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SBOMs > Musculokeletal > Flashcards

Musculokeletal Flashcards

1
Q

What proportion of the population don’t have musculoskeletal symptoms?

A

42%

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2
Q

What are the leading causes of sickness absence from work?

A

Back, neck and upper limb pain

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3
Q

Name 5 bone diseases

A 
Osteoporosis
Osteomalacia/rickets
Bone malignancy
Paget's disease
Osteomyelitis
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4
Q

Name 5 joint disorders

A 
Osteoarthritis
Inflammatory arthritis
Crystal arthritis
Septic arthritis
Haemarthosis
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5
Q

Name 5 disorders of muscle

A 
Polymyalgia rheumatica
Polymyositis
Dermatomyositis
Pyomyositis (abscesses)
Neurological issues
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6
Q

Name 4 connective tissue disorders

A

SLE
Systemic sclerosis
Sjogren’s syndrome
Vasculitis

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7
Q

What gait to people with severe OA have?

A

Antalgic gait
Weight bears on unaffected side
Decreased swing phase on unaffected side

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8
Q

What are the 4 changes seen on xray in OA?

A

Joint space narrowing
Sclerosis
Subchondral cysts
Osteophytes

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9
Q

Features of OA

A

Morning stiffness50yrs
Bony enlargements/tenderness
Symmetrical, polyarticular

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10
Q

Pathophysiology of OA

A

Ligament damage
-> instability/malalignment
-> increased load and microtrauma
-> remodelling of adjacent bone (osteophytes)
2º synovial inflammation and crystal deposition

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11
Q

Risk factors for OA

A

FH
Obesity
Ligament rupture/fracture through joint/malalignment
Occupation

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12
Q

Assessment in OA

A 
Effects on activities of daily living
(family duties, hobbies, sleep, occupation)
Pain medication, waking at night?
Self help strategies
Beliefs/expectations/mood
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13
Q

Management of OA

A 
Physio, exercise, weight loss
Local heat and cold
Supports, braces, insoles
Paracetamol and topical NSAIDs
Capsaicin, oral NSAIDs, opioids
Intra-articular joint injections
TENS (transcutaneous electrical nerve stimulation)
Joint arthroplasty
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14
Q

What is DEXA?

A

Dual energy xray absorptometry

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15
Q

What is normal with a DEXA scan?

A

T score of more than -1

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16
Q

What DEXA reading counts as osteoporosis?

A

Less than -2.5

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17
Q

Who should have a DEXA scan? (Give 8 indications)

A 
Prior low trauma fracture
Height loss & kyphosis on examination
Vertebral deformity on spine xray
Steroid users
FH of fracture
Early menopause
Heavy smokers/excess alcohol/malabsorption
FRAX score
18
Q

What is FRAX?

A 
Osteoporosis fracture predicting system
Age, DOB, sex, weight, height
Previous fracture?
Parental hip fracture?
Current smoker?
Glucocorticoids?
RA?
2º osteoporosis?
Alcohol>3units per day
Femoral neck BMD
19
Q

What does a FRAX score of 10% in a 80 yr old mean?

A

10 year probability of major osteoporotic fracture is 10%

Not within treatment level (Needs to be >30% in over 80yr olds)

20
Q

Why is HRT not recommended for osteoporosis anymore?

A

Increases risk of CHD, stroke, breast cancer and VTE

21
Q

What is recommended for treatment of osteoporosis?

A 
Raloxifene
Bisphosphonates
Synthetic parathyroid
Dietary calcium, Vit D
Weight bearing exercise
Smoking cessation
Alcohol restriction
22
Q

What are the revision rates for arthroplasty?

A

5% at 7rs

15% at 7yrs is metal on metal

23
Q

How do you engineer tissue?

A

Bone stem cells + inductive agents + conductive scaffold/forces

24
Q

Where can you derive stem cells for bone grafts?

A 
Embryonic
Induced pluripotent
Adult derived skeletal stem cells
Trabecular bone periosteum
Placental/umbilical cord blood
Foetal derived
25
Q

What can bone stem cells form?

A

Cartilage, bone and fat

Dependent on growth factors (BMPs, VEGF)

26
Q

Positives and negatives of allogenic bone grafts

A

Off the shelf
Risk ratio life threatening situations
Reduced manufacturing costs
Process favoured

27
Q

Positives and negatives of autologous bone grafts

A 
No infectious disease risk
Patient specific therapy
High manufacturing costs
Custom variability
Disease/previous therapy issues
28
Q

How has CAD CAM aided bone grafts?

A

3D printed hydroxyapatite scaffolds
Bone stem cells can proliferate
= bone formation
3D printed titanium constructs for hip revisions and osteointegration tailored to individual’s bone

29
Q

What are osteoblasts derived from?

A

Mesenchymal stem cells

30
Q

What are the most abundant cells in bone? Function?

A

Osteocytes
Can perceive changes in mechanical forces and transmit signals to other cells
Central in bone remodelling

31
Q

What are osteoclasts derived from?

A

Macrophage lineage
RANKL receptors lead to differentiation
Osteoprotegrin-> stay as precursor

32
Q

Can osteoclasts work solo?

A

No, they need low pH for solubilisation of minerals and need factors from osteoblasts

33
Q

How does the matrix of bone versus cartilage differ?

A

Bone is heavily mineralised and mainly type 1 collagen

Cartilage is usually non organic and is formed of type II collagen and proteoglycans

34
Q

3 types of bone development

A

Intramembranous, endochondral, appositional

35
Q

Where does intramembranous ossification occur?

A

Flat bones (skull, clavicle)

36
Q

Where does endochondral bone formation occur?

A

In fetus
Hyaline cartilage model of bones -> bone
1º ossification centre in diaphysis & cartilage anlage
Death of chondrocytes in centre-> infiltration of marrow and blood vessels
2º ossification centre at birth

37
Q

Name the zone in a growth plate

A 
Reserve zone
Proliferation zone
Transition zone
Hypertrophic zone
Calcification
38
Q

What causes growth of bones?

A

Proliferation of chondrocytes
Synthesis of cartilage matrix
Chondrocyte hypertrophy

39
Q

What happens with decreased weight bearing activity?

A

Decreased strain sensed by osteocytes
Osteoprogenitors differentiate into osteoclasts
-> bone resorption

40
Q

How often is the adult skeleton completely remodelled?

A

Every 10yrs

41
Q

Why is bone remodelling useful?

A

Allows adaption to mechanical loading
Enables fracture healing
Prevents bone fatigue by constantly renewing matrix

42
Q

Why do you prescribe differently for children?

A 
Decreased body weight
Different body composition
Decreased surface area
Nutritional status
Organ maturation

SBOMs (18 decks)

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