Musculoskeletal Disorders Part 1

Question 0

What is mutated in osteogenesis imperfecta?

Answer 0

Type 1 collagen (alpha 1 or alpha 2 chains)

Question 1

What is another name for osteogenesis imperfecta?

Answer 1

Brittle bone disease

Question 2

What is the frequency of osteogenesis imperfecta?

Answer 2

1:20,000 live births

Question 3

How is type I collagen affected by osteogenesis imperfecta?

Answer 3

Premature breakdown of collagen

Question 4

Osteogenesis imperfecta follows what type of genetic pattern?

Answer 4

Autosomal dominant

Question 5

What is the main location affected by osteogenesis imperfecta?

Answer 5

Extracellular matrix (ECM)

Question 6

What are the specific areas affected by osteogenesis imperfecta?

Answer 6

Eyes, inner ear bones, skin, joints, teeth

Question 7

Osteogenesis imperfecta affecting the inner ear bones can lead to what issue?

Answer 7

Deafness

Question 8

What type of osteogenesis imperfecta results in a normal lifespan nonetheless?

Answer 8

Type I

Question 9

Which type of osteogenesis imperfecta is lethal in utero?

Answer 9

Type II

Question 10

What are the two extreme issues with type II osteogenesis imperfecta?

Answer 10

Cerebral hemorrhage and respiratory failure

Question 11

Why is cerebral hemorrhage common with type II osteogenesis imperfecta?

Answer 11

Weak skull

Question 12

What is the unique effect of osteogenesis imperfecta on the eye?

Answer 12

Abnormal collagen of the sclera (choroid) giving a bluish appearance instead of white

Question 13

With what type of osteogenesis imperfecta does abnormal collagen of the sclera occur?

Answer 13

Type I

Question 14

Multiple fractures, extremity bowing, scoliosis, ligamentous laxity (dislocations), and hearing loss are associated with what musculoskeletal congenital disorder?

Answer 14

Osteogenesis imperfecta

Question 15

What is an important chiropractic note to remember with those with osteogenesis imperfecta?

Answer 15

Their bones are extremely fragile (low force adjustments)

Question 16

The fragility of the bones of patients with osteogenesis imperfecta is a contraindication to what type of adjustments?

Answer 16

Extremity adjustments

Question 17

The zebra stripe sign is associated with what musculoskeletal congenital disorder?

Answer 17

Osteogenesis imperfecta

Question 18

What is the treatment used for children with osteogenesis imperfecta?

Answer 18

Bisphosphonates

Question 19

What is the most common form of dwarfism?

Answer 19

Achondroplasia

Question 20

What are the results of achondroplasia?

Answer 20

Decreased cartilage synthesis and decreased growth plate expansion

Question 21

What location is specifically affected by the decreased cartilage synthesis with achondroplasia?

Answer 21

Growth plate

Question 22

What is the genetic mutation with achondroplasia?

Answer 22

Fibroblast growth factor receptor (FGFR3) mutation

Question 23

What is the result of a FGFR3 mutation in achondroplasia?

Answer 23

Inhibition of epiphyseal (growth plate) chondrocytes

Question 24

Is achondroplasia usually sporadic or inherited?

Answer 24

Sporadic (75%)

Question 25

What is the genetic pattern of achondroplasia?

Answer 25

Autosomal dominant

Question 26

What musculoskeletal congenital condition is accompanied by short proximal extremities, lower extremity bowing, frontal bossing, and mid face hypoplasia (low nasal bridge)?

Answer 26

Achondroplasia

Question 27

What percentage of achondroplasia diagnoses are inherited?

Answer 27

25%

Question 28

What is frontal bossing (as seen in achondroplasia)?

Answer 28

Rounding of the frontal bone

Question 29

What type of dwarfism is primarily endocrine oriented and is more rare than achondroplasia?

Answer 29

Hypopituitary dwarfism

Question 30

What is the frequency of achondroplasia?

Answer 30

1:10,000

Question 31

Spinal issues including hyperlordosis and hyperkyphosis at birth, bullet vertebrae, scoliosis, and spinal stenosis are common among which musculoskeletal genetic disorder?

Answer 31

Achondroplasia

Question 32

What two specific types of spinal stenosis are common among achondroplasia patients?

Answer 32

Foramen magnum stenosis and spinal canal stenosis

Question 33

What is usually the death of those with achondroplasia?

Answer 33

Brain stem compression

Question 34

What is the result with brain stem compression with achondroplasia?

Answer 34

Cardiovascular abnormalities (may be lethal)

Question 35

What type of dwarfism is completely fatal?

Answer 35

Thanatophoric dwarfism

Question 36

What is the frequency of thanatophoric dwarfism?

Answer 36

1:20,000 births

Question 37

Extremely small thorax with shortened long bones leading to perinatal respiratory failure occurs with which musculoskeletal congenital disorder?

Answer 37

Thanatophoric dwarfism

Question 38

What is the unique appearance of the vertebrae in patients who have achondroplasia?

Answer 38

Bullet-shaped

Question 39

What is trident hand that is associated with achondroplasia?

Answer 39

Underdevelopment of the bones in the hands

Question 40

What rare genetic disorder is a result of decreased osteoclast-mediated bone resorption?

Answer 40

Osteopetrosis

Question 41

What type of bone cell is inhibited in osteopetrosis & what is the result of that?

Answer 41

Osteoclasts; osteoblasts therefore overwork and build up extreme bone density leading to increased fractures

Question 42

Why are cranial nerve palsies associated with osteopetrosis?

Answer 42

Foraminal stenosis occurs narrowing the bony canals for the nerves

Question 43

Why is deranged hematopoiesis common with osteopetrosis?

Answer 43

The medullary cavity fills with extra bone due to the decreased osteoclast activity

Question 44

What are some issues that occur when the medullary cavity fills with excess bone in osteopetrosis?

Answer 44

Hepatosplenomegaly, recurrent infections, anemia

Question 45

Why does hepatosplenomegaly occur with osteopetrosis?

Answer 45

The liver and spleen attempt to take over the function of the bone marrow that has been compressed and therefore hypertrophy

Question 46

What is the treatment for osteopetrosis?

Answer 46

Stem cell replacement

Question 47

Erlenmeyer flask deformity is present among which musculoskeletal disorder?

Answer 47

Osteopetrosis

Question 48

What is the most important form of osteopenia?

Answer 48

Osteoporosis

Question 49

What is the general definition of osteoporosis?

Answer 49

Loss of bone mass and increased porosity

Question 50

What is osteopenia?

Answer 50

Reduced bone mineralization

Question 51

At what point does osteopenia become the severe form of osteoporosis?

Answer 51

T score of 2.5 standard deviation (threshold from the norm)

Question 52

What is usually the cause of localized osteoporosis?

Answer 52

Disuse/isolation (example = arm in a cast)

Question 53

What is the most common type of osteoporosis?

Answer 53

Primary

Question 54

When does primary osteoporosis occur?

Answer 54

Postmenopausal, senile (age-related)

Question 55

Neoplasia, hyperparathyroidism, nutrient deficiency, and drug exposure are causes of what which type of osteoporosis?

Answer 55

Secondary

Question 56

Enlargement of what organ is a cause of secondary osteoporosis?

Answer 56

Parathyroid

Question 57

What types of drugs can be a cause of secondary osteoporosis?

Answer 57

Alcohol, smoking, long term corticosteroids

Question 58

Osteoporosis is more likely to affect what kind of bone?

Answer 58

Trabecular (cancellous/spongy) bone

Question 59

How is the cortex of the bone affected by osteoporosis?

Answer 59

Thinned (not completely destroyed)

Question 60

What are specific common locations of fractures as a result of osteoporosis due to these areas possessing increased amounts of trabecular bone?

Answer 60

Vertebral bodies, femoral neck, calcaneus

Question 61

What type of bone cell is less impacted by aging and therefore retains normal activity?

Answer 61

Osteoclasts

Question 62

Beginning in mid-20s, bone loss occurs at what rate?

Answer 62

.5% per year

Question 63

What percentage of postmenopausal women experience an osteoporosis related fracture?

Answer 63

50%

Question 64

What percentage of males (of the same age as postmenopausal women) experience an osteoporosis related fracture?

Answer 64

3%

Question 65

Reduction in what hormone accelerates bone loss as seen in postmenopausal women with osteoporosis?

Answer 65

Estrogens

Question 66

Activity of what substances are decreased in senile osteoporosis?

Answer 66

Growth factors and osteoblasts

Question 67

What is the age of maximum bone density?

Answer 67

Mid adulthood (25 years of age)

Question 68

How can osteoporosis be prevented?

Answer 68

Diet and exercise

Question 69

What types of exercise can help prevent osteoporosis?

Answer 69

Resistance training, athletics, increasing weight load more than overall cycles

Question 70

What supplements may benefit those with or prevent osteoporosis?

Answer 70

Calcium and vitamin D

Question 71

Calcium and vitamin D deficiency are most common among what gender?

Answer 71

Females

Question 72

Who are at risk for osteoporosis?

Answer 72

Older people of both ages, postmenopausal women

Question 73

Osteoporosis is usually asymptomatic, true or false?

Answer 73

True

Question 74

When does osteoporosis become symptomatic?

Answer 74

With skeletal fragility

Question 75

What is the exaggerated forward hunching of those with osteoporosis called that is due to multiple compression fractures?

Answer 75

Dowager's hump

Question 76

What are some concerns following surgery for a femoral neck (hip) fracture?

Answer 76

Pneumonia, deep vein thrombosis, pulmonary embolism (result of disablement)

Question 77

What type of bone cells is affected by the menopausal cause of osteoporosis?

Answer 77

Osteoclasts (increased)

Question 78

What type of bone cells is affected by the aging cause of osteoporosis?

Answer 78

Osteoblasts (decreased synthesis)

Question 79

What hormone is decreased with the menopausal cause of osteoporosis?

Answer 79

Estrogen

Question 80

What is another feature important to consider with the aging cause of osteoporosis besides the reduction in osteoblast synthesis?

Answer 80

General sedentary lifestyle

Question 81

What is the treatment for osteoporosis in females?

Answer 81

Estrogen therapy

Question 82

What are some risk factors with estrogen treatment for osteoporosis?

Answer 82

Deep vein thrombosis (increased blood clots), endometrial cancer, and breast cancer

Question 83

What is the appropriate way of determining osteoporosis?

Answer 83

DEXA scan

Question 84

What are preventative mechanisms for osteoporosis?

Answer 84

Activity, supplements, bisphosphonates