Gen Ortho Term, Reax of MSK to disorder

Question 1

Orthoped Patho Goal

Answer 1

Prev. + corr of disorders of MSK sys + assoc str

Question 2

Bone patho examples

Answer 2

Frac, inflam dis, gen+disem disor, neoplasm, epip discord, congen abn

Question 3

Jt+soft tis patho ex

Answer 3

Deg, inflam disor, trauma, neoplasm

Question 4

Muscle path ex

Answer 4

Motor unit, Mm. injury, dystrophy, neoplasm

Question 5

Bone funct (nm. SPPHT)

Answer 5

Support (attch pt) of soft tis, Prot org., movement, Ca/P tank,
Hemopoesis, triglyceride in adipose (yellow marrow)

Question 6

Bone c. type

Answer 6

Osteoprogenitor -> diff into below types
Osteoblasts -> bone-building matrix (collagen)
Osteocytes -> mature bone c.
Osteoclast (WBC lineage) -> remodel + resorp bone ECM (extra cell matrix), cause bone to rel Ca.

Question 7

Volksmann canal

Nutrient foramen

Answer 7

Periosteal a.+ v., through diaphysis

Nutrient a.+v., center of diaph

Question 8

4 scenarios of osteogen (bone form)

Answer 8

Embro + fetal dev
Growth before adult
Remodeling
Fracture healing

Question 9

Ossification 2 Forms

Answer 9

Intramembranous: CT mem replaced by flat bone (e.g. skull)
Osteoblast - ECM, mesenchyme (stem c.) surrounding
Ca salts depo around osteocytes in lacuna, ECM Ca’s
ECM dev. Trabeculae -> fuse into spongy bone
Periosteum - esenchyme @ periphery dev. Into periostem.

Endochondral: cartilage repl w/ bone in dev. Embryo
Mesemchyme dev into chondroblasts to form cartilage model
Model growth via chondryocte c. div
Prim ossification centre - bone repl. cartilage
Medullary cav. Dev via osteoclast resorp
2ndry ossification centre @ epiphysis
Artic. Cartil. + epiphyseal plate -> hyaline cartilage

Question 10

Bone growth/form

Answer 10

Periosteum ridges - groove for priosteal b.v.
Ridges fuse = endosteum-lined tunnel (Volksmann canal)
Osteoblast in endosteum -> new concentric lamellae inwards to tunnel
Osteoblast in periosteum build circumferential lamellae

Question 11

Bone react

Answer 11

Alt’d deposit: ^| osteopetrosis (def resorb-?), acromegaly (excessive intramem oss from periosteum)
v| osteoporosis (v| osteoblastic activity, ^| resorp), rickets/osteomalacia (hypocalc, vit D def),

reabsorb, combo of alt depos + reabsorb (osteolytic neoplm

Question 12

Epiphyseal plate

reax

Answer 12

^| growth: Generalized {Arachnodactyly, pituitary gigantism (gwth hmr)
Local { chronic inflamm
v| growth: Generalized {Achondroplasia=dwarfism, rickets, staphyloccocus
Local {disuse retardation, trauma or ischemia to plate
Torsional (growth twists)

Question 13

6 Factors det ROM

Answer 13

Struct + shape of artc surf: complementary?
Str + tension of ligaments: position of jt
Arrg + tension of muscle: hamstr |v ext of leg when thigh flx’d
Contact of soft part
Hormns: Relaxin - ligamt + fibroct
Disease

Question 14

Arti Cartl Reax

Answer 14

Destruction: Ex Irreparable lesion - RA (pannus), ankylosing spondylitis
Infections (staph, TBC), prolonged immobil, cont compress, intra-artic injec of corti

Degen: Prem aging (wear and tear), Prev destr -> degen of remaining cart, irregular artic surfc
Peripheral prolif: After degen of central jt area, peripheral tissue prolif ossifying “ring”

Question 15

Syn Mem Reax

Answer 15

Excs flu pdn (eff): serous, inflam, hemmorrhagic
Hypertrophy
Adhesions - prolog’d lim mvm

Question 16

Jt cap + lig Reax

Answer 16

Joint lax (overstr - gene, inj, infec)
Jt contractures (tight) (congen, infec, chron arth, Mm contrax)

Question 17

SkelMm Reax

Answer 17

Disuse atrophy
Hypertrophy
Ischemic necrosis (trauam vasc spasm, thromb, embol)
Contract (prolong imm, abn contrx)

Question 18

Msk infec etiology

Answer 18

Temp/perm implant (heart valv, dent implant, morphine pump)
Pyogen
Granulomatous (TB)

Question 19

Common Msk infec disease

Answer 19

Osteomyelitis
Diskitis
Infectious Arthritis
TBC

Question 20

Osteomylitis

Bone marrow ,

Answer 20

Infection due to: Bacteria (common), fungi, parasite, virus
Key factors:
Virulence of organism
Immune health
Location/vasculariz of bone

Acute - children/seniors: exogen or endog (common in IV -> septicemia/chronic)
Chronic- Adults 2ndary to bone/surround tiss (relapse, undiag infec, drug resist bact, impant)
Acute Hematogenous (most common) - more in children/boys

Question 21

Acute

Osteomyelitis

Answer 21

Cause: Staphcocc Aureus (SA) 90% (upper respit tract - nose/throat infect, binds to cartilage. Protect glcocalyx + endotox → resist antibiot)

Pathog:
Pus accum ^| oressyre-> in-situ thromb/ischem-> bone necrosis

Question 22

Osteomyeltis Clinical signs

Answer 22

pain near end of long bone, malaise, anorexia, fever, local soft t. Swel
Erthrocyte Sedimentation Rate (ESR elev), leukocytosis (^|)

Question 23

Osteomyelitis Tx

Prognosis

Complications

Answer 23

Antibacterial (penicilin), bed rest + analgesics, IV fluid, split/traction, surgical decomp if no improv >24 hrs of ICU

Time (30 mins earlier Tx), effect, dos, durx of drug

Early: Septicemia (blood posion), abcess form -> sept arth (abcess drain into jtmed emerg)
Late: chronic osteomyelitis, patho frac, jt contr, local gwth dist

Question 24

Diskitis

Cause

Prognosis

Answer 24

IV disk most common site

SA, TB, unknown microorg

(P) for mths, complic: vc collapse, kyphosis, ankylosis

Question 25

Diskitis in Children

Cause

Clinical sign

Answer 25

Children: hematogenous (URI, UTI after cath)

Fever + spinal (P)
Abd (P), diff bend, complic w/ vertebral osteomylitis

Question 26

Diskitis in Adults

Clin sig

Answer 26

Adult: postop diskectomy

Symtom after surgery
Sev spinal (P)
Radi to LE
Rest doesn’t help

Question 27

Skel TB

Pathogen

Tx + Prog

Answer 27

10-15% of TB is extrapul, 10% is skel
Only 25% w/ Skel TB have history of pul TB
Small # of bac cause dmg to bone (via blood in immuno-comp)

2-3 yr post-infect (P)/stiff
Low thorx 25% + lumb 20% involved (Pott’s)

Drugs simlar to pulm TB, decomp surgery

Question 28

Latent TB

Extrapul TB

Answer 28

prev antibiotx eradicates the disease

TB not in lung, diff to access + diag
CNS Meningitis
Pleura - TBC Pleurisy
Disseminated - Miliary TBC
Spinal bone + jt - Pott’s

Question 29

Septic(Infect=bacterial) Arthritis Etiology

Answer 29

S. Aureus + Neisseria gonorrhea (inoculation, extension- periarticular osteomyelit, continguous soft t. inf, hematogenous)

Bact (Gonnococcal, lyme, syphilis, TB)
Fungal (Candida)
Viral (Epstein-Barr, Hepatitis, Mumps)
Reactive (chlamydial, acute fever)

Question 30

Bact Arth Pathogen

Answer 30

Introduct: Penetrat inj - human bite, frac, arthrocentesis (syringe biopsy), arthroscopy (microsp in body), arthroplasty (replacement)

Bact mult -> micrab-> phagocytosis of bact -> lysomo -> toxins intravasc -> syn Mem prolif = pannus

Question 31

Bacteria Arthritis Causes

Answer 31

Underlying jt disease or abdn jt 47% of cases.
Child+older adult ^| risk of non-gonoccocal infectious arthritis

Predisposing: system corticosteriod, Radiation tx, preexisting arthiri, arthrocentesis, HIV, DM, Alcohol/drug ab, trauma, other infectious dis, idiopathic

Question 32

Sept Arthritis Clinic Manife

Answer 32

All age groups, acute onset of jt (P) - P
Local swell+ tender (ROM restriction) - A, S
Fever, chills/signs of infection - H
Pus - R

Children: refuse to bear weight in affected, v. tender to palp, v. quick jt destruction (faster metabolism), longer term deformities

Adults:
Monoarticular if due to SA
Usually hip/knee affected, prosthetic usually sites of infection
Gonococcus affects women (urethra length to uterus location - internal secretion difficult to detect vs. pus from male urethra)

Question 33

Septic Arthritis Tx

Answer 33

Any jt infect = med emerg
IV antibiotics 2-3 wk
Splint, tract, casting to drain, v| bump

Question 34

Sept Ar Prog

Answer 34

Good if Tx w/i 5-7 days
Mortality higher in >65 yr, overall 25% or less
Pt jt disability 25-50%, knee better outcome than hip

Question 35

Infectious Buritsitis + Tenosynovitis

Answer 35

Uncommon, SA 80% of infect
Superficial more susceptible (Hand, elbow, knee), diabetics more vulnerable (v| in blood flow bug goes undetected)

Trauma > human bites 25% > animal 10%

Question 36

Myositis

Infection induced

Drug induced

Answer 36

Possible 1st sign of malignancy. DM: Threefold ^| risk, PM: 40% increase risk

S.A., Parasites
Trichinella (parasite), from undercooked pork, beef, game, 4% of popN.
Tapeworm larvae (tania solium): eggs in infected pork feces contaminate soil + ingest w/ raw vege.

Satins (red flag) - prescribed for high cholesterol, have they mentioned to dr of side effects, mention having muscle (P) get them to eval.
Statin -induced rhabdomyolysis

Question 37

3 Forms of Myosites

Answer 37

Dermatomyositis(DM): Child+ older adult
Polymyositis (PM)
Inclusion Body Myositis: most common acq muscle disease >50, progressive/debilit, not responsive, appears autoimmune

Question 38

Myositis
Clinical Mani

Tx

Answer 38

Non-specific: malaise/lethargy, fever, (P) + swell, weakness
Atrophy and necrosis

Necessary for aggressive early Tx

Anti-parasite Tx
Immunosuppressive Tx