Deck 3b Flashcards
(18 cards)
Q. What risks are associated with fixation in paeds?
Growth arrest
Name two features associated with non-accidental injury (NAI)
A. Long bone fracture in non-ambulant (not able to walk etc), multiple bruises,
multiple fractures in various stages of healing, corner fractures, posterior rib
fractures, mid bone fractures (diaphseal)
B. Commonly occurs in children < 4yrs
C. XR, skeletal survey, Admit, refer to paeds and safe guarding services, treat as
usual
Q. Why may a supracondylar fracture occur? Which nerve is at risk?
A. Fall to outstretched hand – common paeds presentation
B. High risk of neurovascular injury: medial nerve most common (OK)
C. Urgent reduction and crossed K-wiring in majority of cases
Q. Name 2 complications associated with fractures
A. Open, NV compromise, mal union (bone heals with deformity), non-union
(failure of bone to heal), compartment syndrome (pain, pain, pain), metal wear
problems, cast problems (tight, compartment syndrome, plaster burns/blister,
loss of reduction
Q. Describe the 5 stages of the bone cycle
A. Quiescence: resting stage
B. Recruitment and differentiation: preosteoclasts
C. Bone resorption: Osteoclasts
D. Recruitment and differentiation: obestoblasts
E. Bone formation: Osteoblasts – mineralization
Q. Describe the changes in trabecular architecture with ageing
A. Decrease in trabecular thickness, more pronounced for non-load- bearing horizontal trabeculae
B. Decrease in connections between horizontal trabeculae
C. Decrease in trabecular strength and increased susceptibility to fracture
Q. What is a DXA scan?
A. Dual energy X-ray absorptiometry: low radiation dose – measures important
fracture sites
B. T score: standard deviation score, compared with gender-matched young adult
average (peak bone mass)
Q. What T scores constitutes a diagnosis of: normal bone density
/osteopenia/osteoporosis/severe osteoporosis?
A. >-1 = normal
B. -1.0 - -2.5 = osteopenia
C. < -2.5 = osteoporosis
D. < -2.5 plus fracture = severe osteoporosis
Q. Name two endocrine causes of decreased bone density
Endocrine: Hyperthyroidism, primary hyperparathyroidism (thyroid hormone and
PTH increase bone turnover)
B. Cortisol= increases bone resorption and induces osteoblast apoptosis (Crushing’s
syndrome)
Q. Name two medications that may affect bone density
A. Glucocorticoids, depo-provera, aromatase inhibitors, GnRH analogues, androgren deprivation
- Q. Name two risk factors that increase the risk of osteoporosis
A. Prev fracture, FHx of osteoporosis/fracture, alcohol, smoking
Q. Name three features of the FRAX questionnaire
Age sex, weight, height, prev fracture, smoking, glucosteroids, Rh arthritis,
secondary osteoporosis, alcohol, femoral neck BMD
Q. Name two drug treatments of OA
- Lifestyle mod
- Topical products - capsicum
- Analgesics/NSAIDS - paracetamol, dihydrocodeine (weak opioids)
- Visco-supplementation: injections Injected into the synovial fluid of affected joint – increasing lubrication to relieve symptoms/pain e.g. Hyaluronic acid
- Steroid injections: Intraarticular corticosteroid infections to provide short term improvement where there is painful joint effusion e.g intra-muscular depot methylprednisolone
- Surgery - total hip/knee replacement
Describe the Tx of RA
- NSAIDS/COX inhibitors e.g. Slow release diclofenac, paracetamol +-codeine/dihydrocodeine
- Corticosteroids: Suppress disease activity in the short term by modifying transcription and protein synthesis causing anti-inflammatory actions e.g. Intra-muscular methylprednisolone
- DMARDS: Used early on to reduce inflammation and slow joint erosion/irreversible damage and reduce CVD risk
e. g. Sulfasalazine, methotrexate, lefunomide - Biological DMARDS: Relatively new treatment used to halt erosion formation, used in pts with active disease despite treatment e.g. Etanercept, infliximab adalimumab, certolizumab
- Lifestyle mod - physios etc
- Surgery - arthroplasty (joint replacement)
- Q. What is the origin of sarcoma? Where do they usually occur?
A. Mesenchymal origin
B. Usually soft tissue (incidence increases with age)
C. Bone - rarer, however more common in children and YP
- Q. Name 4 features suggestive of sarcoma
Pt presents with a lump > 5cm, increasing in size, the lump is deep to the fascia, pain
- Q. Describe the management of sarcoma
Ultrasound of soft tissue, MRI (good for soft tissue), CT is MRI not feasible, core needle biopsy, CT thorax for lung mets (first location of metastasis)
Surgery with wide excision + radiotherapy
Triple assessment by sarcoma MDT (history, imaging, biopsy)
Treatment of oestoporosis
A. Anti-resorptive drugs: decrease osteoclast activity and bone turnover
a. Bisphosphonates: inhibits an enzyme in the cholesterol synthesis
pathway (Farnesylpyrophosphate synthase) reducing rate of bone
breakdown – cheap, effective
i. Oral: alendronate, risedronate, ibandronate
ii. IV: ibandronate, zoledronate
b. Hormone replacement therapy (oestrogen): post-menopausal women
c. Monoclonal antibody: Denosumab (RANK ligand) – rapid acting and very
potent anti-resorptive, good fracture risk reduction, rebound increase of
bone turnover when stopped
B. Anabolic: increase osteoblast activity and bone formation
a. Teriparatide: PTH analogue, increases bone density (up to 20%), improves
trabecular structure
