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Musculoskeletal > How to Treat MSK Conditions > Flashcards

How to Treat MSK Conditions Flashcards

1
Q

what is a osteogenic cell?

A

bone ‘stem cell’

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2
Q

what is a osteoblast cell?

A

bone forming cell

catalyse the mineralisation of osteoid

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3
Q

osteoblasts secrete?

A

osteoid

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4
Q

what is a osteocyte cell?

A

mature bone cell
formed when an osteoblast becomes imbedded in its secretions
sense mechanical strain to direct osteoclast and osteoblast activity

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5
Q

what is a osteoclast cell?

A

‘Bone breaking’
Dissolve and resorb bone by phagocytosis
Derived from bone marrow

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6
Q

list some functions of bone

A

protection
support
resist stresses produce by weight of movement

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7
Q

repeated structural units of bone are called?

A

osteons

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8
Q

osteons are composed of?

A

concentric lamellae around a central Haversian canal

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9
Q

Haversian canals contain?

A

contain blood vessels, nerves and lymphatics

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10
Q

what are lacunae?

A

small spaces containing osteocytes

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11
Q

Tiny ______ radiate from lacunae filled with ___________.

A

Canaliculi

extracellular fluid.

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12
Q

What is a Volkmans canal?

A

transverse perforating canals

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13
Q

what is the periosteum?

A

connective tissue covering

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14
Q

the medullary cavity contains?

A

yellow bone marrow

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15
Q

outline the mechanisms of bone fracture

A

trauma: high or low energy
stress: abnormal stresses on normal bone
pathological: normal stresses on abnormal bone

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16
Q

give examples of pathological causes of fracture

A 
osteoporosis
malignancy (primary, bone mets)
vitamin D deficiency (osteomalacia, rickets)
osteomyelitis
osteogenesis imperfecta
pagets
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17
Q

what is Wolff’s Law?

A

bone grows and remodels in response to the forces that are placed on it

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18
Q

clinical signs of fracture

A 
pain 
swelling
crepitus
deformity
adjacent structural injury: nerves, vessels, ligament, tendon
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19
Q

investigations for suspected fracture

A

radiograph
CT
MRI
bone scan

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20
Q

how to describe a fracture radiograph

A 
location
pieces
pattern
displaced/undisplaced
translated/angulated
X/Y/Z plane
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21
Q

general fracture complications?

A 
fat embolus
DVT
PE
infection
sepsis
prolonged immobility (UTI, chest infections, sores)
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22
Q

urgent local complications of fractures

A 
local visceral injury
vascular injury
nerve injury
compartment syndrome
haemarthrosis
infection
gas gangrene
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23
Q

less urgent local complications of fractures

A 
fracture blisters
plaster sores
pressure sores
nerve entrapment
myositis ossificans
ligament injury
tendon lesions
joint stiffness
algodystrophy
24
Q

late local complications of fractures

A 
delayed union
malunion
non-union
avascular necrosis
muscle contracture
joint instability
osteoarthritis
25
Q

common causes of fractured NOF

A

osteoporosis
trauma
combination

26
Q

important things t o get from history of patient w/ fractured NOF

A

age
comorbidity
preinjury mobility
social hx: relatives, stairs

27
Q

list types of NOF by location

A 
Subcapital (intracapsular)
Transcervical (extracapsular)
Intertrochanteric (extracapsular)
subtrochanteric
3 part intertrochanteric
28
Q

how are synovial joints stabilised?

A

muscles/tendons
ligaments
bone surface congruity

29
Q

main components of a synovial joints

A

synovium: cell lining contains macrophage-like phagocytic cells + type I collagen
synovial fluid: hyaluronic acid rich
articular cartilage: type II collagen, aggrecan

30
Q

cartilage is composed of?

A

specialised cells (chondrocytes) and ECM

31
Q

is cartilage vascularised?

A

no its avascular

32
Q

what is aggrecan?

A

proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains

33
Q

aggrecan is characterised?

A

its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates

34
Q

two major divisions of arthritis?

A 
osteoarthritis (degenerative)
inflammatory arthritis (main type is RA)
35
Q

radiographic changes in rheumatoid arthritis

A

joint space narrowing
osteopenia
bony erosions

36
Q

radiographic changes in osteoarthritis

A

joint space narrowing
subchondral sclerosis
osteophytes

37
Q

what are Heberden’s nodes?

A

osteophytes at the distal inter-phalangeal joints

38
Q

what are Bouchard’s nodes?

A

osteophytes at the proximal inter-phalangeal joints

39
Q

inflammatory mediators in arthritis include?

A

matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα)

40
Q

main risk factors for OA

A

age, obesity, mechanical constraints, hereditary, female gender, menopause, osteonecrosis, oestrogen deficiency, metabolic syndrome, adv hip OA caused by RA or spondylarthritis

41
Q

other risk factors for OA

A

infectious disease involving bone, RA sequelae, metabolic diseases, injury

42
Q

what to look out for on assessment for msk conditions

A

inspection: alignment, gait
palpation: effusion?
angle of flexion
special tests: anterior drawer?

43
Q

conservative OA management

A 
analgesics
physiotherapy
walking aids
avoidance of exacerbating activity
injections (steroids)
44
Q

operative OA management

A 
Replace (knee/hip)
Realign (knee/big toe)
Excise (toe)
Fuse (big toe)
Synovectomy (Rheumatoid)
Denervate (wrist)
45
Q

cause of septic arthritis

A

Bacterial infection of a joint (usually caused by spread from the blood)

46
Q

risk factors for septic arthritis

A

immunosuppressed, pre-existing joint damage, intravenous drug use (IVDU)

47
Q

is septic arthritis a medical emergency?

A

yes, if untreated, it can rapidly destroy a joint

48
Q

how many joints are usually affected in septic arthritis?

A

1, monoarthritic

49
Q

when should you consider septic arthritis?

A

in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever

50
Q

diagnosis of septic arthritis

A

joint aspiration. Send sample for urgent Gram stain and culture

51
Q

common organisms that cause septic arthritis

A

Staphylococcus aureus, Streptococci, Gonococcus

52
Q

what about gonococcal septic arthritis is an exception?

A

often affects multiple joints (polyarthritis)

-It is less likely to cause joint destruction

53
Q

treatment of septic arthritis

A

surgical wash-out (‘lavage’) and intravenous antibiotics

54
Q

radiological investigations for septic arthritis

A 
Plain films
MRI scans: bony architecture/collections
CT if MRI not available
Bone scans: multifocal disease
Labelled White cell scans
55
Q

bloods for septic arthritis

A

CRP: acute marker
ESR slower response
WCC
TB culture/PCR

56
Q

treatment for osteomyelitis

A

Antibiotics: iv weeks
Surgical drainage: especially collections/sequestrum
Chronic: antibiotic suppression/dressings
??amputation

57
Q

treatment for septic arthritis

A 
Surgery: joint washout and drainage (repeated if required)
Iv antibiotics (days/weeks)
Immobilise joint in acute phase
Physiotherapy once over acute phase

Musculoskeletal (7 decks)

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