Life structure
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| List possible causes for widespread musculoskeletal Pain | Fibromyalgia, Rheumatiod arthritis, lupus erythematosus, polyarticular osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, osteomalacia
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| Describe what happens if there is too much Ca2+ in the blood | Thyroid releases Calcitonin -> increases uptake in bone -> decreases reabsorbtion in kidneys and increases absorbtion in GIT
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| Describe what happens when the levels of calcium in the blood are too low. | Parathyroid releases PTH -> increases Ca2+ released by bones -> increases absorption in GIT -> increases reabsorption in the kidneys.
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| What effect does PTH have on phosphate? | PTH causes kidneys to excrete increased levels of phosphate.
Increased absorbtion in the GIT
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| How is magnesium metabolised? | Renal regulation of magnesium reabsorption
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| What effect does vitamin D have on bones? | Regulation of intestinal calaium absorption.
Binds osteoblastc and increases osteoclast function
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| What are the three things that control calcium levels in the blood? | Calcitonin, vitamin D, Parathyroid hormone
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| What are the major causes of hypercalcaemia? | Hyperparathyroidism,
Cancer (lung cancer)
Kidney failure
excess vitamin d
Thiazide Diuretics
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| List the major causes of hypocalcaemia? | Eating disorders
alcoholism
kidney function problems
malnutrition
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| Describe the clinical features of osteomalacia | Aches and pains in lumbar regions and down thigh.
later spreading to arms and ribs.
Pain is symmetrical and nonradiating. Waddeling gate.
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| What movement problems are common clinical signs related to osteomalacia? | proximal muscle weakness and difficultly getting up from seated position
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| What physical features are a sign of osteomalacia? | Lordosis as bones demineralise
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| Risk factors for osteomalacia | inadequate dietary intake of vitamin D and little exposure to sunlight, such as older adults and those who are housebound or hospitalized. Age.
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| Risk factors for rickets | Age. Children 6 to 24 months
Northern latitudes and dark skin
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| Pathology of rickets (only in young children) | Mineral deficiency prevents normal process of bone mineral deposition. If mineral deficiency occurs at the growthplate growth slows + bone age is retarded
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| Pathology of osteomalacia | poor mineralisation of trabecular bone resulting in greater proportion of unmineralised osteoid. All rickets patients have osteomalacia, not all osteomalacia patients have rickets
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| What imaging techniques would be used if rickets is suspected? What radiographic features would you expect to see? | X-RAY- widening of the epiphyseal plate, loss of definition of the zone of provisional calcification at the epiphyseal/metaphyseal interface, cupping, splaying, and fraying of the metaphysis; Looser's zone (pseudofracture)
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| What woudl you look for in serum levels? | Calaium - decreased in hypocalcaemic rickets but not in hypophosphataemic rickets
Phoisphate serum levels - decrease in both hypocalcemic and hypophosphataemic rickets
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| What hormone could you test for if rickets was suspected | Parathyroid hormone - high in hypocalcaemic rickets. Normal in hypophosphataemic rickets
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| What radiographic features would you expect to see in osteomalacia? | Looser pseudofractures associated with sclerotic borders, perpendicular to the cortical margins of bone. They are often bilateral and symmetric and are found at the femoral neck, on the medial part of the femoral shaft, or at the pubic and ischial rami.
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| What other tests would you use to diagnose osteomalacia? | Serum calcium levels - low or normal
vitamin D - low
Phosphate - low
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| How would you prevent osteomalacia? | Adequate sunlight exposure and dietary intake of fortified foods containing vitamin D, calcium, and phosphorus may help avoid osteomalacia. 600IU per day
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| Primary revention of rickets? | Pregneant women should take 600 - 1000IU in second and third trimester
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| Treatment of Rickets and osteomalacia? | Vitamin D and/or phosphate supliments
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| Where is hyaline cartilage found? | It is found on the ends of bones, nose, trachea and larynx
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| What are the properties of hyaline cartilage? | Elastic material with a matrix containing chondritin sulphate into which many collagen fibrils are embedded. contains many chondracytes
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| What is the function of hyaline cartilage? | It provides a smooth surface for tissues to glide over. flexability and support
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| Where is fibrocartilage found? | Site of heeling fracture, intervertebral discs, menisci in knee joint,
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| Properties of fibrocartallage? | consists of chondocytes scattered among collagen. Tough fibrous. Stongest of the three types of cartillage
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| Function of fibrocartilage? | Provides support and rigidity
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| Where is elastic cartallige found? | External ear, eustatian tube, eppiglottis
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| Properties of elastic cartilage? | Yellow in colour, Chondrocytes are contained in a network of elastic within a matrix of cartillage.
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| Function of elastic cartilage? | Support
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| Describe the main signs, symptoms and pattern of joint involvement in osteoarthritis. | Pain worsens on activity and lessens on rest (worse later in day), crepetations, weight bearing joints - Hip, knee, lumbar, cervical spine. Also well used joints - MTP, DIP, PIP
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| What are the typical radiological/physical findings in osteoarthritis? | Narrowed joint space
OSteophytes
Local osteosclerosis
Subchondral cysts
Bouchard's and Heberdens nodes
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| Speed of onset compared to rheumatoid arthritis? | OSteoarthritis - Months
Rheumatoid - weeks - months
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| Indication for joint replacement in osteoarthritis? | Pain PARTICULARLY NIGHT PAIN- dull ache, difficult to localise in buttock and hip.
Functional limitations,
Stiffness
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| What are the non-pharmachological treatments for osteoarthritis? | Education, exersize, physiotherapy, occupational therapy, weight loss, patella bracing, footwear, acupuncture
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| Pharmalogical treatments for osteoarthritis? | STEP WIZE: Topical NSAIDS, oral NSAIDS, Cox2 specific NSAIDS, Opioids, intra-articular injections of corticosteroids, surgery
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| What is chronic pain? Give an example of a chronic pain syndrome. | >3-6months of pain.
Chronnic pain syndrome/fibromyalgia
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