MSK Flashcards by John Darlington

Where do osteoid Osteomas usually affect on the bone and what is a classical symptoms of them?

Long bones on the diaphysis area
spine

Very painful at night. Made completely better by NSAIDs

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How is osteoid osteomas treated? why is this?

they have a very classic radio presentation of bony mass with hollow centre.

treated by radio destruction

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Where do osteosarcomas present and who gets them?

Metaphysis of long bones.

Children mainly, but adults with Paget’s can get them too.

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What are the typical clinical findings in osteosarcoma?

Large swelling around the area

pain

inability to move area

pathological fracture

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What clinical sign is seen on the x-ray that is suggestive of osteosarcoma?

Codman’s triangle

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What’s the treatment for Osteosarcoma?

Chemotherapy
- 8 weeks

Surgery

removal bone
check to see if itis responding

> 95% necrosis then chemo is working

if no response then change of chemo for another 8 weeks.

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What are the stages of indirect fracture healing? give brief info on all them:

Haematoma and inflammation
- 6-8 hours

TGF-beta
PDGF
Osteoblasts stimulated

Fibrocartilage - soft callus
1day - 3 weeks

Pro- callus - granulation tissue.
type II collagen

Bony Callus
- 3 weeks - 4 months

Woven bone

Bone remodelling
- lamellar bone laid down

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Highlight some of the key changes in direct fracture healing:

Artificial wound healing

Osteoclasts drill into the opposite bone - cutting cones

osteoblasts then fill it with osteoid

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Name a malignant cartilage tumour:

Chondrosarcoma

middle aged people
men

grows within the medulla

Surgery is only option

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Define tenosynovitis:

Inflammation of tendon and its overlying structures

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What is tendinopathy and list some key features of it:

degeneration of the tendon, where the healing is unable to keep up with the degradation.

disorganisation of the collagen fibres
increased cellularity
inflammation usually around the tendon(this is minimal)

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What cytokines are released in tendinopathy that cause pain?

NO
IL-1
Prostaglandins
MMPs

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Name the type of femoral neck fractures that can occur

Subcapital

Transcervical

Basevericical

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List the type of fractures that can occur:

Transverse

oblique

Spiral

Comminuted

Avulsion

**along with them being open or closed

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What investigations are carried out for tendinopathy?

Ultrasound

shape of tendon
neovascularization

MRI
- T1 weighted

X-ray
- only useful for calcification

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List some presenting complaints of OA:

Dull ache over area

Radiation
- hip radiates to knee and groin

pain worse after periods of no movement

Pain on movement

Changes in Gait

Sleep disturbance
- later on in the disease

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What are the three broad categories of back pain?

Mechanical

systemic

Referred

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List some cases of mechanical/ non specific lower back pain:

Lumbar sprain

Degenerative disc

Disc Prolapse

Compression fracture

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List some symptoms of disc hernia:

Pain localised down the dermatome.

Myelopathy

Radiculopathy

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What is the pain of spinal stenosis:

Claudication pain in both calf muscles

Pain on walking

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What is it called when one vertebra slips over another?

Spondylolistheiss

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Whats the pain described in compression fracture?

Sudden severe pain

Radiates around the chest like a belt
- dermatome pattern

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What are the treatments for compression fracture?

Analgesics

vertebroplasty
- cement

Kyphoplasty
- baloon

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List some key causes of referred back pain:

AAA

Acute pancreatitis

Peptic ulcer

Acute pyelonephritis

endometriosis

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What is a common presenting complaint of discitis?

Fever - something this is it and they are said to be pyrexia with no known origin Back pain - doesn't get better

What would usually be seen radiologically for discitis?

destruction to the vertebrae on both sides. older cases the disc heals over with scarring.

What are the symptoms of bone cancer?

Pain that doesn't let up - worse at night due to pressures and swelling compression on nerves - spinal cord Systemic systems of cancers

Whats the pathological cycle that occurs with compartment syndrome?

Increased pressure - increased venous pressure - reduced blood flow - ischemia- muscle swelling- increased permeability- increased pressure

Describe the timeline in compartment syndrome::

1 hour - normal nerve conduction - muscle viable 4 hours - neuropraxia (lack of conduction) - muscle ischemia 8 hours - nerve axontemsis (damage to shealths) - muscle necrosis final stage: - fibrotic muscle compartment - clawing of limbs

What are the clinical features of compartment syndrome:

Pain Pallow Paresthesia Paralysis Pulseless - this is usually last thing to occur

What other factors must be monitored when there is compartment syndrome? and why?

Due to the contents of the muscle getting out: - fluids - electrolytes - K+ - acidosis

In gout what type of crystals are laid down?

Monosodium urate crystals

What are the deposits of long standing gout called?

Tophi

What medication may increase the risk of gout?

thiazides

What investigations are done for gout?

Joint aspiration Serum uric acid levels U&Es

What kind of crystals are seen on the joint aspiration of gout?

negative birefringent crystals - needle shaped - yellow and low

What are the treatments for gout?

NSAIDs Allopurinol Febuoxostat Uricosuric agents - increase the secretion of uric acid Rasburicase - urate oxidase

What is meant by arthroplasty? and Resection of arthroplasty?

New artificial joint Taking diseased out and putting in artificial one

What is revision of arthroplasty?

Re-operating on artificial joint

Describe the pathogenesis behind prosthetic joints being so susceptible to infection?

Material is avascular and has no immune cells on it. bacteria easily make a biofilm on it. the cement used, actively reduces phagocytosis and complement activation.

What is it called when there is degeneration of the vertebral discs?

Spondylosis

What is likely damaged if there is increased pain when extending (leaning backwards)?

Facet joint degeneration

What is the immediate management of compartment syndrome?

Remove any casts or restrictions on the limb Elevate the limb administer IV fluids Monitor U&Es carefully - looking for K+ rise. Discuss with surgeons about fasciectomy

What are normal pressures of the ABPI?

0.8- 1.2

What nerves are usually first affected in compartment syndrome, and where would this manifest?

Deep nerves - such as deep peroneal nerve 1st interweb space on 1st.

If someone present with late compartment syndrome >48 hours, what should your management be?

non- surgical as it will predispose to infection

In bone tumours, what is it that leads to the bone destruction?

Osteoclast activation by the tumour cells via cytokines. Bone is not directly destroyed by tumour

Which cancers are most likely to metastasis to the bone?

Breast, Lung, follicular of thyroid, prostate and kidney

Which secondary tumours of bone are most likely to be sclerotic and not lytic?

Breast and prostate

Which tumours usually appear as solitary masses?

Renal and thyroid

Where do osteosarcomas usually metastasis too?

Lung

What is a worse prognosis factor for osteosarcoma?

If it develops from Paget's

What sensory symptom may occur with Paget's disease and why?

Deafness - due to fusion of the mallus, incus and staples

Name the cartilaginous tumours:

Osteochondroma (Osseouscartilganious exotosis) Enchondroma Chondrosarcoma

What mutation leads to Ewing's Sarcoma?

11:22 translocation

What radiological features does Ewing's sarcoma have?

Onion layering

What is a common radiological finding with psoriatic arthritis?

Pencil and Cup deformity Dactylitis

What tests would you do in the suggestion of Psoriatic arthritis?

FBC X-ray ESR Rheumatoid factor Anti CCP Uric Acid levels - rule out gout Lipid profile - patient often have metabolic syndrome as well

What is the antibiotic regimen for septic arthritis, and how long is this maintained?

Native: Flucloxacillin +/- (gentamicin) - if evidence of gram negative 2-3 weeks IV 4 weeks oral Prosthetic: Vancomycin + Gentamicin

What is the regimen for diabetic foot infections?

``` Flucloxacillin + Gentamicin + Metronidazole ``` 6 weeks

How long is the antibiotic regimes in endocarditis

4 weeks - native valve 6 weeks - prosthetic valve

What are the three phases of pagets disease?

Osteolytic phase Mixed phase Osteoscelerotic phase

MSK Flashcards

(62 cards)