Musculoskeletal System

Question 1

How do fractures naturally heal immediately (blood vessels) ?

Answer 1

• blood vessels cause haematoma which fills the fracture gap
• provides a fibrin meshwork to allow formation of granulation tissue

Question 2

How do fractures heal naturally?

Answer 2

• inflammatory cells release cytokines to activate osteoblast and osteoclast
• development of cartilage cap (1 week)
• bone deposition begins to strengthen callous

Question 3

What may hinder fracture healing?

Answer 3

• bones not aligned
• area not immobilised
• if fracture site contains dead bone
• infection

Question 4

What is osteoporosis when looking at the bones?

Answer 4

• decrease in bone mass and density

- can lead to fractures

Question 5

What are the hormonal influences of osteoporosis?

Answer 5

• lack of oestogen (increases bone resorption and deceases bone formation)
• calcium metabolism and vitamin D deficiency
• certain drugs

Question 6

What is the drug of choice in treating osteoporosis?

Answer 6

• alendronic acid

Question 7

What is arthritis and its characteristics?

Answer 7

• inflammation of the joints
• pain, swelling, stiffness, warmth and redness in joint
• restricted movement
• can get bone thickening or outgrowth (osteophytes)

Question 8

What are the risk factors in osteoarthritis (progressive deterioration in weight bearing joints) ?

Answer 8

• increasing age
• female sex, menopause
• obesity
• pre-existing joint deformity
• excess mechanical stress
• family history / genetics
• hypermobility
• other diseases

Question 9

What are the features of osteoarthritis?

Answer 9

• morning stiffness
• pain worse with movement
• reduced range of movement
• progressive reduction in mobility
• joint effusions (fluid in the joints)
• crepitus (sounds like crackles )

Question 10

Rheumatoid arthritis is an auto immune disorder. What happens in in it?

Answer 10

rheumatoid factors help to form immune complexes in the circulation

• generates inflammation in synovium
• membranes thicken
• chronic inflammation leads to cartilage and joint destruction
• other tissues can be involved eg. lungs and vessels

Question 11

What are the features of rheumatoid arthritis?

Answer 11

• usually affects small joints of hands and feet
• pain
• swelling and deformities (swan neck deformities)
• fever, fatigue, generalised pain
• joints often stiff without prior activity

Question 12

How is rheumatoid arthritis diagnosed?

Answer 12

• morning stiffness that last over an hour
• effects 3 or more joints
• arthritis typical of hand joints
• symmetric arthritis
• rheumatoid nodules
• serum rheumatoid factor
• typical radiographic changes
• must have 4 of these

Question 13

Crystal arthropathies are associated with intra-articular crystals. What are two examples of this?

Answer 13

• gout
• pseudogout
• crystals in the joint space

Question 14

What can cause gout?

Answer 14

• drugs (aspirin, diuretics)
• alcohol
• renal disease
• hypothyroidism
• dehydration

Question 15

What happens in gout?

Answer 15

• raised uric acid (produced by breakdown of xanthine oxidase) - usually excreted by kidneys
• deposits as crystals in the joint
• repeated attacks lead to chronic arthritis

Question 16

What is the difference between what is deposited in the joints in gout and pseudogout?

Answer 16

gout - uric acid

pseudogout - calcium pyrophosphate

Question 17

What are the features of gout?

Answer 17

• sudden onset excruciating burning joint pain
• redness, warmth, tenderness, stiffness
• usually first attack involved big toe
• subsequent stacks are less severe

Question 18

Where does psuedogout usually appear?

Answer 18

knees and ankles

Question 19

What can happen with the crystals in psuedogout?

Answer 19

crystals in cartilage can enlarge and rupture

- shows symptoms of arthritis

Question 20

What are the causes of pseudogout?

Answer 20

• can be hereditary
• associated with osteoarthritis
• trauma or surgery
• more common with increasing age

Question 21

What is septic arthritis?

Answer 21

inflammation of the joint caused by bacterial infection

Question 22

Where does septic arthritis usually affect?

Answer 22

the knee

Question 23

What does septic arthritis cause/symptoms

Answer 23

• severe pain, swelling, redness and heat in affected joint
• difficulty moving joint
• tends to develop quickly over a few hours or days
• Some people have high temp
• can cause sepsis which can case death

Question 24

How do you treat septic arthritis?

Answer 24

• iv antibiotics
• may require washout of the joint
• can cause sepsis! serious !

Question 25

What is osteomyelitis?

Answer 25

- bone infection usually caused by bacteria

Question 26

What causes osteomyelitis?

Answer 26

- trauma - surgery - presence of foreign bodies - diabetics at increased risk

Question 27

How does osteomyelitis spread?

Answer 27

haematogenous spread | - so can develop sepsis

Question 28

The most common bone tumour is from metastatic disease. where is it from normally?

Answer 28

prostate kidney breast

Question 29

What are the three types of muscle?

Answer 29

- striated (skeletal) - smooth - cardiac

Question 30

What is striated muscle involved in?

Answer 30

involved in voluntary movement eg. biceps, legs

Question 31

What is smooth muscle involved in?

Answer 31

involuntary actions eg. bowel peristalsis | controlled by autonomic nervous system

Question 32

What can go wrong in the skeletal muscles ?

Answer 32

muscular dystrophies | neuromuscular disorders

Question 33

What can go wrong in smooth muscles?

Answer 33

leiomyomas