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Neet PG 2023 > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

What is Rickets?

A

Rickets occurs d/t deficiency in vitamin D.
It occurs before skeletal maturity, seen in children.

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2
Q

What is Osteomalacia?

A

It is also vitamin D deficiency seen in adults or after skeletal maturity

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3
Q

What are the causes of rickets?

A

Decrease in Vitamin D leads to hypocalcemia.
* Nutritional (MC)
* Malabsorption
* Lack of sunlight
* Liver and kidney diseases
* Drugs
Decrease in calcium
Decrease in phosphate

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4
Q

Osteoid Maturation Time

A

Time taken by the osteoid to become osteon.
Hypocalcemia increases the osteoid maturation time.

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5
Q

Mineral Apposition Rate

A

Speed at which the mineral gets deposited on the osteoid.
Hypocalcemia decreases the mineral apposition rate

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6
Q

What are laboratory finding in rickets?

A
  • Ca+2: Decrease or normal
  • PTH: Increased
  • Phosphate: Decreased
  • ALP: Increased (Bone turnover)
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7
Q

What are the skull manifestations in rickets?

A
  • Craniotabes or Ping pong skull: Softening of skull (earilest change)
  • Frontal bossing
  • Delayed closure of fontanelle
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8
Q

What are the chest manifestations of rickets?

A
  • Rachitic Rosary: Costochondral junction swellings (Blunt and non-tender)
  • Pigeon chest or pectus carinatum: prominent sternum
  • Harrison sulcus: Under the ribs where the diaphragm inserts.
  • Bending of long bones once the child starts bearing weight not seen in infants
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9
Q

10 important clinical features in rickets

A
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10
Q

What are the clinical findings seen in knee in rickets?

A
  • B/L Genu Valgum (Knock knees)
  • B/L Genu varum (Bow knees)
  • Wind swept deformity - varus on one side and valgus on other side
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11
Q

What are the Most common cause in children of
1.B/L genu varum
2.B/L Genu valgum
3.wind swept deformity

A
  1. B/L genu varum: Rickets > Idiopathic
  2. B/L genu valgum: idiopathic > rickets
  3. Wind swept deformity: Rickets

MCC overall : Rickets

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12
Q

What is the most common cause in adults of
1.B/L Genu varum
2.B/L genu valgum
3.Wind swept deformity

A
  1. B/L Genu varum: Osteoarthritis > Rheumatoid arthritis
  2. B/L genu valgum: Rheumatoid arthritis > Osteoarthritis
  3. Windswept deformity: Rheumatoid arthritis

MCC in adults: Rheumatoid arthritis

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13
Q

What is the radiological features of rickets?

A

Bowing of legs

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14
Q

What are the other radiological features in rickets?

A
  • Joints are swollen d/t hypertrophic layer of growth plate keeps on expanding without mineralization
  • Cupping of metaphysis
  • Splaying of metaphysis
  • Fraying of metaphysis
  • Widening of epiphyseal plates

Most of deformities are reversible on Tx with vit.D

Osteoclasts cannot act on improperly ossified bone.

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15
Q

What is the treatment of rickets and Osteomalacia?

A

STOSS regimen:
* 3 lakh- 6lakh IU deep IM or oral (stat or over 1-5days)
* Daily: 2k - 5K IU for 4-6 weeks
* Weekly: 50k - 60k IU for 8-12 weeks

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16
Q

What is the treatment of deformity in rickets?

A
  • Mermaid splint and vitamin D therapy
  • Surgery for deformity correction.
  • Young: Wait for remodeling
  • Older child: Osteotomy after the bone activity is reduced which is assessed by bone turnover (Normal serum ALP)
17
Q

What is healing rickets

A

Dense mineralization of growth plate.

Whiteline of frankel: Thick band of calcification on the metaphysis

18
Q

What is the best method to assess the healing rickets?

A

X-ray > Serum ALP

19
Q

What are the characteristics of osteomalacia?

A
  • Occurs after skeletal maturity
  • Females > Males
  • seen in Young people
  • Presentation: Polyarthralgia, bone pains, proximal myopathy
20
Q

What deformity can be seen in osteomalacia?

A

Milkman’s fractures or Looser zone or Pseudo fractures or cortical infarctions.

21
Q

What is Milkman’s fracture or Cortical infarctions?

A
  • Pulsations from the arteries around the bone can cause stress fractures which heal by the callus which deficient in mineral.
  • These appear as transverse bands of rarefraction which are perpendicular to long axis of bone
22
Q

What is the most common location of cortical infarction or milkaman’s fractures?

A

MC sites: Neck of femur, clavicle, ribs, scapula, pubic ramus

23
Q

What are the other conditions where looser zone or milkman’s fractures can be seen?

A
  • Hypothyroidism
  • Paget’s disease
  • Fibrous dysplasia
  • Osteogenesis imperfecta
  • Renal osteodystrophy
  • X linked hypophosphatemic rickets
24
Q

What are the other deformities can be seen in osteomalacia?

A
  • Triradiate pelvis
  • Trefoil pelvis
  • Protrusio acetabuli
  • Champange glass pelvis (also seen in achondroplasia)
25
Q

What are the tumors that induce osteomalacia?

A
  • Fibrosarcoma
  • Osteoblastoma
  • Osteosarcoma
  • Non-ossifying fibroma
26
Q

What is scurvy?

A

Collagen maturity deformity because of vitamin C deficiency.
Laboratory values are normal as mineralisation is normal.

27
Q

What are clinical manifesation of scurvy on bone?

A

Neet PG 2023 (1 decks)

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