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Patho Exam 2 > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

Musculoskeletal System

A

Bones and Cartilage

Includes bones, joints, muscles, ligaments, tendons, and other connective tissue

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2
Q

Axial Skeleton

A

Skull, thorax, vertebral column (axis of the body)

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3
Q

Appendicular Skeleton

A

upper and lower extremities, shoulders, and hip girdles

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4
Q

Bones

A

206 Bones
specialized form of connective tissue
Site of fat and mineral storage as well as hematopoiesis

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5
Q

Long bones

A

upper and lower extremities

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6
Q

Short Bones

A

Ankle and Wrist

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7
Q

Flat Bones

A

Scapula, skull

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8
Q

Irregular bones

A

jaw, vertebrae

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9
Q

Sesamoid Bones

A

knee cap

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10
Q

Periosteum

A

layer of connective tissue that covers compact bone surfaces

serves as the site of muscle attachment (via tendons)

The outer surface contains cells that aid in remodeling and repair (osteoblasts)

Richly supplied with blood vessels and nerve fibers

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11
Q

Bone Marrow

A

in the shaft of long bones

Red marrow is the site of hematopoiesis

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12
Q

osteoclasts

A

break down spongy bone

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13
Q

osteoblasts

A

rebuild new compact bone

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14
Q

osteocyte

A

osteoblasts surrounded by calcified extracellular material

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15
Q

Matrix

A

Extracellular material in which the osteocytes are embedded

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16
Q

appositional growth

A

new bone forms on the surface of a bone

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17
Q

Endochondral growth

A

bone eventually replaces new cartilage growth in the epiphyseal plate

growth plate

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18
Q

Calcium

A

activates vitamin D

sun, milk

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19
Q

Calcitonin and parathyroid hormone

A

regulate bone remodeling and mineralization of calcium

Vitamin D

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20
Q

Estrogen

A

inhibits formation of osteoclasts in women

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21
Q

Skeleton

A

forms from hyaline cartilage during fetal development

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22
Q

cartilage

A

tough and flexible connective tissue

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23
Q

PTH

A

promotes bone resorption by decreasing calcium

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24
Q

Calcitonin

A

increased blood calcium levels

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25
Q

Synovial joints

A

freely moveable

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26
Q

Amphiarthroses joints (cartilaginous)

A

slightly moveable

found in the vertebral column

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27
Q

Synarthroses joints (fibrous)

A

immoveable

found in the skull and pubic symphysis

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28
Q

fracture

A

a break in the rigid structure of the bone

Most common traumatic musculoskeletal disorders

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29
Q

simple fractures

A

fracture—a single break with bone ends maintaining their alignment and position

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30
Q

spiral

A

sports injury

spin and twist

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31
Q

greenstick

A

an incomplete break in which the bone is bent and only the outer curve of the bend is broken

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32
Q

transverse

A

complete break all the way across

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33
Q

comminuted

A

different pieces from the fracture, multiple fracture lines and bone pieces
gunshot wound, crushing

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34
Q

complete fracture

A

obvious deformities

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35
Q

incomplete fractures

A

partial breaks

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36
Q

closed fractures

A

skin is intact

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37
Q

compression fracture

A

bone is crushed or collapses into small pieces

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38
Q

depressed fractures

A

mainly in the skull

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39
Q

stress fractures

A

runners

40
Q

Pathologic fractures

A

fractures due to tumors

41
Q

impacted fractures

A

daredevils

42
Q

Fractures Manifestations

A

deformity (e.g., angulation, shortening, and rotation), swelling and tenderness at the site, inability to move the affected limb, crepitus, pain, paresthesia(tingling in extremities), and muscle flaccidity progressing to spasms

43
Q

Diagnosis for Fracture

A

history, physical examination, and X-rays

44
Q

Treatment of Fractures

A

immediate immobilization (e.g., splints or traction, reduction (closed or open), surgery (may include pins, plates, rods, or screws), debridement, long-term immobilization (e.g., casts, splints, or traction), and physical therapy

45
Q

Complications

A

Delayed union: aren’t toughing yet, longer to heal
malunion: bone grows along the side of another bone
nonunion:

46
Q

compartment syndrome

A

swelling around the fracture site, losing blood flow, swelling proximal or distal
MEDICAL EMERGENCY
limb threatening

47
Q

Fat embolism

A

stops the blood from flowing

***biggest, most common complication from a fracture

48
Q

Osteamyelitis

A

bone inflammation

49
Q

Osteonecrosis

A

bone death

50
Q

avascular necrosis

A

no vessels or blood supply, necrosis occurs

51
Q

Fracture Healing

A
  1. Hematoma formation
  2. Necrosis of the broken bone ends
  3. Fibroblasts invade the clot within a few days
  4. Fibroblasts secrete collagen fibers, which form a mass of cells and fibers called a callus
  5. Callus bridges the broken bone ends together inside and outside over 2–6 weeks
  6. Osteoblasts invade the callus and slowly converts it to bone over 3 weeks to several months (usually 4–6 weeks)
52
Q

Dislocations

A

separation of two bones at a joint

53
Q

manifestations of dislocations

A

Visibly out-of-place, discolored, or deformed joint
Limited movement
Swelling or bruising
Intense pain, especially with movement or weight bearing
Paresthesia(tingling) near the injury

54
Q

Diagnosis of dislocations

A

history, physical examination, X-rays, and magnetic resonance imaging(MRI)

55
Q

Sprains

A

***LIGAMENT
Injury to a ligament that often involves stretching or tearing of the ligament or the capsule surrounding the joint.
Heal more slowly

56
Q

RICE

A

Rest, Ice, Compression, Elevation

57
Q

Strains

A

Injury to a muscle or tendon that often involves stretching or tearing of the muscle or tendon
***TENDON
possible surgery of severe tendon tears

58
Q

Osteomyelitis

A

Acute or chronic infection of the bone or marrow; difficult to treat

Manifestations: fever, redness, swelling; bacteremia

Treatment: Treat causative agent; Abx, possible surgery for I & D

59
Q

Osteomyelitis

A

Acute or chronic infection of the bone or marrow; difficult to treat

Manifestations: fever, redness, swelling; bacteremia

Treatment: Treat causative agent; Antibiotics, possible surgery for I & D(incision and drainage)

60
Q

Osteonecrosis

A

Avascular necrosis
Caused by interruption in blood flow rather than infection

Fractures, vessel injury (trauma), decompression sickness (SCUBA diving), sickle cell disease, radiation therapy, compartment syndrome.
Can also be caused by corticosteroid therapy

61
Q

Neoplasms

A

Bone Tumors
More frequently benign than malignant
Both can develop from the cartilage (chondrogenic), bone (osteogenic), and supporting elements of bone (fibrinogenic)
Location of the tumor provides important diagnostic information.

Manifestations:
Pain, presence of a mass, 
impairment of function. 
Some tumors are found 
incidentally
62
Q

Osteosarcoma

A

adolescent boys (12-17): more in the legs
Aggressive and highly malignant bone tumor
Men > Women
Unknown Causes (some link it to age and growing)

Treatment: Surgery and Chemotherapy

63
Q

Chondrosarcoma

A

Malignant tumors of cartilaginous lineage and sub-classified according to site of origin.
CHONDRO: cartilage

Commonly arise in the central portions of the skeleton, pelvis, shoulders, and ribs.

Middle to later in life, slow growing often metastasize late and are often painless.

Early dx is important because radical surgery excision tends to have better outcomes.

Treatment:
Radical surgery excision, combo chemotherapy.
Typically does NOT respond to radiation.

64
Q

Ewing Sarcoma

A

A member of the family of tumors that include primitive neuroectodermal tumor (PNET)

usually seen in children

Densely packed, regularly shaped, small cells with round or oval nuclei, reciprocation of chromosome 11 and 31.

Primarily seen in children, and usually located in the femur and pelvis, but can be found in other bones.

Treatment:
Multiagent chemo for shrinking of tumor, surgery, and radiation therapy.

65
Q

Osteogenesis Imperfecta

A

“brittle bone disease”
Autosomal recessive trait that causes deficiencies in the synthesis of type I collagen
Extreme skeletal fragility
No definitive treatment for correction

66
Q

Genu Varum

A

“Bowlegs”

Bowing of the knees greater than 1inch when the medial malleoli of the ankles are touching.

67
Q

Genu Valgum

A

“Knock knees”

Deformity in which there is decreased space between the knees

68
Q

Developmental Dysplasia of the Hip (DDH)

A

“congenital dislocation of the hip”
Can lead to unstable, malformed, subluxed, or dislocated hip in severe cases.
Newborn screening includes Barlow test. Confirmation of dysplasia is obtained with Ortolani “click”

69
Q

Legg-Calve-Perthes Disease

A

Idiopathic osteonecrotic disease of the proximal femoral epiphysis. Avascular necrosis of the bone and marrow involving the epiphyseal growth center.
Main symptoms are pain in the hip and groin area
Unknown cause
Typically treated with surgery to reduce deformity and preserve femoral head.

70
Q

Osgood Schlatter Disease

A

Micro fractures in the area where the patellar tendon inserts to the tibial tubercle.
Pain in the front of the knee associated with inflammation and thickening of the patellar tendon.
Treatment is rest, activity restriction, and occasional knee immobilization

71
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

“coxa vera” disorder of the growth plate that occurs near the age of skeletal maturity.
Three dimensional displacement of the epiphysis (posteriorly, medially, and inferiorly)
Pain usually in the knee area with fatigue and difficulty walking.
Diagnosis is made by x-ray and treatment is determined by severity of slippage.

72
Q

Scoliosis

A

Curvature of the spine in the upright position

Congenital, neuromuscular, and idiopathic

73
Q

Scoliosis

A

Curvature of the spine in the upright position
Congenital, neuromuscular, and idiopathic

Complications: pulmonary compromise, chronic pain, degenerative arthritis of the spine, intervertebral disk disease, and sciatica

Manifestations vary depending on the degree of curvature and are exaggerated when an affected person bends over
Include: asymmetrical hip and shoulder alignment, asymmetrical thoracic cage, asymmetrical gait, back pain or discomfort, fatigue, and indications of respiratory compromise

74
Q

Scoliosis

A

Lateral deviation of the spine that may affect the thoracic or lumbar area or both
May also include a rotation of the vertebrae

75
Q

Kyphosis

A

Increase in the curvature of the thoracic spine outward

76
Q

Lordosis

A

Exaggerated concave of the lumbar spine

in children

77
Q

Osteoporosis

A

Metabolic condition characterized by a progressive loss of bone calcium that leaves the bones brittle

Complications: pathological fractures (typically in the wrist, hip, and spine)

Manifestations
Often asymptomatic in early stages
Includes: osteopenia, bone pain or tenderness, fractures with little or no trauma, low back and neck pain, kyphosis, and height reduction (as much as 6 inches) over time

Diagnosis
Conducted screening periodically on those persons at risk
Include: history, physical examinations, bone density scans, X-rays, and spinal computed tomography
Advances in diagnostic methods of bone mass density have made early detection possible

78
Q

Rickets and Osteomalacia

A

Rickets (pediatric form)– soft, weak bones in children, usually because of an extreme and prolonged vitamin D, calcium, or phosphate deficiency
Osteomalacia – adult form

Manifestations
Becomes apparent in children as the soft bones cannot support the growing child
Skeletal deformities (e.g., bowed legs, asymmetrical skull, scoliosis, kyphosis, pelvic deformities, sternum projection)
Delayed growth in height or limbs
Dental problems
Bone pain
Muscle cramps or weakness

79
Q

Paget’s Disease

A

Progressive metabolic condition characterized by excessive bone destruction that occurs along with the replacement of bone by fibrous tissue and abnormal bone
The new bone is bigger but weakened and filled with new blood vessels

manifestations: 
Vary depending on the area affected
Often insidious in onset and may be asymptomatic early
Bone pain
Skeletal deformities (e.g., bowing of the legs, asymmetrical skull, and enlarged head)
Fractures
Headache
Hearing and vision loss
Joint pain or stiffness
Neck pain
Reduced height
Warmth over the affected bone
Paresthesia or radiating pain in the affected region 
Hypercalcemia
80
Q

Osteoarthritis

A

Degenerative joint disease characterized by local deterioration of articulating cartilage and its underlying bone as well as bony overgrowth
Bone rubbing on bone
Results in joint space narrowing, joint instability, stiffness, and pain

Manifestations
Gradual onset, usually beginning after the age of 40
Joint pain that worsens during or after movement or weight bearing
Joint tenderness with light pressure
Enlarged, hard joints
Limited joint range of motion
Hard nodules around the affected joint (bone spur)

81
Q

Rheumatoid Arthritis

A

Systemic, autoimmune condition involving multiple joints

The exact cause is unknown, but it is thought to be caused a genetic vulnerability that permits a virus or bacteria to trigger the disease
Risk factors: being female, family history, advancing age (however, there is a juvenile form), and smoking

manifestations: 
Usually insidious onset Progressively worsen
Fatigue
Anorexia
Low-grade fever
Lymphadenopathy
Malaise
Muscle spasms
Morning stiffness lasting more than 1 hour
Warmth, tenderness, and stiffness in the joints when not used
Bilateral joint pain
Swollen and boggy- joints
Limited joint range of motion
Contractures and joint deformity (e.g., boutonniere deformity and swan neck deformity)
Unsteady gait
Depression
Anemia
82
Q

Difference in osteo and rheumatoid

A

Osteoarthritis is usually just one joint

Rheumatoid happens in all of them equally

83
Q

Gout

A

Inflammatory disease resulting from deposits of uric acid crystals in tissues and fluids

84
Q

Phases of gout: 1

A
  1. Asymptomatic
    Uric levels climb in the bloodstream and crystals deposit in the tissue
    Crystals accumulate, damaging tissue
85
Q

2

A
  1. Acute flares or attack
    Tissue damage triggers an acute inflammation
    Characterized by pain, burning, redness, swelling, and warmth at the affected joint lasting days to weeks
    Most initial attacks occur in the lower extremities (most often the big toe)
86
Q

3

A
  1. Intercritical period
    After the attack subsides and the disease is clinically inactive until the next flare
    Hyperuricemia and crystal accumulation continues
    These periods in between attacks become shorter as the disease progresses
    Reoccurring attacks are often precipitated by sudden increases in serum uric acid
87
Q

4

A
  1. Chronic gouty arthritis
    Characterized by joint soreness and aching present most of the time
    May also develop tophi that can drain or renal calculi
88
Q

Gout Manifestations

A

Vary depending on the phase
Intense pain at the affected joint that frequently starts during the night and is often described as throbbing, crushing, burning, or excruciating
Joint warmth, redness, swelling, and tenderness (even to light touch)
Fever
Joint deformities
Limited joint mobility

89
Q

Ankylosing Spondylitis

A

Progressive inflammatory disorder affecting the sacroiliac joints, intervertebral spaces, and costovertebral joints

hips and spine

90
Q

Ankylosing Spondylitis Manifestations

A

Intermittent lower back pain (early)
Pain and stiffness that typically worsens with inactivity and improves after activity
Lower back pain that evolves to include the entire back
Pain in other joints (especially the shoulders, hips, or lower extremities)
Muscle spasms
Fatigue
Low-grade fever
Weight loss
Kyphosis

91
Q

Muscular Dystrophy

A

Group of inherited disorders characterized by degeneration of skeletal muscle
Most types are inherited, but some occur because of a genetic mutation (often spontaneously)
Some types cause tremendous disability and rapidly decline whereas others have minimal symptoms and hardly noticeable progression
males more than females

92
Q

MD diagnosis

A

Diagnosis: history, physical examination, muscle biopsy, electromyelography, electrocardiogram, serum creatine kinase levels, serum presence of defective dystrophin, genetic testing, and fetal chorionic villus testing (as early as 12 weeks’ gestation)

93
Q

Muscular Dystrophy Manifestations

A

All of the muscles may be affected or only a selected group
Mental retardation (in some types)
Muscle weakness and spasms that progresses
Delayed development of muscle motor skills
Difficulty using one or more muscle groups
Poor coordination
Drooling
Ptosis: drooping of the eyelids
Frequent falls
Progressive loss of joint mobility and contractures (e.g., clubfoot and foot drop)
Unilateral calf hypertrophy
Scoliosis or lordosis

94
Q

MD Treatment

A

No cure for MD
Gene therapy may potentially be the answer
Goal is to maintain motor function and prevent deformities as long as possible
Includes: physical therapy, muscle relaxants, immunosuppressant agents, assistive devices (e.g., walker, braces, and splints), surgical contracture release, coping strategies, and support

95
Q

Fibromyalgia

A

Syndrome predominately characterized by widespread muscular pains and fatigue
Affects muscles, tendons, and surrounding tissue, but it does not affect the joints

96
Q

Fibromyalgia Manifestations

A

Vary depending on the weather, stress, fatigue, physical activity, and time of day
Widespread pain, typically described as a constant, dull muscle ache with trigger points
Fatigue, sleep disturbances, depression, irritable bowel syndrome, headaches, and memory problems

Patho Exam 2 (3 decks)

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