Bone And Joint Disorders

Question 1

what is avascular necrosis

Answer 1

Failure of the blood supply to the end of a bone, resulting in ischaemic necrosis of bone and marrow

Question 2

where is most commonly affected by avascular necrosis

Answer 2

head of the femur

Question 3

who usually presents with avascular necrosis

Answer 3

males 35-50

Question 4

clinical presentation of femoral head AVN

Answer 4

commonly bilateral
insidious onset of groin pain exacerbated by stairs or impact

Question 5

hanging rope sign

Answer 5

femoral head AVN

Question 6

how is osteoarthritis often described

Answer 6

wear and tear

Question 7

x-ray changes seen in osteoarthritis

Answer 7

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

Question 8

clinical presentation of osteoarthritis

Answer 8

joint pain and stiffness, worse on activity

Question 9

clinical signs of osteoarthritis in the hands

Answer 9

heberdens nodes
bouchards nodes
squaring at the base of the thumb
weak grip, reduced ROM

Question 10

clinical marker of generalised OA

Answer 10

heberdens nodes

Question 11

clinical signs in osteoarthritis

Answer 11

joint line tenderness
crepitus
joint effusion

Question 12

management of osteoarthritis

Answer 12

physio, weight loss, NSAIDs, activity modification

Question 13

surgical management of osteoarthritis

Answer 13

joint replacements
arthroscopic surgery to remove loose bodies

Question 14

who is more likely to have joint hypermobility syndrome

Answer 14

females

Question 15

name some genetic syndromes associated with joint hypermobility syndrome

Answer 15

marfans, ehlers danlos

Question 16

when does joint hypermobility syndrome usually present

Answer 16

childhood or 3rd decade

Question 17

clinical presentation of joint hypermobility syndrome

Answer 17

pain
thin stretchy skin

Question 18

what is used to classify joint hypermobility syndrome

Answer 18

modified beighton score

Question 19

what is septic arthritis

Answer 19

inflammation of joint space caused by infection

Question 20

most common cause of septic arthritis in adults

Answer 20

staph aureus

Question 21

most common cause of septic arthritis in the elderly

Answer 21

e.coli

Question 22

what predisposes to salmonella arthritis

Answer 22

sickle cell

Question 23

clinical presentation of septic arthtitis

Answer 23

acute monoarthropathy, knee most commonly affected

Question 24

clinical signs of septic arthritis

Answer 24

reduced ROM and swelling
systemic fever

Question 25

name some risk factors for a prosthetic joint infection

Answer 25

corticosteroids
prior infection/surgery
prolonged duration of surgery

Question 26

most common organisms in prosthetic joint infection

Answer 26

staph aureus, staph epi

Question 27

management of early prosthetic joint infection

Answer 27

debridement, antibiotics, implant retention

Question 28

what is osteomyelitis

Answer 28

infection of the bone/bone marrow

Question 29

who usually presents with osteomyelitis

Answer 29

children

Question 30

risk factors of osteomyelitis

Answer 30

immunocompromised, chronic disease

Question 31

most common cause of osteomyelitis

Answer 31

staph aureus

Question 32

clinical presentation of osteomyelitis

Answer 32

fever, pain/tenderness, erythema, swelling

Question 33

best diagnostic tool for osteomyelitis

Answer 33

MRI

Question 34

what is osteoporosis

Answer 34

a significant reduction in bone density

Question 35

what is a less severe version of osteoporosis

Answer 35

osteopenia

Question 36

when does physiological loss of bone density start

Answer 36

30 yrs

Question 37

who is more likely to have osteoporosis

Answer 37

females

Question 38

what is type 1 osteoporosis

Answer 38

exacerbated loss of bone in the post‐menopausal period

Question 39

what is type 2 osteoporosis

Answer 39

osteoporosis of old age with a greater decline in bone mineral density than expected

Question 40

name a drug that can exacerbate osteoporosis

Answer 40

corticosteroids

Question 41

what can be used to measure bone mineral density

Answer 41

DEXA scan

Question 42

lifestyle advice for osteoporosis

Answer 42

increase calcium intake
high intensity strength training
avoid smoking and excess alcohol

Question 43

pharmacological management of osteoporosis

Answer 43

calcium + vit d supplements
oral bisphosphonates
zoledronic acid

Question 44

what is osteomalacia

Answer 44

a condition where defective bone mineralisation causes “soft” bones

Question 45

what is the most common cause of osteomalacia

Answer 45

vitamin D deficiency

Question 46

symptoms of osteomalacia

Answer 46

bone pain
pathological fractures
symptoms of hypocalcaemia

Question 47

symptoms of hypocalcaemia

Answer 47

paraesthesia, muscle cramps, irritability, fatigue

Question 48

bloods in osteomalacia

Answer 48

↓ calcium and serum phosphate, ↑ serum ALP

Question 49

x-ray of osteomalacia

Answer 49

pseudofractures

Question 50

management of osteomalacia

Answer 50

vit D + calcium and phosphate supplementation

Question 51

what is pagets disease

Answer 51

excessive bone turnover due to increased osteoclast and osteoblast activity

Question 52

where does paget’s particularly affect

Answer 52

axial skeleton

Question 53

presentation of pagets

Answer 53

can be asymptomatic
Bone pain
Bone deformity
Fractures
Hearing loss

Question 54

what are the 3 main stages of pagets

Answer 54

osteolytic
mixed
osteosclerotic

Question 55

bloods in pagets

Answer 55

↑ alkaline phosphatase with otherwise normal LFTs

Question 56

x-ray appearance of pagets

Answer 56

cotton wool appearance
bone enlargement and deformity

Question 57

management of pagets

Answer 57

bisphosphonates

Question 58

complications of pagets

Answer 58

osteosarcoma, fibrosarcoma