Musculoskeletal Flashcards
(110 cards)
1
Q
What is osteoporosis?
A
A disease in which bone tissue is normally mineralised but the mass (density) of bone is decreased and structural integrity of trabecular bone is impaired.
2
Q
What percentage of the Australian population was estimated to have osteoporosis in 2020?
A
3.8% of the population.
3
Q
What happens to cortical bone in osteoporosis?
A
Cortical bone becomes more porous and thinner.
4
Q
What is compared to determine osteoporosis?
A
Individual bone density is compared with the mean bone mineral density of a young adult reference population.
5
Q
At what age is peak bone mass typically reached?
A
Around age 30.
6
Q
What major risk is associated with osteoporosis?
A
Fractures.
7
Q
What is the lifetime risk of a fracture due to osteoporosis after 50 years of age for women in Australia?
A
42%.
8
Q
True or False: Osteoporosis is solely a consequence of the aging process.
A
False.
9
Q
What are the common sites of fractures due to osteoporosis?
A
- Spine
- Wrists
- Hip
10
Q
What is postmenopausal osteoporosis primarily caused by?
A
Oestrogen deficiency.
11
Q
What hormonal imbalance occurs in postmenopausal osteoporosis?
A
Increased osteoclast activity and decreased osteoblast activity.
12
Q
List three dietary risk factors for osteoporosis.
A
- Low dietary calcium
- Low vitamin D
- High caffeine intake
13
Q
What is a common clinical manifestation of osteoporosis?
A
Fractures.
14
Q
What imaging technique is considered the gold standard for detecting osteoporosis?
A
Dual x-ray absorptiometry (DXA).
15
Q
What T-score indicates osteoporosis in a bone density test?
A
A T-score of –2.5 or lower.
16
Q
What are the goals of osteoporosis treatment?
A
To slow down the rate of bone deterioration.
17
Q
What medication class is commonly used to inhibit the resorption of bone in osteoporosis?
A
Bisphosphonates.
18
Q
Fill in the blank: Osteoporosis affects more than _____ of women aged 60 and older.
A
half
19
Q
What can increase the risk of osteoporosis according to lifestyle factors?
A
Sedentary lifestyle, smoking, and excessive alcohol consumption.
20
Q
What is one adverse effect of bisphosphonates?
A
Atypical femoral fracture.
21
Q
What role does oestrogen play in bone health?
A
It helps osteoclast apoptosis, reducing bone resorption.
22
Q
What is the relationship between osteoclasts and osteoblasts in maintaining bone health?
A
Osteoclasts are bone-destroying cells, while osteoblasts are bone-building cells.
23
Q
What is glucocorticoid-induced osteoporosis characterized by?
A
Increased bone resorption and decreased bone formation.
24
Q
Name two factors that can contribute to further decline of bone density with age.
A
- Loss of osteoblast function
- Decreased physical activity
25
What is kyphosis?
A condition caused by vertebral collapse, leading to a hump-like curvature of the spine.
26
What can excessive sodium intake affect in relation to osteoporosis?
It may interfere with calcium benefits.
27
What is the significance of cytokines in bone remodeling?
They control osteoclast precursor cell activity.
28
What are bisphosphonates used for?
To inhibit the resorption of bone by osteoclasts and manage bone loss related to osteoporosis.
## Footnote
Available in tablet or injectable form.
29
What are some adverse effects associated with bisphosphonates?
* Atypical femoral fracture
* Osteonecrosis of the jaw
* Gastrointestinal disturbances, especially oesophageal irritation
## Footnote
Particularly in older females with poor dental hygiene.
30
What is a 'medication holiday' in the context of bisphosphonates?
A break from the medication to reduce risks associated with long-term use.
31
How does denosumab function in osteoporosis treatment?
It prevents the maturation of osteoclasts, thereby reducing bone resorption.
32
How often is denosumab administered?
Every 6 months subcutaneously.
33
What type of exercise can help manage osteoporosis?
Regular, moderate weight-bearing exercise.
34
What are the benefits of an exercise program for older adults?
* Slows down bone loss
* Reduces risk of falls
* Promotes bone quality
35
What factors increase the risk of falls in older adults?
* Worsening eyesight
* Inner ear-related imbalances
* Touch sensitivities
* Slowing response times
36
What is the consequence of a proximal femur fracture in older adults?
Up to 28% may die within one year, and 24–75% may not return to their pre-fracture level of independence.
37
What percentage of osteoporosis-related fractures occur in males?
20–25% of the 8.9 million fractures sustained annually.
38
What is the osteoporosis risk profile for males compared to females?
* Fractures occur 10 years later
* More overlap of primary and secondary osteoporosis risk factors
* Higher risk of death after hip fracture
39
What are some newer pharmaceutical treatments for osteoporosis?
* Bisphosphonates (e.g. alendronate, risedronate)
* Denosumab
* Raloxifene
* Teriparatide
40
What is Paget’s disease?
A state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling.
41
Which bones are most often affected by Paget’s disease?
* Vertebrae
* Skull
* Sacrum
* Sternum
* Pelvis
* Femur
42
What age group is most frequently diagnosed with Paget’s disease?
Individuals over 50 years of age.
43
What is a common clinical manifestation of Paget's disease in the skull?
Thickening and asymmetrical shape of the skull, potentially compressing areas of the brain.
44
What is the typical treatment for Paget’s disease?
Bisphosphonates to reduce bone resorption.
45
What are osteochondroses?
A series of childhood diseases involving areas of significant tensile or compressive stress.
46
What is Legg-Calvé-Perthes disease?
A common osteochondrosis affecting the femoral head in children aged 3-10 years.
47
What are the stages of Legg-Calvé-Perthes disease?
* Incipient stage
* Necrotic stage
* Regenerative stage
* Residual stage
48
What is Osgood-Schlatter disease?
A condition causing microfractures of the tibial tubercle and associated patellar tendonitis.
49
What is the primary goal of treatment for Osgood-Schlatter disease?
To decrease stress at the tibial tubercle.
50
What are the three main types of scoliosis?
* Idiopathic
* Congenital
* Teratological
51
What is scoliosis?
A lateral deviation of the spine
52
What are the three main types of scoliosis?
* Idiopathic (unknown cause)
* Congenital (due to bone deformity)
* Teratological (due to another systemic syndrome)
53
What percentage of scoliosis cases is idiopathic?
Eighty percent
54
What characterizes true structural scoliotic deformity?
Involves both a side-to-side curve and rotation
55
What is the Cobb method used for?
Measuring the severity of scoliosis curves
56
At what degree of curvature is bracing required for idiopathic scoliosis?
25° or greater
57
What is the success rate of bracing in slowing scoliotic progression?
It is the only non-operative measure known to slow progression
58
What is the typical age group for rapid progression of idiopathic scoliosis?
During growth spurts
59
True or False: Bracing is equally effective for teratological and congenital curves as it is for idiopathic curves.
False
60
What is rheumatoid arthritis?
A systemic, inflammatory autoimmune disease affecting multiple joints
61
What are common symptoms of rheumatoid arthritis?
* Swelling
* Pain
* Stiffness
* Fatigue
62
How is rheumatoid arthritis classified?
By the number of joints affected, serology, acute-phase reactants, and duration of symptoms
63
What is the estimated prevalence of rheumatoid arthritis in Australia?
Over 456,000 Australians, with a prevalence rate of 1.9
64
What factors contribute to the pathophysiology of rheumatoid arthritis?
* Activated neutrophils breaking down cartilage
* Cytokine release stimulating inflammation
* Synovium digesting cartilage
65
What is pannus in the context of rheumatoid arthritis?
A mass of synovium and inflammatory cells that forms over denuded areas
66
What are common joint deformities seen in rheumatoid arthritis?
* Ulnar deviation
* Boutonnière deformity
* Swan-neck deformity
67
What complications can arise from chronic rheumatoid arthritis?
* Formation of cysts in articular cartilage
* Rupture of cysts or synovial joints
68
What are rheumatoid nodules?
Swellings that are collections of inflammatory cells found in areas of pressure or trauma
69
What systemic symptoms may accompany rheumatoid arthritis?
* Fever
* Malaise
* Rash
* Lymph node enlargement
70
What is the role of serological tests in the evaluation of rheumatoid arthritis?
To detect rheumatoid factor and C-reactive protein levels
71
Fill in the blank: Rheumatoid arthritis can cause _______ in the joints.
Inflammation and pain
72
What are the typical symptoms of kidney damage in systemic autoimmune conditions?
Kidney damage, vascular insufficiency in hands and fingers (Raynaud’s phenomenon).
73
What are the primary evaluation methods for rheumatoid arthritis?
Physical examination, radiographic investigation, serological tests for rheumatoid factor, C-reactive protein (CRP), circulating immune complexes.
74
What is the diagnostic criterion for rheumatoid arthritis according to the American College of Rheumatology?
Presence of four or more of the following criteria:
* Morning stiffness lasting more than 1 hour
* Arthritis of three or more joint areas
* Arthritis of the hand joints
* Symmetrical arthritis
* Rheumatoid nodules over extensor surfaces or bony prominences
* Serum rheumatoid factor
* X-ray changes (hand and wrist).
75
What are common non-surgical treatments for rheumatoid arthritis?
Patient education, resting the inflamed joint, hot and cold packs, physical therapy, smoking cessation, relaxation techniques, diet high in kilojoules and vitamins.
76
What is the role of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis treatment?
Aggressive, early intervention to manage the disease.
77
What are the three modes of onset for juvenile rheumatoid arthritis?
Oligoarthritis, polyarthritis, Still’s disease.
78
What distinguishes juvenile rheumatoid arthritis from adult rheumatoid arthritis?
Oligoarthritis is more common, large joints are affected, chronic uveitis is common if antinuclear antibody is positive, rheumatoid nodules and factor are usually absent.
79
What percentage of patients with juvenile rheumatoid arthritis have active disease 10 years later?
One-third to half.
80
What is the primary cause of ankylosing spondylitis?
Not well understood, but roughly half the risk is associated with the HLA–B27 gene.
81
What characterizes the pathophysiology of ankylosing spondylitis?
Inflammation of fibrocartilage in joints leading to fibrosis, ossification, and fusion of the joint.
82
What are common clinical manifestations of early ankylosing spondylitis?
Low back to buttock pain and stiffness, early morning stiffness, restricted spine motion.
83
What is the typical age of onset for ankylosing spondylitis?
Late adolescence and young adulthood, peak incidence around 20 years.
84
What is gout characterized by?
Inflammation and pain of the joints due to defects in uric acid metabolism.
85
What causes hyperuricaemia in gout?
Excessive uric acid production or underexcretion by the kidneys.
86
What is the typical first joint affected in gout?
Joint of the great toe.
87
What critical factor influences the solubility of urate and crystal formation in gout?
Temperature; urate is less soluble in lower temperatures.
88
What is the role of purine metabolism in gout pathophysiology?
Uric acid is a breakdown product of purine nucleotides, with accelerated production leading to hyperuricaemia.
89
What are some mechanisms that may lead to urate crystal deposition in joints?
* Precipitation at lower body temperatures
* Decreased albumin or glycosaminoglycan levels
* Changes in ion concentration and pH
* Trauma.
90
What is the role of neutrophils in the inflammatory response during a gout attack?
They ingest urate crystals, die, and release enzymes that cause tissue damage and further inflammation.
91
What are the treatment goals for individuals with ankylosing spondylitis?
Controlling pain, maintaining mobility, controlling inflammation, preventing deformity.
92
What are some surgical options available for advanced ankylosing spondylitis?
Osteotomy, total hip replacement, cervical spinal fusion, radiation therapy.
93
What stimulates and perpetuates the inflammatory response in gout?
Urate crystals
## Footnote
Urate crystals attract neutrophils that phagocytose them, leading to tissue damage and further inflammation.
94
What are the five clinical manifestations of gout?
* Increase in serum urate concentration (hyperuricaemia)
* Recurrent attacks of monarticular arthritis
* Deposits of urate monohydrate (tophi) in and around the joints
* Renal disease involving glomerular, tubular and interstitial tissues
* Formation of renal stones
95
What are the three clinical stages of gout?
* Asymptomatic hyperuricaemia
* Acute gouty arthritis
* Tophaceous gout
96
What is the primary symptom of gouty arthritis?
Severe pain
97
What is podagra?
Gout affecting the metatarsophalangeal joint of the great toe
98
What is the most common site for tophi in chronic gout?
Helix of the ear
99
How do renal calculi relate to primary gout?
Renal calculi are 1000 times more prevalent in individuals with primary gout than in the general population.
100
What treatments are commonly used for acute gouty arthritis?
* Colchicine
* NSAIDs (especially indomethacin)
* Allopurinol
101
What dietary changes can help reduce future gout attacks?
* Low purine diet
* Increased oral fluid intake
* Reduction in alcohol intake
* Gradual weight loss
102
What is osteoporosis?
A condition resulting in pathological fractures due to reduced bone mass/density and imbalance of bone resorption and formation
103
What are potential causes of osteoporosis?
* Decreased levels of oestrogen and testosterone
* Decreased activity level
* Inadequate vitamin D, Ca2+ or Mg2+
* Sedentary lifestyle
* Alcoholism, corticosteroids, cigarette smoking
* Short stature, low body weight
104
What is rhabdomyolysis?
A life-threatening complication of severe muscle trauma leading to muscle cell damage and release of toxic materials into the blood
105
What characterizes rheumatoid arthritis?
Chronic inflammatory condition causing systemic autoimmune damage to connective tissue, primarily in the joints
106
What are the manifestations of rheumatoid arthritis?
* Systemic manifestations
* Local manifestations
107
What is osteomalacia?
A condition due to vitamin D deficiency leading to inadequate or delayed mineralisation of bone
108
What is Paget's disease?
Excessive resorption of spongy bone and accelerated formation of softened bone, leading to disorganized and thickened bones
109
What is cauda equina syndrome?
A space-occupying lesion within the lumbosacral canal, including disc herniation
110
Fill in the blank: Gout manifests high levels of uric acid in the blood and other body fluids when the uric acid concentration increases to high enough levels to _______.
crystallise
