Week 8- Bones, Joints And Soft Tissue

Question 1

What is osetopetrosis

Answer 1

Rare genetic disease

Reduced bone restoration due to deficient osteoclasts development/ function which leads to diffuse symmetric skeletal sclerosis

Results in brittle and fragile bones

Identified in utero or soon after

Hydrocephaly (abnormal buildup of CSF)

Postpartum mortality
Severe cranial nerve defects

Question 2

What is the difference between primary and secondary osteoporosis

Answer 2

Primary= idiopathic, post menopausal (decreased oestrogen or progesterone)
Senile (vitamin D)

Secondary= hyperthyroidism, malabsorption of calcium or vit D, alcohol, smoking

Question 3

List clinical features of osteoporosis

Answer 3

Vertabral fractures
Painful, loss of height
Lumbar lordosis and kyphosis

Compression factors in mid back region

Question 4

What can fractures of the femoral neck, pelvis or spine cause

Answer 4

Immobilisation and complications such as
Pulmonary embolism
Pneumonia

Question 5

What is osteomalacia and rickets

Answer 5

Impaired mineralisation of bone matrix
Rickets= children
Adults= osteomalacia
Vitamin D= metabolism or deficiency

Question 6

What is hyperparathyroidism

Answer 6

Increased bone restoration
Primary- excessive or inappropriate PTH secretion
Secondary- renal disease

Signs and symptoms= osteoporosis
Brown tumours (haemorrhage, ingrown fibrous tissue)

Routin blood tests will detect early

Question 7

What is renal osteodystrophy

Answer 7

Skeletal changes which occur in chronic renal disease

-osteoporosis
- growth retardation
-secondary hyperthyroidism

Set,m from decreased tubular, glomerular and hormonal renal function s

Question 8

What is Paget’s disease

Answer 8

Increased, disordered, structurally unsound bone mass

3 stages:
1.initial osteolytic stage (increase osteoclasts)
2.mixed osteoclasts-osteoblasts stage
3.burned out quiescent osteclerotis stage (increase osteblasts)

Mc in over 50
Caucasians
M>F
2-3% POPULATION

Axial Skelton and proximal femur (80% of cases)
Asymptomatic
Pain - compression of facial nerves
Heavy cranium
Secondary OA
Ant bowing of femur and tibia
Heavy cranium

Can be caused by steroid use. Heavy eyebrows

Question 9

List different types of fractures

Answer 9

 Simple: the overlying skin is intact.
 Compound: the bone communicates with the skin surface.
 Displaced: the ends of the bone at the fracture site are not aligned.
 Stress: slowly developing fracture that follows a period of increase physical
activity in which bone is subjected to repetitive loads.
 Greenstick: extending only partially through the bone, common in infants when
bones are soft.
 Pathological: bone weakened by underlying disease process

Question 10

Describe fracture repair

Answer 10

1. Hematoma formation
   ]blood vessels in bone and surrounding tissues rupture at fracture site forming a hematoma.
   Inflammation occurs, releasing growth factors.

2.Fbirocartilaginous Callus Formtaion
Fibroblasts and chondroblasts produce collagen and cartilage forming a soft callus, bridging broken ends of bone

3.Bony callus formation
Osteoblasts replace soft callus with hard vine callus made of bone, stability

4.bone remodelling
Osteoclasts and osteboblasts remodel bony callus into compact bone
Bones shape, structure and Trent’s is restored

Question 11

What is osteomyelitis

Answer 11

Inflammation of bone and marrow secondary to infection
Virus, bacteria (80-90%) fungi, parasites

S&S:
Malaise, fever, chills
Leukocytosis: release inflammatory cells to fight bacteria
Intense throbbing over infected bone

Question 12

What are bone tumours and tumour like lesions

Answer 12

Primary bone tumours
-50% survival
-propensity for long bones
-Beningn: mostly asymptomatic. Identified incidnelty, some produce pain

MC primary bone tumours:osteosarcoma, chondrosarcoma, ewing sarcoma

Question 13

What is osteoid osteoma

Answer 13

13% primary bending bone tumours
Small
Limited growth potential
Severe localised pain which is worse at night. Relieved by aspirin and anti inflammatory meds

Imaging: well defined, round, lucent tumours, surrounded by zone of sclerosis

X-ray

Question 14

What is osteoblastoma

Answer 14

Uncommon
Large tumour
Locally aggressive
Constant achy pain
Expansive, well defined, oval, missed lyric and blasting mass

Question 15

what is osteochondroma

Answer 15

Cartilaginous tumour
MC beningn
Attached to skeleton by bony stalk
Cured by simple excision
Form in endochonral origin

Question 16

What is chondroma

Answer 16

Benign tumour of hyaline cartilage occurring in bone or endochonral origin
Intraosseous cartilage tumour
Solitary
Hands, feet

Question 17

What is osteosarcoma

Answer 17

MC Primary malignant tumour of the bone
(20% of all bone cancers)
• 75% occur before 20 y.o
• 2nd peak in older adults (2nd to Pagets,
radiation etc)
• M>F (1.6:1)
• 50% in the knee in the distal femur or
proximal tibia
• Painful
• Codman Triangle indicates aggressive
tumour
• 5 year survival rate >70%

Question 18

What is chondrosarcoma

Answer 18

• Malignant cartilage-producing tumours.
• 2nd mc malignant tumour of bone.
• >40 y.o.
• M>F (2:1)
• Typically arise in axial skeleton, pelvis, shoulder and ribs.
• Distal extremities rarely involved
S&S
• Painful
• Progressively enlarging mass
• Grade 1 (90%) 5 year survival, Grade 3, 43%

Question 19

What is Ewing sarcoma

Answer 19

• Accounts for 6-10% of primary malignant bone tumours
• 2nd mc bone sarcoma in children
• 80% <20 y.a.
• M>F
• Caucasians
• African & Asian descent individuals rarely affected
• Long tubular bones (femur, pelvis)
• Painful, enlarging mass
• Affected site is tender, warm and swollen
• Mimic’s infection (fever, increased ESR)
• Aggressive but 75% 5 year SR & 50% LT cure rate

Question 20

What is giant cell tumour

Answer 20

Benign but can be locally aggressive
30-50years

Question 21

What is aneurysmal bone cysts (ABC)

Answer 21

-multiloculated blood-filled spaces
-mc in adolescence
-mc in demur, tibia and vertabral (posterior)
-locals pain and swelling
-may result on limp or nerve compression

Question 22

What is fibrous dysplasia

Answer 22

Benign
Localised development arrest
Components of bone but they do not differentiate into mature structures

S&S= lesions raise during skeletal development
Femur, tibia, jaw, cranial bones
Often asymptomatic
May cause pain, leg length discrepancy and pathological

Question 23

What is metastasis

Answer 23

MC form of skeletal malignancy,
• Via direct extension, lymphatic or haematogenous dissemination.
• 75% of metastasis originate from cancers of the prostate, breast,
kidney and lung.
• Poor prognosi

Question 24

What is osteoarthritis

Answer 24

• Aka Degenerative Joint Disease (DJD)
• Characterised by cartilage degeneration
structural and functional failure of synovial joints
• Insidious onset
• Oligoarticular (affecting a few joints)
• MC Primary/Idiopathic OA (age)
• 2nd causes in younger people result from joint deformation, previous
joint injury, DM, obesity, underlying systemic diseas

-females= knees and hands
-males= hips
40% people over 70
Degeneration of articyalr cartilage and disordered repair
Bio mechanical stress is primary pathogenic mechanism

S&S
• Asymptomatic until >50 years
• Decreased ROM
• Deep, achy pain
• Osteophytes - nerve root
compression, radicular pain, muscle atrophy
• Worsens with use - radicular pain
• Morning stiffness - muscle
atrophy/spasms
• Crepitus

Question 25

Name the node in PIP

Answer 25

-Buchards nodes are bony enlargements that occur in the proximal interphalangeal joints and a hallmark of OA
-Develop due to chronic inflammation and joint damage caused by degeneration
-Sclerosis,
-osteophytes form wideneing the joint space. -Floating cartilage in joint, decreasing ROM
-Bone on bone
-Crepitus
-Unilateral because wear and tare

Question 26

Name the node in the distal interphalangeal joints

Answer 26

Heberdens nodes
Bony enlargements due to degeneration
Wear and tear
Chronic inflammation
Pain and tenderness
Stiffness and reduced ROMS
Pain may decrease but nodes persist as permanent deformities

Question 27

Which genes are passed on for RA

Answer 27

HLAB27

Question 28

What is Rheumatoid Arthritus

Answer 28

-Chronic auto immune (women) disorder that affects joints
-mc in women 3:1
-RA occurs when immune system mistakenly attacks the synovium (lining of joints) causing inflammation that can damage the cartilage and bone within joints
-extraarticular lesions: heart, eye, skin, lungs, blood vessels as it is systemic
-avoid cervical spine adjustments as it can affect the integrity of transverse spinal ligament
- diagnosis in blood tests as there will be an increased in CRP and HLAB27
-symmetrical joint pain

-more swelling
-deviation of ulnar (swan neck)
-morning stiffness, spasms which doesn’t subside with activity
-warm and painful joints
-radial deviation of wrist
-ulnar deviation of fingers
-swan neck fingers

Question 29

What is analysing spondylitis

Answer 29

• Destruction of articular cartilage and bony ankyloses
• MC in sacroiliac and vertebral apophyseal joints between tuberosities and
processes
• Presents as LBP & spinal immobility
• 2nd – 3rd decade of life
• Peripheral joints (hips, knees, shoulders) are involved in 1/3rd cases
• 90% are HL-B27 positive

Question 30

When would you get reactive arthritis

Answer 30

Post infections
Post shingles

Affects heels, toes, fingers low back, knees and ankles

Question 31

What is polymalgia rheumatica

Answer 31

• Muscle pain and stiffness in B shoulders, upper arms, hips, neck, wrist elbows or knees.
• Sunrise stiffness or after being inactive for a time
• Systemic S&S
• >65 y.o.a.
• Caucasian women
• Linked to Giant Cell Arteritis
• ↓ROM
• Self-limiting (months-years)
• Autoimmune

-blood tests may show RF, C reactive protein, CBC, ANA, ESR

Treatment with rest and exercises, steroids

Question 32

What is gout

Answer 32

-foods high in alapurine (rich foods) forming crystals form this
-sudden onset
-excruciating pain
-hours-weeks
-lifestyle modifications: weight loss, reduced purine intake, reduce alcohol and sugar, regular exercise

-require drugs

Question 33

What is a ganglion cyst

Answer 33

Nearly always located near a joint capsule or tendon sheath
Ct degeration
Small

Question 34

What is modular fascitis

Answer 34

Self limiting
Firbobalstic prolifertaion in young adults
Trauma
Mc in formram, chest neck,
Rapid growth over weeks-months