Diseases of Musculoskeletal System

Question 1

What is meant by the term Arthritides?

Answer 1

Pain and stiffness in the joint
Inflammation in joint
Lots of diseases come under this title

Question 2

Is osteoarthritis acute or chronic? What structures are formed/destroyed?

Answer 2

Chronic and degenerative
Progressive erosion of articular cartilage
Formation of bony spurs/cysts at the margin of joints

Question 3

What parts of the body are most commonly affected by osteoarthritis?

Answer 3

knees

hands

Question 4

What are chondrocytes?

Answer 4

cells that produce cartilage

Question 5

What 2 processes that affect chondrocytes in osteoporosis?

Answer 5

Chondrocytes produce IL-1 = initiate matric breakdown

Postaglandin derivatives cause release of lytic enzymes = prevents matrix synthesis

Question 6

How does muscle strength affect osteoporosis?

Answer 6

Increase muscle strength delays onset due to less pressure on the joints

Question 7

What are Herberdens and Bouchard nodes?

Answer 7

Bouchard’s nodes = hard, bony outgrowths/gelatinous cysts on the PIJ
Herberden’s nodes = hard, bony outgrowths/gelatinous cysts on the DIJ

Question 8

What is Rheumatoid arthritis?

Answer 8

Chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility
Ankylosis of joints - abnormal stiffness due to fusion of the bone

Question 9

What parts of the body are affected in Rheumatoid arthritis?

Answer 9

joints
skin
muscles
heart
lungs
blood vessels

Question 10

What is the pathogenesis of Rheumatoid arthritis?

Answer 10

Thickening of the synovium - produces a pannus ( sticky substance filled with inflammatory cells)
Causes erosion of articular cartilage
Penetrates into bone = cysts

Question 11

What are the clinical features of rheumatoid arthritis?

Answer 11

Malaise/fatigue
Generalised musculoskeletal pain initially
Joints swollen/warm/stiff - In morning/after activity
Deformed joints
Symmetrical
Rhematoid nodes - later stages
Rhematoid factor
Radiological changes - narrowing of joint space, loss of cartilage

Question 12

How is rheumatoid arthritis diagnoised?

Answer 12

Rheumatoid factor - not very specific though

Analysis of synovial fluid for neutrophils

Question 13

What is palisaded granuloma?

Answer 13

Subtype of necrotizing granuloma

Mononuclear phagocytes at the periphery have elongated or spindle-shaped nuclei

Question 14

What is gout?

Answer 14

A type of arthritis in which small uric acid crystals form inside and around the joints

Question 15

What are the clinical features of gout?

Answer 15

Acute arthritis - red, swollen, painful
Tophi - deposit of crystalline uric acid at the surface of joints or in skin or cartilage
Gouty Nephropathy - decreasing kidney function due to hyperuraemia

Question 16

What is pyogenic osteomyelitis?

Answer 16

pathogen causing infection of the bone

Question 17

What are the signs and symptoms of pyogenic osteomyelitis?

Answer 17

systemic illness - fever/malaise/chills
Pain over affected region
Bone destruction surrounded by sclerosis
Blood culture = positive

Question 18

What microorganisms most commonly cause infective arthritis?

Answer 18

Staphylococcus

Streptococcus

Question 19

What is osteoporosis and its characteristics?

Answer 19

Bones become brittle and fragile from loss of bone mass

Can be localised or the entire skeleton

Question 20

What two factors contribute to primary osteoporosis?

Answer 20

Age

Post-menopause = oestrogen exposure

Question 21

What 3 things can osteoporosis cause?

Answer 21

Verterbral fractures
Kyphosis
Scoliosis

Question 22

What 3 conditions cause secondary osteoporosis?

Answer 22

Endocrine disorders - hyperparathyroidism, Type I diabetes
Neoplasias - multiple myeloma
Malnutrition

Question 23

What 4 conditions are caused by osteoclast dysfunction?

Answer 23

Paget’s disease
Osteomalacia
Hyperparathyroidism
Renal osteodystrophy

Question 24

What virus causes Paget’s Disease?

Answer 24

Paramyxovirus

Question 25

What is Paget's disease?

Answer 25

Cells are 'mosaic' or 'chaotic' | Too much bone but weak due to irregular structure

Question 26

What is a rare but serious complication of Pagets disease?

Answer 26

Tumours - can be benign or malignant

Question 27

What is osteomalacia and what causes it?

Answer 27

Defect in matrix mineralisation | Related to lack of Vit Decreased bone density

Question 28

What does 'osteitis fibrosa cystica' mean?

Answer 28

Loss of bone mineral with osteoporosis

Question 29

What is renal osteodystrophy?

Answer 29

``` Skeletal changes that occur during chronic renal disease. Includes: Increased bone reabsorption Delayed matrix mineralisation Osteosclerosis Growth retardation Osteoporosis ```

Question 30

Where does soft tissue originate from embryologically?

Answer 30

Mesoderm

Question 31

What is a malignant soft tissue tumour called?

Answer 31

Sarcoma

Question 32

How is diagnosis of soft tissue tumours done?

Answer 32

Ultrasound guided core biopsy Wide excision Karyotypic analysis Molecular genetics via FISH/PCR

Question 33

What is the comment site for malignant bone tumours (osteosarcoma) to arise?

Answer 33

the knee

Question 34

How are the cells described in bone and soft tissue tumours?

Answer 34

Pleomorphic

Question 35

What is the most common sign of SLE on the skin?

Answer 35

'Butterfly rash' - affects bridge of nose and cheeks

Question 36

What other systems are affected in SLE?

Answer 36

Cardiac Renal CNS

Question 37

What is systemic sclerosis?

Answer 37

Autoimmune disease of the connective tissue Thickening of the skin caused by accumulation of collagen Injuries to the smallest arteries

Question 38

What body systems are affected in systemic sclerosis?

Answer 38

Renal Cardiorespiratory GI MSK i.e. artharlgia, arthritis

Question 39

What is Polymyalgia Rheumatica?

Answer 39

Pain, stiffness and inflammation in the muscles around the shoulders, neck and hips Associated with giant cell artheritis Immunological mechanism

Question 40

What are the symptoms of polymyalgia rheumatica?

Answer 40

Affects occipital/facial arteries: Pyrexia Headache Severe scalp pain