Exam #5- Musculoskeletal Pathophysiology Flashcards
1
Q
complete fracture
A
bone is broken all the way through
2
Q
incomplete fracture
A
bone is damaged, but still in 1 piece
closed/simple- skin is intact
open/compound- skin is broken
3
Q
comminuted fracture
A
bone breaks into more than 2 fragments
4
Q
linear fracture
A
fracture runs parallel to long axis of bone
5
Q
oblique fracture
A
fracture of shaft of bone is slanted
6
Q
spiral fracture
A
encircles bone
7
Q
transverse fracture
A
straight across bone
8
Q
greenstick fracture
A
perforates 1 cortex and SPLINTERS spongy bone
common in children
9
Q
torus fracture
A
cortex buckles BUT does NOT break
10
Q
bowing fracture
A
longitudinal force is applied to bone
11
Q
pathologic fracture
A
break happens at site of PRE-EXISTING abnormality
12
Q
stress fracture
A
fatigue/insufficiency
13
Q
a NP is reading a report of a humerus x/ray and reads that there is a communited transverse fracture of the distal humerus. what does this mean in regards to the characteristics of the fractures?
A
the bone is fractured in more than 2 pieces, and the break is straight across the bone
14
Q
inflammatory phase of bone fracture
A
3-4 days
bone tissue destruction
triggers inflammatory response
hematoma forms
15
Q
repair phase of bone fracture
A
several days
capillary ingrowth, mononuclear cells, fibroblasts form which leads to hematoma which leads to granulation tissue.
osteoblasts w/in procallus make collagen and matrix which form callus
16
Q
remodeling phase of bone fracture
A
months to eyars
callus is reabsorbed (no longer necessary)
trabeculae are formed
now bone can withstand normal stress
17
Q
what is the first thing that happens when a bone fractures to begin the healing process?
A
hematoma forms
18
Q
what is the correct term used when a fracture heals in a nonanatomic position?
A
malunion
19
Q
pathophysiology of support structure injuries
A
inflammatory exudate forms between torn ends
granulation tissue grows inward
collagen forms 3-4 days after injury
vascular fibrous tissues fuse new and surrounding tissues into 1 mass
healing tendon/ligament doesn’t have strength to withstand strong pull for 4-5 weeks after injury
20
Q
dislocation
A
temporary displacement of bone FROM joint
21
Q
subluxation
A
PARTIALLY LOST contract between bones in the joint
22
Q
strain
A
tear/injury to TENDON (attaches MUSCLE to bone)
sTrain=Tendon
23
Q
sprain
A
tear/injury to LIGAMENT (attaches BONE to bone)
24
Q
avulsion
A
COMPLETE separation of TENDON or LIGAMENT
25
epicondylitis
inflammation of tendon where it attaches to bone
ex: tennis elbow (lateral) or golfer's elbow (medial)
26
tendinitis
inflammation of tendon
27
tendinosis
painful wearing down of collagen fibers
tiny tears
28
bursitis
bursa inflammation (synovial fluid sacs) d/t repeated trauma
septic bursitis is d/t a wound infection
29
a patient presents with soreness of the lateral hip. the NP suspects inflammation of the greater trachanteric bursa. what would the NP document as the diagnosis in the chart?
bursitis
30
tennis elbow
lateral epicondylitis
causes pain on the outside of the albow
31
golfer's elbow
also called medial epicondylitis
causes pain on the inside of the elbow
32
pathophysiology of myositis ossificans (heterotopic ossification)
complicated local muscle injury
inflammation of muscle tissue
calcification and ossification of muscle
calcification=think HARDENING
33
exampels of myositis ossificans (hetertopic ossification)
"rider's bone" in equestrians
"drill bone" in infantry soldiers
thigh muscles in football players
34
what is it called when the muscle becomes hard like bone?
myositis ossificans
35
rhabdomyolosis pathophysiology
severe muscle trauma (compartment syndrome, crush syndrome)
QUICK **breakdown of muscle**
releases intracellular contents (MYOGLOBIN) into bloodstream
**muscle cell loss** (life-threatening)
36
s/s of rhabdomyolysis
muscle pain, weakness, and DARK URINE from MYOGLOBIN
37
compartment syndrome can lead to what?
rhabdomyolosis
38
pathophysiology of compartment syndrome
complication of fracture
increases venous pressure
decreased arterial flow
not enough blood flow to affected area
ischemia and edema
39
s/s of compartment syndrome
(5P's)
pain (much more than initial injury should have caused)
paresthesia
pallor
pulselessness
paralysis (late)
40
a patient presents to the provider with no pulse in their hand, pallor, and weakness/paralysis of their thumb after experiencing an ulnar fracture. the provider would document which diagnosis in the chart?
compartment syndrome
41
osteoporosis "porous bone"
decreased bone mass/density
imbalance of bone resorption and formation
42
**RANKL
ligand that's released by osteoblast
activates receptor-RANK (on the osteclast)
RANKL SUPPRESSES apoptosis
**osteoclasts survive longer=more bone BREAKING than bone MAKING**
RANKL is BLOCKED by OPG
43
causes/patho of osteoporosis
decreased estrogen/testosterone, decreased activity levels, decreased vitamin D, calcium, magnesium
alteration in osteoprotogen (OPG), receptor activator of nuclear factor kappa K (kB), ligand (RANKL), and receptor of nuclear factor kB (RANK): **OPG/RANKL/RANK system**
post menopause; glucocorticoids (increase RANKL, inhibits OPG production which decreases bone density)
44
s/s of osteoporosis
pain, bone deformity, fracture, kyphosis, decreased height
treatment=denosumab
45
what is RANK?
receptor on osteoclasts
KNOW THIS!!!!
46
on of the theories behind the pathophysiology of osteoporosis is that there is an alteration of the RANK/RANKL/OPG's normal system. how does estrogen play an important role with this system and in the development of osteoporosis in the post menopausal female?
decreased estrogen decreases OPG secretion from osteoblasts
47
osteomalacia
soft bones
48
pathophysiology of osteomalacia
decreased vitamin D
decreased absorption of calcium from intestines
slow/inadequate mineralization osteoid formation BUT **calcification doesn't happen**
SOFT BONES
49
s/s of osteomalacia
pain, bone fracture, vertebral collapse, bone malformation, waddling gait
50
cause of osteomyelitis
STAPH INFECTION
infection spreads under periosteum and along bone shaft or into bone marrow
51
s/s of osteomyelitis
acute/chronic inflammation, fever, pain, necrotis bone (SEQUESTRUM)
52
pathophysiology of paget disease (osteitis deformans)
state of increased metabolic activity in bone
TOO MUCH bone resorption/formation of large/soft bones (usually axial skeleton)
53
s/s of paget disease
brain compression, impaired motor function, deaf, optic nerve atrophy
advanced: enlarged head, headache, deafness due to compression of nerve in bony meatus, increased cardiac output due to great bone vascularity, kyphosis, bone pain, most commonly in back of hips, bowing of limbs, increased warmth and tenderness over bones, increased limb volume
54
noninflammatory joint disease
NO synovial membrane inflammation, NO systemic s/s, NORMAL synovial fluid
OA
55
inflammatory joint disease
inflammatory damage/destruction in synovial membrane or articular cartilage
does have systemic s/s (fever, increased WBC, malaise, anorexia, hyperfibrinogenemia)
can be infectious or noninfectious
RA
56
what is one of the things that differentiates inflammatory joint disease from non-inflammatory joint disease?
inflammatory joint disease has prodromal symptoms
57
prodromal symptoms
early symptoms that signals onset of disease/illness (so in inflammatory there are symptoms that signify a flare up is coming)
58
osteoarthritis (DJD)
NONINFLAMMATORY
59
pathophysiology of osteoarthritis
loss of articular cartilage, sclerosis (hardening) of underlying bone, new bone spurs (osteophytes)
60
s/s of osteoarthritis
local areas of damage and loss of articular cartilage, new bone forms of joint margins, joint capsule thickens
pain, stiffness, joint gets bigger, deformed, swelling
61
rheumatoid arthritis
INFLAMMATORY
62
pathophysiology of RA
systemic AUTOIMMUNE destruction of synovial membrane and joints
synovial membrane is destroyed 1st
articular cartilage, joint capsule, and surrounding ligaments/tendons
63
s/s of RA
RA or RF test- will have **antibodies IgG and IgM**
systemic s/s, symmetric joint swelling/deformities, **stiffness 1 hour after rising**, rheumatoid nodules in organs
caplan syndrome= pulmonary nodules and pneumoconiosis
64
basics of bone tumors
may originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue
all tumors have s/s of pain and swelling
65
osteosarcoma
contain masses of osteoids
common in young people
usually occurs around the knees
66
chrondrosarcoma
makes cartilage/chondroid
common in middle-age/elderly
usually in spongy bone of long bones
causes erosion of soft tissues
67
fibrosarcoma
firm, fibrous masses of collagen
usually affects femur/tibia
lung mets is common
this mass you can actually feel
(picture of guy with tumor in calf)
68
myelogenic tumors
develop from bone
**Marrow cells. giant cell tumor leads to mass bone resorption. found in femur, tibia, radius, or humerus. slow and relentless growth rate. limited movement**
Myelogenic=Marrow
69
from which cells do collagenic tumors arise?
fibroblast
70
pathophysiology of ankylosing spondylitis
chronic inflammatory joint disease of spine/sacroiliac joints
inflammatory cells infiltrate and erode fibrocartilage
repair w/ scar tissue that ossifies and calcifies
stiffening and fusion of joints
there is uncontrolled bone formation
71
what gene is associated with ankylosing spondylitis
gene HLA-B27
72
s/s of ankylosing spondylitis
low back pain, stiffness, pain, restricted motion, "bamboo" spine, kyphosis
73
which disease process is characterized by the infiltration of inflammatory cells into the fibrocartilage and eventually erodes it, which leads to fusion of the bones?
ankylosing spondylitis
74
pathophysiology of gout
r/t purine metabolism
metabolic disorder that disrupts body's control of uric acid production/excretion
HIGH uric acid levels
crystallized uric acid
deposit in connective tissue b/c purine synthesis/breakdown is increased or uric acid is poorly secreted by kidneys
75
stages of gout
asymptomatic hyperuricemia- URATE level is HIGH, but **NO s/s**
acute gouty arthritis- attacks are here
tophaceous gout- TOPHI appear in cartilage, synovial membranes, tendons, and soft tissues
76
s/s of gout
pain in great toe (worse QHS), hyperuricemia, recurrent attacks of monoarticular arthritis, renal stones
TOPHI: small, white visible nodules
77
physiologic contracture
muscle fiber shortens WITHOUT an AP
TEMPORARY
78
cause of physiologic contracture
failure of SR (calcium pump) even though ATP is available
79
pathologic contracture
muscle fiber shortens d/t muscle spasm/weakness
PERMANENT
drop foot (inability to lift the front part of the foot off the ground)- related to peroneal nerve
80
cause of pathologic contracture
lots of ATOP
contracture occurs even though there's a normal AP
81
pathophysiology of chronic fatigue syndrome (myalgic encephalomyelitis)
profound fatigue, neuro energy production, immune impairments
can be caused by CNS dysregulation, heart/immune problems, chronic proinflammatory cytokines, cellular energy metabolism problems, ion transport problems
82
s/s of chronic fatigue syndrome
unrestful sleep
debilitating fatigue made worse by physical/mental exercise
muscle pain, noninflammatory joint pain, HA, flu-like s/s, memory/concentration problems
83
pathophysiology of disuse atrophy
prolonged inactivity
decreased muscle cell size
84
causes of disuse atrophy
BR, trauma, casting, nerve damage
oxidative stress
decreased protein synthesis and increased proteolysis
85
which disease process is the result of a mutation in the SCN4A gene?
periodic paralysis
86
pathophysiology of fibromyalgia
chronic, widespread joint and muscle pain, fatigue, and tender points
CNS dysfunction amplified pain transmission and interpretation
may be d/t the flu, chronic fatigue syndrome, HIV, lyme disease, meds, physical/emotional trauma
87
s/s of fibromyalgia
vague increased sensitivity to touch, no inflammation, fatigue, sleep problems
diffuse, chronic pain
must have tenderness in 11 of the 9 pairs (18 totel) of tender points
88
9 areas of tender points for fibromyalgia
occiput
trapezius
supraspinatus
gluteal
greater trochanter
low cervical
second rib
lateral epicondyle
knee
89
pathophysiology of poly/dermatomyositis
autoimmune inflammation of connective tissue and muscle fibers
90
poly/dermatomyositis
symmetric proximal muscle (pelvic and shoulder girdle) weakness and myalgia that develops over weeks to months
91
polymyositis
generalized muscle inflammation
mediated by T CELLS
92
dermatomyositis
polymyositis **PLUS skin rash**
B CELL mediated
