Non-Neoplastic Bone Disease

Question 1

Describe the epidemiology,aetiology,clinical features, investigations and management[NPR] of gout and pseudogout. Identify the joints affect for them.(212)

Answer 1

Gout:

Affects any joint, but the great toe is affcet in 90% of cases

• Usually limited to lower extremities
• Precipitate of needle shaped crystals into the joint
• Tophus is the pathogenic lesion (this is pathognomonic of gout)

Pseudogout:

Usually age > 50 years

• Crystal of:

o Calcium pyrophosphate- mainly affects the knees

o Calcium phosphates (hydroxyapatite)- affecting knees and shoulders

• The crystals are more rhomboid shaped and positively birefringent

Question 2

Describe fracture aetiology(212)

Answer 2

An impacted fracture occurs when the broken ends of the bone are jammed together by the force of the injury.A closed fracture is when the bone breaks but there is no puncture or open wound in the skin. An open fracture is one in which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection.A greenstick fracture in which the bone is bent, but not broken all the way through.A comminuted fracture is when the bone breaks into several pieces

Question 3

Discuss osteomyelitis aetiology ,presentation and investigation outcomesNPR

Answer 3

Question 4

Discuss osteoarthritis aetiology and clinical featuresNPR

Answer 4

Question 5

Discuss rheumatoid arthritis aetiology and clinical featuresNPR

Answer 5

Pannus formation with exuberant inflamed synovium overlying the articular surface

• There may also be a particular type of multi-nucleate giant cell called Grimley-

Sokoloff cells (look similar to Langerhans-type giant cells but don’t have the same horseshoe shaped nucleus)