Introduction to the Diseases of the Musculoskeletal System

Question 1

Medical terms that begin with chrond relates to what?

1 - bone
2 - cartilage
3 - muscle
4 - joints

Answer 1

2 - cartilage

- chondrocytes are precursors for cartilage

Question 2

Medical terms that begin with osteo relates to what?

1 - bone
2 - cartilage
3 - muscle
4 - joints

Answer 2

1 - bone

- comes from osteon

Question 3

Medical terms that begin with my/myo relates to what?

1 - bone
2 - cartilage
3 - muscle
4 - joints

Answer 3

3 - muscle

- comes from myoblasts

Question 4

Medical terms that begin with arth relates to what?

1 - bone
2 - cartilage
3 - muscle
4 - joints

Answer 4

4 - joints

- arthrosis means joint

Question 5

Medical terms that begin with itis relates to what?

1 - inflammation
2 - cartilage
3 - muscle
4 - joints

Answer 5

1 - inflammation

Question 6

Medical terms that begin with algia relates to what?

1 - inflammation
2 - cartilage
3 - muscle
4 - pain

Answer 6

4 - pain

Question 7

What does tendonitis refer to?

Answer 7

• inflammation of a tendon

Question 8

What does bursitis refer to?

Answer 8

• inflammation of a bursae
• bursae = closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body

Question 9

What does enthesitis refer to?

Answer 9

• inflammation of entheseal

- entheseal is the where tendons attach into bones

Question 10

What is osteoporosis?

Answer 10

• reduced bone mineral density

Question 11

What is Osteomalacia?

Answer 11

• mineralisation of the bone is low

- less severe form of osteoporosis

Question 12

What is Osteomyelitis?

Answer 12

• infection of a bone

Question 13

What is a osteosarcoma?

Answer 13

• malignant bone tumour

Question 14

Joint inflammation can occur in one or more joints. What does the following refer to?

MonoARTHRITIS
OligoARTHRITIS
PolyARTHRITIS

Answer 14

• MonoARTHRITIS = arthritis affecting 1 joint
• OligoARTHRITIS = arthritis affecting 4 or fewer joints (2-4)
• PolyARTHRITIS = arthritis affecting 5 or more joints (>=5)

Question 15

What does inflammation relate to in rheumatoid arthritis?

Answer 15

• inflammation of a joint with an immune response

- immune system attacks there own joints

Question 16

How long would morning stiffness last for in inflammatory and non-inflammatory conditions?

Answer 16

• inflammatory = >1 hour (RA)

- non-inflammatory conditions = <30 minutes (osteoarthritis)

Question 17

Does exercise improve or accentuate joint pain in inflammatory and non-inflammatory conditions?

Answer 17

• inflammatory = improves (reduces joint pain)

- non-inflammatory conditions = worsens

Question 18

Does rest improve or accentuate joint pain in inflammatory and non-inflammatory conditions?

Answer 18

• inflammatory = accentuates (makes worse)

- non-inflammatory conditions = reduces pain

Question 19

Is joint pain worse in the morning or evening in inflammatory and non-inflammatory conditions?

Answer 19

• inflammatory = worse in the morning

- non-inflammatory conditions = worse in the evening

Question 20

In patients with inflammatory and non-inflammatory joint pain, do they suffer with fatigue?

Answer 20

• inflammatory = profound

- non-inflammatory conditions = minimal

Question 21

Would steroid be useful in inflammatory and non-inflammatory joint pain?

Answer 21

• inflammatory = dramatic effect

- non-inflammatory conditions = minimal effect

Question 22

In an inflammatory joint disorder, which involved the immune system attacking your own joints, is the swelling acute or chronic?

Answer 22

• generally chronic

- >6 weeks

Question 23

In an inflammatory joint disorder, which involves the immune system attacking your own joints, is it generally just one joint that is affected?

1 - MonoARTHRITIS
2 - OligoARTHRITIS
3 - PolyARTHRITIS

Answer 23

• no

- >3 joints so OligoARTHRITIS or PolyARTHRITIS

Question 24

In an inflammatory joint disorder, which involved the immune system attacking your own joints, what are 2 inflammatory markers that can be measured clinically?

1 - CRP and creatine kinase
2 - creatine kinase and erythrocyte sedimentation rate
3 - CRP and erythrocyte sedimentation rate
4 - CRP and IL-6

Answer 24

3 - CRP and erythrocyte sedimentation rate

Question 25

What are the 2 key joints in the hands that are commonly affected in RA? 1 - DIP and PIP 2 - DIP and MCP 3 - MCP and PIP 4 - MCP and DIP ``` MCP = metacarpophalangeal joint PIP = proximal interphalangeal joint DIP = distal interphalangeal joint ```

Answer 25

3 - MCP and PIP | - wrist can also be affected

Question 26

The 2 key joints in the hands that are commonly affected in RA are the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. What joints in the feet can be affected? 1 - digits I-V MTP joints 2 - digits II-V MTP joints 3 - PIP and all MTP joints 4 - DIP and PIP joints ``` MTP = metatarsophalangeal joint PIP = proximal interphalangeal joint DIP = distal interphalangeal joint ```

Answer 26

2 - digits II-V MTP joints

Question 27

RA can be defined as a symmetric polyarthritis, particularly of the MCP, MTP, and/or PIP joints. What do the following parts of this definition relate to? - symmetric - polyarthritis

Answer 27

- symmetric = occurs on both sides of the body | - polyarthritis = >5 joints affected

Question 28

What are the 2 RA specific antibody markers used in RA?

Answer 28

- rheumatoid factor (RF) | - anti-citrullinated peptide antibodies (ACPA) called anti-CCP

Question 29

Peptides and proteins can undergo citrullination. During inflammation arginine is enzymatically converted into citrulline. If the citrulline forms abnormal shapes like rings, this can present like an antigen and antibodies will target this antigens as a foreign antigen (CD4 and CD8 cells). These can then be measured in the blood as what?

Answer 29

- anti-citrullinated peptide antibodies (ACPA) | - diagnostic marker is referred to as anti-CCP

Question 30

The 2 RA specific antibody markers used to help diagnose are rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) (anti-CCP). Do all patients posses these antibodies?

Answer 30

- no, this is can be called sero-negaitve | - could have just RF or ACPA, both or neither

Question 31

What does Sero-positive and Sero-Negative Arthritis mean?

Answer 31

- Sero-positive = patient has symptoms with elevated levels of antibody markers RF and or ACPA - Sero-Negative Arthritis = patient has symptoms but no elevated antibodies for RF or ACPA ACPA is the same as anti-CCP

Question 32

Sero-positive and Sero-Negative Arthritis relate to the presence of absence of RF and/or ACPA (see below). Do patients have the same disease prognosis? - Sero-positive = patient has symptoms with elevated levels of antibody markers RF and or ACPA - Sero-Negative Arthritis = patient has symptoms but no elevated antibodies for RF or ACPA

Answer 32

- no | - sero-positive patients have worse prognosis

Question 33

30-year-old female, who presents with a three month history of painful, swollen metacarpophalangeal (MCP) joints and wrists. The pain is worse in the mornings and early morning stiffness (EMS) lasts 3 hours. Heat and movement help the pain but when she stops moving her hands the pain returns. Does this patient have Non-inflammatory or Inflammatory joint pain?

Answer 33

- inflammatory joint pain | - long pain in the morning, symptoms improve with exercise but worsen with rest

Question 34

50-year-old ex-rugby player presents with 3 years of painful swollen right knee and painful left hip. He works as builder and by the end of the day the pain is worse. Rest and elevation of the knee helps the pain. EMS lasts 30 minutes. Does this patient have Non-inflammatory or Inflammatory joint pain?

Answer 34

- Non-inflammatory | - improves with rest, morning stiffness is short and pain is worse at the end of the day

Question 35

When we consider joint pain, we need to think is it articular or periarticular. What is periarticular and give a few examples?

Answer 35

- periarticular = outside of the joint cavity | - soft tissue, tendons, bursae, ligaments etc..

Question 36

When we consider joint pain, we need to think is it articular or periarticular. What is articular pain?

Answer 36

- articular = pain from inside the joint cavity | - articular cartilage for example

Question 37

You are asked to review a patient presenting with thenar eminence atrophy. The patient has numbness in the lateral 4 fingers (half of the ring finger). Which nerve do you think is affected? 1 - Ulnar nerve 2 - Radial nerve 3 - Median nerve

Answer 37

3 - median nerve

Question 38

RA commonly affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the hands, and can affect the wrist. Therefore, what common nerve pathology that involves the trapping of a nerve is common in RA? 1 - cubital syndrome 2 - radial claw 3 - ulnar claw 4 - carpal tunnel syndrome

Answer 38

4 - carpal tunnel syndrome

Question 39

Which epicondyle of the humerus is affected in tennis elbow? 1 - Medial 2 - Lateral

Answer 39

2 - Lateral

Question 40

What does epicondylitis mean?

Answer 40

- inflammation of epicondyles | - generally where muscles originate and is due to over use

Question 41

What is a connective tissue disease? 1 - damage to connective tissue caused by an infection 2 - damage to connective tissue caused by an vaccine 3 - damage to connective tissue caused by an auto-immune disease 4 - damage to connective tissue caused by an trauma

Answer 41

3 - damage to connective tissue caused by an auto-immune disease - collagen and elastin are the 2 main proteins that are affected and what make up all connective tissue in different proportions

Question 42

The most common connective tissue disease is Systemic Lupus Erythematosus (SLE). What is SLE? 1 - acute autoimmune disease affecting a specific organ 2 - chronic autoimmune disease affecting a specific organ 3 - chronic autoimmune disease affecting non-specific tissue 4 - chronic autoimmune disease affecting a muscles

Answer 42

3 - chronic autoimmune disease affecting non-specific tissue

Question 43

Which word would you use to describe muscle inflammation? 1 - Myopathy 2 - Myositis 3 - Myalgia

Answer 43

2 - Myositis

Question 44

What is a key marker of muscle inflammation?

Answer 44

- creatine kinase (CK)

Question 45

What % do musculoskeletal disorders account for in terms of death and disability in the UK? 1 - 5% 2 - 10% 3 - 15.6% 4 - 20%

Answer 45

3 - 15.6% | - lower back pain accounts for >50%

Question 46

How much do you estimate the NHS in the UK spends in a year on treating musculoskeletal conditions? 1 - 50 million 2 - 1 billion 3 - 10 billion 

Answer 46

3 - 10 billion 

Question 47

What accounts for 20% of all GP appointments? 1 - eye problems 2 - heart problems 3 - hearing problems 4 - musculoskeletal disorders

Answer 47

4 - musculoskeletal disorders

Question 48

Rheumatoid factor is an autoantibody, which is an antibody that recognised part of our normal cells as foreign. RF are autoantibodies that target what region of IgG? 1 - Fc region 2 - Fab region 3 - hinge 4 - heavy chain

Answer 48

1 - Fc region