Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > 11/16 > Flashcards

11/16 Flashcards

1
Q

Type of Spondyloarthropathies

A
  1. Ankylosing arthritis: long term inflammation of the spine, fused vertebrae
  2. Reactive arthritis: inflammatory arthritis from an infection in another part of the body
  3. Psoriatic arthritis: long term inflammatory arthritis caused by the autoimmune disease psoriasis, common to have distal interphalanges joint coloration
  4. Enteropathic arthritis: long term arthritis with occurrence of inflammatory bowel disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of Spondyloarthropathies

A
  1. Involvement of the axial skeleton, esp. sacroiliac joint
  2. Peripheral arthritis: lower limbs more common than upper limbs, asymmetric
  3. Enthesitis: inflammation of enthesis or where the ligament/tendon attaches to the bone
  4. Uveitis of the eye and mucocutaneous probs

Male predominance and familial clustering, autosomal dominance with 20% penetrance

HLA-B27 association and absence of autoantibodies, Haida Indians and eskimos have high prevalence of HlA-B27 positive people, not cause but may impact way we react to bacteria especially those in the gut, overzealous reactions to bacteria may trigger systemic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Inflammatory stuff for Spondyloarthropathies

A

Enthesitis: periosteal new bone formation, subchondral bone inflammation and resorption

Dactylitis: sausage digit, tendons and ligaments of the digit becomes inflammed and causes swelling, also seen in sarcoidosis and sickle cell

Uveitis: red painful eye

Urethritis or Cervicitis: from chlamydia or gonorrhea that triggers reactive arthritis, may have circinate balantis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Schooner Test

A

Have limited ROM of flexion with spondyloarthropathies, mark lower back by L5, want to turn 10 cm line segment into 15 cm line segment by flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ankylosing spondylitis

A

Males more affected than females, normally 20-40 at diagnosis but there is juvenile AS

Diagnosis: inflammatory lower back/butt pain, peripheral arthritis
Uveitis, GI ulcers, lung disease or aortic valve insufficiency is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Psoriatic Arthritis

A

Males and females affected equally, 20-40 at diagnosis, there’s a juvenile PsA

Diagnosis: skin and nail lesions, enthesitis, uveitis, axial and peripheral inflammatory arthritis, peripheral is oligo or polyarticular and involves DIP joints

Silvery plaques over elbows and umbilicus, onycholysis on nails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Enteropathic Arthritis

A

Complication of inflammatory bowel disease, arthritis can be axial or peripheral

Clinical signs: pyoderma gangrenosum, symptomatic uveitis, oral ulcers,erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Reactive Arthritis

A

Aseptic peripheral or axial arthritis occurring within a month of infection (GI, urethral, cervical or other)

Self limited or chronic, HLA-B27 positive increases risk of chronicity

Signs: Keratoderma blenorrhagicum (scaly pustules on feet), urethritis, cervicitis, vulvitis, circinate balinitis, inflammatory eye disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Radiographic findings of Spondyloarthropathies

A

Sacroilitis: unilateral or bilateral, has widening/irregularity of joint space, sclerosis, erosions

Lumbar spine: bridging syndesmophytes, bamboo spine, new bone forms along interosseous ligaments

Enthesitis: new bone and erosion where attach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for Spondyloarthropathies

A

Intraarticular/topical steroids, PT, OT

Anti-TNF Agents are most effective for moderate to severe forms

NSAIDS then sulfasalazine and methotrexate (often ineffective for axial disease but work for peripheral) then anti-TNF agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Biomechanics of Fractures

A
  1. Extrinsic Factors: magnitude, duration, and direction of force

Stress: load/area on which load acts

  1. Intrinsic Factors: energy absorbing capacity, modulus of elasticity, fatigue strength

Bone is a two phase material with type I collagen and hydroxyapatite, strength of bone depends on density, mineral content, and amount of collagen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Classifications of Fractures by Injury

A
  1. Direct trauma-
    Nightstick fracture: small force over a small area, minimal soft tissue damage

Direct crush: large force over a large area, comminuted fracture, extensive soft tissue trauma

Penetrating fractures: large force over small area, gunshot, depends on velocity

  1. Indirect trauma-
    Tension fracture: bone pulled apart, muscles and tendons, transverse fracture line

Compression fracture: short oblique fracture line, 45° shear strain, failure of cancellous in spine

Bending fractures: tension/compression, butterfly fragment on compression side

Rotational Fractures: spiral pattern, torsional stresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fracture Clinical Evaluation and Care

A

Soft tissue care: primary goal to halt the continued trauma to the tissues, get pressure off soft tissue, may immobilize fracture with splint

Reduction: sooner is better, imperative in neurovascular injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pediatric Fractures

A

Thicker periosteum, more amenable to closer reduction and casts, more rapid healing

Physis-
Growth plate injury can be limb/life altering, leads to decreased growth

Nonphyseal-
Torus (buckle) fracture: More ductile so incomplete fracture, one side of bone/cortex broke

Greenstick fracture: bone bends but doesn’t break

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Apophysis

A

Small projection on a bone without an independent center of ossification

Can be tendon/bone interface, due to infused nature of structure when subject to high force, ischial tuberosity or ASIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Occult fracture

A

Often not easily seen on X-rays, hard to differentiate between and soft tissue injury

Present with pain/difficulty if weight bearing

Treat like fracture if think maybe, immobilize and re-examine (diagnosis is - if symptoms resolve)

Get MRI or other imaging if high stress area like femoral neck

Why a concern: can displace if at weight bearing joint, can violate blood supply, lead to nonunion or malunion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bone Fracture Treatment

A
  1. Primary- rigid fixation
    Direct attempt by cortical bone to reestablish itself, need fracture fragments to be anatomically near each other, no callus

New osteoid on bone closes gals, cutting cones to allow new blood vessel entry

  1. Secondary-
    Periosteum is important, enhanced by some motion and decreased by rigidity, endochondral/intramembranous, rapid, bridge lap gaps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

6 Stages of Secondary Bone Healing

A
  1. Hematoma/Inflammation: direct bone formation via osteoprogenitor cells at periosteum (hard callus), Inflammatory Signaling
  2. Angiogenesis/cartilage form: angiogenesis, mesenchymal Cells differentiate to chondrocytes to deposit cartilage
  3. Cartilage calcification
  4. Cartilage removal
  5. Bone formation
  6. Remodeling
19
Q

Fracture Fixation Stability

A
  1. Cast/Splint- least stable
    Splints allow swelling and aren’t circumferential while casts are opposite, use for fractures with little displacement, limit motion, maintain alignment to limit soft tissue damage

More common in kids, secondary bone healing

  1. External Fixation-
    Middle stable, temporary
    Open fractures, intrarticular fractures, fractures with soft tissue swelling and injury
  2. Intermedullary Nails-
    Long bone fractures/diaphyseal (femur, tibia, humerus), closed reduction techniques, greater preservation of soft tissue compared to ORIF

Secondary bone healing, will see callus

  1. Open Reduction Internal Fixation (ORIF)-
    Incision, realign bone/joint, plates and screws, middle stability

Plating method determines rigidity, can be 1° or 2° healing

  1. Compression plating-
    Most stable, transverse or oblique fractures, compress bones to decrease gap bone must bridge which creates stability, need anatomic fixation

Bridge plating for comminution with proximal/distal fixation and little fixation in zone of injury, non-anatomic fixation, Secondary healing

20
Q

4 Sources of Blood Supply to Long Bones

A
  1. Nutrient artery and branches: divide into multiple small branches when reach medullary cavity, some supply medullary cavity and others enter cortex to supply inner 2/3 via Haversian System, anastomoses with metaphyseal artery
  2. Metaphyseal Artery: subdivide into numerous small branches,
  3. Epiphyseal artery: pass through reserve zone of cartilage but no Capillaries, supply blood to proliferating zone of cartilage and the distal zones are less vascularized
  4. Periosteal Artery
21
Q

Growing vs. Mature Bone Circulation

A

Blood doesn’t flow through physis and intramedullary vessels don’t reach epiphysis, direct epiphyseal artery is main blood supply to epiphysis (loses prominence when growth plate closes at skeletal maturity

Metaphyseal Blood Supply provides nutrients for active cells in enchondral ossification, doesn’t cross physis

22
Q

Disruption of Blood Supply to Bones

A

Medial circumflex humeral Artery is main blood supply to femoral head, branches transverse neck and may be torn by fracture, artery to the head of the femur is insufficient for blood supply when fractured so get avascular necrosis

Most nutrient arteries enter the neck of the talus, fracture can create osteonecrosis

Some people only have nutrient arteries on distal half of scaphoid, fracture of scaphoid makes osteonecrosis of proximal scaphoid

Common cause of secondary arthritis

Osteocytes disappear from lacunae

Revascularization extends inward from adjacent live bone

Dead bone is more opaque than live bone: new bone formation and collapse with old bone compression

23
Q

Osteonecrosis

A

Osteoclastic resorption: vessels approach and dead bone resorbed, articular surface weakens and a portion of it can collapse leading to degenerative arthritis

History/Physical: pain with activity, younger patient, limited joint ROM

Imaging: need MRI for early stage but radiographs work for later stages

Prevention and Treatment: restore Anatomy in fracture, total hip for end stage

Risk Factors: trauma, corticosteroid use, alcohol abuse, smoking, sickle cell, high cholesterol, organ transplant, Gaucher disease

24
Q

Osteonecrosis Etiology and Treatment

A
  1. Etiology-
    Idiopathic is most common

Arterial compromise from fracture or heminoglobinpathies/arterial thrombosis

High intraosseous pressure: pressure in bone rises above capillary pressure from steroids, alcohol abuse, or Gaucher’s disease

  1. Treatment-
    Early: core decompression

Later: bone grafting with vascularized fibula, osteotomy vs. total hip arthroplasty

25
Q

Osteonecrosis Stages

A

I: no X-ray changes but clinical symptoms are suspicious

II: some bone remodeling, subchondral sclerosis, and cysts

III: crescent sign on X-ray, subchondral fracture

IV: narrowing, osteophyte development, deformation of bone (flattening of femoral head with normal joint space)

V: narrowing of joint space, loss of articular cartilage on femoral head

VI: arthritis involving femoral head and acetabular sides of the joint

26
Q

Osteochondrosis

A

Vascular insult to growing bone (osteonecrosis if to mature bone)

Degenerative change in ossification center of epiphysis that goes on to avascular necrosis, perthes for femoral head, Freiberg on 2nd metatarsal involves flattening of the head

Pathophysiology-
Obliteration of the epiphyseal Blood Supply results in necrosis of the epiphysis
1. Cartilage cells deep in growth plate deprived of nutrients
2. Longitudinal growth stops
3. If collateral circulation not restored, growth plate closes

27
Q

Osteochondritis Dissecans

A

Damage at the articular cartilage due to blood deprivation of the subchondral bone, lose support for overlying articular cartilage

Etiology can be traumatic (overuse) but is often idiopathic, could be underlying avascular necrosis

Use plain radiographs or MRI

Presents commonly in distal humerus, distal femur, and talus

28
Q

Osteochondritis Dissecans Stages

A
  1. Normal X-ray and scintigraphically invisible
  2. Bulge on medial femoral condyle due to partial separation of bone fragment, articular cartilage intact but show up on X-ray, no scintigraphically
  3. Fragment demarcated by separation of articular cartilage, scintigraphically visible
  4. Fragment of cartilage/bone completely separated, increased isotope uptake in lesion and femoral condyle
  5. Increased uptake in adjacent tibial plateau
29
Q

Osteochondritis Dissecans Presentation and Treatment

A
  1. Presentation-
    Mild aching to severe pain with joint effusion and sometimes a mechanical block
  2. Treatment- depends on fragment status and child age

Observation and stop activities, drilling, osteochondral allograft, mosaic plasty, ORIF

30
Q

Primary Survey for MSK Emergency

A

ABCDE

A- airway
Move air between mouth/nose to lungs, mechanical block or lost due to unconsciousness
Treatment: endotracheal, nasotracheal, circothyroid intubation

B-breathing
Ability of lungs to exchange oxygen to the blood for transport to the tissues
Impaired by hemothorax, pneumothorax, flail chest from multiple rib fxs, pulmonary contusions/pain
Treatment: address specific injury, possible intubation with mechanical support

C-circulation
Assessing for shock when the body can’t deliver adequate oxygenated blood to tissues
Evaluate for bleeding, cardiac tamponade, neurogenic shock from spinal cord injury
Clinical signs: tachycardia, faint peripheral pulse, lower skin temp, sweating, loss of consciousness

D-neurologic disability
Give brief neuro exam

E-exposure
Remove all clothes to see all injuries

31
Q

Secondary Survey for MSK Emergencies

A

Systematic head to toe examination

Immobilized on a spine board

Rectal exam, Foley catheter, do every hole

Do X-rays or act scans as needed

32
Q

Orthopedic Emergencies

A

Crush injuries

Compartment syndrome

Open fractures

Bite wounds

Pelvic/acetabulum fractures

Dislocations

33
Q

Crush injuries

A

Earthquake, prolonged extremity compression, too much beer/drugs

Continuous pressure on muscle causes cellular ischemia and death

Cells leak K+ and myoglobin, while absorb Na/Ca/water, metabolic acidosis from hypotension and
hyperkalemia/calcemia

Renal failure as myoglobin precipitates in renal tubules, Metabolic abnormalities cause cardiac failure and arrhythmia

Be wary of Compartment syndrome

Treatment: prevention of renal failure, aggressive fluid resuscitation, sodium bicarbonate to prevent myoglobin precipitation, dialysis

34
Q

Pelvic and Acetabular Fractures

A
  1. Pelvic fractures-
    Can injure multiple other areas, hemorrhage is leading cause of death and mainly comes from intra-abdominal source

Manage hypotension: fluid resuscitation, evaluate chest/abs, sheet immobilization, angiography

Fairly high mortality

  1. Acetabular Fracture-
    High energy with associated injuries, not associated with ongoing blood loss, check for dislocation
35
Q

Compartment Syndrome

A

Increased pressure: ischemia, oxygen deprivation, damage to muscle and nerve tissue

Extrinsic Factors: tight dressing/cast, burns, occlusive dressings

Intrinsic factors: bleeding from injury or fracture, iatrogenic fluid infusion, swelling from tissue injury

Often with closed Tibial shaft fractures, swelling can cause compression of muscles/neurovasculature

Medical emergency, death of muscle and injury to nerves if untreated, can be reversible if release pressure

36
Q

Signs and Symptoms of Compartment Syndrome

A

Pain out of proportion

Pallor

Parathesia (late)

Paralysis (progressive weakness)

Pulselessness

Others: elevated muscle compartment pressures, tense swollen area (porkiness), poikilothermia (cold)

37
Q

Open fractures

A

Emergency, infection increases greatly without prompt treatment, antibiotics help

Generally high energy with multiple associated injuries like soft tissue loss and compartment syndrome

Staph aureus most common, Cephalosporin for Grade I/II, add aminoglycosides (Gent) when Grade III, add penicillin if high contamination

Thorough irrigation and debridement, skeletal stabilization

38
Q

Bite wound

A

Human: From punching, examine with hand in fist, Staph is common

Cat bites have Pasteurella multocida

Plan: local wound care, debridement open joints, antibiotics, rabies, tetanus

39
Q

Flexor tenosynovitis

A

Caused by puncture wound, very painful

Staph aureus is most common, high index of suspicion, need prompt treatment

Treatment-
Prompt IV antibiotics, nonoperative Treatment should see improvement after 2 days but operate if not help after a day, can do closed continuous irrigation, open treatment

40
Q

Kanavel’s 4 Cardinal Signs of Flexor Tenosynovitis

A
  1. Symmetric swelling of the entire digit
  2. Exquisite tenderness along the sheath
  3. Digit with semi-flexed posture
  4. Pain with attempted passive extension
41
Q

Effusions

A

Abnormal collection of fluid in a joint, aspirate synovial fluid

Immobilize, antibiotics, irrigate and debridement since infection damages cartilage

History important and most effusions are benign

Arthrocentesis: >50k WBC indicates infection, pain upon palpating and weight bearing

42
Q

Deep Vein Thrombosis

A

Diagnosis is clinically hard-
Swelling, calf tenderness, Homan’s sign is unreliable, fever, elevated WBCs

Can use Doppler ultrasound

43
Q

Virchow’s Triad

A
  1. Hypercoagulable state-
    Malignancy, IBD, pregnancy or postpartum, oestrogen therapy, trauma of LE, sepsis, nephrotic syndrome
  2. Vascular wall injury-
    Trauma or surgery, venipuncture, atherosclerosis, chemical irritation
  3. Circulatory stasis- decreases blood flow rate
    Atrial fibrillation, immobility or paralysis, venous obstruction from tumor/obesity/pregnancy

MSK (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions