orthopaedics

Question 1

Causes of lumbar back pain? mechanical/inflammatory/serious

Answer 1

MECH - disc prolapse, arthritis, fractures, spinal stenosis
INFLAMMATORY - ankylosing spondylitis, infection
SERIOUS - cancer, myeloma, TB

Question 2

features of mechanical back pain?

Answer 2

sudden onset, worse in the afternoon, no morning stiffness, exercise aggravates

Question 3

features of inflammatory back pain?

Answer 3

gradual onset, pain worse in the morning + morning stiffness

Question 4

features of serious back pain causes?

Answer 4

> 50, constant pain (even in the night), systemically unwell, localised bone tenderness, bilateral leg signs, bladder/bowel dysfunction

Question 5

Ix into back pain?

Answer 5

detailed Hx - pain + neurological history
ESR/CRP/Ca/Ph/PSA
Spine X ray
bone scan
MRI

Question 6

Features of acute disc prolapse?

Answer 6

acute severe back pain following a strenuous activity
aggravated by movement
pain can radiate to the areas supplied by the nerve
pain related to position

Question 7

Mx for acute disc prolapse?

Answer 7

bed rest, pain relief, epidural corticosteroid

surgery

Question 8

What causes chronic disc disease? Features

Answer 8

degenerative changes in L spine and facet joints, causes mechanical pain
Pain can radiate to the sciatic region

Question 9

Mx for chronic disease?

Answer 9

decompress the nerve roots

Question 10

What is spondylolisthesis?

Answer 10

slipping forward of one vertebra on another (commonly at L4/5)

Question 11

what is spinal stenosis?

Answer 11

narrowing of the lower spinal canal compressing the cauda equina

Question 12

features of spinal stenosis?

Answer 12

back and buttock pain at the end of the day

Question 13

Mx of spinal stenosis?

Answer 13

surgical decompression

Question 14

RF for osteoarthritis?

Answer 14

obesity, fractures, joint dysplasia, occupation, age, remale

Question 15

What is the process that leads to osteoarthritis?

Answer 15

inflammatory and reparative process. There is progressive destruction and loss of articular cartilage. Exposed bone becomes sclerotic - increased vascularity with cyst formation and osteophyte formation

Question 16

features of osteoarthritis?

Answer 16

joint pain which worsens with movement, relieved by rest

affects weight bearing joints and DIPJ

Question 17

hand signs for OA?

Answer 17

heberden nodes (swelling at DIPJ)
bouchard nodes (swelling at PIPJ)

Question 18

findings OE of OA?

Answer 18

deformities, bone enlargements, crepitus, joint effusion

Question 19

Ix for OA?

Answer 19

FBC, ESR, RF
Xray
MRI

Question 20

what are the X ray findings for OA?

Answer 20

loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts

Question 21

How do you manage OA?

Answer 21

PHYSICAL - physio, exercises, lose weight, local heat and ice packs, joint supports, shoe insoles
MEDS - paracetamol, NSAIDS
SURGERY - THR/TKR

Question 22

What is the common cause of septic arthritis?

Answer 22

staph aureus

Question 23

risk factors for septic arthritis?

Answer 23

prosthetic joint, pre-existing joint disease, recent IA steroids, DM

Question 24

features of septic arthritis?

Answer 24

hot painful swollen joint, develops acutely, fever, joint discharge, effusion, reduced function of joint

Question 25

Ix for septic arthritis

Answer 25

Joint aspiration - gram stain, recent IA steroids
FBC/ESR/CRP/culture
XRay joint
swab urethra - gonorrhea?

Question 26

Mx for septic arthritis

Answer 26

IV flucloxacillin, drain the joint, immobilise the joint, NSAIDS for pain

Question 27

what is osteoporosis?

Answer 27

reduced bone mass and microarchitectural deterioration of bone = bone fragility and increased risk of fracture

Question 28

name some BMD dependant RF for osteoporosis?

Answer 28

female, caucasian, immobilisation, CKD, GI disease, reduced Ca intake, Vit D deficiency, steroids, DM, myeloma

Question 29

name some BMD independant RF for osteoporosis?

Answer 29

increased age, previous fragility fracture, family history of hip fracture, low BMI, smoking, alcohol, RA

Question 30

Features of osteoporosis

Answer 30

fractures!

• T and L spine - kyphosis (widows stoop)
• proximal femur
• distal radius

Question 31

Ix into osteoporosis?

Answer 31

DXA - frax score
XRay - identify fractures
Bloods - Ca, Ph, ALP (normal)
secondary causes screen - myeloma, coeliac, thyrotoxicosis

Question 32

Mx of osteoporosis?

Answer 32

Fractures: pain relief, bed rest, stop smoking, reduce alcohol, increase calcium intake, weight bearing exercise

Bisphosphonates - alendronate (inhibit osteoclasts)
strontium ranelate
Raloxifene (SERM)
HRT if post menopausal

Question 33

what is Paget’s disease?

Answer 33

focal disorder of bone remodelling - increased osteoclastic bone resorption and formation of weaker bone

Question 34

where are paget disease lesions commonly found? features of these lesions

Answer 34

pelvis, L spine, femur, T spine, skull, tibia

Pain + deformities (e.g bowed tibia)

Question 35

Ix for pagets disease?

Answer 35

raised ALP
increased urinary hydroxyprotine excretion
XRay of the affected bone

Question 36

Mx for pagets disease?

Answer 36

bisphosphonates

Question 37

RF for Vitamin D deficiency

Answer 37

pigmented skin, suncream, concealing clothing, elderly, institutionalised, malabsorption (small bowel issues), liver disease

Question 38

Features of vitamin D deficiency?

Answer 38

proximal muscle weakness

low bone density

Question 39

Ix for vitamin D deficiency?

Answer 39

low serum Vit D, serum biochemistry (raised ALP, Ph, Ca) X ray

Question 40

Mx for vitamin D deficiency

Answer 40

Calciferol