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R - MSK Pathologies (Meg & Rach) > wanna bone > Flashcards

wanna bone Flashcards

1
Q

what is developmental dysplasia of the hip

A

socket of the hip does not fully cover the head of the femur and femur is at risk of dislocating

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2
Q

what can cause developmental dysplasia of the hip/what are risk factors

A 
anything that decreases the space for the baby in the womb 
first born 
oligohydramnios 
female 
over 10 pounds 
other bone deformities 
breech birth
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3
Q

what are clinical indications of developmental dysplasia of the hip

A 
leg length discrepancy 
limp  
barlows sign 
ortolani's sign
piston motion sign 
hamstring sign
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4
Q

what are barlow, ortolani, piston motor and hamstring signs?

A

barlow - adduct hip and apply pressure on knee a loose hip will slip out the socket
ortolani - do after barlow, flex hips and knees and put pressure on greater trochanters then abduct, hip may pop back in
piston motion sign - as leg is moved longitudinally it moves and it shouldn’t
hamstring sign - can move thigh to abdomen and fully extend knee

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5
Q

what investigations could you do for DDH

A

Ultrasound is gold standard
x-ray
US if patient is at risk - family history etc

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6
Q

how do you manage DDH

A

<3 months - splint/pavlik harness
3-12 months - closed recuction and spica cast
1yr - 18 months - open reduction with capsule reefing
>18 months - open reduction with femoral shortening
>6 + bilateral - don’t operate
10+ - don’t intervene

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7
Q

what is perthes disease

A

avascular necrosis of head of femur/hip
fragmentation - osteoclasts remove dead bone
re-ossification and healing - osteoblasts lay down new growth models

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8
Q

what are risk factors for perthes disease

A 
primary school aged boy 
overweight 
family history 
low social status
4-12 yrs
most common in ages 5-8
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9
Q

how does perthes disease present

A

groin pain relieved on rest
knee and thigh pain on exercise
stiff hip

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10
Q

What is the blood supply to the hip?

A

The medial and lateral circumflex arteries.

the artery of the ligamentum teres.

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11
Q

what investigations could you do for perthes disease

A

X-ray
herring grade - see how much of the head is involved (grade B is worst prognosis)
stulberg classification for ‘roundness’

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12
Q

how could you treat perthes disease

A 
maintain hip motion 
analgesics 
splints 
physio 
supervised neglect 
osteotomy can be considered in 7+
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13
Q

what is slipped upper femoral epiphysis

A

when the head of the femur slips off the shaft at the growth plate

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14
Q

what are risk factors for SUFE

A

boys
overweight
endocrine abnormalities like hyperthyroidism

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15
Q

what are symptoms of SUFE

A 
pain in groin 
hip and knee pain 
inability/painful to bear weight
shorter leg
inability to internally rotate leg - hip help in external rotation
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16
Q

fuck

A

this

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17
Q

what investigations could you do for SUFE

A

X-ray - klein’s line for trehowan’s sign

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18
Q

how can you manage SUFE

A

surgery to fixate with a screw
splints
don’t try to reduce - might damage blood supply and cause AVN.

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19
Q

what is osteomyelitis

A

infection of the bone
acute inflammation destroys the bone as well as the bacteria
sequester of bone occurs
can be haematogenous spread, local spread via infection in skin,
can become chronic

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20
Q

what are causes/risk factors for osteomyelitis

A 
sickle cell anaemia 
HIV
TB
surgery 
open fracture 
immunocompromised
diabetes
steroids
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21
Q

cba

A

cba

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22
Q

what are the symptoms of osteomyelitis

A

in children the joint is usually very sire, reluctance to bear weight, joints held flexed, systemically unwell
in adults the thoracolumbar spine is usually effected causing pain and stiffness

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23
Q

what investigations would you do for osteomyelitis

A 
MRI
X-ray
US
biopsy 
blood cultures - 3 at peak temps 
bloods for WBC count, CRP. ESR
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24
Q

how could you manage osteomyelitis

A

antibiotics
rehydration
analgesics
if severe surgery to debride dead tissues may be needed

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25
Q

when does chronic osteomyelitis come on and how do you manage it

A

usually presents in 70s
old wounds reopen and can spit out dead tissue and bone
give long term antibiotics
may need surgery where joint is filled with collatamp
may need amputation

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26
Q

what is cauda equina syndrome

A

compression of the cauda equina

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27
Q

what can cause cauda equina syndrome

A 
lumbar IV disk prolapse 
tumours 
trauma 
infection 
recent surgery
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28
Q

what are symptoms of cauda equina syndrome

A

sudden leg weakness
incontinence
bilateral buttock and leg pain

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29
Q

what investigations could you do for cauda equina syndrome

A

urgent MRI
PR exam for anal tone
CT

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30
Q

how do you manage cauda equina syndrome

A

operate within 48 hours

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31
Q

what is spinal claudication

A

compression of spinal nerves

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32
Q

what can cause spinal claudication

A

prolapsed disk
osteophytes
osteoarthritis
tumours

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33
Q

how does spinal claudication present

A

pain and tingling on exercise
sensory problems
worse on extension

34
Q

what investigations could you do for spinal claudication

A

3CT
MRI
X-ray

35
Q

how could you manage spinal claudication

A

treat underling cause - surgical decompression

steroid injection to nerve root or epidural injection

36
Q

what is scoliosis

A

more than 10 degrees coronal deviation of spine

37
Q

what causes scoliosis

A

abnormalities in vertebral segmentation

38
Q

how does scoliosis present

A

visible deviation of spine

more obvious when patient leans forward

39
Q

what investigations could you do for scoliosis

A

regular x-rays to look at progress

40
Q

how can you manage scoliosis

A

watchful waiting
back braces or casts
surgery

41
Q

what is paget’s disease of bone

A

disorder of bone turnover
more new bone and vessels are formed
causes disorganised larger less compact bone with more vasculature
more likely to fracture

42
Q

what causes paget’s disease of bone

A

genetics

environment

43
Q

what are risk factors for paget’s disease of bone

A

anglo-saxon origin

over 40

44
Q

how does paget’s disease present

A

deep constant bone pain usually in long bones, pelvis
nerve deafness
bone deformity
heat over bone

45
Q

what investigations can you do for paget’s disease

A

isotope bone scan
x-ray
elevation of serum alkaline phosphatase

46
Q

how can you manage pagets disease

A

dont need to treat unless in the skull or in an area requiring surgical intervention
IV bisphosphonates

47
Q

what is osteomalacia

A

bones weaken

osteoalacia is term used for adults

48
Q

what is childhood rickets

A

weakened bones in children

before the growth plated close

49
Q

what causes osteomalacia/rickets

A

insufficient mineralisation

calcium or vitamin D deficiency

50
Q

what are risk factors for osteomalacia

A

age

asian

51
Q

how does osteomalacia/rickets present

A

bone pain
muscle weakness
increased falls risk

52
Q

what investigations could you do for osteomalacia/rickets

A 
x-ray for microfractures
DEXA
serum calcium and phosphate (may be low)
serum vitamin D 
PTH levels
53
Q

how do you manage osteomalacia/rickets

A

correct deficiency

54
Q

what is osteogenesis imperfecta

A

genetic disorder
type 1 collagen defect
causes brittle bones prone to fractures

55
Q

what are the different types of osteogenesis imperfecta

A

type 1 - milder, presents when child starts to walk of in adults
type 2 - lethal by age 1
types 3 and 4 - like 1 but more severe with faster progression and earlier onset blindness

56
Q

what causes osteogenesis imperfecta

A

genetic

marfan’s is a risk factor

57
Q

how does osteogenesis imperfecta present

A 
fragile bones 
pathological fractures 
short stature 
growth deficiency
hearing loss 
easy bruising 
scoliosis 
tooth malformation 
hypermobility
blue sclera
58
Q

g

A

b

59
Q

what investigations do you do in osteogenesis imperfecta

A

US for type 2
X-ray - cortical thinning, cystic metaphyses, osteoporosis, calcifiction
biopsy
Ca in urine

60
Q

how do you manage osteogenesis imperfecta

A

surgery to treat fractures, intermedulary nails in children
bisphosphonates
lifestyle advice
genetic counselling

61
Q

what is osteoporosis

A

genetic disease
bone reabsorption overpowers bone formation
low bone mass and micro architectural deformation
bones are likely to fracture

62
Q

what causes osteoporosis

A 
low sex hormones 
cushing's 
hyperprolactaemia 
hypopituitarism 
rheumatoid arthritis 
ulcerative colitis 
chron's 
malabsorption 
PPIs
63
Q

how does osteoporosis present

A

asymptomatic until fracture

64
Q

what investigations could you do for osteoporosis

A

FRAX to assess fracture risk

DEXA scan if FRAX is significant - look at Z score for age group >2.5 below mean = osteoporosis

65
Q

how can you manage osteoporosis

A 
minimise lifestyle factors - smoking, obesity, steroids, low Ca in diet 
bisphosphonates
correct any hormone deficiency 
SERMs (block effect of oestrogen)
denosumab - safe in renal impairment 
teriparatide - last resort
66
Q

what is femeroacetabular impingement

A

bony deformity that restricts movement of hip
can be cam lesion - the head to neck ratio of the femur is decreased - basically gets fatter
pincer lesion - the acetabulum extends too much over the head

67
Q

what are risk factors for FAI

A

active female
RA
marfan’s

68
Q

how does FAI present

A

block to movement
painful in some manoeuvres - cam is painful in flexion
groin pain
reduced flexion and internal rotation

69
Q

what investigations could you do for FAI

A

X-ray
MRI
positive FABER test

70
Q

how could you manage FAI

A 
NSAIDs
physio
arthroscopy 
open surgery 
hip arthroplasty/replacement
71
Q

What is the most common cause of septic arthritis in young people?

A

Neisseria Gonorrhoea

72
Q

What is the broad spectrum antibiotics first used in septic arthritis?

A

flucloxacillin and rifampicin or benzylpenicillin (vancomycin of MRSA)

73
Q

What is the most unique presentation of osteogenesis imperfecta?

A

recurrent and inappropriate fractures.

BLUE/GREY SCLERA,

74
Q

What is the difference between osteoporosis and osteomalacia?

A

In osteoporosis the bones are pores and brittle. In osteomalacia the bones are under mineralised and soft.

75
Q

What are the most common fractures in osteoporosis?

A

Vertebral body compression
Scapula
Femoral head
distal radius

76
Q

What are key risk factors of osteoporosis?

A

Females - menopause (oestrogen is protective)
SSRI - depression
PPIs
anti-epileptics.
long term corticosteroids >7.5mg for >3 months

77
Q

What is FRAX tool?

A

1st investigation done in osteoporosis - gives result of a percentage of a 10 year probalility of a hip fracture.
Bone mineral density - DEXA scan.

78
Q

How is bone mineral density measured?

A

DEXA scans - the reading at the hip is the key one.
T score - average healthy young adult (most important - measured at hip)
Z score - average for their age

79
Q

What is the definition of osteoporosis?

A

less than -2.5 T score.

80
Q

What is the treatment for osteoporosis?

A

1st line - bisphosphonates - zolandronic acid, alandronic acid, risedronate.

81
Q

What is cerebral palsy?

A

A permanent, non-progressive brain disorder causing motor problems.

82
Q

What is the cause of cerebral palsy?

A

Damage to the brain before birth or in the 1st 2 years of life.

R - MSK Pathologies (Meg & Rach) (11 decks)

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