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Unit 42 – Researching Treatments for Bone Marrow Oedema

Difficulty: Medium

Time: 4 minutes 30 seconds

The passage below is an extract from ‘Short-term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: results of an exploratory phase II study of 41 patients’, by M.E. Mayerhoefer et al. originally published in Rheumatology (2007) 46 (9).

It was the goal of this study to compare the effect of oral treatment with the vasoactive iloprost to the effect of symptomatic treatment with tramadol, with regard to the outcome of painful isolated BME of the knee. While we were able to exclude all causes for reactive BME, and also a history of trauma suggesting mechanical BME, we were not able to reliably exclude minor to moderate axis deviations compatible with mechanical BME, because only standard antero-posterior and lateral radiographs of the knee joint, but no long radiographs of the entire lower limb, were available. Therefore, the BME observed in our patient population was regarded as either ischaemic or mechanical.
In recent studies, iloprost, which is currently registered for the intravenous therapy of peripheral arterial occlusive disease, thrombangiitis obliterans and Raynaud’s phenomenon, has been presented as an effective novel approach for the management of BME. Iloprost inhibits platelet and leucocyte activation, induces vasodilatation, counteracts vasospasm, protects the endothelium and reduces vessel wall permeability. Because it is believed that the main factors responsible for the development of BME are thrombo-, fat- and air-embolization, obstruction of venous and pre-capillary drainage or elevated venous pressure and decreased arterial perfusion, vessel wall injuries and decreased fibrinolysis, iloprost may represent a truly causative treatment option.

 

1. Based on information provided in the passage, which of the following is not associated with mechanical BME of the knee?

  • A      Vessel wall injuries
  • B      Necrosis of the femur
  • C      Lower-leg axis deviations
  • D      Trauma-induced injury

 

2. What was the goal of this study?

  • A      To study the effects of intravenously-administered iloprost on reactive and mechanical BME
  • B      To compare the effects of tramadol and orally-ingested iloprost on ischaemic and mechanical BME
  • C      To find the most effective treatment for patients who have BME of the knee and also arterial occlusive diseases
  • D      To overcome the necessity for BME patients to be hospitalised throughout treatment

 

 

 

  • Answers:
    The challenge was intended to be in reading and understanding the piece, so hopefully you found the questions to be quite easy.

    Q1: B
    There is no reference to necrosis of the femur in the passage at all. Vessel wall injuries are considered to be one of the causes of BME, and C & D are mentioned specifically in relation to mechanical BME.

    Q2:B
    “It was the goal of this study to compare the effect of ORAL treatment with the vasoactive iloprost to the effect of symptomatic treatment with tramadol, with regard to the outcome of painful isolated BME of the knee. … the BME observed in our patient population was regarded as either ischaemic or mechanical.”
    Pretty straightforward. The patients involved in the research did not have arterial occlusive disease, it was only mentioned because iloprost is also used to treat it. There is no information in the passage that would suggest that BME patients being treated with tramadol need to be hospitalised. Therefore, BME patients do not need to be hospitalised all the time as things stand, and so D cannot be true.

    Gamsat Sample Questions

    June 23, 2012

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