MSK disorder treatment

Question 1

types of bone cells

Answer 1

osteogenic
osteoblast
osteocyte
osteoclast

Question 2

structure of compact bone

Answer 2

osteons - central haversian canals
concentric matrix lamellae
canniculi radiate from lacunae to haversian canals to provide passageways

Question 3

what are lacunae

Answer 3

small spaces containing osteocytes

Question 4

what are volksmanns canals

Answer 4

transverse perforating canals

Question 5

structure of long bone

Answer 5

periosteum
outer cortex
cancellous bone mostly
medullary cavity - yellow bone marrow
nutrient artery and articular cartilage

Question 6

what is an epiphysis

Answer 6

end of bone in contact with joint

Question 7

what is a metaphysis

Answer 7

connects epiphysis (physis in children) to diaphysis

Question 8

what is a diaphysis

Answer 8

middle section of long bone

Question 9

mechanisms of fractures

Answer 9

trauma - high/low energy
stress - abnormal stresses on normal bone
pathological - normal stresses on abnormal bone

Question 10

patholopgical fractures

Answer 10

osteoporosis
malignancy
vit D insufficiency
osteomyelitis
osteogenesis imperfecta
pagets disease

Question 11

investigations for fractures

Answer 11

MRI for soft tissue
X-ray for bones - not hairline fractures
bone scans - uncommon

Question 12

describe a fracture x-ray

Answer 12

location - bone and part of bone
pieces
pattern - transverse etc
displaced or undisplaced
translated/angulated XYZ plane

Question 13

urgent complications of fractures

Answer 13

local visceral injury
vascu;ar injury
nerve injury
compartment syndrome
haemarthrosis
infection
gas gangrene

Question 14

what is compartment syndrome

Answer 14

blood leaks into soft tissue
pressure builds
cuts off its own arterial blood supply

Question 15

less urgent fracture complications

Answer 15

fracture blisters
plaster sores
pressure sores
nerve entrapment
myositis ossificans
ligament injury
tedon lesions
joint stiffness
algodystrophy

Question 16

late complications of fractures

Answer 16

delayed union
malunion/non-union
avascular necrosis
muscle contracture
joint instability
osteoarthritis

Question 17

joint classifications

Answer 17

fibrous
cartilaginous
synovial

Question 18

types of fibrous joints

Answer 18

sutures
syndesmosis
interosseous membrane

Question 19

types of cartilaginous joints

Answer 19

synchondroses (spine)

symphyses (pubic)

Question 20

types of synovial joint

Answer 20

plane
hinge
condyloid
pivot
saddle
ball and socket

Question 21

what is synovium

Answer 21

lining of joint cavity containing macrophage like cells (type A synoviocyte)
and fibroblast like cells producing hyaluronic acid (type B synoviocyte)
type I collagen

Question 22

what is cartilage composed of

Answer 22

chondrocytes

ECM - water, collagen, proteoglycans (aggrecan)

Question 23

what is aggrecan

Answer 23

proteoglycan possessing chondroitin sulfate and keratin sulfate chains
interacts with hyaluronan to form large proteoglycan

Question 24

pathophysiology of osteoarthritis

Answer 24

degenerative disease of chondral cartilage, bones end up rubbing together causing stiffness, pain, impaired movement
early - cartilage oedema
late - cartilage damage and loss, osteophytes, subchondral cysts, synovial inflammation

Question 25

inflammatory mediators in late OA

Answer 25

MMPs
aggrecanases
IL-1b TNF-a

Question 26

risk factors for OA

Answer 26

age
excess weight
mechanical constraints
FH
female - menopause
osteonecrosis
leg bone malalignment - uneven stress
metabolic syndrome
injury

Question 27

presentation of OA

Answer 27

pain on exertion
disability
deformity
PMH of infection or trauma possible

Question 28

special knee ACL tests

Answer 28

anterior drawer test

lachmanns test

Question 29

conservative management of OA

Answer 29

analgesics
physiotherapy
walking aids
avoidance of exacerbating activity
injections - steroids etc

Question 30

operative management of OA

Answer 30

replacement
realignment
excise or fuse toes
denervate - wrist

Question 31

what is osteomyelitis

Answer 31

infection of bone

acute/chronic and primary/secondary

Question 32

signs of septic arthritis

Answer 32

red
painful
hot
swelling
fever
immunosuppressed, intravenous drug use

Question 33

scans for osteomyelitis and septic arthritis

Answer 33

Xrays
MRI scans - CT if not available
bone scans
labelled white cell scans

Question 34

bloods for osteomyelitis and septic arthritis

Answer 34

CRP
ESR
WCC
TB culture/PCR

Question 35

management of osteomyelitis

Answer 35

antibiotics IV
surgical drainage
amputation and antibiotic suppression if chronic

Question 36

management of septic arthritis

Answer 36

surgery - joint lavage and drainage
IV antibiotics
immobilise joint acutely
physiotherapy after

Question 37

shoulder conditions young people

Answer 37

dislocation

fractures

Question 38

shoulder conditions middle aged people

Answer 38

impingement
dislocation
ACJ OA
rotator cuff tears
fractures

Question 39

shoulder conditions old people

Answer 39

glenohumeral OA
impingement
cuff tears
fracture

Question 40

hip conditions young people

Answer 40

developmental dysplasia
leg length discrepancy
impingement

Question 41

hip conditions middle aged people

Answer 41

OA
avascular necrosis
impingement

Question 42

hip conditions old people

Answer 42

OA

post-total hip replacement

Question 43

knee conditions young people

Answer 43

patellofemoral maltracking
ACL/PCL
meniscal tears
fractures

Question 44

knee condiitons middle aged

Answer 44

OA
patellofemoral maltracking
ACL/PCL
meniscal tears
fractures

Question 45

knee conditions old people

Answer 45

OA