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Pathopharm II Exam 1 > 1: Musculoskeletal (Part 2) 59-100 > Flashcards

1: Musculoskeletal (Part 2) 59-100 Flashcards

1
Q

Trauma
Is the leading cause of…

A

death of people, ages 1 to 44 years, of all races and at all socioeconomic levels.

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2
Q

Fracture

A
  • Is a break in the continuity of a bone.
  • when force exceeds the tensile or compressive strength of the bone.
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3
Q

Fracture classifications

A
  • Comminuted: breaks into >2 fragments
  • Linear: runs parallel to the long axis of the bone.
  • Oblique: shaft of the bone is slanted.
  • Complete: Bone is broken all the way through.
  • Incomplete: damaged but still in one piece.
  • Closed or simple (complete or incomplete): Skin is intact.
  • Open or compound (complete or incomplete): Skin is broken.
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4
Q

Fracture classifications
Part 2

A
  • Spiral: Encircles the bone.
  • Transverse: straight across the bone.
  • Greenstick: Perforates one cortex & splinters the spongy bone.
  • Torus: Cortex buckles but does not break.
  • Bowing: Longitudinal force is applied to a bone.
  • Pathologic: Break occurs at the site of a preexisting abnormality.
    Stress:
    -Fatigue and insufficiency
    -Transchondral
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5
Q

Broken bone can damage the surrounding…

A

tissue, periosteum, and blood vessels in the cortex and marrow

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6
Q

Bone is unique b/c….

A

After a fracture it will heal with normal tissue, not scar tissue.

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7
Q

T/F
Healing occurs in phases

A

True

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8
Q

Healing Phases

A
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9
Q

Whats this?

A

Callus formation

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10
Q

Fractures
Clinical manifestations

A
  • Unnatural alignment
  • swelling
  • muscle spasm
  • tenderness
  • impaired sensation
  • pain
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11
Q

Fractures
Treatment

A
  • Closed manipulation
  • traction (skeletal or skin)
  • open reduction
  • internal fixation
  • external fixation
  • Splints and casts

pic is external fixation

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12
Q

Improper reduction or immobilization
(3)

A

Nonunion
Delayed union
Malunion

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13
Q

Nonunion vs. Delayed union vs. Malunion

A

Nonunion:
* Bone ends don’t grow together.
* Gap between the broken ends fills with dense fibrous and fibrocartilaginous tissue.
* fibrous tissue may have fluid-filled space that resembles a joint (false joint/pseudarthrosis)
Delayed union: 8 to 9 months after a fracture
Malunion: heals in nonanatomic position

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14
Q

Improper reduction or immobilization
Treatment

A

goal: stimulate new bone formation

  • Implantable/external electric current devices
  • electromagnetic field generations
  • low-density ultrasound
  • Stem cell & gene therapy
  • Bone graft or synthetic materials (calcium phosphate cement): To fill large defects
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15
Q

Dislocation and Subluxation

A
  • Dislocation: Temporary displace bone from its joint
  • Subluxation: Contact between the bones in the joint only partially lost
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16
Q

Dislocation and Subluxation
Associated with…

A

fractures, muscle imbalance, rheumatoid arthritis, other joint instability

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17
Q

Dislocation and Subluxation
Clinical manifestations & Treatment

A
  • Pain
  • swelling
  • limitation of motion
  • joint deformity

Treatment:

  • Reduction and immobilization for 2 to 6 weeks
  • Exercises
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18
Q

Support Structure Trauma

A
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19
Q

Support Structure Trauma
(strain, sprain, avulsion)
Pathophys

A
  1. Inflammatory exudate develops between torn ends
  2. inward Granulation
  3. collagen formation 3 to 4 days after injury.
  4. Vascular fibrous tissue fuses the new and surrounding tissues into a single mass.
  5. Healing tendon or ligament lacks sufficient strength to withstand a strong pull for 4 to 5 weeks after the injury.
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20
Q

Support Structure Trauma
S/S & Treatment

(strain, sprain, avulsion)

A
  • painful
  • usually w/ soft-tissue swelling & changes in tendon/ligament contour.

Treatment

  • Splinting, early motion, and rehabilitation
  • Suturing: To treat a complete rupture
  • If suturing is not possible: Tendon or ligament grafting
  • Prolonged rehabilitation exercises
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21
Q

Tendinopathy and Bursitis

A
  • Tendinitis: tendon inflammation
  • Tendinosis: Painful degradation of collagen fibers
  • Epicondylitis: tendon inflammation where it attaches to a bone.

Bursitis: bursa inflammation
* Is caused by repeated trauma.
* Septic bursitis: Is caused by a wound infection

bursa: sacs; lined with synovial membrane; filled with synovial fluid; located among the tendons, muscles, and bony prominences.

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22
Q

Epicondylitis Types

A

Tennis elbow: Lateral epicondylitis
Golfer’s elbow: Medial epicondylitis

Is inflammation of a tendon where it attaches to a bone.

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23
Q

Treatment for tendinopathy and bursitis

A
  • Systemic analgesics, ice or heat applications
  • local injection of an anesthetic + corticosteroid to reduce inflammation
  • Bursitis: Aspiration to drain excess fluid
  • Physical therapy
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24
Q

Muscle Strain

A

sudden, forced motion, causing the muscle to become stretched beyond its normal capacity.

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25
Q

Muscle Strain causes local muscle damage & can also involve the ____

A

tendons

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26
Q

Regardless of the cause of trauma, muscle cells can usually regenerate, which may take…

A

up to 6 weeks

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27
Q

heterotopic ossification

A

Myositis Ossificans

28
Q

Myositis Ossificans

heterotopic ossification

A
  • Complication of local muscle injury
  • Inflammation of muscular tissue with subsequent calcification and ossification of the muscle
  • “Rider’s bone” in equestrians
  • “Drill bone” in infantry soldiers
  • Thigh muscles in football players
29
Q

Rhabdomyolysis

A
  • Life-threatening complication of severe muscle trauma with muscle cell loss
  • Rapid breakdown of muscle that causes the release of intracellular contents
30
Q

Injuries a/w Rhabdomyolysis

A

Crush syndrome versus crush injuries
Compartment syndromes

31
Q

In Rhabdomyolysis, ________ goes into extracellular space and bloodstream

A

protein pigment myoglobin

32
Q

Rhabdomyolysis
Classic triad

A

Muscle pain, weakness, and dark urine (from myoglobin)

33
Q

Rhabdomyolysis
Treatment

A
  • Rapid IV hydration: maintain adequate kidney flow
  • Hyperkalemia: temporary hemodialysis if needed
34
Q

Malignant Hyperthermia is a potentially life-threatening hereditary disorder of ….

A

skeletal muscle ryanodine receptors

35
Q

Malignant Hyperthermia
pathophys

A
  1. Large quantities of Ca are released from the sarcoplasmic reticulum (SR) after exposure to certain volatile anesthetics.
  2. hypermetabolic state
  3. respiratory & metabolic acidosis, muscle rigidity, altered cell permeability, & hyperkalemia.
36
Q

Dantrolene

A
  • skeletal muscle relaxant
  • inhibits Ca release from the SR to reverse the effects
37
Q

Compartment Syndrome is a complication of _____

A

fractures

38
Q

Compartment Syndrome

A

Blood flow to affected area is compromised because of increased venous pressure
⬇️
decreased arterial inflow, ischemia, and edema

39
Q

Compartment Syndrome
manifestations

A
  • Pain: Out of proportion to the injury
  • Paresthesia
  • pallor
  • pulselessness
  • paralysis (late sign)
40
Q

Compartment Syndrome
Rising compartment pressure can be directly measured by….

A

inserting a wick catheter, needle, or slit catheter into the muscle

41
Q

Compartment Syndrome
Treatment

A
  • Immediate fasciotomy and debridement
  • Emergency treatment may be required to save an affected limb.
42
Q

Compartment Syndrome
Pathophysiology

A
43
Q

Osteoporosis

A

Porous bone
Poorly mineralized bone
Primary versus secondary

44
Q

Bone density
normal vs osteopenic vs osteoporosis

A
  • Normal bone: 833 mg/cm2
  • Osteopenic bone: 833 - 648 mg/cm2
  • Osteoporosis: <648 mg/cm2

Osteopenia: Decreased bone mass

45
Q

Osteoporosis
Potential causes

A
  • ↓ estrogen, testosterone, activity level, Vit D, Ca, Mag
  • Altered osteoprotegerin (OPG), receptor activator of nuclear factor kappa B (κB) ligand (RANKL), and receptor activator of nuclear factor κB (RANK): OPG/RANKL/RANK system
46
Q

How do menopause and glucocorticoids contribute to osteoporosis?

A

Postmenopausal:

  • ↑ osteoclast activity, insulin-like growth factor (IGF)
  • family history

Glucocorticoids:

  • Increase RANKL expression and inhibit OPG production by osteoblasts, leading to lower bone density
47
Q

OPG/RANKL/RANK system

A
48
Q

Osteoporosis: Reduced bone mass/density and….

A

an imbalance of bone resorption and formation

49
Q

T/F
In Osteoporosis, the bone’s histologic anatomy is usually normal but lacking in structural integrity.

A

True

50
Q

Osteoporosis Evaluation

A

Dual x-ray absorptiometry (DXA)

51
Q

Types of osteoporosis

A
  • Perimenopausal
  • Iatrogenic
  • Regional
  • Postmenopausal
  • Glucocorticoid-induced
  • Age-related bone loss
52
Q

Osteoporosis
Clinical manifestations

A
  • Pain
  • bone deformity
  • fractures
  • kyphosis (hunchback)
  • diminished height
53
Q

Osteoporosis
Prevention & Treatment

A

Prevention:

  • Regular moderate weight-bearing exercises
  • maintain normal Ca balance during adolescence
  • Sufficient magnesium

Treatment:

  • Estrogen
  • Bisphosphonates, denosumab (Prolia), teriparatide (Forteo), parathyroid hormone (PTH) 1-84
54
Q

Osteomalacia

A
  • Deficient vitamin D = less Ca absorption from intestines
  • Mineralization inadequate/delayed.
  • Bone formation progresses to osteoid formation, but calcification does not occur; result is soft bones
55
Q

Osteomalacia
Clinical manifestations

A
  • Pain
  • bone fractures
  • vertebral collapse
  • bone malformation
  • waddling gait
56
Q

Osteomalacia Treatment

A
  • normal calcium & phosphorus levels
  • Suppress secondary hyperthyroidism.
  • Chelate bone aluminum
  • calcium carbonate to decrease hyperphosphatemia.
  • vitamin D supplements
  • dialysis.
  • Renal transplantation for renal osteodystrophy.
57
Q

Paget Disease

osteitis deformans

A
  • increased, abnormal metabolic activity in bone
  • excessive resorption & formation
  • Enlarges & softens bones
  • Most often affects the axial skeleton.

Clinical manifestations:
Brain compression, impaired motor function, deafness, atrophy of the optic nerve

58
Q

Paget Disease
Treatment

A

Bisphosphonates and calcitonin

59
Q

Osteomyelitis is usually caused by a _____ infection

A

staphylococcal

60
Q

Osteomyelitis is often exogenous, but can also be from….

A

a bloodborne (endogenous) infection

61
Q

Osteomyelitis
definition

A
  • Infection spreads under the periosteum and along the bone shaft or into the bone marrow.
  • adults: Affects the cortex
  • Sequestra: Sections of dead bone from periosteal separation
  • Involucrum: Periosteal new bone

Acute vs. subacute vs. chronic

62
Q

Osteomyelitis
Sequestration and involucrum

A
63
Q

Osteomyelitis
Clinical manifestations
&
Treatment

A
  • Acute & chronic inflammation
  • fever
  • pain
  • necrotic bone

Treatment:
Antibiotics, débridement, surgery, hyperbaric oxygen

64
Q

Bone Tumors May originate from ….

A
  • bone cells, cartilage, fibrous tissue, marrow, or vascular tissue
  • Osteogenic, chondrogenic, collagenic, and myelogenic
65
Q

Malignant bone tumor
characteristics

A
  • Increased nuclear-cytoplasmic ratio
  • irregular borders
  • excess chromatin
  • prominent nucleolus
  • increase in the mitotic rate
66
Q

Derivation of bone tumors

A
67
Q

Bone Tumors
Patterns of bone destruction

A
  • Geographic: Well-defined margins of lytic bone with normal bone
  • Moth-eaten: partially destroyed bone adjacent to completely lytic areas
  • Permeative: Abnormal lytic bone imperceptibly merges with surrounding normal bone

Pathopharm II Exam 1 (11 decks)

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