📚🦴 Anatomy and Physiology of the Musculoskeletal System
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
Definition:
The musculoskeletal system consists of bones, muscles, joints, cartilage, tendons, and ligaments that support the body, allow movement, protect internal organs, and store minerals.
“The musculoskeletal system is the structural framework of the body, enabling posture, movement, and protection of vital organs.”
A bone is a rigid, mineralized connective tissue that forms the skeletal framework of the body. It provides support, protection, movement, and serves as a site for blood cell production and mineral storage.
“Bone is a dynamic living tissue composed of cells, fibers, and ground substances that undergo constant remodeling.”
| Structure | Description |
| Diaphysis | The shaft or central part of a long bone; contains medullary cavity filled with yellow bone marrow |
| Epiphysis | Rounded ends of a long bone; contains spongy bone and red marrow |
| Metaphysis | Region between diaphysis and epiphysis; includes growth plate (epiphyseal plate) in children |
| Epiphyseal plate/line | Growth plate in children; replaced by epiphyseal line in adults |
| Periosteum | Tough outer fibrous membrane covering the bone; contains blood vessels, nerves, and osteoblasts |
| Endosteum | Thin membrane lining the medullary cavity; involved in bone growth and repair |
| Medullary cavity | Hollow central cavity in diaphysis; contains yellow bone marrow in adults |
| Articular cartilage | Smooth, hyaline cartilage covering the ends of bones at joints; reduces friction |
| Cell Type | Function |
| Osteoblasts | Bone-forming cells; synthesize matrix and promote mineralization |
| Osteocytes | Mature bone cells; maintain bone matrix |
| Osteoclasts | Bone-resorbing cells; involved in bone remodeling |
| Osteoprogenitor cells | Stem cells that differentiate into osteoblasts |
| Type | Description |
| Compact (Cortical) Bone | Dense outer layer; contains Haversian systems (osteons) |
| Spongy (Cancellous) Bone | Lighter, porous; found in epiphysis and flat bones; contains red bone marrow |
Q1. The shaft of a long bone is called the:
🅰️ Epiphysis
✅ 🅱️ Diaphysis
🅲️ Metaphysis
🅳️ Endosteum
Q2. Which cell is responsible for bone resorption?
🅰️ Osteocyte
🅱️ Osteoblast
✅ 🅲️ Osteoclast
🅳️ Chondrocyte
Q3. The outer membrane covering the bone is known as:
🅰️ Endosteum
🅱️ Epimysium
✅ 🅲️ Periosteum
🅳️ Perimysium
Q4. The cavity in the diaphysis that contains yellow marrow is called:
🅰️ Osteon
🅱️ Central canal
✅ 🅲️ Medullary cavity
🅳️ Lacuna
Q5. Which part of the bone is responsible for growth in length?
🅰️ Periosteum
🅱️ Diaphysis
✅ 🅲️ Epiphyseal plate
🅳️ Endosteum
The human skeletal system is made up of 206 bones in an average adult, organized into two major parts: the axial skeleton and the appendicular skeleton. These bones support the body, protect internal organs, and assist in movement.
“The adult human body contains 206 bones, classified based on their location in the axial or appendicular skeleton.”
| Division | Description | Number of Bones |
| 1. Axial Skeleton | Forms the central axis of the body | 80 bones |
| 2. Appendicular Skeleton | Bones of the limbs and girdles | 126 bones |
| Region | Bones | Count |
| Skull | Cranial (8) + Facial (14) | 22 |
| Hyoid Bone | Supports tongue | 1 |
| Auditory Ossicles | Malleus, Incus, Stapes (each ear) | 6 |
| Vertebral Column | Cervical (7), Thoracic (12), Lumbar (5), Sacrum (1), Coccyx (1) | 26 |
| Rib Cage | Ribs (24) + Sternum (1) | 25 |
🔹 Total = 22 + 1 + 6 + 26 + 25 = 80 bones
| Region | Bones | Count |
| Upper Limbs | Humerus, Radius, Ulna, Carpals, Metacarpals, Phalanges (each side) | 30 × 2 = 60 |
| Pectoral Girdle | Clavicle (2), Scapula (2) | 4 |
| Lower Limbs | Femur, Patella, Tibia, Fibula, Tarsals, Metatarsals, Phalanges (each side) | 30 × 2 = 60 |
| Pelvic Girdle | Hip bones (2, each = ilium + ischium + pubis) | 2 |
🔹 Total = 60 (arms) + 4 (shoulder) + 60 (legs) + 2 (hip) = 126 bones
| Division | Number of Bones | Major Parts |
| Axial Skeleton | 80 | Skull, vertebrae, ribs, sternum, hyoid |
| Appendicular Skeleton | 126 | Limbs, pelvic & pectoral girdles |
| Total | 206 bones | Entire adult skeleton |
Q1. How many bones are there in the adult human body?
🅰️ 201
🅱️ 212
✅ 🅲️ 206
🅳️ 209
Q2. Which of the following belongs to the axial skeleton?
🅰️ Femur
✅ 🅱️ Sternum
🅲️ Clavicle
🅳️ Scapula
Q3. The appendicular skeleton includes how many bones?
🅰️ 86
🅱️ 116
✅ 🅲️ 126
🅳️ 136
Q4. How many vertebrae are present in the vertebral column?
🅰️ 30
🅱️ 24
✅ 🅲️ 26
🅳️ 28
Q5. Which bone is part of the auditory ossicles?
🅰️ Clavicle
✅ 🅱️ Stapes
🅲️ Hyoid
🅳️ Mandible
📚🦴 Classification of Bones
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Anatomy and Physiology Exams
🔰 I. Definition:
Bones are rigid organs that form part of the endoskeleton, providing support, protection, movement, and mineral storage. Based on their shape, structure, and function, bones are classified into five main types.
“Bone classification refers to the categorization of bones based on their shape and structure, which relates to their function in the body.”
📖 II. Classification of Bones (Based on Shape):
| Type of Bone | Description | Examples |
| 1. Long Bones | Longer than they are wide; consist of a shaft (diaphysis) and two ends (epiphyses); act as levers for movement | Femur, Humerus, Radius, Ulna, Tibia, Fibula |
| 2. Short Bones | Roughly cube-shaped; provide support with limited movement | Carpals (wrist bones), Tarsals (ankle bones) |
| 3. Flat Bones | Thin, flattened, and often curved; protect internal organs and provide large surface area for muscle attachment | Skull, Sternum, Ribs, Scapula |
| 4. Irregular Bones | Complex shapes that do not fit into other categories; often have specialized functions | Vertebrae, Sacrum, Mandible, Facial bones |
| 5. Sesamoid Bones | Small, round bones embedded within tendons; reduce friction and modify pressure | Patella (kneecap), bones in tendons of thumb and big toe |
📖 III. Additional Classification:
| Basis | Type |
| By Development | Membranous (e.g., flat bones of skull), Cartilaginous (e.g., long bones) |
| By Location | Axial skeleton (e.g., skull, spine, ribs), Appendicular skeleton (e.g., limbs, pelvis) |
| By Texture | Compact (dense outer layer), Spongy (cancellous, inner part with trabeculae) |
📖 IV. Functions of Each Type:
| Bone Type | Primary Function |
| Long | Movement, support, strength |
| Short | Stability, some movement |
| Flat | Protection, surface for muscle attachment |
| Irregular | Specialized protection and support |
| Sesamoid | Protect tendons, reduce friction |
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice:
Q1. Which of the following is a flat bone?
🅰️ Femur
🅱️ Carpals
✅ 🅲️ Sternum
🅳️ Patella
Q2. The patella is classified as a:
🅰️ Short bone
🅱️ Flat bone
✅ 🅲️ Sesamoid bone
🅳️ Irregular bone
Q3. Which bones are found in the wrist and are cuboidal in shape?
🅰️ Long bones
✅ 🅱️ Short bones
🅲️ Flat bones
🅳️ Irregular bones
Q4. Vertebrae are best classified as:
🅰️ Long bones
🅱️ Short bones
🅲️ Flat bones
✅ 🅳️ Irregular bones
Q5. Bones of the limbs like femur and humerus are examples of:
🅰️ Flat bones
🅱️ Sesamoid bones
✅ 🅲️ Long bones
🅳️ Irregular bones
📚🔗 Types of Joints (Articulations)
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Anatomy and Physiology Exams
🔰 I. Definition:
A joint (also called an articulation) is a connection between two or more bones, which allows movement and flexibility to the skeleton. Some joints are movable, some are slightly movable, and some are immovable.
“Joints are anatomical structures where two or more bones meet, allowing varying degrees of movement and providing support.”
📖 II. Classification of Joints (Based on Structure):
| Type | Description | Example |
| 1. Fibrous Joints | Bones joined by fibrous connective tissue; no joint cavity; immovable (synarthrosis) | Skull sutures, inferior tibiofibular joint |
| 2. Cartilaginous Joints | Bones connected by cartilage; no joint cavity; slightly movable (amphiarthrosis) | Intervertebral discs, pubic symphysis, costal cartilage |
| 3. Synovial Joints | Bones separated by a fluid-filled joint cavity; freely movable (diarthrosis) | Knee, elbow, shoulder, hip, wrist |
📖 III. Classification of Synovial Joints (Based on Movement):
| Type | Description | Example |
| 1. Hinge Joint | Allows movement in one plane (flexion/extension) | Elbow, knee, ankle |
| 2. Ball and Socket Joint | Ball-shaped surface fits into cup-like depression; multiaxial movement | Shoulder, hip |
| 3. Pivot Joint | One bone rotates around another | Atlantoaxial joint (neck), radioulnar joint |
| 4. Saddle Joint | Each surface is concave and convex; allows more movement than hinge | Thumb (1st carpometacarpal joint) |
| 5. Condyloid (Ellipsoidal) Joint | Oval surface fits into elliptical cavity; biaxial movement | Wrist joint, metacarpophalangeal joints |
| 6. Gliding (Plane) Joint | Flat or slightly curved surfaces glide past one another | Intercarpal, intertarsal joints, acromioclavicular joint |
📖 IV. Classification Based on Function (Degree of Movement):
| Type | Movement | Example |
| Synarthrosis | Immovable | Sutures of skull |
| Amphiarthrosis | Slightly movable | Intervertebral discs, pubic symphysis |
| Diarthrosis | Freely movable | Most synovial joints like knee, shoulder |
📖 V. Components of Synovial Joints:
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice:
Q1. Which joint is an example of a hinge joint?
🅰️ Shoulder
✅ 🅱️ Elbow
🅲️ Hip
🅳️ Thumb
Q2. Which of the following joints allows multiaxial movement?
🅰️ Hinge joint
🅱️ Pivot joint
✅ 🅲️ Ball and socket joint
🅳️ Gliding joint
Q3. The joint between the first and second cervical vertebrae is a:
🅰️ Hinge joint
🅱️ Ball and socket joint
✅ 🅲️ Pivot joint
🅳️ Condyloid joint
Q4. Which type of joint is immovable?
🅰️ Synovial
🅱️ Cartilaginous
✅ 🅲️ Fibrous
🅳️ Condyloid
Q5. The thumb joint is an example of which type of synovial joint?
🅰️ Ball and socket
🅱️ Hinge
✅ 🅲️ Saddle
🅳️ Gliding
📚🦴 Vertebral Column
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Anatomy and Physiology Exams
🔰 I. Definition:
The vertebral column, also known as the spine or backbone, is a flexible, bony structure that extends from the base of the skull to the pelvis, protecting the spinal cord, supporting the head, and enabling bipedal movement.
“The vertebral column is a vertical series of bones called vertebrae that encase and protect the spinal cord and provide structural support to the body.”
📖 II. Total Number of Vertebrae:
| Region | Number | Characteristics |
| Cervical (neck) | 7 | Smallest, support head, C1 (atlas) & C2 (axis) allow rotation |
| Thoracic (mid-back) | 12 | Articulate with ribs, larger than cervical |
| Lumbar (lower back) | 5 | Largest and strongest, support body weight |
| Sacral (pelvic) | 5 (fused) | Form the sacrum, part of pelvis |
| Coccygeal (tailbone) | 4 (fused) | Form the coccyx, vestigial structure |
📖 III. Curvatures of the Vertebral Column:
| Region | Curve Type | Direction |
| Cervical | Lordosis | Concave posteriorly |
| Thoracic | Kyphosis | Convex posteriorly |
| Lumbar | Lordosis | Concave posteriorly |
| Sacral | Kyphosis | Convex posteriorly |
These curves maintain balance and act as shock absorbers during movement.
📖 IV. General Structure of a Vertebra:
| Part | Function |
| Body | Weight-bearing part, anterior side |
| Vertebral arch | Protects spinal cord; includes pedicles & laminae |
| Vertebral foramen | Central opening for the spinal cord |
| Spinous process | Posterior projection; muscle/ligament attachment |
| Transverse processes | Lateral projections; muscle attachment |
| Articular processes | Form joints between adjacent vertebrae |
| Intervertebral discs | Fibrocartilaginous pads that absorb shock and allow movement |
📖 V. Special Vertebrae:
📖 VI. Functions of Vertebral Column:
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice:
Q1. How many vertebrae are present in the human body?
🅰️ 26
🅱️ 30
✅ 🅲️ 33
🅳️ 28
Q2. The vertebra that allows rotation of the head is:
🅰️ Atlas
✅ 🅱️ Axis
🅲️ Sacrum
🅳️ Coccyx
Q3. The number of cervical vertebrae is:
🅰️ 6
✅ 🅱️ 7
🅲️ 8
🅳️ 9
Q4. Intervertebral discs are made of:
🅰️ Hyaline cartilage
✅ 🅱️ Fibrocartilage
🅲️ Elastic cartilage
🅳️ Bone tissue
Q5. Which region of the vertebral column bears the most weight?
🅰️ Cervical
🅱️ Thoracic
✅ 🅲️ Lumbar
🅳️ Coccygeal
Diagnostic tests are clinical, laboratory, or imaging procedures used to detect, confirm, or monitor diseases, guide treatment decisions, and evaluate the response to therapy.
“Diagnostic tests are systematic procedures conducted to identify a disease, assess the severity, and determine appropriate management.”
| Type | Description | Examples |
| 1. Laboratory Tests | Analyze blood, urine, stool, etc. | CBC, LFT, RFT, Blood glucose |
| 2. Imaging Tests | Visualize internal organs/tissues | X-ray, CT scan, MRI, Ultrasound |
| 3. Endoscopic Tests | Internal viewing via scope | Gastroscopy, Colonoscopy, Bronchoscopy |
| 4. Cardiac Tests | Assess heart structure/function | ECG, Echocardiogram, TMT |
| 5. Pulmonary Tests | Assess lung function | PFT, Spirometry, ABG |
| 6. Neurological Tests | Assess nervous system | EEG, EMG, CT/MRI Brain |
| 7. Genetic/Molecular Tests | Detect genetic disorders | Karyotyping, PCR, DNA sequencing |
| 8. Biopsy/Cytology | Tissue/cell sampling | FNAC, Bone marrow biopsy, Pap smear |
| Test | Full Form | Purpose |
| CBC | Complete Blood Count | Detect anemia, infection, leukemia |
| ESR/CRP | Erythrocyte Sedimentation Rate/C-Reactive Protein | Inflammation marker |
| LFT | Liver Function Test | Evaluate liver enzymes, bilirubin |
| RFT | Renal Function Test | Check creatinine, urea, electrolytes |
| ECG | Electrocardiogram | Detect arrhythmia, MI, ischemia |
| X-Ray | Radiograph | View bones, lungs, chest |
| MRI | Magnetic Resonance Imaging | Brain, spine, joints, soft tissue |
| CT Scan | Computed Tomography | Cross-sectional images of organs |
| Ultrasound (USG) | Sonography | Abdomen, pregnancy, soft tissue |
| Pap Smear | Cervical cytology | Detect precancerous cervical changes |
| TMT | Treadmill Test | Stress test for coronary artery disease |
| EEG | Electroencephalogram | Brain electrical activity (seizures) |
| PFT | Pulmonary Function Test | Lung volumes and capacity |
| ABG | Arterial Blood Gas | Oxygenation, acid-base balance |
| FNAC | Fine Needle Aspiration Cytology | Sampling of masses/tumors |
Q1. Which test is used to assess kidney function?
🅰️ LFT
🅱️ CBC
✅ 🅲️ RFT
🅳️ ECG
Q2. A Pap smear is primarily done to screen for:
🅰️ Uterine fibroids
🅱️ Ovarian cysts
✅ 🅲️ Cervical cancer
🅳️ Endometriosis
Q3. Before a contrast-enhanced CT scan, the nurse must check for allergy to:
🅰️ Latex
🅱️ Aspirin
✅ 🅲️ Iodine
🅳️ Shellfish
Q4. ECG is useful in the diagnosis of:
🅰️ Lung fibrosis
✅ 🅱️ Myocardial infarction
🅲️ Kidney stones
🅳️ Anemia
Q5. Which test measures the lung’s air capacity and function?
🅰️ ECG
🅱️ EEG
🅲️ ABG
✅ 🅳️ PFT
A cast is a rigid external immobilizing device that is applied to encase a fractured bone or injured joint to maintain alignment during healing.
“A cast is a molded, rigid dressing made of plaster or fiberglass applied to immobilize a body part for healing after fracture, surgery, or orthopedic injury.”
| Type | Description | Use |
| Plaster of Paris (POP) Cast | Made from gypsum; inexpensive, molds well; heavy, not water-resistant | Temporary immobilization |
| Fiberglass Cast | Lightweight, water-resistant, stronger | Long-term immobilization |
| Short Arm Cast | Covers hand to below elbow | Wrist/forearm fractures |
| Long Arm Cast | Covers hand to upper arm | Elbow/forearm fractures |
| Short Leg Cast | Covers foot to below knee | Ankle or foot fractures |
| Long Leg Cast | Covers foot to thigh | Tibia/fibula/knee fractures |
| Spica Cast | Encases part of the trunk and one or both legs | Hip dysplasia in children |
| Body Cast | Encases trunk (torso) | Spine/pelvis injuries |
Plaster casts take 24–72 hours to fully dry, whereas fiberglass dries in minutes.
| Complication | Description |
| Compartment syndrome | Increased pressure inside limb; medical emergency |
| Pressure sores | From tight cast or poor padding |
| Circulatory impairment | Due to compression |
| Cast syndrome | Abdominal cast compressing duodenum (in body cast) |
| Joint stiffness | From prolonged immobilization |
| Skin infection or irritation | Due to moisture or scratching |
Q1. Which material is commonly used for making a temporary cast?
🅰️ Plastic
✅ 🅱️ Plaster of Paris
🅲️ Rubber
🅳️ Leather
Q2. A nurse handling a freshly applied plaster cast should:
🅰️ Use fingertips
🅱️ Keep it hanging down
✅ 🅲️ Use palms to prevent indentations
🅳️ Apply lotion to soften it
Q3. A sign of neurovascular impairment in a casted limb is:
🅰️ Pink skin and warm toes
🅱️ Free movement of fingers
✅ 🅲️ Numbness and weak pulse
🅳️ Slight discomfort
Q4. Which is NOT a type of cast?
🅰️ Short arm cast
🅱️ Long leg cast
🅲️ Hip cast
✅ 🅳️ Rib cage cast
Q5. Compartment syndrome under a cast requires:
🅰️ Massage and rest
🅱️ Ice pack application
✅ 🅲️ Immediate cast removal and emergency care
🅳️ Painkillers only
A splint is a non-circumferential external device used to immobilize, support, or protect an injured body part, typically in acute injuries or during the healing process.
“A splint is a rigid or flexible appliance used to prevent movement of a joint or broken bone, commonly used temporarily until casting or definitive treatment is applied.”
| Type | Area Applied | Common Use |
| Arm splint | Forearm or upper arm | Forearm/wrist fractures, sprains |
| Leg splint | Lower limb | Tibia/fibula injuries |
| Finger splint | Individual fingers | Finger fracture or tendon injury |
| Thumb spica splint | Wrist & thumb | Thumb fracture, ligament injury |
| Posterior ankle splint | Back of leg & ankle | Ankle fracture, sprain |
| U-slab | Around elbow | Humerus fracture |
| Gutter splint | Along side of limb | Hand/finger injuries |
| Cock-up splint | Wrist in extension | Wrist drop (radial nerve palsy) |
| Thomas splint | Lower limb with traction | Femur fracture stabilization |
| Air splint | Inflatable, emergency use | Temporary immobilization in field settings |
| Complication | Cause |
| Pressure sores | Poor padding or prolonged use |
| Compartment syndrome | Tight splint obstructing circulation |
| Skin maceration | Moisture under the splint |
| Joint stiffness | Prolonged immobilization |
| Nerve compression | Improper positioning or tight straps |
Q1. A splint is defined as:
🅰️ A circumferential rigid support
✅ 🅱️ A non-circumferential external support
🅲️ A surgical internal fixation
🅳️ A muscle relaxant
Q2. The Thomas splint is used for which fracture?
🅰️ Radius
🅱️ Humerus
✅ 🅲️ Femur
🅳️ Tibia
Q3. The cock-up splint is applied in which condition?
🅰️ Foot drop
✅ 🅱️ Wrist drop
🅲️ Finger contracture
🅳️ Elbow dislocation
Q4. Which of the following is an advantage of splinting?
🅰️ Prevents all limb movement permanently
🅱️ Restricts blood flow
✅ 🅲️ Allows swelling accommodation
🅳️ Replaces the need for surgery
Q5. Which is a key nursing observation after splint application?
🅰️ Cough and breath sounds
🅱️ Bowel sounds
✅ 🅲️ Circulation and sensation distal to splint
🅳️ Pupillary reaction
A brace is an orthotic device designed to support, align, prevent, or correct deformities, or to improve the function of a movable body part, especially joints such as the spine, knee, ankle, or neck.
“A brace is a supportive device used to stabilize, align, or assist movement in joints or body parts weakened by injury, disease, or deformity.”
| Type of Brace | Area | Use |
| Cervical collar | Neck | Whiplash, cervical strain, post-neck surgery |
| Milwaukee brace | Spine | Scoliosis correction (thoracolumbar) |
| Taylor brace | Spine | Supports dorsolumbar region |
| LS (Lumbosacral) belt | Lower back | Lumbar disc prolapse, back pain |
| Knee brace | Knee joint | Ligament injuries, post-arthroscopy |
| Ankle-foot orthosis (AFO) | Ankle & foot | Foot drop, cerebral palsy |
| Thoracolumbosacral orthosis (TLSO) | Upper & lower spine | Spinal fractures, scoliosis |
| Wrist brace (Cock-up splint) | Wrist | Wrist drop, carpal tunnel syndrome |
| Clavicle brace | Shoulders | Clavicle fracture, posture correction |
| Complication | Cause |
| Skin breakdown or pressure sores | Improper fitting or prolonged wear |
| Joint stiffness or muscle atrophy | Inadequate movement during prolonged use |
| Pain or discomfort | Poor adjustment or over-tightening |
| Poor compliance | Due to discomfort, aesthetics, or lack of education |
Q1. The Milwaukee brace is used for which condition?
🅰️ Clubfoot
✅ 🅱️ Scoliosis
🅲️ Wrist drop
🅳️ Shoulder dislocation
Q2. Which brace is commonly used for foot drop?
🅰️ TLSO
🅱️ Cervical collar
✅ 🅲️ Ankle-foot orthosis (AFO)
🅳️ Clavicle brace
Q3. A TLSO brace is used to support which region of the spine?
🅰️ Cervical only
🅱️ Lumbar only
✅ 🅲️ Thoracic and lumbar
🅳️ Sacral only
Q4. Which of the following is a key nursing responsibility for brace use?
🅰️ Encourage complete bed rest
🅱️ Remove brace permanently after 2 days
✅ 🅲️ Monitor for skin irritation and educate on use
🅳️ Avoid brace cleaning
Q5. A patient with carpal tunnel syndrome may benefit from which brace?
🅰️ LS belt
🅱️ Cervical collar
✅ 🅲️ Wrist brace (Cock-up splint)
🅳️ AFO
Traction is a therapeutic orthopedic procedure that applies a pulling force on a part of the body (usually a limb or spine) to align bones, reduce fractures, relieve pain, or prevent and correct deformities.
“Traction is the application of a steady pulling force to align fractured bones, reduce muscle spasms, and maintain position of injured parts.”
| Type | Description | Example |
| Skin traction | Applied to the skin using adhesive straps or foam boots; non-invasive | Buck’s traction, Russell’s traction |
| Skeletal traction | Applied directly to bone using pins, wires, or screws | Balanced suspension traction, Cervical skeletal tongs |
| Region | Type |
| Lower limb | Buck’s traction, Russell’s traction, Thomas splint with Pearson attachment |
| Upper limb | Dunlop traction |
| Cervical spine | Cervical traction using halter or tongs |
| Pelvis/Spine | Pelvic traction |
| Type | Purpose |
| Buck’s Traction | Temporary skin traction for hip/femur fractures |
| Russell’s Traction | Combines skin traction with knee suspension |
| Balanced Suspension Traction | Used for femoral fractures to maintain alignment |
| Cervical Traction | Relieves pressure on cervical vertebrae/discs |
| Pelvic Traction | Relieves lower back pain and sciatica |
| Complication | Description |
| Skin breakdown | Due to poor padding or friction |
| Nerve damage | If too much pressure is applied |
| Infection (osteomyelitis) | Especially with skeletal traction |
| Compartment syndrome | From tight bandaging or swelling |
| Deep vein thrombosis (DVT) | Due to immobility |
| Muscle atrophy/joint stiffness | Prolonged immobilization |
Q1. Which of the following is a type of skin traction?
🅰️ Skeletal tongs
🅱️ Balanced suspension
✅ 🅲️ Buck’s traction
🅳️ External fixator
Q2. A key nursing responsibility in traction management is to:
🅰️ Remove weights during bathing
🅱️ Elevate weights to reduce pressure
✅ 🅲️ Ensure weights hang freely and are not obstructed
🅳️ Frequently adjust the ropes
Q3. Pin site care is essential in:
🅰️ Buck’s traction
✅ 🅱️ Skeletal traction
🅲️ Cervical collar
🅳️ Cast application
Q4. Which of the following is a purpose of traction?
🅰️ Increase muscle mass
🅱️ Encourage walking
✅ 🅲️ Reduce fracture and relieve muscle spasm
🅳️ Treat anemia
Q5. The most serious complication of skeletal traction is:
🅰️ Constipation
🅱️ Pain
✅ 🅲️ Osteomyelitis
🅳️ Nausea
📚🦴 Joint Replacement
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical/Orthopedic Nursing Exams
🔰 I. Definition:
Joint replacement is a surgical procedure in which a damaged or diseased joint is removed and replaced with an artificial prosthesis to restore mobility and relieve pain.
“Joint replacement is the orthopedic surgical process of replacing all or part of an arthritic or dysfunctional joint with a prosthetic implant.”
📖 II. Common Types of Joint Replacements:
| Joint | Procedure Name | Common Conditions |
| Hip | Total Hip Replacement (THR) | Osteoarthritis, rheumatoid arthritis, hip fracture |
| Knee | Total Knee Replacement (TKR) | Osteoarthritis, joint deformity, trauma |
| Shoulder | Shoulder Arthroplasty | Rotator cuff injury, arthritis |
| Elbow | Elbow Replacement | Rheumatoid arthritis, trauma |
| Ankle | Ankle Replacement | Severe arthritis, joint degeneration |
| Finger/Wrist | Small Joint Replacement | Rheumatoid arthritis, deformity |
📖 III. Indications for Joint Replacement:
📖 IV. Contraindications:
📖 V. Preoperative Nursing Responsibilities:
📖 VI. Postoperative Nursing Care:
| Focus Area | Key Interventions |
| Pain management | Administer analgesics, use cold compress if prescribed |
| Neurovascular checks | Monitor CSM: color, sensation, movement, pulses |
| Positioning | Avoid adduction in hip; use abduction pillow |
| Mobility | Early ambulation with physiotherapy support |
| Wound care | Monitor for drainage, redness, swelling, infection |
| DVT prevention | Use compression stockings, encourage foot exercises |
| Patient education | Joint precautions, assistive devices, fall prevention |
📖 VII. Rehabilitation and Follow-Up:
📖 VIII. Complications of Joint Replacement:
| Complication | Description |
| Infection | Superficial or deep joint infection |
| Dislocation | Particularly common after hip replacement |
| Deep vein thrombosis (DVT) | Due to immobility |
| Loosening of prosthesis | May require revision surgery |
| Nerve or blood vessel injury | During surgery |
| Prosthetic joint failure | Over time, requiring replacement |
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice:
Q1. Which of the following is the most commonly replaced joint?
🅰️ Elbow
🅱️ Shoulder
✅ 🅲️ Knee
🅳️ Ankle
Q2. After total hip replacement, the patient should be positioned to:
🅰️ Adduct the hip
🅱️ Flex hip more than 90°
✅ 🅲️ Maintain abduction of hip
🅳️ Lie on the operated side
Q3. A serious complication of joint replacement is:
🅰️ Nausea
🅱️ Headache
✅ 🅲️ Deep vein thrombosis
🅳️ Constipation
Q4. Which of the following is a key nursing role post joint replacement?
🅰️ Encourage complete bed rest
🅱️ Avoid checking neurovascular status
✅ 🅲️ Promote early mobilization with physiotherapy
🅳️ Encourage high-impact exercises
Q5. Loosening of a prosthetic joint may require:
🅰️ Casting
🅱️ Blood transfusion
✅ 🅲️ Revision surgery
🅳️ NSAIDs only
Crutches are assistive walking devices that help transfer body weight from the lower limbs to the upper body, providing support and balance for individuals with temporary or permanent mobility impairment.
“Crutches are orthopedic mobility aids used to assist walking by relieving weight-bearing on lower extremities due to injury, surgery, or weakness.”
| Type | Description | Indications |
| Axillary crutches | Placed under the armpits; used short-term | Fractures, post-operative care, sprains |
| Elbow (Forearm/Lofstrand) crutches | Have cuffs that wrap around forearms; used long-term | Polio, cerebral palsy, long-term rehab |
| Gutter crutches | Padded forearm support; for weak grip | Rheumatoid arthritis, elderly with weak hands |
| Platform crutches | Similar to gutter, forearm rests on platform | Severe hand or wrist disability |
| Gait Type | Use | Pattern |
| 2-point gait | Partial weight bearing | Move crutch and opposite leg together |
| 3-point gait | Non-weight bearing | Move both crutches + affected leg, then good leg |
| 4-point gait | Maximum support (slow) | One crutch → opposite leg → other crutch → other leg |
| Swing-to gait | Bilateral leg involvement | Crutches move forward, both legs swing to crutches |
| Swing-through gait | For trained users | Legs swing past the crutches |
| Complication | Cause |
| Axillary nerve injury | Crutch pressing on axilla (incorrect use) |
| Wrist/elbow pain | Poor height adjustment or overuse |
| Fatigue or falls | Improper gait technique |
| Skin abrasions or sores | Poor padding or prolonged use |
Q1. The space between axilla and crutch top should be:
🅰️ Touching the axilla
🅱️ 5 inches
✅ 🅲️ 2 inches or 2–3 fingerbreadths
🅳️ No gap needed
Q2. Forearm crutches are also known as:
🅰️ Axillary crutches
🅱️ Gutter crutches
✅ 🅲️ Lofstrand crutches
🅳️ Shoulder crutches
Q3. The gait pattern suitable for non-weight-bearing patients is:
🅰️ 2-point gait
🅱️ 4-point gait
✅ 🅲️ 3-point gait
🅳️ Swing-to gait
Q4. A major complication of improper axillary crutch use is:
🅰️ Skin rash
🅱️ Hip pain
✅ 🅲️ Brachial plexus injury
🅳️ Foot drop
Q5. During crutch walking, the ideal elbow flexion should be:
🅰️ 0–10 degrees
🅱️ 10–15 degrees
✅ 🅲️ 20–30 degrees
🅳️ 40–50 degrees
Crutch walking refers to the technique of ambulation using crutches for support, balance, and mobility when the lower limb is weak, injured, or non-weight bearing.
“Crutch walking is a method of locomotion in which crutches are used to assist walking while minimizing or eliminating weight-bearing on one or both lower limbs.”
| Gait Type | Description | Indicated For |
| 2-point gait | Right crutch + left leg → left crutch + right leg | Partial weight bearing; mild bilateral weakness |
| 3-point gait | Both crutches + affected leg → then unaffected leg | Non-weight bearing on one leg |
| 4-point gait | One crutch → opposite leg → other crutch → other leg | Maximum support; poor balance |
| Swing-to gait | Both crutches forward → swing both legs to crutches | Bilateral weakness with good upper body strength |
| Swing-through gait | Crutches forward → swing both legs beyond crutches | For experienced users (e.g., paraplegics) |
Q1. Which gait pattern is most appropriate for a non-weight bearing leg?
🅰️ 2-point gait
✅ 🅱️ 3-point gait
🅲️ 4-point gait
🅳️ Swing-to gait
Q2. During crutch walking, the elbow should be flexed at:
🅰️ 10–15°
✅ 🅱️ 20–30°
🅲️ 40–50°
🅳️ Fully extended
Q3. Resting the axilla on the crutch pad may cause:
🅰️ Neck pain
🅱️ Shoulder stiffness
✅ 🅲️ Brachial plexus injury
🅳️ Hip dislocation
Q4. Which gait provides the maximum support and stability?
🅰️ 2-point gait
🅱️ Swing-through gait
🅲️ 3-point gait
✅ 🅳️ 4-point gait
Q5. A swing-through gait is typically used by patients with:
🅰️ Hip dislocation
🅱️ Mild knee sprain
🅲️ Elderly with arthritis
✅ 🅳️ Paraplegia with strong arms
📚🦴 Disorders of the Musculoskeletal System
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
Definition:
Musculoskeletal disorders (MSDs) refer to a wide range of conditions that affect bones, muscles, joints, tendons, ligaments, and cartilage, resulting in pain, stiffness, swelling, or reduced mobility.
“These disorders may be acute or chronic and can be due to trauma, infection, inflammation, degeneration, or autoimmune processes.”
Classification / Types:
| Type | Examples |
| Inflammatory | Rheumatoid arthritis, ankylosing spondylitis |
| Degenerative | Osteoarthritis, spondylosis |
| Traumatic | Fractures, dislocations, sprains |
| Metabolic | Osteoporosis, rickets, osteomalacia |
| Congenital | Clubfoot, hip dysplasia, scoliosis |
| Infectious | Osteomyelitis, septic arthritis |
| Tumors | Osteosarcoma, Ewing’s sarcoma |
A fracture is a break in the continuity of a bone, which may result from trauma, pathological conditions, or repetitive stress.
“Fracture is a medical condition in which a bone is cracked or broken due to force, disease, or overuse.”
| Type | Description |
| Closed (simple) | Bone breaks but does not pierce the skin |
| Open (compound) | Bone breaks and pierces the skin, increasing risk of infection |
| Type | Description |
| Complete | Bone is broken into two or more pieces |
| Incomplete (greenstick) | Bone cracks but does not break fully; common in children |
| Comminuted | Bone is shattered into multiple fragments |
| Oblique | Diagonal break across the bone |
| Transverse | Straight horizontal break |
| Spiral | Twisting injury causes the break to spiral |
| Impacted | Ends of bone are driven into each other |
| Pathological | Due to underlying disease (e.g., osteoporosis, cancer) |
| Stress fracture | Tiny crack due to repetitive force or overuse |
| Treatment | Description |
| Closed reduction | Manual realignment of bone ends without surgery |
| Open reduction | Surgical realignment (ORIF) with internal fixation |
| External fixation | Stabilization using external rods/pins |
| Traction | To align bones using weights |
| Casting/Splinting | To immobilize and support healing bone |
Q1. The most common investigation to confirm a fracture is:
🅰️ MRI
🅱️ Ultrasound
✅ 🅲️ X-ray
🅳️ CT angiography
Q2. Greenstick fractures are typically seen in:
🅰️ Adults
✅ 🅱️ Children
🅲️ Elderly
🅳️ Athletes
Q3. Which of the following is a sign of neurovascular compromise in fracture?
🅰️ Headache
✅ 🅱️ Paresthesia
🅲️ Itching
🅳️ Cough
Q4. Open reduction involves:
🅰️ Manual bone setting
✅ 🅱️ Surgical alignment of bone
🅲️ Massage therapy
🅳️ External splint only
Q5. Which nursing action is essential in a patient with a cast?
🅰️ Encourage hot compress
✅ 🅱️ Check for distal pulses regularly
🅲️ Keep limb lowered
🅳️ Apply tight bandage over cast
Rheumatoid Arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that primarily affects synovial joints, causing pain, swelling, stiffness, and progressive joint deformity.
“RA is a symmetrical polyarthritis characterized by inflammation of synovial membranes, leading to joint destruction and systemic involvement.”
| Type | Description |
| Seropositive RA | Rheumatoid factor (RF) and anti-CCP antibodies are present |
| Seronegative RA | RF and anti-CCP negative but clinical symptoms present |
| Juvenile RA | RA onset before age 16 |
| Felty’s Syndrome | RA + splenomegaly + neutropenia (rare complication) |
| Drug Class | Examples |
| NSAIDs | Ibuprofen, naproxen – for pain and inflammation |
| DMARDs | Methotrexate (1st-line), sulfasalazine, hydroxychloroquine |
| Biologic agents | TNF inhibitors (e.g., etanercept, infliximab) |
| Steroids | Prednisone – for flares and short-term control |
Q1. Which of the following is a hallmark of RA?
🅰️ Morning stiffness <30 min
✅ 🅱️ Symmetrical joint swelling
🅲️ Single joint involvement
🅳️ Painless joints
Q2. Which is the most specific diagnostic marker for RA?
🅰️ ESR
🅱️ CRP
✅ 🅲️ Anti-CCP antibody
🅳️ Rheumatoid factor
Q3. The first-line disease-modifying drug for RA is:
🅰️ Paracetamol
🅱️ Prednisolone
✅ 🅲️ Methotrexate
🅳️ Azathioprine
Q4. A deformity commonly seen in RA is:
🅰️ Genu valgum
🅱️ Clubfoot
✅ 🅲️ Swan-neck deformity
🅳️ Foot drop
Q5. Which nursing intervention is most important during RA flare-ups?
🅰️ Encourage exercise
✅ 🅱️ Promote joint rest and splinting
🅲️ Apply heat packs only
🅳️ Give high-protein diet immediately
Ankylosing Spondylitis (AS) is a chronic, progressive inflammatory disease that primarily affects the spine and sacroiliac joints, leading to pain, stiffness, and eventual fusion of vertebrae (ankylosis).
“AS is a seronegative spondyloarthropathy characterized by inflammation of spinal joints and eventual rigidity of the axial skeleton.”
| Type | Description |
| Axial AS | Involves spine and sacroiliac joints (most common form) |
| Peripheral AS | Involves peripheral joints (shoulders, hips, knees) |
| Juvenile AS | Onset before 16 years of age |
| Non-radiographic AS | Early stage with no radiographic changes but clinical symptoms present |
| Drug Class | Examples |
| NSAIDs | Indomethacin, naproxen – first-line for pain & stiffness |
| DMARDs | Sulfasalazine – if peripheral joints involved |
| Biologic agents | TNF inhibitors (etanercept, adalimumab) – for severe cases |
| Corticosteroids | For flares or eye involvement |
Q1. Ankylosing Spondylitis primarily affects which part of the body?
🅰️ Fingers
🅱️ Elbows
✅ 🅲️ Spine and sacroiliac joints
🅳️ Skull
Q2. Which genetic marker is commonly found in patients with AS?
🅰️ HLA-A3
✅ 🅱️ HLA-B27
🅲️ HLA-DR4
🅳️ HLA-Cw6
Q3. Which radiological feature is characteristic of AS?
🅰️ Osteolytic lesion
🅱️ Onion peel appearance
✅ 🅲️ Bamboo spine
🅳️ Sunburst appearance
Q4. Which activity helps reduce symptoms of AS?
🅰️ Prolonged bed rest
🅱️ Immobility
✅ 🅲️ Regular spinal exercises
🅳️ Carrying heavy loads
Q5. Which of the following is a common extra-articular manifestation of AS?
🅰️ Diabetes
🅱️ Hypertension
✅ 🅲️ Uveitis
🅳️ Nephritis
Gout is a metabolic disorder characterized by recurrent episodes of acute arthritis due to the deposition of monosodium urate crystals in joints and soft tissues caused by elevated uric acid levels (hyperuricemia).
“Gout is a painful inflammatory arthritis caused by uric acid crystal deposition in joints, typically starting in the big toe.”
| Type | Description |
| Acute Gout | Sudden onset of joint pain due to uric acid crystal deposition |
| Chronic Tophaceous Gout | Repeated attacks leading to joint deformities and tophi formation |
| Intercritical Gout | Asymptomatic phase between acute attacks |
| Pseudogout | Calcium pyrophosphate crystals (not uric acid); mimics gout |
| Phase | Drugs |
| Acute attack | NSAIDs (e.g., indomethacin), colchicine, prednisone |
| Chronic prevention | Allopurinol, febuxostat – inhibit uric acid synthesis Probenecid – increases uric acid excretion |
Avoid starting allopurinol during acute attack
Q1. The most common joint affected in gout is:
🅰️ Knee
✅ 🅱️ Big toe (MTP joint)
🅲️ Elbow
🅳️ Wrist
Q2. Which crystal is seen in gouty arthritis?
🅰️ Calcium oxalate
🅱️ Calcium pyrophosphate
✅ 🅲️ Monosodium urate
🅳️ Cholesterol crystals
Q3. Which drug is used for acute gout attack?
🅰️ Allopurinol
🅱️ Probenecid
✅ 🅲️ Colchicine
🅳️ Methotrexate
Q4. Which dietary habit should be avoided in gout?
🅰️ High-fiber foods
🅱️ Citrus fruits
✅ 🅲️ Organ meats and alcohol
🅳️ Low-fat milk
Q5. What is the purpose of allopurinol in gout?
🅰️ Reduce inflammation
✅ 🅱️ Lower uric acid levels
🅲️ Increase pain threshold
🅳️ Improve joint mobility only
Osteoarthritis (OA) is a chronic, non-inflammatory, degenerative joint disease characterized by progressive destruction of articular cartilage, formation of osteophytes, and joint space narrowing, leading to pain and stiffness.
“OA is the most common form of arthritis that causes joint degeneration, typically affecting weight-bearing joints like knees, hips, and spine.”
| Type | Description |
| Primary OA | Occurs with aging and wear-and-tear without underlying cause |
| Secondary OA | Due to predisposing factors like trauma, obesity, congenital joint deformity, or inflammatory diseases |
| Localized OA | Affects 1 or 2 joints (e.g., knee, hip) |
| Generalized OA | Affects 3 or more joints (including hands and spine) |
| Drug Class | Examples |
| Analgesics | Paracetamol – first-line for pain relief |
| NSAIDs | Ibuprofen, diclofenac – for pain and inflammation |
| Topical agents | Capsaicin cream, diclofenac gel |
| Intra-articular injections | Corticosteroids, hyaluronic acid |
Q1. Which joint is most commonly affected in osteoarthritis?
🅰️ Elbow
✅ 🅱️ Knee
🅲️ Shoulder
🅳️ Ankle
Q2. Which radiographic feature is typical of OA?
🅰️ Bamboo spine
🅱️ Osteopenia
✅ 🅲️ Osteophyte formation
🅳️ Joint fusion
Q3. The first-line analgesic for mild OA is:
🅰️ Aspirin
✅ 🅱️ Paracetamol
🅲️ Diclofenac
🅳️ Tramadol
Q4. Morning stiffness in OA usually lasts:
🅰️ More than 1 hour
✅ 🅱️ Less than 30 minutes
🅲️ All day
🅳️ No stiffness at all
Q5. Heberden’s nodes in OA are found in:
🅰️ Elbow joint
🅱️ Knee joint
✅ 🅲️ Distal interphalangeal joints
🅳️ Shoulder joint
Osteoporosis is a metabolic bone disorder characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures, especially in the hip, spine, and wrist.
“Osteoporosis is a silent disease of bones where bones become weak, brittle, and prone to fractures due to loss of bone density.”
| Type | Description |
| Primary Osteoporosis | Occurs due to aging, postmenopause, or idiopathic causes |
| Secondary Osteoporosis | Caused by underlying diseases (e.g., Cushing’s, hyperthyroidism) or drugs (e.g., steroids) |
| Senile Osteoporosis | Age-related bone loss in elderly (both sexes) |
| Postmenopausal Osteoporosis | Due to estrogen deficiency after menopause |
| Juvenile Osteoporosis | Rare, occurs in children/adolescents without known cause |
| Treatment | Examples |
| Calcium + Vitamin D supplements | Calcium 1000–1200 mg/day, Vit D 800–1000 IU/day |
| Bisphosphonates | Alendronate, risedronate – reduce bone resorption |
| Selective Estrogen Receptor Modulators (SERMs) | Raloxifene |
| Hormone Replacement Therapy (HRT) | In postmenopausal women (with caution) |
| Calcitonin nasal spray | Reduces bone pain and preserves BMD |
| Denosumab | Monoclonal antibody for severe osteoporosis |
| Teriparatide | Recombinant PTH analog – promotes bone formation |
Q1. The gold standard test for diagnosing osteoporosis is:
🅰️ X-ray
🅱️ MRI
✅ 🅲️ DEXA scan
🅳️ Bone biopsy
Q2. A T-score of -2.8 on a DEXA scan indicates:
🅰️ Normal bone density
🅱️ Osteopenia
✅ 🅲️ Osteoporosis
🅳️ Hyperparathyroidism
Q3. Which drug reduces bone resorption in osteoporosis?
🅰️ Paracetamol
🅱️ Aspirin
✅ 🅲️ Alendronate
🅳️ Iron sulfate
Q4. Which of the following is a common site for osteoporotic fracture?
🅰️ Skull
🅱️ Elbow
✅ 🅲️ Vertebrae
🅳️ Sternum
Q5. Which vitamin is most essential in calcium absorption?
🅰️ Vitamin A
🅱️ Vitamin C
✅ 🅲️ Vitamin D
🅳️ Vitamin K
Osteomalacia is a metabolic bone disorder characterized by softening of bones in adults due to defective bone mineralization, primarily caused by vitamin D deficiency.
“Osteomalacia refers to the softening of adult bones due to inadequate mineralization of the bone matrix, commonly resulting from vitamin D deficiency.”
| Type | Description |
| Nutritional Osteomalacia | Due to inadequate dietary intake or sun exposure |
| Malabsorptive Osteomalacia | Due to poor absorption in GI disorders (e.g., celiac disease) |
| Renal Osteodystrophy | Due to chronic kidney disease affecting vitamin D metabolism |
| Drug-induced Osteomalacia | Caused by anticonvulsants, antacids, etc. interfering with vitamin D |
| Treatment | Purpose |
| Vitamin D supplementation (cholecalciferol or ergocalciferol) | Corrects deficiency |
| Calcium supplements | Enhances bone mineralization |
| Phosphate supplements | In selected cases with hypophosphatemia |
| Treat underlying cause | E.g., malabsorption, renal disease |
Q1. Osteomalacia occurs due to deficiency of:
🅰️ Vitamin B12
🅱️ Vitamin C
✅ 🅲️ Vitamin D
🅳️ Vitamin K
Q2. A common symptom of osteomalacia is:
🅰️ Joint deformity
🅱️ High-grade fever
✅ 🅲️ Bone pain and proximal muscle weakness
🅳️ Clubbing of fingers
Q3. Looser’s zones in osteomalacia are:
🅰️ Joint swelling
🅱️ Inflammatory changes
✅ 🅲️ Pseudofractures seen on X-ray
🅳️ Areas of bone cancer
Q4. The enzyme most elevated in osteomalacia is:
🅰️ Creatinine
🅱️ LDH
✅ 🅲️ Alkaline phosphatase
🅳️ Amylase
Q5. Best initial management of nutritional osteomalacia is:
🅰️ High protein diet
🅱️ Bed rest
✅ 🅲️ Vitamin D and calcium supplementation
🅳️ Corticosteroids
Osteomyelitis is an infection of the bone, bone marrow, and surrounding soft tissues caused by bacteria, fungi, or other pathogens, leading to inflammation, necrosis, and bone destruction.
“Osteomyelitis is a severe bone infection usually caused by Staphylococcus aureus, leading to inflammation and possible bone death if untreated.”
| Type | Description |
| Acute Osteomyelitis | Sudden onset, <2 weeks duration, mostly in children |
| Subacute Osteomyelitis | Lasts weeks to months, mild symptoms |
| Chronic Osteomyelitis | Long-standing infection with necrotic bone (sequestrum) and possible sinus tract formation |
| Hematogenous | Spread via bloodstream (common in children) |
| Contiguous spread | Infection spreads from adjacent tissues or wounds |
| Direct inoculation | From trauma, fracture, or orthopedic surgery |
| Treatment | Details |
| Antibiotic therapy | High-dose IV antibiotics for 4–6 weeks (e.g., vancomycin, ceftriaxone) based on culture sensitivity |
| Analgesics | For pain relief |
| Antipyretics | For fever control |
| Nutritional support | High-protein, high-calorie diet for healing |
Q1. The most common causative organism of osteomyelitis is:
🅰️ Streptococcus pneumoniae
✅ 🅱️ Staphylococcus aureus
🅲️ Mycobacterium tuberculosis
🅳️ Escherichia coli
Q2. A hallmark radiographic feature of chronic osteomyelitis is:
🅰️ Bamboo spine
✅ 🅱️ Sequestrum formation
🅲️ Joint space widening
🅳️ Bone tumors
Q3. What is the gold standard investigation for diagnosing osteomyelitis?
🅰️ X-ray
🅱️ ESR
🅲️ MRI
✅ 🅳️ Bone biopsy
Q4. Which antibiotic route is preferred initially in osteomyelitis?
🅰️ Oral
✅ 🅱️ Intravenous
🅲️ Intramuscular
🅳️ Subcutaneous
Q5. A major nursing intervention in osteomyelitis is:
🅰️ Encourage walking
✅ 🅱️ Administer IV antibiotics and provide wound care
🅲️ Apply heat compresses
🅳️ Use anticoagulants daily
Septic arthritis is an acute infection of a joint space caused by bacteria, viruses, or fungi, leading to inflammation, joint destruction, and potential loss of function if not treated promptly.
“Septic arthritis is a painful infection in a joint that occurs when pathogens invade the joint cavity, commonly via bloodstream or direct injury.”
| Type | Description |
| Acute Septic Arthritis | Sudden onset, typically bacterial, medical emergency |
| Chronic Septic Arthritis | Slow onset, often due to tuberculosis or fungal infections |
| Gonococcal Arthritis | Caused by Neisseria gonorrhoeae, usually in sexually active adults |
| Prosthetic Joint Infection | Involves artificial joints (post-replacement surgery) |
| Treatment | Details |
| Empiric IV antibiotics | Started immediately after aspiration (e.g., vancomycin + ceftriaxone) |
| Targeted antibiotics | Based on culture sensitivity, continued for 2–6 weeks |
| NSAIDs / Analgesics | For pain and inflammation |
| Antipyretics | For fever management |
Q1. The most common organism causing septic arthritis is:
🅰️ E. coli
✅ 🅱️ Staphylococcus aureus
🅲️ Mycobacterium tuberculosis
🅳️ Neisseria gonorrhoeae
Q2. What is the most definitive test for septic arthritis?
🅰️ X-ray
🅱️ MRI
✅ 🅲️ Joint fluid aspiration with culture
🅳️ ESR
Q3. Which joint is most commonly involved in septic arthritis?
🅰️ Shoulder
✅ 🅱️ Knee
🅲️ Elbow
🅳️ Spine
Q4. The initial treatment of septic arthritis includes:
🅰️ Oral steroids
🅱️ Immobilization only
✅ 🅲️ IV antibiotics and joint drainage
🅳️ NSAIDs alone
Q5. A nursing priority in a patient with septic arthritis is:
🅰️ Encourage ambulation
✅ 🅱️ Administer antibiotics and monitor joint condition
🅲️ Massage the joint
🅳️ Apply cold packs directly
Tendinitis is an acute or chronic inflammation of a tendon — the thick fibrous cords that attach muscle to bone — resulting in pain, tenderness, and limited movement of the affected joint.
“Tendinitis is the inflammation of a tendon, often caused by overuse, injury, or repetitive motion.”
| Type | Common Site | Description |
| Rotator cuff tendinitis | Shoulder | Inflammation of tendons around shoulder joint |
| Tennis elbow (Lateral epicondylitis) | Elbow | Affects tendons on the outside of elbow |
| Golfer’s elbow (Medial epicondylitis) | Elbow | Affects tendons on the inside of elbow |
| Achilles tendinitis | Heel | Affects tendon connecting calf muscles to heel |
| Patellar tendinitis (Jumper’s knee) | Knee | Affects tendon connecting kneecap to shinbone |
| Therapy | Purpose |
| RICE therapy | Rest, Ice, Compression, Elevation (first-line treatment) |
| NSAIDs | Ibuprofen, naproxen – for pain and inflammation |
| Topical analgesics | For localized relief |
| Corticosteroid injections | For persistent inflammation (short-term use) |
| Physiotherapy | Stretching and strengthening exercises |
Q1. Which of the following is NOT a typical cause of tendinitis?
🅰️ Repetitive strain
🅱️ Trauma
✅ 🅲️ Bacterial infection
🅳️ Poor posture
Q2. The initial treatment approach for tendinitis includes:
🅰️ Surgery
✅ 🅱️ Rest, ice, and NSAIDs
🅲️ Chemotherapy
🅳️ Immunotherapy
Q3. Tennis elbow is a type of tendinitis affecting which joint?
🅰️ Shoulder
🅱️ Knee
✅ 🅲️ Lateral elbow
🅳️ Wrist
Q4. Which imaging technique best shows soft tissue like tendons?
🅰️ X-ray
🅱️ CT scan
✅ 🅲️ MRI
🅳️ Bone scan
Q5. Which class of drugs is used to reduce inflammation in tendinitis?
🅰️ Antibiotics
🅱️ Antivirals
✅ 🅲️ NSAIDs
🅳️ Antacids
Bursitis is the inflammation of a bursa, which is a small, fluid-filled sac that cushions bones, tendons, and muscles near joints. It results in pain, swelling, and restricted movement of the affected area.
“Bursitis is a painful condition caused by inflammation of a bursa, typically resulting from overuse, trauma, or infection.”
| Type | Common Site | Description |
| Subacromial bursitis | Shoulder | Most common, related to rotator cuff impingement |
| Olecranon bursitis | Elbow | Swelling over the tip of the elbow |
| Trochanteric bursitis | Hip | Pain over the outer side of the hip |
| Prepatellar bursitis (Housemaid’s knee) | Knee | Swelling over kneecap |
| Anserine bursitis | Inner side of knee | Common in obese and osteoarthritic individuals |
| Infectious (septic) bursitis | Any site | Caused by bacterial infection (usually Staph aureus) |
| Therapy | Purpose |
| NSAIDs | For pain and inflammation (e.g., ibuprofen, naproxen) |
| Cold compresses | To reduce swelling and pain |
| Antibiotics | In case of septic bursitis |
| Corticosteroid injections | In resistant or chronic inflammation |
| Aspiration of bursal fluid | To relieve pressure and diagnose infection |
Q1. What is the most common cause of bursitis?
🅰️ Viral infection
✅ 🅱️ Repetitive motion or overuse
🅲️ Fracture
🅳️ Metabolic disorder
Q2. Which site is commonly involved in “Housemaid’s knee”?
🅰️ Hip
🅱️ Elbow
✅ 🅲️ Prepatellar bursa
🅳️ Shoulder
Q3. Which medication is used first-line in non-infectious bursitis?
🅰️ Antibiotics
🅱️ Opioids
✅ 🅲️ NSAIDs
🅳️ Antidepressants
Q4. A key diagnostic test for septic bursitis is:
🅰️ CT scan
✅ 🅱️ Bursal fluid aspiration
🅲️ X-ray
🅳️ ECG
Q5. A priority nursing action in bursitis includes:
🅰️ Encourage joint overuse
🅱️ Hot fomentation only
✅ 🅲️ Administer NSAIDs and provide cold compress
🅳️ Apply tight bandage
Paget’s disease of bone is a chronic skeletal disorder characterized by abnormal bone remodeling, where there is excessive bone resorption followed by disorganized bone formation, resulting in enlarged, weakened, and deformed bones.
“Paget’s disease is a chronic metabolic bone condition that leads to structurally abnormal and fragile bones due to defective remodeling.”
| Type | Description |
| Monostotic | Involves a single bone (e.g., skull, femur) |
| Polyostotic | Involves multiple bones (more common) |
| Asymptomatic | Found incidentally during X-rays or elevated ALP |
| Symptomatic | Presents with bone pain, deformities, or fractures |
| Drug Class | Examples |
| Bisphosphonates (first-line) | Alendronate, risedronate – inhibit bone resorption |
| Calcitonin | Alternative if bisphosphonates not tolerated |
| NSAIDs / analgesics | For bone and joint pain |
| Calcium & vitamin D | Supplementation to maintain bone health |
Bisphosphonates are given intermittently in Paget’s disease to control bone turnover.
Q1. The most common biochemical abnormality in Paget’s disease is:
🅰️ Low calcium
🅱️ Low phosphate
✅ 🅲️ Elevated alkaline phosphatase
🅳️ Elevated PTH
Q2. Which bone is commonly involved in Paget’s disease?
🅰️ Mandible
✅ 🅱️ Skull
🅲️ Sternum
🅳️ Clavicle
Q3. The radiological term “cotton wool appearance” refers to:
🅰️ Tuberculosis
🅱️ Osteoporosis
✅ 🅲️ Paget’s disease
🅳️ Osteosarcoma
Q4. What is the drug of choice for Paget’s disease?
🅰️ Calcitonin
🅱️ Teriparatide
✅ 🅲️ Bisphosphonates
🅳️ Methotrexate
Q5. A patient with Paget’s disease should be monitored for:
🅰️ Hypoglycemia
🅱️ Urinary retention
✅ 🅲️ Pathological fractures and hearing loss
🅳️ Hypertension only
Rhabdomyolysis is a serious medical condition involving the rapid breakdown of damaged skeletal muscle, leading to the release of muscle cell contents (e.g., myoglobin, creatine kinase, electrolytes) into the bloodstream, which can cause acute kidney injury (AKI).
“Rhabdomyolysis is the breakdown of striated muscle that releases intracellular toxins into circulation, leading to systemic complications.”
| Type | Description |
| Traumatic | Caused by direct muscle injury (crush injury, accident) |
| Non-traumatic exertional | Due to overexertion (e.g., marathon, heavy exercise) |
| Non-traumatic non-exertional | Due to drugs, infections, metabolic causes, toxins |
| Treatment | Purpose |
| Aggressive IV fluids (NS or bicarbonate) | Prevent acute kidney injury by diluting myoglobin |
| Electrolyte correction | Manage hyperkalemia, hypocalcemia, etc. |
| Diuretics (e.g., mannitol) | Promote urine flow (used selectively) |
| Alkalinization of urine (sodium bicarbonate) | Prevent precipitation of myoglobin in renal tubules |
| Dialysis | In severe cases of acute renal failure |
Q1. The most specific lab finding in rhabdomyolysis is:
🅰️ Low calcium
🅱️ High BUN
✅ 🅲️ Elevated creatine kinase
🅳️ Elevated ESR
Q2. What is the classic urine appearance in rhabdomyolysis?
🅰️ Pale yellow
🅱️ Cloudy white
✅ 🅲️ Tea or cola-colored
🅳️ Red with RBCs
Q3. The most serious complication of rhabdomyolysis is:
🅰️ Hepatic failure
✅ 🅱️ Acute kidney injury
🅲️ Stroke
🅳️ Gastrointestinal bleeding
Q4. Initial management priority in rhabdomyolysis is:
🅰️ Oxygen therapy
✅ 🅱️ Aggressive IV fluid replacement
🅲️ Diuretics
🅳️ Blood transfusion
Q5. Which electrolyte imbalance is commonly seen in rhabdomyolysis?
🅰️ Hypokalemia
✅ 🅱️ Hyperkalemia
🅲️ Hypercalcemia
🅳️ Hyponatremia
Rickets is a pediatric metabolic bone disorder caused by defective mineralization of growing bones and cartilage at the epiphyseal growth plates, primarily due to vitamin D, calcium, or phosphate deficiency, leading to soft, weak, and deformed bones.
“Rickets is the childhood counterpart of osteomalacia, presenting with bone pain, deformities, and growth disturbances due to vitamin D deficiency.”
| Type | Cause |
| Nutritional Rickets | Vitamin D, calcium, or phosphate deficiency (most common) |
| Vitamin D–dependent Rickets | Genetic defect in vitamin D metabolism |
| Vitamin D–resistant (hypophosphatemic) Rickets | Renal phosphate wasting (X-linked or autosomal) |
| Renal Rickets | Secondary to chronic kidney disease |
| Drug-induced Rickets | Long-term use of anticonvulsants interfering with vitamin D metabolism |
| Therapy | Details |
| Vitamin D supplementation | Cholecalciferol (Vitamin D₃) orally or by injection |
| Calcium supplements | As per requirement (elemental calcium) |
| Phosphate supplements | In vitamin D–resistant rickets |
| Active vitamin D analogs | Calcitriol in renal rickets |
| Treat underlying causes | e.g., CKD, malabsorption |
Q1. The most common cause of rickets is:
🅰️ Protein deficiency
🅱️ Vitamin C deficiency
✅ 🅲️ Vitamin D deficiency
🅳️ Iron deficiency
Q2. A classic radiological finding in rickets is:
🅰️ Bamboo spine
🅱️ Codfish vertebrae
✅ 🅲️ Cupping and fraying of metaphysis
🅳️ Sunburst appearance
Q3. Rachitic rosary is seen in:
🅰️ Asthma
🅱️ Marasmus
✅ 🅲️ Rickets
🅳️ Scurvy
Q4. Which biochemical marker is elevated in rickets?
🅰️ Serum phosphate
🅱️ Serum vitamin C
✅ 🅲️ Serum alkaline phosphatase
🅳️ Serum albumin
Q5. What is the priority nursing advice for prevention of rickets in infants?
🅰️ Limit milk intake
🅱️ Avoid sunlight
✅ 🅲️ Ensure vitamin D supplementation and sunlight exposure
🅳️ Avoid physical activity
Spinal column deformities are structural abnormalities of the curvature or alignment of the spine, resulting in abnormal posture, discomfort, or functional impairment. These deformities may be congenital, developmental, or acquired.
“Spinal deformities refer to abnormal curvatures of the spine such as scoliosis, kyphosis, or lordosis that may affect appearance, movement, or internal organs.”
| Type | Description |
| Scoliosis | Lateral (sideways) curvature of the spine, often S- or C-shaped |
| Kyphosis | Exaggerated outward curvature of thoracic spine → hunched back |
| Lordosis | Exaggerated inward curvature of lumbar spine → swayback |
| Gibbus deformity | Sharp angular kyphosis, usually due to tuberculosis or fracture |
| Flat back syndrome | Loss of natural spinal curves causing a straight posture |
| Treatment | Purpose |
| Postural correction and physiotherapy | Improve alignment and muscle balance |
| Bracing (e.g., Milwaukee or Boston brace) | Prevent curvature progression in scoliosis |
| Analgesics and muscle relaxants | For pain relief |
| Back exercises and yoga | To strengthen paraspinal muscles |
Bracing is most effective in skeletally immature children with moderate scoliosis.
Q1. Which spinal deformity is described as lateral curvature of the spine?
🅰️ Kyphosis
🅱️ Lordosis
✅ 🅲️ Scoliosis
🅳️ Gibbus
Q2. The Cobb angle is used to assess severity of:
🅰️ Fractures
🅱️ Lordosis
✅ 🅲️ Scoliosis
🅳️ Kyphosis
Q3. Gibbus deformity is typically seen in:
🅰️ Osteoporosis
🅱️ Idiopathic scoliosis
✅ 🅲️ Tuberculosis of spine
🅳️ Lumbar disc herniation
Q4. Which of the following is a non-surgical treatment for scoliosis?
🅰️ Spinal fusion
✅ 🅱️ Bracing
🅲️ Harrington rod placement
🅳️ Laminectomy
Q5. A key nursing role in spinal deformity management includes:
🅰️ Applying ice packs to spine
🅱️ Avoiding physical activity
✅ 🅲️ Teaching posture correction and brace care
🅳️ Encouraging bed rest only
Pott’s disease is a form of extrapulmonary tuberculosis that affects the vertebral column, particularly the thoracic and lumbar spine, leading to vertebral destruction, spinal deformity, and possible neurological complications.
“Pott’s disease refers to tuberculosis infection of the spine, characterized by vertebral collapse, gibbus deformity, and risk of spinal cord compression.”
| Type | Description |
| Typical (classic) Pott’s disease | Involves adjacent vertebral bodies and intervertebral disc |
| Atypical | Non-contiguous vertebral involvement or skip lesions |
| With neurological deficit | Spinal cord or nerve root compression present |
| Without neurological deficit | Localized pain and deformity only |
| Treatment | Duration |
| Anti-tubercular therapy (ATT) | 6–12 months total duration (Intensive + Continuation phases) |
| Analgesics/NSAIDs | For pain relief |
| Immobilization | Bed rest or orthosis (brace) in early stages |
First-line ATT drugs include:
Q1. Pott’s disease refers to tuberculosis of the:
🅰️ Hip
🅱️ Lung
✅ 🅲️ Spine
🅳️ Brain
Q2. Which imaging technique is most sensitive for early Pott’s disease?
🅰️ X-ray
🅱️ Ultrasound
✅ 🅲️ MRI
🅳️ PET scan
Q3. A visible spinal deformity in Pott’s disease is known as:
🅰️ Lordosis
🅱️ Scoliosis
✅ 🅲️ Gibbus
🅳️ Kyphoscoliosis
Q4. The first-line treatment for spinal TB includes:
🅰️ IV antibiotics
🅱️ Corticosteroids only
✅ 🅲️ Anti-tubercular therapy
🅳️ Surgical fusion
Q5. The most serious complication of Pott’s disease is:
🅰️ Joint pain
🅱️ Weight loss
✅ 🅲️ Paraplegia
🅳️ Fever
Carpal Tunnel Syndrome (CTS) is a neuromuscular disorder caused by compression of the median nerve as it passes through the carpal tunnel of the wrist, resulting in pain, numbness, tingling, and weakness in the hand.
“CTS is an entrapment neuropathy of the median nerve within the carpal tunnel of the wrist.”
| Type | Description |
| Idiopathic CTS | No clear cause; most common type |
| Secondary CTS | Due to underlying conditions (RA, hypothyroidism, pregnancy) |
| Occupational CTS | Associated with repetitive hand/wrist movement (e.g., typing, sewing) |
| Bilateral CTS | Affects both hands (common in systemic diseases) |
| Treatment | Purpose |
| Wrist splinting (especially at night) | Prevents wrist flexion and reduces nerve compression |
| NSAIDs (ibuprofen, naproxen) | Reduce inflammation and pain |
| Activity modification | Avoid repetitive hand movements |
| Corticosteroid injections | Reduce local inflammation |
Q1. Carpal tunnel syndrome involves compression of which nerve?
🅰️ Radial nerve
🅱️ Ulnar nerve
✅ 🅲️ Median nerve
🅳️ Musculocutaneous nerve
Q2. Which test is used to diagnose CTS?
🅰️ Romberg test
✅ 🅱️ Phalen’s test
🅲️ Babinski sign
🅳️ Trendelenburg test
Q3. Which muscle group is affected in advanced CTS?
🅰️ Hypothenar muscles
✅ 🅱️ Thenar muscles
🅲️ Deltoid muscles
🅳️ Calf muscles
Q4. Which of the following is a first-line conservative treatment for CTS?
🅰️ Muscle relaxants
✅ 🅱️ Wrist splinting
🅲️ Surgical repair
🅳️ Heat therapy only
Q5. CTS is most commonly associated with:
🅰️ Kidney disease
✅ 🅱️ Repetitive wrist movement
🅲️ Stroke
🅳️ Visual impairment
Lower limb deformities involve abnormal angulation or alignment of the knee joint and lower extremities, leading to impaired gait, joint pain, or cosmetic concerns.
“Genu valgum, genu varum, and genu recurvatum are deformities affecting the normal axis of the lower limb, especially around the knee.”
| Type | Description |
| Genu Valgum (Knock knees) | Knees touch but ankles stay apart when standing |
| Genu Varum (Bow legs) | Knees stay apart when ankles are together |
| Genu Recurvatum | Hyperextension of the knee joint beyond normal limit |
| Deformity | Signs & Symptoms |
| Genu Valgum | Knees close together; awkward gait; pain in lateral knees or ankles |
| Genu Varum | Wide leg gap at knees; waddling gait; pain in medial knees |
| Genu Recurvatum | Knee bends backward when standing; hyperextension; instability or frequent falls |
Common across types:
| Indication | Management |
| Physiological cases in children | Observation (often resolves with age) |
| Mild/moderate deformities | Bracing, orthotic shoes, physiotherapy |
| Nutritional deficiency | Vitamin D and calcium supplementation |
| Indication | Management |
| Severe deformity or progressive cases | Osteotomy (bone cutting and realignment) |
| Growth modulation | Epiphysiodesis or guided growth surgery |
| Knee instability (recurvatum) | Ligament reconstruction or correction surgery |
Q1. Genu valgum is also known as:
🅰️ Bow legs
🅱️ Flat foot
✅ 🅲️ Knock knees
🅳️ Clubfoot
Q2. Genu varum is commonly associated with which deficiency?
🅰️ Iron
🅱️ Vitamin C
✅ 🅲️ Vitamin D
🅳️ Folic acid
Q3. The best initial approach in mild physiological genu valgum in a 4-year-old is:
🅰️ Surgery
🅱️ Casting
✅ 🅲️ Observation
🅳️ Steroid therapy
Q4. In genu recurvatum, the knee shows:
🅰️ Medial deviation
🅱️ Lateral deviation
✅ 🅲️ Hyperextension
🅳️ Flexion contracture
Q5. A key nursing responsibility in lower limb deformities is:
🅰️ Restrict all movement
🅱️ Apply heat therapy only
✅ 🅲️ Encourage physiotherapy and brace compliance
🅳️ Avoid calcium supplementation