MSK Red Flashcards
What is osteomalacia?
- poor bone mineralisation leads to soft bones
- lack of Ca2+ in adults
What is rickets?
inadequate mineralisation of the bone and epiphyseal cartilage in growing skeleton of children
Pathophysiology of osteomalacia/rickets
- Ca2+ deficiency
- usually due to vitD deficiency
Presentation of osteomalacia
- widespread bone pain and tenderness → dull ache, worse on weight bearing
- fractures → NOF
- muscle weakness → waddling gait, difficulty with stairs
- gradual onset, persistent fatigue
Presentation of rickets
- knock-kneed, bow-legged
- tender swollen joints
- growth retardation
- bone and joint pain
- dental deformities
- enlargement of end of ribs → rachitic rosary
Diagnosis of osteomalacia/rickets
- xray → loss of cortical bone → defective mineralisation
- bloods → low Ca2+ and phosphate
- bone biopsies → incomplete mineralisation
Management of osteomalacia/rickets
vitamin D supplements
- rapid mineralisation of bone
- resolution of symptoms
- malabsorption → IM calcitrol
- renal disease → alfacalcidol
What is Paget’s disease?
disorder of bone turnover
Pathophysiology of Paget’s disease
- excessive bone turnover (formation and resorption)
- due to excessive osteoblast and osteoclast activity
- leads to patchy areas os high density (sclerosis) and low density (lysis)
- enlarged and misshapen bones → risk of fracture
Presentation of Paget’s disease
- bone pain
- bone deformity
- fractures
- hearing loss → if bones of ear affected
Investigations for Paget’s disease
xray
- bone enlargement and deformity
- osteoporosis circumscripta → well defined osteolytic lesions
- cotton wool appearance of skull → poorly defined areas of sclerosis and lysis
- v-shaped defects in long bones
bloods
- raised ALP
- normal Ca2+ and phosphate
Management of Paget’s disease
- bisphosphonates
- NSAIDs for bone pain
- Ca2+ and vitD supplements
Complications of Paget’s disease
- osteosarcoma
- spinal stenosis and cord compression
Causes of osteomalacia
- malnutrition
- drug induced
- defective 1-alpha hydroxylation
- liver disease
What is the most common type of back pain?
mechanical
Differential diagnoses for back pain
- congenital
- iatrogenic
- infection → osteomyelitis
- trauma → fracture
- malignancy → multiple myeloma, metastases
- lifestyle → posture/overuse
- inflammatoin
What types of inflammation can cause back pain
- HLA B27
- osteoporosis
- osteoarthritis
- pyelonephritis
What are the red flags for lower back pain
- cauda equina syndrome
- cancer of the spine
- spinal fracture → trauma/osteoporotic collapse
- spinal infection
Investigations for back pain
bloods
- inflammatory markers
- FBC → anaemia, WBC
- ALP levels
imaging
- DEXA scan
- MRI
Treatment for mechanical back pain
- analgesia ladder
- lifestyle advice
- physiotherapy
What is the analgesia ladder?
- PCM
- NSAIDs
- weak opiates
- strong opiates
- neuropathic pain treatment → gabapentin/tricyclic
Pathophysiology of granulomatosis with polyangiitis
- small vessel vasculitis
- affects respiratory tracts and kidney
- common in late teenage years/early adulthood
Presentation of granulomatosis with polyangiitis
- saddle-shaped nose
- epistaxis
- crusty nasal/ear secretions → hearing loss
- sinusitis
- cough, wheeze, haemoptysis
Investigations for granulomatosis with polyangiitis
- high eosinophils
- histology → granulomas
- presence of c-ANCA
Management of granulomatosis with polyangiitis
- nasal corticosteroid
- cyclophosphamide
complications of granulomatosis → glomerulonephritis
Pathophysiology of Marfan syndrome
- autosomal dominant
- affects gene involved in creating fibrillin
Presentation of Marfan syndrome
- tall stature
- long limbs
- long fingers
- hypermobility
- high arch palate
- pectus carinatum
Investigations for Marfan syndrome
- physical exam
- Ghent criteria
Management of Marfan syndrome
- avoid intense exercise/caffeine
- beta blockers/ARBs
- annual echo
Complications of Marfan sybdrome
- mitral/aortic valve prolapse with regurgitation
- aortic aneurysms
- lens dislocations
Pathophysiology of Ehlers-Danlos syndrome
- group of inherited connective tissue disorders
- faulty collagen
- varied presentation
Presentation of Ehlers-Danlos
- joint hypermobility
- easily stretched skin
- easy bruising
- chronic joint pain
- reoccurring dislocations
Investigations for Ehlers-Danlos
Beighton score → assesses hypermobility
Management of Ehlers-Danlos
- physiotherapy
- OT
- psychological support → chronic condition, pain
Complications of Ehlers-Danlos
- hernias
- prolapse
- aortic root dilation
- joint pain
- abnormal wound healing
