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Pathophysiology and Pharmacology 2 > MS: Acute Disorders > Flashcards

MS: Acute Disorders Flashcards

1
Q

concepts related to musculoskeletal

A 
comfort/pain 
infection 
inflammation/oxidative stress
cellular regulation 
mobility
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2
Q

fractures

A

break in a bone
result of increase in energy beyond what a bone can tolerate
direct vs indirect

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3
Q

fracture risk factors

A

age (younger = sports; older = falls/disease)
bone disease
poor nutritions (vitamin D, calcium, phosphorus)
lifestyle habits

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4
Q

fracture classifications

A

direct vs indirect
simple/closed
compound/open (broken skin/infection–reduced blood supply/poor healing)
degree (incomplete or complete)

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5
Q

fracture s/s

A 
pain
deformity
edema
numbness
muscle spasms
skin bruising
hypovolemia
crepitus
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6
Q

fracture types

A

incomplete/greenstick (fragments partially joined, common in children due to more collagen/less mineralized)
complete (fragments separate completely)

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7
Q 
complete fracture types
[transverse
oblique
spiral
comminuted
impacted
compression]
A

transverse- right angle to cone’s long axis
oblique - runs at oblique angle to bone (diagonal)
spiral - stripe on candy cane (twisting motion)
comminuted –many fragments (over 2)
impacted – bone fragments driven into each other
compression – crushed bones (often spinal column)

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8
Q

indirect healing fractures

[inflammatory > reparative > remodeling]

A 
inflammatory stage (bleeding causes hematoma, inflammatory cells degrade debris/bacteria)
reparative stage (fibrocartilage formed > soft callus joins fractured bone > hard callus develops > blood vessels form)
Remodeling stage (lamellar bone replaces woven bone)
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9
Q

Direct healing fractures

A

surgery to realign bone
best for severely comminuted/threatened vascularity (less long-term complications)
external fixation/internal fixation (/closed reduction)
hematoma forms/fibrin fills > soft tissue > calcium salts in new tissue > tissue remodeled to new shape

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10
Q

Union vs nonunion vs delayed union vs malunion

A

normal healing
no clinically significant progress for at least 3 months according to X-rays
significantly longer than expected healing time
bone fragments joined in incorrect position

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11
Q

fracture complications: infection

A

common agents (pseudomonas/staphylococcus/clostridium)
greater soft tissue damage/compromised immune system
TX: ABX/proper hygiene

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12
Q

Fracture blisteres

A

tense vesicles or bullae arising swollen skin directly overlying fracture
contain sterile fluid that can contribute to infection

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13
Q

fracture complications

A

compartment syndrome

fat embolism syndrome

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14
Q

compartment syndrome

A

edema & swelling > increased pressure in muscle compartment
causes:
decreased blood flow
continual increasing pressure in limb
ischemia (muscle/nerve damage) > amputation

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15
Q

compartment syndrome common sites/prevention/complications/tx

A

LE & forearm
ice/elevation
paralysis/volkmann contracture
remove cast/bandage/fascia

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16
Q

volkmann’s contracture
cause
mild/moderate/severe

A

cause: compartment syndrome (lack of blood flow to forearm)
forearm muscles severely injured (deformities in fingers/hand/wrist)
mild: 2-3 fingers/no or limited loss of feeling
moderate: all fingers bent & thumb stuck to palm, wrist may be stuck/some loss of feeling
severe: all muscles involved, severely disabling

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17
Q

fat embolism syndrome

A

closed long bone/pelvic fractures
early complication of ^
large amount of fat released from bone marrow into venous sytem
respiratory distress 24-72 hrs after event
no symptoms in most patients

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18
Q

fat embolism syndrome s/s and tx

A 
chest pain
dyspnea
tachycardia
pallor
disorientation
cyanosis
lo-grade fever
petechiae rash (axilla/conjunctiva/palate)
early assessment: blood gases
tx: O2, mechanical ventilation
prophylactic tx: corticosteroids & early immobilization of injury
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19
Q

dislocation

A

ends of bones moved out of normal position
attachment to join lost
cause; trauma

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20
Q

subluxation

A

bones of joint remain in partial contact

cause: trauma

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21
Q

dislocation/subluxation s/s

A

pain
limb/joint deformity
altered mobility of affected joint

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22
Q

dislocation/subluxation tx [general/shoulder/hip]

A 
manual traction (closed reduction) or open reduction
closed reduction and short-term immobilization 
immediate reduction to prevent necrosis of femoral head then bedrest after closed reduction
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23
Q

carpal tunnel syndrome

A

neuropathy causing nerve damage & muscle weakness or atrophy
caused by repetitive use injury
median nerve compressed by inflammation & swelling of synovial lining of tendon sheaths
most prone where nerves pass over rigid areas/through narrow canals

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24
Q

carpal tunnel syndrome s/s

A

numbness & tingling of thumb/index finger/lateral ventral surface of middle finger
hand weakness

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25
Q

carpal tunnel dx

A

tinel’s test
phalen maneuver
nerve conduction studies w/ ultrasound

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26
Q

carpal tunnel tx

A

splinting & application of ice/heat

surgery to enlarge tunnel

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27
Q

tingel’s test

A

light percussion over irritated median nerve to elicit a tingling sensation (bone on open palm bottom by wrist)

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28
Q

phalen’s test

A

maintained flexion of wrist @ 90 degreees for 30-60 sec elicits tingling/pain

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29
Q

bursitis

A

inflammation of bursa (small fluid sac of synovial joint)

results from overuse of joint/trauma to joint

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30
Q

bursitis s/s

A

tenderness of surrounding area
pain with extension/flexion of joint
warm/red/swollen skin over bursa

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31
Q

bursitis tx

A 
rest
compression
elevation
NSAIDs
ice (acute inflammation)
gentle stretching/strengthening exercises
corticosteroid injection
arthroscopic surgery
ABX (if infection is cause)
32
Q

strain

A

overstretching injury to muscle or muscle-tendon unit
forces muscle to extend beyond capacity = microscopic tears
usually lower back or neck

33
Q

sprain

A

ligaments around joint stretched/torn
oppositional forces cause ligaments to overstretch & tear
most common site: ankle

34
Q

sprain/strain tx

A 
RICE
NSAIDs
casts
splints
immobilizers/slings
surgery if severe
PT
35
Q

strain s/s

A 
immediate pain
reduced ROM
muscle spasms
edema
muscle weakness
bleeding
swelling
bruising
36
Q

sprain s/s

A 
severely hindered ROM
pop/rip when injury occurs
brusing 
pain
immediate swelling
37
Q

ACL tears

A

one of 4 major ligaments connecting femur to tibia
occurs when stressed/strained/torn
decelerating while running/twisting or jumping
tear down middle of ligament
ligament torn completely from femur

38
Q

ACL tears s/s

A

intense pain
feeling that knee popped or gave out
swelling

39
Q

ACL dx and tx

A

x-ray/mri

ice elevation NSAIDs, non-weight bearing until swelling subsides, PT, surgery

40
Q

Meniscus injury

A

injury to cartilage between femure & tibia

results from forced twist/rotation

41
Q

meniscus injury s/s

A 
popping wound at knee
pain when knee touched
edema
restricted joint mobility
knee locks up/doesn't move smoothly
knee feels weak/buckling
42
Q

meniscus dx

A

ROM assessment

testing (x-ray MRI ultrasound)

43
Q

meniscus tx

A 
ice 
elevation
NSAIDs
no weight bearing (crutches)
elastic bandage
PT
arthroscopic surgery
44
Q

achilles tendon rupture

A

achilles = largest tendon connecting to heel
sudden pivoting/rapid acceleration
common in tennis, BBall, softball
occurs with recurrent microtrauma (degeneration) > damaged tendon becomes calcified/thickened/inelastic/fibrotic > shear stress > tear/rupture
can be caused by fluroquinolones

45
Q

achilles tendon rupture s/s

A

pop
pain
feel struck violently in back of ankle

46
Q

achilles tendone rupture dx/tx

A

clinical exam, U/S, MRI (U/S = best)

ice, NSAIDS, APAP, rest (non-weightbearing w/ crutches), immobilization, surgical repair

47
Q

osteochondral lesions

A

occur at end of bone

lack of blood supply/direct trauma to joint/repetitive use

48
Q

osteochondral lesions s/s

A

pain w/ weight bearing
swelling
tenderness
limited mobility (occasional locking of knee)

49
Q

osteochondral lesions tx

A 
NSAIDS 
use of growth hormone
weight loss
rest
ice
use of assistive devices to walk
PT
nutritional supplements
arthroscopic surgery
50
Q

Rotator cuff tears

A

tendon supporting muscle rips/tears from bone
causes:
fall on shoulder, attempt to break fall with outstretched hand, repeated overhead motions

51
Q

rotator cuff tears s/s

A

dull ache in joint from microsopic tears
weakness when raising arm
inability to reach behind back

52
Q

rotator cuff tears dx/tx

A

shoulder ROM assessment, X-ray, CT scan, MRI, ultrasound/arthrogram
rest, heat/cold, NSAIDS, electrical stimulation of muscle, cortisone injections, surgery

53
Q

adhesive capsultitis

A

frozen shoulder
acute inflammation of ligaments in shoulder joint capsule
shoulder bones unable to freely move in joint
not completely understood (inflammation of capsule)

54
Q

adhesive capsulitis causes

A

primary (idiopathic)
thyroid disease, dyslipidemia, prolonged immobilization, stroke, autoimmune disease
rare: parkinsons, HIV tx (protease inhibitors)

55
Q

adhesive capsulitis s/s

A

self-imposed immobility of shoulder due to pain
stiffness
continued loss of motion
unable to move arm above head or behind back

56
Q

adhesive capsulitis dx and tx

A

shoulder ROM assessment, x-ray to rule out other things, MRI
NSAIDS, steroid injections, PT, arthroscopic surgery
can resolve w/in 2 years with minimal lasting damage w/out tx

57
Q

impingement syndrome

A

swimmer’s shoulder
acute shoulder injury
due to repeated movement
rotator cuff tendon trapped under acromion
compression between humeral head & undersurface of acromion joint or arch

58
Q

impingement s/s

A

pain when raising arm above head or behind back

59
Q

impingement dx/tx

A

pain relief w/ anesthetic, x-ray to rule out others

ice, NSAIDS, PT, steroid injections, arthroscopic surgery

60
Q

osteomyelitis

A

penetrating wound from blood infection/skin breakdown/joint replacement/internal fixation surgeries
infection carried to bone from bacteria/fungi/parasites/viruses

61
Q

osteomyelitis s/s

A

local: bone pain, drainage, ulceration, swelling, redness, warmth, tenderness
systemic: lymph node swelling, fever w/ chills, general malaise, tachycardia, nausea, vomiting, anorexia

62
Q

osteomyelitis dx

A

abscess/bone changes/bone destruction (X-ray/bone scan/MRI)
WBC count
blood cultures
bone biopsy/tissue samples

63
Q

osteomyelitis tx

A

ABX
surgery
drainage tubes inserted into bone
procedure to fill dead tissue space w/ muscle

64
Q

osteonecrosis

A

avascular necrosis, aseptic necrosis, ischemic necrosis
reduced blood flow to joint
bone breakdown outpaces replacement
cause: fracture, thrombosis/embolism, vessel injury, compartment syndrome, steroid therapy

65
Q

osteonecrosis risk factors

A 
long-term use of steroids
heavy alcohol intake
direct injury to bone/joint
chemo
organ transplantation 
disease
66
Q

osteonecrosis s/s

A

insidious
no symptoms
pain when pressure/weight applied to joint
inability to use limb

67
Q

osteonecrosis dx

A 
x-rays
mri
ct scan
bone scan
bone biopsy
measurement of bone pressure
68
Q

osteonecrosis tx

A 
NSAIDS
nonweight bearing 
ROM
electrical stimulation 
surgery
69
Q

bone tumors benign

A

abnormal growth of normal tissue
doesn’t metastasize w/ body organ fx
affected by growth hormones
lump associated w/ ache or pain

70
Q

benign bone tumor tx

A

tumor heals when fracture heals
stops growing when growth hormones slows
surgery

71
Q

malignant bone tumors

A

come from cartilage/cone cells/collagen/bone marrow
exact cause unknown
r/t high bone growth/bone overstimulation by disease, radiation, bone marrow transplant, osteolysis
most common in adolescents under 20

72
Q

malignant bone tumors s/s

A

deep bone pain
skin over mass warm
erythematous

73
Q

malignant bone tumors dx/tx

A

x-rays, CT scans, MRI, bone biopsy, alk phos & calcium levels
surgery, chemo, radiation

74
Q

metastatic bone disease

A

cancer from another part of the body that migrates to bone

most common in spine/pelvis/thigh

75
Q

metastatic bone disease s/s

A 
sometimes asymptomatic
bone pain
fractures
changes in urinary/bowel continence
limb weakness
76
Q

metastatic bone disease dx

A 
x-rays
ct scans
MRI
blood tests
bone/positron emission tomography scan
77
Q

metastatic bone disease tx

A

radiation

chemotherapy

Pathophysiology and Pharmacology 2 (27 decks)

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