dislocatable hip with flexion and posterior displacement
47
what are the investigations for DDH and the limitation
XR but can't be used until after 6 months as femoral head hasn't ossified
48
what is the treatment for DDH depending on the stages mild dislocated or persistently unstable over 18 months
closely observed US done reduced and help with parlik harness (used full time for 6 weeks then part time for 6 weeks - used in ages 4-6 months) over 18 months - open reduction
49
when does transient synovitis occur who does it occur in what is the treatment
after a URTI 2-10 year old. boys short course of steroids and rest
50
what is the commonest cause of hip pain in childhood
transient synovitis
51
what is perthes disease
idiopathic osteochonditis of the femoral head | femoral head loses blood supply becomes necrotic and leads to abnormal growth
52
who does perthes disease occur in and how do they present | what are the signs
4-9 yr olds active boys with short stature pain and limp loss of internal rotation followed by loss of abduction and tredenlburgs sign is positive
53
what might bilateral perthes disease mean
underlying skeletal dysplasia or thrombophilia
54
what is the treatment of perthes disease
XR observation and avoid physical activity
55
who does a SUFE occur
obese pre pubertal boys
56
what is a SUFE
femoral head slips inferiorly in relation to femoral neck
57
when does a SUFE occur in girls
hypothyroidism or renal disease predisposes them to a SUFE
58
presentation of a SUFE
limp pain - may only be pain in knee loss of internal rotation
59
investigation and treatment of SUFE
lateral view XR pin femoral head if chronic then osteotomy
60
what is apophysitis and where can it occur
inflammation of growing tubercle where tendon attaches | either side of the patella tendon
61
what is Osgood shatters
inflammation of tibial tubercle apophysitis
62
what can osteochondiritis discens result in which predisposes to OA
loose bodies - pot holes on surface
63
meniscal problems in children are caused why | treatment
some children have abnormally shaped discoid meniscus which is circular and can cause pain and popping arthroscopic partial meniscectomy
64
what is clubfoot and what is the treatment
``` ankle equinus (plantar flexion) supination of forefoot and various alignment of foot donsets technique ```
65
what is tarsal coalition
abnormal bridge between calcaneus and navicular or between talus and calcaneus
66
``` what is spondolythesis where does it usually occur who does it usually occur in symptoms/signs treatment ```
slippage of one vertebrae over the other L4/L5 or L5/S1 adolescents low back pain, flat back, waddling gait physio. if severe stabilisation and reduction
67
what can metal particles in joint replacement lead to | what can polyethylene particles in joint replacement lead to
``` inflam granuloma (pseudotumour) osteolysis ```
68
in osteomyelitis if there is dead bone what can happen
might break off (sequestrum) | and new bone (involucrum) will form around the area of necrosis
69
what is a brodies abscess
in osteomyelitis in children the area is just cut off - abscess formed with thin rim of sclerotic bone
70
how can chronic OM present | what can cause it
can lie dormant for years localised pain, inflammation systemic upset TB esp spinal OM
71
how does spinal OM present
insidious back pain which is constant and unremitting paraspinal muscle spasm tenderness in spine fever
72
``` list the nerves that can be damaged in the following fractures/dislocations: colles fracture anterior shoulder dislocation humeral shaft fracture supracondylar fracture posterior dislocation of the hip bumper injury to lateral knee ```
``` median nerve axillary nerve radial nerve intertossous branch of median nerve sciatic nerve common perineal nerve ```
73
what does degloving mean and what are the symptoms
avulsion of skin from underlying blood vessels | skin will not bleach on pressure and loss of sensation
74
treatment of soft tissue injuries
``` RICE rest ice compression elevation ```
75
commonest cause of septic arthritis in adults, second most commonest cause commonest cause in children young adults E Coli occurs in who
SA, streptococci H influence - not since vaccination Neisseria gonorrhoea (rare) elderly, IVDU, very ill

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