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Ortho/Rheum Wk1

Describe the structure of a normal long bone Collagen matrix impregnated with calcium carbonate, calcium phosphate and osteocytes. Periosteum, compact bone (with Haversian systems), spongy bone (with trabeculae and marrow). Diaphysis, metaphyses, epiphyses.
What vessels are found within a Haversian canal? Vein, artery, lymphatic vessel
Describe the process of bone remodelling Osteoclasts resorb old bone, osteoblasts secrete a surrounding collagen matrix which is then mineralised. A surrounded osteoblast is an osteocyte.
What is osteoid? The collagen matrix of bone
How might osteoporosis present? Fracture, kyphosis due to vertebral collapse
Describe the presentation of Paget's disease Pain at site (usually pelvis, lumbar spine, femur), hearing loss due to VIIIth nerve compression, tibial bowing, abnormal modelling, eczematous nipple
How may multiple myeloma present? Bone pain, pathelogical fracture, lassitude, pyogenic infection, amyloidosis, bleeding
What are the laboratory findings associated with osteoporosis? DEXA scan. Ca, phos, and alk phos normal.
What do investigations show in Paget's disease? ^ALP, normal Ca, x-rays show expansion, deformity, and osteolytic and sclerotic areas
How do investigations suggest multiple myeloma? ^ESR, (^urea, creatinine, urate, and Ca in 40%), bone biopsy, urine contains Bence-Jones protein, x-rays show lytic lesions
List the bone imaging techniques Plain film, nuclear medicine, ultrasound, CT, MRI
Describe the pros and cons of plain film Cheap, available, easy, quick, transportable BUT radiation, limited contrast (insensitivity to early pathology and soft tissue)
Describe the pros and cons of nuclear medicine Physiological, sensitive to early pathology, covers whole body BUT radiation, limited spatial resolution
Describe the pros and cons of ultrasound No radiation, cheap, portable, available, soft tissue detail BUT can't see through bone, user dependent
Describe the pros and cons of CT Exquisite bone detail, multiple planes BUT very high radiation, limited soft tissue contrast
Describe the pros and cons of MRI Exquisite soft tissue detail, multiple planes, no radiation BUT not widely available, expensive, claustrophobic, pacemaker hazard
Describe the pharmacology of NSAIDs Inhibit COX enzymes which control formation of prostaglandins (inflammatory mediators)
Describe and explain the side-effects of NSAIDs Peptic ulceration (irritation of mucosa, lack of prostaglandin protection), worsens renal impairement causing salt + fluid retention, hypertension (lack of PG mediation in haemodynamics)
How do patients with osteomalacia present? Bone pain, fracture (often NoF), waddling gait (proximal myopathy)
What would investigations show in osteomalacia? Mildly lowered Ca, phos, vit D; ^alk phos
How does bone infection present? Pain, reluctance to move, may be swelling, heat, oedema over pus formation in later stages
What are the common causative agents in bone infection? Staph aureus, pseudomonas, E. coli, M. tuberculosis
Created by: kuc