Chapter 37 - Musculoskeletal - Diseases

Question 1

Tendinopathy

Answer 1

Painful inflammation of tendons (tendonitis) due to micro tears in the
tendon, the presence of disorganized collagen fibers and neovascularization. Micro tears
cause bleeding, edema, and pain in the involved tendons.

Question 2

Epicondylopathy:

Answer 2

Tennis elbow or Golfer’s elbow caused by irritation and overstretching
of the extensor carpi radialis brevis (ECRB) tendon and forearm extensor muscles,
resulting in tissue degradation. (tennis elbow- lateral epicondylopathy) also cause by the
result of similar force affecting the forearm muscles responsible for forearm flexion and
pronation (golfer’s elbow-medial epicondylopathy) Figure 37-4 page 983

Question 3

bursitis

Answer 3

Painful inflammation of bursae that is reactive to overuse or excessive pressure but also can be caused by infection or acute trauma. Bursae are small sacs lined with synovial and filled with synovial fluid that are located between bony prominences and
soft tissues such as tendons muscles and ligament. (Figure 37-5)

Question 4

Rhabdomyolysis

Answer 4

Rapid breakdown of muscle and Releases the protein pigment myoglobin
into extracellular space and bloodstream

Question 5

Rhabdomyolysis: pathophysiology

Answer 5

Relatively rare, Many causes which can result in serious complications,
Hyperkalemia , Metabolic acidosis, Acute renal failure

Question 6

Rhabdomyolysis: causes

Answer 6

alcohol or illegal drugs, crush injury, long-lasting muscle compression, use of medications

Question 7

Rhabdomyolysis: complications

Answer 7

electrolyte abnormalities, hypoalbuminemia, compartment syndrome

Question 8

compartment syndrome

Answer 8

Result of increased pressure within a muscle compartment and Skeletal muscles do not expand

Question 9

compartment syndrome - pathophysiology

Answer 9

o Weight of limp extremity generates enough pressure to produce muscle ischemia
o Edema, rising compartment pressure, & tamponade which lead to muscle infarction &

Question 10

compartment syndrome - compartments affected

Answer 10

Anterior & deep posterior tibial compartments, Gluteal compartments
in buttocks, Abdominal wall

Question 11

Malignant hyperthermia

Answer 11

Inherited muscle disorder

Question 12

Malignant hyperthermia - cause

Answer 12

hypermetabolic reaction to

certain volatile anesthetics or succinylcholine, and Prolonged release of intracellular calcium

Question 13

Malignant hyperthermia - manifestations

Answer 13

Hypermetabolism, Extremely high body temperature, Muscle rigidity,
Rhabdomyolysis, Sinus tach, respiratory acidosis, masseter muscle spasm neural injury

Question 14

Osteoporosis

Answer 14

A complex, multifactorial, chronic disease that often progresses silently for decades until fractures occur. Old bone is being resorbed faster than new bone is being made, causing the bones to lose density, becoming thinner and more porous.

Question 15

Osteoporosis - risk factors

Answer 15

Genetics, Caucasian race, Increased age, Female, Small, thin stature, Fair, pale, Sedentary, Smoking, Excessive alcohol consumption, and Early menopause

Question 16

Osteoporosis - clinical manifestations

Answer 16

Specific s/s depend on bones involved, Pain, Bone deformity, kyphosis, fractures of the long bones

Question 17

Osteoporosis - complications

Answer 17

Bones can fracture spontaneously, bones can get so weak that the skeleton cannot support itself. In elderly patients they can further develop pneumonia and blood clots of the legs if they break a bone and are on prolonged bed rest.

Question 18

Osteomalacia

Answer 18

A metabolic disease characterized by inadequate and delayed mineralization of osteoid in mature compact and spongy bone. Bone volume does not change but is replaced with soft osteoid instead of ridged bone. Occurs in adult bone. Decreased amount of calcium producing softening of the bone.

Question 19

Osteomalacia - risk factors

Answer 19

**Deficiency of Vitamin D **
Causes of Vitamin D deficiency: decreased endogenous production of Vitamin D, intestinal malabsorption of vitamin D, renal tubular diseases, certain types of tumors (mesenchymal usually), anticonvulsant therapy, and disorders of the small bowel, hepatobiliary system, and pancreas.

Question 20

Osteomalacia - clinical manifestations

Answer 20

Pain particularly in hips-individual hesitant to walk, Muscular weakness common, Waddling gait, Bowed legs or “knock knees”, Low back pain may be early complaint, Fragility factures may occur, & uremia may be present

Question 21

Osteomalacia - complications

Answer 21

Symptoms can return if deficiency returns. You are more at risks for fractures.

Question 22

Paget’s disease.

Answer 22

A state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling, both resorption and formation. Also known as Osteitis Deformans

Question 23

Paget’s disease. - cause

Answer 23

unknown, but suspected combination of environmental and genetic factors that contribute to the disease

Question 24

Paget’s disease. - clinical manifestations

Answer 24

Evident in skull first, Skull thickens and assumes an asymmetric shape, Deafness, Sensory deficits, Dementia, Headache, & Stress fractures in lower extremities

Question 25

Paget’s disease. - complications

Answer 25

Hypercalcemia, Heart Failure, Bone Cancer, bone fractures, osteoarthritis, hearing loss

Question 26

Paget’s disease. - risk factors

Answer 26

Age (older than 40), men are more commonly affected, more common in England, Scotland, central Europe, and greece

Question 27

Osteomyelitis

Answer 27

bone infection most often caused by bacteria; however fungi, parasites, and viruses also can cause bone infection. It is categorized according to the pathogen’s mode of entry in bone tissue.

Question 28

Osteomyelitis - risk factors

Answer 28

long-term infections, inadequately controlled diabetes, poor blood circulation, immune system deficiency, prosthetic joints, use of intravenous drugs, sickle cell anemia, acncer

Question 29

Osteomyelitis - complications

Answer 29

bone death, septic arthritis, impaired growth, skin cancer

Question 30

Osteomyelitis - manifestations

Answer 30

· Varies with:
o the age of the individual
o site involvement, the initiating event
o the infecting organism
o type of infection (acute, subacute or chronic)
§ Acute causes abrupt onset inflammation
§ Subacute signs/symptoms are vague
· single or multiple abcesses—Brodie abscesses (**progression from acute to subacute may be the result of inadequate therapy or drug-resistant microorganisms)
§ Chronic is indolent or silent between exacerbations
(single or multiple abcesses—Brodie abscesses

Question 31

HEMATOGENOUS osteomyelitis has insidious onset. Symptoms include:

Answer 31

fever, malaise, anorexia, weightloss, pain in and around infected areas, edema, recent infection, recent instrumentation

Question 32

EXOGENOUS osteomyelitis signs/symptoms:

Answer 32

Soft tissue infection predominate, low grade fever, lymphadenopathy, local pain, swelling

Question 33

Ankylosing spondylitis

Answer 33

Chronis inflammatory joint disease

Stiffening of fusion (ankylosis) of spine and sacroiliac joints

Question 34

Ankylosing spondylitis - risk factors

Answer 34

men are more likely to develop this, generally occurs in late adolescence or early adulthood, your heredity

Question 35

Ankylosing spondylitis - locations

Answer 35

joints in the spine

Question 36

Ankylosing spondylitis - manifestations

Answer 36

o Low back pain and stiffness
o Worse after prolonged rest and alleviated by physical activity
o Early morning stiffness

Question 37

Ankylosing spondylitis - complications

Answer 37

o New bone formation between vertebrae and fuses them together
o Eye inflammation
o Compression fractures
o Heart problems (aorta)

Question 38

Gout

Answer 38

Caused by incomplete purine metabolism resulting in excess serum uric acid levels
Inflammation and pain in the joints

Question 39

Gout - risk factors

Answer 39

diet, medications, family history, medical conditions (diseases and conditions), obesity, occurs more often in men, recent surgery or trauma

Question 40

Gout - manifestations

Answer 40

o Hyperuricemia
o Inflammation of single joint
o Tophi in and around joints
o Renal disease and renal stones

Question 41

Gout - locations

Answer 41

big toe, insteps, ankles, heels, knees, wrists, fingers, elbows

Question 42

Gout - complications

Answer 42

o Recurrent gout (could cause erosion and destruction of joint)
o Advanced gout (tophi buildup)
o Kidney stones

Question 43

Fibromyalgia

Answer 43

Chronic musculoskeletal syndrome

Diffused pain, fatigue, increased sensitivity to touch

Question 44

Fibromyalgia - risk factors

Answer 44

your sex, family history, rheumatic disease

Question 45

Fibromyalgia - manifestations

Answer 45

o Diffuse, chronic pain
o Tenderness in 11 of 18 tender points
o Burning or gnawing pain

Question 46

Fibromyalgia - complications

Answer 46

o   Depression
o   Anxiety
o   Chronic fatigue
o   Tension headaches
o   Migraines
o   OA

Question 47

osteosarcoma

Answer 47

characterized by the formation of bone or osteoid tissue with a sarcomatous tissue. The tissue can have theapperance of callus or compact orspongy bone. It is themost common malignant bone forming tumor. It peaks around puberty in both boys and girls. 60% occurs in persons under 20. Second peak betweenages 50-60. They are neither normal nor embryonal. Most common initial symptoms are pain and an enlarging mass. The pain is light but within a short time it is severe. Systemic system are uncommon.

Question 48

chondrosarcoma

Answer 48

second most common primary malignant bone tumor and isa tumor of middle aged and older adults. It is a large, ill-defined malignant tumor that infiltrates trabeculae in spongy bone. Symptoms have an insidious onset. local swelling and pain are usual presenting symptoms. pain is dull at first and gradually intensifies

Question 49

fibrosarcoma

Answer 49

is a solitary tumor thatmost often affects the metaphyseal region of the femor or tibia. Originates from mesenchymal cells and produce fibrous connective tissue. most common collagenic tumor. Starts in the marrow cavity ofthe bone and infiltrates thetrabeculae. system have aninsidious onset, which delays diagnosis. Pain and swelling are usual present. localtenderness, palpable mass, and limitation of motion.

Question 50

giant cell tumors

Answer 50

6th most common ofthe primary bone tumors. Generallybenign but can become malignant after radiation. they have a wide age group they affect. It is a solitary circumscribed tumor thatcauses extensive bone resorption because of its osteoclastic orgin. It islocated in the center of theepiphysis in the femor, tibia, radius, or humerus.

Question 51

rhabdomyosarcoma

Answer 51

Malignant tumor of striated muscle. Infants, children, and teens account for 85%. It is highly malignant with rapid metastasis. Located in the muscles tissue of the head, neck, and genitourinary tract account for 75% rest found in trunk and extremities.