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Musculoskeletal > MSK Pathology > Flashcards

MSK Pathology Flashcards

1
Q

What is cubital tunnel syndrome

A

Compression of the ulnar nerve as it passes around the medial epicondyle

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2
Q

What is the 2nd most common nerve entrapment

A

Cubital tunnel

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3
Q

Causes of cubital tunnel syndrome

A

Osteoarthritic or rheumatic narrowing of the ulnar groove
Can be without obvious cause
Fractures (injury)
Joint dislocation (injury)

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4
Q

Non-operative Rx for cubital tunnel

A

NSAIDs

Bracing/splinting

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5
Q

Surgical Rx for cubital tunnel

A

Nerve release

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6
Q

Clinical features of cubital tunnel syndrome

A 
Hypothenar wasting 
Clas deformity 
Numbness 
Decreased sensation of little ad medial 1/2 of ring finger 
Tingling in hands and fingers 
Shooting pain when leaning on the elbow
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7
Q

What is a more common name for medial epicondylitis

A

Golfer’s elbow

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8
Q

What is more common golfers elbow or tennis

A

Tennis

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9
Q

What is the medial epicondyle the common origin for

A

Flexor tendons

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10
Q

Pathology of golfers elbow

A

Form repetitive strain injury

Microtears and degeneration in the tendons from overuse

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11
Q

Rx for golfers elbow

A

Activity modification
Rest
Physio.

Biological:
Platelet rich plasma injection

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12
Q

Which Rx should you never give in golfers elbow?

A

Nerve inject steroids

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13
Q

Clinical features of golfers elbow

A

Aching elbow pain (typically over medial elbow)
Worse with activity
Typically affects dominant arm

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14
Q

What is a more common name for lateral epicondylitis

A

Tennis Elbow

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15
Q

What is the most common elbow overuse injury

A

Tennis elbow

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16
Q

In shoulder dislocation what is stability sacrificed for

A

Mobility

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17
Q

What type of injury is tennis elbow

A

Repetitive strain injury

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18
Q

Ix for tennis elbow

A

Clinical Dx
Mill’s test
Cozen’s test

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19
Q

Clinical features of tennis elbow

A

Pain lateral elbow
Worsens with activity
Typically affects dominant arm
Point tenderness over lateral epicondyle

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20
Q

Rx for tennis elbow

A

Activity modification
NSAIDS
Physio.
Platelet rich plasma injections

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21
Q

What is Adhesive capsulitis also commonly known as

A

Frozen shoulder

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22
Q

What are the 3 stages of frozen shoulder

A
  1. PAIN with freezing (pain and decreased ROM)
  2. Stiffening or FREEZING(pain slightly resolves but stiffening worsens)
  3. Resolution/THAWING
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23
Q

How long can frozen shoulder take to resolve

A

up to 2yrs

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24
Q

Clinical features of frozen shoulder

A

Acute pain on movement and resting
Difficulty sleeping on affected side
Restricted ROM

Pain settles and stiffening begins
Stiffening persists more than the pain

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25
Q

Ix for frozen shoulder

A

Clinical Dx

Normal on x-ray

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26
Q

Rx for early presentation of frozen shoulder

A

Steroid injection
Physio
Analgesia (NSAIDs)

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27
Q

What is a shoulder dislocation

A

Loss of congruity between the head of the humerus and the glenoid fossa

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28
Q

What is the most common direction of dislocation

A

Anterior

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29
Q

What should potentially be considered in a posterior dislocation

A

Seizures

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30
Q

What type of joint is the shoulder joint

A

Synovial ball and socket

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31
Q

Clinical features of should dislocation

A

Extreme pain
Decreased ROM

Held in ABDUCTED and EXTERNALLY ROTATED position

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32
Q

Ix for shoulder dislocation

A

X-ray

AP and lateral

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33
Q

Rx for shoulder dislocation

A

Analgesia
Manipulation
Immobilisation
Physio.

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34
Q

Complications of shoulder dislocation

A

Labral tear
Axillary n. or a damage
Damage o brachial plexus
Increased risk of recurrence

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35
Q

When should you operate in shoulder dislocations

A

> 2 dislocations

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36
Q

How do ACL injuries typically occur

A

Through sporting

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37
Q

Common causes of ACL

A 
Twisting injury to the knee with foot fixed to the ground 
Landing incorrectly 
Stopping sudden 
Changing direction suddenly 
Collision
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38
Q

Signs of ACL damage

A

Unstable knee
Effusion
+ve drawer test

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39
Q

Symptoms of ACL damage

A

Heard a pop
Pain
Quick swelling
Loss of full ROM

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40
Q

Ix for ACL damage

A

Often clinical

Rarely MRI

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41
Q

Rx for ACL injury

A

Rest
Physio
Swelling reduction
Analgesia

Surgery:
ACL reconstruction

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42
Q

Indications for surgical reconstruction in ACL injury

A

Prevention of further injury
Back to work
Back to sport
Prevention OA

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43
Q

Which is stronger the ACL or PCL of the knee

A

PCL

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44
Q

What is a common cause of PCL injury

A

Car crashes:

Bent knee hitting the dashboard

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45
Q

Signs of PCL injury

A

Posterior draw test

Posterior sag

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46
Q

Symptoms of PCL injury

A

Pain
Swelling
Difficult weight bearing
Unstable knee

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47
Q

Rx for PCL Injury

A

Analgesia
Physio.
Immobilisation
Swelling reduction

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48
Q

Why is PCL injury treated more conservatively

A

Surgical reconstruction is more difficult and more difficult to predict compared to ACL reconstruction

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49
Q

What is the most commonly fractures carpal bone

A

Scaphoid

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50
Q

What is a common complication of scaphoid fracture

A

AVN

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51
Q

What is AVN

A

Avascular necrosis

Death of the bone due to interrupted blood supply

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52
Q

Ix for suspected scaphoid fracture

A

Easily missed on x-ray

So dedicated scaphoid series

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53
Q

Clinical features of scaphoid fracture

A 
Tender anatomical snuffbox 
Tender over scaphoid tubercle 
Pain on axial compression of thumb 
Pain on ulnar deviation of pronated wrist 
Pain on supination against pronation
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54
Q

Main cause of scaphoid fracture

A

Falling

On outstretched hand

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55
Q

Rx for scaphoid fracture

A

Cast

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56
Q

Rx for clinically suspected scaphoid fracture that is not detected x-ray

A

Cast

Re-xray in 2 weeks

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57
Q

Which of the collateral ligaments is more commonly injury

A

Medial

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58
Q

How is the medial collateral ligament injured

A

Due to lateral blow to the knee

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59
Q

Which ligament does a blow to the lateral knee injure

A

Medial collateral

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60
Q

Which ligament does a blow to the medial knee injure

A

Lateral collateral ligament

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61
Q

Describe injury to the lateral collateral ligament

A

Less common than medial injury
Tends to be more extensive and involve:
Cruciate
Common perineal nerve

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62
Q

Rx for collateral ligament injury

A

Rest
Firm support
Physio

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63
Q

When is surgery indicated for collateral ligament injury

A

Rarely

Unless complicated LCL injury

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64
Q

Clinical features of collateral ligament injury

A 
No or minimal effusion 
Swelling 
Bruised one side
Lateralised pain 
Feel of 'crack' sharp pain
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65
Q

What is an open fracture

A

Direct communication between a fracture and the external environment

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66
Q

What is the classification system used for open fractures

A

Gustilo Classification of Open Fractures

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67
Q

Complications of open fractures

A

Infection
Compartment syndrome
Non-union
Neurovascular injury

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68
Q

Describe Gustilo Classification System

A

Classifies open fractures
Based on:
Size of wound
Tissue damage

Classified into:
Stage 1
Stage 2
Stage 3 (3A,B,C)

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69
Q

Which open fractures require a vascular surgeon

A

Stage 3C (involvement of neuromuscular structures)

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70
Q

Ix for open fractures

A 
Full ALTS assessment 
Repeated neurovascular examination 
Take photographs with ruler beside it 
X-rays 
Sometimes CT
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71
Q

Indications for emergency surgery

A

Polytraumatised
Gross contamination
Compartment syndrome
Neurovascular compromise

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72
Q

What are the BOAST guidelines for dealing with open fractures

A 
Analgesia 
Take a photograph with a ruler next to it 
Splinting 
Neurovascular examination of patient 
Document it!!
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73
Q

What is the commonest reason for knee arthroscopy

A

Meniscal injury

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74
Q

What is the function of the menisci

A

Shock absorbers

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75
Q

What are the menisci of the knee

A

Medial

Lateral

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76
Q

Clinical features of meniscal injury

A 
Slow swelling 
Painful to weight bear 
Sensation of knee giving way 
Locked knee (extension limited)
Loss of full ROM
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77
Q

What does McMurrays test assess for

A

Knee meniscal injury

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78
Q

Surgery options for meniscal injury

A

Arthroscopy
Meniscal repair
Partial meniscectomy
Meniscal transplantation

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79
Q

Conservative Rx for meniscal injury

A

Physio
Analgesia
Swelling reduction

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80
Q

What causes Carpal Tunnel Syndrome

A

Compression of the median nerve as it passes through the carpal tunnel

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81
Q

Is carpal tunnel more common in F or M

A

F>M

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82
Q

Underlying causes of Carpal tunnel

A 
Pregnancy 
Gout 
DM 
Idiopathic 
Acromegaly 
Local tumours 
RA 
Hypothyroidism 
Amyloidosis 
Sarcoidosis
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83
Q

What is the most common neuropathy

A

Carpal tunnel

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84
Q

Symptoms of carpal tunnel

A

Tingling in median nerve distribution
Numbness in medin nerve distribution
Pain
Can be worse at night

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85
Q

What is the median nerve distribution in the and

A

Lateral 3.5 digits

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86
Q

Ix for Carpal Tunnel

A

Usually clinical Dx (O/E)
Tinel’s Test
Phalens Test

Sometimes nerve conduction studies

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87
Q

Describe Tinel’s test

A

Tapping over the anterior wrist of the affected

+ve would elicit symptoms

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88
Q

Describe Phalen’s Test

A

Backwards paying
For 60 seconds
+ve if this elicits symptoms

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89
Q

Rx for Carpal Tunnel

A

Splintage
Rest
Weight reduction
Corticosteroid injection

Sometimes surgery if persistent

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90
Q

Surgery for carpal tunnel syndrome

A

Carpal tunnel release

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91
Q

Is Trigger finger more common in M or F

A

F>M

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92
Q

Associations with Trigger Finger

A

DM!
RA
Gout
Thyroid disease

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93
Q

Clinical features of trigger finger

A

Clicking sensation with movement of this digit
Lump in palmar aspect under pulley
May have to use the other hand to unlock the finer
Clicking may progress to locking (in flexed position)

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94
Q

Which level of pulley is commonly affected in trigger finger

A

Level of A1 pulley

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95
Q

Ix for trigger finger

A

Clinical Dx

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96
Q

Non-operative Rx trigger finger

A

Splintage
Rest
Steroid injection
Analgesia

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97
Q

Operative Rx trigger finger

A

Surgery:
Percutaneous release
Open surgery

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98
Q

Which finger is the most commonly affected in trigger finger

A

Ring finger

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99
Q

Who does Legg-Calve/Perthes disease affect

A

Children

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100
Q

What causes Legg-Calve

A

Idiopathic

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101
Q

Pathology of Legg-Calve disease

A

AVN of femoral head occurs

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102
Q

What are the phases of Legg-Calve disease

A

Avascular necrosis at femoral head (due to lack of blood supply)
Fragmentation (revascularisation) - painful phase
Reossification - bone healing

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103
Q

Clinical features of Perthes disease

A 
Short stature 
Limping child 
Knee pain (referred from hip)
Groin/hip pain
Stiff hip joint 
Limited ROM of hip
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104
Q

Ix for Perthes/Legg -Calves disease

A

X-ray

MRI

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105
Q

Outcome of Perthes/Legg-Calves disease

A

Alot will resolve by itself

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106
Q

Is the prognosis better or worse for Perthes disease that occurs <6yrs

A

Better

As children bones recover well and model

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107
Q

Is the prognosis better or worse for Perthes disease that occurs in Adolescence

A

Worse
Poorer prognosis
More risk of developing OA

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108
Q

Ddx for unilateral Perthes/Legg-Calves disease

A

Septic hip
JIA
SCFE

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109
Q

Rx for Perthes/Legg-Calves

A

No definitive Rx
Maintain good hip motion.mobility
Analgesia
X-ray surveillance

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110
Q

What is the long term prognosis of Perthes/Legg-Calves disease determined by

A

The risk of developing OA in the deformed hip

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111
Q

Who is Legg-Calves/Perthes disease more common in M or F

A

Males

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112
Q

Is majority of Legg-Calves/Perthes disease unilateral or bilateral

A

Unilateral

only 15% is unilateral

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113
Q

What is the clinical term for irritable hip

A

Transient synovitis of the hip

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114
Q

What is the child cause of hip pain in children

A

Transient synovitis of the hip (irritable hip)

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115
Q

What type of Dx is hip transient synovitis

A

Dx of exclusion

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116
Q

What causes irritable hip

A

Inflammation of the synovium

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117
Q

Clinical features of irritable hip

A 
Acute onset 
Acute hip pain 
Stiffness 
Limp 
Non-weight bearing
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118
Q

Ix for irritable hip

A

Dx of exclusion
Bloods normal
X-ray normal

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119
Q

Rx for irritable hip (transient synovitis)

A

Self limiting
Rest
Analgesia (NSAIDs)

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120
Q

What Dx do you need to exclude in order to Dx transient synovitis (irritable hip)

A

Septi arthritis
Osteomyelitis
Fractures
SUFE

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121
Q

What does SCFE stand for

A

Slipper Capital Femoral Epiphysis

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122
Q

What is the cause of SCFE

A

Unknown

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123
Q

Pathology of SCFE

A

Fracture through the growth plate which results in slippage of the overlying end of the femur
Displacement through the hypertrophic zone

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124
Q

What is the difference between stable and unstable SCFE

A

Stable - can weight bear

Unstable - cannot weight bear

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125
Q

What is a major risk factor for SCFE

A

obesity

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126
Q

What 2 signs can be seen on X-ray in SCFE

A

Trethowan Sign

Klein’s Line

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127
Q

Symptoms of SCFE

A

Pain in hip or knee
Groin pain
Some unable to weight bear
Limp

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128
Q

Signs of SCFE

A

Externally rotates posture and gait (waddling)

Reduced internal rotation (esp. in flexion)

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129
Q

Difference between chronic and acute SCFE

A

Chronic is >3 weeks

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130
Q

Which view of x-ray will you best see SCFE

A

Lateral

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131
Q

Describe the radiological classification of SCFE

A

Grade I/mild = <1/3 slippage
Grade II/moderate = 1/3 - 1/2 slippage
Grade III/severe = >1/2 slippage

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132
Q

Complications of SCFE

A 
AVN (femoral head)
Chorndrylosis 
Deformity 
Early OA 
Stable becoming unstable
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133
Q

What is a complication of stable SCFE

A

Stable becoming unstable

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134
Q

DD for SCFE

A 
Transient synovitis 
Infection 
Missed DDH 
JIA 
Perthes
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135
Q

Operative Rx for SCFE

A

Pinning
Early internal fixation
Consultation orthopaedic surgeon

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136
Q

Where does the metaphysics move in SCFE

A

Anterior and proximal

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137
Q

Does stable or unstable SCFE have a higher risk for AVN

A

Unstable

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138
Q

What is acute osteomyelitis

A

Acute infection of the bone

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139
Q

Who does acute osteomyelitis normally affect

A

Children

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140
Q

What type of organism is the most common for acute osteomyelitis

A

Bacterial

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141
Q

Common Ddx for acute osteomyelitis

A

Acute septic arthritis
Acute inflammatory arthritis
Trauma (fracture, dislocation)
Transient synovitis

142
Q

Rarer Ddx for acute osteomyelitis

A

Sickle cell crisis
Gaucher’s Disease
Rheumatic fever
Haemophilis

143
Q

Skin Ddx for acute osteomyelitis

A

Cellulitis
Erisypelas
Necrotising fasciitis
Gas gangrene

144
Q

Potential source of osteomyelitis in infants

A

Umbilical cord

145
Q

Acute osteomyelitis organisms in infants <1yr

A

Staph Aureus
Group B strep
E.coli

146
Q

Acute osteomyeltiis organisms in older children

A

Staph Aureus
Strep Pyogenes
Haemophilus influenza

147
Q

Acute osteomyelitis organisms in adults

A

Staph Aureus
Coagulative -ve staphylococci
Pseudomonas aeroginosa

148
Q

Acute osteomyelitis organisms in diabetic foot

A

Mixed infection

Including anaerobes

149
Q

Acute osteomyelitis organisms in sickle cell disease

A

Salmonella

150
Q

in which group would candida more commonly cause acute osteomyelitis

A

HIV/Aids

Debilitating illnesses

151
Q

Complications of acute osteomyelitis

A 
Septicaemia; death 
Metastatic infection 
Pathological fracture 
Chronic osteomyelitis 
Septic arthritis 
Altered bone growth
152
Q

Clinical features acute osteomyelitis in infants

A 
May be minimal signs 
Or may be very ill 
Failture to thrive
Drowsy irritable 
Metatphyseal tenderness and swelling 
Decreased ROM 
Positional change
153
Q

Clinical features acute osteomyelitis in children

A 
Sever pain 
Reluctant to move 
Neighbouring joints held flexed 
Not weight bearing 
Fever
Tachycardia 
Malaise (fatigue, nausea, vomiting)
154
Q

Clinical features osteomyelitis in Adults

A

Primarily seen in thoracolumbar spine
Acute backache
Temperature/fever
History UTI, DM or immunocompromised

155
Q

Basic Ix of acute osteomyelitis

A 
Hx
Examination 
FBC 
Diff WCC 
ESR 
CRP 
Blood cultures x3 at peak temperature 
U&amp;E's - ill, dehydrated
156
Q

Imaging Ix of acute osteomyelitis

A 
Xray 
USS 
Aspiration 
Isotope bone scan 
Labelled white cell scan 
MRI
157
Q

Gold standard for making a microbiological Dx in acute osteomyelitis

A

Bone biopsy and culture (though this is rarely required)

158
Q

Supportive Rx for acute osteomyelitis

A

Fluids
Analgesia
Rest
Splintage

159
Q

Abx Rx for acute osteomyelitis (including route and for how long)

A 
Start on IV then switch to oral 
Duration 4-6weeks depending on response 
empirical choice (flucloxacillin + benzylpenicillin_
160
Q

Indications for surgery in acute osteomyelitis

A

Aspiration of pus for Dx an culture
Abscess drainage
Debridement of dead/infected/contaminated tissue

161
Q

Common sources of infection for osteomyelitis

A

Haemotogenous spread

Local spread from contiguous site fo infection - trauma (open fracture), surgery, joint replacement

Secondary to vascular insufficiency

162
Q

Common source of acute osteomyelitis infection for osteomyelitis in adults

A

UTI

arterial line

163
Q

Common sources of acute osteomyelitis infection in children

A

Boils
Tonsilitis
Skin abrasions

164
Q

If there is no resolution of acute osteomyelitis what occurs

A

Chronic osteomyelitis

165
Q

What is sequestrum

A

Necrosis of bone

166
Q

What is Involucrum

A

Formation of new bone

167
Q

Which three common conditions can cause intoeing

A

Tibial torsion
Metatarsus adducts
Femoral anteversion

168
Q

What is intoeing

A

When a child walks or runs with their feet turned inwards

169
Q

What is the main Rx for intoeing

A

In the vast majority it will correct itself

170
Q

Rx for metatarsus adductus

A

95% will resolve on their own
Stretching/manipulation exercises can help

Some cases:
Casts/special shoes
Surgery

171
Q

What is metatarsus adductus

A

Common foot deformity noted at birth

Which causes intoeing

172
Q

when is flexible metatarsus adductus Dx

A

If the heel and forefoot can be aligned with each other on gentle pressure no forefoot while holding eel steady

173
Q

Ix for metatarsus adductus

A

Physical examination

X-ray if non flexible/rigid

174
Q

Signs of Metatarsus adductus

A

High arch

Wide separation of big and 2nd toe

175
Q

What causes tibial torsion

A

Inwards rotation of the tibia

176
Q

Prognosis for tibial torsion

A

Very good

Almost always corrects itself as the child grow

177
Q

what common thing does tibial torsion cause

A

Intoeing

178
Q

What is congenital dysplasia of the hip

A

Congenital hip dislocation

179
Q

Who is DDH incidence higher in

A 
First born 
girls>boys 
Left>right 
Olidohydramnios 
Breech position 
FH 
Other limb deformities
180
Q

Which hip is more commonly affected in DDH

A

Left

181
Q

Ix for DDH

A

All babies given full hip examination within 72hrs
Early Dx is crucial

Another hip examination at 68 weeks -

182
Q

when is USS recommended for Dx DDH

A 
If the hip feels unstable on routine examination 
FH of childhood hip problems 
Baby was breech 
Twins or multiple 
premature
183
Q

Why are x-rays not used to diagnose DDH

A

Because most of babies bones are cartilaginous

184
Q

Rx for DDH

A

Pavlik Harness

185
Q

Describe Pavlik Harness

A

Where legs are held in flexed abducted position

Adjusted during growth

186
Q

When is surgery indicated for DDH

A

If Dx>6 months
Or
Failure of Pavlik Harness

187
Q

Why is the Left hip more affected in DDH

A

due to the way that babies present down the birth canal

188
Q

What can excessive abduction in Pavlik harness (DDH) lead to

A

AVN

189
Q

What are 2 clinical signs of DDH

A

Ortolani’s Sign

Barlows Sign

190
Q

Red flags for Cauda Equine Syndrome

A

Saddle anaesthesia
Bilateral sciatic
Bowel/urinary dysfunction (incontinence/retention)

191
Q

Rx for Cauda Equina

A

Urgent decompressive surgery

192
Q

What is sciatica

A

Pain from lower back down the back of the thighs

193
Q

What is saddle anaesthesia

A

Loss of sensation of buttocks, perineum ad inner thighs

194
Q

What is caudal equine syndrome

A

Caused by the compression of the caudal equine (horses tail of the spinal cord)

195
Q

Causes of caudal equine syndrome

A 
Central lumbar disc props 
Tumours 
Trauma 
Infection
Iatrogenic (spinal injection/surgery)
196
Q

Where is the clavicle most commonly fractures

A

middle 1/3 (80%)

197
Q

Rx for broke collarbone

A

Sling
Immobilisation
analgesia

198
Q

Complications of clavicle fracture

A

Pneumothorax
Blood vessel injury
Nerve injury

199
Q

What is the most common cause of compartment syndrome

A

Fractures

200
Q

what is the pathology of compartment syndrome

A

Pressure within muscles build dangerous levels
Occluding vascular supply
Leading to hypoxia and eventually necrosis of the tissue

201
Q

1st line/urgent Ix in compartment syndrome

A

Measuring intra-compartment pressure

>30mmHg defined as critical

202
Q

What intra-compartment pressure is considered critical in compartment syndrome

A

> 30mmHg

203
Q

Risk factors for compartment syndrome

A

Trauma
Bleeding Disorder
thermal injury
Intense muscular activity

204
Q

Rx for compartment syndrome

A

Surgical review at Dx
Dressing release
Supportive
PROMPT fasciotomy

Worst case scenario:
Amputation

205
Q

Clinical features of compartment syndrome

A 
Pain 
Muscle tightness
Paralysis 
Pallor 
Pulselessness 
Redness 
Oedema 
Mottling 
Firm wooden feeling on palpation
206
Q

Which carpal fracture is easily missed on X-ray

A

Scaphoid

207
Q

What is a common complication of scaphoid fracture

A

AVN

208
Q

What is osteoporosis

A

Metabolic bone disease characterised by low/reduced bone mass and micro architectural deterioration of bone tissue

Fragile bones

209
Q

What is there an increased risk of in osteoporosis

A

Increased fracture risk

210
Q

Factors that the risk of fracture is related to

A 
Increased age 
Females following menopause (due to decreased oestrogen)
FH 
BMD 
Long term steroid use 
Smoking 
Alcohol
211
Q

Endocrine causes of osteoporosis

A 
Thyrotoxicosis 
hypoparathyroidism 
Cushing's
Hyperprolactinaemia 
Hypopituitarism 
Low sex hormones (hypogonadism)
212
Q

Rheumatic causes of osteoporosis

A

Rheumatoid arthritis
Ankylosing Spondylitis
Polymyalgia Rheumatica
SLE

213
Q

GI causes of osteoporosis

A 
IBD (UC or CD)
Malabsorption syndromes (e.g coeliac)
Chronic active hepatitis 
Alcoholic cirrhosis
Cystic fibrosis 
Chronic pancreatitis 
Whipples disease
214
Q

Medication Causes of Osteoporosis

A 
Steroids!! 
PPI 
Aromatase inhibitors
Heparin 
Warfarin 
Enzyme inducting anti epileptic medications
215
Q

What is the main clinical relevance of Osteoporosis

A

Increased risk of fracture

216
Q

Which assessment tool is used to assess the risk of fractures

A

FRAX assessment tool

217
Q

Clinical features of osteoporosis

A

No specific symptoms

but fractures of bones occur n situations which would not normally cause a break in healthy bones

218
Q

Ix for Osteoporosis

A

FRAX assessment tool (to determine risk of fracture)
X-ray
DEXA scan
Bloods (to rule out underlying causes)

219
Q

Methods of preventing osteoporotic fractures

A

Minimise risk factors

Ensure good calcium and Vitamin D status

Falls prevention strategies

Medications

220
Q

General Rx for osteoporosis

A

Quite smoking
Decreased alcohol
Weight bearing exercises
Calcium and Vitamin D rich diet

221
Q

Medication Rx for Osteoporosis

A 
Biphosphonates (1st line/main Rx)
Denusomab 
Teriparatide (artificial PTH)
Calcium supplements 
Vit. D supplements 
HRT
222
Q

What is Denusomab

A

Monoclonal Antibody

223
Q

What is the action of Denusomab

A

Reduces osteoclastic bone resorption

224
Q

What is Teriparatide

A

Artificial parathyroid hormone

225
Q

Who does HRT help in osteoporosis

A

Post-menopausal women

226
Q

Side effects of HRT

A

Increased risk blood clots

Increased risk breast cancer

227
Q

What is required for the use of bisphosphonates

A

Adequate renal function
Adequate vitamin D and Calcium required

Good dental health and hygiene also advised

228
Q

Side effects of biphosphonatees

A

Oesophagitis
Uveitis
Not safe when eGFR<30mls/min
Atypical femoral fracture

229
Q

Side effects of Denosumab

A

Allergy/rash

Symptomatic hypocalcaeimia when given to vit D deficient

230
Q

Side effects of Teriparatide

A

Injection site allergy
Rarely hypercalcaemia
Allergy

231
Q

what is the first line biphosphonate given

A

Alendronic acid

232
Q

What is Paget’s Disease

A

Localised disease of bone turnover

233
Q

Pathology of Paget’s Disease

A

Increased bone reabsorption followed by increased bone formation
Leads to disorganised/dysregulated bone remodelling

234
Q

Aetiology of Paget’s Disease

A 
Strong genetic component 
Environmental trigger (potentially viral infection?)
235
Q

What is the commonest presentation of Paget’s Disease

A

Asymptomatic increase in serum alkaline phosphatase

236
Q

What can develop rarely in Paget’s disease

A

Osteosarcoma

237
Q

Symptoms of Paget’s Disease

A

Majority asymptomatic

Bone pain 
Bone deformity 
Bone fracture
Excessive heat over Paget's bone 
Other neurological complications (e.g deafness if occurs at ossicles)
238
Q

What complication can arise if Paget’s Disease affects the ossicles

A

Deafness

239
Q

What are the 3 ossicle bones

A

Malleus
Incus
Stapes

240
Q

Ix for Paget’s Disease

A

Serum Alkaline Phosphate
Xray
Pyridinoline (urine)
Bone scan

241
Q

Should you treat asymptomatic Paget’s Disease

A

No
There is no evidence to treat asymptomatic Paget’s disease based on increased alkaline phosphatase alone

Keep an eye on it

242
Q

Supportive Rx for Paget’s

A

NSAIDs
Paracetamol
Physio.
OT

243
Q

Diet Rx for Paget’s

A

Calcium and Vitamin D rich

244
Q

Medication Rx for Paget’s

A

Biphosphonates:
Zoledronic acid (one off injection)
Risedronate
Pamidnate

245
Q

Who is surgery recommended for in Paget’s

A

Fractures
Deformities
Severe OA

246
Q

What is osteogenesis imperfecta

A

Genetic disorder of connective tissue

247
Q

What is osteogenesis imperfect characterised by

A

Fragile and fractured bones from mild trauma and even daily acts of life

248
Q

Main clinical feature of osteogenesis imperfecta

A

Bones that break with little or no force

249
Q

How many different types of osteogenesis imperfect are there?

A

8

250
Q

Which is the most severe type of osteogenesis imperfecta

A

Type II

251
Q

What is the cure for osteogenesis imperfecta

A

No cure

252
Q

Rx for preventing fractures in OI

A

Prevent fractures:
IV Bisphosphonates
Immobilisation

253
Q

Rx for managing fractures in OI

A

Rodding

Surgery

254
Q

Rx for social aspects of OI

A

Education and social adaptations

Physio.

255
Q

Rx for genetic aspect of OI

A

Genetic counselling for parents and next generation

256
Q

Other features of Osteogenesis imperfecta apart from easily fractures bones

A

Growth deficiency

Defective tooth formation (dentigenesis imperfecta)

Hearing loss

Blue sclera

Scoliosis / Barrel Chest

Ligamentous laxity

Easy bruising

257
Q

Ix for OI

A

X-ray
DNA collagen testing
Type II often Dx by USS at pregnancy

258
Q

X-ray features of OI

A

Many fractures!!
Osteoporotic bones with thin cortex
Bowing deformities of long bones

259
Q

What is an important Ddx in OI

A

Potential child abuse

260
Q

What is Osteomalacia

A

Metabolic bone disease characterised by incomplete mineralistion of the underlying mature organic bone matrix (osteoid) following growth plate closure in adults

261
Q

Difference between osteomalacia and Rickets

A

Underlying pathology is the same

Osteomalacia:
Occurs in adults when the epiphyseal plates have closed

Rickets:
Occurs in growing children when the epiphyseal plates are still open

262
Q

Which deficiency causes rickets/osteomalacia

A

Vitamin D

Calcium

263
Q

Ix for Osteomalacia

A 
Serum calcium level 
Serum 25-hydroxyvitamin D levels 
Serum phosphate levels 
Serum urea and creatinine 
Intact PTH
Serum alkaline phosphatase 
24 hr urinary calcium
264
Q

Ix for Rickets

A 
Xray of a long bone 
Serum calcium 
Serum inorganic phosphorus
Serum parathyroid hormone level 
Serum 25-hydroxyvitamin D levels 
Alkaline phosphatase and LFTs
Serum createnine and urea 
Urinary calcium and phosphorus
265
Q

Risk factors for Rickets

A 
Age 6-18 month
Inadequate sunlight exposure 
Breastfeeding 
Calcium defiency 
Phosphate deficiency 
FH 
Malabsorption disease
Asian. African-Carribean
266
Q

Risk factors for osteomalacia

A

Dietary Vitamin D and calcium deficiency
CKD
Limited sunlight exposure
Inherited disorder of Vit D and bone metabolism
FH

267
Q

Clinical features of Rickets

A 
Bone pain 
Muscle weakness 
Stunted growth 
Bone deformities: bowed legs 
Dental issues 
Fracture prone bones
268
Q

Clinical features of osteomalacia

A 
Vitamin D and Calcium deficient diets 
Lack of sunlight exposure 
Fractures 
Malabsorption syndrome 
Diffuse bone pain and tenderness
Proximal muscle weakness
Increased risk of falls
269
Q

Rx for osteomalacia

A

Diet rich in calcium and Vitamin D
Vitamin D and calcium supplements
Vitamin D injection

270
Q

Rx for Rickets

A

Diet rich in calcium and Vitamin D
Vitamin D and calcium supplements
Vitamin D injection

271
Q

What is Femoral anteversion

A

When there is excessive femoral torsion and the femur turns inwards

272
Q

What does femoral anteversion cause

A

Intoeing

273
Q

Ix for femoral anteversion

A

Hx

O/E

274
Q

Rx for femoral anteversion

A

Commonly corrects by itself as child grows

Very rare cases:
Surgery

275
Q

Clinical features of anteversion

A

Intoeing

Sitting in W position

276
Q

Is clubfoot a common or rare birth defect?

A

Common

277
Q

Rx for Clubfoot

A

Ponseti method

278
Q

Describe ponseti method

A

Gentle manipulation of the foot
Then putting into a cast
Repeated weekly for 5-8 weeks

279
Q

Clinical appearance of clubfoot

A

foot turns medially and is inverted

280
Q

Is clubfoot associated with limited space in the womb

A

Yes

281
Q

Describe a negative trendelenburg test

A

Normal for pelvis to rise on the side of the lifted leg

282
Q

Describe a positive trendelenburg test

A

Pelvis falls on the side of the affected leg

283
Q

What is the cause of a positive trendelenburg test

A

Abductor muscle paralsysis

Meaning it cannot pull up the pelvis on the affected side

284
Q

How to perform tredenelnburgs test

A

Place hands on either side of the patients pelvis
Use yourself to support the patient
Ask them to raise one leg
Assess to see if the pelvis dips on the side of the lifted leg

285
Q

What is a chondrosarcoma

A

malignant tumour of cartilage

286
Q

Symptoms of chondrosarcoma

A

Pain (particularly at night)
Mass or swelling

If on axial skeleton:
Sciatica
Bladder symptoms

287
Q

Where does a chondrosarcoma typically affect

A

Most commonly axial skeleton compared to the appendicular skeleton

288
Q

What is the issue with Rx for chondrosarcoma

A

Relatively insensitive to both chemotherapy and radiotherapy

289
Q

Main Rx for chondrosarcoma

A

Surgery

290
Q

What is the commonest joint disease in Europe

A

Knee OA

291
Q

Risk factors for Knee OA

A

F>M
>55yrs (age)
Trauma to knee
FH

292
Q

Strong associations for knee OA

A

obesity/increased BMI
Occupation
Age
Genetics

293
Q

Symptoms of knee OA

A 
Limited ROM 
Crepitus 
Joint deformity 
Bony overgrowths 
Swelling 
Pain on initiating movement 
Stiffness 
Morning stiffness often removes <30 mins
294
Q

Rx for knee OA

A 
NSAIDs
Capsaicin 
Weight loss 
Exercise 
Local steroid injections 
Physio.

Surgery: knee replacement

295
Q

Causes of rib fractures

A

CPR
Direct trauma
Coughing
Metastatic cancer

296
Q

Clinical features of rib fracture

A

Pain worse on respiration

Sometime bruising on skin

297
Q

Ix for rib fractures

A

x-ray

298
Q

Complications of rib fractures

A

Pneumothorax

Pneumonia

299
Q

Rx for rib fractures

A

No specific Rx
Analgesia
Rest
Ice pack

3-8 weeks to heal

300
Q

What can chronic osteomyelitis follow

A

Acute osteomyelitis

301
Q

Describe de novo chronic osteomyelitis

A

Never amounts to an acute infection
Moulders unnoticed then presents
Mild bone infection for yrs
Repeated breakdown of healed wounds

302
Q

Pathology of chronic osteomyelitis

A

Cavities
Dead bone(retained sequestra)
Involucrum
Histological picture of chronic inflammation

303
Q

Ix for chronic osteomyelitis

A 
MRI (Dx)
FBC 
WBC 
ESR 
CRP 
U&amp;E's
x-ray 
CT 
USS 
Blood cultures 
Aspiration 
Isotope bone scan 
Labelled white cell scan 
Bone biopsy
304
Q

De novo causes of chronic osteomyelitis

A

Following operation

Following open fractures

305
Q

Organisms for chronic osteomyelitis

A

Staph. Aureus
E.Coli
Strep. Pyogenes
Proteus

However, commonly more than 1 organism

306
Q

Rx for chronic osteomyelitis

A

Long term abx.
Surgery (surgical debridement)

Amputation not an unlikely scenario

307
Q

Complications of chronic osteomyelitis

A 
Chronically discharging since + flare ups 
Ongoing metastatic infection 
Pathological fracture 
Growth disturbances/deformities 
SCC at discharging site
Recurrence 
Amputation
308
Q

Who is chronic osteomyelitis commonly seen in

A

Adults

309
Q

Who is acute osteomyelitis commonly seen in

A

Children

310
Q

What is a rotator cuff tear

A

Tears in supraspinatus tendon

Or adjacent sub-scapularis and infraspinatus

311
Q

Which is the most commonly affected muscle in rotator cuff tear

A

Supraspinatus

312
Q

What are the 2 broad causes of rotator cuff tear

A

Chronic and cumulative

Acute tear

313
Q

Describe acute rotator cuff tear

A

Trauma in younger patient

314
Q

Describe chronic rotator cuff tear

A

Degeneration condition
Common elderly
Long term overhead activity

315
Q

Which is more common acute or chronic rotator cuff tear

A

Chronic

316
Q

Clinical features of potato cuff tear

A

Shoulder weakness
Shoulder pain
Night pain may affect sleep
Lying on affected shoulder

Acute:
Snapping sensation
Immediate arm weakness
Pain same

317
Q

Ix for rotator cuff tear

A

O/E Clinical
X-ray
USS

MRI but USS is quicker and cheaper

318
Q

non-operative Rx for rotator cuff tear

A

Analgesia: NSAIDs
Steroid injection
Physio.

319
Q

Operative Rx for rotator cuff tear

A

Acute, young and active = early surgery

Chronic = surgery if symptomatic (try non-operative first)

320
Q

What causes painful arc

A

Impingement syndrome

321
Q

What is impingement syndrome

A

When the tendon catches under the acromion during abduction

322
Q

When does impingement syndrome cause pain

A

On shoulder abduction

323
Q

Pathology of impingement syndrome

A

Caused by a pathology which either:
the volume of the Subacromial space (e.g. OA)

Or

The size of the contents (e.g. Tendinopathy, Bursitis)

324
Q

Clinical features of impingement syndrome

A 
Pain 
Painful arch 
Pain during day to day activities 
Weakness 
Decreased ROM 
Pain at night 
Can affect sleep
325
Q

Conservative Rx for impingement syndrome

A 
Rest 
Avoid precipitating activities 
Physio. 
Analgesia 
Ice
Steroid injections
326
Q

What types of pathology can cause impingement syndrome

A

Rotator cuff tendinosis
Subacromial bursitis
Calcific tendinitis
OA shoulder

327
Q

What 2 joints can shoulder osteoarthritis affect

A

Acromioclavicular

Glenohumeral

328
Q

Risk factors for shoulder OA

A

Same as OA
age
Overuse
Shoulder trauma e.g dislocation

329
Q

Clinical features of shoulder OA

A 
Pain 
Crepitus 
Loss or ROM 
Morning stiffness <30 mins 
Worse with activity 
Better with rest 
Tenderness 
Joint swelling
330
Q

Ix for shoulder OA

A

X-ray
Examination
FBC

331
Q

Rx for shoulder OA

A 
NSAIDs
Physio 
Analgesia 
Heat treatment 
Joint replacement/surgery
332
Q

Clinical features of olecranon bursitis

A

Swelling
Redness
Warmth skin
Pain/tenderness

333
Q

What Ix should you carry out if concerned olecranon bursitis is infected

A

Joint aspirate

Send for culture an microscopy

334
Q

Complications of olecranon bursitis

A

Septic bursitis

Abscess formation

335
Q

Which 2 types of bursitis is it very important to differentiate between

A

Aseptic

and Septic

336
Q

Aetiology of olecranon bursitis

A

Trauma
Infection
Gout
RA

337
Q

Rx for septic bursitis

A

Urgent drainage

IV abx

338
Q

Rx for aseptic bursitis

A 
Avoid further trauma
Rest 
ICE 
NSAIDs 
Corticosteroid injections
339
Q

What is spinal stenosis

A

Narrowing of spinal canal which results in compression of the spinal cord and spinal nerves

340
Q

What does spinal stenosis commonly result from

A

Degenerative changes in the lumbar spine

341
Q

Clinical features of spinal stenosis

A

Unilateral or bilateral leg pain +/- back pain
Sciatica
Relieved by sitting forward
Worse on walking
Claudication type pain
Weakness at and below level affected
Numbness at and below level affected (paraesthesia)

342
Q

Risk factors for spinal stenosis

A 
OA/degenerative arthritis
Age 
Manual labour 
FH
Trauma 
Space occupying lesion 
Smoking
343
Q

Ix for spinal stenosis

A

X-ray
MRI

Consider:
CT pyelogram
CT spine
EMG walking test

344
Q

What will x-ray show in spinal stenosis

A

Degenerative changes Overgrowth of the facet joints
Narrowing of the disc spaces
Osteophyte formation.

345
Q

Non-operative management of spinal stenosis

A

Education
Analgesia
Exercise
Physio.

Nerve root injection
Epidural injection

346
Q

Why does leaning/sitting forwards relieve spinal stenosis

A

Increased intervertebral space

347
Q

Other Rx for spinal stenosis

A

Nerve root injection

Epidural steroid injection

348
Q

Red flags for spinal stenosis

A 
Fever
Nocturnal pain 
Weight loss
Previous carcinoma 
Recent trauma 
Neurological deficit 
Bilateral sciatica + Saddle Anaesthesia _ urinary/bowel incontinence
349
Q

What Rx is required in acute spinal stenosis with acute neurological deficit

A

Urgent surgical review and decompression

350
Q

What is cervical spondylosis

A

Specific term for OA of the cervical spine

Musculoskeletal (13 decks)

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