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W7 Musculoskeletal Disorders Flashcards

1
Q

What components make up the musculoskeletal system?

A

Bones, ligaments, tendons, cartilage

The musculoskeletal system requires blood for nutrients and waste removal.

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2
Q

What is the primary function of bones in the musculoskeletal system?

A

Provide a rigid frame for the body and anchor points for organs

Bones encase vital organs such as the heart and lungs.

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3
Q

What is red bone marrow responsible for?

A

Production of red blood cells

Yellow marrow forms part of the body’s fat reserves.

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4
Q

What role do muscles play in the musculoskeletal system?

A

Allow movement (articulation) by contracting and relaxing.

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5
Q

What do tendons connect?

A

Muscles to bones.

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6
Q

What do ligaments connect?

A

Bones to each other.

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7
Q

What is the function of cartilage in the musculoskeletal system?

A

Provides a smooth surface for bones to glide over each other.

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8
Q

What is the epiphysis of a long bone?

A

Located at the ends of the bone, contains spongy bone with red marrow cavities

Important for hematopoiesis (blood cell production).

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9
Q

What is the metaphysis in a long bone?

A

Transitional zone between diaphysis and epiphysis.

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10
Q

What does the diaphysis of a long bone contain?

A

Mainly compact bone; houses the medullary cavity.

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11
Q

What is the medullary cavity?

A

Central canal within diaphysis containing yellow marrow.

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12
Q

What is the difference between compact bone and spongy bone?

A

Compact bone is dense and strong; spongy bone is lighter and porous.

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13
Q

What is the role of the periosteum?

A

Tough outer fibrous membrane covering the bone, involved in growth and repair.

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14
Q

True or False: The endosteum lines the outer surface of the bone.

A

False

The endosteum lines the inner surface of the medullary cavity.

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15
Q

What are osteoblasts and osteoclasts responsible for?

A

Bone remodeling.

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16
Q

What is the structural unit of compact bone?

A

Osteon (Haversian system).

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17
Q

What is the function of canaliculi in bone tissue?

A

Enable communication and nutrient exchange between osteocytes.

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18
Q

What is the primary action of the pectoralis major muscle?

A

Arm flexion and adduction.

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19
Q

What muscle is responsible for hip flexion?

A

Iliopsoas.

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20
Q

Which muscles are part of the hamstrings?

A

Semitendinosus, Semimembranosus, Biceps femoris.

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21
Q

What is the primary function of the gastrocnemius muscle?

A

Plantar flexion of the foot.

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22
Q

Fill in the blank: The _______ is the tough outer layer of a long bone.

A

periosteum.

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23
Q

True or False: Spongy bone contains organized osteons.

A

False.

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24
Q

What is the function of the trapezius muscle?

A

Elevates shoulders and extends the neck.

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25
What does the term 'hematopoiesis' refer to?
Blood cell production.
26
What is the role of the flexor carpi radialis?
Wrist flexion.
27
What type of muscle is the deltoid?
Shoulder abductor.
28
What is the primary action of the rectus abdominis?
Trunk flexion.
29
What is the largest structural unit of skeletal muscle?
Whole Muscle ## Footnote The whole muscle is composed of bundles called fasciculi surrounded by connective tissue.
30
What are fasciculi?
Bundles of muscle fibers ## Footnote Fasciculi are groups of muscle fibers that form the whole muscle.
31
What connective tissue surrounds the whole muscle?
Epimysium ## Footnote Epimysium is the outer layer of connective tissue surrounding the muscle.
32
What is contained within each muscle fascicle?
Many muscle fibers ## Footnote Each fascicle is composed of multiple muscle fibers, which are the individual muscle cells.
33
What is a muscle fiber?
A single elongated multinucleated cell ## Footnote Muscle fibers are the basic cellular units of muscle tissue.
34
Where is the nucleus located in a muscle fiber?
On the periphery of the muscle fiber ## Footnote The nuclei of muscle fibers are located at the edges, allowing room for myofibrils.
35
What are myofibrils?
Cylindrical structures within each muscle fiber ## Footnote Myofibrils are responsible for the striated appearance and contraction of muscle tissue.
36
What is the functional contractile unit of the muscle?
Sarcomere ## Footnote Sarcomeres are the repeating units that make up myofibrils and are essential for muscle contraction.
37
What are the two types of myofilaments?
Actin and Myosin ## Footnote Actin (thin filaments) and Myosin (thick filaments) work together for muscle contraction.
38
True or False: Myosin pulls on actin using ATP.
True ## Footnote Myosin uses ATP to bind and pull on actin during muscle contraction.
39
Fill in the blank: The ______ is responsible for contraction via myofilament action.
Sarcomere ## Footnote The sarcomere is where the sliding filament theory occurs, leading to muscle contraction.
40
What does the sliding filament theory explain?
Muscle contraction at the sarcomere level ## Footnote This theory describes how actin and myosin filaments slide past each other to shorten the sarcomere.
41
What is the significance of multinucleated fibers in muscle function?
Allow for large-scale protein synthesis ## Footnote The presence of multiple nuclei in muscle fibers supports the high demand for proteins needed for muscle repair and growth.
42
What is the most common health problem related to back pain in Australia?
Lower back pain ## Footnote Most people experience back pain at some stage during their life.
43
What are the significant costs associated with back pain?
* Mental health impact * Activity limitation * Absence from work * Health system expenditure
44
What are the types of back pain?
* Upper Back Pain * Lower Back Pain * Acute Back Pain * Chronic Back Pain
45
What is upper back pain?
Pain / discomfort felt from the base of the neck to the thoracic region
46
What are the risks for developing upper back pain?
* Sedentary lifestyle * Obesity * ↑ stress * Smoking * Pregnancy * Prior injuries * Frequent heavy lifting
47
What are the common causes of upper back pain?
* Herniation of intervertebral discs * Injury to ligaments * Overuse of muscles * Osteoarthritis * Kyphosis
48
What is lower back pain?
Pain / discomfort felt in the lumbar region
49
Why is the lumbar region significant?
It bears most of the weight of the body and has high-risk nerve roots for injury
50
What are the risks for developing lower back pain?
* Poor muscle tone * Poor posture * Sedentary lifestyle * Previous injuries
51
What are the causes of lower back pain?
* Lumbosacral sprain * Instability of lumbosacral mechanisms * Osteoarthritis * Degenerative disc disease * Herniation of intervertebral discs
52
What characterizes acute back pain?
Back pain that lasts < 4 weeks, mostly caused by trauma
53
What are common symptoms of acute back pain?
* Muscle ache * Shooting or stabbing pain * Poor range of movement * Difficulty weight-bearing * Difficulty standing straight
54
What is chronic back pain?
Back pain that lasts > 3 months or involves repeated incapacitating events
55
What are the causes of chronic back pain?
* Previous injury * Chronic strain * Congenital abnormalities * Degenerative disorders
56
What is Degenerative Disc Disease (DDD)?
A condition resulting from the normal aging process leading to deterioration and herniation of intervertebral discs
57
What are the risk factors for Degenerative Disc Disease?
* Advancing age * Family history * Excessive strain * Sedentary lifestyle * Smoking * Obesity
58
How is Degenerative Disc Disease diagnosed?
* Past medical history * Clinical presentation * Imaging (x-rays, CT, MRI)
59
What are common complications of Degenerative Disc Disease?
* Chronic pain * Incontinence * Limb weakness * Altered sensation * Herniated discs * Osteoarthritis * Reduced mobility
60
What does treatment for Degenerative Disc Disease usually involve?
* Supportive care * Pharmacological management * Surgery (last option)
61
What are examples of pharmacological management for DDD?
* NSAIDs (e.g. Ibuprofen) * Corticosteroids * Analgesics (e.g. Tramadol) * Opioids (short-term) * Antidepressants (e.g. Amitriptyline) * Anticonvulsants (e.g. Gabapentin)
62
What surgical options are available for severe DDD?
* Microdiscectomy * Laminectomy * Hemilaminectomy * Discectomy
63
What are the clinical manifestations of Degenerative Disc Disease?
* Radiculopathy * Spinal instability * Altered limb sensation * Muscle spasms * Spinal deformity
64
What is radiculopathy?
Irritation of the nerve root, often caused by a herniated disc
65
What are the types/locations of radiculopathy?
* Cervical radiculopathy (shoulders, arms, hands) * Lumbar radiculopathy (hips, buttocks, legs)
66
What does spinal instability feel like?
Sensation of spine 'giving out' or locking up
67
What are some symptoms of spinal instability?
* Altered lower limb sensation * Decreased lower limb motor function * Loss of spinal flexibility
68
What is Osteoporosis?
A type of metabolic bone disease characterized by abnormal bone structure including: * Decreased bone density * Loss of structural integrity of trabecular (spongy) bone * Weaker, thinner, and more porous cortical (compact) bone ## Footnote Refer to patho book, p. 526.
69
What are the risk factors for developing Osteoporosis?
Risk factors include: * Genetics * Advancing age (especially > 65 years) * Gender (increased risk for women) * Poor nutritional status (calcium, Vitamin D, etc.) * Lack of physical exercise * Decreased sun exposure * Unhealthy lifestyle choices (caffeine, smoking, alcohol) * Certain medications * Comorbidities (obesity, anorexia nervosa, etc.) ## Footnote These factors contribute to decreased nutrient concentration necessary for bone remodeling.
70
What are the different types of Osteoporosis?
Types of Osteoporosis include: * Generalised: involves major portions of the axial skeleton * Regional: involves one segment of the appendicular skeleton ## Footnote This classification helps in understanding the extent and location of the disease.
71
What diseases are associated with Osteoporosis?
Diseases associated with Osteoporosis include: * Inflammatory Bowel Disease (IBD) * Intestinal malabsorption * Kidney disease * Rheumatoid arthritis * Diabetes Mellitus * Cirrhosis of the liver * Hyperthyroidism * Hypogonadism ## Footnote These conditions can affect calcium absorption and metabolism.
72
What investigations are used for diagnosing Osteoporosis?
Investigations include: * Past medical history * Clinical presentation * Dual-energy x-ray absorptiometry (DEXA) scan * Pathology/laboratory results (calcium, phosphate, Vitamin D, etc.) * Other x-rays to rule out other diagnoses * Bone Mineral Density (BMD) tests ## Footnote DEXA scan results are presented as a T-score, with lower scores indicating higher fracture risk.
73
What are common complications of Osteoporosis?
Common complications include: * Disability * Pathological fractures (especially in thoracic and lumbar spine, neck, intertrochanteric region of femur, wrists) ## Footnote These complications arise due to weakened bone structure.
74
How can Osteoporosis be prevented?
Prevention strategies include: * Lifestyle modifications * Balanced diet (high in calcium and Vitamin D) * Regular weight-bearing exercises * Avoid excessive alcohol intake * Smoking cessation * Adequate sun exposure * Medical advice regarding medications and comorbidities ## Footnote These measures help improve bone health and reduce risks.
75
What is the aim of treatment for Osteoporosis?
Treatment aims to: * Slow down the rate of calcium and bone loss * Prevent further deterioration * Increase dietary intake of calcium and Vitamin D * Implement weight-bearing exercises ## Footnote Post-menopausal women may be given hormone therapies, but these carry risks.
76
Define Bone Remodeling.
Bone Remodeling is the formation and resorption of bone, involving: * Osteoblasts (bone-building cells) * Osteoclasts (bone-resorbing cells) ## Footnote This process continues throughout life and is essential for maintaining bone health.
77
What causes an imbalance leading to Osteoporosis?
An imbalance occurs when: * The rate of bone resorption by osteoclasts exceeds the rate of bone formation by osteoblasts ## Footnote This imbalance results in weakened, brittle bones.
78
What are common clinical manifestations of Osteoporosis?
Common clinical manifestations include: * Joint and bone pain * Bone deformities * Fractures (long bones, distal radius, ribs, vertebrae, neck of femur) * Kyphosis * Diminished height * Low energy, fatigue ## Footnote These manifestations often occur once the disease is advanced.
79
True or False: Osteoporosis often has insidious onset.
True ## Footnote Symptoms typically appear only when the disease is advanced.
80
Fill in the blank: The primary cells responsible for bone formation are _______.
[osteoblasts] ## Footnote Osteoblasts play a crucial role in building new bone.
81
What role does Vitamin D play in bone health?
Vitamin D is crucial for: * Intestinal calcium absorption * Regulating osteoclast activity ## Footnote Deficiency can lead to increased bone resorption and osteoporosis.
82
What effect does decreased physical activity have on bone health?
Decreased physical activity leads to: * Reduced secretion of growth hormone * Increased osteoclast activity * Decreased osteoblast actions ## Footnote These factors contribute to bone loss.
83
What is arthritis?
An inflammatory joint disease that affects more than 15% of the population ## Footnote Arthritis rates increase with age, with the majority of diagnoses in women over 75 years of age.
84
How many types of arthritis are there?
Over 100 different types of arthritis
85
What are the three most common types of arthritis?
* Osteoarthritis * Rheumatoid arthritis * Gout
86
What are the non-modifiable risk factors for arthritis?
* Advanced age * Stressful environment, low socioeconomic areas * Genetics * Existing endocrine disorders
87
What are the modifiable risk factors for arthritis?
* Occupation * Obesity * Smoking * Excessive alcohol intake * Poor diet * Sedentary lifestyle
88
What is an infectious cause of arthritis?
Invasion of the joint by bacteria, mycoplasma, viruses, fungi, or protozoa causing inflammation
89
What is an example of infective arthritis?
Septic arthritis
90
What are the two causes of non-infectious arthritis?
* Inappropriate immune response * Deposition of urate crystals in the synovial fluid
91
What is osteoarthritis?
A disease process rather than a specific illness, most prevalent and disabling of all joint disorders
92
What is the leading cause of pain and disability in the elderly?
Osteoarthritis
93
At what age do 90% of the population show degenerative joint changes in weight-bearing joints?
By the age of 40
94
What are the classifications of osteoarthritis?
* Primary / secondary * Localised / generalised * Early / moderate / advanced
95
What are some known causes of osteoarthritis?
* Post-inflammation disorders * Septic joint * Trauma * Fracture / dislocation of a joint * Cumulative occupation or recreational trauma
96
What is the pathophysiology of osteoarthritis?
A combination of articular cartilage degradation, bone stiffening, and reactive inflammation of the synovium
97
What happens to cartilage in osteoarthritis?
It becomes dull, yellow, granular, soft, and less elastic
98
What are common clinical manifestations of osteoarthritis?
* Pain * Joint stiffness * Crepitus * Asymmetry of joints * Joint effusions * Joint deformity * Functional impairment
99
What is the typical duration of joint stiffness in osteoarthritis?
Most commonly experienced in the morning for less than 30 minutes
100
What factors contribute to joint pain in osteoarthritis?
* Synovium inflammation * Joint capsule or ligament stretching * Irritation of nerve endings * Micro fractures * Bursitis * Tendinitis * Muscle spasms
101
True or False: Systemic manifestations occur in osteoarthritis.
False
102
Fill in the blank: Osteoarthritis can cause _______ to the groin, buttocks, medial side of thighs and knees.
pain
103
What type of disease is Rheumatoid Arthritis (RA)?
A chronic systemic, autoimmune disease
104
How does RA typically affect joints?
Affects multiple joints, usually bilaterally
105
What is a common characteristic of RA in terms of symptoms?
Periods of remission with exacerbations
106
Which demographic is more commonly affected by RA?
More common in women and increases with age
107
In which climates is RA generally worse?
Worse in colder climates
108
What are the most commonly affected joints in RA?
* Fingers * Wrists * Elbows * Feet * Ankles * Knees
109
Can RA affect tissues outside of joints?
Yes, it can affect lungs, heart, and eyes
110
What are the classifications of RA based on?
* Number of joints involved * Serology inflammatory markers (CRP and ESR) * Duration of symptoms
111
What are the main suspected causes of RA?
Linked with genetics and environmental triggers
112
What are some risk factors for developing RA?
* Advancing age * Smoking * Gender * History of live births * Obesity * Stress * Genetics * Infection * Surgery
113
What is the initial immune response phase in RA?
Formation of abnormal immunoglobulin G (IgG) and development of rheumatoid factor (RF)
114
What triggers the inflammatory response in RA?
Phagocytes ingest immune complexes leading to cartilage breakdown
115
What are the clinical manifestations of RA?
* Fever * Fatigue * Malaise * Rash * Anorexia * Weight loss * Joint pain * Joint stiffness * Disability * Spleen enlargement * Lymphadenopathy
116
What is a typical deformity associated with RA?
Subluxation of joints
117
True or False: RA is primarily a localized disease.
False
118
Which age group is most commonly affected by RA?
People in their 60's and above
119
What is the typical onset pattern of RA?
Insidious, gradual onset
120
What type of arthritis is characterized by systemic disease with exacerbations and remissions?
Rheumatoid arthritis
121
What is the typical serum finding in RA?
RF positive (80%), elevated ESR and CRP
122
Fill in the blank: RA is characterized by _______ joint involvement.
symmetrical
123
Which joint deformity is characterized by fingers deviating toward the ulnar side?
Ulnar Drift
124
What is the cause of Boutonnière Deformity?
Damage to the central slip of the extensor tendon
125
What are the two pathological changes in early and progressive RA?
* Early RA: Thickened synovium, lymphocytic infiltration * Progressive RA: Pannus formation, cartilage destruction
126
True or False: Bone erosion in RA is caused by mechanical wear and tear.
False
127
What is pannus in the context of rheumatoid arthritis?
Granulation tissue that invades and destroys cartilage
128
What is the clinical impact of Hallux Valgus?
Pain with walking, balance issues
129
What leads to joint deformity in late-stage RA?
Cartilage destruction and ligament laxity
130
What is characterized by fingers deviating toward the ulnar side?
Ulnar Drift ## Footnote Often seen in rheumatoid arthritis, affecting hand function.
131
Which joints are involved in Ulnar Drift?
MCP joints ## Footnote Metacarpophalangeal joints are primarily affected.
132
What is the functional impact of Ulnar Drift?
Weak grip, impaired fine motor skills ## Footnote Affects daily tasks and hand coordination.
133
What deformity involves the PIP joint flexed and DIP joint extended?
Boutonnière Deformity ## Footnote Commonly associated with rheumatoid arthritis.
134
Which joints are involved in Boutonnière Deformity?
PIP, DIP ## Footnote Proximal interphalangeal and distal interphalangeal joints.
135
What is the functional impact of Boutonnière Deformity?
Limited finger extension ## Footnote Makes it difficult to extend the fingers fully.
136
What deformity is characterized by the great toe deviating toward the second toe?
Hallux Valgus ## Footnote Commonly known as a bunion.
137
Which joint is involved in Hallux Valgus?
MTP joint (foot) ## Footnote Metatarsophalangeal joint of the big toe.
138
What is the functional impact of Hallux Valgus?
Pain with walking, balance issues ## Footnote Can lead to difficulty in ambulation.
139
What deformity involves PIP hyperextension and DIP flexion?
Swan Neck Deformity ## Footnote Can cause cosmetic concerns and functional limitations.
140
Which joints are involved in Swan Neck Deformity?
PIP, DIP ## Footnote Impacts the proximal and distal interphalangeal joints.
141
What is the functional impact of Swan Neck Deformity?
Trouble grasping objects, cosmetic concern ## Footnote Affects grip strength and hand appearance.
142
What deformity is characterized by hyperextension of the PIP joint and flexion of the DIP joint?
B. Swan neck deformity ## Footnote This was confirmed in a sample quiz question.
143
Ulnar drift in rheumatoid arthritis primarily affects which joints?
C. MCP joints ## Footnote This was confirmed in a sample quiz question.
144
True or False: Hallux valgus is exclusive to rheumatoid arthritis.
False ## Footnote It can also occur in non-RA populations but is more severe in RA.
145
What is Gout?
A complex, recurring, inflammatory arthritis characterized by acute exacerbation and long periods of remission.
146
What is a key characteristic of Gout?
Disruption of the body's control of uric acid production or excretion.
147
What are the possible severities of Gout?
Ranges from infrequent, mild episodes to multiple severe exacerbations (> 12 per year).
148
Which gender is more affected by Gout?
Men are affected more than women, particularly between ages 40 - 60.
149
What are the classifications of Gout?
Primary, Secondary, Acute, Chronic.
150
What percentage of Gout cases are classified as Primary?
90% of Gout cases.
151
What causes Primary Gout?
Hereditary origin and dysfunction of purine metabolism.
152
What is Acute Gout characterized by?
Sudden onset of symptoms in peripheral joints, usually at night, resolving in 2 - 10 days.
153
What is the most common joint affected in Acute Gout?
The great toe (first metatarsophalangeal joint).
154
What are Tophi?
Visible deposits of sodium urate crystals in chronic Gout.
155
What are the initial causes of Gout?
* Under-excretion of uric acid * Overproduction of uric acid.
156
What is Hyperuricaemia?
Elevated uric acid levels when production exceeds excretion.
157
What happens when uric acid levels are high?
It crystallizes into monosodium urate (MSU) crystals that deposit in joints.
158
What triggers an acute inflammatory response in Gout?
The immune system detects MSU crystals as foreign.
159
What cells are involved in the inflammatory response of Gout?
* Neutrophils * Cytokines.
160
What is the clinical outcome of an acute gout attack?
Red, hot, swollen, and extremely painful joint.
161
What can increase the risk of Gout?
* Medications (e.g., diuretics) * Obesity * Systemic infection * Trauma * Anorexia Nervosa * Post-menopausal status. * Comorbidities (hypertension, diabetes) * Excessive alcohol consumption.
162
What are the two main contributors to the body’s uric acid pool?
* Dietary purines (30%) * Tissue nucleotide synthesis (70%).
163
What is the primary method of uric acid elimination?
Renal excretion (70%).
164
What are purines?
Natural chemical compounds found in food and produced in the body, used for the production of ATP and nucleic acids.
165
What are the stages of Crystal Deposition in Gout?
* Asymptomatic hyperuricaemia * Acute gouty arthritis * Tophaceous gout.
166
What are common clinical manifestations of Acute Gout?
* Dusky appearance * Sudden swelling * Excruciating pain * Hot-to-touch joint.
167
What are potential complications of Gout?
* Kidney dysfunction * Tophi * Acute Kidney Injury (AKI) * Kidney stones.
168
True or False: Gout only has dietary causes.
False. Gout is deeply connected to renal function, metabolic health, and systemic processes.
169
Fill in the blank: Gout is a metabolic disorder characterized by _______.
[acute exacerbation with long periods of remission].
170
What is septic arthritis?
An infectious arthritis caused by the invasion of a bacteria into the joint cavity.
171
How do bacteria reach the joint cavity in septic arthritis?
Through haematogenous seeding, where bacteria travel in the bloodstream and deposit in any joint cavity.
172
What is the most common presentation of septic arthritis?
Usually monoarthritic, affecting one joint only.
173
Which large joints are most commonly affected by septic arthritis?
* Knees (50% of cases) * Elbows * Hips * Shoulders
174
Why is septic arthritis considered a medical emergency?
Due to the high risk of serious complications.
175
What are some common causes of septic arthritis?
* Active infection elsewhere in the body * Trauma * Surgical incisions and procedures * IV drug use
176
What is the hematogenous route in the context of septic arthritis?
Bacteria travel through the bloodstream and localize in the synovial membrane.
177
Which bacteria is the most common cause of septic arthritis?
Staphylococcus aureus, accounting for 50% of cases.
178
What are some risk factors for developing septic arthritis?
* Immunocompromise * Recent infection * Medications (corticosteroids, immunosuppressants) * Pre-existing joint disease * Advancing age * IV drug use
179
What is the role of biofilms in septic arthritis?
Biofilms protect bacteria from immune responses and antibiotics, leading to persistent infections.
180
What triggers the inflammatory response in septic arthritis?
Activation of Toll-like receptors (TLRs) by bacterial components.
181
What are the clinical manifestations of septic arthritis?
* Severe pain in a single joint * Poor range of movement * Effusion * Inflammation symptoms (erythema, swelling, warmth) * Infection symptoms (fever, rigors, lethargy)
182
What complications can arise from untreated septic arthritis?
* Irreversible cartilage destruction * Septicaemia * Sepsis * Avascular necrosis * Osteomyelitis * Permanent joint dysfunction
183
True or False: Septic arthritis can lead to death if left untreated.
True
184
Fill in the blank: Septic arthritis can progress from a localized infection to _______.
sepsis
185
What is the mortality rate associated with untreated septic arthritis?
10 - 20%
186
What is Psoriatic Arthritis?
A chronic, immune-mediated inflammatory joint disorder ## Footnote It is part of seronegative spondyloarthropathy and can involve oligoarthritis.
187
What percentage of Psoriatic Arthritis patients have a history of psoriasis?
1 in 5 ## Footnote This indicates a strong connection between psoriasis and psoriatic arthritis.
188
Define oligoarthritis.
A chronic, inflammatory arthritis affecting <5 joints with onset <6 years of age lasting approximately 6 weeks.
189
What characterizes psoriasis?
A chronic autoimmune disorder with rapid skin cell buildup causing scaly, itchy, dry patches ## Footnote Patches are typically red or silvery.
190
List common triggers for psoriasis.
* Infections * Stress * Cold weather
191
How does psoriatic arthritis typically affect joints?
It affects large joints, mostly of the lower extremities, fingers/toes, back/pelvis.
192
What are the types of Psoriatic Arthritis?
* Symmetric * Asymmetric * Distal * Spondylitic * Arthritis Mutilans
193
What is the symmetric type of Psoriatic Arthritis?
Similar to RA, affecting joints bilaterally at the same time ## Footnote About 50% of PsA patients have this type.
194
What is the asymmetric type of Psoriatic Arthritis?
Usually more mild, affecting one side of the body at a time ## Footnote About 30% of PsA patients have this type.
195
Describe distal Psoriatic Arthritis.
Inflammation and stiffness at the ends of fingers and toes, including nails.
196
What characterizes spondylitic Psoriatic Arthritis?
Pain and stiffness of the spine and neck ## Footnote It affects men more than women.
197
What defines Arthritis Mutilans?
The most severe form of PsA with deformities of the small joints ## Footnote About 5% of PsA patients have this type.
198
What is the main cause of Psoriatic Arthritis?
The main cause is unknown but involves strong genetic links with immune and environmental factors.
199
List risk factors for developing Psoriatic Arthritis.
* Having psoriasis * Obesity * Trauma * Smoking * Infections * Stress * Extreme weather
200
What is the pathophysiology of Psoriatic Arthritis?
A chronic, complex, multifaceted disease characterized by musculoskeletal inflammation ## Footnote Involves genetic predisposition and environmental triggers.
201
What are common clinical manifestations of Psoriatic Arthritis?
* Joint inflammation * Skin changes * Ridging and pitting of nails * Lower back pain * Onycholysis * Dactylitis * Enthesitis
202
What is a hallmark feature of Psoriatic Arthritis?
'Pencil-in-cup' deformity ## Footnote This deformity involves one bone tapering to fit into an eroded adjacent bone.
203
What is ankylosis?
Fusion of two bones at a joint, resulting in loss of mobility and rigidity.
204
What does joint deterioration encompass?
A broad term for cartilage and bone loss, causing deformity, pain, and stiffness.
205
List PsA-associated comorbidities.
* Psoriasis * Systemic Lupus Erythematosus (SLE) * Crohn's Disease * Ulcerative colitis * Coronary heart disease * Depression * Atherosclerosis
206
What is inflammatory arthritis?
A group of diseases resulting in joint inflammation, swelling, stiffness, and decreased range of movement.
207
True or False: Inflammatory arthritis is more common than osteoarthritis.
False
208
What can cause inflammatory arthritis?
* Wear and tear * Infections * Underlying diseases causing overactive immune response or urate crystal deposits
209
What is a fracture?
A break in the continuity of a bone when the force exerted exceeds what the bone can absorb.
210
What factors influence the incidence of fractures?
Varies according to individual bones, age, and gender.
211
In which populations is the highest occurrence of fractures observed?
Young males and the elderly.
212
How many fractures does the average person experience in their lifetime?
Two fractures.
213
How is a fracture often documented in medical notes?
Written as '#' followed by the bone, e.g., Left Femur #.
214
What is a common term used in the community for a fracture?
'Broken bone'.
215
What is the aim of a classification system for fractures?
To help clinicians organize knowledge, guide treatment, estimate prognosis, and improve communication.
216
Fractures can be classified by which criteria?
* Location * Displacement of fracture lines * Appearance of the limb * Which part of the bone is fractured * Fracture pattern * Severity of overall injury
217
What is a displaced fracture?
Bone breaks in two or more parts and shifts so that the ends do not align.
218
What characterizes a non-displaced fracture?
Bone breaks but maintains proper alignment.
219
What is an open fracture?
Bone breaks through the skin, increasing the risk of deep bone infection.
220
What is a closed fracture?
No break or puncture wound through the skin.
221
What defines a greenstick fracture?
Bone is bent but does not separate into two pieces.
222
What is a buckle fracture?
Also known as a torus fracture, resulting from compression of two bones driving into each other.
223
What is a growth plate fracture?
Fracture through the joint that can impact bone growth and shorten bone length.
224
What is a comminuted fracture?
Bone breaks into three or more fragments, usually from high-impact trauma.
225
What defines an oblique fracture?
Break is on an angle through the bone, resulting from a sharp blow.
226
What is a spiral fracture?
Spiral break around the bone caused by a twisting injury.
227
What is a transverse fracture?
Fracture line is perpendicular to the bone shaft, often caused by trauma.
228
What is a compression fracture?
Bones are crushed, resulting in flatter, wider bones, most often occurring in the spine.
229
What is an impacted fracture?
Broken ends of the bone are driven together by the force of injury.
230
What is a pathological fracture?
Caused by disease that weakens the bone.
231
What is a stress fracture?
Fatigue and insufficiency cause a hairline crack from repetitive motion.
232
What is an avulsion fracture?
Bone fragment is pulled off by a tendon or ligament.
233
What is a hip fracture?
A break occurring at the upper third of the femur, extending 5 cm below the lesser trochanter.
234
What does #NOF stand for?
'Neck of Femur'.
235
What percentage of women and men will sustain a #NOF by age 90?
* 33% of women * 17% of men
236
What are common comorbidities associated with #NOF?
* Cardiovascular * Pulmonary * Renal * Endocrine
237
What are the two classifications of hip fractures?
* Extracapsular * Intracapsular
238
What is a common complication of hip fractures in the elderly?
Delirium.
239
What can cause delirium post-fracture?
* Shock * Intense pain * Hypovolaemia * Medication * Secondary infections
240
What are direct complications of fractures?
* Osteomyelitis * Non-union or malunion * Permanent disability * Avascular necrosis
241
What are indirect complications associated with fractures?
* Nerve damage * Blood vessel damage * Soft tissue injury * Complex Regional Pain Syndrome (CRPS) * Compartment Syndrome
242
What are some prevention strategies for fractures?
* Adequate Calcium and Vitamin D * Healthy exercise * Minimize alcohol intake * Cease smoking * Avoid falls
243
What are some lifestyle risk factors for fractures?
* Smoking * Excessive alcohol * Obesity
244
What medications are associated with increased fracture risk?
Steroids.
245
What demographic factors influence fracture risk?
* Age * Comorbidities * Family history
246
What determines the pathophysiology of fractures?
Bone strength and frequency/effects of injuries ## Footnote Factors include force exceeding bone strength, normal force on improperly developed bone, weakened normal bone due to deterioration, and fatigued normal bone from repeated force.
247
What happens when force exceeds what the bone can absorb?
Fracture occurs ## Footnote Example: falling onto an outstretched hand.
248
What condition can cause normal force to result in a fracture?
Osteogenesis imperfecta ## Footnote This is a genetic disorder characterized by fragile bones.
249
What is a common condition that weakens normal bone leading to fractures?
Osteoporosis ## Footnote Osteoporosis leads to decreased bone density and increased fracture risk.
250
What occurs when normal bone is fatigued?
Fracture may occur ## Footnote Example: seen in marathon runners due to repeated stress.
251
What structures are disrupted in all types of fractures?
Periosteum, cortex blood vessels, marrow, and surrounding soft tissue ## Footnote This disruption leads to bleeding and potential blood loss.
252
What is the approximate blood loss from a humerus fracture?
200 - 300 mLs ## Footnote This is a significant amount but less than that associated with femur or pelvis fractures.
253
What is the blood loss range for a femur fracture?
500 - 1000 mLs ## Footnote Femur fractures can lead to more severe blood loss.
254
What is the blood loss range for a pelvis fracture?
1000 - 1500 mLs ## Footnote Pelvic fractures are among the most serious in terms of potential blood loss.
255
What are the three phases of bone healing?
1. Inflammatory phase 2. Reparative phase 3. Remodelling phase ## Footnote Each phase has distinct processes and timelines.
256
How long does the inflammatory phase last post-fracture?
0 - 2 weeks ## Footnote This phase includes bleeding and inflammation at the fracture site.
257
What is formed during the inflammatory phase?
Fracture haematoma ## Footnote This structure provides initial stability and framework for new bone.
258
What is the timeline for the bone production phase?
2 - 6 weeks ## Footnote This is when the soft callus is formed and replaced by hard callus.
259
What happens during the remodelling phase?
Bone becomes compact and returns to original shape ## Footnote This phase can last several months to years.
260
What factors affect bone healing post-fracture?
* Complexity/type of fracture * Genetics * Age * Lifestyle choices * Endogenous factors * Immobilisation * Internal fixation devices ## Footnote Each of these factors can influence the speed and quality of healing.
261
What is delayed union in fracture healing?
Fracture healing progresses more slowly than expected ## Footnote Healing eventually occurs.
262
What is non-union in fracture healing?
Fracture fails to heal despite treatment ## Footnote No X-ray evidence of callus formation.
263
What is malunion in fracture healing?
Fracture heals in an unsatisfactory position ## Footnote This can lead to deformity or dysfunction.
264
What is pseudoarthrosis?
Type of non-union where a false joint forms ## Footnote This results in abnormal movement at the fracture site.
265
What is myositis ossificans?
Deposition of calcium in muscle tissue ## Footnote Occurs at sites of significant blunt muscle trauma.
266
What are the common clinical manifestations experienced with fractures?
Some common manifestations include: * Immediate localised pain / tenderness * Swelling * Paraesthesia * Bruising * Deformity * Muscle spasms * Loss of function * Crepitation * Guarding ## Footnote Paraesthesia refers to damaged nerves, while bruising is also known as ecchymosis. Crepitation is the crunching and grating of bony fragments.
267
What is paraesthesia in the context of fractures?
Paraesthesia refers to damaged nerves, often experienced as a clinical manifestation of fractures. ## Footnote It can indicate nerve involvement due to the injury.
268
What does crepitation indicate in fractures?
Crepitation indicates the crunching and grating together of bony fragments, producing a palpable or audible sound. ## Footnote This can occur when the fracture is displaced.
269
What is guarding in relation to fractures?
Guarding is a protective response where a person with a fracture will protect the injury against movement to avoid further injury. ## Footnote This is a common behavioral response to pain and instability.
270
What are the clinical manifestations specific to hip fractures?
Clinical manifestations of hip fractures include: * Pain in hip and groin or medial side of the knee * Decreased range of movement * Limited ability to weight-bear * Muscle spasms * Change in neurovascular status * Comfortable leg position with slight flexion in external rotation ## Footnote The specific leg position is often referred to as 'abducted with external rotation'.
271
True or False: Muscle spasms are a common symptom in fractures.
True ## Footnote Muscle spasms can occur due to irritation of tissues and protective responses.
272
Fill in the blank: Loss of function in fractures may include loss of strength, range of movement, and inability to _______.
weight-bear ## Footnote This is a significant functional impairment resulting from fractures.
273
What is a common management option for unstable fractures?
Surgery on fractured bone ## Footnote Most common example is an 'Open reduction with internal fixation' (ORIF) surgery.
274
What is the purpose of reduction of the fracture?
To re-establish correct anatomical alignment of fractured bone.
275
What is closed reduction?
Non-surgical, manual re-alignment of bone fragments using traction and counter-traction under anaesthesia.
276
What is open reduction?
Surgical incision to realign fractured bone.
277
What are internal fixation devices?
Pins, plates, rods, and screws surgically inserted to realign and secure bony fragments.
278
What is the purpose of external fixation?
To stabilize fractures using metal pins and rods attached to external rods.
279
When is external fixation indicated?
For simple and complex fractures, increased infection risk, defect correction, non-union or malunion, or limb lengthening.
280
What are the risks associated with external fixation?
Increased risk of infection and potential need for device removal.
281
What is the aim of immobilization with casting?
To allow patients to perform Activities of Daily Living (ADLs) as normally as possible.
282
What materials are used in the casting process?
Cotton stockinette, softban (padding), and casting material (POP or fibreglass).
283
What is the purpose of traction?
To attain re-alignment, prevent pain and muscle spasms, and immobilize the joint.
284
What are the two types of traction?
* Skin: short-term (48 - 72 hours) * Skeletal: longer-term.
285
What are the characteristics of skin traction?
Applied with tape, boots, or splints directly to skin; traction weights of 2.3 - 4.5 kgs often used.
286
What are the characteristics of skeletal traction?
Continuous traction applied with pins or wires inserted into the bone; weights of 2.3 - 20.4 kgs often used.
287
What additional treatments are required for open fractures?
* Tetanus prophylaxis * Infection prophylaxis with antibiotics * Surgical cleaning and/or debridement of wounds * Closure of the wound.
288
What is the aim of counter-traction in traction treatment?
To pull in the opposite direction and maintain alignment.
289
What should be regularly assessed when using skin traction?
Integumentary assessments to determine early skin breakdown and pressure injuries.
290
What complications can arise from skeletal traction?
High-risk of infection, skin and neurovascular damage, and complications from immobility.
291
What is the role of casting in immobilization?
Covers joints distal and proximal to the fracture.
292
What is the purpose of pin-site care in external fixation?
To prevent pin loosening and pin-site infection.
293
Fill in the blank: Casting incorporates joints ______ to the fracture.
distal and proximal.
294
What are the types of soft tissues in the body?
* Muscle * Tendon * Ligament * Fascia * Fibrous tissue * Blood vessels * Nerves * Synovial membranes * Fat
295
What is a sprain?
Injury to a ligament (connective tissue between bones at a joint)
296
What is a strain?
Injury to a muscle or tendon (connects muscle to bone)
297
What are common symptoms of both sprains and strains?
* Sudden onset pain * Swelling * Bruising * Difficulty in performing movements
298
What are sprain-specific symptoms?
* Feeling of joint instability * May present with increased range of motion
299
What are strain-specific symptoms?
* Muscle spasms * Palpable defect in muscle belly * Reduced range of motion of the joint
300
What is the affected structure in a sprain?
Ligaments
301
What is the affected structure in a strain?
Muscles or tendons
302
What is a common trigger for a sprain?
Twisting injury
303
What is a common trigger for a strain?
Overstretch or overuse
304
What are special findings associated with sprains?
Joint instability
305
What are special findings associated with strains?
Muscle spasm, palpable defect
306
What usually causes a sprain?
A traumatic event, such as a fall or an external force that displaces the surrounding joint
307
What are common sites for sprains?
* Ankle * Knee * Wrist * Fingers
308
What usually causes a strain?
Overexertion (overstretching or over contraction), trauma or repetitive movement
309
What are common sites for strains?
* Lower back * Calf * Hamstrings
310
What are some risk factors for sprains and strains?
* Advancing age * Obesity * Poor physical fitness * Smoking * Medications (e.g., steroids) * Poor posture * Comorbidities leading to muscle fatigue * Not warming up before activity
311
What methods are used for diagnosis of sprains and strains?
* Patient history * Physical exam * Imaging (e.g., x-ray, ultrasound, CT scan, MRI)
312
What complications can arise from severe sprains?
* Fracture * Dislocation * Chronic instability * Loss of function/strength * Chronic pain and swelling * Arthritis * Muscle atrophy * Muscle fibrosis * Compartment syndrome
313
What are some prevention strategies for sprains and strains?
* Balanced nutrition * Maintain a healthy weight * Regular exercise * Avoid exercising when fatigued or in pain * Be aware of falling hazards * Maintain strength * Warm up and stretch before exercise * Wear good fitting shoes * Use protective braces/equipment during sports
314
What factors may require surgical intervention for sprains and strains?
* Poor recovery from conservative management * Severely torn ligament with an unstable joint * Complete tear in the muscle becoming unattached from the bone
315
What are the three grades of sprains based on ligament damage?
Grade I, Grade II, Grade III ## Footnote Grade I - mild stretching; Grade II - partial tear; Grade III - complete rupture
316
What characterizes a Grade I sprain?
Mild stretching of the ligament without joint instability ## Footnote Only a few fibres are torn
317
What is the key difference between Grade II and Grade III sprains?
Grade II has partial tear without significant instability; Grade III has complete rupture with instability ## Footnote Grade II may have mild instability
318
What triggers the inflammatory process after a tendon or ligament is torn?
Torn tendon or ligament ## Footnote This initiates the accumulation of inflammatory fluids and cells
319
Which cells are involved in the inflammatory process following a ligament injury?
Macrophages, fibroblasts, capillary buds, prostaglandins ## Footnote Each plays a role in tissue repair and healing
320
What is the timeline for the formation of new collagen after a ligament injury?
4-5 days post-injury ## Footnote New collagen begins to form and organize
321
What happens 4-5 weeks after a tendon or ligament injury?
Healing tendon or ligament gains adequate strength to withstand strong pull ## Footnote Indicates progression in the healing process
322
List the common signs and symptoms of sprains and strains.
* Pain / tenderness * Swelling / oedema * Ecchymosis (bruising) * Loss of function * Difficulty weight bearing * Antalgic gait * Contusion * Altered sensation with severe oedema * Muscle spasms ## Footnote Symptoms can overlap between sprains and strains
323
True or False: A Grade II sprain always results in joint instability.
False ## Footnote Grade II may have mild instability or none at all
324
Fill in the blank: The inflammatory cells that remove damaged tissue are called _______.
macrophages ## Footnote They play a crucial role in the initial healing process
325
What is the role of fibroblasts in the healing process of a sprain?
Make collagen ## Footnote Collagen is essential for the structural integrity of tendons and ligaments
326
What is the initial step in the nursing assessment of a patient with a musculoskeletal injury?
A Primary Assessment should be completed as part of an admission, start of shift and/or as clinically indicated. ## Footnote This assessment is crucial for evaluating the patient's condition and planning further care.
327
What are the key components of obtaining a brief patient history?
Questions should include: * Are you normally well, do you have any existing illnesses? * What was the mechanism of injury today? * What was the position of the patient post-injury? * Were you alone at the time? ## Footnote This helps gather subjective and objective information for a comprehensive assessment.
328
What is the purpose of the Secondary Assessment?
To rule out any injuries that may have been missed in the primary assessment. ## Footnote This assessment includes checking general appearance and vital signs.
329
What are the 6 P's to observe in a neurovascular assessment?
The 6 P's include: * Pain * Paresthesia * Pallor * Polar (Temperature) * Paralysis * Pulses ## Footnote These observations help identify compromised circulation and nerve supply.
330
What does RICE stand for in non-pharmacological management of sprains and strains?
RICE stands for: * Rest * Ice * Compression * Elevation ## Footnote This method is effective in managing pain and reducing swelling.
331
Fill in the blank: Fractures can result in neurovascular changes of the injured extremity, such as a fractured hip resulting in changes in the _______.
toes ## Footnote This highlights how injuries can affect distant areas of the body.
332
What is the overall aim of fracture management?
The overall aim includes: * Managing and relieving pain * Identifying mechanism of injury * Assessing clinical presentation * Improving joint function * Correcting deformity and malalignment * Reducing the risk of complications ## Footnote Effective management is crucial for optimal recovery.
333
True or False: Nurses can order X-rays for fracture assessment.
False ## Footnote Nurses assist with transfer and ensure pain relief but do not order imaging.
334
What should be included in postoperative nursing management for fractures?
Postoperative management includes: * Vital signs monitoring * Pain assessment * Neurovascular assessment * Wound assessment * Mobilisation encouragement ## Footnote Early intervention is key to prevent complications.
335
What are the pharmacological treatments for managing pain in fractures?
Pharmacological treatments include: * Paracetamol * NSAIDs * Opioids for severe fractures ## Footnote The choice of medication depends on the severity of pain and clinical guidelines.
336
What is the significance of a neurovascular assessment?
To detect compromised circulation and nerve supply, especially after injuries. ## Footnote This assessment can prevent serious complications like permanent nerve damage.
337
What is the recommended frequency for neurovascular observations post-intervention?
Neurovascular observations should be increased to: * 15 minutely for the 1st hour * Hourly for the next 3-4 hours ## Footnote This is crucial when there is a risk to limb perfusion.
338
In the context of musculoskeletal injuries, what does HARM stand for?
HARM stands for: * Heat * Alcohol * Running * Massage ## Footnote These activities should be avoided in the first 72 hours post-injury.
339
What is the role of a falls risk assessment in musculoskeletal injuries?
To identify the risk of falling and implement preventive measures. ## Footnote This is particularly important for patients with impaired mobility or pain.
340
Fill in the blank: In the event of an open fracture, saturate gauze with normal saline and apply over the _______.
wound ## Footnote This is a temporary measure until further surgical intervention.
341
What is the purpose of a logroll in postoperative care?
To avoid internal or external rotation of the hip while assisting with hygiene or pressure area care. ## Footnote This technique is important for patients with hip fractures.
342
What are some common tools used in a neurological assessment?
Common tools include: * GCS (Glasgow Coma Scale) * Pupil light test * Vital signs ## Footnote These tools help monitor central nervous system function.
343
What should be done if capillary refill time (CRT) is greater than 4 seconds?
Escalation is required. ## Footnote This may indicate compromised circulation.
344
What is the significance of patient education in managing musculoskeletal injuries?
Educating patients on home management, safe use of medicines, and when to seek help is essential for recovery. ## Footnote This empowers patients and improves outcomes.
345
What is the main focus of pharmacology for musculoskeletal disorders?
Pain management ## Footnote Medications for specific disorders are covered in individual sub-chapters.
346
What is the World Health Organisation's Analgesic Ladder used for?
A guide to the modalities used to manage pain ## Footnote Originally developed in 1986 for cancer pain management.
347
True or False: The modified WHO Analgesic Ladder is always effective for chronic non-cancer pain.
False ## Footnote Recent research suggests it may not meet requirements for persistent non-cancer pain.
348
What should be the starting step for a patient with 7/10 pain on the WHO Analgesic Ladder?
Step 3 ## Footnote This incorporates elements of Step 1 and Step 2.
349
What are analgesics commonly used for?
To treat pain, especially associated with musculoskeletal disorders.
350
What are considered first-line analgesics for acute pain?
Non-opioids ## Footnote Effective for mild to moderate pain and can manage severe pain in a multi-modal approach.
351
Fill in the blank: Non-opioids have an analgesic _______.
ceiling ## Footnote Administering above the upper dose limit will not provide additional analgesia.
352
What are some examples of non-opioid analgesics?
* Paracetamol * Aspirin * NSAIDs like ibuprofen
353
What triggers the inflammatory response in musculoskeletal disorders?
Tissue damage activating pain receptors.
354
What is the role of NSAIDs in managing inflammation?
Suppress inflammation through inhibition of cyclo-oxygenase (COX).
355
What does inhibition of COX-1 result in?
Impaired gastric cytoprotection and antiplatelet effects.
356
What does inhibition of COX-2 result in?
Anti-inflammatory and analgesic action.
357
List two types of NSAIDs based on COX selectivity.
* Non-selective NSAIDs * Selective COX-2 inhibitors
358
What is the primary aim of pharmacological management of osteoporosis?
Preventing fractures and associated morbidities.
359
What is essential for effective osteoporosis treatment?
Adequate calcium intake, often via supplements combined with vitamin D.
360
What are antiresorptive drugs used for in osteoporosis?
Reducing bone resorption.
361
Name one class of medications that promote bone formation in osteoporosis.
Teriparatide.
362
What are the most common resorptive medications for osteoporosis?
Biphosphonates.
363
List three examples of biphosphonates.
* Alendronate * Ibandronic acid * Risedronate
364
What is the goal of medication management for rheumatoid arthritis (RA)?
Provide relief of symptoms, maintain function, and prevent damage.
365
What are non-steroidal anti-inflammatory medications (NSAIDs) used for in RA?
Symptomatic relief.
366
What are disease-modifying antirheumatic drugs (DMARDs) used for?
Reduce joint destruction and slow disease progression.
367
Name one non-biological DMARD.
Methotrexate.
368
What type of medications do biological DMARDs target?
Specific components of the inflammatory process.
369
List two examples of tumor necrosis factor (TNF) antagonists.
* Adalimumab * Infliximab
370
What is the primary focus of anti-gout medications?
Managing acute or chronic episodes of gout.
371
What is the first-line agent for treatment of gout?
NSAIDs.
372
What medication is used to decrease uric acid production in gout?
Allopurinol.
373
What is the role of colchicine in gout treatment?
Used only in patients unresponsive to safer agents at lower doses.
374
How can physiotherapists assist in patient recovery?
By strengthening bones and muscles during the acute phase and encouraging patients to sit out of bed. ## Footnote Exercise helps maintain bone strength and density, improving patients' spirits and facilitating earlier discharge.
375
What role do occupational therapists play in patient care?
They work with physiotherapists to gather equipment for home use, aiding in the transition back into the community post-discharge. ## Footnote Equipment may include bathroom assist devices and handles for steps and bed frames.
376
What is the importance of pharmacists in the hospital setting?
They ensure smooth transitions of medications during admission and discharge and manage risks associated with certain medications. ## Footnote This includes monitoring steroid use and recommending supplements for bone development.
377
How can dieticians support patients during their admission?
By helping patients discuss necessary dietary changes related to their diagnosis. ## Footnote Key nutrients for healthy bones include vitamins, minerals, and electrolytes.
378
What is the role of social workers in the context of a new diagnosis?
They help ease patient concerns, establish support relationships, and assist with community resources post-discharge. ## Footnote This may include meal services and at-home physiotherapy.
379
What are key components of diagnostic assessment for amputation?
* History and physical examination * Physical appearance of soft tissues * Skin temperature * Sensory function * Presence of peripheral pulses * Arteriography * Venography * Plethysmography * Transcutaneous ultrasonic Doppler recordings ## Footnote These assessments are critical for determining the need for amputation.
380
What medical management is involved in interprofessional care for trauma victims?
Appropriate management of underlying disease and stabilization of the trauma victim. ## Footnote This is crucial to ensure the patient's safety before further interventions.
381
What surgical interventions might be necessary after amputation?
Residual limb management and immediate or delayed prosthetic fitting. ## Footnote These interventions are vital for restoring mobility and independence.
382
What rehabilitation activities are coordinated post-amputation?
* Coordination of prosthesis-fitting * Gait-training activities * Muscle-strengthening and physical therapy regimens * Psychological support ## Footnote Rehabilitation aims to support the patient's adjustment and recovery process.
383
Q1: Which of the following medications is commonly used short-term for severe back pain in DDD? A. Ibuprofen B. Amitriptyline C. Gabapentin D. Tramadol
Q1: Which of the following medications is commonly used short-term for severe back pain in DDD? A. Ibuprofen B. Amitriptyline C. Gabapentin D. Tramadol ✅
384
Q2: Which spinal region is most commonly affected by degenerative disc disease (DDD)? A. Cervical B. Thoracic C. Lumbar D. Sacral
Q2: Which spinal region is most commonly affected by degenerative disc disease (DDD)? A. Cervical B. Thoracic C. Lumbar ✅ D. Sacral
385
Q3: Which diagnostic test is considered the gold standard for assessing bone mineral density? A. X-ray B. CT scan C. DEXA scan D. MRI
Q3: Which diagnostic test is considered the gold standard for assessing bone mineral density? A. X-ray B. CT scan C. DEXA scan ✅ D. MRI
386
Q4: What is the primary function of osteoblasts in bone metabolism? A. Bone resorption B. Bone formation C. Calcium excretion D. Synovial fluid production
Q4: What is the primary function of osteoblasts in bone metabolism? A. Bone resorption B. Bone formation ✅ C. Calcium excretion D. Synovial fluid production
387
Q5: What type of arthritis is characterized by symmetrical joint involvement and systemic inflammation? A. Osteoarthritis B. Rheumatoid arthritis C. Gout D. Psoriatic arthritis
Q5: What type of arthritis is characterized by symmetrical joint involvement and systemic inflammation? A. Osteoarthritis B. Rheumatoid arthritis ✅ C. Gout D. Psoriatic arthritis
388
Q6: Which medication is used to treat neuropathic pain associated with chronic back disorders? A. Gabapentin B. Paracetamol C. Naproxen D. Prednisolone
Q6: Which medication is used to treat neuropathic pain associated with chronic back disorders? A. Gabapentin ✅ B. Paracetamol C. Naproxen D. Prednisolone
389
Q7: Which structure is responsible for producing red blood cells in the long bones? A. Compact bone B. Yellow marrow C. Red marrow D. Periosteum
Q7: Which structure is responsible for producing red blood cells in the long bones? A. Compact bone B. Yellow marrow C. Red marrow ✅ D. Periosteum
390
Q8: What is the hallmark microscopic feature of compact bone? A. Trabeculae B. Lacunae C. Osteons D. Canaliculi
Q8: What is the hallmark microscopic feature of compact bone? A. Trabeculae B. Lacunae C. Osteons ✅ D. Canaliculi
391
Q9: What condition is characterized by progressive thinning and weakening of trabecular bone? A. Osteoarthritis B. Osteomyelitis C. Osteoporosis D. Psoriatic arthritis
Q9: What condition is characterized by progressive thinning and weakening of trabecular bone? A. Osteoarthritis B. Osteomyelitis C. Osteoporosis ✅ D. Psoriatic arthritis
392
Q10: Which class of drugs reduces bone resorption and is used in osteoporosis treatment? A. NSAIDs B. Corticosteroids C. Bisphosphonates D. Anticonvulsants
Q10: Which class of drugs reduces bone resorption and is used in osteoporosis treatment? A. NSAIDs B. Corticosteroids C. Bisphosphonates ✅ D. Anticonvulsants
393
Q11: Which form of arthritis involves urate crystal deposition in the synovial fluid? A. Osteoarthritis B. Gout C. Rheumatoid arthritis D. Psoriatic arthritis
Q11: Which form of arthritis involves urate crystal deposition in the synovial fluid? A. Osteoarthritis B. Gout ✅ C. Rheumatoid arthritis D. Psoriatic arthritis
394
Q12: Which joint is most commonly affected during an acute gout flare? A. Knee B. Wrist C. Great toe D. Shoulder
Q12: Which joint is most commonly affected during an acute gout flare? A. Knee B. Wrist C. Great toe ✅ D. Shoulder
395
Q13: Which arthritis type is strongly linked to psoriasis? A. Septic arthritis B. Osteoarthritis C. Rheumatoid arthritis D. Psoriatic arthritis
Q13: Which arthritis type is strongly linked to psoriasis? A. Septic arthritis B. Osteoarthritis C. Rheumatoid arthritis D. Psoriatic arthritis ✅
396
Q14: In rheumatoid arthritis, which deformity results in ulnar deviation of fingers? A. Swan neck B. Boutonnière C. Ulnar drift D. Hallux valgus
Q14: In rheumatoid arthritis, which deformity results in ulnar deviation of fingers? A. Swan neck B. Boutonnière C. Ulnar drift ✅ D. Hallux valgus
397
Q15: What term describes the abnormal layer of granulation tissue in RA that invades cartilage? A. Osteophyte B. Pannus C. Tophi D. Bouchard’s node
Q15: What term describes the abnormal layer of granulation tissue in RA that invades cartilage? A. Osteophyte B. Pannus ✅ C. Tophi D. Bouchard’s node
398
Q16: What inflammatory mediator is a key player in RA pathophysiology? A. Dopamine B. IL-6 C. Insulin D. GABA
Q16: What inflammatory mediator is a key player in RA pathophysiology? A. Dopamine B. IL-6 ✅ C. Insulin D. GABA
399
Q17: Which medication class is most associated with increasing the risk of osteoporosis? A. Antidepressants B. Corticosteroids C. Opioids D. Antibiotics
Q17: Which medication class is most associated with increasing the risk of osteoporosis? A. Antidepressants B. Corticosteroids ✅ C. Opioids D. Antibiotics
400
Q18: Which arthritis type often begins asymmetrically and affects the distal interphalangeal joints? A. Gout B. Osteoarthritis C. Psoriatic arthritis D. Rheumatoid arthritis
Q18: Which arthritis type often begins asymmetrically and affects the distal interphalangeal joints? A. Gout B. Osteoarthritis C. Psoriatic arthritis ✅ D. Rheumatoid arthritis
401
Q19: Which term describes reduced spinal flexibility and sensation of the spine “seizing” in DDD? A. Spinal stenosis B. Radiculopathy C. Spinal instability D. Bone spur
Q19: Which term describes reduced spinal flexibility and sensation of the spine “seizing” in DDD? A. Spinal stenosis B. Radiculopathy C. Spinal instability ✅ D. Bone spur
402
Q20: Which scan is most useful for visualizing herniated discs in degenerative disc disease? A. CT B. MRI C. X-ray D. DEXA
Q20: Which scan is most useful for visualizing herniated discs in degenerative disc disease? A. CT B. MRI ✅ C. X-ray D. DEXA
403
Q21: What immune complex is commonly detected in RA and contributes to joint inflammation? A. ANA B. CRP C. Rheumatoid factor D. PSA
Q21: What immune complex is commonly detected in RA and contributes to joint inflammation? A. ANA B. CRP C. Rheumatoid factor ✅ D. PSA
404
Q22: Which type of arthritis is a medical emergency due to its rapid joint destruction? A. Rheumatoid arthritis B. Gout C. Septic arthritis D. Psoriatic arthritis
Q22: Which type of arthritis is a medical emergency due to its rapid joint destruction? A. Rheumatoid arthritis B. Gout C. Septic arthritis ✅ D. Psoriatic arthritis
405
Q23: Which MSK disorder is associated with the formation of bone spurs? A. Osteoporosis B. Degenerative disc disease C. Rheumatoid arthritis D. Psoriatic arthritis
Q23: Which MSK disorder is associated with the formation of bone spurs? A. Osteoporosis B. Degenerative disc disease ✅ C. Rheumatoid arthritis D. Psoriatic arthritis
406
Q24: Which arthritis-related deformity is described as a hyperextension of the PIP and flexion of the DIP joint? A. Boutonnière deformity B. Swan neck deformity C. Hallux valgus D. Ulnar drift
Q24: Which arthritis-related deformity is described as a hyperextension of the PIP and flexion of the DIP joint? A. Boutonnière deformity B. Swan neck deformity ✅ C. Hallux valgus D. Ulnar drift
407
Q25: What is the main pathophysiological mechanism of osteoporosis? A. Increased bone formation B. Impaired cartilage repair C. Imbalance between osteoclast and osteoblast activity D. Overproduction of synovial fluid
Q25: What is the main pathophysiological mechanism of osteoporosis? A. Increased bone formation B. Impaired cartilage repair C. Imbalance between osteoclast and osteoblast activity ✅ D. Overproduction of synovial fluid
408
Q26: Which of the following is a hallmark symptom of an acute gout attack? A. Joint deformity B. Crepitus C. Hot, swollen joint D. Nail pitting
Q26: Which of the following is a hallmark symptom of an acute gout attack? A. Joint deformity B. Crepitus C. Hot, swollen joint ✅ D. Nail pitting
409
Q27: What structure in compact bone allows blood vessels to connect osteons? A. Lacunae B. Canaliculi C. Volkmann’s canals D. Lamellae
Q27: What structure in compact bone allows blood vessels to connect osteons? A. Lacunae B. Canaliculi C. Volkmann’s canals ✅ D. Lamellae
410
Q28: Which arthritis is associated with morning stiffness lasting more than 1 hour? A. Gout B. Osteoarthritis C. Rheumatoid arthritis D. Septic arthritis
Q28: Which arthritis is associated with morning stiffness lasting more than 1 hour? A. Gout B. Osteoarthritis C. Rheumatoid arthritis ✅ D. Septic arthritis
411
Q29: What condition is associated with the 'pencil-in-cup' deformity on X-ray? A. Gout B. Psoriatic arthritis C. Rheumatoid arthritis D. Osteoarthritis
Q29: What condition is associated with the 'pencil-in-cup' deformity on X-ray? A. Gout B. Psoriatic arthritis ✅ C. Rheumatoid arthritis D. Osteoarthritis
412
Q30: Which structure is found at the ends of long bones and contains red marrow? A. Diaphysis B. Metaphysis C. Epiphysis D. Periosteum
Q30: Which structure is found at the ends of long bones and contains red marrow? A. Diaphysis B. Metaphysis C. Epiphysis ✅ D. Periosteum
413
Q31: Which MSK condition is linked with chronic back pain and vertebral disc herniation? A. Osteoporosis B. Degenerative disc disease C. Osteoarthritis D. Psoriatic arthritis
Q31: Which MSK condition is linked with chronic back pain and vertebral disc herniation? A. Osteoporosis B. Degenerative disc disease ✅ C. Osteoarthritis D. Psoriatic arthritis
414
Q32: Which medication is a tricyclic antidepressant used in managing chronic back pain? A. Amitriptyline B. Ibuprofen C. Tramadol D. Gabapentin
Q32: Which medication is a tricyclic antidepressant used in managing chronic back pain? A. Amitriptyline ✅ B. Ibuprofen C. Tramadol D. Gabapentin
415
Q33: Which hormone, when decreased, contributes to osteoporosis in postmenopausal women? A. Insulin B. Progesterone C. Estrogen D. Cortisol
Q33: Which hormone, when decreased, contributes to osteoporosis in postmenopausal women? A. Insulin B. Progesterone C. Estrogen ✅ D. Cortisol
416
Q34: Which physical sign is most associated with osteoarthritis? A. Ulnar drift B. Symmetrical joint involvement C. Joint crepitus D. Tophi
Q34: Which physical sign is most associated with osteoarthritis? A. Ulnar drift B. Symmetrical joint involvement C. Joint crepitus ✅ D. Tophi
417
Q35: Which arthritis is caused by uric acid crystal deposition? A. Gout B. Psoriatic arthritis C. Osteoarthritis D. Rheumatoid arthritis
Q35: Which arthritis is caused by uric acid crystal deposition? A. Gout ✅ B. Psoriatic arthritis C. Osteoarthritis D. Rheumatoid arthritis
418
Q36: What inflammatory mediator is involved in pannus formation in RA? A. TNF-alpha B. Insulin C. Epinephrine D. ADH
Q36: What inflammatory mediator is involved in pannus formation in RA? A. TNF-alpha ✅ B. Insulin C. Epinephrine D. ADH
419
Q37: Which of the following is a complication of untreated septic arthritis? A. Tophi B. Bone spurs C. Joint fusion D. Osteomyelitis
Q37: Which of the following is a complication of untreated septic arthritis? A. Tophi B. Bone spurs C. Joint fusion D. Osteomyelitis ✅
420
Q38: What does the metaphysis of a long bone contain in adults? A. Red marrow B. Growth plate C. Epiphyseal line D. Periosteum
Q38: What does the metaphysis of a long bone contain in adults? A. Red marrow B. Growth plate C. Epiphyseal line ✅ D. Periosteum
421
Q39: Which medication is classified as an anti-gout drug and reduces uric acid levels? A. Allopurinol B. Methotrexate C. Prednisolone D. Bisphosphonates
Q39: Which medication is classified as an anti-gout drug and reduces uric acid levels? A. Allopurinol ✅ B. Methotrexate C. Prednisolone D. Bisphosphonates
422
Q40: Which clinical manifestation is most typical of osteoporosis? A. Erythematous joint B. Pathological fractures C. Joint effusion D. Radiculopathy
Q40: Which clinical manifestation is most typical of osteoporosis? A. Erythematous joint B. Pathological fractures ✅ C. Joint effusion D. Radiculopathy
423
Q1: Which non-opioid analgesic is not classed as an anti-inflammatory medication? A. Aspirin B. Paracetamol C. Ibuprofen D. Celecoxib
Q1: Which non-opioid analgesic is not classed as an anti-inflammatory medication? A. Aspirin B. Paracetamol ✅ C. Ibuprofen D. Celecoxib
424
Q2: Which enzyme is selectively inhibited by newer NSAIDs like celecoxib and meloxicam? A. Prostaglandin E2 B. Cyclin D1 C. COX-2 D. COX-1
Q2: Which enzyme is selectively inhibited by newer NSAIDs like celecoxib and meloxicam? A. Prostaglandin E2 B. Cyclin D1 C. COX-2 ✅ D. COX-1
425
Q3: Which of the following is an example of a bisphosphonate used to treat osteoporosis? A. Calcitriol B. Alendronate C. Raloxifene D. Teriparatide
Q3: Which of the following is an example of a bisphosphonate used to treat osteoporosis? A. Calcitriol B. Alendronate ✅ C. Raloxifene D. Teriparatide
426
Q4: What is the main action of bisphosphonates in managing osteoporosis? A. Increase calcium absorption B. Inhibit osteoclast activity C. Suppress the immune system D. Stimulate osteoblast activity
Q4: What is the main action of bisphosphonates in managing osteoporosis? A. Increase calcium absorption B. Inhibit osteoclast activity ✅ C. Suppress the immune system D. Stimulate osteoblast activity
427
Q5: Which medication is commonly used to decrease uric acid production in chronic gout? A. Colchicine B. Prednisolone C. Allopurinol D. Probenecid
Q5: Which medication is commonly used to decrease uric acid production in chronic gout? A. Colchicine B. Prednisolone C. Allopurinol ✅ D. Probenecid
428
Q6: Which medication increases uric acid excretion in gout management? A. NSAIDs B. Probenecid C. Paracetamol D. Allopurinol
Q6: Which medication increases uric acid excretion in gout management? A. NSAIDs B. Probenecid ✅ C. Paracetamol D. Allopurinol
429
Q7: Which DMARD is considered a biological therapy targeting B-lymphocytes in RA treatment? A. Hydroxychloroquine B. Methotrexate C. Rituximab D. Sulfasalazine
Q7: Which DMARD is considered a biological therapy targeting B-lymphocytes in RA treatment? A. Hydroxychloroquine B. Methotrexate C. Rituximab ✅ D. Sulfasalazine
430
Q8: What is the purpose of the WHO analgesic ladder? A. To promote opioid use B. To diagnose chronic pain C. To classify types of pain D. To guide pain management based on severity
Q8: What is the purpose of the WHO analgesic ladder? A. To promote opioid use B. To diagnose chronic pain C. To classify types of pain D. To guide pain management based on severity ✅
431
Q9: Which NSAID is considered COX-2 selective? A. Ibuprofen B. Celecoxib C. Ketorolac D. Aspirin
Q9: Which NSAID is considered COX-2 selective? A. Ibuprofen B. Celecoxib ✅ C. Ketorolac D. Aspirin
432
Q10: Which medication is a bone-forming agent used in severe osteoporosis? A. Raloxifene B. Denosumab C. Teriparatide D. Alendronate
Q10: Which medication is a bone-forming agent used in severe osteoporosis? A. Raloxifene B. Denosumab C. Teriparatide ✅ D. Alendronate
433
Q11: Which analgesic does not produce tolerance or dependence? A. Morphine B. Paracetamol C. Codeine D. Oxycodone
Q11: Which analgesic does not produce tolerance or dependence? A. Morphine B. Paracetamol ✅ C. Codeine D. Oxycodone
434
Q12: Which clinical sign is typically associated with a hip fracture? A. Medial knee bruising B. Flexed leg with internal rotation C. Leg shortened and externally rotated D. Straightened leg and muscle rigidity
Q12: Which clinical sign is typically associated with a hip fracture? A. Medial knee bruising B. Flexed leg with internal rotation C. Leg shortened and externally rotated ✅ D. Straightened leg and muscle rigidity
435
Q13: What is a potential complication of intracapsular neck of femur fractures? A. Muscle fibrosis B. Avascular necrosis C. Deep vein thrombosis D. Non-union of tibia
Q13: What is a potential complication of intracapsular neck of femur fractures? A. Muscle fibrosis B. Avascular necrosis ✅ C. Deep vein thrombosis D. Non-union of tibia
436
Q14: What is the main rationale for applying ice in fracture management? A. Increase circulation B. Stimulate nerve activity C. Promote vasodilation D. Reduce swelling and pain
Q14: What is the main rationale for applying ice in fracture management? A. Increase circulation B. Stimulate nerve activity C. Promote vasodilation D. Reduce swelling and pain ✅
437
Q15: Which assessment finding would require urgent escalation in a patient with a limb fracture? A. Pain score of 5/10 B. CRT of 2 seconds C. CRT greater than 4 seconds D. Presence of pedal pulses
Q15: Which assessment finding would require urgent escalation in a patient with a limb fracture? A. Pain score of 5/10 B. CRT of 2 seconds C. CRT greater than 4 seconds ✅ D. Presence of pedal pulses
438
Q16: Which of the following is considered a focused musculoskeletal assessment technique? A. Glucose level monitoring B. Pupil reactivity C. Range of motion D. Jugular vein distension
Q16: Which of the following is considered a focused musculoskeletal assessment technique? A. Glucose level monitoring B. Pupil reactivity C. Range of motion ✅ D. Jugular vein distension
439
Q17: Which of the following is a late sign of neurovascular compromise? A. Pain B. Pallor C. Pulses D. Paresthesia
Q17: Which of the following is a late sign of neurovascular compromise? A. Pain B. Pallor C. Pulses ✅ D. Paresthesia
440
Q18: What type of fracture is most likely to result from twisting injuries? A. Oblique B. Spiral C. Transverse D. Greenstick
Q18: What type of fracture is most likely to result from twisting injuries? A. Oblique B. Spiral ✅ C. Transverse D. Greenstick
441
Q19: A comminuted fracture is defined as a bone that: A. Breaks across a joint B. Breaks into two pieces C. Breaks into three or more fragments D. Is misaligned but stable
Q19: A comminuted fracture is defined as a bone that: A. Breaks across a joint B. Breaks into two pieces C. Breaks into three or more fragments ✅ D. Is misaligned but stable
442
Q20: What is the purpose of external fixation in fracture management? A. Internal structural support B. Minimise weight bearing C. Provide traction and stabilise bone externally D. Increase callus formation
Q20: What is the purpose of external fixation in fracture management? A. Internal structural support B. Minimise weight bearing C. Provide traction and stabilise bone externally ✅ D. Increase callus formation
443
Q21: Which assessment method detects dermatomal changes after a fracture? A. Light palpation B. Reflex hammer C. Pinprick testing D. Capillary refill
Q21: Which assessment method detects dermatomal changes after a fracture? A. Light palpation B. Reflex hammer C. Pinprick testing ✅ D. Capillary refill
444
Q22: Which drug is used in rheumatoid arthritis to slow disease progression? A. Ibuprofen B. Methotrexate C. Aspirin D. Paracetamol
Q22: Which drug is used in rheumatoid arthritis to slow disease progression? A. Ibuprofen B. Methotrexate ✅ C. Aspirin D. Paracetamol
445
Q23: What is the first-line pharmacological treatment for an acute gout flare-up? A. Colchicine B. NSAIDs C. Probenecid D. Methotrexate
Q23: What is the first-line pharmacological treatment for an acute gout flare-up? A. Colchicine B. NSAIDs ✅ C. Probenecid D. Methotrexate
446
Q24: What type of traction is used for short-term stabilisation and uses splints or boots? A. Skeletal B. Skin C. Frame-based D. Intramedullary
Q24: What type of traction is used for short-term stabilisation and uses splints or boots? A. Skeletal B. Skin ✅ C. Frame-based D. Intramedullary
447
Q25: What medication is a selective estrogen receptor modulator used in osteoporosis? A. Ibandronate B. Raloxifene C. Zoledronic acid D. Romosozumab
Q25: What medication is a selective estrogen receptor modulator used in osteoporosis? A. Ibandronate B. Raloxifene ✅ C. Zoledronic acid D. Romosozumab
448
Q26: What medication class is Romosozumab part of in osteoporosis treatment? A. NSAIDs B. Antirheumatic drugs C. Sclerostin inhibitors D. COX-2 inhibitors
Q26: What medication class is Romosozumab part of in osteoporosis treatment? A. NSAIDs B. Antirheumatic drugs C. Sclerostin inhibitors ✅ D. COX-2 inhibitors
449
Q27: What is the best definition of a sprain? A. Injury to a muscle B. Injury to a tendon C. Injury to a ligament D. Dislocation of a joint
Q27: What is the best definition of a sprain? A. Injury to a muscle B. Injury to a tendon C. Injury to a ligament ✅ D. Dislocation of a joint
450
Q28: Which grade of sprain is a complete ligament rupture with joint instability? A. Grade I B. Grade II C. Grade III D. Grade IV
Q28: Which grade of sprain is a complete ligament rupture with joint instability? A. Grade I B. Grade II C. Grade III ✅ D. Grade IV
451
Q29: Which symptom is more likely in a strain than a sprain? A. Joint instability B. Muscle spasm C. Hyperflexibility D. Loose ligaments
Q29: Which symptom is more likely in a strain than a sprain? A. Joint instability B. Muscle spasm ✅ C. Hyperflexibility D. Loose ligaments
452
Q30: Which part of the WHO analgesic ladder includes strong opioids for severe pain? A. Step 1 B. Step 2 C. Step 3 D. Step 4
Q30: Which part of the WHO analgesic ladder includes strong opioids for severe pain? A. Step 1 B. Step 2 C. Step 3 ✅ D. Step 4
453
Q31: Which assessment is used to detect compartment syndrome in fracture patients? A. 6 P’s assessment B. Braden scale C. GCS D. ECG
Q31: Which assessment is used to detect compartment syndrome in fracture patients? A. 6 P’s assessment ✅ B. Braden scale C. GCS D. ECG
454
Q32: What is the correct order of fracture healing phases? A. Remodelling → Reparative → Inflammatory B. Reparative → Inflammatory → Remodelling C. Inflammatory → Reparative → Remodelling D. Inflammatory → Remodelling → Reparative
Q32: What is the correct order of fracture healing phases? A. Remodelling → Reparative → Inflammatory B. Reparative → Inflammatory → Remodelling C. Inflammatory → Reparative → Remodelling ✅ D. Inflammatory → Remodelling → Reparative
455
Q33: Which analgesic is safe for long-term use without dependence or tolerance? A. Codeine B. Morphine C. Paracetamol D. Oxycodone
Q33: Which analgesic is safe for long-term use without dependence or tolerance? A. Codeine B. Morphine C. Paracetamol ✅ D. Oxycodone
456
Q34: Which fracture type results from a bone fragment being pulled off by a ligament or tendon? A. Spiral B. Avulsion C. Stress D. Compression
Q34: Which fracture type results from a bone fragment being pulled off by a ligament or tendon? A. Spiral B. Avulsion ✅ C. Stress D. Compression
457
Q35: What is the main goal of using assistive devices in MSK nursing management? A. Promote dependence B. Decrease ADLs C. Improve stability and mobility D. Reduce nerve pain
Q35: What is the main goal of using assistive devices in MSK nursing management? A. Promote dependence B. Decrease ADLs C. Improve stability and mobility ✅ D. Reduce nerve pain
458
Q36: Which drug is classified as a COX-2 selective NSAID? A. Diclofenac B. Aspirin C. Celecoxib D. Indomethacin
Q36: Which drug is classified as a COX-2 selective NSAID? A. Diclofenac B. Aspirin C. Celecoxib ✅ D. Indomethacin
459
Q37: What fracture complication involves formation of a false joint with abnormal movement? A. Non-union B. Angulation C. Pseudoarthrosis D. Delayed union
Q37: What fracture complication involves formation of a false joint with abnormal movement? A. Non-union B. Angulation C. Pseudoarthrosis ✅ D. Delayed union
460
Q38: What term describes the crunching sound made by broken bone fragments? A. Guarding B. Paraesthesia C. Crepitation D. Spasm
Q38: What term describes the crunching sound made by broken bone fragments? A. Guarding B. Paraesthesia C. Crepitation ✅ D. Spasm
461
Q39: Which nursing intervention is critical in the first 72 hours after a sprain? A. Apply heat B. Encourage massage C. Elevate and ice the limb D. Begin resistance training
Q39: Which nursing intervention is critical in the first 72 hours after a sprain? A. Apply heat B. Encourage massage C. Elevate and ice the limb ✅ D. Begin resistance training
462
Q40: What medication is a biologic DMARD used in RA and acts as a TNF inhibitor? A. Sulfasalazine B. Etanercept ✅ C. Hydroxychloroquine D. Leflunomide
Q40: What medication is a biologic DMARD used in RA and acts as a TNF inhibitor? A. Sulfasalazine B. Etanercept ✅ C. Hydroxychloroquine D. Leflunomide

#NUR2226 (7 decks)

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