Musculoskeletal CORETEX Flashcards
What is the cause of an enchondroma?
Failure of normal enchondral ossification at the growthplate
How may simple bone cysts present?
Asymptomatic incidental finding on xray.
Pathological fracture
What is treatment for a simple and aneurysmal bone cyst?
Curettage
Bone grafting
Stabilisation may be required
What is thought to be the cause of aneurysmal bone tumours?
Small arteriovenus malformation
What is the microscopic appearance of giant cell tumour of bone?
Multi-nucleate giant cells
What is the treatment for giant cell tumous of the lung?
Intralesional excision
Destruction of remaining bone tumour with phenol, bone cement or liquid nitrogen.
Joint replacement may be required
What is the treatment for giant cell tumous of the lung?
Intralesional excision
Destruction of remaining bone tumour with phenol, bone cement or liquid nitrogen.
Joint replacement may be required
What is the appearance of fibrous dysplasia?
Angular deformities
The affected bone is wider with thinned cortices
Shepherd’s crook deformity
What is the treatment for fibrous dysplasia?
BISPHOSPHONATES - may reduce pain
What are signs of malignant primary bone tumours on x-ray?
Cortical destruction
Periosteal reaction - raised periosteum producing bone
New bone formation
Exstention into the surrounding soft tissue envelope
What is the most common method of spread of osteosarcoma?
Haematogenous
What is osteosarcoma?
Malignant tumour producing bone
What is chondrosarcoma?
Cartilage producing primary bone tumour
What is the most common location for chondrosarcoma?
Pelvis and proximal femur
What are fibrosarcoma and malignant fibrous histiocytoma?
Fibrous malignant primary bone tumours that tend to occur in abnormal bone.
What is ewings sarcoma?
A malignant tumour of primative cells in the marrow
What are the main signs of ewings sarcoma?
Fever
Raised inflammatory markers
Warm swelling
What is lymphoma?
A cancer of round cells of the lymphyocytic system/macrophages
What is myeloma?
A malignant B cell proliferation that arises from the marrow
What is a lipoma?
A neoplastic proliferation of fat
What is the most common location of a lipoma?
Subcutaneous fat
however this may occur in the muscle
What can lead to the formation of a Ganglion Cyst?
herniation or out‐pouching of a weak portion of joint capsule or tendon sheath.
What are the features of a ganglion cyst?
well‐defined, may be quite firm and readily transilluminate.
What is a bursa?
A small fluid filled sac lined by synovium
What leads to bursitis?
Repeated pressure or trauma
Bacterial infection
What can lead to abscess formation?
Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cyst
What is avascular necrosis?
An ischaemic necrosis of bone predominantly in adults
What can lead to avascular necrosis?
Fracture Idiopathic Alcoholism Steroid use/abuse Thrombophilia Sickle Cell disease Antiphospholipid deficiency Cassions disease
How do alcoholism and steroid use lead to avascular necrosis?
Alter fat metabolism which can result in mobilisation of fat into the circulation which can sludge up the capillary system and promote coagulability
What is cassions disease?
Decompression sickness - Nitrogen gas bubble form in the circulation after too rapid a depressurisation after deep sea diving
What are the characteristics of osteoporosis?
Reduced bone mineral density
Increased porosity
What are the two types of osteoporosis?
Type 1 - Post-menopausal Osteoporosis
Type 2 - Osteoporosis of old age
What are the risk factors for osteoporosis?
Chronic Disease
Inactivity
Reduced sunlight exposure
Fracture
What is osteomalacia?
A qualitative defect of bone with abnormal softening of the bone due to deficient mineralisation of osteoid (immature bone) secondary to inadequate amounta of calcium and phosphorus
What are the principle causes of osteomalacia and rickett’s?
Insufficient calcium absorption from the intestine due to lack of dietary calcium or resistance to the action of vitamin D.
Increased renal phosphate loss
What are the symptoms of osteomalacia and rickett’s?
Bone pain
Deformities of the soft bone
Pathological fracture
Hypocalcaemia
What is hyperparathyroidism?
Involves overactivity of the parathyroid glands with high levels of parathyroid hormone.
What is a seropositive condition?
Auto-antibodies are present in the serum
What are autoantibodies?
antibodies generated by the immune system against the body’s own proteins, usually within cells.
What are some of the risk factors for osteoarthritis?
Joints with an abnormal allignment
Previous injuries
Strenuous work
What are the four broad groups of inflammatory arthropathies?
Seropositive
Seronegative
Infections
Crystal Deposition Disorders
What is a cause of many inflammatory arthropathies?
Auto-immune mediated conditions
What is the mainstay of treatment for inflammatory arthropathies?
Simple analgesia
Anti-inflammatories - Steroids; NSAIDs
Steroid Injections
Disease modifying anti rheumatic drugs
What are some triggers for RA?
Smoking
Infection
Trauma
What is ankylosing spondylitis?
A chronic inflammatory disease of the spine and sacroiliac joints which can lead to fusion of the intervertebral joints and SI joints
What is gout?
A crystal arthropathy caused by deposition of urate crystals within a joint
What is the cause of gout?
High serum uric acid levels
What are features of gout?
Red, painful hot swollen joint - may mimic septic arthritis
Gouty tophi
How is gout diagnosed?
Analysis of synovial fluid - negatively biofringent needle shaped crystals
What is the treatment for acute gout?
NSAIDs
Corticosteroids
Opioid Analgesics
Colchicine
What is the treatment for chronic gout?
Allopurinol - urate lowering therapy
What is pseudogout?
A crystal arthropathy that leads to acute arthritis caused by calcium pyrophosphate crystals
What does chondrocalcinosis mean?
When calcium pyrophosphate deposition occurs in cartilage and other soft tissues in the absence of acute inflammation
Where are the typical locations for pseudogout?
Knee
Wrist
Ankle
