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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
carpal tunnel dx
tinel's test phalen maneuver nerve conduction studies w/ ultrasound
26
carpal tunnel tx
splinting & application of ice/heat | surgery to enlarge tunnel
27
tingel's test
light percussion over irritated median nerve to elicit a tingling sensation (bone on open palm bottom by wrist)
28
phalen's test
maintained flexion of wrist @ 90 degreees for 30-60 sec elicits tingling/pain
29
bursitis
inflammation of bursa (small fluid sac of synovial joint) | results from overuse of joint/trauma to joint
30
bursitis s/s
tenderness of surrounding area pain with extension/flexion of joint warm/red/swollen skin over bursa
31
bursitis tx
``` rest compression elevation NSAIDs ice (acute inflammation) gentle stretching/strengthening exercises corticosteroid injection arthroscopic surgery ABX (if infection is cause) ```
32
strain
overstretching injury to muscle or muscle-tendon unit forces muscle to extend beyond capacity = microscopic tears usually lower back or neck
33
sprain
ligaments around joint stretched/torn oppositional forces cause ligaments to overstretch & tear most common site: ankle
34
sprain/strain tx
``` RICE NSAIDs casts splints immobilizers/slings surgery if severe PT ```
35
strain s/s
``` immediate pain reduced ROM muscle spasms edema muscle weakness bleeding swelling bruising ```
36
sprain s/s
``` severely hindered ROM pop/rip when injury occurs brusing pain immediate swelling ```
37
ACL tears
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
ACL tears s/s
intense pain feeling that knee popped or gave out swelling
39
ACL dx and tx
x-ray/mri | ice elevation NSAIDs, non-weight bearing until swelling subsides, PT, surgery
40
Meniscus injury
injury to cartilage between femure & tibia | results from forced twist/rotation
41
meniscus injury s/s
``` popping wound at knee pain when knee touched edema restricted joint mobility knee locks up/doesn't move smoothly knee feels weak/buckling ```
42
meniscus dx
ROM assessment | testing (x-ray MRI ultrasound)
43
meniscus tx
``` ice elevation NSAIDs no weight bearing (crutches) elastic bandage PT arthroscopic surgery ```
44
achilles tendon rupture
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
achilles tendon rupture s/s
pop pain feel struck violently in back of ankle
46
achilles tendone rupture dx/tx
clinical exam, U/S, MRI (U/S = best) | ice, NSAIDS, APAP, rest (non-weightbearing w/ crutches), immobilization, surgical repair
47
osteochondral lesions
occur at end of bone | lack of blood supply/direct trauma to joint/repetitive use
48
osteochondral lesions s/s
pain w/ weight bearing swelling tenderness limited mobility (occasional locking of knee)
49
osteochondral lesions tx
``` NSAIDS use of growth hormone weight loss rest ice use of assistive devices to walk PT nutritional supplements arthroscopic surgery ```
50
Rotator cuff tears
tendon supporting muscle rips/tears from bone causes: fall on shoulder, attempt to break fall with outstretched hand, repeated overhead motions
51
rotator cuff tears s/s
dull ache in joint from microsopic tears weakness when raising arm inability to reach behind back
52
rotator cuff tears dx/tx
shoulder ROM assessment, X-ray, CT scan, MRI, ultrasound/arthrogram rest, heat/cold, NSAIDS, electrical stimulation of muscle, cortisone injections, surgery
53
adhesive capsultitis
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
adhesive capsulitis causes
primary (idiopathic) thyroid disease, dyslipidemia, prolonged immobilization, stroke, autoimmune disease rare: parkinsons, HIV tx (protease inhibitors)
55
adhesive capsulitis s/s
self-imposed immobility of shoulder due to pain stiffness continued loss of motion unable to move arm above head or behind back
56
adhesive capsulitis dx and tx
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
impingement syndrome
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
impingement s/s
pain when raising arm above head or behind back
59
impingement dx/tx
pain relief w/ anesthetic, x-ray to rule out others | ice, NSAIDS, PT, steroid injections, arthroscopic surgery
60
osteomyelitis
penetrating wound from blood infection/skin breakdown/joint replacement/internal fixation surgeries infection carried to bone from bacteria/fungi/parasites/viruses
61
osteomyelitis s/s
local: bone pain, drainage, ulceration, swelling, redness, warmth, tenderness systemic: lymph node swelling, fever w/ chills, general malaise, tachycardia, nausea, vomiting, anorexia
62
osteomyelitis dx
abscess/bone changes/bone destruction (X-ray/bone scan/MRI) WBC count blood cultures bone biopsy/tissue samples
63
osteomyelitis tx
ABX surgery drainage tubes inserted into bone procedure to fill dead tissue space w/ muscle
64
osteonecrosis
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
osteonecrosis risk factors
``` long-term use of steroids heavy alcohol intake direct injury to bone/joint chemo organ transplantation disease ```
66
osteonecrosis s/s
insidious no symptoms pain when pressure/weight applied to joint inability to use limb
67
osteonecrosis dx
``` x-rays mri ct scan bone scan bone biopsy measurement of bone pressure ```
68
osteonecrosis tx
``` NSAIDS nonweight bearing ROM electrical stimulation surgery ```
69
bone tumors benign
abnormal growth of normal tissue doesn't metastasize w/ body organ fx affected by growth hormones lump associated w/ ache or pain
70
benign bone tumor tx
tumor heals when fracture heals stops growing when growth hormones slows surgery
71
malignant bone tumors
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
malignant bone tumors s/s
deep bone pain skin over mass warm erythematous
73
malignant bone tumors dx/tx
x-rays, CT scans, MRI, bone biopsy, alk phos & calcium levels surgery, chemo, radiation
74
metastatic bone disease
cancer from another part of the body that migrates to bone | most common in spine/pelvis/thigh
75
metastatic bone disease s/s
``` sometimes asymptomatic bone pain fractures changes in urinary/bowel continence limb weakness ```
76
metastatic bone disease dx
``` x-rays ct scans MRI blood tests bone/positron emission tomography scan ```
77
metastatic bone disease tx
radiation | chemotherapy

Pathophysiology and Pharmacology 2 (27 decks)

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