Msk Exam Flashcards
What percent of the population >65 years of age are affected by Osteoarthritis?
80%
What medications should be avoided in an individual with an acute gout flare and has both kidney and liver issues?
NSAID’s and Colchicine
Who is at greater risk for developing pseudogout?
Individuals over 60, Hyperparathyroidism, OA, RA, Hemochromatosis, 24-48 hours after surgery
What is the treatment for calcium pyrophosphate dihydrate disease?
NSAID’s or Colchicine
Are greater incidence rates of OA found in high or low sociodemographic index areas?
High
What is osteoarthritis?
Progressive degeneration of articular cartilage.
True or false there will be associated changes in synovial fluid make up seen in osteoarthritis?
True
What are the risk factors for osteoarthritis?
Increasing age, Female, Genetics, Prior joint injury, Obesity (BMI >30), Occupational
What nodes will be seen in patients with osteoarthritis and where are they located?
Heberdens nodes-DIPJ, Bouchards nodes-PIPJ
What is metabolic bone disease?
Any bone disorder resulting from chemical aberrations
What T-Score defines osteoporosis?
Less than -2.5
What other hormone disorders can contribute to osteoporosis?
Cushings, Thyroid disorders, Hyperparathyroidism, DM
What are the risk factors for osteoporosis?
Pathologic fracture, Post menopausal women >65, Younger post-menopausal women with + FH, All men >70
Who receives pharmacological treatment with osteoporosis?
T-score less than -2.5, 10 year hip fracture risk >3%, 10 year major fracture risk of 10+% get treatment, Any patient with a fragility fracture
What education must be given to a patient when prescribing bisphosphonates?
Medication must be taken in the AM 40 minutes before eating with at least 8 oz of water. The patient must also remain sitting upright to avoid esophagitis
What medication should be given to someone to treat osteoporosis if they have a history of breast cancer?
Denosumab
What is the most commonly prescribed medication for an individual with osteoporosis?
Bisphosphonates
What is the black box warning for Teriperatide?
Increased risk of osteosarcoma
What are the radiographic properties of benign bone lesions?
Well-defined, sclerotic border, no cortical destruction or soft tissue extension
What are the radiographic properties of a malignant bone lesion?
Poorly defined, moth eaten, periosteal reaction, may have extension into soft tissue
What type of cancer metastases creates osteolytic bone lesions?
Renal cell cancer
What type of cancer metastases creates osteoblastic bone lesions?
Prostate cancer
What type of cancer metastases creates both osteoblastic and osteolytic lesions?
Breast cancer and gastrointestinal cancers
What is the most common cause of bone tumors in older adults?
Metastatic disease
What organs are commonly the primary sources of metastases?
Lung, Breast, Prostate, Kidney
What are the symptoms of metastatic disease?
Pain that is worse at night, Possible nerve pain or complaints, Unintentional weight loss, Unexplained fatigue, Fever/night sweats, Malaise, Lymphadenopathy, Evidence of hypercalcemia, Reduced muscle tone, Diminished deep tendon reflexes
What diagnostics will be performed if there is concern for metastatic bone disease?
Calcium-Elevated, Alkaline phosphatase-Elevated (could be d/t liver or bone), Initially radiographs, CT, if spine order MRI, Biopsy-definitive diagnosis
What is the treatment for metastatic bone disease?
Bisphosphonates (Note: consider calcium and vitamin D supplementation, and requires renal clearance), Monoclonal antibodies, Radiation, Ablation
What is the age distribution of osteosarcoma?
Children ages 13-18, Older adults ages 80-84
What are the risk factors of developing osteosarcoma?
Radiation, Chemo, Pagets disease, Retinoblastoma, Li-Fraumeni syndrome (turns off TP53 tumor suppressor gene)
What areas are most commonly affected in osteosarcoma?
Distal femur, Proximal tibia, Proximal humerus
What will be found on physical exam for osteosarcoma?
Large tender soft tissue mass, Limping, Decreased ROM, Regional lymphadenopathy
What diagnostics will be used for osteosarcoma?
Lactate Dehydrogenase (LDH), Alkaline Phosphatase (ALP), X-Ray-sunburst appearance, codmans triangle, MRI of the entire bone, Chest CT to check for metastases, Biopsy-definitive diagnosis
What are the treatment options for osteosarcoma?
Wide excision/limb sparing, +/- chemotherapy, +/- radiation, Possibly amputation
What is an osteochondroma?
Cartilage forming tumor
Are osteochondromas malignant or benign?
Benign
Where are the most common locations of osteochondromas?
Long bones of the leg, pelvis, shoulder blade
What are the physical exam findings of osteochondromas?
Painless, palpable lump, May cause neurovascular changes
What diagnostics are used for osteochondroma?
X-ray: cartilage cap, typically grows near the growth plate and away from it, Additional imaging for other complications CT vs MRI
What is an osteoid osteoma?
Benign bone tumor that has prostaglandins. night pain relieved with NSAID’s, and swelling
What is an osteoblastoma?
Benign bone tumor that lacks prostaglandins and is more vascularized. Characterized by dull, localized pain with little relief from NSAIDs
How are osteoid osteomas treated?
Conservatively with NSAIDS, surgical excision; CT guided RF ablation
How are aneurysmal bone cysts treated?
Surgical excision, sclerotherapy, embolization of the vessel, denosumab
What is the most common type of bone cyst?
Simple/unicamerial bone cyst
What is a fibrous lesion and how is it caused?
Benign bone lesion caused by proliferation of fibrous tissue d/t missense mutation on the GNAS 1 gene on chromosome 20.
