Metabolic Bone Diseases

Question 1

What is osteoarthritis?

Answer 1

Degenerative joint disease involving cartilage loss, bone sclerosis, and joint space narrowing.

Question 2

Risk factors for osteoarthritis?

Answer 2

Age, female, obesity, joint injury, genetic predisposition, overuse.

Question 3

Clinical features of OA?

Answer 3

1. Sx related: pain, sweling, stiffness, clicking/grinding
2. Muscle: wasting
3. Bone: bowing varus
4. Mechanical: instability, gait disturbance

Sign:
Look- altered gait pattern, swelling, deformity
Feel - crepitus, tenderness
Move - reduced ROM

Question 4

Radiographic features of OA?

Answer 4

Loss of joint space, osteophytes, subchondral sclerosis, cysts.

Question 5

Management of OA?

Answer 5

1. Non pharmaco: (tahu, ubah, PT, OT)
   Education, lifestyle modification (Weight loss, exercise), physiotherapy, occupational therapy
2. Pharmaco
3. Analgesic (NSAID, tramadol)
4. SYSADOA (diucerin, chondrotin sulphate, glucosamine)
5. Injection (corticosteroid, viscosupplement [HA, PRP], stem cell)
6. Surgery
   THR/TKR
   Arthrodesis

Question 6

What is avascular necrosis?

Answer 6

Bone death due to interrupted blood supply, especially in femoral head.

Question 7

Risk factors for AVN?

Answer 7

Steroids, trauma, alcohol, SLE, sickle cell, smoking.

Question 8

Crescent sign on X-ray indicates?

Answer 8

Avascular necrosis (subchondral sclerosis)

Question 9

MRI finding in AVN?

Answer 9

Diagnostic for early AVN with marrow changes.

Question 10

Management of AVN?

Answer 10

Conservative: observation, analgesic, bisphosphonate, limit activity

Operative: Core decompression, joint preservation, THR.

Question 11

What is rheumatoid arthritis?

Answer 11

Chronic autoimmune inflammatory disease affecting small joints symmetrically.

Question 12

Key deformities in RA?

Answer 12

Swan neck, boutonniere, ulnar deviation, Z-thumb.

Question 13

RA treatment?

Answer 13

DMARDs (e.g. methotrexate), NSAIDs, steroids, joint replacement.

Question 14

Poor prognostic factors in RA?

Answer 14

High CRP, RF/anti-CCP positive, joint erosion.

Question 15

What is tuberculous arthritis?

Answer 15

Joint infection caused by Mycobacterium tuberculosis with granulomatous inflammation.

Question 16

Features of TB arthritis?

Answer 16

Chronic joint pain, swelling, limited ROM, constitutional symptoms.

Question 17

Radiograph features in TB arthritis?

Answer 17

Osteoporosis, joint space narrowing, soft tissue swelling.

Question 18

Management of TB arthritis?

Answer 18

Prolonged rest, anti-TB drugs, surgical drainage.

Question 19

What is rickets?

Answer 19

Defective mineralization of bone before physis closure due to Vit D/calcium/phosphate deficiency.

Question 20

Signs of rickets?

Answer 20

Genu varum, rachitic rosary, craniotabes, delayed fontanelle closure.

Question 21

Investigations for rickets?

Answer 21

Low calcium, phosphate, Vit D; high ALP.

Question 22

Radiograph features in rickets?

Answer 22

Widened epiphyseal plate, cupping, fraying.

Question 23

Treatment of rickets?

Answer 23

Vitamin D, calcium, phosphate replacement.

Question 24

What is osteomalacia?

Answer 24

Defective bone mineralization in adults.

Question 25

Symptoms of osteomalacia?

Answer 25

Bone pain, fractures, proximal muscle weakness.

Question 26

Radiograph findings in osteomalacia?

Answer 26

Looser zones, osteopenia, codfish vertebra.

Question 27

Treatment of osteomalacia?

Answer 27

High dose Vit D, treat underlying cause.

Question 28

What is osteoporosis?

Answer 28

Reduced bone mass with normal mineralization.

Question 29

4 osteoporotic bones

Answer 29

Vertebrae NOF Proximal humerus Distal radius

Question 30

Investigation for osteoporosis?

Answer 30

DEXA scan, bone profile, vertebral X-ray.

Question 31

T-score for osteoporosis?

Answer 31

< -2.5 on DEXA scan.

Question 32

Risk factors for osteoporosis?

Answer 32

1' Age, menopause, 2' lifestyle- low BMI, inactivity 2' meds‐ steroids 2' disease- endocrine (thyroid, PTH), renal, malabsorption

Question 33

Treatment for osteoporosis?

Answer 33

Bisphosphonates, calcium, Vit D, exercise.

Question 34

What is gout?

Answer 34

Arthritis due to monosodium urate crystal deposition from hyperuricemia.

Question 35

Common joint in acute gout?

Answer 35

First MTP joint (podagra).

Question 36

Features of chronic gout?

Answer 36

Tophi, joint erosion, stiffness, deformity

Question 37

Investigation for gout?

Answer 37

To confirm: Serum uric acid, joint aspiration with MSU crystals. See u/l: FBC, serum creatinine, blood glucose, urinalysis Detect compli: xrays (tophi, punched out lesion), renal imaging

Question 38

Management of acute gout?

Answer 38

NSAIDs, colchicine, steroids.

Question 39

Long-term gout treatment?

Answer 39

Allopurinol + low dose colchicine, lifestyle changes.

Question 40

What is pseudogout?

Answer 40

Calcium pyrophosphate deposition disease.

Question 41

Crystals in pseudogout?

Answer 41

Rhomboid-shaped, weakly positively birefringent.

Question 42

Radiograph finding in pseudogout?

Answer 42

Chondrocalcinosis.

Question 43

Management of pseudogout?

Answer 43

NSAIDs, intra-articular steroids, colchicine.

Question 44

What is scurvy?

Answer 44

Vitamin C deficiency causing defective collagen synthesis.

Question 45

Signs of scurvy?

Answer 45

Bleeding gums, joint pain, pseudoparalysis, corkscrew hair.

Question 46

Radiograph signs in scurvy?

Answer 46

Frankel line, Wimberger ring, Pelken spur.

Question 47

Treatment of scurvy?

Answer 47

Vitamin C supplementation.

Question 48

What is hyperparathyroidism?

Answer 48

Excess PTH causing bone resorption.

Question 49

Radiograph signs in hyperparathyroidism?

Answer 49

Subperiosteal resorption, salt and pepper skull, brown tumors.

Question 50

What is secondary hyperparathyroidism?

Answer 50

PTH elevation due to chronic renal failure.

Question 51

What is tertiary hyperparathyroidism?

Answer 51

Autonomous PTH secretion after prolonged secondary HPT.

Question 52

Management of hyperparathyroidism?

Answer 52

Treat underlying cause, surgery for adenoma.

Question 53

What is Heberden’s node?

Answer 53

Bony swelling at DIP joint in OA.

Question 54

What is Bouchard’s node?

Answer 54

Bony swelling at PIP joint in OA.

Question 55

Common investigation for metabolic bone disease?

Answer 55

Serum calcium, phosphate, ALP, Vit D levels.

Question 56

What is osteopenia?

Answer 56

Reduced bone density but not low enough for osteoporosis.

Question 57

What is the FRAX tool?

Answer 57

Estimates 10-year risk of major osteoporotic and hip fracture.

Question 58

What is the role of bisphosphonates?

Answer 58

Inhibit osteoclast-mediated bone resorption.

Question 59

What are Looser zones?

Answer 59

Pseudofractures seen in osteomalacia.

Question 60

What is codfish vertebra?

Answer 60

Biconcave vertebral deformity seen in osteoporosis/osteomalacia.

Question 61

What is the champagne glass pelvis?

Answer 61

Radiographic sign in osteomalacia indicating acetabular indentation.