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Y2 - my own > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What proportion of bone is organic/ inorganic?

A 
Organic = 65% (calcium hydroxyapatite)
Inorganic = 35%
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2
Q

Give the four functions of bone

A

Structure, mechanical, protective, metabolic.

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3
Q

Which region joins the diaphysis and epiphysis?

A

The metaphysis.

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4
Q

Describe the structure of the diaphysis

A

Diaphysis = main long part of the bone.
Inner part = medulla
Outer part = Cortex
Most outer part = periosteum

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5
Q

What is another name for the diaphysis?

A

The shaft

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6
Q

What are the three ways in which we can classify bone?

A

Anatomical (long, short, flat), macroscopic (trabecular/cortical) and microscopic (woven/lamellar)

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7
Q

What is the difference between cortical and cancellous bone?

A 
Cortical = long bones i.e. appendicular
Cancellous = vertebrae and pelvis i.e. axial
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8
Q

Which is mainly structural and which is mainly metabolic between cortical and cancellous bone?

A 
Cortical = mainly structural
Cancellous = mainly metabolic
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9
Q

What is the function of osteoblasts?

A

To make new bone: osteoid

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10
Q

What are osteocytes?

A

Bone cells in mature bone

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11
Q

Which cells do osteoclasts derive from compared with osteoblasts?

A 
Osteoclasts = monocytes
Osteoblasts = mesenchymal cells
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12
Q

Name x3 metabolic bone diseases

A

Osteoporosis, osteomalacia and Paget’s disease.

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13
Q

What is osteoporosis defined as?

A

Bone mineral density T-score of -2.5 or lower.

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14
Q

What is the difference between osteoporosis and osteomalacia?

A

Osteoporosis: reduction in bone mass

Osteomalacia = reduction in bone mineralisation.

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15
Q

Name the two types of osteomalacia causes.

A

Deficiency in Vitamin D

Deficiency in PO4.

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16
Q

What will blood phosphate levels be like in hyperparathyroidism?

A

Low; PTH inhibits reabsorption.

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17
Q

What will PTH and Ca2+ levels be like primary hyperparathyroidism?

A 
PTH = high
Calcium = high
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18
Q

What will PTH and Ca2+ levels be like secondary hyperparathyroidism?

A 
PTH = high
Calcium = normal/ low
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19
Q

What are the signs and symptoms associated with hyperparathyroidism?

A

Stones, bones (osteitis fibrosa cystica), abdominal groans and psychic moans

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20
Q

What are the clinical symptoms of Paget’s disease?

A

Pain, microfractures and nerve compression

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21
Q

Is RANK on the osteoblast or osteoclast?

A

Osteoclast; RANKL is on the osteoblast

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22
Q

What do mature osteoblasts produce that blocks the RANK/RANKL binding?

A

Osteoprotegrin

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23
Q

Which type of ossification leads to the formation of long bones?

A

Endochondral ossification

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24
Q

Which type of ossification leads to the formation of flat bones?

A

Intramembranous ossification

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25
Q

Which three forms of imaging are used to look at bone density?

A

X-rays, CT and bone densitometry (DEXA).

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26
Q

When is an MRI requested in bone disease?

A

To look at biochemical composition

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27
Q

Which test is primarily used to diagnose Osteoporosis?

A

DEXA (bone densitometry)

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28
Q

What does a T test score of -1.5-2.5 indicate?

A

Osteopenia

29
Q

What does a T test score of

A

Osteoporosis

30
Q

Give x2 radiological signs of osteoporosis

A

Cortical thinning

Loss of trabeculae

31
Q

What is the radiological sign for osteomalacia and ricket’s?

A

Looser’s zone = pseudo-fractures at stress areas of bone

32
Q

What is a radiological sign seen in osteoporosis and osteomalacia?

A

Codfish (Biconcave) vertebrae.

33
Q

What is a brown tumour?

A

Osteitis cystica fibrosa = due to excessive osteoclast activity. Seen in hyperparathyroidism.

34
Q

What marker will be raised in Paget’s disease?

A

Alkaline phosphate.

35
Q

Compare the microstructure in osteoporosis compared with osteomalacia.

A

Osteoporosis = normal
Osteomalacia = Too little mineral (osteopenia)
Looser’s zones

36
Q

What is osteopenia?

A

Reduced mineral and protein content.

37
Q

Name the pathology for increased density of bone (hardness).

A

Osteosclerosis

38
Q

What is lucency?

A

An area that allows x-rays through and so appears darker on the image.

39
Q

Define arthralgia

A

Pain in the joint without demonstratable inflammation when examined physically.

40
Q

Define subluxation

A

A partial dislocation

41
Q

The rheumatoid factor is what type of antibody and recognises which antigen type?

A

IgM antibodies which are anti- IgG

42
Q

Which substance makes synovial fluid viscous?

A

Hyaluronic acid

43
Q

What is hyaluronic acid?

A

A non-sulphated GAG (glycosaminoglycan)

44
Q

What is reactive arthritis?

A

STERILE inflammatory synovitis FOLLOWING an infection.

45
Q

Which HLA is seen in rheumatoid arthritis?

A

HLA-DR4

46
Q

Which HLA is seen in reactive arthritis?

A

HLA-B27

47
Q

What is osteoarthritis primarily a disease of?

A

ARTICULAR CARTILAGE (irreversible)

48
Q

Define proteoglycan

A

A glycoprotein containing sulphated GAG. Not hyaluronan as this is non-sulphated!

e.g. Aggrecan

49
Q

Which is the major collagen type found in articular cartilage?

A

Type II Collagen (not IV!)

50
Q

In which bone disorder is bone chemistry (ALP, serum Ca2+, PTH) normal?

A

Osteoporosis

51
Q

The T score is used to diagnose which bone disorder?

A

Osteoporosis

52
Q

What is the form of Rickets seen in adults?

A

Osteomalacia

53
Q

Why would we want a drug with a slower elimination?

A

To avoid major fluctuations in the blood.

54
Q

What is the MoA of Diazepam? What drug type is benzodiazepam?

A

Binds to GABA-A receptors: sedative effects.

Diazepam is a benzodiazepam.

55
Q

What drug type are fluoxetine and venlafaxine?

A

Anti-depressants. SSRIs.
Fluoxetine = specific for serotonin receptors (blocks reuptake)
Venlafaxine = serotonin, noradrenaline AND dopamine receptors

56
Q

What does SSRI stand for? Give an example.

A

Selective serotonin reuptake inhibitor.

Fluoxetine.

57
Q

Overstimulation of which pathway leads to schizophrenia?

A

Mesolimbic; excessive dopamine release

58
Q

Which form of cannabis is particularly associated with psychosis?

A

delta-9 THC.

59
Q

What does ‘QD’ mean?

A

Once daily.

60
Q

What is Haloperidol? Where is it used?

A

Dopamine receptor (D2) antagonist. Used to treat psychosis.

61
Q

On a particularly difficult day a gentleman takes double the recommended dose of haloperidol and attends A&E because his upper body is stiff and neck is rotated to the left and locked in flexion. The adverse effects are due to what system?

A

Extra-pyramidal tracts.

62
Q

What is Carbidopa?

A

a Dopamine decarboxylase inhibitor = prevents breakdown of L-DOPA.

63
Q

Give x2 drugs used in the treatment of Alzheimer’s disease.

A

Cholinesterase inhibitors e.g. Rivastigmine

NMDA receptor antagonists e.g. memantine (only for moderate-severe alzheimer’s).

64
Q

Is the calcium hydroxyapatite part of the organic or inorganic bone?

A

Inorganic

65
Q

Describe the structure of a long bone

A

Epiphysis, metaphysis, diaphysis, metaphysis, epiphysis.

66
Q

How do we define the ‘microscopic’ structure of the bone?

A

Lamellar (mature)

Woven (immature)

67
Q

What type of needle do you use for inaccessible, sclerotic lesions?

A

Open needle. (not Jamshidi - the closed needle).

68
Q

What are in effect the two causes of Osteomalacia?

A
  1. Phosphate deficiency

2. Vitamin D deficiency

69
Q

Give two potential radiological signs in Osteomalacia.

A 
Looser's zones
Codfish vertebrae (also seen in osteopenia).

Y2 - my own (7 decks)

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