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380: Patho/Physio > Ch. 39 Alterations of Musculoskeletal Function > Flashcards

Ch. 39 Alterations of Musculoskeletal Function Flashcards

1
Q

Is a closed fracture complete or incomplete?

A

Complete

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2
Q

Is an open fracture complete or incomplete?

A

Complete

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3
Q

Is a comminuted fracture complete or incomplete?

A

Complete

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4
Q

Is a linear fracture complete or incomplete?

A

Complete

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5
Q

Is an oblique fracture complete or incomplete?

A

Complete

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6
Q

Is a spiral fracture complete or incomplete?

A

Complete

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7
Q

Is a transverse fracture complete or incomplete?

A

Complete

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8
Q

Is a pathologic fracture complete or incomplete?

A

Complete

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9
Q

Is a greenstick fracture complete or incomplete?

A

incomplete

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10
Q

Is a torus fracture complete or incomplete?

A

incomplete

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11
Q

Is a bowing fracture complete or incomplete?

A

Incomplete

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12
Q

Is a stress fracture complete or incomplete?

A

Incomplete

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13
Q

Is a transchondral fracture complete or incomplete?

A

incomplete

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14
Q

A ____ is a break in the continuity of a bone

A

fracture

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15
Q

Two types of fracture healing

A

Direct and indirect

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16
Q

Explain direct fracture healing

A

Most often occurs when surgical fixation is used to repair a broken bone. NO callus formation

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17
Q

Is there callus formation in direct healing of fracture?

A

No

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18
Q

Explain indirect fracture healing

A

Most often observed when a fracture is tx with a cast or non-surgical method. Callus formation is hallmark. Remodeling of solid bone

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19
Q

Is there callus formation with indirect healing of fractures?

A

Yes

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20
Q

Patient presents with swelling, muscle spasm, and impaired sensation of wrist. Pt most likely has a

A

bone fracture

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21
Q

List manifestations of bone fracture

A

Unnatural alignment. Swelling. Muscle spasm. Tenderness. Pain. Impaired sensation. Decreased mobility.

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22
Q

Dx of bone fracture

A

X ray or bone scan

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23
Q

Tx

A
  1. Immobilization 2. Realignment 3. Internal/external fixation
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24
Q

______ of a bone fracture is closed manipulation, traction, and open reduction

A

Realignment (closed manipulation si where the doctor pulls and straightens the fracture without opening the skin.

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25
Q

Example of internal and external fixation

A

i.e with shoulders or torn ligaments. Dislocated shoulder…doctors pushes back into place

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26
Q

List three main complications of fracture

A
  1. Nonunion 2. Delayed 3. Malunion
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27
Q

_____ is a complication of a fracture where there is failure of union

A

Non-union

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28
Q

_____ is a fracture complication. Delayed by 8 to 9 months

A

Delayed

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29
Q

____ is a fracture complication where the healing is in a incorrect position

A

Malunion

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30
Q

_____ is displacement of one or more bones in a joint

A

dislocation

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31
Q

______ is loss of contact between articular cartilage

A

Dislocation

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32
Q

_____ is where contact between articular surfaces is only partially lost

A

Subluxation

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33
Q

Which two types of trauma are associated with fractures, muscle imbalance, rheumatoid arthritis, or other joint instability.

A

Dislocation and subluxation

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34
Q

What is possible with dislocation and subluxation?

A

damage to adjacent tissue can occur

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35
Q

What would you see in a patient with dislocation or subluxation

A

Pain, swelling, limited motion….joint deformity. Complications: interrupted circulation and nerve compression

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36
Q

Tx of dislocation and subluxation

A

Reduction with immobilization

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37
Q

List the three main injuries of support structures

A
  1. strain 2. sprain 3. avulsion
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38
Q

______ is tearing or stretching to a tendon or muscle

A

strain

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39
Q

_____ is a tear or injury to a ligament

A

sprain

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40
Q

_____ is a complete separation of a tendon or ligament from its bony attachment site

A

avulsion

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41
Q

T or F: a sprain is injury to a tendon

A

False; ligament

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42
Q

Pt presents with swelling and pain in the knee. Tests reveal the ligament has completely separated from the bone. Dx?

A

Avulsion

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43
Q

Pathophysiology of tendon and ligament injuries

A

-Inflammatory exudate…release of growth factors. granulation. Collagen formation.

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44
Q

____ and ____ injuries usually lack sufficient strength to withstand some stress for 4-5 weeks after the injury

A

Tendon and ligament

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45
Q

Dx of tendon and ligament injuries besides xrays

A

Arthroscopy

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46
Q

Tx of tendon and ligament injuries

A

PRICE, brace…and rehabilitation is CRUCIAL to regaining good function

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47
Q

_____ strain is the sudden, forced motion causing the muscle to become stretched beyond normal capacity

A

Muscle strain

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48
Q

Can muscle strain be acute or chronic

A

Yes

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49
Q

Does muscle strain involve tendons sometime?

A

Yes

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50
Q

Name the three healing phases of muscle strain

A
  1. Destruction 2. Repair 3. Remodeling
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51
Q

______: the healing phase of muscle strain with contraction and necrosis of damaged myofibers. Inflammatory response.

A

Destruction

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52
Q

_____: healing phase of muscle strain with phagocytosis and new capillary formation

A

Repair

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53
Q

_____ is the phase of muscle strain with myofiber maturation and contractile formation

A

remodeling

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54
Q

Dx of muscle strain

A

Physical exam; maybe MRI

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55
Q

Tx of muscle strain

A

ICe, rest, exercises

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56
Q

______ is the rapid breakdown of muscle

A

Rhabdomyolysis

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57
Q

What’s happening with the rapid breakdown of muscle

A

myocytes burst

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58
Q

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

A

Rhabdomyolysis and myoglobin

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59
Q

Rhabdomyolysis can result in _______, or acute renal failure

A

Hyperkalemia (intracellular K+)

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60
Q

What is the triad of manifestations of rhabdomyolysis

A
  1. Muscle pain 2. Weakness 3. Dark urine (myoglobin)
61
Q

How would you diagnose rhabdomyolsis

A

Blood test….when CPK is level five to 10x upper limit of normal (1000 units/L). Renal failure also indicated Rhabd.

62
Q

Tx goals of rhabdomyolysis

A

-preventing kidney failure, maintaining urinary output, and hemodialysis if necessary

63
Q

______ syndrome is a result of increased pressure within a muscle fascial compartmnet

A

Compartment syndrome

64
Q

What causes compartment syndrome

A

By any condition that disrupts the vascular supply to an extremity

65
Q

____ ___ causes edema, rising compartment pressure, tamponade, and ultimately leads to M.I and neural injury

A

Muscle ischemia

66
Q

Manifestations of compartment syndrome….6 P’s

A

Pain, pressure, pallor, parasthesia, paresis, and pulselessness

67
Q

What is the complication of unrecognized compartment syndrome

A

Volkmann ischemic contracture

68
Q

Dx of compartment syndrome

A

Measure the intra-compartmental pressure

69
Q

Tx of compartment syndrome

A

-Relieve external pressure (tight bandage) -Surg. intervention (fasciotomy) when pressure reaches 30mmHg

70
Q

At which pressure is surgical intervention necessary for Compartment Syndrome

A

30mmHg

71
Q

What is the name of the surgical procedure to relieve compartment syndrome

A

Fasciotomy

72
Q

______ ______ is a hypermetabolic reaction to certain anesthetics or muscle relaxants (used in the OR)

A

Malignant hyperthermia

73
Q

What type of disorder is Malignant Hyperthermia

A

Autosomal dominant

74
Q

The pathophysiology of malignant hyperthermia is a ______ in the ryanodine receptor of skeletal muscle RyR1. It’s responsible for the majority of cases

A

Mutation

75
Q

What is the name/abbreviation of the ryanodine receptor that can have the mutation for malignant hyperthermia

A

RyR1

76
Q

Malignant hyperthermia causes continuous muscle contractions that eventually causes hypermetabolism. What causes this?

A

Uncontrolled calcium release

77
Q

What occurs after hypermetabolism of the muscles (associated with malignant hyperthermia)

A

Muscle spasm/rigidity, high body temp, Rhabdomyolysis, and death if not treated quickly enough

78
Q

Best way to avoid M.H?

A

Pre-op evaluation. Family history and can be predicted with a muscle-contracture test.

79
Q

treatment of M.H?

A

Dantrolene sodium infusion to relax muscle spasm (also called Dantrium). Manage symptoms.

80
Q

______ is defined as decreased bone mineral density < 2.5 SD from the mean

A

Osteoporosis

81
Q

What is the range for osteopenia(weak but not bad enough to be considered osteoporosis)

A

-1.0 to -2.49 SD

82
Q

After age 30, bone resorption exceeds what?

A

Bone formation

83
Q

Because bone resorption exceeds bone formation after age 30, what do you see with mineral density over time in aging adults?

A

Decreasing bone mineral density

84
Q

Is osteoporosis found in all older adults?

A

No

85
Q

Pathophysiology of Osteoporosis

A

-increase in osteoclast activity compared to osteoblasts. -results in bones that are less dense, thinner, more porous, and increased risk of fractures

86
Q

Who is at risk for osteoporosis

A

Women: caucasian and asian. Small frame size.

87
Q

The _____ hormone is a potential cause for osteoP

A

Parathyroid

88
Q

Which medication is a potential cause for osteoP

A

Corticosteroids

89
Q

Does tobacco and excessive ethanol use increase the risk of osteoP

A

Yes

90
Q

What is a major complication of osteoP

A

Fractures

91
Q

Who is more at risk for osteoP, someone with high physical activity or low?

A

low

92
Q

What are the two important types of osteoP

A

Postmenopausal and Glucocorticoid-induced

93
Q

Is glucocorticoid-induced osteoP primary or secondary?

A

Secondary

94
Q

This type of osteoporosis improves osteoclast survival, inhibiting osteoblast formation and function

A

glucocorticoid-induced

95
Q

This type of osteoP is caused by estrogen deficiency associated with increased bone resorption.

A

Postmenopausal

96
Q

Kyphosis is commonly seen in patients with osteoporosis. T or F

A

True

97
Q

Vertebral and green stick fractures are commonly seen in patients with osteoP

A

False; vertebral and long bone fractures

98
Q

How to diagnose osteoP

A

-Peripheral DXA of heel and wrist is the screening recommendation. -The gold standard is the DXA of hip and spine. -Trabecular bone score (TBS) evaluates pixel variations in gray-level areas of lumbar spine images from DXA scans

99
Q

OsteoP prevention and management?

A

-Weight bearing physical activity -Adequate calcium and vitamin D intake -Bisphosphonates and biologics -fracture prevention strategies

100
Q

_______ is inadequate or delayed mineralization of osteoid, the organic component of bone

A

Osteomalacia

101
Q

_____ results in soft, deformed bones due to vitamin D deficiency (calcification/ossification does not occur)

A

Osteomalacia

102
Q

Where do you see Osteomalacia

A

Third world countries

103
Q

Tx of osteomalacia?

A

Calcium and vitamin D supplementation

104
Q

What is another name for Paget disease

A

Osteitis deformans

105
Q

_____ disease is a chronic accelerated remodeling of spongy (trabecular) bone

A

Paget

106
Q

_____ disease enlarges and softens affected bones. Increases risk for fractures and bone tumors

A

Paget

107
Q

Which disease has an increased risk of bone tumors

A

Paget

108
Q

Which disorder is genetic

A

Malignant Hyperthermia

109
Q

Paget disease mostly affects which areas?

A

Vertebrae, skull, sacrum, sternum, pelvis, and femur

110
Q

A patient presents with an enlarged bony prominence of the neck that feels soft to the touch and recently had a viral infection. What can the patient possibly have

A

Paget disease

111
Q

How to evaluate for paget disease?

A

X-rays and bone scans

112
Q

Tx of paget disease?

A

Pain relief and fracture prevention

113
Q

_______ is a bone infection often caused by bacteria, specifically _____ ______

A

Osteomyelitis; S. aureus

114
Q

Osteomyelitis is usually caused by S. aureus. What is the route the pathogen takes that manifests as cutaneous, sinus, ear, and dental infections?

A

-Hematogenous origin(carried in blood stream) -insidious onset -vague symptoms

115
Q

What are the symptoms of osteomyelitis

A

Fever, malaise, anorexia, weight loss, and pain

116
Q

What is the route of pathogen, when considering osteomyelitis, where the infection spreads to an adjacent bone…notably open fractures, penetrating wounds, and surgical procedures

A

Contiguous origin

117
Q

A patient is in the hospital one week post op from knee surgery. Patient has a low grade fever, is losing weight, and complaining of radiating pain in her knee up to her thigh. The incision had been healing well when she left the hospital last week but now the tissue appears to be dying. Patient likely has

A

Osteomyelitis of contiguous origin from contracting S. aureus during her knee surgery or afterwards during wound care. S. aureus is common in hospitals. swelling and low grade fever indicate contiguous origin.

118
Q

_____ provokes an inflammatory response, abscesses can form, and the disrupted blood supply results in necrosis

A

Osteomyelitis

119
Q

For ______ osteomyelitis, you would see lymphadenopathy, local pain, swelling, and a low grade fever in patients

A

contiguous

120
Q

Which type of osteomyelitis do you see Brodie abscesses (circumscribed lesions in the ends of long bones)

A

Contiguous

121
Q

Tx of osteomyelitis

A

Antibiotics, debridement, surgery, and hyperbaric oxygen therapy

122
Q

_______ is the loss and damage of articular cartilage with subchondral bone changes

A

Osteoarthritis

123
Q

Thickening of the joint capsule that ultimately leads to narrowed joint space and bone spurs is _______

A

osteoarthritis

124
Q

Prevalence of osteoarthritis increases with….

A

age

125
Q

Risk factors of osteoarthritis

A

Age, joint trauma, long term mechanical stress, and obesity

126
Q

Pathophysiology of osteoarthritis

A

-Enzymes break down cartilage, and abnormal subchondral bone remodeling occurs

127
Q

Manifestations of osteoarthritis

A

-Pain (worsens with activity) -Stiffness (diminishes w activity) -Tenderness -limited motion -muscle wasting

128
Q

Dx of osteoarthritis

A

Radiologic studies

129
Q

What is the conservative treatment of osteoarthritis

A

Exercise and weight loss. Analgesics and anti-inflammatories

130
Q

What is the surgical treatment of osteoarthritis

A

-surg to improve joint movement, -new joint with artificial implants

131
Q

What is classic inflammatory joint disease

A

Inflammatory damage or destruction in the synovial membrane or articular cartilage

132
Q

CIJD can be infectious or noninfectious in origin. T or F

A

True

133
Q

What are the three CIJD

A

Rheumatoid arthritis, ankylosing spondylitis, and gout

134
Q

____ ____ is an inflammatory autoimmune disease: systemic autoimmune damage to connective tissue

A

R A (rheumatoid A)

135
Q

Cause of RA?

A

Unknown. multifactorial with strong genetic predisposition

136
Q

Vasculitis can be caused by RA. T or F

A

True

137
Q

____ is a syndrome caused by either overproduction or underexcretion of uric acid

A

Gout

138
Q

Manifestation of gout?

A

High levels of uric acid in the blood and other body fluids. Uric acid crystallizes and precipitates in body tissues (joints, subcutaneous tissues, kidneys)

139
Q

Risk factors for gout

A

Male sex, age, high intake of alcohol, red meat, fructose, and drugs

140
Q

______ is linked to abnormal purine metabolism

A

Gout

141
Q

In ______ ____, neutrophils and other cells in synovial fluid become activated

A

R.A

142
Q

Inflammatory cytokines induce enzymatic breakdown of cartilage and bone. T cells also interact with synovial fibroblasts through TNF-alpha, converting synovium into a thick, abnormal layer of granulation tissue. This is all seen with which CIJD

A

R.A

143
Q

Normal antibodies morph into auto-antibodies IgM and IgG called _______ factors

A

Rheumatoid

144
Q

Does rheumatoid arthritis have an insidious onset?

A

yes

145
Q

Rheumatoid nodules cause ______ syndrome

A

Caplan

146
Q

What would you see in a patient with RA

A

Inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness. Painful, tender, and stiff joints. Joint formalities. Rheumatoid nodules

147
Q

Diagnostics for RA?

A

Joint involvement, serology–presence of auto-antibodies, acute-phase reactants

148
Q

Tx for RA

A

Early treatment with disease-modifying antirheumatic drugs. Goal is to delay disease progression. Joint destruction.

380: Patho/Physio (8 decks)

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