CCA Revision
DRUGS
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Analgesics
Opioids
Non-Opioids (NSAIDS)
Paracetamol
BONE DISORDERS
Most hardest part – Compact Bone
Epiphyseal Plate
Hyline Cartilage for Joint
Spongy bony always in the middle of compact bone. Contain trabeculae with marrow
space.
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4 TYPES OF BONE CELLS
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Osteogenic (stem cell for bone)
Osteoblasts (secrete Collagen therefore build EC Matrix and initiate
calcification – Building cells)
Osteocytes – Matured Osteoblasts (Maintain daily metabolism)
Osteoclasts – Big cells which have lysosomal properties which reabsorbs the
bone itself
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GENETIC DISORDERS OF BONE
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Achondroplasia (Only Affects Long Bone
Pituitary Dwarfism
Osteogenesis Imperfecta – Type 1 Collegen Defect (Brittle Bones)
Marfans
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INFECTION
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Osteomylitis (At risk if had surgery or graze to the knee)
Tuberculosis Osteomylitis (Usually affects TSp – Presents like Shermanns
Disease)
Chronic Myelitis
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Pagets Disease - (Excessive proliferation – Rapid destruction and rapid
regrowth  New bone is weaker).
Affects Pelvis tibia and lower vertebra (may have bowing of legs). UK has
highest prevalence  50% go on to get osteosarcoma. Can cause
ENCROUCHMENT, THORACIC OUTLET SYMPTOMS ETC...
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METABOLIC BONE DISEASE
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Rickets & Osteomylasia
Vitamin D deficiency or calcium deficiency.
Weak bones and deformed
Swelling of costochondral joints
Pigeon Chest
Muscle weakness and lax ligaments.
TTT by VIT D Injection
Affect bone mineralisation  reduced bone density
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Osteoporosis
Risk Factors include being inactive, smoking and poor diet. Post menopause
in women due to decrease in Oestrogen levels  Oestrogen maintains bone
density. Treatment = HRT
Bone pain
Fractures of hip and distal radial head can occur.
STEROIDS – Decrease bone turnover, inhibit osteoblasts and decrease
calcium absorbtion.
TTT = Calcium injections, Floride and Vit D & Calcium, HRT (In post
menopausal women)
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BONE TUMORS
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Most are secondary coming from glandular tissues such as epithelium, breast,
prostate, kidney and lung.
Metastasis settle in marrow spaces and result in erosion of trabeculae and
cortex  Fracture.
Common Symptoms include bone pain not related to movement, anaemia,
hypercalcimea, nerve and spinal compression, fatigue.
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BENIGN TUMORS
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Osteochondroma
Usually under 20yrs old.
Pain when tumor expands and compresses connective tissue.
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Chondromas
20-50yr olds
Affects small bones of hands and feet
Multiple tumors  chondrosarcoma malignancy
Osteosarcoma predisposed by Pagets Disease.
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BORDERLINE TUMORS
Can often reoccur
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Giant Cell Tumor
Aggressive to epiphysis
Common above and below knee
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Osteoblastoma
Children and young adults usually affects
Can be in the vertebra or the extremities
It is a large singular tumor
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MALIGNANT TUMORS
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Osteosarcoma
10-20yrs of age
Peaks at 50years+ with Pagets Disease
Arises in Medullary cavity
Close to Epiphyseal plate
Metastatises early to lungs via blood
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Chondrosarcoma
Slow growing
Peripheral or central end bone
Late metastasise
Can be primary or from a chondroma
Males more than females
30-60yrs of age
BLOOD DISORDERS
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Anaemia
Reduced Haemoglobin
Physiological  Menopause, Pregnancy etc…
Pathological
Functional Classification of Anaemia
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Increase in destruction of RBC’s (Haemolytic)
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Decrease Production of RBC’s
o Deficiency of requirement (E.g, B12, Folic Acid and Iron)
o Iron Deficiency (Brittle Nails, Kolinikhia, Angular Stomatosis)
o B12 Deficiency (Pernicious Anaemia) B12 transported via Intrinsic
Factor (prod in stomach).
 Can cause peripheral neuropathy, Crohns and Tabes Dorsalis
o Folic Acid Deficiency (Folic Acid makes new cells)
 Can be involved in Coeliac Disease.
o Anaemia of Chronic Disease
 Secondary to underlying pathology
 2nd Most Common cause
 Renal Disease – Dysfunction of kidney (Erythropoietin)
o Sideriblastic Anaemia
o Aplastic Anaemia
 Aplastic anemia is a condition where bone marrow does
not produce sufficient new cells to replenish blood cells
Blood Loss (Haemorrhage)
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Types of Haemolytic Anaemia (Increase Destruction of RBC’s)
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Sickle Cell Anaemia
Thalassemia
o Alpha & Beta
o Generally Inherited
o Not producing RBC’s efficiently
o 300+ types of Thalassemia
G6PD Deficiency (Glucose-6-Phosphate Dehydrogenase)
Hereditary Spherolytosis
Immune Haemolytic Anaemias
o Haemolytic Disease of newborn
o Blood Transfusion
Non- Immune Haemolytic Anaemias
o Maleria, Toxins, Chemicals
Myeloproliferative Disorders
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Polycythaemia Rubra Vera “Erythrocytosis)
o 50-70 years
o Asymptomatic
o Erythropoiasis is not normally controlled by its normal mechanism
o Producing RBC’s outside of where theyre normally supposed to be
produced  produced in the spleen (Splenomegaly)
o Tiredness, Lethargy, Rusty skin appearance, Thrombosis due to
increase viscosity  DVT, Embolism
o Pruritis (Itchy Skin)
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Myelofibrosis
o Mylosis of Fibroblast Cells  Reduced function of bone Marrow 
Lethargy, Weight Loss
Essential Thrombocythaemia
o Proliferation of thrombocytes in bone marrow
o CV Symptoms
o HA’s
o Neurological Symptoms
o Bleeding and bruising in GIT
Mutiple Myloma
o Elderly Disease
o Most common in men
o 60yrs of age
o Proliferation of plasma cells in bone marrow
o Plasma cells produce…?
o Bone pain
o Bone Erosion
o 60-70% LBP as it affects LSp Vertebra  Fracture  Vertebral
Collapse
o Hypercalcaemia  Constipation, Thirst, Nausea, Confusion
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