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Pathophysiology > 39. Musculoskeletal Alterations > Flashcards

39. Musculoskeletal Alterations Flashcards

1
Q

noncommunicating wound between bone and skin

A

closed fracture

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2
Q

communicating wound between bone and skin

A

open fracture

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3
Q

fracture with multiple bone fragments present

A

comminuted fracture

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4
Q

fracture line parallel to long axis of bone

A

linear fracture

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5
Q

fracture line at an angle to long axis of bone

A

oblique fracture

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6
Q

fracture line perpendicular to long axis of bone

A

transverse fracture

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7
Q

fracture line encircling bone

A

spiral fracture

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8
Q

fracture fragments pushed into each other

A

impacted fracture

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9
Q

fracture at a point where bone has been weakened by disease; can occur with normal weight bearing activity

A

pathologic fracture

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10
Q

fragment fo bone connected to a ligament or tendon detaches from the main bone

A

avulsion fracture

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11
Q

fracture wedged or squeezed together on one side of bone

A

compression fracture

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12
Q

fracture with one, both, or all fragments out of normal alignment

A

displaced fracture

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13
Q

fragment close to joint but remains outside of joint capsule

A

extracapsular fracture

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14
Q

fragment within joint capsule

A

intracapsular fracture

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15
Q

5 types of incomplete fractures

A
  • greenstick - torus - bowing - stress - transchondral
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16
Q

fracture where bone is broken entirely

A

complete fracture

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17
Q

fracture where bone is damaged but still in one piece; occur more often in flexible, growing bones of children

A

incomplete fracture

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18
Q

break in one cortex of bone with splintering of inner bone surface; commonly occurs in children and elderly

A

greenstick fracture

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19
Q

buckling of cortex of a bone

A

torus fracture

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20
Q

bending of a bone

A

bowing fracture

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21
Q

microfracture

A

stress fracture

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22
Q

separation of cartilaginous joint surface (articular cartilage) from main shaft of bone

A

transchondral fracture

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23
Q

diseases that cause pathologic fractures

A
  • osteoporosis - RA - Paget disease - osteomalacia - rickets - hyperparathyroidism - radiation therapy - cancer - infection
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24
Q

healing that occurs when adjacent bone cortices are in contact with one another; usually due to surgical fixation and restriction of movement between fragments

A

direct/primary healing

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25
Q

healing that involves both intramembranous and endochondral bone formation, development of callus, and bone remodeling; occurs in fractures that are treated with non-rigid or semi-rigid bone fixation (casts, braces, etc.)

A

indirect/secondary healing

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26
Q

T/F: both direct and indirect fracture healing involve callus formation

A

False; only indirect

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27
Q

List the 5 steps of callus formation

A
  • hematoma formation - organization of hematoma into fibrous network - invasion of osteoblasts; lengthening of collagen strands and deposition of calcium -callus formation -remodeling: excess callus is reabsorbed and trabecular bone is deposited
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28
Q

Signs and symptoms of a bone fracture (7)

A
  • unnatural alignment (deformity) - swelling - muscle spasm - tenderness - pain - imparted sensation - decreased mobility
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29
Q

5 treatment methods for fractures

A
  • immobilization - reduction of displaced fractures - traction - closed manipulation - internal/external fixation
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30
Q

failure of bone ends to grow together

A

nonunion

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31
Q

union that does not occur until about 8-9 months after fracture

A

delayed union

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32
Q

healing of a bone in an incorrect anatomic position

A

malunion

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33
Q

Purpose of traction

A

stretches and fatigues muscles that have pulled bone fragments out of place -> more readily allowing distal fragments to align with proximal fragments

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34
Q

procedure in which pins or rods are surgically placed into uninjured bone near fracture site and the stabilized with external frame of bars (used to treat fxs that wouldn’t be stabilized well with a cast)

A

external fixation

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35
Q

displacement of one or more bones in a joint in which the opposing joint surfaces entirely lose contact with each other

A

dislocation

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36
Q

contact between articular surfaces is only partially lost

A

subluxation

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37
Q

Conditions associated w/ dislocation/subluxation (4)

A
  • fractures (trauma) - muscle imbalance - incongruities in the articulating surface of bone (RA) - joint instability
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38
Q

tear or injury to a muscle tendon

A

strain

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39
Q

tear or injury to a ligament

A

sprain

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40
Q

complete separation of a tendon/ligament from its bony attachment

A

avulsion

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41
Q

inflammation of a tendon

A

tendinitis

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42
Q

inflammation of a bursa that is caused by repeated trauma; can also be septic due to wound infection

A

bursitis

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43
Q

inflammation of a tendon where it attaches to a bone

A

epicondylitis

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44
Q

lateral epicondylitis

A

tennis elbow

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45
Q

medial epicondylitis

A

golfer’s elbow

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46
Q

rapid breakdown of muscle that causes release of intracellular contents, including protein pigment myoglobin, into the extracellular space and bloodstream

A

rhabdomyolysis (myoglobinuria)

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47
Q

Classic triad of rhabdomyolysis

A
  • muscle pain - weakness - dark urine (sometimes only thing present)
48
Q

Most important lab value for rhabdomyolysis

A

serum creatinine kinase (CK) level

49
Q

Normal CK level

A
  • men: 5-25 - women: 5-35
50
Q

causes of rhabdomyolysis

A
  • electrical injury/burns - blunt trauma - drugs (EtOH, PCP, amphetamines, heroin, cocaine) - DKA - heat stroke - status epilepticus - tetanus - strenuous exercise
51
Q

Goals of treatment for rhabdomyolysis

A

maintaining adequate urinary flow (IV hydration) and prevention of kidney failure

52
Q

result of increased pressure within a muscle compartment

A

compartment syndrome/crush injury

53
Q

causes of compartment syndrome

A
  • bleeding after fracture (increases pressure) - decrease compartment volume (tight bandage or cast) - combination both conditions
54
Q

Explain the pathophysiology of compartment syndrome

A
  • limb compression -> local pressure -> tamponade - muscle/capillary necrosis - edema -> rising compartment pressure -> compartment tamponade - muscle ischemia/infarction - neural injury -> Volkmann ischemic contracture
55
Q

explain pathophysiology of crush syndrome

A
  • muscle infarction due to compartment syndrome - myoglobinemia -> renal failure - ECF shift -> shock - acidosis/hyperkalemia -> cardiac dysrhythmia
56
Q

treatment for compartment syndrome

A

fasciotomy

57
Q

decreased bone mineral density (BMD) and increased risk of fractures because of alterations in bone microarchitecture

A

osteoporosis (porous bone)

58
Q

causes of osteoporosis

A
  • decreased levels of estrogen (main hormone) and testosterone - decreased activity level - inadequate levels of vitamin D, C, and Mg
59
Q

based on the number of standard deviations that differ from the mean bone mineral density of a young-adult reference population

A

bone density

60
Q

Bone density for: - normal bone - osteopenic bone - osteoporosis

A
  • normal bone: 0 to -0.99 - osteopenic bone: -1.0 to -2.49 SD - osteoporosis: <2.5 SD
61
Q

bone histology for osteoporosis

A

usually normal but bone lacks structural integrity

62
Q

What type of vertebral structural abnormality is common with osteoporosis

A

kyphosis (hunchback)

63
Q

How does osteoporosis generally appear in men vs women?

A
  • men: thinning of trabecular bone (usually have greater mass) - women: complete loss/perforation of bone
64
Q

progressive softening and bending of bone (decreased mineralization of osteoid)

A

osteomalacia

65
Q

causes of osteomalacia

A
  • deficiency of vitamin D -> lowers absorption of calcium from intestines
66
Q

clinical manifestations of osteomalacia

A
  • pain - bone fractures - vertebral collapse - bone malformations (bowed legs or “knock-knees”) - muscular weakness -> waddling gait
67
Q

state of increased metabolic activity in bone characterized excessive resorption of spongy bone and accelerated formation of softened bone

A

Paget disease

68
Q

Which bones are most often affected by Paget disease?

A

axial skeleton (vertebrae, skull, sacrum, sternum, pelvis)

69
Q

characteristics of Paget diseased bone

A
  • disorganized - thickened - soft (BM replaced by vascular fibrous tissue)
70
Q

thickened bones from Paget disease causes what?

A
  • abnormal bone curvature - brain compression - imparted motor function - deafness - atrophy of optic nerve
71
Q

bone infection most often caused by staphylococcal infection

A

osteomyelitis

72
Q

bone infection caused by pathogens carried through the bloodstream

A

hematogenous (endogenous) osteomyelitis

73
Q

bone infection that occurs when infection spreads to adjacent bone due to open wounds (most common) or surgical procedures

A

contiguous (exogenous) osteomyelitis

74
Q

clinical manifestations of osteomyelitis

A
  • acute/chronic inflammation - fever - pain - necrotic bone
75
Q

Treatment for osteomyelitis

A
  • antibiotics - debridement - surgery - hyperbaric O2 therapy
76
Q

area of dead/devitalized bone

A

sequestrum

77
Q

new layer of of bone surrounding infected bone

A

involucrum

78
Q

generation and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes)

A

osteoarthritis

79
Q

manifestation of OA

A
  • pain - stiffness - enlargement of joint - tenderness - limited ROM - deformity
80
Q

3 causes of joint effusion

A
  • presence of osteophyte fragments in synovial cavity - drainage of cysts from diseased subchondral bone - acute trauma to joint structures (hemorrhage or inflammatory exudation)
81
Q

chronic, systemic, inflammatory autoimmune disease distinguished by joint swelling and tenderness and destruction of synovial joints

A

rheumatoid arthritis (RA)

82
Q

What is activated in RA that develop an exaggerated immune response?

A

synovial fibroblasts (SFs)

83
Q

main 2 classes of immunoglobulins that are part of rheumatoid factors (RF)

A
  • IgM and IgG - occasionally IgA
84
Q

What will be present in joint fluid with RA?

A

inflammatory exudate

85
Q

Explain the pathogenesis of RA

A
  • CD4 T helper cells and others in synovial fluid activated -> release cytokines - activation of B lymphocytes -> formation of RF -> formation of autoimmune complexes and probable deposition in joint tissue - inflammatory cytokine release - RANKL release and osteoclast activation - angiogenesis in the synovium
86
Q

synovium converted to a thick abnormal layer of granulation tissue (when T cells interact with synovial fibroblasts)

A

pannus (seen in RA)

87
Q

Pt is said to have RA if the have 4 or more of the following:

A
  • morning joint stiffness - arthritis in 3 or more joints - arthritis in hand joints - symmetric arthritis - rheumatoid nodules - abnormal amounts of serum RF - radiographic changes
88
Q

Hand changes seen in late stage RA

A
  • Boutonniere deformity of thumb - ulnar deviation of metacarophalangeal joints - swan-neck deformity of fingers
89
Q

systemic, immune, inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusing of the joints

A

ankylosing spondylitis

90
Q

explain the pathophysiology of ankylosing spondylitis

A
  • inflammation of fibrocartilage (mainly in vertebrae and sacroiliac joint) - inflammatory cells infiltrate and erode fibrocartilage - repair begins -> scar tissue ossifies and calcifies - joint eventually fuses
91
Q

clinical manifestations of ankylosing spondylitis

A
  • low back pain - stiffness - restricted ROM - loss of normal lumbar curvature
92
Q

Metabolic disorder that disrupts the body’s control of uric acid production or excretion

A

gout

93
Q

when uric acid crystals occur in synovial fluid

A

gouty arthritis

94
Q

type of metabolism gout is related to

A

purine (adenine and guanine) metabolism -> uric acid is end product

95
Q

How is uric acid generated and eliminated

A
  • generated through diet and recycled after cell breakdown - eliminated via intestinal and renal excretion
96
Q

3 stages of gout

A
  • asymptomatic hyperuricemia - acute gouty arthritis - tophaceous gout
97
Q

stage of gout; serum urate level is elevated but arthritic symptoms, tophi, and renal stones not present

A

asymptomatic hyperuricemia

98
Q

stage of gout; attacks develop w/ increased serum urate concentrations; tends to occur w/ sudden/sustained increases in hyperuricemia but can be triggered by trauma, drugs, and alcohol

A

acute gouty arthritis

99
Q

stage of gout; progressive inability to excrete uric acid expands to curate pool until monosodium rate crystal deposits (tophi) appear in cartilage, synovial membrane, tendons, and soft tissue

A

tophaceous gout

100
Q

muscle fiber shortening without action potential; caused by failure of SR even w/ ATP

A

contracture

101
Q

associated w/ chronic anxiety

A

stress induced muscle tension

102
Q

symptoms of stress induced muscle tension

A
  • neck stiffness - back pain - clenching teeth - hand grip - headache
103
Q

reduction in normal size of muscle cells as a result of prolonged inactivity

A

disuse atrophy

104
Q

causes of disuse atrophy

A
  • bedrest - trauma - casting - nerve damage
105
Q

chronic widespread joint and muscle pain with associated increased sensitivity to touch, absence of inflammation, fatigue, and sleep disturbances

A

fibromyalgia (FM)

106
Q

possible factors associated w/ fibromyalgia

A
  • flu-like viral illness - chronic fatigue syndrome - HIV - Lyme disease - medications - physical/emotional trauma
107
Q

osteoblasts (bone cell precursor) cause what type of bone tumor

A

osteogenic tumors (ex. osteosarcoma)

108
Q

chondroblast (cartilage cell precursor) cause what type of bone tumor

A

chondrogenic tumors (ex. chondrosacroma)

109
Q

fibroblasts (collage-producing cells) cause what type of bone tumor

A

collagen tumors (ex. fibroma, fibrosarcoma)

110
Q

various blood cell precursors in bone marrow can cause what type of bone tumor

A

myelogenic tumors

111
Q

osteosarcoma is predominant in what pts

A
  • adolescents and young adults - elderly if they have a Hx of radiation therapy
112
Q

non-calcified bone matrix and callus seen in osteosacroma

A

streamers

113
Q

Where are majority of osteosarcomas found?

A

located in the metaphyses of long bones; about half occur around the knees

114
Q

most common symptoms of osteosarcoma

A

pain with an enlarging mass

115
Q

malignant tumor of striated muscle; highly malignant w/ rapid metastasis

A

rhabdomyosarcoma

116
Q

What muscles most commonly develop rhabdomyosarcoma?

A
  • tongue, neck, larynx, nasal cavity, axilla, vulva, and heart

Pathophysiology (20 decks)

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