Pathology

Question 1

Which joints does osteoarthritis commonly affect?

Answer 1

Weight-bearing joints

Question 2

Name some of the systemic features that can occur with rheumatoid arthritis

Answer 2

Subcutaneous nodules
Anaemia
Splenomegaly
Amyloidosis

Question 3

Define osteoporosis

Answer 3

Reduction in total bone mass causing weakening of the bones

Question 4

Osteoporosis can be a complication of…

Answer 4

Cushing’s syndrome

Steroid therapy

Question 5

What is the pathology behind osteomalacia and rickets?

Answer 5

Inadequate mineralisation of the organic bone matrix due to a deficiency in the active metabolites of vitamin D

Question 6

What can cause vitamin D deficiency?

Answer 6

Lack of dietary vitamin D
Lack of sunlight
Intestinal malabsorption
Renal and liver disease

Question 7

Define Paget’s disease of bone

Answer 7

Common disease of unknown aetiology causes a localised increase in bone turnover

Question 8

Which bones are most commonly affected in Paget’s?

Answer 8

Pelvis and spine

Question 9

What will be elevated in plasma of a patient with Paget’s Disease of Bone?

Answer 9

Alkaline Phosphatase

Question 10

What are the most prominent symptoms of osteoarthritis?

Answer 10

Pain and limitation of movement

Question 11

What is Herpes Zoster?

Answer 11

Shingles
Viral infection
Almost always affects the skin of a single dermatome
Dormant version of chicken pox that gets reactivated when the host is immunosuppressed

Question 12

Describe sciatica

Answer 12

Pain going down the leg from the lower back
Typically symptoms only on one side of the body
Weakness or numbness may occur
Typical cause = spinal disc herniation
In most people it goes away by itself

Question 13

Describe spina bifida

Answer 13

Failure of apoptosis
There isn’t continuity of the epithelium, neural tube and mesoderm
Spinal cord may be exposed
Can cause deformity and hypoplasia of the legs

Question 14

Describe hip dysplasia

Answer 14

Abnormal growth of the hip
Relatively common
Can be dislocated at birth or sometime later
Problem can be: acetabulum, head of femur or capsule

Question 15

Describe a slipped upper femoral epiphysis

Answer 15

Fracture through the growth plate
Rest of femur rides up and forward in relation to epiphysis
Ages 10-16 years most affected

Question 16

How would the limb appear after a posterior dislocation of the hip?

Answer 16

Limb looks shortened and medially rotated

Question 17

What muscles cause the medial rotation of the femur after a posterior dislocation?

Answer 17

Gluteus medius

Gluteus minimus

Question 18

Which type of muscles cause the shortened limb appearance after a posterior dislocation of the hip?

Answer 18

Extensors

Adductors

Question 19

Are trochanteric fractures intra or extra capsular?

Answer 19

Extra capsular

Question 20

How does the limb appear after a hip fracture?

Answer 20

Shortened limb
Externally rotated
Abducted

Question 21

Which muscles cause external rotation after a hip fracture?

Answer 21

Iliopsoas

Question 22

Which muscles cause abduction after a hip fracture?

Answer 22

Gluteus medius

Gluteus minimus

Question 23

Name the stages of rheumatoid arthritis

Answer 23

Synovitis
Pannus
Fibrous ankylosis
Bony ankylosis

Question 24

What is piriformis syndrome?

Answer 24

Hypertrophy and spasms of piriformis
Pain down the back of the leg
Can present with similar pain as slipped disc (sciatic nerve)
Usually presents in young athletes

Question 25

Name 2 types of fracture of the distal radius

Answer 25

Colles' fracture | Smith's fracture

Question 26

Describe Colles' fracture

Answer 26

Fracture of distal radius Tends to be older people Posterior displacement of distal fragments of radius Falling on an outstretched hand

Question 27

Describe Smith's fracture

Answer 27

Fracture of the distal radius Anterior displacement of the distal fragments Falling on a flexed wrist/direct trauma to forearm

Question 28

How can we fracture the scaphoid?

Answer 28

Falling on an outstretched hand

Question 29

What is another name for popliteal cysts?

Answer 29

Bakers cysts

Question 30

What is a popliteal cyst a sign of?

Answer 30

Chronic knee effusion

Question 31

What does Popeye sign indicate?

Answer 31

Rupture of the long head of the biceps tendon

Question 32

What is Froment's sign?

Answer 32

Test for ulnar nerve palsy Tests the action of adductor pollicis Place a piece of paper between thumb and index finger and try to pull it out whilst seeing if the patient can prevent you without flexing their thumb

Question 33

After a fracture, what happens to the different parts of the clavicle?

Answer 33

Lateral end = displaced inferiorly by weight of arm and medially by pectoralis major Medial end = pulled superiorly by muscles

Question 34

Unopposed medial arm rotation can produce which deformity?

Answer 34

Waiter's tip

Question 35

What is the standard treatment for muscle injuries?

Answer 35

RICE | Rest, ice, compression and elevation

Question 36

When would we want to check the blood supply to the legs and feet?

Answer 36

If they have peripheral vascular disease | If they have just had an operation

Question 37

What are varicose veins?

Answer 37

Very obviously dilated veins | If we remove them, we need to be aware of the nerve supply around them

Question 38

Over what age do we consider it old age?

Answer 38

Over 65 years

Question 39

Define some of the consequences of ageing

Answer 39

Loss of muscle strength and endurance Loss of bone strength Increased fall and fracture risk Reduction in ability to go about daily life

Question 40

Bone mineral loss is accelerated by ....

Answer 40

Low reproduction hormones Poor calcium/vitamin D Inactivity Endocrine or GI pathologies

Question 41

What is a T score?

Answer 41

The bone density of a patient 0 = normal More negative = lower bone mass

Question 42

Describe Type 1 osteoporosis

Answer 42

Post-menopausal women | Loss of oestrogen accelerates bone loss

Question 43

Describe Type 2 osteoporosis

Answer 43

Senile Age related Usually to do with hyperparathyroidism or calcium deficiency

Question 44

What are bisphosphonates?

Answer 44

Anti-resorptive agents for bone | Affects osteoclasts - inhibits

Question 45

Describe osteoarthritis

Answer 45

Disorder of synovial joints characterised by areas of damage to articular cartilage Formation of osteophytes Pain, stiffness, deformity, joint swelling (Distal IP) Decreased joint space

Question 46

Define dislocation

Answer 46

Complete loss of continuity of the articulating surfaces of a joint

Question 47

What is meralgia parasthetica?

Answer 47

Nerve compression syndrome Common in pregnancy and in obese people No muscle weakness associated - sensory nerves only Rare in children

Question 48

Which system do we use to classify nerve injuries?

Answer 48

Seddon classification

Question 49

Describe a class I peripheral nerve injury

Answer 49

Neurapraxia Temporary block to conduction Everything is intact - no degeneration Complete recovery made

Question 50

Describe a class II peripheral nerve injury

Answer 50

``` Axonotmesis Compression/moderate traction Loss of continuity of myelin sheath Some Wallerian degeneration Partial/full recovery ```

Question 51

Describe a class III peripheral nerve injury

Answer 51

``` Neurotmesis Partial or complete division of the structure Disruption of axon and sheath Wallerian degeneration No recovery without surgery ```