Non-neoplastic Bone Disease Flashcards
Define Gout:
a rheumatic disease resulting from deposition of uric acid crystals ( monosodium urate) in tissues and fluids within the body.
Define pseudogout:
a form of arthritis characterized by sudden, painful swelling in one or more of your joints.
What is the main difference between gout and pseudogout?
Pseudogout is caused by calcium pyrophosphate dihydrate (CPPD) crystals, and gout is caused by sodium urate crystals.
Who is affected by gout?
Middle aged men]
Who is affected by pseudogout?
> 50 years
Which joints are commonly affected in Gout?
Big toe - MTP (podagra)
Lower extremities e.g. kneeBig toe - MTP (podagra)
Lower extremities e.g. kneeBig toe - MTP (podagra)
Lower extremities e.g. knee
Which joints are commonly affected in pseudoGout?
Knee
ShoulderKnee
ShoulderKnee
Shoulder
What can cause gout?
Increased dietary purine intake (dairy + protein)
ETOH
Diuretics
inherited metabolic abnormalitiesIncreased dietary purine intake (dairy + protein)
ETOH
Diuretics
inherited metabolic abnormalitiesIncreased dietary purine intake (dairy + protein)
ETOH
Diuretics
inherited metabolic abnormalities
What can cause pseduogout?
Idiopathic HyperPTH DM Hypothyroid WilsonsIdiopathic HyperPTH DM Hypothyroid WilsonsIdiopathic HyperPTH DM Hypothyroid Wilsons
Clinical features of pseudogout?
Hot swollen joint with effusion
Clincial features of gout?
Swollen
red
Exquisitely painful joint
Tophus (s/c deposits of urate) is the pathognomonic lesion e.g. on pinna and handsSwollen
red
Exquisitely painful joint
Tophus (s/c deposits of urate) is the pathognomonic lesion e.g. on pinna and handsSwollen
red
Exquisitely painful joint
Tophus (s/c deposits of urate) is the pathognomonic lesion e.g. on pinna and hands
Describe and name the crystal in gout?
Urate crystals
Needle shapeUrate crystals
Needle shapeUrate crystals
Needle shape
Describe and name the crystal in pseudogout?
Calcium pyrophosphate crystals
Rhomboid shapedCalcium pyrophosphate crystals
Rhomboid shapedCalcium pyrophosphate crystals
Rhomboid shaped
What investigations diagnose gout?
Negatively birefringent crystals
What investigations diagnose pseudogout?
Positively birefringent (P for positive and pseudo)Positively birefringent (P for positive and pseudo)Positively birefringent (P for positive and pseudo)
What is the management of acute gout?
Colchicine
What is the management of long term gout?
Allopurinol
Conservative: lower ETOH and purine intake e.g. sardines and liverAllopurinol
Conservative: lower ETOH and purine intake e.g. sardines and liver
What is the management of pseudogout?
NSAIDs or intra-articular steroids
What are the 5 different types of fracture?
Simple Compound Greenstick Comminuted ImpactedSimple Compound Greenstick Comminuted Impacted
What is the healing process of a fracture?
1) Organisation of haematoma (pro-callus)
2) Formation of fibrocartilaginous callus
3) Mineralisation of fibrocartilaginous callus
4) Remodelling of bone along weight bearing lines1) Organisation of haematoma (pro-callus)
2) Formation of fibrocartilaginous callus
3) Mineralisation of fibrocartilaginous callus
4) Remodelling of bone along weight bearing lines
What can influence how a fracture heals?
Fracture type Metabolic disorder Drugs Vitamin deficiency InfectionFracture type Metabolic disorder Drugs Vitamin deficiency Infection
Define osteoarthritis
degeneration of joint cartilage and the underlying bone, most common from middle age onward. It causes pain and stiffness, especially in the hip, knee, and thumb joints.
Which joints may you see Heberdens nodes and in what disease?
DIP joint - Osteoarthritis
Which joints may you see Bouchard’s nodes and in what disease?
PIP joint - Osteoarthritis
Define ostemyelitis:
inflammation of bone or bone marrow, usually due to bacterial infection. Caused by haematogenous spread or local infection e.g. post trauma
Which organism causes osteomyelitis in Adults and where does it commonly affect?
S. Aureus.
Vertebrae, jaw (2ndary to dental abscess) and toes (2ndary to diabetic skin ulcer)S. Aureus.
Vertebrae, jaw (2ndary to dental abscess) and toes (2ndary to diabetic skin ulcer)
Which organism causes osteomyelitis in children and where does it commonly affect?
Haemophilus influenza
Group B strep
Long bonesHaemophilus influenza
Group B strep
Long bones
How does osteomyelitis present?
Pain
swelling
Tenderness
General features of; malaise, fever, chills, leukocytosisPain
swelling
Tenderness
General features of; malaise, fever, chills, leukocytosis
What are rare causes of osteomyelitis?
TB (immunocompromised patients)
Syphilis (congenital/acquired)TB (immunocompromised patients)
Syphilis (congenital/acquired)
What are the X-ray changes in osteomyelitis?
Lytic destruction of bone ~10days after onset
What is the clinical presentation of rheumatoid arthritis?
Symmetrical
Small joints of hands and feet (spares DIPJ), wrists, elbows, ankles and knees
Usually slow progressionSymmetrical
Small joints of hands and feet (spares DIPJ), wrists, elbows, ankles and knees
Usually slow progression
Which joints does rheumatoid usually spare?
DIP
What are the characteristic deformaties of rheumatoid?
Z shaped thumb
Swan neck and Boutonniere deformity of fingers
Radial deviation of wrist and ulnar deviation of fingers
