musculoskeletal Flashcards
(81 cards)
1
Q
what is compartment syndrome?
A
fracture in area, tight facial planes, swelling/bleeding, increased pressure = numbness/no blood supply
2
Q
what is a le fort 1 fracture?
A
through palate
3
Q
le fort 2?
A
through nasal bridge
4
Q
le fort 3?
A
through zygomatic bone
5
Q
3 phases of fracture healing?
A
- inflammatory
- reparative
- remodelling
6
Q
what happens during inflammatory stage of healing?
A
bleeding + clot acute inflammatory resposne bone necrosis at fracture end macrophage removes dead material formation of vascular granulation tissue
7
Q
which stage of healing do bisphosphonate impede?
A
inflammatory
8
Q
at what time period does the reparative stage happen?
A
6-12 weeks
9
Q
at what time period foes the remodelling stage happen?
A
up to 2 years
10
Q
what is ORIF?
A
open reduction internal fixation
bone broken/reduced/put back in place
internal fixation device placed on bone e.g. plates, screws nails
11
Q
4 stages of fracture management?
A
- reduction
- fixation
- immobilsation
- rehabilitation
12
Q
complications of fracture fixation?
A
immediate - haemorrhage, tissue loss, nerve/vessel damage, compartment syndrome
local - necrosis, infection, failure to alignment
general - fat embolism, crush syndrome, DVT/PE
13
Q
do patients with joint replacements require antibiotic proph?
A
no
14
Q
where is calcium found in the body?
A
absorbed in intestine
stored in bones
stored in ECF In blood
excreted through kidneys
15
Q
how is calcium carried in ECF in blood?
A
ionised calcium or protein bound
ionised = active
16
Q
how does vit D effect calcium absorption?
A
increases absorption
17
Q
how does PTH effect serum calcium?
A
increases serum calcium by increasing bone turnover
18
Q
4 steps of bone turnover?
A
- osteoclasts
- osteoclast apoptosis
- osteoblasts
- resting phase
19
Q
what protein is calcium bound to in blood?
A
albumin
20
Q
active form of calcium in blood?
A
ionised
21
Q
what does alkaline phosphatase levels mean and when is it increased?
A
shows levels of osteoblasts
increased in fracture + liver problems
22
Q
what does high phosphate in blood suggest?
A
kidney failure
23
Q
what do beta cross laps levels show?
A
osteoclastic activity
24
Q
4 types of imaging to show fracture?
A
- xray
- ct/mri
- radioisotope scanning
- DEXA
25
2 types of hyperparathyroidism?
1. primary - caused by tumour, high Ca + PTH
| 2. secondary - homeostatically correct caused by low Ca
26
what does vit d deficiency cause in adults?
osteomalacia
27
what does vit d deficiency cause in children?
rickets
28
3 causes of rickets?
low vit d, low ca intake, phosphaturia
29
why must patients with renal disease + hypoparathyroidism be given active metabolites calciferol + alphacalcidol instead of just vit D meds?
kidnes cannot activate precursors
30
what is pages disease?
disease of unknown aetiology causing uncoordinated bone remodelling
pain, deformity, increased fracture risk, compression of nerves (palsies, deafness)
31
most common treatment for pages disease?
bisphophanates - inhibit osteoclastic activity + prevent resorption
32
4 bone conditions bisphophonates are used for?
1. pagets - high
2. bone metastases - high
3. hypercalcaemia - higher dose
4. osteoporosis - low
prevent bone resorption in all
33
what Is osteoporosis?
generalised skeletal disorder
| reduced bone density + impaired structure + increased fracture risk
34
causes of osteoporosis?
```
age
post menopause
steroid treatment (Cushings syndrome)
chronic liver + kidney disease
nutritional disorders affecting Ca + vit D
```
35
imaging for osteoporosis?
DEXA
36
treatment options for osteoporosis?
```
bisphophonates - low dose
HRT
Ca + vit D
denosumab - monoclonal antibody injected 6 monthly
PTH injections
```
37
which bisphophonates are taken orally weekly?
alendronate + risedronate
38
which bisphophonates are injected quarterly or annually?
ibandroante or zoledronate
39
what are bone metastases?
secondary malignant growths at distance from primary cancer
40
common primary sites of bone metastases?
breast, lung, prostate
41
what is myeloma?
malignancy of plasma cells in bone marrow
| stimulates osteoclasts but not osteoblasts - can cause hypercalcaemia
42
what is the name for active vit D that increases ca absorption?
calcitrol
43
treatment for bone metastases?
radiotherapy
surgery for complications
pain relief
high dose IV bisphophonates or denosumab can reduce progression
44
what does the WHO ICF 2001 assess?
international classification of functioning, disability + health
impairments, activity limitations, participation restrictions
45
7 examples of inflammatory rheumatological disorders?
1. rheumatoid arthritis
2. psoriatic arthritis
3. enteropathic
4. ankylosing spondylitis
5. reactive arthritic
6. juvenile idiopathic arthritis
7. gout
46
3 categories of rheumatological diseases?
inflammatory
mechanical
connective tissue disease
47
3 examples of rheumatological connective tissue disease?
1. sjogrens syndrome
2. SLE
3. scleroderma
48
an example of mechanical rheumatoligcal disorder?
osteoarthritis
49
MOA of osteoarthritis?
wear of cartilage --> bone less protected --> pain --> less movement --> muscle atrophy
50
symptoms of osteoarthritis?
localised pain
pain on weight baring
advanced = non-weight baring
short lived early morning stiffness <30mins
51
pharmacological management of osteoarthritis
analgesics
NSAIDs
steroid injections
52
typical features of rheumatoid arthritis?
```
symmetrical
hand joints
at least 3 areas
morning stiffness >60mins
rheumatoid nodules
serum rheumatoid factor
```
53
presentation of rheumatoid arthritis on radiograph?
inflammation causes bone loss
early - peri-articular osteoporosis + erosions
late - joint space narrowing, dislocation, ankylosis
54
3 pharmacological options for RA?
painkillers
NSAIDs
DMARD
55
what are DMARDs?
disease modifying anti-rheumatic therapy
56
5 commonly used DMARDs
1. methotrexate
2. sulphasalazine
3. leflunomide
4. hydroxychloroquine
5. steroids
57
common DMARDs triple therapy?
methotrexate, sulphasalazine, hydroxychloroquine
58
why must you look harder if patients on biologics?
less likely to notice disease e.g. abscess
59
what do most DMARDs biologics end in?
-mab
60
what is ankylosing spondylitis?
inflammatory disease causing vertebrae to fuse
61
4 other manifestations of anklylosing spondylitis?
1. iritis + conjunctivits
2. pulmonary fibrosis
3. fatigue
4. aortic valve disease
62
what is the action of biologic DMARDs?
anti-TNF (high in inflammatory)
63
3 pharmacological treatments for anklylosing spondylitis
NSAIDS/coxibs
DMARDs - for peripheral arthritis
anti-TNF - for peripheral + spinal disease
64
clinical features of ankylosing spondylitis?
```
gradual onset
teens/twenties
morning/nigh stiffness
persistence >6/52
improvement with exercise
improvement with NSAIDs
```
65
clinical features of psoriatic arthritis?
dactylitits
iritis
enthesitis
RF is usually negative
66
what is reactive arthritis?
arthritis triggered by infection elsewhere
typically asymmetrical oligoarthritis
10-14days after infection
67
what is reiters syndrome?
reactive arthritis, urethritis + conjunctivitis
68
clinical features of sjogrens syndrome?
dry eyes + mouth
arthritis
chronic + incurable
risk of transformation to lymphoma originating within salivary gland
69
how do you position neck in patient with RA?
jaw thrust instead of neck lift/head tilt
70
why might osteogenesis imperfects be dentally relevant?
brittle bone disease - chest deformities - complicate GA/IV sedation
sign = blue sclera
71
what is osteopetrosis?
bone becomes harder - spongy bone not present, bone compacts, marrow space disappears
as marrow absent, less haematopoisis = anaemia
72
how might osteopetrosis effect XLA?
possible osteomyelitis caused by tooth snapping in socket as brittle + bone doesn't loosen
73
what is fibrous dysplasia?
bone replaced with fibrous tissue
painless hard swelling in jaw
'Chinese letter' on xray
74
what is cherubim?
bilateral variant on fibrous dysplasia + giant cells
exclude hyperparathyroidism with blood tests
75
why are extractions difficult in pages disease?
hypercementosis of roots
76
complications of pages disease?
cardiac
chest deformaties
dentures get tighter
>55yrs common
77
what happens to hands in RA?
ulnar deviation - OH hard
78
how to avoid osteoradionecrosis?
extractions prior to radiotherapy advised + cover bone with soft tissue
avoid extractions first 6months - 1 year after
don't use vasoconstrictor
79
oral relevance of marfans syndrome?
high arched palate
80
patients with gout have increased risk of what 3 conditions?
hypertension
ischaemic heart disease
diabetes mellitus
81
dental anomalies in cleidocranial dysostosis?
delayey/no eruption
| supernumerary teeth
