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SBOMS > Musculoskeletal disorders? > Flashcards

Musculoskeletal disorders? Flashcards

1
Q

What is antalgic gait?

A

a limp with weight bearing on the unaffected side, decreased swing phase of unaffected limb

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2
Q

Radiographic features of arthritis?

A

Joint space narrowing
Subchondral cysts
Osteophytes
Sclerosis

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3
Q

Clinical features of osteoarthritis?

A

Morning stiffness

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4
Q

Who does OA affect commonly?

A

Women

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5
Q

Management of OA?

A

Line 1: Education advice, weight loss support, strengthening exercises

Line 2: Paracetamol, topical NSAIDS

Line 3: Oral NSAIDs, opioids, capsaicin, injections, arthroplasty, supports/assisting devices

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6
Q

What is a T score?

A

Measurement of bone mineral density

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7
Q

T score in osteoporosis and osteopaenia?

A

T score of -1.0 to -2.5 - osteopaenia

T score of less than -2.5 - osteoporosis

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8
Q

What is osteopenia?

A

Slightly reduced bone mineral density

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9
Q

In what situations should you give a DEXA scan?

A
  • Low trauma (osteoporotic) #
  • Height loss/kyphotic
  • Vertebral deformity on X ray
  • FHx of #
  • Steroid use
  • Early menopause
  • Low BMI
  • Heavy smoker/excess alcohol/ malabsorption
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10
Q

Treatment choices for osteoporosis? Examples?

A

SERMs (Selective Estrogen Receptor Modulator) e.g. raloxifene

Bisphosphonates e.g. alendronate

Teriparatide is a synthetic parathyroid hormone

Denosumab

HRT

Exercise

Calcitonin

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11
Q

Mode of action of SERMs and Bisphosphonates?

A

SERMs - inhibit bone resorption by stimulating oestrogen receptor in bone

Bisphosphonates - bind to hydroxyapetite and inhibit osteoclast bone resorption

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12
Q

Risks associated with bisphosphonates?

A

Oesophageal ulcers

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13
Q

Risks associated with SERMs?

A

Risk of VTE

Worsen peri-menopausal vasomotor symptoms

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14
Q

When would you use a SERM?

A

Healthy post menopausal women worried about breast cancer, with vertebral osteoporosis (not effective in hip)

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15
Q

Teriparatide mode of action?

A

synthetic parathyroid hormone - increases formation more than it increases bone resorption.

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16
Q

Denosumab mode of action?

A

Inhibits formation of osteoclasts.

17
Q

When would you use Teriparatide?

A

Steroid induced osteoporosis

18
Q

Basic process of bone formation?

A

Bones initially appear as flat layers of CT

Mesenchymal stem cells in the CT differentiate to form osteoblasts

Bone matrix builds up to form trabeculae

Trapped osteoblasts become osteocytes

19
Q

Basic process of cartilage formation?

A

Development of primary ossification centre at diaphysis

Marrow cavity formed by death of chondrocytes within bony collar

Longitudinal bone growth formed by chondrocyte hypertrophy at growth plate

20
Q

Why does bone remodelling occur?

A

Adaptation to mechanical loading

Enabling fracture healing

Prevents “bone fatigue” by continually renewing matrix

21
Q

Patho-physiology of arthritis?

A

Focal destruction of articular cartilage

Remodelling of adjacent bone = hypertrophic reaction at joint margins (osteophytes)

Remodelling and repair process (efficient but slow)

22
Q

R/F for osteoarthritis?

A

Family history (genetics)

Obesity

Ligament rupture
Fracture through joint
Malalignment

Occupational factors

23
Q

OA treatments?

A

Exercise

Capsaicin

NSAIDS

Opioids

Joint steroid injection

Replacement

TENS machine

24
Q

What is an autologous bone graft, and a allogenic bone graft?

A

Specific bone graft with the patients human stem cells - autologous

Off the shelf made from an animals stem cells - allogenic

25
Q

Advantages and disadvantages to an autologous bone transplant graft over allogenic?

A

No infectious disease risk

Patient specific therapy

High mfg. cost

26
Q

Main differences in bone and cartilage?

A

Inorganic matrix in bone is heavy mineralised, in cartilage it is only mineralised in the growth plate

Bone is 90% collagen 4% proteoglycans, cartilage is 50% collagen and 50% proteoglycans

Cartilage is avascular and bone is vascular

Bone undergoes appositional growth and cartilage interstitial

27
Q

Two types of bone formation?

A

Intramembranous - on top of a membrane

Endochondral - on top of cartilage

28
Q

R/Fs for osteoporosis?

A

Age

Female

FH

Asian/caucasian

Cigarettes/Alcohol

SBOMS (18 decks)

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