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Clinical scenarios by CBL > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What are the differential diagnoses for a stiff neck?

A

-Muscular Strain
-Cervical Spondylosis/ Arthritis
-Herniated Disc
-Meningitis
-Torticollis

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2
Q

What is the presentation of a neck muscle strain?

A
  • Pain and stiffness in the neck and shoulders - Limited range of motion - Tenderness when touched - Gradual onset
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3
Q

What are the risk factors for Muscle strain?

A

-Overexertion - Poor posture - Muscle imbalances - Repetitive motion - Injury

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4
Q

What is the pathophysiology of a neck muscle strain?

A

Overstretching or tearing of neck muscles

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5
Q

What is the treatment for a severe muscle strain?

A

Analgesia (Aspirin, Ibuprofen, Naproxen)
+Ice pack

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6
Q

What is the presentation for Cervical Spondylosis?

A
  • Stiffness - Pain, especially with movement - Numbness or tingling in the arms or hands - Weakness in the arms
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7
Q

What are the risk factors for Cervical Spondylosis?

A
  • Aging - Genetics - Past neck injuries - Smoking - Sedentary lifestyle
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8
Q

What is duration onset of symptoms for Cervical Spondylosis?

A

Insidious onset with symptoms gradually worsening over time

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9
Q

What is the pathophysiology for Cervical Spondylosis?

A

Degeneration of the spinal discs and joints from ageing or just repetative movements.

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10
Q

What is are the investigations for suspected Cervical Spondylosis?

A

Imaging - Xray, CT,
Electromyography

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11
Q

What is a common complication of Cervical Spondylitis or a Herniated Disc of the neck?

A

Cervical Radiculopathy
-nerve compression

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12
Q

What age is Cervical Radiuculopathy most prevalent in?

A

50s

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13
Q

What are Radicular symptoms?

A

-Burning / stinging pain
-Radiation of pain to leg
-Numbness and tingling
-Muscle weakness (severe cases)

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14
Q

A patient with a history of Cervical Spondylitis has presented with new symptoms of numbness and burning pain radiating down the leg. What could this be?

A

Cervical Radiculopathy
(description of radicular symptoms with the fact that it can be caused by cervical spondylitis, and herniated disc)

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15
Q

What is the presentation of Herniated Disc?

A
  • Neck pain - Radiating pain into the arms or shoulders - Numbness or tingling in the arms or hands - Weakness
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16
Q

What are the risk factors of a Herniated Disk?

A
  • Aging - Genetics - Past neck injuries - Heavy lifting - Repetitive motion
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17
Q

What is the duration of onset for a Herniated Disk?

A

Sudden or Gradual

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18
Q

What is the pathophysiology of a Herniated Disk?

A

Rupture of the intervertebral disc

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19
Q

What is the treatment for a Herniated Disk?

A

-Conservative ( rest, therapy, analgesia etc )
-Epidural Injections
-Surgery in severe cases

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20
Q

What is the presentation of Meningitis?

A
  • Severe neck pain - Stiff neck - High fever - Headache - Nausea - Vomiting - Photophobia (sensitivity to light)
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21
Q

What are the risk factors for Meningitis?

A
  • Weakened immune system - Close contact with infected individuals
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22
Q

What is the onset duration of Meningitis?

A

Sudden

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23
Q

What is the pathophysiology?

A

Inflammation of the meninges (protective membranes of the brain and spinal cord)

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24
Q

What investigations are required for suspected Meningitis?

A

-Lumbar puncture (CSF fluid analysis)
-Blood tests
-CT and MRI

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25
Q

What is the management for Meningitis?

A

–>Hospitilisation
-Ceftriaxone (antibiotic)

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26
Q

What is another name for Cervical Spondylosis?

A

Cervical Arthritis

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27
Q

What is the presentation of Rheumatoid Arthritis?

A

-Joint pain and stiffness, typically affecting multiple joints, often in a symmetrical pattern.
-Swelling, redness, and warmth in the affected joints.
Morning stiffness lasting for more than 30 minutes.
Fatigue and general malaise.
Loss of joint function and deformities over time.
Rheumatoid nodules, subcutaneous lumps, often near affected joints.
Systemic symptoms such as fever, weight loss, and dry eyes and mouth in some cases.

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28
Q

What are the risk factors for Rheumatoid Arthritis?

A

-Genetic factors: Individuals with a family history of RA are at higher risk.
-Gender: Women are more susceptible to RA than men.
-Age: Although RA can develop at any age, it most commonly starts between the ages of 30 and 60.
-Environmental factors: -Smoking and exposure to certain infections can increase the risk.

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29
Q

What is the onset duration for Rheumatoid Arthritis?

A

Variable, but it typically develops insidiously and progresses gradually.

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30
Q

Describe the pathophysiology of Rheumatoid Arthritis.

A

Autoimmune condition causing an attack of the synovial membrane resulting in inflammation and:
-formation of abnormal tissue that invades joint structures
-Cartilage, bone and ligament destruction

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31
Q

What substances(hormones, factors etc) particular would you expect to be present in a patient with Rheumatoid Arthritis?

A

-Rheumatoid Factor
-Anti-Cyclic Citrullinated Peptide (anti-CCP)

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32
Q

What investigations are to be done for a suspected Rheumatoid Arthritis and what results would you expcet?

A

-Blood tests
=Rheumatoid factor, anti-CCP, antibodies ESR and CRP

-Imaging : e.g Xray / MRI

-Synovial fluid analysis
=inflammatory changes in joint fluid

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33
Q

What is ESR an indicator for?

A

Inflammation

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34
Q

What is the treatment for Rheumatoid Arthritis?

A

1.Methotrexate
(Disease-modifying antirheumatic drug to slow down progression)

2.NSAIDs

3.Corticosteroids

4.Tumour Necrosis Factor (TNF) Inhibitors (reduce inflammation)

5.Supportive (physical therapy, lifestyle modifications)

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35
Q

What is the presentation of Ankylosing Spondylitis?

A

Paint- LadyBirds Humming Keane Songs, Every Fun Friday
-Pain:
-Lower Back pain and stiffness (early - in the morning)
-Peripheral joint involvement (pain and swelling other joints e.g Hips, Knees and Shoulders)
-Enthesitis (inflammation of the attachment between tendons and ligaments - pain in heel / bottom of foot)
-Fatigue
-Reduced spinal Flexibility (bending / twisting)

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36
Q

What is Enthesitis?

A

Inflammation where tendons and ligaments attach to bones, causing pain and swelling in areas such as the heels or the bottom of the foot.

Note: Can be due to Ankylosing Spondylitis

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37
Q

What gene is strongly associated with the development of Ankylosing Spondylitis?

A

HLA-B27

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38
Q

When does Ankylosing Spondylitis typically present?

A

Late adolescence / Early adulthood

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39
Q

What group of people are more likely to get Ankylosing Spondylitis?

A

Males

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40
Q

What joints are primarily affected in Ankylosing Spondylitis?

A

Spine and Sacroiliac joints

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41
Q

What is the pathophysiology Ankylosing Spondylitis?

A

-Idiopathic cause but strong susceptibility linked to HLA-B27 gene
-Chronic inflammatory disorder
-causing inflammation of the sacroiliac joints
-which leads to the formation of new bone (Syndesmophytes)
-and ultimately the fusion of adjacent vertebrae in the spine.

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42
Q

What are the key investigations to be done for suspected Ankylosing Spondylitis?

A

-Imaging (Xray, CT, MRI)
-Bloods
=presence of gene (HLA-B27) and inflammatory markers (ESR and CRP)
-Genetic testing
HLA-B27

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43
Q

What is the management for Ankylosing Spondylitis?

A

-NSAIDs (first line for pain and inflammation)
-Sulfasalazine (disease-modifying antirheumatic drug)
-TNF inhibitor (to reduce inflammation)

Note: SIMILAR treatment to RHEUMATOID ARTHRITIS

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44
Q

What is the pathophysiology of Fibromyalgia?

A

Idiopathic, causing CENTRAL SENSITISATION DISORDER
-due to abnormal processing of pain signals from the CNS and therefore there is AMPLIFICATION OF PAIN PERCEPTION

=dysregulation of seretonin and norepinephrine

-stress and trauma can trigger it (both physical and mental)

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45
Q

What is the diagnostic gold standard for Fibromyalgia?

A

There isn’t one! It is a diagnosis of exclusion and therefore there is no clinical criteria for diagnosing.

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46
Q

What is the presentation of Fibromyalgia?

A

-Widespread MSK pain
(=constant full ache that affects both sides of the body and present for at least 3mnths)

-Tender joints (when force applied)

-Fatigue

-Sleep disturbances

-Cognitive Symptoms (‘Fibro Fog’ - difficulty with concentration, memory and cognitive function)

-Other symptoms:
-Headaches
-IBS
Irritable bladder
-Anxiety
-Depression

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47
Q

When is the typical age and gender of onset for Fibromyalgia?

A

Middle age, Female

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48
Q

List the risk factors for Fibromyalgia?

A

-Family history of Fibromyalgia
-Other rheumatic conditions (e.g Rheumatoid Arthritis, Lupus)

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49
Q

Describe the duration time of onset for Fibromyalgia?

A

Insidious gradually worsening symptoms

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50
Q

What is the treatment for Fibromyalgia?

A

Pain:
=Analgesics, NSAIDs, Opioids

Depression:
=Anti-depressants - Serotonin Norepinephrine Reuptake Inhibitors (e.g Duloxetine, Milnacipran and Venlafaxine)

Sleep:
=Anti-convulsants (e.g Pregabalin and Gabapentin)

Therapies–>
-Physical
-CBT
-Supportive

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51
Q
A
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52
Q

Who is more likely to be affected by Rheumatoid Arthritis?

A

Women

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53
Q

What is another name for Herniated disc?

A

-Slipped Disc or Prolapsed Intervertebral Disc

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54
Q

What are the common symptoms of a slipped disc?

A

-Pain at site (usually back or neck) and aggravated by movement
-Nerve compression
=Numbness, Tingling, Weakness in ARMS AND LEGS
-Reduced or absent reflexes in affected areas

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55
Q

When would a slipped disc cause sciatica?

A

If it is a lumbar disc

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56
Q

What is a Vertebral Compression Fracture?

A

Vertebral collapse due osteoporosis
=Weakened vertebrae cannot withstand the weight and result in a collapse which causes pain and deformity

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57
Q

What is the presentation of Vertebral Compression Fracture?

A

Bulky Loads Kill Health
-Back pain (sudden or gradual)
-Limited mobility
-Kyphosis (abnormal curvature of the spine)
-Height loss

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58
Q

What group of peope are most susceptible to Vertebral Compression Fractures?

A

Women particularly after menopause

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59
Q

What medications could potentially cause weakening of bones and therefore lead to complications such as Osteoporosis?

A

-PPIs
-SSRIs (sertraline)
-Glitazones (Type 2 diabetic medication e.g Pioglitazone)
-Anti-convulsants
-Glucocorticoids (e.g Prednisolone)
-Antiepileptic medications (e.g Phenytoin, Carbamazepine)

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60
Q

What is the difference between Fibromyalgia and Polymyalgia?

A

1.Polymyalgia is an inflammation of the muscles, while fibromyalgia is due to the central nervous system incorrectly processing sensory information.

2.Fibromyalgia can occur at ANY age while Polymyalgia mainly occurs after 50yrs.

3.Polymyalgia usually resolves within 2 yrs while Fibromyalgia lasts a lifetime

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61
Q

What pre-existing medical conditions can increase the risk of Osteoporosis?

A

-Rheumatoid Arthritis
-Hyperthyroidism

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62
Q

What investigations can identify Oesteoporosis?

A

-Xrays
=vertebral fractures (if Vertebral collapse as a result)
-DXA scan (measure bone mineral density)
=which would be low

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63
Q

What is Psoriatic Arthropathy?

A

Inflammatory arthritis associated with Psoriasis.

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64
Q

Describe the presentation of Psoriatic Arthropathy.

A

-Joint pain, swelling and stiffness (worse in the mornings)
–>affects fingers and toes especially
-Psoriasis (red and scaly skin)
-Enthesitis
-Dactylitis
-Thickening of nails
-Back pain (can develop spondylitis)
-Uveitis (rare)

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65
Q

What are the risk factors of Psoriatic Arthropathy?

A

-Psoriasis
-Family history
-HLA-B27 gene(autoimmune gene marker - specifically for Ankylosing Spondylitis)

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66
Q

When is the typical onset of Psoriatic Arthropathy?

A

30-50yrs

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67
Q

What investigations are required for diagnosing Psoriatic Arthropathy?

A

Bloods :
Inflammation:
-ESR and CRP
-Autoantibodies

  • Imaging : Xray , MRI
    -Joint Aspiration (synovial fluid) to rule out other differentials
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68
Q

What is the management for Psoriatic Arthropathy

A

-NSAIDs
-Methotrexate, Sulfasalazine, Leflunomide (slow progression)
-TNF inhibitors
-Rheumatology and Dermatology referral

Note: Similar to Rheumatoid arthritis

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69
Q

What is a key complication of Psoriatic Arthropathy?

A

Spondylosis
a painful condition of the spine resulting from the degeneration of the intervertebral discs.

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70
Q

What is Dactylitis?

A

Swelling of an entire digit (fingers or toes)

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71
Q

What is Uveitis?

A

Eye inflammation

72
Q

What is Viral Polyarthritis and how does it come about?

A

Type of arthritis as a result of the body’s immune response to a viral infection leading to inflammation in the synovium (attacks healthy joint tissues causing swelling and pain).

Common viruses to cause this:
-Epstein Baar
-Hep B and C
-Zika
-Parvovirus

73
Q

What is the onset duration of Viral Polyarthritis

A

ACUTE occurring shortly after viral infection has taken hold

74
Q

Describe the presentation of Viral Polyarthritis.

A

-Join pain and stiffness, and sometimes swelling
-Pyrexia (fever)
-General malaise
-SKin rashes
-Conjunctivitis (red eyes)
-Redness and warmth (hot joint)

75
Q

What are the investigations for Viral Polyarthritis?

A

-Bloods
=Viral serology, CRP, ESR
-Synovial fluid analysis
=joint aspiration

76
Q

What is the treatment for Viral Polyarthritis?

A

-Antiviral medications
-Pain relief
-Corticosteroids

77
Q

What are the potential triggers of exacerbation of osteoarthritis?

A

-injury
-overexertion
-changes in weather
-stress
-development of another medical condition

78
Q

What is Traumatic Synovitis?

A

Inflammation of the synovial lining due to trauma / injury causing congestion of blood resulting in pain and swelling.

79
Q

What is the presentation Traumatic Synovitis?

A

-Joint pain, stiffness, swelling
-Redness and Warmth (hot joint)
-Bruising (severe cases)

80
Q

What is the duration/ onset of Traumatic Synovitis?

A

Shortly after injury / trauma to joint

81
Q

What is the management for Traumatic Synovitis?

A

Usually just basic stuff but in severe cases:
+Corticosteroid injections
+Aspiration

82
Q

What is the management for Acute gout / pseudogout attacks?

A

-NSAIDs
-Colchicine
-Corticosteroids

83
Q

What is the management for chronic gout?

A

Urate lowering medications - XOIs
=Allopurinol and febuxostat

84
Q

What joint is most affected by gout and which one for pseudogout?

A

Gout : Big toe
Pseudogout: Knee

85
Q

What causes Pseudogout?

A

Accumulation of Calcium Pyrophosphate Crystals in joint tissues

86
Q

What causes Gout?

A

High levels of uric acid in the blood (Hyperuricaemia) which causes the accumulation of urate crystals

87
Q

What is Chondromalacia patellae?

A

Softening and degenerating of cartilage of the patella (KNEE) causing an increased pressure on the knee during movement.

88
Q

What is the presentation of Chondromalacia patellae?

A

-Knee pain (dull, aching pain around or behind the kneecap) that may worsen with activity
-Crepitus
-Instability (feels the knee is giving way)
-Swelling and stiffness

89
Q

What are the risk factors of Chondromalacia patellae?

A

-Repetitive stress
-Weakness in thigh muscles
-Previous knee injury

90
Q

When is the typical age of onset for Chondromalacia patellae?

A

Young adults

91
Q

What is the onset duration for Chondromalacia patellae?

A

Gradual with worsening symptoms over time.

92
Q

What investigations are to be done for a suspect Chondromalacia patellae?

A

Imaging

93
Q

What is the management for Chondromalacia patellae?

A

-Supportive usual stuff
+Corticosteroid injections for temporary relief in flare ups
+Over the counter pain relief

94
Q

What is Traumatic Haemarthrosis?

A

Results from a sports injury causing damage to blood vessels within the joint capsule

-which leads to the bleeding of blood into the joint space.

95
Q

What investigations are to be done for suspect Traumatic Haemarthrosis?

A

Imaging = blood within joint

96
Q

What is the presentation for Traumatic Haemarthrosis?

A

-Joint swelling, pain and stiffness in affected joint
-Decreased function of joint
-Bruising
-Warmth and redness (hot joint)

97
Q

What is the treatment for Traumatic Haemarthrosis?

A

Supportive usual stuff
+Corticosteroids and joint aspiration in severe cases

98
Q

What is Plantar Fasciitis?

A

Common condition due to repetative microtrauma of the plantar fascia (thick band of tissue from heel bone to toes) leading to inflammation and degeneration of the tissue.

99
Q

What are the symptoms for Plantar Fasciitis?

A

-Heel pain (severe in the morning or after periods of inactivity and while walking)
-Stiffness and swelling)

100
Q

When is the typical age onset for Plantar Fasciitis?

A

40-60yrs

101
Q

What is the treatment for when there is no response to usual conservative therapy Plantar Fasciitis?

A

Extracorporeal Shock Wave Therapy

102
Q

What medical conditions can increase the risk of Plantar Fasciitis?

A

-Obestity
-Rheumatoid arthritis-
-Ankylosing spondylitis
-SLE (lupus)
-Spondyloarthritis
-Diabetes (neuropathy)
-HyPOthyroidism
-Cushing’s syndrome

103
Q

What is Osteomalacia?

A

Softening and weakening of bones due to vit d deficiency

104
Q

What is the presentation of Osteomalacia?

A

-Diffuse bone pain (dull and aching)
-Muscle weakness
-Fractures
-Stiffness and difficulty walking

105
Q

What medications can cause an increase risk of Osteomalacia?

A

-Heparin
-Warafin
-Cyclosporine
-Glucocorticoids
-Thyroid hormone

106
Q

What medication can be protective against Osteomalacia?

A

Thiazide diuretics

107
Q

What are the risk factors for Osteomalacia?

A

-Vit d deficiency
-Malabsorption disorders (Coeliac, IBD)
-Medications (heparin and warafin)
-Chronic Kidney Disease

108
Q

What is the duration onset of Osteomalacia?

A

Over months to years with symptoms being insidious.

109
Q

What investigations are to be done for a suspect Osteomalacia?

A

1.Bloods
-Vit D
-Calcium
-Phosphate
-Alkaline Phosphatase (bone turnover indicator)
2.Xrays and DEXA
-Fractures
-Bone density

110
Q

What results would you expect from investigations from an Osteomalacia patient?

A

Bloods:
-Low 25-Hydroxyvitamin D
-Low Serum calcium
-Low or normal phosphate levels
-Elevated Alkaline Phosphatase (sometimes)

Imaging:
-Pseudofractures (sometimes)
-Reduced bone density

111
Q

What is the management for Osteromalacia?

A

Supplements (Vit D, Calcium), Dietary changes

112
Q

What is Costochondritis?

A

Idiopathic, characterised by inflamation of the costal cartilages causing chest pain/ abdominal pain and tenderness

113
Q

What idiopathic bone disorder could present as a chest or abdominal issue?

A

Costochondritis!

Remember patient from placement

114
Q

What is the presentation of Costochonditis?

A

-Chest pain (sharp, stabbing or aching varying in intensity)
-Tender
-Radiation of pain to BACK, SHOULDERS OR ARMS

115
Q

What symptom of Costochondritis could indicate complications and what would those be?

A

-Radiation of pain (to back, shoulder, arms)

=Cardiac / Respiratory conditions

116
Q

Who is least likely to present with Costchondritis?

A

Children

117
Q

What is the duration onset of Costochondritis?

A

Sudden onset with chest pain appearing unexpectedly.

118
Q

What investigations are done into suspected Costochondritis and what would the results be?

A

Imaging
=NORMAL

119
Q

What is the management for Costochondritis?

A

Basic:
-NSAIDS
-Hot and cold therapy

120
Q

What is another name for Paget’s Disease?

A

Osteitis deformans

121
Q

What is Paget’s Disease?

A

Idiopathic although seems to have a genetic link
-causing abnormal bone remodelling due to overactivity of osteoblasts and Osteoclasts (the cells responsible for remodelling)
-the abnormal structural formation means the BONES are WEAKER

122
Q

What investigations are done for a suspect Paget’s Disease and what would the results be?

A

Blood:
-Elevated Alkaline Phosphatase levels
-Abnormal calcium and phosphate levels

Imaging :
-Areas of Increased bone density (sclerosis)
-Enlarged and deformed bones

123
Q

What is the management for Paget’s Disease?

A

-Bisphosphonate Medications - to slow bone turnover (e.g Alendronate and Risedronate)
-Calcitonin (reduce bone reabsorption)
-over the counter pain relief

124
Q

When does Paget’s Disease usually present?

A

Over 50yrs

125
Q

What is the presentation of Paget’s Disease?

A

-Can be ASYMPTOMATIC
-Pain (in affected areas)
-Fractures
-Deformities (e.g bowing, enlarged skull, spinal shape changes
-Neurological symptoms (due to pressure on the nerves of the spine)
-Hearing loss (if the skull is involved)

126
Q

What is Epicondylitis?

A

Inflammation of the elbow due to repetitive stress injury (e.g golfer’s elbow)

127
Q

What results would you expect from an Xray from a patient with Epicondylitis?

A

NORMAL
-Unless : complications
=Calcification or Bone Spurs present

128
Q

What is the treatment for Epicondylitis?

A

-Basic pain relief stuff and support
-Corticosteroid injections
-Extracorporeal Shock Wave Therapy
-Platelet Rich Plasma therapy (promote tissue healing)

129
Q

What is Subacromial bursitis?

A

Due to Repetitive overhead movement / direct trauma, inflammation of the sac (bursa) of synovial fluid cushioning the rotator cuff tendons

130
Q

What is the presentation of Subacromial bursitis?

A

-Shoulder pain (and with arm movements)
-Tenderness
-Weakness

131
Q

What would an Xray show for a patient with Subacromial bursitis?

A

Inflammation and fluid accumulation in the subacromial bursa

132
Q

What is the management for Subacromial bursitis?

A

-Basic, supportive
-Corticosteroid injections
-Ultrasound-guided aspiration (drain excess fluid to relieve pain and pressure)

133
Q

What other illnesses can be confused with Coccydynia and how would you differentiate them?

A

-Anorectal Conditions such as anal fistulas or haemorroids
(character of pain - this is more of a stinging pain, and the past medical history and clinical exam)

-Pelvic Floor Dysfunction
(would be associated with altered muscle function)

-Neuropathic pain
(may feel pain in other places as well)

134
Q

What is the presentation of Coccydnia?

A

-Pain around the coccyx (sharp, throbbing or constant dull ache)
-Tenderness of coccyx
-Pain with activities (e.g intercourse, standing from sitting, moving bowels)

135
Q

What is Cauda Equina and how does it present?

A

SURGICAL EMERGENCY where the nerve roots at the bottom of the spine are compressed causing:

-Lower motor neurone signs (reduced tone and reflexes)
-Reduced sensation to lower limbs
-urinary retention
-sciatica
-motor weakness
-reduced anal tone

136
Q

What are the causes of Cauda Equina?

A

-Herniated disc (the most common cause)
-Tumours, particularly metastasis
-Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
-Abscess (infection)
-Trauma

137
Q

Apart from surgery what is the management for Cauda Equina?

A

-High dose DEXAMETHASONE

138
Q

What medication can cause Achilles Tendinopathy and RUPTURE within 48hrs of starting treatment?

A

Fluoroquinolone antibiotics
e.g Ciprofloxacin and Levofloxacin
-used for pneumonia, sinusitis, UTIs etc

139
Q

What is Osteomyelitis?

A

Inflammation in bone and bone marrow usually caused by a BACTERIAL INFECTION

140
Q

What is the most common cause of Osteomyelitis?

A

Staphylococcus aureus

141
Q

Is Osteomyelitis acute or chronic?

A

Can be either!

142
Q

List the risk factors for Osteomyelitis.

A

Open fractures
Orthopaedic operations, particularly with prosthetic joints
Diabetes, particularly with diabetic foot ulcers
Peripheral arterial disease
IV drug use
Immunosuppression

143
Q

What is the presentation of Osteomyelitis?

A

Non-specific symptoms:
Fever
Pain and tenderness
Erythema
Swelling
-Lethargy
-Nausea
-Muscle aches

144
Q

What is the best imaging diagnostic for Osteomyelitis?

A

MRI

145
Q

What Xray changes would you expect in Osteomyelitis later in the disease (as no changes may be seen early in the disease)?

A

Periosteal reaction (changes to the surface of the bone)
Localised osteopenia (thinning of the bone)
Destruction of areas of the bone

146
Q

What is the management for Osteomyelitis?

A

-Surgical debridement

-Antibiotics (prolonged course)
=6 weeks of Flucloxacillin (with Rifampicin or Fusidic acid added for first 2 weeks)

147
Q

What is Osteopetrosis?

A

Also known as Marble Bone Disease, is a rare disorder of defective osteoclast function resulting in failure of normal bone reabsorption causing dense, thick bones that are prone to fracture.

148
Q

What is the genetic mode of inheritance for Osteopetrosis?

A

1.Adult onset: Autosomal dominant
2.Infantile and Intermediate: Autosomal Recessive

149
Q

What is the prognosis for Osteopetrosis?

A

Poor for infantile and intermediate types but Good for adult onset.

150
Q

What is the general presentation of Osteopetrosis?

A

-Fracture easily
-Nasal stuffiness
-Head manifestations = deafness, proptosis and hydrocephalus
-Pancytopenia
-Anaemia, easily bruising and bleeding
-Sleep apnea
-Retinal degeneration

151
Q

What investigations are required for diagnosing Osteopetrosis and what is the key diagnostic tool?

A

-Radiology
-Serum : Calcium, phosphorus, creatinite, 25-Hydroxy vit D, PTH,
-MRI of brain (checking for cranial nerve involvement, hydrocephalus)

152
Q

What are the histologic findings of Osteopetrosis?

A

-Islands of calcified cartilage within mature bone (from what has not been reabsorpbed)
-woven bone

153
Q

What is the treatment for Osteopetrosis?

A

-Calcium and Ergocalciferol / Cholecalciferol
-Red blood cell transfusion (for anaemia)
-Interferon gamma (increase recovery and decrease bone mass)

154
Q

What is Langerhans Cell Histiocytosis?

A

Rare Multi-system disease and it is a proliferative condition of the dendritic cells in the skin. The disease involves the formation of multiple granulomas throughout the body. It typically presents in childhood with bony lesions.

155
Q

What is the presentation and key clinical findings of Langerhans Cell Histiocytosis?

A

-Bone pain, typically in the skull or proximal femur
-Cutaneous nodules
-Recurrent otitis media/mastoiditis
-Tennis racket-shaped Birbeck granules on electromicroscoy

156
Q

In blood results, what is the key differentiator between Paget’s and Osteopetrosis?

A

Isolated increase in ALP indicated Paget’s.

157
Q

Name a common examples of Bisphosphonates.

A

Alendronate (Alendronic acid), Aisedronate

ending - ronate

158
Q

What are the clinical uses of Bisphosphonates?

A

Inhibit osteoclast activity (so for over active osteoclasts):

-Osteoporosis (prevention and treatment)
-Hypercalcaemia
-Paget’s Disease
-Pain from bone metastases

159
Q

What is the treatment for Osteoporosis?

A

Bisphosphonates
e.g Risedronate

160
Q

What are the contraindications of Bisphosphonates?

A

-Dysphagia / Oesophageal issues
-Chronic Kidney Disease
-Pregnancy / Breastfeeding

161
Q

What is the second line treatment for Osteoporosis?

A

-Raloxifene (selective-oestrogen receptor modulator since oestrogen protects bones)
-Denosumab (monoclonal antibody inhibiting bone reabsorption)

162
Q

What commonly prescribed medication prescribed with Methotrexate can cause problems and why?

A

Aspirin
=it interferes with clearance of Methotrexate causing

BONE MARROW TOXICITY

163
Q

What advice must be given to a patient that is about to be put on Alendronic Acid?

A

=Bisphosphonates
(can cause oesophageal problems such as heart burn)

TAKE 30MIN BEFORE EATING, WHILE STANDING UP STRAIGHT

164
Q

What are the Xray findings for Rheumatoid Arthritis?

A

-Soft tissue swelling
-Subchondral sclerosis
-Narrowing of joint space

165
Q

What are the Xray findings for Osteoarthritis?

A

-Subchondral sclerosis
-OSTEOPHYTES
-Narrowed Joint space

166
Q

A patient’s Xray shows normal joint space with some mild soft tissue swelling. What could this indicate?

A

Early sign of rheumatoid arthritis before there is a narrowing of joint space

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Clinical scenarios by CBL (8 decks)

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