Exam 6 (Musc/connective) Flashcards
What is the most important factor in development of osteomalacia?
Vitamin D deficiency
What is osteomalacia?
Osteomalacia is loss of bone related to vitamin D deficiency. Because of softening of the bone resulting from inadequate deposits of calcium and phosphorus in the bone matrix. Normal remodeling of the bone is disrupted, and calcification does not occur. Osteomalacia is the adult equivalent of rickets, or vitamin D deficiency, and children.
Osteomalacia versus osteoporosis
Osteomalacia
Demineralized bone mass
Lack of vitamin D
Calcium & phosphate levels are low or normal
Parathyroid & Alkaline levels are high
Osteoporosis
Decreased bone mass
Lack of calcium
Calcium levels may be low but all other levels are normal
True or false
Osteomalacia is not common in the United States and Western Europe. However it is more common in countries where famine is common
True
What are some causes of osteomalacia?
- Vitamin D deficiency
- Kidney disease
- Familial metabolic error (hypophosphatemia )
What are some symptoms of osteomalacia?
In some cases, proximal muscle weakness in the shoulder and pelvic girdle area is the only presenting symptoms.
What is Paget’s disease?
It’s a chronic metabolic disorder in which bone is excessively broken down and reformed. The result is bone that is structurally disorganized causing dogs to be weak with increased risk for Boeing of long bones and fractures. Two types of Paget’s disease can occur familial and sporadic
True or false
Paget’s disease is second only to osteoporosis is one of the most common bone diseases in the United States
True
What is the most dreaded complication of Paget’s disease?
Cancer, most commonly osteogenic sarcoma
What is the most common type of osteomyelitis?
Hematogenous osteomyelitis is the most common type of osteomyelitis. It occurs more often children
What is osteomyelitis?
Bone infection
What is dupuytrens contracture?
Slowly progressive thickening of the Palmer fascia, resulting in flexion contracture of the fourth and fifth fingers of the hand
What is a ganglion?
Around, benign cyst, often found on the wrist or foot joint or tendon
What is the hallux valgus?
The hallex Vegas deformity is a common foot problem in which the great toe drifts laterally at the first metatarsal joint. The first metatarsal head becomes enlarged, resulting in a bunion.
What is planter fasciitis?
An inflammation of the planter fascia, which is located in the area of the arch of the foot.
What is scoliosis?
When the spinal column begins to move into a lateral curve, most commonly in the right lateral thoracic area is the degree of curvature increases, damage to the vertebral bodies results. Curvature of greater than 50° results in an unstable spine, and curvature of greater than 60° in the thoracic spine result in compromises cardiopulmonary function
What are some complications of fractures?
Acute compartment syndrome crush syndrome hypovolemic shock fat embolism syndrome Venous thromboembolism infection chronic complications such as ischemic necrosis and delete union
What is the pathologic or spontaneous fracture?
That occurs after minimal trauma to bone that has been weakened by disease. For example, a patient with bone cancer or osteoporosis can easily have a pathologic fracture.
What are the stages of bone healing?
- Hematoma formation
- Hematoma to granulation tissue
- Callous formation
- Osteoblastic proliferation
- Bone remodeling
- Bone healing completed
What is crush syndrome?
Crush syndrome occurs from an external crush injury that compresses one or more compartments in the leg, arm, or pelvis. It is a potentially life-threatening, systemic complications that results from hemorrhage and edema after a severe fracture injury. As muscles become ischemic and necrotic from pressure within the compartment, myoglobin is released into circulation, where can occlude the distal renal tubules and result in kidney failure
Fat embolism syndrome
Fat embolism syndrome is another serious complication and which fat globules are released from the yellow bone marrow into the bloodstream within 12 to 40 hours after an injury or other illness. These globules Clog small blood vessels that supply vital organs, most commonly the lungs, and impair organ perfusion.
What is the earliest manifestation of fat embolism syndrome?
Altered mental status, which is caused by a low arterial oxygen level. Dyspnea and chest pain may follow. Petechiae is a late sign
Running versus balanced traction
In running traction, the pulling force is in one direction in the patient’s body axis counter traction. Balance suspension provides the counter traction so that the pond force of attraction is not altered when the better patient is moved. This allows for increased movement and facilitates care. The two most common types of traction our skin and skeletal traction. Skin traction and both the use of the Velcro boot belt or halter which is usually secured around the affected leg. The primary purpose of skin traction is to decrease painful muscle spasms that accompany hit fractures. And skeletal traction, pins, wires or screws are surgically inserted directly into the bone. Skeletal traction aids in bone realignment
Gout
Primary gout is the most common it’s caused by excessive uric acid
Fibromyalgia
Chronic pain syndrome noninflammatory disease
mental health overlay
women 30 to 50 years old
A simple versus compound fracture
In a compound fracture the skin surface over the broken bone is disrupted and in a simple fracture it does not extend to the skin and therefore has no visible wound
Diagnostic tests for osteomalcia
Pseudofractures or Looser’s lines
Etiology of pagets disease
Unknown but my be latent viral infection
Symptoms of pagets disease
Physical Manifestations 80 % are asymptomatic Bone and joint aching pain* Enlarged thick skull Pathologic fractures Flushed warm skin Fatigue, lethargy Hyperuricemia or gout
Diagnosing Pagets disease
Increased serum alkaline phosphate levels
Elevated hydroxyproline levels
Xrays show thickened areas or punched out areas
Treatment for pagets disease
NSAIDS for pain relief Calcitonin: increases calcium absorption Biphosonates – Didronel : helps strengthen bones Heat Massage
What is osteomyelitis?
Infectious organism invades the bone tissue and initiates an inflammatory response
Infection in another part of the body moves to and invades bone tissue from bacteremia
Direct inoculation from a penetrating trauma
Staph can cause it, elderly and diabetics are at risk
What are some risk factors for osteomylitis?
Bacteremia UTIs Long term IV catheters Animal bites Puncture wounds Bone surgery Open fractures
(more common in children)
Symptoms of osteomyelitis?
Acute: Fever >101 Swelling Erythema Bone pain – pulsating Increased WBC Elevated ESR
Chronic Lasting > month Slightly elevated WBC Ulceration of the skin Localized pain Drainage from infected area
Treatments for osteomyelitis
IV Antibiotics for several weeks to months
Hyperbaric oxygen therapy to increase tissue perfusion
Surgical managment
An 80 yr old male of European decent presents to the clinic complaining of aching bone and joint pain, especially in his lower back, which is aggravated by walking. His skull is thick and enlarged and his skin is flushed and warm.
What do you suspect?
Pagets disease
Because older adult, european decent, thick skull, bone pain, warm flushed skin
What tests do you expect to run: Alkaline phosphate, hydroxyproline….both will be elevated. Then xrays, CTs, MRIs
Mr. Hanson, a 70 yr old male with a history of alcoholism and secondary malnutrition presents to ER with a mild fever and complaints of pain in his lower right right leg. Upon assessment, his right leg area reveals a 10x10 cm ulcer with serosanguinous drainage.
What do you suspect?
Osteomyelitis
Because hes male, ETOH, malnutrition, low grade fever, pain, drainage
What tests do you expect to run: Blood and wound culture, Bone scan, MRI. Labs: WBC, ESR, SED rate
Mr. Salsi, an 86 yr old Ethiopian male who lives in a local nursing home complains of bone pain in both legs and lower back which worsens at night. He has recently experienced weakness in his legs which contributed to a recent fall at the nursing home. Mr. Salsi has a history of alcohol abuse.
What do you suspect?
Osteomalacia
Because ethiopian, famine, ETOH, bone pain, fall, leg weakness
What tests do you expect to run: XRAYS to check for pseudofractures
Labs: calcium, phosphate…both decreased….Alkaline phosphate, paratyhroid hormone…..both increased
What is Muscular Dystrophy ?
Muscular Dystrophy
Group of inherited disorders that cause progressive muscle weakness.
Cause
Muscular dystrophies are caused by genetic defects
Pathophysiology of muscular dystrophy
Pathophysiology
Faulty action of muscle protein called dystrophin
Dystrophin maintains muscle integrity by sending signals to coordinate muscle fiber contraction
Diagnostic test for muscular dystrophy
Diagnosis
Muscle biopsy
Analysis of serum muscle enzymes
EMG : stick probes in muscles/ electrical shocks
Orhtopedic sensory assessment
Deep peroneal – Great toe and second toe
Superficial peroneal – top/dorsal area of foot
Posterior tibial – sole of foot both laterally and medially
Types of fractures
Closed: nondisplaced
Open: (compound)
Comminuted: (fragmented)
