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Pathophysiology > Ch 39 - Alteration in Musculoskeletal Function > Flashcards

Ch 39 - Alteration in Musculoskeletal Function Flashcards

1
Q

What type of musculoskeletal injuries is associated with the leading cause of death in individuals 1-44 yrs old?

A

Skeletal trauma

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2
Q

Majority of occupational injuries in a hospital are _____ _____

A

registered nurses

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3
Q

Majority - 70% of hospital visits come from _____

A

fractures

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4
Q

What is the first line of defense againts external forces?

A

Musculoskeletal system

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5
Q

What does the musculoskeletal system enables? (2pts)

A
  • mobility
  • protection of internal organs
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6
Q

The damage to musculoskeletal system results in?

A

difficult and painful movement

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7
Q

What skeletal trauma is usually associated with break in bone, accompanied by surrounding tissue damage?

A

fractures

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8
Q

What is the highest incidence for fractures?

A

males = 15-24 yrs old
adults = less than 65 yrs old

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9
Q

What is the trauma is someone has a fracture?

A

bone subjected to stress greater than it can absorb

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10
Q

What are the most common fracture for YOUNG ADULTS, WORK PLACE, & OLDER INDIVIDUALS?

A

For young adults: CLAVICLE, tibia, and humerus

In workplace: hands and feet

Older individuals: humerus, femur, VERTEBRA, PELVIS

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11
Q

What age does skeletal trauma most common?

A

1-44 yrs old

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12
Q

Fractures in older individuals can be linked to what bone disease?

A

osteoporosis

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13
Q

What terms is associated with stress on TIBIA by overworking your MUSCLES like starting TOO FAST and not allowing muscles time to grow and warm up?

A

shin splints

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14
Q

Describe the main fracture types.
Complete fracture (CF)
Incomplete fracture (IF)
Open fractures (OF)
Comminuted
Linear
Oblique
Spiral
Transverse
Greenstick

A

CF: bone entirely broken

IF: bone damaged but still in one piece

OF: skin is open

Comminuted: bone breaks into more than 2 fragments

Linear: runs parallel to long axis of bone

Oblique: occurs at slanted angle

Spiral: encircles bone

Transverse: straight across bone

Greenstick: bone cracks on one side only

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15
Q

What is pathological fracture?

A

break at a site of pre-existing abnormality due from force that would not fracture a normal bone

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16
Q

What are the signs and symptoms for fracture? (9 pts)

A

swelling, pain, deformity, dislocation, ab position, crepitus, bruising, nerve damage, pulselessness at site.

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17
Q

Description of pain when having fracture.

A

muscle spasm that continues until bone fragments are immobilized

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18
Q

What is crepitus?

A

rubbing of bone fragments against each other

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19
Q

What does nerve damage lead for people with fractures?

A

impaired sensation

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20
Q

When vessels are compressed, there is _______ at site. A symptom for people with ______

A

pulselessness; fracture

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21
Q

What is the difference between dislocation and subluxation?

A

dislocation: joint surfaces LOSE CONTACT with each other

subluxation: PARTIAL CONTACT between opposing joint surfaces

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22
Q

T or F: Subluxation is the complete joint disruption whereas Dislocation can damage ligaments, nerves and cartilage.

A

FALSE; other way around (Dislocation, Subluxation)

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23
Q

What are the causes of dislocation and subluxation?

A

developing joint, muscular imbalance, trauma & joint instability

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24
Q

Define the 4 causes of dislocation and subluxation.

A

DJ: ligaments not full developed
Trauma:
MI: unbalanced exercise programs, bad posture
JI: repetitive dislocations, stretched ligaments from previous injury

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25
Q

What type of causes of dislocation and subluxation is associated with REPETITIVE dislocations, STRETCHED ligaments from previous injury

A

joint instability

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26
Q

What are the cautions for dislocation and subluxation that could lead to permanent disability?

A

numbness and tingling

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27
Q

What are the tx for skeletal trauma? (3pts)

A

Fixation, splints, & traction

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28
Q

What is fixation?

A

PIN or ROD placed in uninjured bone to help stabilize fracture site

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29
Q

Define autograft, allograft and xenograft. Which tx are these associated?

A

autograft: bone graft from the individual

allograft: bone graft from a cadaver

xenograft: bone graft taken from another species

These three are associated with fixation

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30
Q

What are the bone substitutes for fixation tx?

A

artificial joints

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31
Q

What are the 2 types of traction tx?

A

skin & skeletal traction

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32
Q

What is skin traction?

A
  • TAPE applied to skin to hold bone in place; used in pt waiting in operating room
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33
Q

What is the most common bone for skeletal traction?

A

femur

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34
Q

What is skeletal traction?

A
  • PINS drilled into bone DISTAL to fracture
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35
Q

What are splints?

A

protect injured body part from moving

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36
Q

T or F: Traction can provide restrictive movement or complete immobilization.

A

FALSE; Splints

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37
Q

Name the 4 bone healing stages?

A

a. hematoma
b. soft callus
c. hard callus
d. remodeling

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38
Q

Which stage of bone healing is associated with OSTEOBLASTS within soft callus sythesize collagen to form hard callus?

A

hard callus

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39
Q

Which stage of bone healing is associated with unnecessary callus is reabsorbed and repaired tissues are realigned?

A

remodeling

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40
Q

Which stage of bone healing is associated with BLEEDING at site of injury and surrounding tissue?

A

hematoma

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41
Q

Which stage of bone healing is associated with hematoma at site forms FIBROUS network?

A

soft callus

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42
Q

T or F: Hard callus forms on outer bone surface over fracture.

A

FALSE; Soft callus

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43
Q

T or F: Bone can form new bone without forming scar tissue.

A

TRUE

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44
Q

Timeframe for the healing of most fractures?

A

4-8 weeks

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45
Q

What are the support structures?

A

strains, sprains, Rhabdomyolysis, & Compartment syndrome

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46
Q

What is the difference between sprain and strains?

A

Strains: tearing or stretching of MUSCLE/ TENDON

Sprain: tearing of a LIGAMENT

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47
Q

In which part of the body are strains and sprains most commonly found?

A

Strains: hands, feet, knees, upper arm, thigh, ankle

Sprain: wrist, ankle, elbow, knee

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48
Q

What are the three degrees of injury for strains/sprains?

A
  1. fibers stretched; muscle and joint stable
  2. more tearing of tendon or ligament – muscle weakness/ joint instability
  3. inability to contract muscle
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49
Q

T or F: For the third degree of injury, full recovery is expected but potential for arthiritis.

A

TRUE

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50
Q

How many months are required for stability of joint?

A

3 months

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51
Q

Excessive stretching could damage _____. Result in scar tissue or poor tendon/ligament function.

A

recovery

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52
Q

How long does healing tendon/ligament lacks strength to withstand some levels of stress after injury?

A

4-5 weeks

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53
Q

What is Rhabdomyolysis?

A

rapid breakdown of muscle cause release of INTRACELLULAR contents (myoglobin, enzymes, potassium) into ECF & blood.

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54
Q

T or F: Rhabdomyolysis is a serious medical condition that can be fatal and lead to permanent damage.

A

TRUE

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55
Q

Causes of rhabdomyolysis?

A
  • trauma: crash injuries/ meds & drugs
  • excessive muscular contractions; infectious agents; toxins: CO
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56
Q

What are the complications for rhabdomyolysis?

A

hyperkalemia, cardiac dysrhythmia & kidney failure

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57
Q

What is hyperkalemia? Which musculoskeletal injuries is this associated?

A
  • excess K+ released into circulation; rhabdomyolysis
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58
Q

What are the signs and symptoms for rhabdomyolysis?

A
  • muscle pain, weakness ,dark urine
  • CREATINE KINASE
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59
Q

What are the triad of symptoms for rhabdomyolysis?

A

muscle pain, weakness, dark urine

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60
Q

Where does the dark urine of rhabdomyolysis comes from?

A

myoglobin

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61
Q

T or F: Dark urine is not always indicative of rhabdomyolysis.

A

TRUE

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62
Q

What is the most reliable indicator of rhabdomyolysis?

A

Creatine Kinase

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63
Q

What is the function of Creatine Kinase?

A

add phosphate to ADP to rephosphorylate ATP and maintain cellular ATP homeostasis

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64
Q

What tx goal for rhabdomyolysis?

A

maintain urinary output and prevent kidney failure

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65
Q

What are tx for rhabdomyolysis?

A

-rapid IV fluids to maintain urine output
- may require hemodialysis to deal with hyperkalemia

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66
Q

What is compartment syndrome?

A

damage WITHIN compartment but FASCIA encircling compartment is intact

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67
Q

What term is associated with well-defined compartment containing muscle and associated nerves and blood vessels enclosed by fascia?

A

muscle compartment

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68
Q

In compartment syndrome, increased pressure caused decreased blood supply = ______ = necrosis

A

hypoxia

69
Q

What is the cause of compartment syndrome?

A

Increased compartment CONTENT (e.g., bleeding) or decrease volume of compartment (e.g., cast/ bandage that is too tight)

70
Q

The increased compartment content and decrease volume of compartment result in?

A

disturbance of muscles MICROVASCULATURE

71
Q

What conditions can increase compartmental pressure?

A

burns, snake or insect bites

72
Q

What are the 6Ps manifestation for compartment syndrome?

A

Pain
Pressure
Paralysis
Parasthesia
Pulselessness
Poikilothermia

73
Q

What is paresthesia?

A

numbness/tingling due to nerve impingement

74
Q

What is paresis?

A

muscle weakness

75
Q

What is pulselessness in compartment syndrome?

A

inadequate blood perfusion to compartment

76
Q

What is the diagnosis for compartment syndrome?

A

measurement of intra-compartmental pressure with MANOMETER

77
Q

What does manometer measure?

A

pressure

78
Q

Out of the 6 Ps of Compartment Syndrome, _____ with radiation to fingers/ toes of affected limb, and _____ are most suggestive of compartment syndrome.

A

pain; parethesia

79
Q

What is the tx for compartment syndrome?

A

cutting FACIA to relieve pressure

80
Q

What disorder of bones is associated with decreased bone mineral density (BMD) and increased risk of fractures?

A

osteoporosis

81
Q

What is the most common bone affected by osteoporosis?

A

hip, wrist & SPINE

82
Q

What is the difference between postmenopausal and secondary osteoporosis?

A

Postmenopausal: caused by ESTROGEN deficiency

SECONDARY: caused by ENDOCRINE dsyfunction

83
Q

What hormones are associated with secondary osteoporosis?

A

parathyroid hormone, thyroid hormone, and growth hormone

84
Q

What are other factors to get osteoporosis?

A

meds, lack of physical activity, ab BMI

85
Q

T or F: Osteoporosis is a chronic disease that progresses silently for decades but not necessarily related to aging.

A

TRUE

86
Q

In osteoporosis, old bone reabsorbed ___ than new bone is made.

A

faster

87
Q

What is the peak bone mass?

A

around 30 yrs old

88
Q

After 30, there is increased risk of _____:

A

fractures

89
Q

How many women and men will sustain a vertebral fracture?

A

women: 1/6
men: 1/12

90
Q

What are the signs and symptoms of osteoporosis?

A
  • bone deformity, and pain due fractures
  • vertebral fractures can cause KYPHOSIS
  • occurence of osteoporosis exposed by fall
91
Q

What is kyphosis?

A

humpback

92
Q

What are the diagnosis for osteoporosis?

A

BMD using x-ray

DXA scanner

93
Q

What does DXA scanner measures?

A

amount of x-ray from each beam passing through bone

94
Q

DXA scanner utilizes two x-ray beams, what are they?

A

one HIGH energy and one LOW energy

95
Q

When diagnosing osteoporosis, by the time diagnosed, ___% of bone tissue could be lost.

A

30

96
Q

What are the tx of osteoporosis? (5 pts)

A

meds, limit alcohol and caffeine, stop smoking, moderate weight-bearing exercise, prevent fracture.

97
Q

Another name for Paget’s Disease?

A

osteitis deformans

98
Q

What disorder of bones is associated with increased metabolic activity which leads to localized ab and excessive bone modelling?

A

Paget’s Disease

99
Q

What is the result of localized ab and excessive bone remodelling? (Paget’s disease)

A

enlarged but soft bones/ neurological problems

100
Q

T or F: Paget’s disease can occur in one bone or multiple bones.

A

TRUE

101
Q

What are the causes of Paget’s disease?

A

GENETICS & environmental factors

102
Q

Who are at risk for Paget’s disease?

A

Men older than 55 yrs old; women older than 40 yrs old

103
Q

If Paget’s disease are asymptomatic it can be diagnosed using __-___

A

x-ray

104
Q

For Paget’s disease, familial is up to ___% of cases involve family members.

A

25%

105
Q

What are some environmental causes for Paget’s disease?

A
  • viruses like mumps& measles
  • Human Parainfluenza – not related to influenza
106
Q

Pathophysiology of Paget’s Disease:
Excessive ____ (1) of spongy bone and replaced with disorganized bone at increased rate.

_____ (2) diminish, bone marrow is replaced by extremely vascular ___ (3) tissue.

Collagen fibers are disorganized, and mineralization of bone extends into bone marrow.

Result in increased bone ___ (4) and increased risk of bone ____ (5)

A
  1. reabsorption
  2. Trabeculae
  3. Fibrous
  4. Fragility
  5. Tumours
107
Q

The manifestations of Paget’s disease ___ upon site. What are the two types of manifestations for Paget’s disease.

A

depend.

cranium & long bones

108
Q

Describe the manifestations of Paget’s disease: Cranium and long bones.

A

Cranium: asymmetrical appearance; brain compression = dementia and altered consciousness.

Long bones: produces lateral curvature in the tibia and femur

109
Q

Which infectious bone disease is most often caused by bacteria but also virus, fungi and parasites?

A

osteomyelitis

110
Q

What are the 2 types of osteomyelitis?

A

HEMATOGENOUS osteomyelitis & Contiguous osteomyelitis

111
Q

What is the difference between hematogenous and contiguous osteomyelitis?

A

Hematogenous osteomyelitis: caused by pathogen carried in blood stream

Contiguous osteomyelitis: infection spreads from adjacent bones.

112
Q

Which type of osteomyelitis is common in children?

A

hematogenous osteomyelitis

113
Q

What is the primary pathogen that causes osteomyelitis?

A

Staphylococcus aureus

114
Q

Osteomyelitis is associated with what blood disorder since both reduces immune ability to clear blood infections?

A

sickle cell anemia

115
Q

What are some causes of osteomyelitis?

A
  • open fractures, penetrating wounds, surgical procedures
  • DIABETES, smoking, alcohol, drug abuse
  • chronic illnesses, IMMUNOSUPPRESSIVE meds.
116
Q

What is the tx for osteomyelitis?

A

debridement of infection bone

117
Q

Explain debridement of infected bone.

A

surgery to remove infected bone and small amount of healthy bone

118
Q

In the pathophysiology of osteomyelitis, S. aureus produces toxins that destroys what type of WBC?

A

neutrophils

119
Q

What is the difference between osteoblast and osteclasts

A

osteoblast - creating bone

osteoclasts - breaking down bone

120
Q

What term describes a fluid that leaks out of blood vessel?

A

exudate

121
Q

What is sequestrum?

A

piece of devitalized dead bone separated from surrounding bone

122
Q

In pathophysiology of osteomyelitis, what is the risk of biofilms adhering to surfaces?

A

risk of implants

123
Q

What is the most common form of arthritis?

A

osteoarthritis

124
Q

What disorder of joints is caused by physical wear and tear on a joint over time?

A

osteoarthritis

125
Q

What is the primary defect of osteoarthritis?

A

loss of articular cartilage

126
Q

In pathophysiology of osteoarthritis, articular cartilage breaks down, it leads to underlying bone to become _____(1). Then ____ (2) develop on bone and its contents forced into ____ (3) cavity. The underlying bone develops projects that break off into synovial fluid called ___ ___ (4). ___ (5) capsule becomes thickened and adheres to deformed bone = reduced motion.

A

sclerotic (1), cysts (2), synovial (3), joint mice (4), Joint (5)

127
Q

What does sclerotic mean?

A

dense and hard

128
Q

Diagnosis for osteoarthritis?

A

x-ray

129
Q

What are the signs and symptoms of osteoarthritis?

A
  • pain, stiffness, decreased ROM, muscle wasting, and deformity
  • swelling of joint due osteocyte fragments in synovial
130
Q

What are tx for osteoarthritis?

A
  • exercise, weight loss, meds (CHONDROITIN)
  • If severe: surgery like implantation of artificial joints
131
Q

What are the most common artificial joints?

A

hip and knee

132
Q

What disorder of joints is associated with chronic autoimmune disease focusing on joints?

A

rheumatoid arthritis

133
Q

What is the difference between osteoarthritis and rheumatoid arthritis?

A

synovial membrane is first tissue affected in RA

134
Q

What are the signs and symptoms for rheumatoid arthritis?

A
  • joint degradation is SYMMETRICAL
  • stiffness most pronounced in morning
  • fixed flexion of small hand joints
135
Q

What are the 2 types of fixed flexion of small hand joints?

A

swan neck and boutonniere

136
Q

What are some characteristics of rheumatoid arthritis?

A
  • joint swelling and tenderness
  • destruction of synovial joint – if severe can result in premature death
  • genetic factors
137
Q

What are the 4 stages of rheumatoid arthritis?

A
  1. Synovitis
  2. Pannus
  3. Fibrous ankylosis
  4. Bony ankylosis
138
Q

In pathophysiology of rheumatoid arthritis (stage 2), what is the result of macrophages initiating inflammatory response?

A

thickening synovial fluid

139
Q

What do you call to the thickening of synovial fluid?

A

pannus

140
Q

In pathophysiology of rheumatoid arthritis (stage 3), as pannus invades bone tissue leads to ab bone remodelling which result in?

A

invasion of fibrous connective tissue

141
Q

What body parts affected by rheumatoid arthritis?

A

fingers, feet, writs, elbow, ankles, knees, also tissue of HEART, LUNG & KIDNEYS

142
Q

What is disorder of joints is the most common inflammatory arthritis world wide? AKA ____ of ____

A

gout; Disease of Kings

143
Q

What is the caused of gout?

A

overproduction or undersecretion of uric acid

144
Q

T or F: Gout has no genetic association.

A

FALSE; GOUT HAS A STRONG GENETIC ASSOCIATION

145
Q

What are characterizes gout?

A

inflammation and joint esp BIG TOE

146
Q

Choose: (Overproduction) or (Underexcretion) of uric acid is responsible for ___% of gout cases.

A

underexcretion; 90%

147
Q

Who are at risk for gout?

A

OLDER male, alcohol, red meat, fructose and increase BMI

148
Q

What are the signs and symptoms for gout

A
  • kidney stones
  • joint enlargement
149
Q

Pathophysiology of gout: When UA reach a specific limit it crystalizes forming ___ (1) that deposit in joints. The crystallization initiates inflammatory process = pain, known as ____ ____ (2). As inflammatory process increased, there is increased in ___ (3) which also an increased in ______(4)/neutrophils. The WBC engulf crystalized urate leads to ___ (5) of WBC = increased inflammation

A
  1. precipitates
  2. gouty arthritis
  3. cytokines
  4. macrophage
  5. rupture
150
Q

What is the breakdown product of uric acid?

A

purine nucleotides (GUANINE & ADENINE)

151
Q

What organ excrete uric acid from body?

During gout, urate excretion is ____

A

kidneys; sluggish

152
Q

What disorder of skeletal muscle is associated with loss of FULL passive range of motion?

A

contractures

153
Q

Where does contractures most likely to occur?

A

secondary to joint, muscle and soft tissue limitations

154
Q

T or F: Contracture is a chronic disorder.

A

FALSE; Contracture can be temporary

155
Q

T or F: Contractures are composed of Physiological & Pathological.

A

TRUE

156
Q

Contractures Physio:
Muscle contraction occurs in _____ (1) of muscle action potential. Thus muscle shortening happens bec of __ (2) pump failure (even in presence of plentiful ATP).

Contractures are present in ____’s (3) disease.

A

absence (1), Ca (2) & McArdle (3)

157
Q

Contractures Patho:
Permanent muscle shortening caused by ___ ____ (1) or _____ (2). _____ (3) tendons contractures are examples.

Contractures occur despite plentiful ATP and ___ (4) action potential. Most common in ___ (5), neuromuscular diseases like _____ (6) dystrophy.

A

muscle spasm (1), weakness (2), achilles (3), normal (4), stroke (5), muscular (6).

158
Q

T or F: Lower extremity contractures are more common.

A

TRUE

159
Q

Which disorder of skeletal muscle is associated with muscle wasting due to REDUCTION in muscle fibers size after PROLONGED INACTIVITY form bed , rest, trauma or local nerve damage?

A

disuse atrophy

160
Q

T or F: Disuse Atrophy can occur within days of inactivity.

A

FALSE; Disuse Atrophy can occur within WEEKs of inactivity.

161
Q

For disuse atrophy, normal individual on ____ (1) rest will lose muscle strenght at a rate of ___%/day (2) (One week = 21)

A

bed (1) & 3 (2)

162
Q

T or F: Normal aging cna also cause muscle atrophy and weakness

A

True

163
Q

What are the tx for disuse atrophy? (4 pts)

A
  • fq forceful contractions
  • passive lengthening exercises
  • brisk walking
  • after one year, regeneration of muscle fibers becomes impaired
164
Q

Which disorder of skeletal muscle is associated with chronic musculoskeletal syndrome characterized by DIFFUSE pain, fatigue and increased SENSITIVITY TO TOUCH?

A

fibromyalgia (FM)

165
Q

Why does fibromyalgia often misdiagnosed?

A

Due to the absence of systemic or localized inflammation

166
Q

Who are affected by the fibromyalgia disorder?

A

90% women, range 30-50 yrs old

167
Q

Where does pain begin in fibromyalgia?

A

begins in neck and shoulders then becomes generalized

168
Q

What is the genetic involvement of fibromyalgia?

A

FM alterations in genes affect serotonin, catecholamines, dopamine — all involved in STRESS RESPONSE and SENSORY PROCESSING

169
Q

FM appears to be result in ___ (1) dysfunction when there is an _____ (2) of pain transmission and interpretaion

A

CNS (1) & amplification (2)

Pathophysiology (20 decks)

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