musculoskeletal (non-inflammatory)

Question 1

definition of osteoporosis

Answer 1

a systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

Question 2

risk factors for osteoporosis

Answer 2

age
parental history
untreated menopause
prolonged immobility
BMI <19
rheumatoid arthritis
>4 units alcohol/day
reduced skeletal loading
inflammatory disease
endocrine disease
smoking
previous fracture
medication

Question 3

why does ageing increase risk of osteoporosis?

Answer 3

decrease in trabecular thickness

Question 4

pathology of osteoporosis

Answer 4

loss of trabecular bone, crush fractures of vertebrae, loss of cortical bone (causing long bone fractures)

Question 5

medications that cause osteoporosis

Answer 5

glucocorticoids
aromatase inhibitors
GnRH analogues
androgen deprivation

Question 6

signs of osteoporosis

Answer 6

chronic pain
osteoporotic fractures
radicular pain (due to compression of spinal cord)

Question 7

how many patients die within the first year of having a hip fracture?

Answer 7

20%

Question 8

how do the results of a DEXA scan work for patients with osteoporosis?

Answer 8

they are given a T score, which is the standard deviation compared to average peak bone mass

Question 9

primary causes of osteoporosis

Answer 9

menopause
old age
juvenile idiopathic

Question 10

secondary causes of osteoporosis

Answer 10

drugs
smoking
alcohol

Question 11

treatments of osteoporosis

Answer 11

weight bearing exercise
balance exercise
calcium and vitamin D rich diet
bisphosphonates
HRT
calcitonin
testosterone for men
denosumab (anti-resorptive treatment)

Question 12

how do bisphosphonates work in the treatment of osteoporosis?

Answer 12

stop osteoclasts working

Question 13

how does denusomab work in the treatment of osteoporosis?

Answer 13

stops RANKL from activating osteoclasts so bone is not resorbed
it is a monoclonal antibody

Question 14

what does a T score of less than -2.5 indicate?

Answer 14

osteoporosis

Question 15

what does a T score of -1 indicate?

Answer 15

osteopenia

Question 16

risk factors for mechanical lower back pain

Answer 16

poor posture
repetitive and fast work
heavy manual handling

Question 17

what percentage of people recover from an acute attack of mechanical lower back pain within 6 weeks?

Answer 17

90%

Question 18

risk factors for osteomalacia and rickets

Answer 18

vitamin D deficiency
anticonvulsant therapy
cancer
liver disease

Question 19

what is rickets?

Answer 19

the result of osteomalacia during a period of bone growth

osteomalacia is if it is after fusion of growth plates

Question 20

pathology of osteomalacia/rickets

Answer 20

mineral content of bone low

excess uncalcified osteoid and cartilage

Question 21

signs of osteomalacia/rickets

Answer 21

femoral neck fractures

Question 22

symptoms of osteomalacia/rickets

Answer 22

bone pain and tenderness

Proximal myopathy due to decrease in PO4 and vitamin D deficiency

Question 23

diagnosis of osteomalacia/rickets from plasma

Answer 23

severe calcium depletion
increased phosphate ions
increased ALP (alkaline phosphatase)
decreased vitamin D

Question 24

diagnosis of osteomalacia/rickets from biopsy

Answer 24

incomplete mineralisation

normal muscle

Question 25

diagnosis of osteomalacia/rickets from XR

Answer 25

loss of cortical bone | partial fractures

Question 26

treatment of osteomalacia/rickets

Answer 26

vitamin D | monitor plasma calcium

Question 27

risk factors for vertebral disc degeneration

Answer 27

poor posture repetitive and fast work heavy manual handling

Question 28

symptoms of vertebral disc degeneration

Answer 28

chronic back pain radiating pain tingling sensation in legs/arms pain often worse when sitting

Question 29

XR/MRI features of vertebral disc degeneration

Answer 29

``` black discs disc space narrowing vacuum disc end plate sclerosis osteophyte formation ```

Question 30

features of vertebral disc degeneration on clinical examination

Answer 30

muscular weakness | limitations in motion

Question 31

treatment for vertical disc degeneration

Answer 31

``` physical therapy NSAIDs traction epidural steroid injection surgery ```

Question 32

risk factors for Paget's disease

Answer 32

>40 temperate climate anglo-saxon

Question 33

pathology of Paget's disease

Answer 33

increased osteoblasts and osteoclasts --> extensive turnover --> extensive remodelling --> bony enlargement, deformity, and weakness

Question 34

where does Paget's disease typically affect?

Answer 34

axial skeleton | lumbar spine

Question 35

symptoms of Paget's disease

Answer 35

asymptomatic in 70% deep boring pain bony deformity enlargement

Question 36

complications of Paget's diesase

Answer 36

spine pathological fractures osteoarthritis increased risk of osteosarcoma

Question 37

XR signs of Paget's disease

Answer 37

``` localised bone enlargement patchy cortical thickening sclerosis osteolysis deformity ```

Question 38

blood test results for Paget's disease

Answer 38

calcium and phosphate normal | ALP (alkaline phosphatase) raised

Question 39

treatment of Paget's disease

Answer 39

analgesia | alendronic acid