Musculoskeletal System Flashcards

Question

What are some tests for reactive arthritis?

Answer 1

1. **Blood test** * Raised ESR/CRP 2. **Aspirate joint** * To exclude infection/crystals. 3. **Urethral swab, stool culture** * Show infection. * Contact tracing if necessary.

Answer 2

1. Symptomatic * Analgesia, NSAIDS, intra-articular steroid * Symptoms rarely last more than 12 months * Oral prednisolone if not responding to NSAIDS and polyarthropathy 2. **Sulfasalazine or methotrexate** * If symptoms \>6 months. (Consider) Treating the original infection may make little difference to the arthritis.

Answer 3

Behcet's syndrome is a complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins. The precise aetiology has yet to be elucidated however. **The classic triad of symptoms are** 1. Oral ulcers 2. Genital ulcers 3. Anterior uveitis

Answer 4

Inflammatory arthritis associated with the occurrence of an inflammatory bowel disease (IBD), the two best-known types of which are ulcerative colitis and Crohn's disease.

Answer 5

1. Peripheral synovitis 2. Asymmetric lower limb arthritis 3. Apthous ulceration 4. Uveitis 5. Erythema Nodosum 6. AS occurs in 7% of patients with IBD. 7. 50% of patients with IBD and HLA-B27 +ve develop sacroiliitis

Answer 6

1. Leucocytosis 2. HIGH - ESR + CRP 3. Hypergammaglobulinaemia 4. Negative RF

Answer 7

**No specific cure** 1. Splint joints 2. NSAIDS or local steroid injections 3. Underlying bowel disease treated

Answer 8

1. Auto-immune. 2. Crystal arthritis. 3. Infection.

Answer 9

Auto-immune inflammatory disease affecting joints and other systems

Answer 10

1. Most common inflammatory arthritis~1% population 2. **_Women_** more common

Answer 11

**Pain eases with use** **Stiffness** Significant (\>60 mins) Early morning/ at rest (evening) **Swelling Synovial +/- bone** **Pt demographics** Eg young, psoriasis, family history **Joint distribution** Eg hands & feet **Responds to NSAIDs**

Answer 12

1. **Pain increases with use** * Clicks/ clunks 2. **Stiffness** * Not prolonged (\<30 mins) * Morning/ evening 3. **Swelling** * None, bony * Not clinically inflamed 4. **Pt demographics** * Eg older, prior occupation/ sport 5. **Joint distribution** * Eg 1st CMCJ, DIPJ, knees 6. Less convincing response to NSAIDs

Answer 13

Combination of genetic and environment 1. HLA DR4 2. Ciagrette smoke or infection

Answer 14

1. Joint pain often worse in morning * (may improve with activity) 2. Morning stiffness-several hours 3. Loss of function 4. General-fatigue, malaise 5. Extra-articular involvement.

Answer 15

**Symmetrical small joints** MCP PIP 1. Ulnar deviation of the fingers. 2. Boutonnière and swan-neck deformities of fingers or Z-deformity of thumbs occur. 3. Baker (poploteal cyst) 4. Larger joints can be involved - atlanto-axial joint subluxation may threaten the spinal cord (rare).

Answer 16

Sicca (dry eyes) Secondary Sjorgren’s syndrome Episcleritis Scleritis (corneal ulceration).

Answer 17

1. **Blood tests** * Rheumatoid Factor - 80% - **NEGATIVE MEANS GOOD PROGNOSIS** * Anti-Cyclic Citrullinated Peptide (Anti-CCP) antibody c - 80% - **MARKER OF PROGNOSIS** * High ESR/CRP * Anti-nuclear antibody (ANA) \< 50% 2. **X-Ray** * Loss joint space * juxta-articular osteopenia * Soft tissue swelling * Sublaxation

Answer 18

1. **DMARDS** * Methotrexate - FIRST LINE WITH STEROIDS * Can switch sulfasalazine - **close allergy to aspirin caution!** 2. **NSAIDS** * Symptom relief, no efect on disease progression * Paracetamol and weak opiates are rarely effective * Physio- and occupational therapy, eg for aids and splints 3. **TNF-inhibitors** 4. **Acute Flares** * Methylprednisolone * Rapidly reduce symptoms and inflammation 5. **Rituximab** - B cells 6. **Abatacept** - T cells

Answer 19

1. Anteroposterior and lateral cervical spine radiographs 2. Incase of atlantoaxial subluxation

Answer 20

1. RA 2. Splenomegaly 3. Low white cell count

Answer 21

Inflammation and necrosis of blood vessel walls with subsequent impaired blood flow

Answer 22

Autoimmune disease, confusing part of the blood vessel as foregin

Answer 23

**_Size of vessel_** Small – medium - large vessel disease **_Target organ(s)_** **_A_****nti-neutrophil cytoplasmic antibodies** (**_ANCA_**) Present or not **_Primary vs secondary_**

Answer 24

Large Medium Small ANCA +ve vasculitis ANCA –ve vasculitis

Answer 25

No single typical presentation Systemically unwell Fever Arthralgia/arthritis Rash Weight loss Headache Footdrop Major event eg stroke, bowel infarction.

Answer 26

ESR/CRP increase. ANCA may be +ve. Increase in Creatinine if renal failure. Urine: proteinuria, haematuria, casts on microscopy. Angiography ± biopsy may be diagnostic.

Answer 27

**_Antineutrophil cytoplasmic antibodies_** Small/medium vessel vasculitis Specific antibodies for antigens in cytoplasmic granules of neutrophils and monocyte lysosomes.

Answer 28

Detected with indirect immunofluorescence microscopy **_Two major patterns_** Cytoplasmic ANCA (c-ANCA) Major antigen Proteinase 3 Peri-nuclear ANCA (p-ANCA) Major antigen Myeloperoxidase (MPO)

Answer 29

Granulomatous arteritis of aorta + larger vessels-extracranial branches of carotid arteries

Answer 30

1. Primarily\>50yrs old 2. Incidence increases with age 3. Twice as common in women

Answer 31

1. Headache 2. Scalp tenderness 3. Jaw claudication 4. Acute blindness 5. Non specific malaise

Answer 32

**3 or more of:** 1. Age\>50 2. New headache 3. Temporal artery tenderness or decreased pulsation 4. ESR \> 50 mm/h 5. Abnormal artery biopsies showing necrotizing arteritis with mononuclear infiltrate or granulomatous inflammation

Answer 33

Sudden, painless, monocular and severe visual loss. May be preceded by transient visual loss The optic disc becomes pale and swollen, often with flame-shaped haemorrhages at the margin.

Answer 34

1. Raised inflammatory markers * ESR \> 50 mm/hr (note ESR \< 30 in 10% of patients) * CRP may also be elevated 2. Temporal artery biopsy * Skip lesions may be present 3. Note creatine kinase and EMG normal 4. **VISION TESTING**

Answer 35

**_Corticosteroids_** Prednisolone **_Prophylaxis of osteoporosis_** Lifestyle advice Calcium/Vitamin D + Bisphosphonate DEXA scan

Answer 36

PAN is a necrotizing vasculitis that causes aneurysms and thrombosis in medium-sized arteries Leading to infarction in affected organs, with severe systemic symptoms.

Answer 37

Some associated with Hep B Others unknown

Answer 38

Immune cells confuse the vessel wall with hep B virus Causes transmural inflammation All layers die Fibosis as vascular wall heals This process is fibrinoid necrosis Anneurysms occur through weakness of artery

Answer 39

1. **Typically systemic features** * Fever, malaise, weight-loss, arthralgia, myalgia 2. **Skin** * Rash and ‘punched out’ ulcers 3. **Renal** * Hypertension 4. **Cardiac** * Angina or MI 5. **GI** 6. **GU**

Answer 40

1. **Gold standard = biopsy** 2. Often WCC increase 3. Normocytic Anaemia 4. ESR increase 5. **Angiography** * String of beads

Answer 41

1. **Control BP** 2. **Corticosteroids** Prednisolone 3. **Cyclophosphamide/Azathioprine** 4. Hepatitis B should be treated with an antiviral after initial treatment with steroids.

Answer 42

Polymyalgia rheumatica is a disease of the muscles and joints characterized by muscle pain and stiffness, affecting both sides of the body, and involving the shoulders, arms, neck, and buttock areas.

Answer 43

PMR and GCA share the same demographic characteristics and, although separate conditions, the two frequently occur together

Answer 44

Over 50 years olds Women more than men

Answer 45

1. Rapid onset \<1 month 2. Tenderness and morning stiffness 3. Bilateral aching 4. Tenosynovitis 5. Carpal tunnel syndrome 6. B symptoms

Answer 46

1. Note **creatinine kinase** levels are normal (helping to distinguish from myositis/myopathies) 2. **EMG normal** 3. CRP increased 4. ESR increased 5. ALP is increased

Answer 47

**_Corticosteroids_** Prednisolone

Answer 48

A non inflammatory disorder Deterioration of articular cartilage Formation of new bone of the joint surfaces and margins

Answer 49

Unknown but risk factors have a big impact

Answer 50

Commonest joint disorder M=F \<45yrs prevalence greater in males \>55yrs prevalence greater in females Common in Caucasians

Answer 51

**_Primary or idiopathic_** No identifiable predisposing cause **_Secondary_** When an underlying cause is implicated

Answer 52

1. **Squaring of the thumb** 2. Swelling 3. Muscle wasting 4. Deformity 5. Decreased ROM 6. Crepitus (cracking or clicking of joint movement) 7. Osteophytes palpable 8. Joint instability (later on) 9. Heberdens 10. Bouchards

Answer 53

**Heberden's nodes** are hard or bony swellings that can develop in the distal interphalangeal joints (DIP) **Bouchard's nodes** are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints

Answer 54

**_Imaging_** X-RAY DIAGNOSTIC **_Laboratory Tests_** Blood & Synovial Fluid

Answer 55

**_L_**oss of joint space **_O_**steophytes (bony projection associated with the degeneration of cartilage at joints.) **_S_**ubarticular sclerosis (denser area of bone just under the cartilage in your joint, appearing as abnormally white bone along the joint line) **_S_**ubchondral cysts (The cartilage tries to repair itself, the bone remodels, the underlying (subchondral) bone hardens, and bone cysts form.)

Answer 56

**_Blood_** ESR, FBC, Rh Factor, Calcium, ALP, Electrophoresis All Normal **_Synovial Fluid Analysis_** Non specific in OA

Answer 57

1. All patients should be offered help with weight loss, given advice about local muscle strengthening exercises and general aerobic fitness 2. **FIRST LINE** * Paracetamol and topical NSAIDs are first-line analgesics. Topical NSAIDs are indicated only for OA of the knee or hand 3. **SECOND-LINE** * Oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids. A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2 inhibitors. These drugs should be avoided if the patient takes aspirin 4. non-pharmacological treatment options include supports and braces, TENS and shock-absorbing insoles or shoes 5. if conservative methods fail then refer for consideration of joint replacement

Answer 58

SLE is a multisystemic autoimmune disease in which autoantibodies are made against a variety of autoantigens (eg ANA).

Answer 59

Women of child bearing age Genetic Association: HLA: DR2, DR3 C4 A Null Allele

Answer 60

* *S**erositis (pleuritis, pericarditis) * *O**ral ulcers * *A**rthritis * *P**hotosensitivity * *B**lood (all are low - anaemia, leukopemnia, thrombocytopenia) * *R**enal (protein) * *A**NA * *I**mmunologic (DSm DNA) * *N**eurologic (psych,seizures) * *M**alar rash * *D**iscoid Rash

Answer 61

1. **Double stranded DNA** **antibody (Anti-dsDNA)** * MOST Specific 2. **Anti-nuclear antibody** * ****Not specific for lupus (screening test), 99% present though - RULE OUT 3. Other antibodies: * **Rheumatoid factor** * Cardiolipin antibodies, Anti Ro, La, Sm, RNP * ESR increase but normal CRP 4. HIGH CRP INDICATES UNDERLYING INFECTION

Answer 62

Four or more of the following. 1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers 5. Arthritis 6. Serositis 7. Renal disorder 8. Neurological disorder 9. Haematological disorder 10. Immunological disorder 11. Anti-nuclear antibody

Answer 63

1. **Topical steroids and sunblock** * Rashes 2. **NSAIDS** and H**ydroxychloroquine (retinal problems)** * Joint and skin symptoms. If internal organ involvement 1. **Steroids** * Suppress immune syste 2. **Immunosupressants** * ****Azathiprine, methotrexate and mycophenolate are used as steroid-sparing agents.

Answer 64

1. Procainamide 2. Hydralazine 1. Anti-histone

Answer 65

Antibodies against protein in the phospholipid membrane Associated with Lupus

Answer 66

Antiphospholipid antibodies (anticardiolipin & lupus anticoagulant) cause **CLOTS**: 1. **_C_**oagulation defect - **Prolonged APTT** 2. **_L_**ivedo reticularis (mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin) 3. **_O_**bstetric (recurrent miscarriage) 4. **_T_**hrombocytopenia (reduced platelets)

Answer 67

1. **Lupus anticoagulant** And/or 1. **Cardiolipin Antibodies** Positive on 2 occasions 12 weeks apart

Answer 68

**Primary thromboprophylaxis** 1. Low-dose aspirin **Secondary thromboprophylaxis** 1. **Initial venous thromboembolic events:** Lifelong warfarin with a target INR of 2-3 2. **Recurrent venous thromboembolic events**: Lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4 3. **Arterial thrombosis** Should be treated with lifelong warfarin with target INR 2-3

Answer 69

Discoloration of the fingers and/or the toes After exposure to changes in temperature or emotional events.

Answer 70

Fingers or toes ache and change colour: pale (ischaemia) to blue (deoxygenation) to red (reactive hyperaemia)

Answer 71

**_Primary_** Raynaud's disease **_Secondary_** Connective tissue diseases e.g. SLE Drugs - Beta Blockers Vascular damage Raynaud's syndrome

Answer 72

Colour changes Numbness, tingling and pain Could cause tissue death

Answer 73

1. Description of episodes 2. Explore underlying condition 3. Nailfold capillary microscopy

Answer 74

1. **Vasodilators** * Calcium channel blockers - Nifedipine * Sildenafil 2. **IV prostacyclin infusions** 3. **Avoid triggers** 4. **Stop smoking**

Answer 75

Autoimmune disease of the connective tissue Thickening of the skin caused by accumulation of collagen And by injuries to small arteries

Answer 76

1. Limited cutaneous 2. Diffuse cutaneous 3. Scleroderma

Answer 77

Mainly affects face and sital limbs predominately 1. **_C_**alcinosis (calcium deposits form in the skin) 2. ****_R_**aynaud’s phenomenon** 3. O**_e_**sophageal reflux, strictures 4. **_S_**clerodactyly (localized thickening and tightness of the skin of the fingers or toes) 5. **_T_**elangectasia (widened venules (tiny blood vessels) cause threadlike red lines or patterns on the skin.) 6. Pulmonary arterial hypertension

Answer 78

Anti-centromere

Answer 79

Mainly affects trunk and proximal limbs predominately Diffuse affects organs too 1. Proximal scleroderma 2. **Pulmonary fibrosis** 3. Bowel involvement 4. Myositis 5. Renal crisis: hypertension

Answer 80

1. Antibodies * Scl-70 * Nucleolar * RNA polymerase

Answer 81

1. **Immunological tests** * Anti-nuclear antibodies ++ * Anti-Scl-70, anti-centromere & anti-nucelolus + 2. **Haematological** * Normocytic anaemia * High ESR 3. **Radiological** * X-rays - calcium in skin of fingers * Barium swallow - oesophageal involvement

Answer 82

1. NO CURE 2. Supression of immune system with * **Cyclophosphamide** 3. **Treat symptoms** * Raynaud's phenomenon * Oesophageal reflux * Sjogren's syndrome 4. **Kidney problems** * ACE inhibitor

Answer 83

Primary Sjogren's syndrome is the association of keratoconjunctivitis sicca and/or xerostomia, with rheumatoid arthritis or other connective tissue disorder

Answer 84

1. Lacrimal and salivary glands (parotid) 2. T cell mediated

Answer 85

Polyarthritis/arthralgia Raynaud’s

Answer 86

**_Sicca complex:_** Dry eyes Dry mouth Enlarged salivary glands **_Systemic features_** InflammatoryArthritis Rash (sub-acute lupus) Neuropathies Vasculitis Neonatal lupus ASSOCIATED WITH LYMPHOMA

Answer 87

1. **Schirmer’s test** Conjunctival dryness 2. **Biopsy** Lymphocyte infiltration in glands 3. **Auto-antibodies** ANA (in most) 70% Rheumatoid factor 50% Anti-Ro 70% Anti-La 30%

Answer 88

1. **Tear and saliva replacement** * Artifical saliva and tears * Pilocarpine may stimualte saliva production 2. **Immuno-suppression for systemic complication** * ****Prednisolone

Answer 89

Systemic connective tissue diseases which are characterised by acute and chronic inflammation of striated muscle. In dermatomyositis there is an accompanying dermatitis **Assocaited with malignancy**

Answer 90

Muscle and skin mainly affected: rash and muscle weakness Lungs can be affected (Interstitial lung disease)

Answer 91

Polymyositis tends to have a chronic natural history and is less responsive to therapy Dermatomyositis can be life-threatening, but is more responsive to treatment

Answer 92

1. Muscle tenderness 2. Proximal, symmetrical muscle weakness 3. May present as difficulty rising from a chair or climbing stairs 4. Dysphagia 5. Dysphonia 6. Respiratory failure

Answer 93

1. Macular rash 2. **Rash on eyelids** - Heliotrope rash 3. **Hand Rash** - Gottron's papules 4. **Nails** - Periungal telangectasias + Cuticular hypertrophy with punctate infarcts 5. **Neck** - poikiloderma 6. **Spots** - Calcinosis cutis

Answer 94

1. **Muscle enzymes** (serum creatinine kinase + serum aldolase) 2. **EMG to identify to do** * --\> Muscle/skin biopsy - muscle necrosis, phagocytosis of muscle fibres + inflammatory infiltrate 3. Autoantibodies such as **ANF** and **RF** are often positive 4. ANA positive

Answer 95

1. Steroids - Prednisoline - 20-60mg daily 2. Immunosuppressive drugs - azathioprine 150mg/day 3. Hydroxychloroquine (skin rash)

Answer 96

Pain of the lower back

Answer 97

Ages of 20-55.

Answer 98

Located in lumbrosacral region, buttocks and tighs.

Answer 99

1. Age on onset less than 20 or greater than 55. 2. Violent trauma e.g. fall from a heigh 3. Constant progressive, non-mechanical back pain 4. Thoracic pain 5. PMH carcinoma, systemic steroids, drug abuse, HIV 6. Systemically unwell, weight loss 7. Persisting servere resistriction of lumbar flexion 8. Structural deformity

Answer 100

With the patient standing, gauge the extent and smoothness of lumbar forward/ lateral flexion and extension. Clinical tests for sacroiliitis: direct pressure, lateral compression, sacroiliac stretch test (pain on adduction of the hip, with the hip and knee flexed). Signs of generalized disease—eg malignancy. Examine other systems (eg abdo- men) as pain may be referred.

Answer 101

15–30yrs: Prolapsed disc, trauma, fractures, ankylosing spondylitis, spondylolisthesis (a forward shift of one vertebra over another, which is congenital or due to trauma), pregnancy. 30–50yrs: Degenerative spinal disease, prolapsed disc, malignancy (primary or secondary from lung, breast, prostate, thyroid or kidney ca). \>50yrs: Degenerative, osteoporotic vertebral collapse, Paget’s, malignancy, myeloma, spinal stenosis.

Answer 102

SIngle excessive force Static loading Repetative wear and tear A bit of reality

Answer 103

Arrange relevant tests if you suspect a specific cause, or if red flag symptoms: **_FBC_**, ESR and CRP (myeloma, infection, tumour), U&E, ALP (Paget’s), serum/urine electrophoresis (myeloma), PSA. **_X-rays_** Exclude bony abnormality but are generally not indicated. **_MRI_** Is the image of choice and can detect disc prolapse, cord compression (fig 1), cancer, infection or inflammation (eg sacroiliitis).

Answer 104

1. For non-specific back pain, focus on education and self-management. 2. Continue with normal activites and be active. 3. **Manage pain** * NSAIDS - FRIST LINE * Codeine 4. **Physiotherapy,** acupuncture or an exercise programme if not improving. 5. **Psychosocial issues** 6. **Surgery**

Answer 105

Infection localized to bone Metaphysis - Kids Epiphysis - Adults

Answer 106

1. **Pyogenic** (involving or relating to the production of pus) * S. aureus * Salmonella in sickle cell patients 2. **Non-pyogenic** * M. tb

Answer 107

1. Direct 2. Contiguous 3. Haematogenous

Answer 108

1. **Behavioural factors** * I.e. risk of trauma 2. **Vascular supply** * Arterial disease * Diabetes mellitus * Sickle cell disease 3. **Pre-existing bone / joint problem** * Inflammatory arthritis * Prosthetic material 4. **Immune deficiency**

Answer 109

1. **Chronic changes** * Necrotic bone ‘sequestra’ * New bone formation ‘involucrum’ * Neutrophil exudates * Lymphocytes & histiocytes

Answer 110

Interruption of periosteal blood supply causing necrosis. Leaves pieces of separated dead bone ‘sequestra’ New bone forms here ‘involucrum’.

Answer 111

**_Systemic_**: Fever, rigors, sweats, malaise **_Local_**: **_Acute OM_** Tenderness, warmth, erythema, and swelling **_Chronic OM_** Tenderness, warmth, erythema, and swelling Draining sinus tract Deep / large ulcers Non-healing fractures

Answer 112

1. **MRI - INVESTIGATION OF CHOICE FOR OSTEOMYELITIS** 2. X-rays 3. **Aspiration of pus + culture** 4. **FBC/WCC** * Rasied or normal 5. **CRP/ESR** * Raised

Answer 113

1. **Antibiotics** * Flucloxacillin and fusidic acid, clindamycin 2. Surgical 3. Splintage 4. Supportive

Answer 114

Inflammation of a joint that's caused by infection.

Answer 115

1. **Staphylococcus aureus** is the most common agent 2. In young adults who are sexually active, Neisseria gonorrhoeae is the most common organism (disseminated gonococcal infection) Also: 1. Streptococcus pyogenes 2. pneumococcus

Answer 116

Pre-existing joint disease Vascular e.g. diabetes mellitus, Immunosuppression Chronic renal failure Recent joint surgery Prosthetic joints, IV drug abuse, age \>80yrs

Answer 117

1. Overlying skin is red and warm 2. Swollen, painful joint 3. Pain on movement - movements are always diminished and often absent if the joint is rigid due to pain and spasm 4. General features include tachycardia and swinging pyrexia.

Answer 118

1. **Joint aspiration - FIRST LINE** for synovial fluid microscopy and culture 2. **Blood cultures** 3. **X-rays** and CRP may be normal

Answer 119

Crystal arthropathies.

Answer 120

1. Antibiotics IV * staphylococci and streptococci in adults, and, additionally, Haemophilus in children 2. Joint drainage 1. **Flucloxacillin** 2. **Clindamycin if penicillin allergic** 3. **Vancomycin** IV if MRSA 4. **Cefotaxime** IV if gonococcal or Gram –ve or- ganisms suspected 4-6 WEEKS OF TREATMENT

Answer 121

Cancer of the bone

Answer 122

Rest pain Night pain Lump present – tender, enlarging, deep to fascia, above 5cm in diameter Loss of function Neurological symptoms Unwell / Weight loss

Answer 123

* Prefix will be tissue of origin, for example: * Osteo… = Bone * Chondro… = Cartilage * Rhabdomyo… = Skeletal Muscle * Lipo… = Fat * Suffix tells you whether it is benign or malignant * …oma = Benign tumour * …sarcoma = Malignant connective tissue tumour * …carcinoma = Malignant epithelial/endothelial tumour …blastoma = (Malignant) Tumour of embryonic cells

Answer 124

Paget’s, Post-Radiation, Fibrous Dysplasia Associated with p53 mutation Also associated with Chondrosarcoma and STS

Answer 125

1. Paget’s Disease 2. Fibrous Dysplasia 3. Associated with McCune-Albright syndrome and Polyostic Fibrous Dysplasia 4. McCune-Albright = fibrous dysplasia + café-au-lai spots + endocrine abnormalities

Answer 126

* Initial treatment with multi-agent chemotherapy pre-op 8-12 weeks * Aims to kill tumour cells, reduce further spread, treat micro-metastases * Repeat procedures to Stage the Tumour * Limb Salvage surgery (where possible) + adjuvant chemotherapy

Answer 127

* Intralesional: The plane of surgery goes through the tumour. * Marginal: The plane of surgery goes through the reactive zone of the lesion (the reactive zone contains oedema, tumour cells, fibrous tissue, and inflammatory cells). * Wide: The plane of dissection goes through normal tissue. * Radical: The entire anatomic compartment of the lesion is removed.

Answer 128

**_Homogenous solid_** ions bonded closely in ordered, repeating, symmetric arrangement **_Stable, hard, high density_**

Answer 129

**_All animals_** Strengthen endo & exo-skeleton Remove excess ions (surface binding)

Answer 130

They are the two routes of excretion of uric aicd.

Answer 131

Purines -\> HypoXanthine-\> Xathine -\> Uric acid -\> monosodium urate

Answer 132

Monosodium urate crystals deposited in joints

Answer 133

Hyperuricemia Too much uric acid in the blood

Answer 134

1. Too much uric acid 2. Formation of sharp crystals 3. In areas of slow blood flow 4. Joints and kidneys 5. Overtime results in destruction of tissue leading to arthritis 6. Inflammation from WBC releasing proinflammatory mediators

Answer 135

Xanthinine oxidase.

Answer 136

Shellfish Anchiovies Red meat Organ meat

Answer 137

1. Occur at the first metatarsophalangeal joint of the big toe * This is called Podagra 2. Other common joints are the ankle, foot, small joints of the hand, wrist, elbow or knee.

Answer 138

Podagra Pain Hot Red

Answer 139

1. **_Polarized light microscopy of synovial fluid_** Shows negatively birefringent urate crystals 2. **_Serum urate_** Raised 3. **_Radiographs_** Soft-tissue swelling ‘Punched out’ erosions There is no sclerotic reaction, and joint spaces are preserved until late

Answer 140

1. **NSAIDs or colchicine** are first-line * NSAID should be prescribed until 1-2 days after the symptoms have settled. Gastroprotection (e.g. a proton pump inhibitor) may also be indicated 2. Oral steroids may be considered if NSAIDs and colchicine are contraindicated. A dose of prednisolone 15mg/day is usually used 3. If the patient is already taking allopurinol it should be continued

Answer 141

1. Allopurinol * Started 2 weeks after an attack * Start this with NSAID or colchicine for 'cover' 2. Lifestyle modifications * Reduce alcohol * Lose weight * Change diet

Answer 142

1. Direct trauma to the joint 2. Intercurrent illness 3. Surgery – especially parathyroidectomy 4. Blood transfusion, IV fluid 5. T4 replacement 6. Joint lavage 7. Most are spontaneous

Answer 143

**Decreased excretion of uric acid** 1. drugs\*: diuretics 2. chronic kidney disease 3. lead toxicity **Increased production of uric acid** 1. myeloproliferative/lymphoproliferative disorder 2. cytotoxic drugs 3. severe psoriasis **Lesch-Nyhan syndrome** 1. hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency 2. x-linked recessive therefore only seen in boys 3. features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation

Answer 144

Calcium pyrophosphate deposition in joints

Answer 145

1. Haemochromatosis 2. **Hyperparathyroidism** 3. Low magnesium, low phosphate 4. Acromegaly, Wilson's disease

Answer 146

Typical distribution – (MCPs), wrists, knees, (ankles)

Answer 147

**_Commonly incidental finding on radiology_** 1. Severe pain, stiffness, swelling 2. Knee, wrist and shoulder more commonly affected 3. Fever

Answer 148

1. **Pattern of involvement** * Wrists, shoulders, ankles, elbows 2. **Marked inflammatory component** 3. **Superimposition of acute attacks**

Answer 149

1. Knee, wrist and shoulders most commonly affected 2. Joint aspiration * Weakly-positively birefringent rhomboid-shaped crystals 3. **X-ray: chondrocalcinosis** * In the knee this can be seen as linear calcifications of the meniscus and articular cartilage

Answer 150

**Acute** NSAIDs, analgesia, colchicine **Injections** Steroids **Immunosuppresants** Methotrexate and hydroxychloroquine for chronic pseudogout

Answer 151

Low bone mass and deterioration of bone tissue Consequent increase in bone fragility and susceptibility to fracture.

Answer 152

Primary (age) Secondary (related to a condition)

Answer 153

1/2 women and 1/5 men over 50

Answer 154

Inflammatory disease Endocrine disease. Reduced skeletal loading Medication. Alcohol and smoking.

Answer 155

**_Bone densitometry_** Dual energy X-ray absorptiometry. (DEXA) **_Bloods_** Calcium and Phosphate **OFTEN NORMAL**

Answer 156

Uses to different beams to assess how much calcium is in the bone. Low radiation dose Measures important fracture sites

Answer 157

Standard deviation score, it compares your score with gender-matched young adult average (peak bone mass)

Answer 158

Diagnose osteoporsis. \< -1.0 Normal -1.0 to -2.5 Osteopenia \> -2.5 Osteoporosis \> -2.5 plus fracture Severe osteoporosis

Answer 159

1. **_Glucocorticoids (corticosteroids)_** 2. GnRH analogues (goserelin) 3. Androgen deprivation

Answer 160

A genorator to see how much at risk of a fracture you are

Answer 161

**Calcium + Vitamin D** **Anti-resorptive** **Decrease osteoclast activity and bone turnover** Bisphosphonates HRT Denosumab - antibody to RANK **Anabolic** **Increase osteoblast activity and bone formation** Teriparatide

Answer 162

**_Benefits_** Reduce the risk of fractures Stop bone loss Prevents hot flushes Reduces risk of colon cancer **_Risks_** Breast cancer Stroke Cardiovascular disease

Answer 163

**_First line treatment_** ORAL Alendronate (daily or weekly) Risedronate (daily or weekly) Ibandronate (monthly) Etidronate (two weeks of 13) IV Ibandronate (3-monthly) Zoledronate (once yearly)

Answer 164

Osteomalacia there is a normal amount of bone but its mineral content is low (there is excess uncalcified osteoid and cartilage).

Answer 165

**_Vitamin D deficiency_** **_Renal failure_** 1,25-dihydroxy-cholecalciferol deficiency **_Drug-induced_** Increased breakdown of 25-hydroxy-vitamin D. **_Vitamin D resistance_**: Osteomalacia responds to high doses of vitamin D **_Liver disease_** Due to reduced hydroxylation of vitamin D to 25-hydroxy-cholecalciferol and malabsorption of vitamin D, eg in cirrhosis Tumour

Answer 166

1. Bone pain and tenderness 2. Fractures 3. Proximal myopathy (waddling gait)

Answer 167

1. **Bloods** Low vitamin D levels Low calcium, phosphate (in around 30%) Raised alkaline phosphatase (in 95-100% of patients) 2. **X-ray** Translucent bands (Looser's zones or pseudofractures)

Answer 168

1. **Vitamin D supplmentation** A loading dose is often needed initially 2. **Calcium supplementation if dietary calcium is inadequate**

Answer 169

1. Increased bone turnover associated with increased numbers of osteoblasts and osteoclasts 2. With resultant remodelling, bone enlargement, deformity, and weakness

Answer 170

Rare in the under-40s. Incidence rises with age (3% over 55yrs old).

Answer 171

Asymptomatic Deep, boring pain, and bony deformity and enlargement Classically a bowed sabre tibia

Answer 172

1. **_X-ray_** Localized enlargement of bone. Patchy cortical thickening with **sclerosis**, osteolysis, and deformity 2. **_Blood chemistry_** Ca2+ and PO43 normal ALP RAISED

Answer 173

1. Analgesia - e.g. Paracetamol, NSAIDs 2. **Bisphosphonates - e.g. Alendronate** 3. Surgery - If fractures occur

Answer 174

Fibromyalgia is a chronic condition affecting fibrous tissue and muscle causing pain

Answer 175

Female more than men

Answer 176

Unknown Thought to be caused by the way the brain receieves pain signals

Answer 177

1. **Genetics** 2. **Environmental** * Child abuse * Depression * Anxiety * Negative beliefs

Answer 178

1. Chronic pain: at multiple site, sometimes 'pain all over' 2. Lethargy 3. Cognitive impairment: 'fibro fog' 4. Sleep disturbance, headaches, dizziness are common

Answer 179

Pain location in more than 7 areas with a symptom severity score of 5/12 OR Pain location in more than 5 areas with a symptom severity score of 9/12 SYMPTOMS must be present for more than 3 months NOT due to another disease

Answer 180

1. Explanation 2. Aerobic exercise * Has the strongest evidence base 3. Cognitive behavioural therapy 4. Medication * Pregabalin * Duloxetine * Amitriptyline

Answer 181

Disorders effecting intervertebral discs: herniation, degeneration, infection.

Answer 182

Herniation = prolapsed vertebral disc.

Answer 183

Major cause of lower back pain. Exact cause is known Could be natural part of ageing Can occur in young people: genetic, environmental, traumatic, inflammatory, infectious, etc. May lead to disc herniation.

Answer 184

Nucleus pulposus herniates, it can irritate or compress the adjacent nerve root - symptoms of sciatica

Answer 185

Symptoms of sciatica Compress cauda equine Nerve root compression Symptoms can correspond to the level.

Answer 186

Symptoms may settle within 6 weeks MRI very sensitive CT Plain x-rays sometimes useful

Answer 187

Analgesia Encourage to keep active Heat and massage to relieve muscle spasm Avoid activities that aggravate pain Physiotherapy Surgery.

Answer 188

1. Loss of height: vertebral osteoporotic fractures of lead to compression of the spinal vertebrae hence a reduction in overall length of the spine and thus the patient becomes shorter 2. Kyphosis (curvature of the spine) 3. Localised tenderness on palpation of spinous processes at the fracture site

Answer 189

1. X-ray of the spine: This should be the first investigation ordered and may show wedging of the vertebra due to compression of the bone. An X-ray of the spine may also show old fractures (which can have a sclerotic appearance)

Answer 190

1. Pyogenic infection of the spine 2. Rare 3. Incidence due to life expectancy

Answer 191

Inflammation of vertebral disc space Can co-exist with osteomyelitis Most commonly effects lumbar spine Usually haematogenous spread of infection from other parts of the body Common sources; urinary tract, lungs, soft tissues

Answer 192

1. Bacterial * Staphylococcus aureus is the most common cause of discitis * Need to do echo to see if organism came from here 2. Viral 3. TB 4. Aseptic

Answer 193

1. Back pain 2. General features * pyrexia, * rigors * sepsis 3. Neurological features * e.g. changing lower limb neurology * **if epidural abscess develops**

Answer 194

1. Imaging: **MRI** has the highest sensitivity 2. **CT guided biopsy** may be required to guide antimicrobial treatment

Answer 195

1. Antibiotics (adjusted after culture results) 2. Immobilization (2 weeks bed rest, then immobilization with brace) 3. Surgery if neurological deficit, deformity or lack of response tp antibiotics.

Answer 196

Raised pressure within a closed anatomical space. The raised pressure within the compartment will eventually compromise tissue perfusion resulting in necrosis. The two main fractures carrying this complication include supracondylar fractures and tibial shaft injuries.

Answer 197

1. Pain, especially on movement (even passive) * excessive use of breakthrough analgesia should raise suspicion for compartment syndrome 2. Parasthesiae 3. Pallor may be present 4. Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise 5. Paralysis of the muscle group may occur

Answer 198

1. Is made by measurement of intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and \>40mmHg is diagnostic 2. Compartment syndrome will typically not show any pathology on an x-ray

Answer 199

1. This is essentially prompt and extensive fasciotomies 2. In the lower limb the deep muscles may be inadequately decompressed by the inexperienced operator when smaller incisions are performed 3. Myoglobinuria may occur following fasciotomy and result in renal failure and for this reason these patients require aggressive IV fluids 4. Where muscle groups are frankly necrotic at fasciotomy they should be debrided and amputation may have to be considered 5. Death of muscle groups may occur within 4-6 hours

Answer 200

Fall onto an outstretched hand

Answer 201

1. **Compromise of the dorsal carpal arch of the radial artery** 2. Pain along the radial aspect of the wrist, at the base of the thumb 3. Loss of grip / pinch strength 4. **Point of maximal tenderness over the anatomical snuffbox** * This is a highly sensitive (around 90-95%), but poorly specific test (\<40%)in isolation 5. Wrist joint effusion * Hyperacute injuries (\<4hrs old), and delayed presentations (\>4days old) may not present with joint effusions. 6. Pain elicited by telescoping of the thumb (pain on longitudinal compression) 7. Tenderness of the scaphoid tubercle (on the volar aspect of the wrist) 8. Pain on ulnar deviation of the wrist

Answer 202

1. Imaging * X-ray * CT * MRI - definitive and exclusive 2. Repeated 7-10 days if first x-ray is normal

Answer 203

1. **Immobilisation with a Futuro splint or standard below-elbow backslab** 2. Undisplaced fractures of the scaphoid waist * Cast for 6-8 weeks 3. **Displaced scaphoid waist fractures** * requires surgical fixation 4. **proximal scaphoid pole fractures** * require surgical fixation

Answer 204

1. Pain 2. The classic signs are a **shortened and externally rotated leg** 3. Patients with non-displaced or incomplete neck of femur fractures may be able to weight bear

Answer 205

Avascular necrosis

Answer 206

1. **Intracapsular** (subcapital): from the edge of the femoral head to the insertion of the capsule of the hip joint 2. **Extracapsular**: these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)

Answer 207

The **Garden system** is one classification system in common use. 1. Type I: Stable fracture with impaction in valgus 2. Type II: Complete fracture but undisplaced 3. Type III: Displaced fracture, usually rotated and angulated, but still has boney contact 4. Type IV: Complete boney disruption Blood supply disruption is most common following Types III and IV.

Answer 208

1. **Undisplaced Fracture:** * Internal fixation, or hemiarthroplasty if unfit. 2. **Displaced Fracture:** * NICE recommend replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture * Total hip replacement is favoured to hemiarthroplasty if patients: * Were able to walk independently out of doors with no more than the use of a stick and * Are not cognitively impaired and * Are medically fit for anaesthesia and the procedure.

Answer 209

1. Stable **intertrochanteric** fractures: **dynamic hip screw** 2. If reverse oblique, transverse or **subtrochanteric fractures:** **intramedullary device**

Answer 210

1. Perioperative * venous thromboembolism * intraoperative fracture * nerve injury * surgical site infection 2. Leg length discrepancy 3. Posterior dislocation * may occur during extremes of hip flexion * typically presents acutely with a 'clunk', pain and inability to weight bear * on examination there is internal rotation and shortening of the affected leg 4. - Aseptic loosening (most common reason for revision ) 5. prosthetic joint infection

Answer 211

Leg shortening and internal rotation

Answer 212

Hip adduction and external rotation

Answer 213

1. Common in middle-age and diabetics 2. Characterised by painful, stiff movement 3. Limited movement in all directions, with loss of **external rotation and abduction** in about 50% of patients

Answer 214

1. Rotator cuff injury 2. Painful arc of abduction between 60 and 120 degrees 3. Tenderness over anterior acromion

Answer 215

Cubital tunnel syndrome occurs due to compression of the ulnar nerve as it passes through the cubital tunnel

Answer 216

1. Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant. 2. Over time patients may also develop weakness and muscle wasting 3. Pain worse on leaning on the affected elbow 4. Often a history of osteoarthritis or prior trauma to the area.

Answer 217

1. the diagnosis is usually clinical 2. however, in selected cases nerve conduction studies may be used

Answer 218

1. Avoid aggravating activity 2. Physiotherapy 3. Steroid injections 4. Surgery in resistant cases

Answer 219

Reduce the fracture

Answer 220

Iliotibial band syndrome is a common cause of lateral knee pain in runners, occurring in around 1 in 10 people who run regularly.

Answer 221

1. Tenderness 2-3cm above the lateral joint line

Answer 222

1. activity modification and iliotibial band stretches 2. if not improving then physiotherapy referral

Answer 223

Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission.

Answer 224

1. acute kidney injury with disproportionately raised creatinine 2. elevated creatine kinase (CK) 3. **Tubular cell necrosis** 4. myoglobinuria 5. hypocalcaemia (myoglobin binds calcium) 6. elevated phosphate (released from myocytes) 7. hyperkalaemia (may develop before renal failure) 8. metabolic acidosis

Answer 225

1. seizure 2. collapse/coma (e.g. elderly patients collapses at home, found 8 hours later) 3. ecstasy 4. crush injury 5. McArdle's syndrome 6. drugs: statins (especially if co-prescribed with clarithromycin)

Answer 226

1. IV fluids to maintain good urine output 2. urinary alkalinization is sometimes used

Answer 227

Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.

Answer 228

1. External rotation and abduction 2. 35-40% recurrent (it is the commonest disorder) 3. Associated with greater tuberosity fracture, Bankart lesion, Hill-Sachs defect

Answer 229

Acromioclavicular joint (ACJ) dislocation normally occurs secondary to direct injury to the superior aspect of the acromion. Loss of shoulder contour and prominent clavicle are key features. Note; rotator cuff tears rarely occur in the second decade.

Answer 230

1. **Quinolone use (e.g. ciprofloxacin) is associated with tendon disorders** 2. Hypercholesterolaemia (predisposes to tendon xanthomata)

Answer 231

1. An examination should be conducted using Simmond's triad, to help exclude Achilles tendon rupture. 2. This can be performed by asking the patient to lie prone with their feet over the edge of the bed. 3. The examiner should look for an abnormal angle of declination; Achilles tendon rupture may lead to greater dorsiflexion of the injured foot compared to the uninjured limb. 4. They should also feel for a gap in the tendon and gently squeeze the calf muscles if there is an acute rupture of the Achilles tendon the injured foot will stay in the neutral position when the calf is squeezed.

Answer 232

Ultrasound is the initial imaging modality of choice for suspected Achilles tendon rupture

Answer 233

1. A Charcot joint is also commonly referred to as a neuropathic joint. 2. It describes a joint which has become badly disrupted and damaged secondary to a loss of sensation. 3. In years gone by they were most commonly caused by neuropathy secondary to syphilis (tabes dorsalis) but are now most commonly seen in diabetics.

Answer 234

1. Charcot joints are typically a lost less painful than would be expected given the degree of joint disruption due to the sensory neuropathy. However, 75% of patients report some degree of pain 2. The joint is typically swollen, red and warm

Answer 235

1. Usually gradual onset 2. Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as 'aching', 'crawling'. 3. Relieved by sitting down, leaning forwards and crouching down 4. Clinical examination is often normal

Answer 236

Posterior shoulder dislocation is more likely associated with seizures and electric shock. It presents with unilateral shoulder deformity. While anterior instability and dislocations are still more common in seizures, a shoulder locked in an internally rotated position is highly suggestive of a posterior dislocation.

Answer 237

1. Rotator cuff tears are common in elderly people and may occur following minor trauma or as a result of long standing impingement. Tears greater than 2cm should generally be repaired surgically 2. Passove movement still works

Answer 238

1. Related to the level of the fibular fracture. * Type A is below the syndesmosis * Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis * Type C is above the syndesmosis which may itself be damaged

Answer 239

Weber A fractures -- patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot

Answer 240

Open reduction and external fixation would only be necessary for unstable injuries such as a Weber C fracture.

Answer 241

Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years. As they are typically self-limiting they do not usually require operative intervention and can sometimes be managed with splinting and immobilisation rather than a cast.

Answer 242

The radiograph shows a fracture involving the palmar surface of the distal radius, with minimal dorsal angulation and no disruption of the dorsal cortex. The growth plate appears normal.

Answer 243

1. Radial shaft fracture with associated dislocation of the distal radioulnar joint 2. Occur after a fall on the hand with a rotational force superimposed on it. 3. On examination, there is bruising, swelling and tenderness over the lower end of the forearm. 4. X Rays reveal the displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.

Answer 244

1. **Undisplaced fractures** * ****particularly vertical fractures with an intact extensor mechanism can be managed non-operatively in a hinged knee brace for 6 weeks and patients allowed to fully weight bear. 2. **Displaced fractures** and those with loss of extensor mechanisms * should be considered for operative management with either tension band wire, inter-fragmentary screws or cerclage wires. * Again, patients are placed in a hinged knee brace for 4 to 6 weeks and allowed to fully weight bear.

Answer 245

1. Kocher-technique reduction

Answer 246

1. All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis 2. Young patients, with unstable, high velocity or proximal injuries will usually require surgical repair. Often using a compression plate. 3. Elderly patients, even with potentially unstable injuries usually fare better with attempts at conservative management as their thin bone does not hold metalwork well.

Answer 247

Osteochondritis dissecans (OCD) is a pathological process affecting the subchondral bone (most often in the knee joint) with secondary effects on the joint cartilage, including pain, oedema, free bodies and mechanical dysfunctions

Answer 248

1. Knee pain and swelling, typically after exercise 2. Knee catching, locking and/or giving way: more constant and severe symptoms are associated with the presence of loose bodies 3. Feeling a painful 'clunk' when flexing or extending the knee - indicating the involvement of the lateral femoral condyle

Answer 249

Injury to the AC joint is relatively common and typically occurs during collision sports such as rugby following a fall on to the shoulder or a FOOSH (falls on outstretched hand).

Answer 250

1. Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling. 2. Grade IV, V and VI are rare and require surgical intervention. 3. The management of grade III injuries is a matter of debate and often depends on individual circumstances.

Answer 251

1. Sensory loss over anterior thigh 2. Weak quadriceps 3. Reduced knee reflex 4. Positive femoral stretch test

Answer 252

1. Sensory loss anterior aspect of knee 2. Weak quadriceps 3. Reduced knee reflex 4. Positive femoral stretch test

Answer 253

1. Sensory loss dorsum of foot 2. Weakness in foot and big toe dorsiflexion 3. Reflexes intact 4. Positive sciatic nerve stretch test

Answer 254

1. Sensory loss posterolateral aspect of leg and lateral aspect of foot 2. Weakness in plantar flexion of foot 3. Reduced ankle reflex 4. Positive sciatic nerve stretch test

Answer 255

De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.

Answer 256

1. pain on the radial side of the wrist 2. tenderness over the radial styloid process 3. abduction of the thumb against resistance is painful 4. Finkelstein's test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

Answer 257

1. analgesia 2. steroid injection 3. immobilisation with a thumb splint (spica) may be effective 4. surgical treatment is sometimes required

Answer 258

1. Osteogenesis imperfecta (more commonly known as brittle bone disease) is a group of disorders of collagen metabolism resulting in bone fragility and fractures. 2. The most common, and milder, form of osteogenesis imperfecta is type 1

Answer 259

1. presents in childhood 2. fractures following minor trauma 3. blue sclera 4. deafness secondary to otosclerosis 5. dental imperfections are common

Answer 260

1. Adjusted calcium 2. Phosphate 3. Parathyroid hormone amd 4. ALP results are usually normal in osteogenesis imperfecta

Answer 261

1. Avascular necrosis (AVN) may be defined as death of bone tissue secondary to loss of the blood supply. 2. This leads to bone destruction and loss of joint function. 3. It most commonly affects the epiphysis of long bones such as the femur.

Answer 262

1. long-term steroid use 2. chemotherapy 3. alcohol excess 4. trauma

Answer 263

1. plain x-ray findings may be normal initially. Osteopenia and microfractures may be seen early on. Collapse of the articular surface may result in the crescent sign 2. MRI is the investigation of choice. It is more sensitive than radionuclide bone scanning

Answer 264

1. joint replacement may be necessary

Answer 265

1. Dislocation of the proximal radioulnar joint in association with an ulna fracture 2. Fall on outstretched hand with forced pronation 3. Needs prompt diagnosis to avoid disability

Musculoskeletal System Flashcards

(294 cards)