Brainscape's Knowledge GenomeTM

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


See full index

General practice > Ortho II > Flashcards

Ortho II Flashcards

1
Q

What is most common type of primary malignant bone tumour

A

Osteosarcoma

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

Which most population are more affected by osteosarcomas

A

Children and adolescents

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

where do osteosarcomas mostly commonly occur

A

occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure, with 40% occuring in the femur, 20% in the tibia, and 10% in the humerus

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

What might an x-ray show in osteosarcoma

A

x-ray shows Codman triangle (from periosteal elevation) and ‘sunburst’ pattern

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

What mutation is associated with osteosarcoma

A

mutation of the Rb gene significantly increases risk of osteosarcoma (hence association with retinoblastoma)

other predisposing factors include Paget’s disease of the bone and radiotherapy

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

Definition of osteoporosis

A

presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density.

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

Risk factors for osteoporosis

A 
Age
Female gender 
Corticosteroid use
Smoking 
Alcohol 
Low BMI 
Family Hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Recommended screening tool for assessing fracture risk in osteoporosis

A

Guidelines recommend using a screening tool such as FRAX or QFracture to assess the 10-year risk of a patient developing a fragility fracture.

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

How is bone mineral density assessed

A

To assess the actual bone mineral density a dual-energy X-ray absorptiometry (DEXA) scan is used. The DEXA scan looks at the hip and lumbar spine. If either have a T score of < -2.5 then treatment is recommended.

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

1st line treatment for osteoporosis

A

Oral bisphosphonate such as alendronate

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

How do patients with osteoporotic vertebral fractures typically present

A

Asymptomatic
Acute back pain
Breathing difficulties: changes in the shape and length of vertebrae lead to the compression of organs such as the lungs, heart and intestine

Gastrointestinal problems: due to compression of abdominal organs
Only a minority of patients will have a history of fall/trauma

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

Signs of osteoporotic vertebral fractures

A

Loss of height: vertebral osteoporotic fractures of lead to compression of the spinal vertebrae hence a reduction in overall length of the spine and thus the patient becomes shorter
Kyphosis (curvature of the spine)
Localised tenderness on palpation of spinous processes at the fracture site

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

Advice for supplementation for women with osteoporosis

A

vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete

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

Alternative if patients cannot tolerate alendronate for osteoporosis mx

A

Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate

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

Alternative if patients cannot tolerate bisphosphonates for osteoporosis management

A

Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates

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

What is raloxifene

A

Selective oestrogen receptor modulator(SERM)

has been shown to increase bone density in the spine and proximal femur
may worsen menopausal symptoms
increased risk of thromboembolic events
may decrease risk of breast cancer

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

Features of denosumab

A

human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts
given as a single subcutaneous injection every 6 months

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

Assessing patients following a fragility fracture - Age>75

A

Patients who’ve had a fragility fracture and are >= 75 years of age are presumed to have underlying osteoporosis and should be started on first-line therapy (an oral bisphosphonate), without the need for a DEXA scan.

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

Assessing patient following a fragility fracture - Age<75

A

If a patient is under the age of 75 years a DEXA scan should be arranged. These results can then be entered into a FRAX assessment (along with the fact that they’ve had a fracture) to determine the patients ongoing fracture risk.

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

Management of glucocorticoid-induced osteoporosis

A
  1. Patients over the age of 65 years or those who’ve previously had a fragility fracture should be offered bone protection.
  2. Patients under the age of 65 years should be offered a bone density scan, with further management dependent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Normal DEXA scan T score

A

> -1.0 = normal

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

Interpretation of DEXA scan T score -1.0 to -2.5

A

Osteopenia

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

Interpretation of DEXA scan T score < -2.5

A

Osteoporosis

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

What is osteomalacia

A

Osteomalacia describes softening of the bones secondary to low vitamin D levels that in turn lead to decreased bone mineral content. If this occurs in growing children it is referred to as rickets, with the term osteomalacia preferred for adults.

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

Causes of osteomalacia

A 
vitamin D deficiency
malabsorption
lack of sunlight
diet
chronic kidney disease
drug induced e.g. anticonvulsants
inherited: hypophosphatemic rickets (previously called vitamin D-resistant rickets)
liver disease: e.g. cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Features of osteomalacia

A

bone pain
bone/muscle tenderness
fractures: especially femoral neck
proximal myopathy: may lead to a waddling gait

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

IX for osteomalacia

A

Bloods
low vitamin D levels
low calcium, phosphate (in around 30%)
raised alkaline phosphatase (in 95-100% of patients)

x-ray
translucent bands (Looser's zones or pseudofractures)
28
Q

Treatment for osteomalacia

A

vitamin D supplmentation
a loading dose is often needed initially
calcium supplementation if dietary calcium is inadequate

29
Q

Most common side effects of denosumab

A

Dyspnoea and diarrhoea are generally considered the two most common side effects, occuring in around 1 in 10 patients. Other less common side effects include hypocalcaemia and upper respiratory tract infections.

30
Q

Bisphosphonates mechanism of action

A

Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

31
Q

Clinical uses of bisphosphonatees

A

prevention and treatment of osteoporosis
hypercalcaemia
Paget’s disease
pain from bone metatases

32
Q

Adverse effects of bisphosphonates

A

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
osteonecrosis of the jaw
increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

33
Q

BNF advice for counselling for bisphosphonates

A

Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet

34
Q

What is osteopenia

A

Osteopenia refers to a less severe reduction in bone density than osteoporosis. Reduced bone density makes bone less strong and more prone to fractures.

35
Q

Features of strontium ranelate

A

Strontium ranelate is a similar element to calcium that stimulates osteoblasts and blocks osteoclasts but increases the risk of DVT, PE and myocardial infarction.

36
Q

Risk factors for osteoarthritis

A

Risk factors include obesity, age, occupation, trauma, being female and family history.

37
Q

What is osteoarthritis thought to be linked to

A

It is thought to be the result of an imbalance between the cartilage being worn down and the chondrocytes repairing it leading to structural issues in the joint.

38
Q

X-ray abnormalities of osteoarthritis

A

L – Loss of joint space
O – Osteophytes
S – Subchondral sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone, aka geodes)

39
Q

Osteoarthritis presentation

A

Osteoarthritis presents with joint pain and stiffness. This pain and stiffness tends to be worsened by activity in contrast to inflammatory arthritis where activity improves symptoms. It also leads to deformity, instability and reduced function in the joint.

40
Q

Commonly affected joints in osteoarthritis

A 
Hips
Knees
Sacro-iliac joints
Distal-interphalangeal joints in the hands (DIPs)
The MCP joint at the base of the thumb
Wrist
Cervical spine
41
Q

Signs of osteoarthritis in the hands

A 
Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb at the carpo-metacarpal joint
Weak grip
Reduced range of motion
42
Q

General management of osteoarthritis

A

Start with patient education about the condition and advise on lifestyle changes such as weight loss if overweight to reduce the load on the joint, physiotherapy to improve strength to support the joint and occupational therapy and orthotics to support activities and function.

43
Q

Analgesia in osteoarthritis

A

Oral paracetamol and topical NSAIDs or topical capsaicin (chilli pepper extract).

Add oral NSAIDs and consider also prescribing a proton pump inhibitor (PPI) to protect their stomach such as omeprazole. They are better used intermittently rather than continuously.

Consider opiates such as codeine and morphine.

Intra-articular steroid injections provide a temporary reduction in inflammation and improve symptoms.

44
Q

Causes of mechanical back pain

A

Muscle or ligament sprain
Facet joint dysfunction
Sacroiliac joint dysfunction
Herniated disc
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Scoliosis (curved spine)
Degenerative changes (arthritis) affecting the discs and facet joints

45
Q

Causes of neck pain

A

Muscle or ligament strain (e.g., poor posture or repetitive activities)
Torticollis (waking up with a unilaterally stiff and painful neck due to muscle spasm)
Whiplash (typically after a road traffic accident)
Cervical spondylosis (degenerative changes to the vertebrae)

46
Q

Red-flag causes of back pain

A 
Spinal fracture (e.g., major trauma)
Cauda equina (e.g., saddle anaesthesia, urinary retention, incontinence or bilateral neurological signs)
Spinal stenosis (e.g., intermittent neurogenic claudication)
Ankylosing spondylitis (e.g., age under 40, gradual onset, morning stiffness or night-time pain)
Spinal infection (e.g., fever or a history of IV drug use)
47
Q

Causes of back pain not linked to spine

A 
Pneumonia 
Ruptured aortic aneurysms
Kidney stones
Pyelonephritis
Pancreatitis
Prostatitis
Pelvic inflammatory disease
Endometriosis
48
Q

Spinal nerve roots for the sciatic nerve

A

L4-S3

49
Q

Path of the sciatic nerve

A

The sciatic nerve exits the posterior part of the pelvis through the greater sciatic foramen, in the buttock area on either side. It travels down the back of the leg. At the knee, it divides into the tibial nerve and the common peroneal nerve.

50
Q

What does the sciatic nerve innervate

A

The sciatic nerve supplies sensation to the lateral lower leg and the foot. It supplies motor function to the posterior thigh, lower leg and foot.

51
Q

Presentation of sciatica

A

Unilateral pain from the buttock radiating down the back of the thigh to below the knee or feet.

It might be described as an “electric” or “shooting” pain. Other symptoms are paraesthesia (pins and needles), numbness and motor weakness.

Reflexes may be affected depending on the affected nerve root.

52
Q

Main causes of sciatica

A

The main causes of sciatica are lumbosacral nerve root compression by:

Herniated disc
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Spinal stenosis

53
Q

What is bilateral sciatica a red flag for

A

cauda equina syndrome

54
Q

Which symptoms associated with back pain indicate cauda equina syndrome

A

Saddle anaesthesia
Urinary retention or incontinence
Faecal incontinence
Bilateral neurological motor or sensory symptoms

55
Q

What is the sciatic stretch test

A

can be used to help diagnose sciatica. The patient lies on their back with their leg straight.

The examiner lifts one leg from the ankle with the knee extended until the limit of hip flexion is reached (usually around 80-90 degrees). Then the examiner dorsiflexes the patient’s ankle.

Sciatica-type pain in the buttock/posterior thigh indicates sciatic nerve root irritation. Symptoms improve with flexing the knee.

56
Q

main cancers that metastasise to the bones

A 
Po – Prostate
R – Renal 
Ta – Thyroid
B – Breast
Le – Lung

(portable)

57
Q

ix for ankylosing spondylitis

A

Inflammatory markers (CRP and ESR)
X-ray of the spinal and sacrum (may show a fused “bamboo spine” in later-stage disease)
MRI of the spine (may show bone marrow oedema early in the disease)

58
Q

Which tool can be used to risk stratify patients with acute back pain

A

STarT back screening tool - risk of developing chronic back pain

59
Q

Management of patients with low risk of chronic back pain

A 
Self-management
Education
Reassurance
Analgesia
Staying active and continuing to mobilise as tolerated
60
Q

Management of patients with medium/high risk of developing chronic back pain

A

Physiotherapy
Group exercise
Cognitive behavioural therapy

61
Q

Analgesia options for back pain

A

NSAIDs (e.g., ibuprofen or naproxen) first-line
Codeine as an alternative
Benzodiazepines (e.g., diazepam) for muscle spasm (short-term only – up to 5 days)

62
Q

What is radio frequency denervation

A

Radiofrequency denervation may be an option in patients with chronic low back pain originating in the facet joints. Radiofrequency is used to target and damage the medial branch nerves that supply sensation to the facet joints associated with the back pain. This is done under a local anaesthetic.

63
Q

Pharmacological interventions for sciatica if persisting symptoms

A

Amitriptyline

Duloxetine

64
Q

Specialist management options for chronic sciatica

A

Epidural corticosteroid injections
Local anaesthetic injections
Radiofrequency denervation
Spinal decompression

65
Q

Conservative mx of carpal tunnel syndrome

A

Wrist splints
Corticosteroids
Rest

66
Q

Surgical mx of carpal tunnel syndrome

A

Arthroscopy

67
Q

Most common distal radial fracture

A

Colle’s fracture - extra-articular fracture with dorsal angulation and displacement - dinner fork

General practice (26 decks)

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