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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
when does chronic osteomyelitis come on and how do you manage it
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
26
what is cauda equina syndrome
compression of the cauda equina
27
what can cause cauda equina syndrome
``` lumbar IV disk prolapse tumours trauma infection recent surgery ```
28
what are symptoms of cauda equina syndrome
sudden leg weakness incontinence bilateral buttock and leg pain
29
what investigations could you do for cauda equina syndrome
urgent MRI PR exam for anal tone CT
30
how do you manage cauda equina syndrome
operate within 48 hours
31
what is spinal claudication
compression of spinal nerves
32
what can cause spinal claudication
prolapsed disk osteophytes osteoarthritis tumours
33
how does spinal claudication present
pain and tingling on exercise sensory problems worse on extension
34
what investigations could you do for spinal claudication
3CT MRI X-ray
35
how could you manage spinal claudication
treat underling cause - surgical decompression | steroid injection to nerve root or epidural injection
36
what is scoliosis
more than 10 degrees coronal deviation of spine
37
what causes scoliosis
abnormalities in vertebral segmentation
38
how does scoliosis present
visible deviation of spine | more obvious when patient leans forward
39
what investigations could you do for scoliosis
regular x-rays to look at progress
40
how can you manage scoliosis
watchful waiting back braces or casts surgery
41
what is paget's disease of bone
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
what causes paget's disease of bone
genetics | environment
43
what are risk factors for paget's disease of bone
anglo-saxon origin | over 40
44
how does paget's disease present
deep constant bone pain usually in long bones, pelvis nerve deafness bone deformity heat over bone
45
what investigations can you do for paget's disease
isotope bone scan x-ray elevation of serum alkaline phosphatase
46
how can you manage pagets disease
dont need to treat unless in the skull or in an area requiring surgical intervention IV bisphosphonates
47
what is osteomalacia
bones weaken | osteoalacia is term used for adults
48
what is childhood rickets
weakened bones in children | before the growth plated close
49
what causes osteomalacia/rickets
insufficient mineralisation | calcium or vitamin D deficiency
50
what are risk factors for osteomalacia
age | asian
51
how does osteomalacia/rickets present
bone pain muscle weakness increased falls risk
52
what investigations could you do for osteomalacia/rickets
``` x-ray for microfractures DEXA serum calcium and phosphate (may be low) serum vitamin D PTH levels ```
53
how do you manage osteomalacia/rickets
correct deficiency
54
what is osteogenesis imperfecta
genetic disorder type 1 collagen defect causes brittle bones prone to fractures
55
what are the different types of osteogenesis imperfecta
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
what causes osteogenesis imperfecta
genetic | marfan's is a risk factor
57
how does osteogenesis imperfecta present
``` fragile bones pathological fractures short stature growth deficiency hearing loss easy bruising scoliosis tooth malformation hypermobility blue sclera ```
58
g
b
59
what investigations do you do in osteogenesis imperfecta
US for type 2 X-ray - cortical thinning, cystic metaphyses, osteoporosis, calcifiction biopsy Ca in urine
60
how do you manage osteogenesis imperfecta
surgery to treat fractures, intermedulary nails in children bisphosphonates lifestyle advice genetic counselling
61
what is osteoporosis
genetic disease bone reabsorption overpowers bone formation low bone mass and micro architectural deformation bones are likely to fracture
62
what causes osteoporosis
``` low sex hormones cushing's hyperprolactaemia hypopituitarism rheumatoid arthritis ulcerative colitis chron's malabsorption PPIs ```
63
how does osteoporosis present
asymptomatic until fracture
64
what investigations could you do for osteoporosis
FRAX to assess fracture risk | DEXA scan if FRAX is significant - look at Z score for age group >2.5 below mean = osteoporosis
65
how can you manage osteoporosis
``` 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
what is femeroacetabular impingement
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
what are risk factors for FAI
active female RA marfan's
68
how does FAI present
block to movement painful in some manoeuvres - cam is painful in flexion groin pain reduced flexion and internal rotation
69
what investigations could you do for FAI
X-ray MRI positive FABER test
70
how could you manage FAI
``` NSAIDs physio arthroscopy open surgery hip arthroplasty/replacement ```
71
What is the most common cause of septic arthritis in young people?
Neisseria Gonorrhoea
72
What is the broad spectrum antibiotics first used in septic arthritis?
flucloxacillin and rifampicin or benzylpenicillin (vancomycin of MRSA)
73
What is the most unique presentation of osteogenesis imperfecta?
recurrent and inappropriate fractures. | BLUE/GREY SCLERA,
74
What is the difference between osteoporosis and osteomalacia?
In osteoporosis the bones are pores and brittle. In osteomalacia the bones are under mineralised and soft.
75
What are the most common fractures in osteoporosis?
Vertebral body compression Scapula Femoral head distal radius
76
What are key risk factors of osteoporosis?
Females - menopause (oestrogen is protective) SSRI - depression PPIs anti-epileptics. long term corticosteroids >7.5mg for >3 months
77
What is FRAX tool?
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
How is bone mineral density measured?
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
What is the definition of osteoporosis?
less than -2.5 T score.
80
What is the treatment for osteoporosis?
1st line - bisphosphonates - zolandronic acid, alandronic acid, risedronate.
81
What is cerebral palsy?
A permanent, non-progressive brain disorder causing motor problems.
82
What is the cause of cerebral palsy?
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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