Medicine Finals > MSK > Flashcards

MSK Flashcards

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1
Q

If a patient needing bone protection is unable to tolderate bisphosphonates, what are some alternative medications that can be trialled?

A
  • Denosumab (most common)
  • Romosozumab
  • Teriparatide
  • Hormone replacement therapy
  • Raloxifene
  • Strontium ranelate
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2
Q

Is Azathioprine teratogenic?

A

no, can be taken throughout pregnancy

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3
Q

What advice should be given to patients who regularly take Methotrexate, but are looking to concieve?

A

Patients using methotrexate require effective contraception during and for at least 6 months after treatment in men or women

So, stop the methotrexate for at least 6 months before trying for a baby

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4
Q

What is Padget’s disease of the bone?

A

It involves excessive bone turnover (reabsorption and formation) due to increased osteoclast and osteoblast activity

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5
Q

How does the increased bone turnover in Padget’s present?

A

This excessive turnover is not coordinated, leading to patchy areas of high density (sclerosis) and low density (lysis)

The result is enlarged and misshapen bones, structural problems and an increased risk of pathological fractures. It particularly affects the axial skeleton (the bones of the head and spine)

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6
Q

Blood results in Padget’s disease of the bone? (Ca, Pho, ALP)

A
  • Raised ALP
  • Normal calcium
  • Normal phosphate
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7
Q

Key complications of Padget’s disease of the bone

A
  • Hearing loss (if in bones of the ear)
  • Heart failure (hypervascularity of the abnormal bone)
  • Osteosarcoma
  • Spinal stenosis
  • Spinal cord compression
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8
Q

Presentation of Padget’s disease of bone

A
  • bone pain
  • bone deformity
  • fractures
  • hearing loss
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9
Q

X-ray findings in Padget’s

A
  • Bone enlargement and deformity
  • Osteoporosis circumscripta (well-defined osteolytic lesions that appear less dense compared with normal bone)
  • Cotton wool appearance of the skull (poorly defined patchy areas of increased and decreased density)
  • V-shaped osteolytic defects in the long bones
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10
Q

Mainstay treatment of Padget’s disease of the bone

A

Bisphosphonates
- Calcitonin
- Analgesia (NSAIDs)
- Calcium and vitamin D
- Surgery to treat deformity and fractures

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11
Q

What is myeloma?

A

Cancer of the plasma cells in the bone marrow

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12
Q

What is an M protein in myeloma?

A

an abnormal part of an antibody which is produced in large numbers in myeloma

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13
Q

What is MGUS?

A

Monoclonal gammopathy of undetermined significance is a condition where an abnormal paraprotein is released but there are no other symptoms of myeloma or cancer.

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14
Q

Four features of myeloma (CRAB)

A

Calcium (rasied)
Renal failure
Anaemia
Bone lesions and pain

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15
Q

What is a ‘pepper-pot skull’ / ‘raindrop skull’?

A

It efers to multiple lytic lesions seen in the skull on an x-ray in myeloma

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16
Q

When does the parathyroid gland produce parathyroid hormone?

A

When it detects:
- low calcium
- high phosphate

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17
Q

How does PTH affect the bone?

A

Causes bone resorption, osteoclasts (bone eating cells) release calcium and phosphate into the blood from bone

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18
Q

How does PTH affect the kidneys?

A
  • Increases calcium reabsorption
  • decreases phosphate reabsorption
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19
Q

How does PTH affect the bowels?

A

Calcium and phosphate absorption increased

This is due to the kidneys turning the inactive form of vitamin D into the active form (Calcitriol / 1,25 dihydroxyxholic calciferol)

This targets the gut increasing absorption of calcium and phosphate

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20
Q

What effect does incerased active vitamin D have on the PT gland?

A

Negative feedback, doesn’t need to make as much PTH

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21
Q

Most common cause of primary hyperparathyroidism?

A

Adenoma (benign growth on thyroid gland)

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22
Q

What causes primary hyperparathyroidism?

A

Negative feedback telling PT gland to stop producing PTH is ineffective - lots of PTH continually being produced due to adenoma

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23
Q

Presentation of primary hyperparathyroidism

A
  • polyuria as peeing out lots of calcium and phosphate (get hypercalciuria, but hypophosphataemia as phosphate low in blood)
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24
Q

Treatment for primary parathyroidism

A

Surgical: Thyroidectomy
Medical: Calcimetics (mimics calcium, thinks it has more, so reduces PTH secretion)

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25
Pseudogout associated conditions:
- Haemochromatosis - Hyperparathyroidism - Acromegaly - Wilson's disease - Low Mg, low Pho
26
Name a specific x-ray finding whihc is found in pseudogout but not gout
Chondrocalcinosis
27
What is the special test done on examination of a suspected achilles tendon rupture?
Thompson (calf squeeze) test - failure of the foot to plantarflex indicates a rupture
28
What is the imaging modality of choice for suspected achilles tendon rupture?
Ankle ultrasound
29
What is the Simmond's triad in Achilles tendon rupture?
- Resting ankle dorsiflexion in a prone position with knees bent - Palpable gap above the heel - Lack of plantar flexion when the calf is squeezed (Thompson's test positive)
30
Most common nerve injury due to recent Colle's fracture
Median nerve injury - weakness or loss of thumb or index finger flexion
31
Bones involved in ankle fractures
- Lateral malleuolus (distal fibula) - Medial malleolus (distal tibia)
32
What classification system is used to describe fractires of the distal fibula?
Weber classification
33
What are the 3 Weber classifications for ankle fractures?
- Type A - below the ankle joint (syndesmosis intact) - Type B - at level of ankle joint (syndesmosis will be intact or partially torn) - Type C - above the ankle joint (syndesmosis will be disrupted)
34
What is the syndesmosis?
The fibrous join between the tibia and fibula - very important for the stability and function of the ankle joint (tib/fib ligament)
35
Ligaments join ______ to ________
bone to bone
36
Tendons join ____ to ________
skeletal muscles to bones
37
Typical history of injury from patient with an achilles tendon rupture
- Sudden onset of pain in the Achilles or calf - A snapping sound and sensation - Feeling as though something has hit them in the back of the leg
38
Management of achilles tendon rupture
- Orthopedic review on same day Immediate mangement: - Rest and immobilisation (VTE prophylaxis should be considered while ankle is immobilised) - Ice - Elevation - Analgesia
39
Surgical and non-surgical management of an achilles tendon rupture
Surgical = reattach the achilles, special boot to immolilise ankle and keep foot plantar felxed and gradually adjusted to a neutral position (long rehabilitation) Non-surgical = just the special boot, but start using one that keeps foot fully plantar-felxed, than gradually back to neutral position (6-12 week process and long rehabilitation)
40
First initial management in a fracture where distal pulses are absent
reduce the fracture (put back into correct position)
41
What is a monteggia fracture?
Both: - Fracture of ulna - Dislocation of radial head commonly seen in children aged between 4 and 10 years
42
What is the most common location of a metataral stress fracture in the foot?
2nd metatarsal shaft (long foot bones, between carpal bone and start of phalanges / actual toe bones)
43
When would a hemiarthroplasty be preferred over a total hip replacement in a patient with a displaced intracapsular NOF?
Hemi is preferred in patients with lots of co-morbidities such as dementia as there is a lower risk of hip disolocation
44
When a scaphoid fracture involves the proximal pole of the scaphoid, what is the optimal management?
Surgical fixation
45
First line antibiotic therapy for septic arthritis
IV flucloxacillin
46
Blood levels in polymyalgia rheumatica (ESR, CRP, anti-CCP, CK)
- Raised CRP + ESR - normal anti-CCP - normal CK
47
What does juxta-articular osteoporosis / osteopenia mean?
Localized reduction of bone density specifically around a joint, serving as an early radiographic sign of inflammatory arthritis, most commonly rheumatoid arthritis
48
Medication used in Sjogren's to stimulate saliva production
Pilocarpine
49
What is fat embolism syndrome?
a rare, potentially life-threatening condition where fat globules (emboli) enter the bloodstream, usually following long bone or pelvic fractures, resulting in widespread vascular blockage, inflammation, and organ dysfunction
50
Features of fat embolsim syndrome (FES)
- tachycardia - tachypnoea - hypoxia (72 hrs post) - pyrexia - petechial rash - confusion and agitation - retinal haemorrhages
51
Tennis vs golf elbow
Tennis = lateral epichondylitis, pain on supination of forearm
52
Sjogren's complications / associated conditions
- pneumonia - bronchiectasis - non-hodgkins lymphoma - peripheral neuropathy - vasculitis - renal impairment
53
What is the formal name for 'brittle bone syndrome'?
Osteogenesis imperfecta
54
Features of osteogenesis imperfecta
- recurrent inappropriate fractures - hypermobility - blue / grey sclera - triangular face - short stature - deafness from early adulthood - dental problems, formation of teeth - bone deformities, bowed legs, scloliosis - joint and bone pain
55
What causes osteogenesis imperfecta?
range of genetic mutations that affect the formation of collagen (8 subtypes depending on how the protein is affected and its severity)
56
Management of osteogenesis imperfecta
- Bisphosphonates to increase bone density - Vitamin D supplementation
57
Bechet's disease triad
- painful oral and genital ulcers - skin lesions (erythema nodosum, acne type lesions called pathergy at needle injury sites...) - eye problems (uveitis, scleritis...)
58
What causes Bechet's disease?
Form of primarilty small vessel vasculitis (can affect arteries and veins of all sizes) Autoimmune basis, infection trigers (strep sanguis, HSV, hepatitis, parovirus B-19)
59
Marfan's syndrome is caused by a defect in the __________ protein
fibrilin 1
60
Limited systemic sclerosis is associated with which autoantibody?
anti-centromere
61
What is polyarteritis nodosa (PAN)?
Polyarteritis nodosa (PAN) is a vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation.
62
Who gets polyarteritis nodosum?
more common in middle-aged men and is associated with hepatitis B infection.
63
Side effects of bisphosphonates
- oesophageal problems (inflammation, ulcers, erosions) - n+v, diarrhoea, constipation, indigestion - muscle and joint pain
64
Most common causative organism of reactive arthritis in young adults
Neisseria gonorrhoeae
65
What condition (common in runners) presents with knee pain and pain on palpation of the lateral aspect of the joint line, associated with a 'snapping' sensation?
iliotibial band syndrome
66
Calcium, phosphate, ALP and PTH levels in osteomalacia (high, low, normal...)
- Low serum calcium - Low serum phosphate - Raised ALP - Raised PTH
67
When should someone start bone protection if taking steroids?
immediately (before checking their levels)
68
Difference in blood levels in osteomalacia and padget's disease of the bone
Osteomalacia: - low calcium - low phosphate - raised ALP - raised PTH Padget's: - normal calcium - normal phosphate - raised ALP
69
What structure is actually inflamed in reactive arthritis?
synovium (cushion between joints)
70
Most common STI causing reactive arthritis
Chlamydia
71
Most common STI causing septic arthritis
gonorrhoea
72
What gene would someone who gets raactive arthritis be positive for?
HLA-B27 (seronegative spondyloarthropathy)
73
In a patient with reactive arthritis, is the synovial fluid culture positive or negative?
negative
74
Management of confirmed reactive arthritis
- NSAIDs - steroid injections - systemic steroids If reccurent: - DMARDs - Anti TNF
75
What are phalen's and tinel's tests for carpal tunnel?
phalen's = wrist flexion recreated symptoms tinel's = tapping the wrist, positive if sensory symptoms recreated
76
The garden classification is used for ____________ NOF fractures
intra-capsular
77
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