Bone and Joint Disorders Flashcards by Simi Adewale

What might you expect to see when examining a patient for a fracture?

Inability to bear weight
Severe pain
Swelling and point tenderness
Deformity
Scrapes and Abrasions
Wound
Loss of Movement
Loss of sensation

How well did you know this?

Not at all

Perfectly

What are the three principles of management for fracture management?

Reduce
Hold
Rehabilitate

How well did you know this?

Not at all

Perfectly

What does “rehabilitate” involve?

Weight bear, move and physio

How well did you know this?

Not at all

Perfectly

What does “hold” involve?

Plaster, fixation / metal

How well did you know this?

Not at all

Perfectly

What is the patient likely to have when a snapping sound is heard, and knee swells up immediately?

An anterior cruciate ligament tear

How well did you know this?

Not at all

Perfectly

What is the role of the anterior cruciate ligament?

To prevent anterior / posterior knee replacement

How well did you know this?

Not at all

Perfectly

What symptoms might patients with an ACL tear complain of?

Instability, redness, pain, swelling, lack of rotation, pop sensation

How well did you know this?

Not at all

Perfectly

What are some physical examinations which can be used to determine whether or not an ACL has been torn?

Lachmann’s, Anterior Drawer, Pivot Shift

How well did you know this?

Not at all

Perfectly

What are some short term management techniques for bone and joint injuries?

PRICE
Protect
Rest
Ice
Compress
Elevate

How well did you know this?

Not at all

Perfectly

What factors does the management of an ACL Rupture depend on?

Depends on factors to do with the patient like their age, physical activity status, whether they perform movements which requires the ACL

How well did you know this?

Not at all

Perfectly

Why does the ACL not heal well?

It has poor vascularisation

How well did you know this?

Not at all

Perfectly

What condition is the patient likely to have if they hear a loud snap at the back of their ankle, alongside a very sharp pain?

An injured achilles tendon

How well did you know this?

Not at all

Perfectly

What are some examination findings which would be consistent with a ruptured achilles tendon?

Difficulty walking, unable to perform heel raises, thickening, tenderness

How well did you know this?

Not at all

Perfectly

What would a patient with a ruptured achilles tendon expect to see when they dangle their feet off the end of the bed?

The foot it held in dorsiflexion

How well did you know this?

Not at all

Perfectly

What are the four stages of tendon healing?

Inflammatory, Reparative, remodelling (consolidation and maturation)

How well did you know this?

Not at all

Perfectly

What are some operation complications that may arise from a ruptured achilles tendon?

DVT (deep vein thrombosis)
Infection
Prolonged immobility
Neurovascular injury
Tendon rerupture
Ankle stiffness
Pressure sores from plaster
Reduced strength

How well did you know this?

Not at all

Perfectly

What are the differential diagnoses for groin pain?

Hip fracture
Lumbar Radiculopathy (sciatica)
Arthritis
Hernia
Infection
Hip Labrum tear

How well did you know this?

Not at all

Perfectly

What drugs increase the risk of osteoporosis?

Glucocorticoids
Anti-epileptic
Anti-coagulants (Heparin)

How well did you know this?

Not at all

Perfectly

What lifestyle factors increase the risk of OP?

Excessive alcohol
Smoking
Physical Activity
Low Body Weight

How well did you know this?

Not at all

Perfectly

Which endocrine disorders increase the risk of OP?

Hypogonadism
Hyperthyroidism
Cushings Disease
Growth Hormone deficiency
Hyperparathyroidism

How well did you know this?

Not at all

Perfectly

Which other disorders increase the risk of OP?

Malnutrition
Anorexia
Chronic inflammatory bowel disease

How well did you know this?

Not at all

Perfectly

What is one of the first signs of OP?

Kyphosis - stooped back

How well did you know this?

Not at all

Perfectly

What characterises a stooped back?

weakening of bones

How well did you know this?

Not at all

Perfectly

At what stage do women have an increased risk of OP?

After menopause as there is a lack of oestrogen

What affect does oestrogen have on bone loss?

It slows it down, and also improves the absorption and retention of calcium

What are some causes of OP?

Long term usage of corticosteroids Certain medications for inflammatory conditions Family History Low BMI Drinking and Smoking

Which scan is used to measure bone density?

DEXA scan

A T score of what indicates Osteopenia?

-1 to -2.5

A T score of what indicates Osteoporosis?

Less than -2.5

What is osteopenia?

Pre-osteoporosis

What is the first-line treatment for OP?

Bisphosphonates

Why do bisphosphonates work as an anti-OP drug?

They prevent bone reabsorption by stopping osteoclasts from working

What hormone can patients with OP be given?

Parathyroid hormone as it stops bone thinning

What are SERMs?

Selective Oestrogen Receptor Modulators - have similar effects to oestrogen by helping to maintain bone density

What characterises Osteomalacia?

Inadequate mineralisation of the bone, causing the bone to soften

What causes osteomalacia?

Vitamin D deficiency

What can cause vitamin D levels to be low?

Insufficient dietary intake, faulty vitamin D metabolism, renal tubular acidosis, malnutrition

How can osteomalacia be diagnosed?

Very low vitamin D levels, alongside psuedofractures and protrusion acetabula on radiographic images

How can you treat nutritional osteomalacia?

increased dietary intake Increase outdoor time supplementation of vitamin

What are the two inflammatory markers which are commonly tested for?

C Reactive Protein ESR - Erythrocyte sedimentation Rate

Which bacterial hip infection can be treated with antibiotics before having to be washed out?

Gonococcus

What is meant by aspiration of a joint?

Using a needle to remove the pus within a joint, in order to remove the infection from it

What is osteomyelitis?

Infection of the bone

what are the three categories of possible causes of a limping child?

Inflammation, infection, trauma

What are the common hip conditions which a 10-16 year old patient might present with?

Slipped femoral epiphysis Avulsion fractures Osteomyelitis

What are the common hip conditions which a 4-10 year old patient might present with?

Transient Synovitis Osteomyelitis / septic arthritis

At what age is transient synovitis common?

up to 10 years of age

What conditions might patients under the age of 4 suffer from?

Juvenile idiopathic arthritis Non-accidental injury Transient Synovitis Osteomyelitis

What is transient synovitis?

an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight

What are the Kocher Criteria for Septic Arthritis?

1. Must be non-weight bearing 2. Fever 3. High ESR 4. High White Blood Cell Count

Between septic arthritis and transient synovitis, which should be treated with antibiotics and aspiration?

Septic arthritis

What is the treatment for transient synovitis?

Rest and Observation Keep patient under close observation Pain killers for pain

What is the treatment for septic arthritis?

Multiples aspirations and irrigations, culture pus sample and the give narrow spectrum antibiotics

What are the cardinal signs of inflammation?

Swelling, redness, heat, painful

How does a bacterial infection change the colour the fluid in a joint?

Colour - more cloudy, darker

How does a bacterial infection change the consistency of the fluid in a joint?

Increase viscosity, large volumes of effusions from swellings

How will changes in the joint fluid following infections be reflected in blood tests

Raised inflammatory markers - White cell count, ESR, CRP

What are the three different routes bacteria can use to spread?

Inoculation, blood, from bone

What is the treatment for an infected joint?

Aspirate Culture Antibiotics If confirmed infection - washout with keyhole arthroscopy Continue antibiotics