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Nick's MD1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is the benefit of doing an x-ray early on in osteomyelitis?

A

Rules out fracture and malignancy

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1
Q

Which cells produce osteoid?

A

Osteoblasts

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1
Q

What stimulates PTH release?

A

Low Ca2+

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1
Q

Which bone cells does PTH act on directly to increase calcium?

A

Osteoblasts

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1
Q

What are the 3 organs that PTH acts on to increase calcium levels?

A

Bone, kidney and GIT

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1
Q

What type of collagen is in hyaline cartilage?

A

Type 2

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1
Q

Where are the 3 places that elastic cartilage is present?

A

Ear, epiglottis and thyroid cartilage

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1
Q

What are osteocalcin and alkaline phosphatase both markers of?

A

Osteoblast activity

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1
Q

What are the little tubes that provide nutrients to osteocytes?

A

Canaliculae

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1
Q

What is a displaced fracture?

A

Edges of fracture are not apposed

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1
Q

What causes a stress fracture?

A

Repeated low force injury to a normal bone

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1
Q

What are the 4 stages of fracture healing?

A

Inflammatory Reparative - Soft callus Reparative - Hard callus Remodelling

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1
Q

What are the 2 major processes during the remodelling phase of fracture healing?

A

Osteoblasts and osteoclasts repopulate the bone Woven bone is remodelled to give lamellar bone

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1
Q

Over what time frame does the hard callus phase of fracture healing occur?

A

Weeks to months

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1
Q

Over what time frame does the remodelling phase of fracture healing occur?

A

Months to years

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1
Q

What kind of fracture is most susceptible to infection?

A

Compound fracture

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1
Q

What is the definition of osteoporosis?

A

Bone mass >2.5 SDs below the mean for healthy young women

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1
Q

What is the definition of osteopaenia?

A

Bone mass 1-2.5 SDs below the mean for healthy young women

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1
Q

What is the main concern with long term bisphosphonate treatment?

A

Oesophageal cancer

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1
Q

What are the 2 main risks of long term oestrogen therapy for bone health?

A

Cardiovascular disease and breast cancer

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1
Q

Is sarcopenia inevitable?

A

Yes

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2
Q

What effect does VitD have in the gut?

A

Increases absorption of Ca and PO4 (phosphate)

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4
Q

What are the 2 major processes during the hard callus phase of fracture healing?

A

Osteoblasts synthesise osteoid Osteoid becomes mineralised

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5
Q

What class of hormone is VitD?

A

Steroid

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5
Q

At what age does muscle mass start to deteriorate?

A

50 years old

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6
Q

What is the most common form of calcium phosphate in bone?

A

Hydroxyapatite

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8
Q

What is the difference between the actions of PTH and VitD3 in the distal nephron?

A

PTH causes phosphate excretion, whereas VitD3 promotes phosphate reabsorption

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9
Q

What word means progressive loss of skeletal muscle mass with aging?

A

Sarcopenia

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10
Q

What is the motor uni?

A

An alpha motor neurone and all muscle fibres it supplies

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11
Q

Which protein is abnormal in Becker muscular dystrophy?

A

Dystrophin

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13
Q

What are osteocalcin and osteonectin?

A

Calcium binding proteins in the ECM of bone

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15
Q

Which bone cells produce collagen for cartilage?

A

Chondrocytes

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16
Q

What is the second common pathogen in osteomyelitis?

A

Strep pyogenes / Group A strep

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16
Q

Which pathogen is more common for osteomyelitis after a sneaker penetration injury?

A

Pseudomonas aeruginosa

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17
Q

What protein is a marker of muscle damage?

A

Creatine kinase

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19
Q

What causes progressive stiffening of muscle fibres with age?

A

Loss of elastin

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21
Q

Which gene can be knocked out in mice to cause massive muscles?

A

Myostatin

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22
Q

Define sarcopenia

A

Progressive loss of skeletal muscle mass and strength or performance with aging

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23
Q

In which 2 structures is fibrocartilage found?

A

Menisci and intervertebral discs

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23
Q

What percentage of muscle mass must be lost before there is the risk of mortality?

A

40%

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24
Q

How does denosumab treat osteoporosis?

A

It is a human monoclonal antibody that binds RANKL and iblocks RANK activity => reduces osteoclast activity

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25
Q

What type of collagen is in fibrocartilage?

A

Type 1

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25
Q

What is a compound fracture?

A

Open fracture, ie bone exposed to external world

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25
Q

What are the 2 major processes during the inflammatory phase of fracture healing?

A

Haematoma and granulation tissue

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26
Q

What are the 2 layers of the periosteum?

A

Inner cellular layer with osteoprogenitor cells Outer fibrous layer

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27
Q

Which bone cells are multinucleate?

A

Osteoclasts

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29
Q

In what direction do osteoclasts dig their holes in bone?

A

Along the stress axis of the bone

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30
Q

What are osteons aka?

A

Haversian systems

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31
Q

What is at the end of a bone? (-physis)

A

Epiphysis

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32
Q

What are the main types of muscle atrophy?

A

Disuse atrophy

Denervation atrophy

Cachexia

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33
Q

What is a comminuted fracture?

A

Fracture with more than 2 bits of bone

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34
Q

What percentage of cases of osteomyelitis occur in children <5 years old?

A

50%

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35
Q

Over what time frame does the soft callus phase of fracture healing occur?

A

Days to weeks

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37
Q

What is osteomyelitis better known as?

A

Bone infection

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39
Q

What is the proper way to say ‘bone infection’?

A

Osteomyelitis

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41
Q

Which bones are most commonly involved in osteomyelitis?

A

Long bones: femur, tibia, humerus

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43
Q

What is a pathological fracture?

A

Fracture where underlying bone pathology has made it more vulnerable to fracture

45
Q

How do tendons and ligaments attach to bone?

A

Sharpey’s fibres

46
Q

What is raloxifene?

A

Selective oestrogen receptor modulator

47
Q

What are bisphosphonates used to treat?

A

Osteoporosis

48
Q

In which 3 locations is red bone marrow found in adults?

A

Skull, scapula and pelvis

50
Q

Which protein is abnormal in Duchenne muscular dystrophy?

A

Dystrophin

51
Q

What is the scaffolding for bone that is laid down by osteoblasts?

A

Osteoid

52
Q

What do we call infection of a joint?

A

Septic arthritis

53
Q

What percentage of the body’s calcium is in bone?

A

99%

53
Q

What effect does oestrogen have on bone?

A

Maintains bone density by promoting osteoclast apoptosis and increasing life span of osteoblasts and osteocytes

55
Q

Which cells resorb bone?

A

Osteoclasts

56
Q

How is most calcium lost from the body?

A

Urine

58
Q

What is the main complication with a compound fracture?

A

Infection

60
Q

Which cells are osteoblasts modified from?

A

Fibroblasts

61
Q

What is a greenstick fracture?

A

Only one side of cortical bone is broken

62
Q

How do bisphosphonates work?

A

They are an analogue of pyrophosphate thus taken up into bone matrix Taken up by osteoclasts, causing apoptosis

63
Q

What do osteoclasts secrete?

A

HCl and proteases

65
Q

What effect does PTH have on [Ca2+] in plasma?

A

Increases it

67
Q

How long do most lower limb fractures take to heal?

A

12-16 weeks

68
Q

What can be done to attenuate sarcopenia?

A

Strength training

68
Q

Decreases in which 3 hormones are thought to be related to sarcopenia?

A

Growth hormone, IGF-1 and testosterone

69
Q

What do osteoblasts turn into when they are less active?

A

Osteocytes

70
Q

What is the name of the process by which long bones grow in length?

A

Endochondral ossification

72
Q

What effect does PTH have on plasma [phosphate]?

A

Decreases

74
Q

What is another name for cortical bone?

A

Compact bone

76
Q

Which cells build bone?

A

Osteoblasts

78
Q

Which two conditions are especially common in travellers to Asia?

A

Dengue fever and typhoid fever

79
Q

Which cells are responsible for ongoing maintenance of cartilage?

A

Chondrocytes

80
Q

What is calcitriol?

A

VitD3

81
Q

How long do most upper limb fractures take to heal?

A

6-8 weeks

82
Q

What is a complete fracture?

A

A bone is broken all the way through

84
Q

What is the most common pathogen in osteomyelitis?

A

Staph aureus

85
Q

How does PTH increase VitD levels?

A

PTH activates the kidney enzyme to hydroxylate/activate VitD3

87
Q

What are 4 synonyms for the inner bit of a bone?

A

Medullary; cancellous; trabecular; spongy

89
Q

Which NSAID should not be given for gout?

A

Aspirin

90
Q

What does PTH cause osteoblasts to do?

A

Release OPG and RANK ligand to activate osteoclasts

91
Q

What is Gower’s sign?

A

Muscle weakness causes difficulty getting of floor, so Pt uses accessory muscles such as arms to help themselves get up

92
Q

What is a sarcolemma?

A

Cell membrane of skeletal muscle

94
Q

Where do osteoprogenitor cells usually reside?

A

Periosteum or endosteum

95
Q

What type of muscle is more susceptible to sarcopenia?

A

Fast fatiguable

96
Q

What is the goal of management of a fracture?

A

Unite the ends of the fractured bone

97
Q

Over what time frame does the inflammatory phase of fracture healing occur?

A

Days

98
Q

What is the antibiotic of choice for osteomyelitis?

A

Flucloxacillin

99
Q

What are the 2 major processes during the soft callus phase of fracture healing?

A

Progenitor cells turn into chondrocytes Chondrocytes form cartilage

100
Q

What is the role of dystrohpin?

A

It i links actin in the cytoskeleton to laminin via glycoproteins

101
Q

What is at the middle of a bone? (-physis)

A

Diaphysis

102
Q

What type of cell is in hyaline cartilage?

A

Chondrocyte

103
Q

Name 4 things found inside a Haversian canal

A

Capillary, nerve, supportive connective tissue and lymphatic

104
Q

For joint pathology, what will be the consequence of fibrillation and sloughing of articular cartilage?

A

Loss of joint space

105
Q

For joint pathology, what will be the consequence of calcification of periarticular cartilage and synovium?

A

Osteophytes

106
Q

For joint pathology, what will be the consequence of synovial fluid entering bone?

A

Subchondral cysts

107
Q

For joint pathology, what will be the consequence of thickening of subchondral bone and trabeculae?

A

Subchondral sclerosis

108
Q

What are the 4 main components of hyaline cartilage?

A

Type 2 collagen

Glycoaminoglycans

Chondrocytes

Water

109
Q

What type of blood vessels are present in hyaline cartilage?

A

None

110
Q

What type of nerves are present in hyaline cartilage?

A

None

111
Q

How is hyaline cartilage nurished?

A

Perfusion by compression and decompression of the cartilage

112
Q

What is added to plasma filtrate in the formation of synovial fluid?

A

Hyaluronic acid

113
Q

What are the two types of cell in synovium?

A

Type A cells (macrophage-like)

Type B cells (fibroblast-like)

114
Q

Give a 4 word definition of the pathophysiology of osteoarthritis

A

Chronic degeneration of cartilage

115
Q

Which disease is characterized by degeneration of cartilage that results in structural and functional failure of synovial joints?

A

Osteoarthritis

116
Q

How would you explain osteoarthritis to a lay person in 5 words?

A

Wear and tear of joints

117
Q

At what time of day is pain from osteoarthritis worse?

A

At the end of the day

118
Q

Pain at the end of the day suggests what type of arthritis?

A

Osteoarthritis

119
Q

Which joints tend to be most affected by osteoarthritis?

A

Weight-bearing joints

120
Q

At what time of day does pain from rheumatoid arthritis tend to be worst?

A

In the morning

121
Q

Morning stiffness of joints suggests what type of arthritis?

A

Rheumatoid arthritis

122
Q

Which disease is characterised by autoimmune inflammatory joint disease with systemic involvement?

A

Rheumatoid arthritis

123
Q

What is podagra?

A

Gout in the great toe

124
Q

What do we call gout in the big toe?

A

Podagra

125
Q

Define gout

A

Very painful

acute inflammation

due to accumulation of uric acid crystals

in a joint

126
Q

In which part of bone would you find osteons?

A

Cortical bone

127
Q

What are 3 signs of osteoarthritis?

A

Reduced ROM

Crepitus

Osteophytes

128
Q

What are 3 microscopic pathological features of rheumatoid arthritis?

A

Mononuclear infiltrate

Synovial hyerplasia forming pannus

Germinal centres

129
Q

List 3 signs of rheumatoid arthritis

A

Inflamed joints

Rheumatoid nodules

Destruction and deformity of joints

130
Q

Which joints of the hand are often spared in rheumatoid arthritis?

A

Distal interphalangeal joint

131
Q

What diagnosis should you consider when someone presents with swollen joints, nodules and deformed joints?

A

Rheumatoid arthritis

132
Q

What is the prevalence of rheumatoid arthritis?

A

1% of the population

133
Q

List 3 x-ray features of rheumatoid arthritis

A

Juxta-articular osteopaenia

Subchondral erosions

Uniform joint space loss

134
Q

What percentage of rheumatoid arthritis is genetic?

A

50%

135
Q

List 3 risk factors for rheumatoid arthritis

A

Female gender

Age 25-55

Smoking

136
Q

Accumulation of what causes gout?

A

Uric acid crystals

137
Q

What are tophi?

A

Uric acid crystal depositions in soft tissues other than joints

138
Q

What is the cardinal sign of gout?

A

Acutely inflamed, intensely painful joint

139
Q

What type of inflammation is caused by tophi?

A

Granulomatous inflammation

140
Q

What is the gold standard diagnostic test for gout?

A

Joint or tophus aspiration during an acute attack

Nick's MD1 (28 decks)

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