MS pathologies pt. 3 ( infection/trauma) Flashcards
Osteomyelitis pahto ?
Bacterial or fungal infection in bone
Osteomyelitis routes ?
hematogenous
exogenous ( surgery or trauma)
contiguous ( soft tissue infection nearby )
Osteomyelitis – ACUTE hematogenous patho ?
Bacteria lodge in end artery of metaphysis and multiply below periosteum
**rarely goes into the joint and cause septic arthritis cause the epiphyseal is a barrier ** - can see its not in the joint cause the epiphyseal plate
Osteomyelitis – ACUTE hematogenous Hx ?
Have history of infection, e.g. strep throat, skin, UTI
Osteomyelitis – ACUTE hematogenous sxs ?
pain, malaise, anorexia, vomiting, fever ( vague)
Osteomyelitis – ACUTE hematogenous dx ?
blood culture (+/-)
Osteomyelitis – ACUTE hematogenous pathologic organisms ?
S. aureus, Hemolytic strep, H. flu
Osteomyelitis – ACUTE hematogenous Tx ?
IV antibiotics, possibly surgical drainage
Osteomyelitis – CHRONIC patho ?
Occurs when acute infection is untreated or tx fails
Fragment of necrotic bone gets walled off – sequestrum
May lie quiet for months-years
Osteomyelitis - Chronic facts ?
More sequestra form, bone gets deformed
Diabetics more prone cause they do not heal well cause circulation
Multiple organisms common
Osteomyelitis - Chronic tx ?
surgical debridement, bone reconstruction
Sprains – ligamentous injury 1st degree ?
minimal pain, no joint instability
Sprains – ligamentous injury 2nd degree ?
moderate pain, min. joint instability, partial ligament rupture
Sprains – ligamentous injury 3rd degree ?
severe pain, completely unstable joint, complete ligament tear
**later angle injuries are more common more inversion injuries **
**tuning fork on it - hurts? then yes fracture but it does not hurt if the ligament is tore etc **
Strains – muscle injury 1st degree ?
– mildly or slightly pulled muscle, pain, spasm, swelling, ecchymosis
Strains – muscle injury 2nd degree ?
– moderately pulled, pain, spasm, swelling, torn muscle fibers
Strains – muscle injury 3rd degree ?
– severely pulled, loss of muscle function, palpable defect, ruptured muscle or tendon. Possibly avulsion fx at tendinous attachment ( ecchymosis, spasms, and prolongs liability)
Compartment syndrome causes and patho ?
Fx, crush injury, hemorrhage, burn, edema –
increased pressure in fascial compartment on arteriole walls
Compromises circulation in that space
**not diffusely the whole limb just a compartment and the blood is taking up space and it causes pressure o the arterial wall ( distal pulses are okay)
no risk of whole limb ischemia just the compartment ischemia **
Compartment syndrome Red Flags ?
Pain is out of proportion to injury
Pain is persistent & progressive
Weakness or paralysis of muscle
Tense compartment on palpation
Distal pulses remain intact
**casting should make them feel better but if in a cast and still pain then this is a problem and it is probably this
distal pulses are still okay
pain that is unrelieved with rest **
Compartment syndrome dx ?
check compartment pressure with monitor
Compartment syndrome tx ?
fasciotomy ASAP, with partial closure ( slices through the tissue and let compartment breath again)
**which compartment has a higher pressure **
they will do a partial closure and wait for swelling to go down ( and maybe need to go back to the OR to get all the other stuff out of there)
Fibromyalgia Syndrome etiology ?
Etiology unknown
Fibromyalgia Syndrome sxs and PE ?
Widespread muscle pain, worst in AM
No limitation of movement but stiffness
Trigger points – symmetric, often neck, shoulders, hands, back, knees
Fibromyalgia Syndrome own notes ?
bilateral above and below the waits
need 11/18 tender with no sxs. pressure points positive to dx or 6 with ass. sxs.
these patients are hypersensitive and have a lower pain threshd
paints dont sleep well and are very fatigued
Fibromyalgia patho ?
Unpredictable pattern of spread
Maybe aberrant pain signaling and amplification
Fibromyalgia triggers ?
Triggers – immobility, overuse, cold temps.
No edema, but TTP
Fibromyalgia dx ?
Dx of exclusion
Fibromyalgia tx ?
some what physically active but do not over due it
Polymyalgia Rheumatica (PMR) etiology ?
UKN
Polymyalgia Rheumatica (PMR) age and gender ?
+50 years, F>M ( middle age women)
Polymyalgia Rheumatica (PMR) locations ?
Hip, shoulders, neck, symmetric
Polymyalgia Rheumatica (PMR) sxs ?
Sudden or gradual onset
Worst in AM
Chronic, but ultimately self-limiting
Associated malaise, depression, weight loss
No true weakness
- *muscle pain not the joints
- *
Polymyalgia Rheumatica (PMR) dx ?
no dx test so we treat sxs.
Most common metabolic bone disease in US ( and preventable) ?
Osteoporosis
Osteoporosis gender ?
Females>Males ( cause estrogen loss after menopause)
Osteoporosis etiology ?
↓ estrogen, chronic us of steroids, hyperthyroidism not well controlled, immobilization, smoking, malignancy
50% of postmenopausal women sustain an osteoporosis-related fracture
**alot of patient education here **
Osteoporosis risk factors ?
Postmenopausal
+50 years
Weight<154 lbs
Low dietary calcium
Vita D deficiency - no sunlight
Tobacco and ETOH use
Fx in a first degree relative
Use of corticosteroids
Medical conditions
Medications
Inflammatory disorders
**thin petite people
dietary supplemets are a much better source
celiacs disease etc cause no absorptions ( this is alot of risk fcto5rs ) **
Osteoporosis: increased bone resorption ?
osteoclast
Osteoporosis: normal bone formation ?
osteoblasts
Osteoporosis have a high risk of ?
Fx
**ridges are fragile and susceptible to breaking down **
**susceptible to compression fractures as they get older ( grandma getting shorter) loss of muscle bulk too **
Osteoporosis PE, signs?
Decreased height
Usually asymptomatic until fx
**susceptible to compression fractures as they get older ( grandma getting shorter) loss of muscle bulk too **
Osteoporosis dx ?
DEXA scan, check bone density
Osteoporosis: DEXA screening ?
Screen at 65, younger if at risk
unless they have been VD defficeicnt for a long time to on steroid for a long time you can check earlier
Osteoporosis sxs. ?
usually asxs, until fracture
Osteoporosis Tx ?
prevention!
Dietary calcium (better than supplements) - 1200 mg a day ( but need VD for absorption)
Vitamin D – sun, food, supplements ( havent seen a benefit of supplements after 5 years ( max out effectiveness) )
Weight-bearing exercise
Bisphosphonates – Fosamax, Actonel, Boniva (decrease osteoclastic activity)
Risk of osteonecrosis of the jaw - rare but dramatic when you see it ( side effect of bisphosphonates)
Bisphosphonates side effects ?
Risk of osteonecrosis of the jaw - rare but dramatic when you see it ( side effect of bisphosphonates)
Metastatic bone disease hx ?
Hx of a primary cancer in prostate, breast, lung, thyroid, kidney
Metastatic bone disease sxs. ?
nocturnal pain, unrelieved with rest, weight loss, hx of CA
Metastatic bone disease what may be the first sign ?
Pathologic fx may be first sign – from minor event, due to thin bones
**first sing might be a fracture bone from a minor event like hitting it on the door or sneeze and break a rib **
Metastatic bone disease dx ?
bone scan,
looking for
“hot spots” of
increased
activity
- ↑ serum alk phos
**hot spot - increase uptake in dye ( no definitive - could just be more activity there but a good clue) **
Ehlers-Danlos Syndrome saying ?
“damn that girl is lose”
Ehlers-Danlos Syndrome patho ?
Hereditary connective tissue disorder (autosomal dominant or recessive trait)
Ehlers-Danlos Syndrome prevalence ?
1/10000 to 1/25000
20,000-50,000 EDS patients in the US
Ehlers-Danlos Syndrome signs and sxs. ?
joint hypermobility
skin hyper extensibility
tissue fragility
pain
recurvatum of the knees
**runs in families and not common and they are in alot of pain
no opioids they need to learn to cope with it **
Ehlers-Danlos Syndrome vascular types prevalence ?
5%
Ehlers-Danlos Syndrome vascular types ?
deficit of collagen TIII
decreased /absent collagen synthesis or abnormalities in collagen secretion
Ehlers-Danlos Syndrome prognosis ?
poor prognosis
most severe subtype ( vascular)
life threatening vascular ruptures
Anuerysm formation
