Musculoskeletal Disorders Quiz
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Questions and Answers

What is the primary symptom of an acute gouty attack?

  • Swelling of the joints
  • Severe pain (correct)
  • Loss of mobility
  • Chronic fatigue

    • Which joint is most commonly affected by gout?

  • Elbow
  • Great toe (correct)
  • Wrist
  • Knee

    • Which of the following symptoms are associated with fibromyalgia?

  • Nonrestorative sleep (correct)
  • Joint swelling
  • High fever
  • Increased inflammation

    • What is the primary cause of disuse atrophy?

    <p>Prolonged inactivity</p> Signup and view all the answers

    Which of the following is a characteristic symptom of the secondary muscular dysfunction?

    <p>Muscle fiber shortening</p> Signup and view all the answers

    What is the most common cause of toxic myopathy?

    <p>Alcohol abuse</p> Signup and view all the answers

    Which of the following identifies the most severe complication arising from toxic myopathy?

    <p>Rhabdomyolysis</p> Signup and view all the answers

    What type of bone tumor is the most common malignant bone-forming tumor?

    <p>Osteosarcoma</p> Signup and view all the answers

    Which of the following is NOT a characteristic of malignant bone tumors?

    <p>Regular borders</p> Signup and view all the answers

    In which part of long bones do osteosarcomas primarily occur?

    <p>Metaphysis</p> Signup and view all the answers

    Which cytokines play a role in the breakdown of cartilage and bone in rheumatoid arthritis?

    <p>Tumour necrosis factor-alpha and interleukin-6</p> Signup and view all the answers

    What is the primary pathological site affected in ankylosing spondylitis?

    <p>Enthesis</p> Signup and view all the answers

    Which of the following can be considered a risk factor for developing gout?

    <p>High intake of red meat</p> Signup and view all the answers

    What characterizes the early symptoms of ankylosing spondylitis?

    <p>Low back pain and stiffness</p> Signup and view all the answers

    Which autoantibodies are important in diagnosing rheumatoid arthritis?

    <p>ACPA and RF</p> Signup and view all the answers

    What is a common clinical stage of gout?

    <p>Tophaceous gout</p> Signup and view all the answers

    Which treatment is commonly used to manage symptoms of ankylosing spondylitis?

    <p>Non-steroidal anti-inflammatory drugs (NSAIDs)</p> Signup and view all the answers

    What is a characteristic feature of gouty arthritis?

    <p>Recurrent attacks of monoarticular arthritis</p> Signup and view all the answers

    Which statement best describes the pattern of joint involvement in gout?

    <p>Monoarticular inflammation primarily</p> Signup and view all the answers

    What is a typical sign of systemic manifestations in rheumatoid arthritis?

    <p>Recurrent episodes of fever, fatigue, and weight loss</p> Signup and view all the answers

    What is the primary symptom of fibromyalgia often described?

    <p>Diffuse, persistent pain that is burning or gnawing</p> Signup and view all the answers

    Which of the following is a key characteristic of Chronic Fatigue Syndrome?

    <p>Severe postexertional fatigue</p> Signup and view all the answers

    What is the diagnostic approach for fibromyalgia according to the Canadian Guidelines?

    <p>Specific criteria to aid accurate diagnosis</p> Signup and view all the answers

    What symptom is associated with myotonia?

    <p>Delayed relaxation after voluntary muscle contraction</p> Signup and view all the answers

    Which condition is NOT typically categorized under metabolic muscle diseases?

    <p>Myotonia</p> Signup and view all the answers

    What is a common symptom of polymyositis and dermatomyositis?

    <p>Progressive, symmetrical proximal muscle weakness</p> Signup and view all the answers

    Which element is associated with an increased risk of malignancy in idiopathic inflammatory myopathies?

    <p>Persistent muscle weakness</p> Signup and view all the answers

    What is the typical treatment approach for myositis?

    <p>Immunosuppressive drugs</p> Signup and view all the answers

    What type of fracture involves complete separation of a bone into two or more parts?

    <p>Comminuted</p> Signup and view all the answers

    Which type of bone healing occurs with callus formation?

    <p>Indirect healing</p> Signup and view all the answers

    What term describes the complete separation of a tendon or ligament from its attachment site?

    <p>Avulsion</p> Signup and view all the answers

    Which substance is released into the bloodstream during rhabdomyolysis?

    <p>Myoglobin</p> Signup and view all the answers

    What does the ‘6 Ps’ of compartment syndrome include?

    <p>Pain, pressure, pallor, pulselessness, paresthesia, paralysis</p> Signup and view all the answers

    What is the primary characteristic of osteoporosis?

    <p>Decreased bone density</p> Signup and view all the answers

    Which diagnostic method is considered the gold standard for detecting osteoporosis?

    <p>Dual x-ray absorptiometry (DXA)</p> Signup and view all the answers

    Which type of arthritis is characterized by inflammatory damage in the synovial membrane?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    Which of the following is associated with myositis ossificans?

    <p>Trauma to the musculoskeletal system</p> Signup and view all the answers

    What is a common treatment for osteomyelitis?

    <p>Antibiotics</p> Signup and view all the answers

    What condition results in inadequate or delayed mineralization of osteoid?

    <p>Osteomalacia</p> Signup and view all the answers

    Which joint condition is often exacerbated by obesity and long-term mechanical stress?

    <p>Osteoarthritis</p> Signup and view all the answers

    Which type of fracture does not involve the skin breaking over the fracture site?

    <p>Closed fracture</p> Signup and view all the answers

    Study Notes

    Alterations of Musculoskeletal Function

    • This presentation covers various musculoskeletal injuries and disorders.

    Musculo-Skeletal Injuries

    • Fractures: A break in the continuity of a bone.

      • Classifications:
        • Complete or incomplete
        • Closed or open
        • Comminuted
        • Linear (straight fracture line)
        • Oblique (at an angle)
        • Spiral (a spiral fracture line)
        • Transverse (horizontal fracture line)
        • Greenstick (incomplete fracture, common in children)
        • Torus (buckle fracture)
        • Bowing (bending without breaking)
        • Pathological (due to an underlying disease)
        • Stress (fatigue)

    • Healing:

      • Direct: Most common when surgical fixation is used; intramembranous bone formation, no callus formation.
      • Indirect: Used with casting or other nonsurgical methods; intramembranous and endochondral bone formation, callus formation, remodeling of solid bone.

    • Dislocation: The displacement of one or more bones in a joint.

      • Articular surfaces lose contact completely.
      • Often associated with fractures, muscle imbalances, or joint instability.

    • Subluxation: Contact between articular surfaces is partially lost.

      • Associated with fractures, muscle imbalances, or joint instability.
      • Less severe than dislocation.

    • Support Structures:

      • Strain: Tearing or stretching of a tendon or muscle.
      • Sprain: Tear or injury to a ligament.
      • Avulsion: Complete separation of a tendon or ligament from its bony attachment.

    • Tendon and ligament injuries usually recover within 4-5 weeks. Rehabilitation is essential for good outcomes.

    Tendinopathy, Epicondylopathy, and Bursitis

    • Tendinopathy: Inflammation of a tendon.
    • Epicondylopathy: Inflammation of a tendon at its attachment to a bone (e.g., tennis elbow, golfer's elbow).
    • Bursitis: Inflammation of a bursa (fluid-filled sac that cushions joints).
    • Bursa are located under skin over bone, muscle and tendon over bone, overuse or excessive pressure can lead to inflammation.

    Muscle Strain

    • Sudden, forced motion stretching muscle and tendons beyond normal limits.
    • Healing occurs in three phases: destruction, repair, and remodeling.

    Myositis Ossificans

    • Also known as heterotopic ossification.
    • Late complication of local muscle injury.
    • Associated with burns, joint surgery, and trauma to the musculoskeletal or central nervous system.
    • Soft tissue calcification causing stiffness or deformity.

    Rhabdomyolysis

    • Rapid breakdown of muscle tissue releasing intracellular contents (e.g., myoglobin) into bloodstream.
    • Can lead to complications such as hyperkalemia, cardiac arrhythmia, or acute kidney failure.
    • Diagnosed if creatine kinase (CK) levels are five to ten times the upper limit of normal (approximately 1000 units/L).
    • Kidney failure likely when CK reaches 15,000 units/L.

    Compartment Syndrome

    • Increased pressure within a muscle compartment.
    • Often due to conditions disrupting vascular supply to an extremity.
    • Muscle ischemia results in edema, rising compartment pressure, leading to muscle infarction and nerve injury.
    • "6 Ps" of compartment syndrome: pain, pallor, paresthesia, paralysis, pulselessness.
    • Diagnosis confirmed by measuring intracompartmental pressure.
    • Surgical intervention may be needed if pressure reaches 30 mm Hg or if neurological symptoms develop.

    Malignant Hyperthermia

    • Hypermetabolic reaction to certain anesthetics.
    • Mutation on ryanodine receptor of skeletal muscle (RyR1) is often cause.
    • Results in altered excitation–coupling process of muscle contraction causing high body temperature, muscle rigidity, rhabdomyolysis, and death.
    • Pre-operative evaluation is critical for preventing potential issues.
    • Muscle contracture test can predict risk.

    Osteoporosis

    • Poorly mineralized bone with increased fracture risk due to bone microarchitecture changes.

    • Old bone is resorbed faster than new bone is created (often after age 50).

    • Spontaneous fractures are common. -Caused by endocrine dysfunction (hormonal imbalances like parathyroid, cortisol, thyroid, and growth hormone), medications, vitamin D deficiency, underlying diseases, low physical activity, and abnormal BMI.

    • Postmenopausal osteoporosis is common in middle-aged and older women due to estrogen deficiency. Imbalance between the activity of osteoclasts and osteoblasts contributes to bone remodeling problems and leads to fractures.

    • Secondary osteoporosis: Caused by other conditions (hormonal imbalances, medications, or diseases).

    • Regional osteoporosis: Localized to a part of the appendicular skeleton; potentially transient after disuse.

    • Glucocorticoid-induced osteoporosis: A form of secondary osteoporosis caused by glucocorticoid use; glucocorticoids improve survival of osteoclasts, which inhibits osteoblast formation and function and reduces bone density.

    • Diagnosis: Dual-X ray absorptiometry (DXA) is the standard for detecting and monitoring osteoporosis. Trabecular bone score (TBS) evaluates pixel variations in the image from DXA scans and helps predict fracture risk.

    Osteomalacia

    • Inadequate or delayed mineralization of osteoid resulting in soft bones.
    • Usually due to vitamin D deficiency.
    • Symptoms may include bone pain, fractures, and vertebral collapse.
    • Treatment varies by etiology (cause).

    Paget's Disease

    • Also known as osteitis deformans.
    • Chronic, accelerated remodeling of spongy bone with deposition of irregularly formed bone.
    • Usually affects vertebrae, sacrum, sternum, pelvis, and femur causing enlargement and softening of affected bones.
    • Often asymptomatic.
    • Diagnosis based on radiographic findings.

    Osteomyelitis

    • Bone infection, often bacterial (e.g., Staphylococcus aureus).
      • Hematogenous: Pathogens enter bloodstream (e.g., cutaneous, sinus, ear, dental infections).
      • Contiguous: Infection spreads to an adjacent bone (e.g. open fractures, penetrating wounds, surgical procedures).
    • Symptoms may include: Insidious onset, vague symptoms (fever, malaise, anorexia, weight loss, pain) ,low-grade fever, lymphadenopathy, local pain, and swelling
    • Brodie abscesses: Characterized by subacute, chronic osteomyelitis and typically seen at the ends of long bones.
    • Treatment varies but may include antibiotics, debridement, surgery, or hyperbaric oxygen therapy.

    Osteoarthritis

    • Characterized by loss of articular cartilage, inflammation, and new bone formation at joint margins. Subchondral bone changes often occur and synovitis can become moderate and thickening of the joint capsule.

      • Risk factors include increasing age and joint trauma and mechanical stress as well as being obese.

      • Symptoms can include pain that worsens with activity, stiffness, joint enlargement, tenderness, limited mobility, muscle wasting, partial dislocation, or deformity .

      • Diagnosis is typically through clinical assessment and imaging. Conservative treatment options include exercise, weight control, pharmacologic therapies, analgesics, anti-inflammatories, and nutritional supplements. Surgical treatment options for osteoarthritis include techniques to improve joint movement, correct deformities, or create joints with artificial implants.

    Classic Inflammatory Joint Disease

    • Inflammatory damage or destruction in the synovial membrane or articular cartilage.
    • Systemic signs of inflammation.
    • Can be infectious or noninfectious.

    Rheumatoid Arthritis

    • Inflammatory autoimmune joint disease damaging connective tissue, mainly the synovial membrane.

    • Similar initial symptoms as osteoarthritis.

    • Cause is unknown; a multifactorial disease with a strong genetic predisposition.

      • Pathogenesis includes three main processes: Neutrophils and other cells in synovial fluid become activated, Inflammatory cytokines (e.g., TNF-alpha, IL-1 beta) induce enzymatic breakdown of cartilage and bone, and T cells interact with synovial fibroblasts, converting synovium into a thick abnormal layer of granulation tissue (pannus).

    • Symptoms often include: Insidious onset, Inflammation, fever, fatigue, weight loss, anorexia,aching and stiffness, painful tender stiff joints, rheumatoid nodules, and Caplan's syndrome.

    • Diagnosis: Presence of autoantibodies (ACPA or RF).

    • Treatment: Early treatment with disease-modifying antirheumatic drugs (DMARDs).

    Ankylosing Spondylitis

    • Group of inflammatory arthropathies known as spondyloarthropathies.

      • Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion.

      • Systemic, autoimmune inflammatory disease.

      • Primary pathological site is the enthesis (site where ligaments and tendons connect to bone). End result is fibrosis, ossification, joint fusion.

      • Often associated with HLA-B27 antigen (genetic marker).

      • Symptoms typically include: low back pain starting in early 20s, progressing over time, stiffness, restricted mobility, loss of normal lumbar curvature (lordosis), increased concavity of upper spine (kyphosis), and sacroilitis as shown on imaging.

      • Treatment: Physiotherapy for maintaining skeletal mobility, preventing contractures, and NSAIDS for pain.

    Gout

    • Uric acid metabolism issue causing either an overproduction or underexcretion.
    • High uric acid levels in blood and tissues (hyperuricemia).
      • Crystals Deposit in connective tissues potentially leading to acute inflammation (known as gouty arthritis) within synovial fluid. Crystal formation can occur due to purine metabolism issues in the body.
    • Risk factors: Male sex, increasing age, high alcohol/red meat/fructose intake, and certain medications.
      • Symptoms: Increased serum urate concentration(hyperuricemia), recurrent attacks of monoarticular arthritis, renal disease involving glomerular, tubular, and interstitial tissues, formation of renal stones.
      • Stages: Asymptomatic hyperuricemia, acute gouty arthritis, and tophaceous gout.
      • Clinical stages include: Asymptomatic hyperuricemia (high levels of uric acid without symptoms), Acute gouty arthritis (sudden, sharp pain in a joint), Tophaceous gout (formation of hard lumps of uric acid crystals in joints and soft tissues causing chronic and severe pain).

    Secondary Muscular Dysfunction

    • Contractures: Muscle fiber shortening without an action potential. - Caused by calcium pump failure even with enough ATP.
    • Stress-induced muscle tension: Result of stress leading to neck stiffness, back pain, and headache.
      • Associated with chronic anxiety.
    • Disuse Atrophy: Reduction in muscle cell size due to prolonged inactivity; this can occur due to bed rest, trauma (e.g., casting), local nerve damage.
    • Prevention includes: Isometric and Passive lengthening exercises.

    Fibromyalgia

    • Unexplained chronic widespread pain often in combination with fatigue, sensitivity to touch, sleep disturbances, and mood disorders (i.e., anxiety and depression).
    • Primary symptom is diffuse, constant pain.

      • Tender points or extreme pain in multiple areas.

      • 80-90% of people with the disorder are women aged 30-50 years old.

      • Often co-existent with other autoimmune disorders. Genetic factors impacting serotonin, catecholamines, and dopamine have been suggested to play a potential role in the disorder. Diagnosis is aided by reference to diagnostic guidelines such as the Canadian Guidelines for the Diagnosis and Management of Fibromyalgia.

    Chronic Fatigue Syndrome

    • Neuroimmunoendocrine disease characterized by: cognitive impairment, severe postexertional fatigue, unrefreshing sleep, lower physical activity, exclusionary diagnosis criteria, and psychological/physiological connection or involvement.

    Muscle Membrane Abnormalities

    • Inherited diseases affecting sodium and calcium ion channels causing delayed relaxation after voluntary muscle contraction (e.g., Myotonia).
    • Episodes of flaccid weakness characterizes periodic paralysis (potentially hereditary, thyrotoxic hypokalemic, or hyperkalemic).

    Metabolic Muscle Diseases

    • Endocrine disorders causing systemic hormonal imbalances impacting muscle function
    • McArdle disease (myophosphorylase deficiency).
      • Acid maltase deficiency (Pompe's disease).
      • Myoadenylate deaminase deficiency (MDD).
      • Lipid deficiencies.

    Inflammatory Muscle Diseases: Myositis

    • Viral, bacterial, and parasitic issues causing inflammation (e.g., Tuberculosis, Sarcoidosis, Trichinellosis, Toxoplasmosis, etc).
    • Polymyositis and Dermatomyositis: Idiopathic inflammatory myopathies, characterized by progressive symmetrical proximal muscle weakness and myalgia over weeks to months.
    • Other possible causes of myositis: Associated with an increased risk of malignancy, Muscle biopsy shows inflammatory cells around blood vessels, and atrophy in muscle fascicles. Treatment includes immunosuppressive drugs.

    Toxic Myopathies

    • Alcohol abuse is the most common cause.
      • Pain and swelling and muscle weakness develop from acute attacks, with long duration weakness and necrosis of fibers occurring in chronic cases.
      • Other causes include lipid-lowering agents, antimalarial drugs, steroids, thiol derivatives, and narcotics.

    Bone Tumors

    • May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue.

      • Malignant bone tumors are characterized by features like increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, and prominent nucleolus, as well as mitosis. Tumor patterns such as geographical, moth-eaten, and permeative help in diagnosis. Symptoms are often vague or attributable to other issues.
      • Osteosarcoma is the most common malignant bone-forming tumor and tends to be prevalent in those under age 20 or older than age 50 with radiation therapy history. Commonly found around the knee joint in the metaphyses of long bones. It also comes in the form of osteoid masses or thick streamers.

    • Chondrosarcoma: A cartilage-forming bone tumor often seen in middle-aged and older people. It infiltrates trabeculae in spongy bone.

    • Fibrosarcoma is a firm, fibrous mass of collagen, malignant fibroblasts, and osteoclast giant cells prevalent in the metaphyses of the bones like the femur or tibia, and has a high potential to metastasize to the lungs.

      • Myelogenic tumor is a giant cell tumor that commonly affects the epiphyses of the femur, tibia, radius, or humerus bones and often has a slow and relentless growth rate. It exhibits extensive bone resorption due to osteoclastic origin and overexpression of RANKL.

    • Rhabdomyosarcoma is a highly malignant tumor of the striated muscle often seen in the head, and neck, as well as genitourinary tracts.

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    Description

    Test your knowledge on musculoskeletal disorders with this quiz. It covers topics such as gout, fibromyalgia, and muscle atrophy. Understand the symptoms and causes associated with these conditions.

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