Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ortho and Rheum > Ortho 2 > Flashcards

Ortho 2 Flashcards

1
Q

What is osteomyelitis?

A

Infection of the bone

  • In neonates - metaphysis or epiphysis commonly affected
  • in children - metaphysis
  • in adults - epiphysis and subchondral regions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What increases incidence of osteomyelitis?

A

Incidence increases as living conditions drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can osteomyelitis start?

A

Can be acute primary or can spread from local infection eg. boils, abscesses, pneumonia or GU instrumentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathology of osteomyelitis

A

Cancellous bone is typically affected in adults. Infection leads to cortex erosion with holes (cloacae). Exudation of pus lifts up periosteum interrupting blood supply to underlying bone - necrotic bone fragments form (sequestrum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What areas of bone are most commonly affected by osteomyelitis in IV drug users, diabetics and children

A

Vertebrae in IV drug users, feet in diabetics, children is most commonly vascular bone (eg long bone metaphyses, distal femur, upper tibia etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is typically present in the bone in chronic osteomyelitis?

A

Sequestrum (piece of dead of bone separated from the normal bone by necrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is involucrum in osteomyelitis

A

New bone formation created by the elevated periosteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can happen visually in osteomyelitis?

A

Pus may discharge into the joint spaces or via sinuses to the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typical hx and symptoms of osteomyelitis

A

Pain gradual onset over the course of a few days - tenderness, warmth and erythema at affected part
Unwillingness to move
May have slight joint effusion in neighbouring joints and signs of systemic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In whom are osteomyelitis signs less marked

A

In adults - acute invariably happens in children, in adults it is normally IV drug users or immunosuppressed patients or those with other disease/infection elsewhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common organisms for osteomyelitis x4

A

Staph aureus!!!, Pseudomonas, E.coli, Streptococci (sickle cell may be salmonella)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tests in osteomyelitis

A

Bone biopsy and culture is gold standard

Inflammatory markers will be raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Radiograph in osteomyelitis

A

Changes won’t show for 10-14 days, then slow haziness and loss of density - later sequestrum and involucrum
MRI is specific and sensitive for earlier osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of osteomyelitis

A

Drain abscesses and remove sequestra by open surgery (if very severe)
Vancomycin and cefotaxime IVI for 6 weeks (change if specificity known)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of pseudomonas osteomyelitis

A

Ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is chronic osteomyelitis?

A

Any acute osteomyelitis can become chronic with poor treatment
Generally considered chronic if longer than a month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of chronic osteomyelitis

A

Pain, fever and sinus suppuration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Xray in chronic osteomyelitis

A

Only if advanced infection, acutely - will see soft tissue swelling and may see joint effusion in local joint, then periosteal thickening and regional osteopenia with cortical loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Pott’s disease

A

Bone TB in vertebra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors for osteomyelitis x6

A 
Diabetes
Vascular disease
Sickle cell 
Impaired immunity 
Surgical prostheses
Open fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What cancers commonly metastasise to the bone x4

A

Breast, bronchus, prostate and kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What time of bone cancer is rare

A

Primary (mostly children apart from chondrosarcoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Radiological features of bone cancer x4

A

Bone destruction, new bone formation, soft tissue swelling, periosteal elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common malignant primary tumour of bone

A

Osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Who is typically affected by primary osteosarcoma and where do they get it?

A

Adolescents
Arises in the metaphyses of long bones especially around the knee
Typically in sites of bone growth (metaphysis) presumably because proliferation makes osteoblastic cells more prone to mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment of osteosarcoma

A

Resection + chemotherapy - 90% have limb sparing surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cure rate for primary osteosarcoma

A

60-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Ewings Sarcoma?

A

Round-cell tumour of long bones and limb girdles - usually presents in younger adolescents
Typically occurs in femur, tibia and pelvic bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What do you see on radiograph with Ewings Sarcoma?

A

Concentric layers of new bone formation = “onion-ring sign”

and a soft tissue mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Genetic association of Ewings Sarcoma?

A

Typically have a t11:22 chromosomal translocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Treamtent of Ewings Sarcoma?

A

Chemo, surgery and radiotherapy - chemo first to shrink the tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

5 year recurrence free survival for Ewings Sarcome?

A

22% if mets at diagnosis, 55% if no mets - 30% overtly metastatic at presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Chondrosarcoma and who does it affect?

A

Carcinoma of cartilage producing cells which affects the axial skeleton as well as long bones
In middle-aged people typically (unlike other bone tumours which are more common in children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment of chondrosarcoma

A

Doesn’t respond to chemo or radio

Therefore treat with excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the most common benign bone tumour - where does it occur

A

Osteochondroma
Occurs about the knee, proximal femur or proximal humerus
Usually around growth plates
Grows with the bone and then will usually stop growing when bone stops growing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Presentation of osteochondroma

A

Painless lump or local mass effects
Pain with exercise - tendon snapping over the growth
Neurological symptoms - tingling or numbness
Decreased blood flow from vascular compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Osteochondroma on x ray

A

Bony spur pointing away from the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Treatment of osteochondroma

A

Remove if causing symptoms from pressure on local structures

Or if continuing to grow after skeletal maturity because risk of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What do you suspect if boney pain responding to aspirin within 15mins in young adult?

A

Osteoid Osteoma - nocturnal pain is a significant feature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Details of osteoid osteoma

A

Painful benign bone lesion occurring in long bones of young males 10-25 years old
responds to aspirin (produces prostaglandins which lead to pain unrelated to activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Treatment of osteoid osteoma

A

CT guided biopsy and radiofrequency ablation - treatment is dependant on symptoms, if can be managed with anti-inflammatories then it will be

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Features which lead to suspecting mass as being soft tissue sarcoma x4

A

Bigger than 5cm, increasing in size, deep to deep fascia, painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Treatment of soft tissue sarcoma

A

Excision by wide margins - followed by radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is osteogenesis imperfecta?

A

An inherited disorder of type I collagen that results in fragile, low density bones = brittle bone disease/ Lobstein syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Incidence of osteogenesis imperfecta?

A

1 in 20,000 affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Details of type 1 osteogenesis imperfecta? x8

A 
Mildest and most common 
Autosomal dominant
Blue sclerae (increased corneal translucency)
50% have hearing loss 
Fractures typically before puberty 
Loose joints and poor muscle tone 
Normal life expectancy 
Normal collagen produced but not enough of it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Details of type 2 osteogenesis imperfecta? x3

A

Lethal perinatal form with many fractures and dwarfism
Recessive
Most die within first year of life from respiratory failure or intracerebral haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Details of type 3 osteogenesis imperfecta? x8

A 
Severe form 
Occurs in 20% 
Recessive
Fractures at birth and progressive (key feature of type 3) limb and spinal deformity with resultant short stature
Blue or white sclera
Dentinogenesis imperfecta is common 
Life expectancy decreased
Enough collagen is produced but it's defective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Details of type 4 osteogenesis imperfecta? x6

A 
Moderate form 
Autosomal dominant 
Fragile bones
White sclera after infancy 
Has been expanded into types 4-7
Not high enough quality collagen is produced but enough is produced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Radiographs in osteogenesis imperfecta? x3

A

Many fractures
Osteoporotic bones with thin cortex
Bowing deformity of long bones

51
Q

Treatment of osteogenesis imperfecta? x4

A

Prevent injury
Physio, rehab and occupational therapy
Intramedullary rods sometimes used in long bones
Bisphosphonates

52
Q

What is Achondroplasia?

A

Most common form of dwarfism due to reduced growth of cartilaginous bone

53
Q

Inheritance of achondroplasia

A

Autosomal dominant but 80% are from spontaneous mutations - if inherit two forms of gene (one from each parent) likely to die in first few months of life

54
Q

Gene mutation causing achondroplasia

A

95% are caused by mutation in the gene encoding fibroblast growth factor receptor type 3 (FGFR3)

55
Q

Effects of achondroplasia x5

A 
Large heads with ventriculomegaly and frontal bossing
Normal trunk length 
Short limbs
Fingers all the same length 
Delayed gross motor skills development
56
Q

Appearance of adults with achondroplasia x4

A

Short, increased lumbar lordosis, bowed legs and short proximal arms and legs

57
Q

What is the affect of achondroplasia on lifespan?

A

None - lifespan normal

58
Q

What is the affect of achondroplasia on mental and sexual development?

A

None - both normal

59
Q

Complications of achondroplasia x6

A 
Tibial bowing
Joint hypermobility 
Hydrocephalus, foramen magnum compression 
Recurrent otitis media and hearing loss
Sleep apnoea 
Increased BMI
60
Q

Radiographs in achondroplasia

A

Short proximal long bones and wide ephiphyses

61
Q

What is hereditary multiple exostoses?

A

Autosomal dominant disorder in which certain proteins accumulate in the Golgi apparatus leading to cartilage-capped tumours developing from affected cartilage at the end of long bones (point away from joint)- many osteochondromas/extoses

62
Q

Effects of hereditary multiple exostoses

A

If severe, bones are broad and badly modelled
Causing short stature as well as forearm, knee and ankle deformity
Boney spurs may have local effects, nerve/vascular compression

63
Q

What can occur in hereditary multiple exostoses

A

Malignant transformation from exostoses/osteochondromata to chondrosarcomas or osteosarcomas

64
Q

Treatment of hereditary multiple exostoses

A

Removal of symptom producing exostoses, pain management and physiotherapy

65
Q

What is osteopetrosis

A

Lack of differentiation between cortex and medulla of bone following from underlying failure of osteoclastic bone resorption - Marble bone disease/Albers-schonberg disease

66
Q

What are bones like in osteopetrosis?

A

Very hard, dense ‘marble’ bones that are brittle

67
Q

What can you get with osteopetrosis

A

Anaemia and thrombocytopenia from decreased marrow space
Deafness and optic atrophy from CN compression
Despite being hard the bones are still very brittle therefore multiple fractures

68
Q

Radiograph in osteopetrosis

A

Lack of remodelling therefore ossific density with bone within a bone appearance

69
Q

What are osteochondroses? What are they also called?

A

Group of conditions characterised by abnormal endochondral ossification of epiphyseal growth during childhood
Also called osteochondritis
Bone grows and then stops and then starts again

70
Q

Underlying of cause of osteochondroses?

A

Unknown

Inheritance, overuse/trauma, rapid growth and anatomic configuration may be predisposing factors

71
Q

Pathology of all osteochondroses?

A

Interruption of blood supply to epiphysis, followed by bone and cartilage necrosis, revascularisation and regrowth of bone

72
Q

What is Scheuermann’s disease?

A

Osteochondrosis - Most common cause of kyphosis in 13-16 year olds
Problem with thoracic vertebrae - deforming forces are greatest anteriorly therefore vertebrae narrower here causing kyphosis

73
Q

Presentation of Scheuermann’s disease?

A

Usually present for deformity rather than pain

74
Q

Radiographing features of Scheuermann’s disease? x4

A

Irregular vertebral end plates
Schmorls nodes (protrusion of IVD through vertebral body end plate and into adjacent vertebra)
Decreased disc space
Anterior wedging

75
Q

Treatment of Scheuermann’s disease?

A

Posture control and exercise
Physiotherapy + spinal braces
Surgery if severe

76
Q

What is Calve’s vertebra

A

Not true osteochondroses as due to eosinophilic granulomata but produces similar picture to scheuermann’s disease but in younger child 2-10years

77
Q

Symptoms of Calves vertebra

A

Pain and tenderness over affected vertebra with slight kyphosis

78
Q

Radiograph in Calves vertebra

A

Flattened vertebral body with disc space preserved

79
Q

What is Kienbocks disease?

A

Osteochondroses affecting lunate bone in males 20-40 years

80
Q

Symptoms of Kienbocks disease

A

Pain over lunate especially during active wrist movement

Grip impaired due to pain

81
Q

Radiograph in Kienbocks disease

A

Dense lunate with a depth reduction - leads to OA

82
Q

Treatment of Kienbocks disease

A

Splinting and analgesics

Can do surgery if needs be to restore blood flow to lunate (or to realign bones or remove lunate if severe)

83
Q

What are Panner’s disease and osteochondritis dissecans of the elbow?

A

Spectrum of conditions affecting the capitellum (radial attachment on humerus)

84
Q

Who does Panner’s disease affect and what does it cause?

A

Affects boys under 10

Lateral elbow pain and swelling

85
Q

Management of panner’s disease

A

Usually just conservative management

86
Q

What does osteochondritis dissecans of the elbow cause?

A

Loose body from cartilage becoming avascular and separating from bone
Causes early aching and effusion after use in adolescents
Sudden painful locking if loose bodies

87
Q

Treatment of OCD?

A

Stable lesions managed conservatively in a hinged brace

Unstable lesions may need fixation +/- removal of loose bodies

88
Q

What is Kohlers disease?

A

Navicular osteochondroses in children 3-5 years old

89
Q

What does Kohlers disease cause?

A

Pain in mid-tarsal region
Limp
Navicular tenderness
Dense deformed bone on radiograph

90
Q

Treatment of Kohlers disease

A

Rest the foot or wear walking plaster - symptomatic treatment
Prognosis good

91
Q

What is Freibergs disease?

A

Osteochondritis dissecans of the metatarsal heads - most commonly 2nd

92
Q

Freibergs disease symptoms

A

Forefoot pain, worsens with pressure, usually starting around the time of puberty

93
Q

What is Freidrich disease?

A

Clavicle osteochondroses

94
Q

What is Froelich disease?

A

Humeral condyles osteochondroses

95
Q

What is Perthes disease?

A

Osteochondroses of hip

96
Q

What is Blount disease?

A

Osteochondroses of proximal tibial epiphysis

97
Q

What is Osgood-Schlatter’s syndrome?

A

Osteochondroses - Tibial tuberosity apophysitis (secondary ossification centre) that affects children 10-15 years old - association with overuse

98
Q

Signs and symptoms of Osgood-Schlatters syndrome?

A

Pain below the knee, worse on strenuous activity and quadriceps contraction
Tuberosity looks enlarged and is tender

99
Q

Prognosis of Osgood-schlatters syndrome?

A

Self-limiting in >90% of cases

100
Q

Radiograph of Osgood-schlatters syndrome?

A

Tibial tuberosity enlargement with possible fragmentation (as opposed to normal immature tuberosity appearance)

101
Q

Treatment of Osgood-Schlatters syndrome

A

Limitation of activity with ice, oral anti-inflamm’s, knee padding and physiotherapy
Tibial tubercle excision may be recommended if above fail

102
Q

What is Sinding Larsens disease?

A

Also called jumpers knee - traction tendinopathy with calcification of proximal attachment of patella tendon - may be partially avulsed
Symptoms similar to OSS but earlier presentation 8-13 years

103
Q

Structure of hip prostheses

A

Metal femoral component with intramedullary stem sometimes held in place by bone cement
and a plastic acetabular component

104
Q

Sign of later loosening or infection with hip replacement

A

Return of pain

105
Q

Risk factor BMI for osteoporosis

A

Low BMI

106
Q

Osteoporosis risk factors

A 
Menopause 
RA 
Low BMI
Steroids 
FHx 
Immobility
107
Q

Common cause of tibial nerve injury

A

Posterior hip dislocation

108
Q

Signs of tibial nerve damage

A

Loss of inversion of foot and ability to tiptoe

Sensation of plantar aspect lost (S1)

109
Q

Signs of femoral nerve injury

A

Unable to extend knee
Absent knee jerk
Loss of sensation over front and medial thigh

110
Q

Symptoms of osteosarcoma

A

Pain, may be worse at night and can be intermittent
Typically just below the knee, worse on exercise
Can be present as sudden fracture due to weakened bone

111
Q

Symptoms of Ewing’s sarcoma

A

Pain at site, gets worse and can be extremely painful

Can also get intermittent high fevers, weight loss and severe fatigue (anaemia)

112
Q

Presentation/symptoms of chondrosarcoma

A

Pain most common feature but may be swelling therefore palpable lump or local mass effect

113
Q

Chondrosarcoma on x ray

A

“popcorn calcification” on x-ray with lysis as well

114
Q

Osteoid osteoma on imaging

A

Nidus - Xray is a thickened oval area which is a well-circumscribed lucent area with a sclerotic dot in the centre (black with white in middle)
on CT nidus is seen as well

115
Q

Pathological steps behind septic arthritis

A

Bacteria get into joint, inflammatory response causes damage to articular cartilage. Increased permeability and fluid secretion causes joint effusion.

116
Q

What can happen during healing of septic arthritis?

A

Raw articular surfaces may result in fibrosis and bony ankylosis

117
Q

Most common organisms causing septic arthritis in under 3 yr olds x3

A

Staph Aureus, haem influenza and coliforms

118
Q

Most common organisms causing septic arthritis in adults x2

A

S.aureus and neisseria gonorrhoea

119
Q

Risk factors for septic arthritis

A

Diabetes, IV drug use, immunocompromised, chronic joint disease (rheumatoid)

120
Q

What can be seen in gonococcal septic arthritis

A

Skin pustules near the joint

121
Q

Radiograph in septic arthritis

A

Increased joint space, soft tissue swelling

In late cases subchondral bone destruction

122
Q

Surgical management of septic arthritis

A

Surgical washout of the joint to remove pus and infected material - either arthroscopy or open (arthrotomy)

123
Q

Medical management of septic arthritis

A

Antibiotics given IV 1-2 weeks then oral 4-6 weeks
Splint joint for pain reduction
Physio to prevent fibrosis and maintain joint mobility

Ortho and Rheum (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions