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MSK wk4 Flashcards

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1
Q

What does an osteoblast do?

A

Builds bone

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2
Q

What does an osteoclast do?

A

Deconstructs bone

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3
Q

What is pagets bone disease?

A

A localised disorder of bone turnover
Increased bone resorption followed by increased by increased bone formation
However, disorganised placement
Bigger, less compact, more vascular and more susceptible to deformity and fracture
Deep pulsating pain

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4
Q

What is the genetic component of Paget’s disease?

A

SQSTMI gene

15-30% cases are familial

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5
Q

What is the suspected environmental trigger of pagets disease?

A

Possible chronic viral ingection within osteoclast

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6
Q

What are the symptoms of paget’s disease?

A 
Over 40
Bone pain
Bone deformity
Excessive hear over pagetic bone
Neurological problems such as nerve deafness
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7
Q

What is the presentation of paget’s disease?

A 
Isolated elevation of serum alkaline phospjatase
Bone pain + local heat
Bone deformity/fracture
Hearing loss
Rarely osteosarcoma in bone
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8
Q

How do you treat Paget’s disease?

A

Nothing if asymptomatic
Do not treat on raised alkaline phosphatase alone
IV bisphosphonate therapy
One off therapy of zoledronic acid

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9
Q

What is rickets/osteomalacia?

A

Severe nutritional Vit D/calcium deficiency results in insuficient mineralisation
Rikets in children; osteomalacia in adults

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10
Q

What are the symptoms of rickets?

A 
Stunted growth
Fontanelles in skull don't fuse so enlarged head
Enlarged abdomen
Bent legs
Growth plates enlarged - abnormal joints
More common in darker skin
Failure to thrive
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11
Q

What are the symptoms of osteomalacia?

A

Microfractures
Never get through cortex

Bone pain
Muscle weakness
Increased fall risk

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12
Q

What is osteogeneis imperfecta?

A

Connective dissue genetic disorder
Characterised by fragile bones - fracture in acts of daily life
Other non-bone features as defect in type 1 collagen
Large clinical range (even within families)

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13
Q

How many types of osteogensis imperfecta?

A

8, although only 4 common
Type 1 - milder form - when child starts to walk
Type 2 - lethal by age 1
Type 3 - progressive deforming with severe bone dysplasia and poor growth
Type 4 - similar to type 1 but more severe

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14
Q

What are the other features of osteogensis imperfecta?

A 
Growth deficincy
Defective bone formation
Hearing loss
Blue sclera (eyes etc very obvious)
Scoliosis/barrel chest
Ligamentous laxity
Easy bruising
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15
Q

How do you manage osteogenesis imperfecta?

A

Treat all fractures
Medical - IV bisphosophates
Social - educational and social adations
Genetic counselling

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16
Q

What is osteoporosis?

A

Metabolic bone characterised by low bone mass and micro architectural deterioation of bone tissue leading to enhanced fragility + fracture risk

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17
Q

What is Q fracture?

A

Program with variables to predict risk of fracture within age 30-85 in men and women

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18
Q

What is a DXA scan?

A

Scan that calculates bone density

Along with a T score - standard deviations against the norm

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19
Q

What are the endocrine causes of osteoporosis? (secondary osteoporosis)

A 
Thyrotoxicosis
Hyper/hypo parathyroidism
Cushings
Hyperprolactinaemia
Hypopituitarism
Low sex hormone levels
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20
Q

What are the rheumatic causes of secondary osteoporosis?

A

Rheumatoid arthritis
Ankylosing spondylitis
Polymyalgia rhuematica

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21
Q

What are the gastroenterologycauses of secondary osteoporosis?

A

Inflammatory diseaes (UC/crohns)
Liver diseaes - PBC, CAH, alcoholic/viral cirrhosis
Malabsorption

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22
Q

What medications cause osteoporosis?

A 
Steroirds
PPI
Enzyme inducting antiepipleptic medications
Aromatase inhibitrs
GnRH inhibitors
Warfarin
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23
Q

How do you prevent osteoporotic fractures?

A

Minimise risk factors
Ensure good calcium and vitamin D
Fall prevention strategies
Medications

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24
Q

What medications are used for osteoporosis?

A

HRT (best before early 60s/late 50s)
Selective oestrogen modulator (raloxifene)
Bisphosponates! Normal first line
Denosumab

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25
What are the side effects of HRT?
Increased risk of blood clots Increased risk of breast cancer of breast cancer with extended use into late 50s/early 60s Increased heart disease risk/stroke if used after large gap from menopause
26
What are the side effects of selective osestrogen receptor modulator (raloxifene)?
Endometrium cancer. Therefore limited to 5 yr use
27
What are the negative effects of SERMs?
Hot flushes if taken close to menopause Increased clotting Lack of protection at hip site
28
What are the limitations of bisphosponates?
Adequate renal function needed Adequate calcium/vit D levels Good dental health advised ONLY work in osteoporosis
29
What is the MOA of bisphosponates?
Bind to calcium Inert until osteoclast comes up Poisons osteoclast - and dies
30
What are the side effects of bisphosponates?
``` Oesophagitis Iritis/uveitis Not same in eGFR less than 30 Atypical demorla shaft fractures Osteonecrosis Jaw ```
31
What is denosumab?
Monoclonal antibodiy against RANKL | Reduces osteclatic bone resoprtion
32
What are teh side effects of denosumab?
Allergy/rash | Symptomatic hypogylcaemia if given when vit D deplete
33
What is teriparatide?
An analogue of parathyroid hormone | Only anabolic treatment for bone
34
What are the side effects of teriparatide?
Injection site irritation Rarely - hypercalcaemia Allergy Only one treatment course otherwise osteosarcoma
35
What are the different connective tissue diseases?
``` Systemic Lupus Erythematous (SLE) Scleroderma Sjogren's Syndrome Auto-Immune Myositis Mixed Connective Tissue Disease ```
36
What are the types of systemic vasculitis?
Giant Cell Arteritis ANCA associated vasculitis: Granulomatosis Polyangiitis (Wegner's Granulomatosis) Microscopic Polyangiitis Eosinophilic Granulomatosis Polyangiitis (Churg-Strauss Granulomatosis)
37
What are the types of multi-system autoimmune conditions?
Connetive tissue diseases | Systemic vasculitis
38
What is the process for diagnosing multi-system autoimmune conditions?
``` Cardinal features in history/exam Immunology Imaging Tissue Exclusion of differentials ```
39
What are the mimics of multi-system autoimmune conditions (something that presents with multiple systems at once)?
Drugs (cocaine, minocycline Infection (HIV, Endocarditis, Hep, TB) Malignancy (lymphoma) Cardiac myxoma Cholesterol emboli Scurvey
40
What are the common patterns of SLE (lupus)?
``` 4+ of: Malar rash (butterfly rash) Discoid rash Photosensitivty Oral ulcers Arthritis Serositis Renal Neurological Haematological Immunological ANA ```
41
Who is affected by SLE (Lupus)?
Young females Women 9:1 compared to men Young (20% before 16, 65% before 16-55) Afro-caribbeans >asian > caucasian
42
What is the difference on X-ray between lupus arthritis and rheumatoid arthritis?
In rheumatoid arthritis damage seen on x-ray | Lupus - only ligaments softened (reversible)
43
What are the kidney involvement signs of lupus ?
Blood + protein in urine dipstick
44
What is scleroderma?
Thickening of skin - top layer of skin 5x thicker than it should be
45
Who is affected by scleroderma?
``` Girls 3:1 Middle aged (30-50) ```
46
What are the groups of scleroderma?
Morphea Limited Diffuse
47
What is the morpea group of scleroderma?
No complications beyond cosmetic
48
What s the limited group of scleroderma?
Skin thickening limited to hands and forearms (does not travel above elbow) AKA crest syndrome
49
What does crest stand for?
C - calsidosis R- Ranodes (poor circulation in fingers) E - Oesphageal dismobility (heartburn, GORD) S - scleradactialy (sausage fingers) T - Teljectasia (small blood vessel visible on face/chest) Don't need all to diagnose
50
What is diffuse scleroderma?
Thickening of skin can be across whole body
51
What are the complciations ofl imited scleroderma?
Pulmonary hypertension
52
What are the complications of diffuse scleroderma?
Pulmonary fibrosis Renal crisis Small bowel bacterial overgrowth
53
Who gets sjorgens syndrome?
Women (9:1) Onset 40-50 yrs More common than others, less severe
54
What is sjogren's syndrome?
Syndrome that affects salivary glands + tear glands Dryness in eyes + mouth Parotid enlargement
55
What are the complications of sjogren's syndrome?
``` Lymphoma Neuropathy Pupura Intestitial lung disease Renal tubular acidosis ```
56
What is autoimmune myositis?
Immune system affects muscles, often proximal (upper limb, thigh) Weakness not pain
57
What are the types of auto-immune myositis?
Polymyositis - younger patietns Dermatomyositis - elderly people (skin lesiojns Gottron's papules Helitrope rash
58
What is a heliotrope rash?
Scaly lesion on knucles
59
What is a gottron's papule?
Violet discoleration around eyes
60
What are the complciations of auto-immune myosistis?
Elderly - cancer | Younger - interstitial lung disease
61
What is giant cell arteritis?
Medical emergency Elderly age Can often become blind if not immediately treated Templar artery often affected
62
What are the main classification criteria for giant cell artertiis?
``` 3 or more of following Over 50 New headache Temporal artery tenderness Raised ESR (above 50) Abnomrla temporal biopsy ```
63
What is ANCA?
Anti-neutraphil cytoplasmic antibody | Targets neutrophils + burst innapropriately - destroys blood vesse
64
What are the main ANCA associated vasculitises?
Granulomatosis with Polyangiitis (Wegner's Granulomatosis) Microscopic Polyangiitis Eosinophilic Granulomatosis Polyangiitis (Churg-Strauss Granulomatosis)
65
What is granulomatosis with polyangitis?
NEcrotising granulomatous inflammation Usually invovled URT/LRT esp sinuses Glomerulonephritis common Normally affect small-medium vessels
66
What is Microscoptic polynagintis?
``` Necrotising vasculitis with few/no immune deposits Normally affects small blood vessels Necrotising arteritis may be present Necrotising glomerulonephritis common Pulmonary capillaritis often occurs Granulotomatous infiltration absent ```
67
What is esionpjilic granulomatosis with polyangitis?
Eosinophil rich + necrotising granulotomatomous inflammation Often affects respiratory tract Necrotising vascultiis often small-medium vessels Associated with astham + eosinophillia ANCA more common when glomerulonephritis present
68
What conditions are likely to have anti-nuclear antibodies?
``` SLE (lupus) Systemic sclerosis MCTD Drug induced lupus Sjorgens syndrome Poly/dermatomyositis ```
69
What is the downside to ANA tests?
Very sensitive but not specific
70
What are the specific ANA tests for lupus?
dsDNA Ro Sm
71
What are teh specific ANA for scleroderma?
Scl-70 | Centromere
72
What are the specific ANA tests for polymyositis?
Jo-1
73
What are the specific ANA tests for sjorgens?
Ro | La
74
What lab/radiological investigations are used in auto-immune (multi system) diseases?
MRI Pet-scan Biopsy!
75
What information abuot a patient should be conveyed when the paramedics hand over a patient?
``` Time of injury Mechanism of injury Suspected serious injuries Vital signs If any interventions have been carried out ```
76
What is catastrophic haemorrhage control?
Treating catastrophic haemorrhage first | If not derteriation can occur
77
What do you assess in airway?
Noises (speech, gurgling, stridor?) | Visual (swelling, vomit/blood debris)
78
When should you assume a spine injury?
Dangerous mechanism Reduced conscious level Injury above clavicles Neruolgical signs
79
What is assessed in breathing?
Look for visible injuries, resp rate, effort/expansion Palpate/percuss Ascultate Oxygen, analgesia + frain if required
80
What is the clinical assessment of circulation? (ABC)
``` Heart rate Palpable radial pulse? CRT BP Urine output Confusion? Pulse pressure? ```
81
What are the blood tests taken in circulation assesment?
Haemoglobin levels | lactate
82
What imaging is done during circulation assessment?
Ultrasound | CT
83
What are the five most common sites for blodd loss?
``` Chest Abdomen Pelvis Long bones Floor ```
84
What should be considered when thinking about volume replacement?
IV access vs IO (intraosseous) access Tye of fluid Amount of fluid Follow transfusion protocols - no need to get BP up to normal, only enough to perfuse organs
85
When volume replacement is being performed, what should you monitor?
Vital signs Urine output Lactate
86
What is the lethal triad during blood loss?
Coagulopathy (execssive bleeding) Lactate Hypothermia (clotting factors don't work well if cold)
87
What should be assessed in the disability stage?
``` AVPU GCS Pupils Tone + reflexes Log roll ```
88
What is the expose stage?
Exposure to allow for full examination in case of hidden injuries Recover to keep warm
89
What does DEFG stand for?
Don't ever forget Glucose!
90
What are the bed side tests?
ECG Arterial blood gas Urine dipstick
91
What does the secodnary survery entail?
A detailed head-toe examination Although now with minimal handling Also includes radiology Plan management of injuries
92
What are the options for further managment?
Teahter (operative) Interventional radiology (control bleeding) ITU

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