UW revision avascular necrosis + diabetic neuropathy 12-26 (1)

Question 1

etiology:
…..
alcohol abuse
SLE
Antiphospholipid syndrome
Hemoglobinopathy (eg sickle cell)
Infection (eg osteomyelitis, HIV)
Kidney transplantation
Decompression sickness

Answer 1

steroid use

Question 2

etiology:
steroid use
…
SLE
Antiphospholipid syndrome
Hemoglobinopathy (eg sickle cell)
Infection (eg osteomyelitis, HIV)
Kidney transplantation
Decompression sickness

Answer 2

alcohol use

Question 3

etiology:
steroid use
alcohol abuse
…
Antiphospholipid syndrome
Hemoglobinopathy (eg sickle cell)
Infection (eg osteomyelitis, HIV)
Kidney transplantation
Decompression sickness

Answer 3

SLE

Question 4

etiology:
steroid use
alcohol abuse
SLE
…..
Hemoglobinopathy (eg sickle cell)
Infection (eg osteomyelitis, HIV)
Kidney transplantation
Decompression sickness

Answer 4

Antiphospholipid syndrome

Question 5

etiology:
steroid use
alcohol abuse
SLE
Antiphospholipid syndrome
…..
Infection (eg osteomyelitis, HIV)
Kidney transplantation
Decompression sickness

Answer 5

Hemoglobinopathy (eg sickle cell)

Question 6

etiology:
steroid use
alcohol abuse
SLE
Antiphospholipid syndrome
Hemoglobinopathy (eg sickle cell)
….
Kidney transplantation
Decompression sickness

Answer 6

Infection (eg osteomyelitis, HIV)

Question 7

etiology:
steroid use
alcohol abuse
SLE
Antiphospholipid syndrome
Hemoglobinopathy (eg sickle cell)
Infection (eg osteomyelitis, HIV)
….
Decompression sickness

Answer 7

Kidney transplantation

Question 8

etiology:
steroid use
alcohol abuse
SLE
Antiphospholipid syndrome
Hemoglobinopathy (eg sickle cell)
Infection (eg osteomyelitis, HIV)
Kidney transplantation
….

Answer 8

Decompression sickness

Question 9

CP. 3 pain and local changes

Answer 9

Groin pain on weight bearing

Pain on hip abduction and internal rotation (reduced range of motion)

No erythema, swelling or point tenderness

Early examination can be normal. reduced ROM can progress eventually

Question 10

LAbs? inflammatory

Answer 10

Normal WBC, normal CRP, normal ESR

Question 11

Radiology imaging? 2
what method to use?

Answer 11

MRI - more sensitive modality. Shows boundary between normal and ischemic bone as well as hypervascularity.

x-ray may show later in disease - Crescent sign seen in advances stage

in first few months xray can be normal (in early disease).

Question 12

what mechanism of osteonecrosis?

Answer 12

Osteonecrosis can develop in disorders that disrupt the circulation of bone through microocclusion, abnormal endothelial function, or increased intraosseous pressure

Question 12

osteonecrosis = avascular necrosis

Answer 12

.

Question 13

Diabetic neuropathy. 2 deformities?

Answer 13

Hammer toe
Claw toe

Question 14

Hammer toe, flexions?3

Answer 14

DORSAL flexion at DIP
Plantar flexion at PIP
Dorsal flexion at MTP

Question 15

Claw toe. flexions?

Answer 15

PLANTAR flexion at DIP
Plantar flexion at PIP
Dorsal flexion at MTP

Question 16

deformities. causes?

Answer 16

simple mechanical problems - chronically ill-fitting shoes.
But in longstanding DM patients = diabetic peripheral neuropathy

Question 17

deformities are common in elderly and reflect an IMBALANCE IN STRENGTH and FLEXIBILITY between the flexor and extensor muscle groups.

Answer 17

.

Question 18

Claw/hammer deformities VS Interdigital (Morton) neuroma?

Answer 18

Interdigital (Morton) neuroma - affects interdigitals nerves. Numbness/pain between the 3rd and 4th toes. No deformities

Question 19

Claw/hammer deformities VS Plantar fasciitis?

Answer 19

Plantar fasciitis - Heel pain that is wort when standing on hard surfaces, esp. with the first steps of the day.