Exam 4: Integumentary/MSK Disorders Flashcards
Osteomyelitis
Bone infection most often caused by bacteria, common s. aureus. Exogenous or endogenous. Three categories of osteomyelitis are hematogenous, contiguous, and chronic each with their own characteristics.
CM: Chills, fever, malaise, tenderness, erythema, edema, pain with movement of the infected extremity, and/or loss of ROM. Cultures miss it a lot. Can do needle aspiration.
Osteoporosis
Etiology: disease of low bone density due to prolonged negative calcium balance, hormonal disorders or drugs. Reduction in bone density caused by an imbalance of osteoclasts and osteoblasts, more bone is being destroyed than created.
Silent disease because diagnosis is often made after the individual has already suffered an osteoporotic fracture. Bone density testing.
Fractures
Etiology: sudden/trauma (most common) and stress
Clinical Manifestations/Signs & Symptoms: include deformity, swelling, muscle spasm, impaired sensation and decreased mobility. Localized shock.
Diagnosis: Hx, X-ray, CT, classified by type of break and direction
DVT:
Etiology: Virchow’s triad (venous stasis, hypercoagulability of blood, and injury to vessel wall) increase clots.
Area of DVT may be: tender, edematous, warm, palpable, ropiness along the course of the involved vein, +Homans sign (pain in the calf with dorsiflexion of the foot).
D-dimer, prothrombin time, partial thromboplastin, fibrinogen level, venous studies like an ultrasound. Can develop into a PE.
Fat embolism:
W/in 12-72 hours of injury generally in the long bones or pelvic fracture. Fat droplets in small blood vessels of lung, kidney, brain thought to be from the bone marrow or adipose tissue at the fracture site.
Risk for PE or CVA, skin and mucosal petechial. Need ABGs.
Compartment syndrome:
Common in the anterior compartment of the leg, after surgery or soft tissue injury. Pain that is out of proportion to the degree of injury.
5 P’s: pain, pallor, paresthesia, paresis, pulseless.
Tissue pressure exceeds perfusion pressure. Increase in pressure generally due to inflammation, there is a diminished capillary blood flow, local tissue hypoxia and necrosis which leads to further inflammation. If treated quickly can regain full circulation. If treatment is delayed can lead to rhabdomyolysis, renal failure, and/or death
Osteoarthritis
Slow, progressive, degenerative, inflammatory disease. Risk factors are obesity, athletics, and heavy occupational work. Wears away cartilage, inflammation from bone on bone, fluid accumulates. Narrowing of the joint space. Age related disorder of synovial joints. Common hands, hips, spine.
Swelling at the distal interphalangeal joint (DIP), called Herbeden’s nodes, and proximal interphalangeal joint (PIP), called Bouchard’s nodes.
Rheumatoid arthritis
Autoimmune response, genetic predisposition. Inflammatory disease caused by synovial inflammation and destruction of joint cartilage.
Systemic Lupus Erythematosus
Autoimmune disorder, more often in women and African Americans. Increased formation of autoantibodies and immune complexes that directly damage tissue. Affects a lot of systems in the body.
Arthralgias and arthritis are common early symptoms. Facial butterfly rash is well known.
Gout
Elevation of serum uric acid levels (overproduction or poor elimination) that deposit in the joints and kidneys. (May result from renal failure or cancer).
CM: pain from 1 joint in fingers or large toe. Repeated or untreated can lead to chronic arthritis
Strain:
Caused by overuse or improper use or as a result from another injury to the part of the body when the body compensates for pain by altering the way it moves. Lower back and hamstrings. Stretching injury to the muscle caused by overuse of muscles which can cause spasms, can have some tendon involvement.
CM: Pain, stiffness, swelling, local tenderness. Increase pain with stretching.
Sprain:
Occurs with a quick twist or pull or a force that displaces a joint from its normal alignment. Ligament injury that is overstretched or has a tear.
3 grades (I no tearing, II partial tear, III complete tear) Seen in ankle, knee
Tendinopathy:
A failed healing process of the tendons. Tendon thickening, the classic cellular inflammatory response is minimally present if it is chronic overuse tendinopathy.
CM: localized tendon pain, pain with tendon loading
Rhabdomyolysis:
Etiology: crush injury, burns, drugs, muscular contraction. Breakdown of muscle that causes release of protein myoglobin into the bloodstream.
CM: muscle pain, weakness, dark urine.
Diagnostics: CK, Renal fxt, K levels, Phos levels,
Squamous cell
Tumor of the epidermis, More malignant if left untreated, Sun exposed (ears*, head, neck, hands). Premalignant lesions actinic keratosis, whitish discolored areas
Basal cell
Most common 75% all skin CA, Slow growing, Extend wide and deep. Rarely metastasize, Lesions on face, neck (areas of high UV exposure). Alteration tumor suppressor genes. Pearly or ivory, slightly elevated.
Malignant melanoma
Cancerous tumor of the melanocytes. Intermittent sun exposure, UV light exposure, family history, Fair skin, tendency to freckle. Erythema, Inflammation, Tenderness, Ulcerate, Bleed
Allergic Contact Dermatitis
Type IV hypersensitivity reaction. Caused by synthetics or alloy, poison ivy or medications like neomycin or bacitracin.
Patho: Cell mediated response where you get an increase of IgE. T-cells become sensitized to antigen and release inflammatory cytokines.
CM: Erythema, pruritus, edema
Irritant Contact Dermatitis
Most common dermatitis. A non-immunological inflammation of the skin such as a diaper rash. Causes can be chemicals, soaps, detergents.
Patho: Disruption of the epidermal barrier, damage to cell membranes leads to cytotoxic effects of keratinocytes which activate the innate immunity and you get inflammation.
CM: Erythema, pruritus, edema
Tinea Capitis
Ringworm: fungal infection, direct contact.
Patho: Fungus secretes digestive enzymes that cause skin scaling, nail disintegration, and broken hair.
CM: circular lesion, alopecia, erythema, scaling and raised borders
Scabies
A mite that burrows into the epidermis. Prolonged direct skin to skin contact rarely by clothing or bedding. Mites can survive for several days without the skin’s blood supply.
CM: small papules in folds of skin, nipples or genitalia. Pruritus, erythema.
Lice, Pediculosis Capitis
Parasite that can travel from direct contact by person.
CM: pruritus and scratching of the head, reddened macules, inflammation hyperpigmentation, parallel scratch marks.
Herpes zoster
Shingles - reactivation of the varicella zoster virus, travels up your nerves.
CM: severe pain (before, during and after rash) may get some bumps or blisters, fever, fatigue, presents in clusters or lines along the dermatome, course can be 4-5 weeks. On face can cause blindness, damaged nerves
Psoriasis
Autoimmune- chronic inflammatory disorder of skin, scalp and nails, get the build up of extra skin cells. May or may not show signs, itching, redness, pain, skin red scaly, flaky patches
