Pathophysiology Module 18 Musculoskeletal Disorders

In addition to joint pain, rheumatoid arthritis often manifests with which systemic symptoms? Select all that apply. Fever Malaise Lymphadenopathy Rash Confusion

All apply EXCEPT: Confusion

Which of the following adult populations are at high risk for developing osteomyelitis? Select all that apply. Orthopedic surgery patients Diabetics Intravenous drug users Recieved an animal bite Experienced a closed fracture reduction

All apply EXCEPT: Experienced a closed fracture reduction... no exposure.

What is the primary manifestation of osteoarthritis? Joint fusion Joint pain Hypermobility of joints Contractures

Joint pain: Joint degeneration in osteoarthritis almost always causes pain in affected joints. Osteoarthritis tends to cause decreased joint mobility. Contractures are a phenomenon that occurs in skeletal muscles. Joint fusion is uncommon in osteoarthritis.

What is NOT considered a risk factors for osteoarthritis? Low calcium intake Older age Obesity Orthopedic injury

Low calcium intake: Low calcium intake is a risk factor in the development of osteoporosis. Older age is a risk factor the development of osteoarthritis because of accumulated stress and trauma to the joints. Obesity is a risk factor in the development of osteoarthritis in the lower limb joints because of excessive stress from excess weight. Orthopedic injury involving a joint is a significant risk factor in the development of osteoarthritis because of cartilage damage.

Individuals with gout are much more likely to develop which complication? Coronary artery disease Osteoarthritis Contractures Renal stones

Renal stones: An excessive uric acid level in the blood in gout promotes the development of uric acid calculi (stones) in the kidneys. Gout is not associated with the development of osteorthritis, muscle contractures, or coronary artery disease.

Severe muscle trauma from crush injuries can result in which complication? Myotonia Rhabdomyolysis Myocarditis Fibromyalgia

Rhadomyolysis: Severe crushing trauma can result in the release of myoglobin from skeletal muscle cells, causing a life-threatening condition called rhabdomyolysis. Myotonia results from neuromuscular disorders. Myocarditis is inflammation of the cardiac muscle tissue in the heart wall and is usually related to infection. Fibromyalgia is a chronic disease that manifests with inflammation of the musculoskeletal system.

What term is used to identify the chronic stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue? Tophaceous Monarticular Primary Asymptomatic hyperuricemia

Tophaceous: The third and chronic stage of gout is called tophaceous gout. Monoarticular refers to arthritic joint pain in a single joint. Primary refers to a type of gout with no known etiology (cause). Asymptomatic hyperuricemia is the first clinical stage of gout and is characterized by elevated serum urate without arthritic symptoms, tophi, or renal problems.

Which of the following fractures involves fragmentation of the articular cartilage and generally occurs in adolescents? Greenstick Stress Transchondral Insufficiency

Transchondral: Transchondral fractures involve the separation of the articular cartilage from the bone and typically occur in adolescents. This separation is not associated with either a greenstick, stress, or insufficiency fracture.

Pain and inflammation associated with gout are caused by crystallization of what component in the tissues? Amino acid Uric acid Ketones Hyaluronic acid

Uric acid: Pain and inflammation associated with gout are caused by crystallization of uric acid in the tissues. The pain is not the result of crystallization of amino acid, ketones, or hyaluronic acid.

What results from ankylosing spondylitis? Vertebral joint fusion Instability of synovial joints Costal cartilage degeneration Temporomandibular joint degeneration

Vertebral joint fusion: Ankylosing spondylitis results in joint fibrosis, ossification, and fusion that most commonly affect the intervertebral and sacroiliac joints.

Pain of fibromyalgia is associated with what process? Inflammation Autoimmune destruction of muscle tissue A decrease in pain threshold Increased levels of peripheral neurotransmitters

A decrease in pain threshold: Individuals with fibromyalgia have lowered mechanical and thermal pain thresholds, high pain ratings for provoking stimuli, and altered temporal summation of pain stimuli. Fibromyalgia pain is not associated with inflammation, autoimmune muscle tissue destruction, or peripheral neurotransmitters.

What event is the cause of an avulsion? The synovial capsule is torn The body of a ligament is torn A tendon is torn off its bony attachment A tendon becomes inflamed

A tendon is torn off its bony attachment: An avulsion occurs when a tendon or ligament is completely separated from its bony attachment. Trauma to neither a synovial capsule nor a ligament body is related. An avulsion is not related to the inflammatory process.

Which event would not occur after a bone fracture? Development of a blood clot beneath the periosteum Leukocyte infiltration into bone tissue Blood vessel growth at the fracture site An increase in the number of osteoclasts at the fracture site

An increase in the number of osteoclasts at the fracture site: Osteoblasts, NOT osteoclasts, migrate to the site of injury to repair the fractured bone tissue. Bone fractures result in ruptured vessels, bleeding, and later clot formation at the site of injury. After a fracture, leukocytes and mast cells infiltrate into bone tissue to facilitate the healing process. There is blood vessel growth at the fracture site.

Rheumatoid arthritis results from joint inflammation triggered by what? Bacterial infection Trauma Autoimmune injury Congenital hypermobility

Autoimmune injury: Rheumatoid arthritis is caused by autoimmune injury to synovial joints. Although bacterial infections and trauma can cause joint inflammation and congenital hypermobility can predispose an individual to joint trauma, none of these are triggers for rheumatoid arthritis.

What is the cause of most cases of endogenous osteomyelitis? Fungal skin infection Viral pneumonia Parasitic infection of the gastrointestinal (GI) tract Blood-borne pathogens

Blood-borne pathogens: Endogenous osteomyelitis is caused by bloodborne infections. The specific causative organisms differ among age and population groups. Neither fungal skin infections, viral pneumonia, nor parasitic infections of the GI tract are commonly associated with endogenous osteomyelitis.

A fracture in which the bone breaks into two or more fragments is referred to by what term? Comminuted fracture Open fracture Greenstick fracture Occult fracture

Comminuted fracture: A fracture in which the bone breaks into two or more fragments is called a comminuted fracture. An open fracture is an injury in which the skin is broken at the site of the fracture by fragments of bone. A greenstick fracture involves a small break in the cortex of the bone. An occult fracture is one that is not readily visible and therefore usually does not involve bone fragmentation and separation.

What contributes to the occurance of a torus fracture? Injury occurs at the epiphyseal growth plate Cortex of the bone buckles Spongy bone is damaged without affecting the cortical bone Long bone splinters into many fragments

Cortex of the bone buckles: A torus fracture occurs when the cortex of the bone buckles but does not break. Fractures at the epiphyseal growth plate are called transchondral fractures. Fractures involving the inner spongy bone usually occur in conjunction with cortical bone injury. A fracture in which a bone breaks into more than two fragments is termed a comminuted fracture.

What factor contributes to the development of osteoporosis in older women? Decreased estrogen levels Increased androgen levels Excessive dietary calcium Strenuous exercise

Decreased estrogen levels: The hormone estrogen helps maintain bone strength and integrity in women. In menopause, decreased estrogen production increases a woman's risk of developing osteoporosis. Increased androgen levels would promote bone integrity and strength. Decreased calcium intake is associated with the development of osteoporosis. Strenuous, weight-bearing exercise can help prevent osteoporosis.

What is the chief pathologic feature of degenerative joint disease? Stress fractures of the epiphysis Loss of synovial fluid Degeneration of articular cartilage Thinning of the joint capsule

Degeneration of articular cartilage: The hallmark of degenerative joint disease is degeneration of articular cartilage in synovial joints. Degenerative joint disease is not characterized by an epiphyseal stress fracture, loss of synovial fluid, or thinning of the joint capsule.

What is currently considered the best screening test for osteoporosis? X-ray Bone biopsy Dual-energy x-ray absorptiometry (DEXA) scan A thorough physical examination

Dual-energy x-ray absorptiometry (DEXA): A DEXA scan is the most useful test for evaluating bone density if osteoporosis is suspected because it is the most effective in evaluating bone density. Neither an x-ray nor a physical exam are conclusive in diagnosis osteoporosis. Bone biopsies are used to diagnose osteomalacia.

Inflammation of a tendon where it attaches to the bone is referred to by which term? Epicondylitis Arthritis Delta lesions Bursitis

Epicondylitis: Inflammation of a tendon where it attaches to the bone is called epicondylitis and is caused by repetitive movements. Arthritis is inflammation in a joint. Delta lesions are microscopic holes in the sarcolemmal membrane and occur with myoglobinuria (rhabdomyolysis). Bursitis is inflammation of the bursal sacs that protect the skin over bony protuberances.

The pathophysiology of osteomalacia involves which outcome? Increased osteoclast activity Collagen breakdown in the bone matrix Crowding of cells in the osteoid Excess phophate loss after parathyroid hormone (PTH) stimulation

Excess phosphate loss after parathyroid (PTH) stimulation: Inadequate vitamin D decreases available calcium levels. To compensate, the body releases PTH, which conversly decreases circulating phosphate levels. The lack of phosphate is the pathologic process in osteomalacia. Increased osteoclastic activity is seen in osteoporosis. Collagen breakdown in bone tissue is seen in certain endocrine disorders, such as hypercortisolism. Osteomalacia is a metabolic disease characterized by inadequate or delayed mineralization in the osteoid.

Which factor is NOT generally associated with known triggers of gout? Alcohol Drugs High-fat diet Trauma

High-fat diet: Episodes of gout can be triggered by excessive alcohol intake, use of certain drugs, and trauma. A high-fat diet is not a known trigger for gout.

Treatment priorities in myoglobinuria focus on preventing failure of which organ? Liver Lungs Kidneys Pancreas

Kidneys: Priorities in treatment of myoglobinuria include identifying and treating the underlying disorder and preventing life-threatening renal failure. The condition does not affect the liver, the lungs, or the pancreas significantly.... uria = kidney.

Which of the following cancers involves the proliferation of plasma cells in the bone marrow, causing skeletal pain? Myeloma Leukemia Lymphoma Osteosarcoma

Myeloma: Myeloma is caused by the neoplastic proliferation of plasma cells that eventually penetrate into the bone marrow, resulting in significant bone destruction. The most common early symptom of myeloma is aching skeletal pain that increases in severity as the disease progresses. Leukemia involves the neoplastic proliferation of myeloid or lymphoid stem cells. Lymphoma involves the neoplastic proliferation of lymphocytes and their precursors in the lymphoid tissues. Osteosarcoma is a cancer of the osteogenic cells. None of these conditions result in the proligeration of plasma cells in the bone marrow that results in skeletal pain.

Synovial joint problems in rheumatoid arthritis are due to which pathologic process? Articular cartilage is lost through enzymatic breakdown. Free radicals attach to the synovial membrane and articular cartilage. Neutrophils and inflammatory cytokines cause damage to articular cartilage. Cysts develop in the subchondral bone and create fissures in the articular cartilage.

Neutrophils and inflammatory cytokines cause damage to articular cartilage: In rheumatoid arthritis, neutrophils and inflammatory cytokines (interleukin 1 [IL-1] and tumor necrosis factor alpha [TNF-α]) cause damage to articular cartilage and the nearby synovium. There is no evidence that free radicals are involved in this disease. Enzymatic destruction of cartilage occurs in osteoarthritis. Subchondral bone cysts occur in osteoarthritis.

Which of the following are associated with preventing proper bone healing? Select all that apply. Nicotine Alcohol and nicotine High-protein diet Dehydration Caffiene

Only Nicotine and Alcohol apply.

Which of the following pairs of symptoms is likely to manifest after a femoral fracture? Select all that apply. Cool skin Referred pain Pain Limb paralysis Swelling

Only Pain & Swelling apply.

What are the known causes of osteoporosis? Family history Late menopause Smoking Anorexia Early menarche

Only: late menopause & early menarche apply.

Which of the following disorders presents with significant bone demineralization from a vitamin D deficiency and usually results in skeletal pain? Osteomalacia Osteopenia Osteomyelitis Osteochondrosis

Osteomalacia: Osteomalacia is a rare metabolic disease characterized by inadequate mineralization of bone tissue in compact and spongy bone. The most common cause of osteomalacia is vitamin D deficiency. Osteopenia is not caused by vitamin D deficiency nor does it generally result in skeletal pain. Vitamin D deficiency is not related to osteomyelitis. Osteomalacia results in decreased bone density that is due to vitamin D deficiency.

Which of the following musculoskeletal tumors usually forms in the bone marrow? Rhabdosarcoma Liposarcoma Osteosarcoma Chondrosarcoma

Osteosarcoma: Osteosarcomas are bone cancers that usually originate in the red bone marrow. Rhabdosarcomas form in skeletal muscle tissue. Liposarcomas form in adipose tissue. Chondrosarcomas form in cartilage.

Which disorder is characterized by enlargement and softening of the bones? Osteomyelitis Osteoporosis Paget disease Rickets

Paget disease: Paget disease (osteitis deformans) is characterized by excessive bone resorption and formation, resulting in chronic enlargement and softening of certain bones. Neither osteomyelitis, osteoporsis, nor rickets is characterized by enlargement and softening of the bone.

Patients diagnosed with osteoporosis are at risk for what orthopedic complication? Rhabdomyolysis Osteomyelitis Osteomalacia Pathologic bone fractures

Pathological bone fractures: Osteoporosis weakens the bone structure and increases the risk of pathologic fractures. Rhabdomyolysis occurs with skeletal muscle trauma. Development of osteomalacia is not related to the pathology of osteoporosis. Osteoarthritis does not increase the risk of osteomyelitis.

A bone breaks in a place where there was preexisting disease. What type of fracture is being described? Transchondral Pathological Stress Fatigue

Pathological: A pathologic fracture occurs in a place where there was preexisting disease that weakened the area. This description does not apply to a transchondral, stress, or fatigue fracture.

What feature is characteristic of fibromyalgia? Pressure point pain Headache Permanent shortening of muscles Muscle atrophy

Pressure point pain: Fibromyalgia specifically manifests with pressure point pain or tenderness. Neither a headache, contractures caused by muscle shortening, nor muscle atrophy are associated with fibromyalgia.

Which of the following diseases is characterized by osteomalacia in the growing bones of children? Rickets Osteosarcoma Paget disease Rhabdomyoma

Rickets: Rickets is a form of osteomalacia caused by a vitamin D deficiency, which results in soft, deformable bones. Osteosarcoma is a form of bone cancer and is not similar to osteomalacia. Paget disease shares no connection with psteomalacia. Rhabdomyoma is a muscle tumor.

A partial tear of a ligament is referred to by what term? First-degree sprain Second-degree sprain First-degree strain Second-degree strain

Second-degree sprain: A strain of any degree is a tendon injury. A second-degree sprain involves partial tearing of a ligament. A first-degree sprain involves only minor tearing of ligamentous fibers.

In osteomyelitis, what term is used to identify the area of necrotic bone at the site of the infection? Periosteum Involucrum Drainage tract Sequestrum

Sequestrum: The area of devitalized bone tissue at the site of the infection is called the sequestrum. The periosteum is the connective tissue layer that envelops all bones. The involucrum is the layer of new bone that is formed around the infected bone tissue. The drainage tract connects the area of necrotic bone tissue (sequestrum) to the bone surface.

A tear in a tendon is commonly referred to using what term? Dislocation Sprain Strain Subluxation

Strain: A sprain is a tear in a ligament. A strain is a tear in a tendon. Dislocation is the temporary displacement of a bone from its normal position in a joint. Subluxation is a type of synovial joint injury..... think sTrain = Tendon.

What term is used to identify the displacement of two bones in which the articular surfaces partially lose contact with each other? Subluxation Subjugation Sublimation Dislocation

Subluxation: The displacement of two bones in which the articular surfaces partially lose contact with each other is called subluxation. Dislocation occurs when the articular surfaces of the bones lose complete contact with each other. This description is not related to either subjugation or sublimation.

Which complications would not be associated with the healing of a fractured bone? Malunion Nonunion Subluxion Delayed union

Subluxion: If the contact between the two joint surfaces is only partially lost, the injury is called a subluxation, generally associated with fractures. This results in injury; not associated with the healing process. Malunion, nonunion, and delayed union are all associated with impaired healing of a fractured bone.