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4th year everything > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Embryological development of the musculoskeletal system begins at what week of gestation?

A

Approx. the 4th week

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2
Q

Activations of mesenchymal cells in what embryological structure is responsible for the development of the musculoskeletal system?

A

Somatic lateral mesoderm

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3
Q

What genes are responsible for regulating the musculoskeletal system?

A

Homeobox genes

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4
Q

At what days gestation do the upper and lower limb buds develop?

A

Upper limb buds - day 24

Lower limb buds - day 25-26

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5
Q

What are limb buds?

A

Elongated proliferations of mesenchyme

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6
Q

What structure forms at the apex of each limb bud? What is their function?

A

Ectoderm thickens to form the apical ectodermal ridge (AER) which exerts an inductive influence on the limb mesenchyme causing the growth of blood vessels/cartilage/bone etc.

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7
Q

Outline the process of the embryological formation of hands and feet

A

Distal ends of the limb buds flatten into paddle-like plates which condense into digital rays for hands and feet by six and seven weeks gestation respectively.

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8
Q

What process causes separation of digital rays to make individual fingers and toes?

A

Programmed cell death (apoptosis) mediated by morphogenetic proteins

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9
Q

What defect may arise from the incorrect separation of digits in utero?

A

Syndactyly (simple cutaneous or complicated osseous)

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10
Q

Cartilaginous precursors to the bones of the limbs develop from what embryological structure?

A

Mesoderm

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11
Q

What areas of proto-bone develop between 8 and 12 weeks gestation? What causes their development?

A

Primary centres of ossification appear in response to growth factors

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12
Q

What type of calcification occurs for all limb bones? What is the one exception?

A

Endochondral ossification for all limb bones except the clavicle (membranous ossification instead)

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13
Q

Both limbs rotate in utero during the development of the musculoskeletal system.

Outline rotation of both upper and lower limbs respectively

A

Upper limbs - rotate laterally - extensors are on lateral/posterior surface (remember the thumb is lateral)

Lower limbs - rotate medially - rotate medially so extensors are on anterior surfaces (remember big toe is medial)

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14
Q

Birth defects of the limbs can be either hereditary or teratogenic in nature. What is the word used to describe a total lack of limbs?

A

Amelia

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15
Q

What is meant by the term meromelia?

A

Partial lack of limbs

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16
Q

What is meant by the term phocomelia?

A

Partial loss of long bones

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17
Q

What is meant by the term micromelia?

A

All parts of limbs present but small

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18
Q

What teratogen is associated with meromelia?

A

Thalidomide

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19
Q

What is the medical term of a congenital club-foot?

A

Talipes equinovarus

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20
Q

Describe congenital clubfoot

A

Soles of feet are turned medially and the foot is inverted

21
Q

List different types of bone-forming tumours

A

Benign - osteoid osteoma, osteoblastoma

Malignancy - osteosarcoma

22
Q

List different types of cartilage-forming tumours

A

Benign - enchondroma, osteochondroma

Malignant - Chondrosarcoma

23
Q

List different types of fibrous tissue tumours

A

Benign - fibroma

Malignant - fibrosarcoma, malignant fibrous histiocytoma (MFH)

24
Q

List different types of vascular tissue tumours

A

Benign - haemangioma, aneurysmal bone cyst

Malignant - angiosarcoma

25
Q

List different types of fatty tissue tumours

A

Benign - lipoma

Malignant - liposarcoma

26
Q

List different types of bone marrow tissue tumours

A

Malignant - Ewing’s sarcoma, lymphoma, myeloma

27
Q

What is the commonest primary malignant bone tumour in younger patients?

A

Osteosarcoma

28
Q

What is the commonest primary malignant bone tumour in older patients?

A

Myeloma (not strictly a bone malignancy but it is a major diagnostic aspect of the disease)

29
Q

List some investigation which may be useful in the diagnosis and monitoring of bone tumours

A 
Plain X-Rays 
CT Scan 
Isotope bone scan 
MRI
PET Scan
30
Q

Outline the clinical features of a bone tumour

A 
Pain (worse at night) 
Loss of function (limp/reduced movement/stiff back)
Swelling 
Pathological fracture 
Joint effusion
Deformity 
Neurovascular effects
31
Q

What is the triad of pathophysiology of osteoarthritis?

A

Tear, flare and repair

A lifetime of wear (and injuries) cause inflammation and subchondral changes lead to activation of the repair process - constant cycles of repair lead to destruction of cartilage

32
Q

What are the diagnostic criteria for osteoarthritis?

A

Typically aged +45
Activity related joint pain
No related morning stiffness/stiffness that lasts <30 mins

Pay attention to a history of trauma, prolonged morning stiffness, rapid deterioration or systemic symptoms as this may point to a more serious underlying diagnosis

33
Q

What are some differential diagnoses for osteoarthritis?

A

Gout
Inflammatory arthritides (rheumatoid, psoriatic etc.)
Septic arthritis
Malignancy

34
Q

What is the treatment escalation plan for osteoarthritis?

A

First-line - non-pharmacological treatments
Second line - pharmacological
Third line - surgical intervention

35
Q

What non-pharmacological treatments are available or osteoarthritis?

A

Thermotherapy, electrotherapy, aids and devices, manual therapy

36
Q

What pharmacological treatments are available or osteoarthritis?

A 
Oral analgesia (paracetamol, NSAIDs)
Topical treatments (NSAIDs, capsaicin cream)
37
Q

What age demographic is most likely to develop osteomyelitis?

A

Mostly children with boys being more affected than girls

38
Q

What routes of infection may lead to osteomyelitis?

A

Hematogenous spread

Local spread - from a contiguous site of infection e.g. trauma (open fracture), surgery (ORIF) or joint replacement

39
Q

What are the most likely causes of osteomyelitis in infants, children and adults respectively?

A

Infants - infected umbilical cord
Children - boils, tonsilitis, skin abrasions
Adults - UTI, arterial lines

40
Q

What organisms are most likely to be the cause of osteomyelitis in infants?

A

Staph aureus
Group B strep
E. Coli

41
Q

What organisms are most likely to be the cause of osteomyelitis in older children?

A

Staph aureus
Strep pyogenes
H influenzae

42
Q

What organisms are most likely to be the cause of osteomyelitis in adults?

A

Staph aureus
Coagulase -ve staph
Mycobacterium
Pseudomonas aeroginosa

43
Q

What organism(s) are most likely the cause of osteomyelitis in diabetic foot/pressure sore patients?

A

Mixed infection (including anaerobes)

44
Q

What organism(s) are most likely the cause of osteomyelitis in sickle cell disease patients?

A

Salmonella spp.

45
Q

What organism(s) are most likely the cause of osteomyelitis in fishermen or filleters?

A

Mycobacterium manrium

46
Q

What organism(s) are most likely the cause of osteomyelitis in HIV/AIDS patients?

A

Candida

47
Q

What anatomical sites are most commonly affected by osteomyelitis?

A

Long bones (particularly distal femur, proximal tibia or proximal humerus)

Joints with intra-articular metaphysis (hip, elbow (radial head)

48
Q

Outline the pathophysiology of osteomyelitis

A

Acute inflammation at the metaphysis/suppuration causing vascular stasis.

Release of pressure

4th year everything (43 decks)

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