Non-neoplastic bone disease

Question 1

Gout: what is it? epidemiology?

Answer 1

A type of arthritis in which a high uric acid blood level eventually results in deposition of needle like urate crystals.
epidemiology - middle aged males

Question 2

Gout aetiology (4)

Answer 2

High purine diet
ETOH
Diuretics
Rare genetic metabolic abnormalities

Question 3

Gout Joints affected (2) & clinical features (2)

Answer 3

Usually great toe - MTP (podagra)
Lower extremeties e.g. knee
Clin features - red, hot, painful swollen joint.
TOPHUS (sub cut urate deposits) are pathognomic e.g. in pinna/ hands

Question 4

Gout crystal type (1) Ix (1)

Answer 4

Urate crystals - needle like

Ix - negatively birefringent crystals

Question 5

Gout management: acute (1), long term (1), conservative (2)

Answer 5

Acute - colchocine
chronic - allopurinol
conservative - low ETOH & low purine diet e.g. sardines & liver

Question 6

Pseudogout: what is it? epidemiology (1)

Answer 6

A type of arthritis where get calcium pyrophosphate crystals depositied in joints.
> 50yrs

Question 7

Pseudogout: aetiology (4), joints affected (2)

Answer 7

Idiopathic
Wilsons
DM
HyperPTH
Hypothyroid
Knee & shoulder joints

Question 8

Pseudo gout clin features (2) crystal type (1)

Answer 8

Hot swollen joint, w/ effusion

Calcium pyrophosphate crystals (rhomboid shaped)

Question 9

Pseudogout Ix (1) management (1)

Answer 9

Poitively birefringent

NSAIDS or intra-articular steroids

Question 10

Types of fractures (5)

Answer 10

Simple
Compound
Greenstick
Comminuted
impacted

Question 11

Fracture repair (4)

Answer 11

1. Organization of haematoma - pro callus
2. Formation of fibrocartillaginous callus
3. Mineralisation of fibrocartillaginous callus
4. Remodeling of bone along weight bearing lines

Question 12

Influences on fracture healing (6)

Answer 12

Fracture type
neoplasm
drugs
metabolic disorder
vit def
infection

Question 13

Osteomyelitis - adults: most common organism, common areas (3)

Answer 13

S. Aureus
Vertebrae
Jaw - secondary to dental abscess
Toes - due to diabetic skin ulcer

Question 14

Osteomyelitis - Children: most common pathogens (2), common areas (1)

Answer 14

Haemophilus influenza
GBS
Long bones

Question 15

Presentation of Osteomyelitis (5)

Answer 15

Pain
swelling, tenderness
Features of malaise
fevers
leukocytosis

Question 16

Osteomyelitis x-ray changes (1), Rare causes (2)

Answer 16

Lytic destruction of bone - seen 10 days post-onset
TB
Syphils

Question 17

Osteoarthritis: what is it? What signs (nodes) may be seen? (2)

Answer 17

Degenerative joint disease mainly affecting vertebrae, hips, knees
Herberden’s nodes (DIPJ)
Bouchard’s nodes (PIPJ)

Question 18

RA: clinical presentation (2),

Answer 18

Usually slow progressing course
Symmetrical
Small joints affected of hand and feet - wrists, elbows, ankles, knees - SPARING DIPJ

Question 19

RA: Characteristic deformities (3)

Answer 19

Radial deviation of wrist & ulnar deviation of fingers
“swan neck” & “boutonniere” deformity of fingers
Z shaped thumb