General revision

Question 1

Stages of fracture repair?

Answer 1

Haematoma
- Cytokine and growth factor release

Inflammation
- Macrophage mediated phagocytosis of debris

Granulation tissue
- Collagen and neovascularisation

Soft callus

• in order to form cartilage in endochondral bone growth
• mesenchymal stem cells differentiate and produce fibrous cartilage

Hard callus
- cartilage into bone through chondrocyte apoptosis and osteoclast differentiation

Question 2

Therapies for fracture repair?

Answer 2

PTH

Anti-sclerosin

BMP
- increases strength and stiffness

Question 3

Where are trabecular and cortical bone?

Answer 3

Trabecular inside, cortical outside

Question 4

What type of bone do you lose in osteoporosis?

Answer 4

Trabecular

Question 5

How do bisphosphonates work?

Answer 5

Inhibit osteoclasts

Question 6

What’s a bone lining cell?

Answer 6

Stops osteoclasts getting to bone

Question 7

Osteopenia and osteoporosis T score?

Question 8

Who should have a DEXA scan?

Answer 8

FH

Low BMI/hypogonadism/early menopause

Question 9

Osteoporosis Tx?

Answer 9

Lifestyle

Bisphosphonates

Raloxifen

Strontium ranelate

Teriparatide - PTH, expensive

Question 10

Typical areas of osteoporotic fractures?

Answer 10

Vertebral

Wrist

NOF

Question 11

Big 5 underlying problems?

Answer 11

Infections

Inflammation

Malignancy

Blood flow interruption

Trauma

Question 12

In what two broad situations is the ALP high?

Answer 12

In childhood and in liver dysfunction (and bone)

Question 13

What conditions cause the ALP to be high pathologically?

Answer 13

Liver disease

Bone

Trauma

Question 14

What conditions cause the ALT to be high pathologically?

Answer 14

Liver disease

Muscle disease

Drugs

Question 15

Commonest cause of high calcium?

Answer 15

Primary hyperparathyroidism (parathyroid producing too much PTH)

Question 16

Is rheumatoid factor good? whats better?

Answer 16

Not very specific or sensitive really, can just be raised in inflammation.

Anti-CCP is better

Question 17

HLA B27 positive in 95% of people with what?

Answer 17

Ankylosing spondylitis - although also positive in 7% of population so not very specific

Question 18

Rise in conjugated or unconjugated bilirubin indicative of biliary dysfunction?

Answer 18

Conjugated

Question 19

Rise in conjugated bilirubin Ddx?

Answer 19

Liver disease or biliary obstruction.

Question 20

Obstructive/cholestatic picture in LFTs?

Answer 20

ALP (and GGT) > ALT

Question 21

Spirometry reading that define COPD?

Answer 21

FEV1/FVC less than 70% then COPD

Question 22

Improvement of what percent in the FEV1 following bronchodilator indicates asthma?

Answer 22

15%

Question 23

Normal treatment for TB?

Answer 23

Isoniazid and rifambucin (6 months)

Pyrazinamide and ethambutol (2 months)

If possibly meningeal then give steroids too

Question 24

Four main groups of bacteria?

Answer 24

Gram positive

Gram negative

Anaerobes

Atypicals
- can’r gram stain or grow

Question 25

Common examples of gram positive organisms?

Answer 25

Staph and strep

Question 26

Common examples of gram negative organisms?

Answer 26

E coli Klebsiella pseudomonas Haemophilis influenzae

Question 27

Common examples of atypical bacteria?

Answer 27

Legionella Chlamydia Mycoplasma

Question 28

What is the key structural difference between Gram-positive bacteria and Gram-negative bacteria?

Answer 28

Gram-negative bacteria have a double membrane

Question 29

What drugs need therapeutic monitoring of levels?

Answer 29

``` Cyclosporin Valproate Carbamazepine Phenytoin Digoxin Lithium Clozapine Gentamycin Vancomycin ```

Question 30

Stages of wound healing?

Answer 30

Haemostasis - Clotting Inflammation - Neutrophils then macrophage, chemotaxis and pro inflammatory mediators Proliferation - Granulation tissue - Fibroblasts produce collagen - Neovascularisation - epithelium forms over Maturation or remodelling - Stronger collagen - scar tissue formed

Question 31

Steps in bone healing?

Answer 31

Haematoma Soft callous - Mesh from granulation tissue Bony callous Bone remodelling - Strong compact bone - Osteoblasts

Question 32

Type of pathogen in osteomyelitis, what type of bones?

Answer 32

Osteomyelitis - bone infection Long bones Staphylococcus aureus (gram +ve)