MSK Red

Question 1

What is osteomalacia?

Answer 1

• poor bone mineralisation leads to soft bones
• lack of Ca2+ in adults

Question 2

What is rickets?

Answer 2

inadequate mineralisation of the bone and epiphyseal cartilage in growing skeleton of children

Question 3

Pathophysiology of osteomalacia/rickets

Answer 3

• Ca2+ deficiency
• usually due to vitD deficiency

Question 4

Presentation of osteomalacia

Answer 4

• widespread bone pain and tenderness → dull ache, worse on weight bearing
• fractures → NOF
• muscle weakness → waddling gait, difficulty with stairs
• gradual onset, persistent fatigue

Question 5

Presentation of rickets

Answer 5

• knock-kneed, bow-legged
• tender swollen joints
• growth retardation
• bone and joint pain
• dental deformities
• enlargement of end of ribs → rachitic rosary

Question 6

Diagnosis of osteomalacia/rickets

Answer 6

• xray → loss of cortical bone → defective mineralisation
• bloods → low Ca2+ and phosphate
• bone biopsies → incomplete mineralisation

Question 7

Management of osteomalacia/rickets

Answer 7

vitamin D supplements

• rapid mineralisation of bone
• resolution of symptoms
• malabsorption → IM calcitrol
• renal disease → alfacalcidol

Question 8

What is Paget’s disease?

Answer 8

disorder of bone turnover

Question 9

Pathophysiology of Paget’s disease

Answer 9

• 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

Question 10

Presentation of Paget’s disease

Answer 10

• bone pain
• bone deformity
• fractures
• hearing loss → if bones of ear affected

Question 11

Investigations for Paget’s disease

Answer 11

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

Question 12

Management of Paget’s disease

Answer 12

• bisphosphonates
• NSAIDs for bone pain
• Ca2+ and vitD supplements

Question 13

Complications of Paget’s disease

Answer 13

• osteosarcoma
• spinal stenosis and cord compression

Question 14

Causes of osteomalacia

Answer 14

• malnutrition
• drug induced
• defective 1-alpha hydroxylation
• liver disease

Question 15

What is the most common type of back pain?

Answer 15

mechanical

Question 16

Differential diagnoses for back pain

Answer 16

• congenital
• iatrogenic
• infection → osteomyelitis
• trauma → fracture
• malignancy → multiple myeloma, metastases
• lifestyle → posture/overuse
• inflammatoin

Question 17

What types of inflammation can cause back pain

Answer 17

• HLA B27
• osteoporosis
• osteoarthritis
• pyelonephritis

Question 18

What are the red flags for lower back pain

Answer 18

• cauda equina syndrome
• cancer of the spine
• spinal fracture → trauma/osteoporotic collapse
• spinal infection

Question 19

Investigations for back pain

Answer 19

bloods

• inflammatory markers
• FBC → anaemia, WBC
• ALP levels

imaging

• DEXA scan
• MRI

Question 20

Treatment for mechanical back pain

Answer 20

• analgesia ladder
• lifestyle advice
• physiotherapy

Question 21

What is the analgesia ladder?

Answer 21

1. PCM
2. NSAIDs
3. weak opiates
4. strong opiates
5. neuropathic pain treatment → gabapentin/tricyclic

Question 22

Pathophysiology of granulomatosis with polyangiitis

Answer 22

• small vessel vasculitis
• affects respiratory tracts and kidney
• common in late teenage years/early adulthood

Question 23

Presentation of granulomatosis with polyangiitis

Answer 23

• saddle-shaped nose
• epistaxis
• crusty nasal/ear secretions → hearing loss
• sinusitis
• cough, wheeze, haemoptysis

Question 24

Investigations for granulomatosis with polyangiitis

Answer 24

• high eosinophils
• histology → granulomas
• presence of c-ANCA

Question 25

Management of granulomatosis with polyangiitis

Answer 25

• nasal corticosteroid
• cyclophosphamide

complications of granulomatosis → glomerulonephritis

Question 26

Pathophysiology of Marfan syndrome

Answer 26

• autosomal dominant
• affects gene involved in creating fibrillin

Question 27

Presentation of Marfan syndrome

Answer 27

• tall stature
• long limbs
• long fingers
• hypermobility
• high arch palate
• pectus carinatum

Question 28

Investigations for Marfan syndrome

Answer 28

• physical exam
• Ghent criteria

Question 29

Management of Marfan syndrome

Answer 29

• avoid intense exercise/caffeine
• beta blockers/ARBs
• annual echo

Question 30

Complications of Marfan sybdrome

Answer 30

• mitral/aortic valve prolapse with regurgitation
• aortic aneurysms
• lens dislocations

Question 31

Pathophysiology of Ehlers-Danlos syndrome

Answer 31

• group of inherited connective tissue disorders
• faulty collagen
• varied presentation

Question 32

Presentation of Ehlers-Danlos

Answer 32

• joint hypermobility
• easily stretched skin
• easy bruising
• chronic joint pain
• reoccurring dislocations

Question 33

Investigations for Ehlers-Danlos

Answer 33

Beighton score → assesses hypermobility

Question 34

Management of Ehlers-Danlos

Answer 34

• physiotherapy
• OT
• psychological support → chronic condition, pain

Question 35

Complications of Ehlers-Danlos

Answer 35

• hernias
• prolapse
• aortic root dilation
• joint pain
• abnormal wound healing