MSK Flashcards
1
Q
Risk factors of Rheumatoid Arthritis?
A
Environmental factors, diet, socioeconomic status, smoking
2
Q
Causes of Rhabdomyolysis?
A
Trauma – crush injuries,
Medications and drugs
Excessive muscle contraction
Infectious agents
Toxins – carbon monoxide
3
Q
Complications of Rhabdomyolysis? Why?
A
Hyperkalemia – contents of cell – potassium is released into circulation
Cardiac dysrhythmia
Kidney failure – myoglobin precipitates in tubules, obstructing flow – urine that looks like cocacola
4
Q
What are shin splints/?
A
stress on the tibia by overworking your muscles – going too fast to start and not allowing your muscles time to grow
5
Q
What does RA (rheumatoid arthritis) cause? (symptoms)
A
Inflammation spreads to joint capsule and surrounding ligaments and tendons causing pain, deformity, & loss of function.
Also causes fever, malaise, rash, lymph node or spleen enlargement
6
Q
What is Juvenile Idiopathic Arthritis?
A
Childhood form of rheumatoid arthritis
7
Q
What is fibromyalgia?
A
Syndrome of chronic pain and not a disease of inflammation
8
Q
What is the most reliable indicator of Rhabdomyolysis?
A
Creatine kinase is also released in increased quantities – elevated CK is most reliable indicator
9
Q
What is a flash freeze?
A
4th and final stage of a cold injury
– rapid formation of ice crystals
10
Q
Common sites for Sprains?
A
Most common – wrist, ankle, elbow, and knee
11
Q
Characteristics of a club foot?
A
Either one or both of the feet are twisted downward and inward with an increased arch and an inward facing heal
12
Q
What is the flow phase of burns?
A
Enter a state of hypermetabolic response increase levels of catecholamines, cortisol, glucagon, and insulin correspond to an increase in their increased energy expenditure
13
Q
What kind of potential injury can be caused with rewarming a cold injury?
A
Rewarming has potential for reperfusion injury – multiple factors occurring with inflammatory response - edema, redness, and burning pain
14
Q
What is the rule of 9’s?
A
Rule of 9s – estimate percentage of body burned
15
Q
Oblique Vs Spiral fracture?
A
Oblique breaks on an angle - Spiral – encircles the bone
16
Q
4 stages of bone healing?
A
Bleeding at site of fracture and in surrounding tissue – inflammatory process occurring/going on
Hematoma at site forms into a fibrous network – soft callus forms along outer surface of bone and over fractured ends of bone
Osteoblasts within the soft callus synthesize collagen and matrix to form hard callus
Over time remodeling occurs – unnecessary callus is reabsorbed, repair tissues are realigned – bone is going to absorb what they need
17
Q
What is Cellulitis? Where is it located?
A
Inflammation that is coming from an infection (bacterial infection)
More on superficial levels of the skin
18
Q
What is secondary osteoporosis? (what dysfunction is it associated with?)
A
Secondary osteoporosis can be caused by dysfunction of endocrine system:
Parathyroid hormone, cortisol, thyroid hormone, and growth hormone – most commonly associated with osteoporosis
Other factors include medications, lack of physical activity, abnormal BMI
19
Q
In JIA what kind of stage is the individual in? What plates can it affect?
A
In JA the individual is still in a growth stage, JA can affect the epiphyseal plate
20
Q
Primary risk factors of causing a club foot?
A
Combination of genetic and environmental factors – can be from fetal positioning in womb
21
Q
What is going to be obviously seen when there is a dislocation?
A
Going to see an obvious deformity when there is a dislocation
22
Q
Disease and tissue risk factors for pressure ulcers?
A
Impaired perfusion – ischemia
Exposure to moisture – fecal or urinary incontinence
Malnutrition
Dehydration
History of pressure ulcers
Aging
Prolonged steroid use
Chronic diseases
23
Q
What is a pathological fracture?
A
caused by weakness within the bone – osteoporosis, tumors, infection – disease process over time – pathological because its not trauma
24
Q
What tissue is first affected in RA Vs OA? How is it different?
A
Different than OA, the synovial membrane is the first tissue affected
25
What is a stress fracture? What are some of its characteristics?
Stress from increase load to the point of breakage or fatigue fracture - repetitive stress or torque on the bone – joggers – muscle grows faster than bone so getting in shape needs to be tempered with time – not a complete fracture
26
S+S of Rhabdomyolysis?
Typical triad of symptoms - Muscle pain, weakness, and dark urine
Does not always present with muscle pain and weakness – dark urine from myoglobin in urine – not always indicative of rhabdomyolysis
Creatine kinase is also released in increased quantities – elevated CK is most reliable indicator
27
Structural scoliosis
-Congenital Vs Teratological?
Congenital – attributed to bony deformity
Teratological (study of curvature of the spine) – caused by another systemic syndrome – cerebral palsy – curvature in the spine
80% is idiopathic – unknown cause
28
S+S of scoliosis?
Shortness of breath – impeded gas exchange – can lead to deformed lungs
Reduced pulmonary function – if thoracic curve > 60 degrees
Fatigue, back pain – muscles pulling on spine
Curvature of the spine is going to cause the prominent curve of spine, one shoulder will be higher, and asymmetry of the thoracic cage
Kyphosis – rotation causes prominence along thoracic spine
Right sided heart failure – if curve > 80 degrees
GI disturbances- due to thoracic and lumbar deformity
29
What is rhabdomyolysis? What does it cause?
Rapid breakdown of muscle that causes the release of intracellular contents including myoglobin, enzymes, and potassium into extracellular space and blood stream – working out to fast
Damage to muscle causing a relase
30
What is hematogenous osteomyelitis? what population is it more commonly seen in?
caused by a pathogen carried in the blood stream – more common in children
31
What is Contiguous osteomyelitis?
– caused by infection spreads from adjacent bone
32
S+S of hematogenous osteomyelitis? what precedes the onset?
Vague – fever, malaise, anorexia, weight loss, and pain in or around infected area
Recent infection precedes onset
33
What is Necrotizing Fasciitis?
-Severe form of cellulitis
– rare but potentially fatal dependent on area infected – pain gets out of control (abnormal pain response to the infection)
34
What is Kyphosis? Where is it seen in?
Seen in patients with scoliosis
Kyphosis – rotation causes prominence along thoracic spine
35
S+S of osteoporosis?
Bone deformity and pain due to fractures – vertebral fractures can cause kyphosis – hump back
Fractured hip – fracture of neck of femur due to osteoporosis can caused the fall – did fall cause fracture or did the fracture cause the fall
36
Causes of dislocations and subluxations?
Developing joint – ligaments may have developed looser
Trauma
See it more under the age of 20
Muscular imbalance – unbalanced exercise program, bad posture, inactivity
Incongruities in surfaces – rheumatoid arthritis
Joint instability – repetitive dislocations – stretching of ligaments in previous injury
37
What is a greenstick fracture?
Stress from increase load to the point of breakage or fatigue fracture - repetitive stress or torque on the bone – joggers – muscle grows faster than bone so getting in shape needs to be tempered with time – not a complete fracture
38
What is Osteoarthritis? What is it caused by?
Loss of protective cartilage
Osteoarthritis is caused by physical use – wear and tear of a joint over time (or, occasionally, over a short time as a result of an injury). Wear and tear of joint over time
39
What kind of different signs and symptoms can pathological and stress fractures have?
Pathological – can potentially have asymptomatic deformity and swelling, or have more of a generalized bone pain
Stress – pain can occur during repetitive injury resolved with rest
40
Open Vs closed fracture? What are we particularly worried about with each fracture?
skin is open or if there has not been an interruption in the skin worried about compartment syndrome if close infection if open
41
what are the 4 stages of a cold injury?
1.) Frostnip
2.) Chilblains
3.) Full thickness frost bite
4.) Flash Freeze
42
What areas of the body are most susceptible for cold injuries?
Toes, ears, nose and cheeks most susceptible
43
What is fibromyalgia linked to? Why?
No clear explanation for what causes Fibromyalgia
Abnormally low levels of serotonin – typically reduces pain signals – sleep pattern is affected due to low serotonin as well
Linked to serotonin levels
Firing pian without known cause
Not treated traditionally
44
Stage 1 -4 of pressure ulcers
Stage 1 – non-blanchable erythema – red in colour – still can prevent ulceration with skin care and repositioning
Stage 2 – partial thickness skin loss – skins breaks open or wears away – site is tender and painful – epidermis or dermis involved
Stage 3 – extends to tissues below skin – may see fat tissue, but not muscle, tendon, or bone
Stage 4 – full thickness – muscle, bone, ligaments, or tendons visible
Unstageable – full thickness tissue loss but the base of the ulcer is covered with slough (thick yellow/white coating within the wound bed) and/or eschar (dead tissue in the wound bed)
45
what is a subluxation?
Contact between opposing joint surfaces is only partially lost
subluxation (a partial dislocation followed by relocation) partial contact between opposing joint surface can damage the ligaments, nerves, joint surfaces (cartilage), as well as the bones that make up the joint.
46
What are the characteristics of an effected club foot?
Less flexible
Shorter leg length
Smaller shoe and calf size
47
Risk factors for club foot?
Abnormal intrauterine positioning
Neuromuscular or vascular problems
Maternal smoking
Genetics
48
Who is at greatest risk for developing osteomyelitis?
Chronically ill, diabetics, alcoholics, individuals on high doses of steroids or immunosuppressive medications
49
Direct Vs Indirect bone healing?
Direct healing – bone cortices are in contact with each other
Indirect healing – development of callus and eventual remodeling of solid bone
50
What is full-thickness frostbite?
What sensations are felt?
3rd stage of a cold injury
– tissues freeze – ice crystal formation – numbness – no sensation of pain – not reversible
51
What is frost nip? What are some symptoms?
1st stage of cold injury
superficial frostbite – pallor and pain – increased during tissue rewarming – top tissue
52
Sprain Vs Strain?
Strain - Tearing or stretching of a muscle or tendon
Sprain – ligament tears
53
What can gout lead to?
Gout occurs intermittently, but can lead to chronic disability, HTN, & renal disease
54
S+S of osteomyelitis?
pain, fever, voluntary immobility of affected limb
55
Risk factors for osteroprosis?
Biggest risk is older post menopausal women
56
With compartment syndrome what can muscle ischemia cause? What does this lead to?
Muscle ischemia can cause edema, increased compartment pressure, and tamponade = leads to muscle infarction & neural injury
57
S+S of Rheumatoid Arthritis?
Joint degradation is symmetrical – unlike in OA
Stiffness – more pronounced in morning- lasts longer than 1 hour
3 or more affected joints
Symmetrical involvement of hands
Low-grade fever
Fixed flexion of the smaller hand joints – ‘swan neck and boutonniere’
Other organ involvement – lymphadenopathy, splenomegaly, nephropathy, eyes
58
S+S of a fracture?
Swelling at site of injury
Pain - muscle spasm, will continue until bone fragments are immobilized
Loss of function
Deformity
Crepitus- rubbing of bone fragments against each other
Bruising
Impaired sensation
Hypotension – large volume of blood moving from blood stream into site of injury – can be related to bleeding or pain – loose sensation
Pulselessness
59
What is Scoliosis?
Abnormal lateral curvature of the spine
60
What is gout caused by?
Caused by overproduction of uric acid or underexcretion of uric acid by kidneys – 90% of gout is underexcretion – strong genetic basis
61
What can non-structural scoliosis become if left untreated?
Non-structural can become structural if not treated
62
What are dislocations and subluxations often accompanied by? Why?
Often accompanied by;
Fractures due to the stress of the joint moving to a less supportive area of bone
Bruising - tearing of adjacent nerves, blood vessels, ligaments, and soft tissues
Going to see an obvious deformity when there is a dislocation
63
What kind of state do we see patients go into while in the flow phase of burns?
They will have hyperglycemia with increased insulin resistance and loss of muscle (up to 25%)– this stage can last up to 2 years – want to get the calories up – high increase energy expedndature
64
When does compartment syndrome occur? What is its result?
Compartment syndrome occurs when there is damage within a compartment but the fascia encircling the compartment is intact
– result is increased pressure within the compartment restricting blood flow
65
what is a comminuted fracture?
fractured into more than 2 fragments
66
How can a club for be classified?
Can be classified as positional, idiopathic or teratological (resulting from another disease – commonly spina bifida) – inward downward flexation of the foot
67
Complications of osteoporosis?
fractures – 1 in 6 women and 1 in 12 men will sustain a vertebral fracture
68
S+S of Cellulitis?
Warm, erythematous, swollen, pain
Usually in lower extremities, swollen lymph nodes
69
Causes of contiguous osteomyelitis? What are some risk factors?
caused by open fractures, penetrating wounds, or surgical procedures
Can also be caused by metabolic or vascular disease, - diabetes, PVD, lifestyle risks – smoking, alcohol or drug abuse, and age
70
Structural Vs non-structural scoliosis?
Non-structural – causes other than the spine
Structural – cause is vertebral rotation – uneven leg length
71
Causes of Scoliosis?
Congenital deformity
Neuromuscular disease – MD, CP, polio
Different leg lengths
Trauma & paraspinal
inflammation – stress or disease of spine
Age – degenerative scoliosis – osteoporosis of spine
High arches in feet – alters balance
72
Risk factors for dupytren's contractures? Where do they come from?
genetic factors, alcohol, tobacco use, and diabetes may be risk factors. – comes from harding of the tentionds on the body - has to be relased (adehesion on the outside of our body)
73
What can excessive stretching during the healing process of stains and sprains result in?
Excessive stretch during healing process could cause ends to separate and lengthen shape – results in scar tissue formation or poor tendon or ligament function
74
What are the 3 different kinds of burn? What are their characteristics?
(Thermal Vs Non-thermal burns)
Thermal - heat contact, scalds, or radiation
Nonthermal sources –
Chemical – ingestion of acids, alkalis, or blistering agents
Electrical – passage of current through the body to the ground
75
Where is Rheumatoid arthritis most commonly seen?
Swan neck deformity of the thumbs
76
Risk factors for cold injury?
Winter season.
No or inadequate shelter from the cold.
High wind chill factor.
Exposure at a high altitude.
Prolonged duration of exposure.
Prolonged exposure to a wet condition.
Altered mental status.
Alcohol or drug abuse.
77
S+S of sprains and strains
Pain (sharp, localized), swelling, changes in contour of ligament or tendon, dislocation or subluxation
78
S+S of osteoarthritis?
Pain, stiffness, swelling, decreased ROM, muscle wasting, partial dislocation, & deformity
Joint stiffness – difficulty initiating joint movement –dissipates after a few minutes, can last longer but not common
Joint effusion – swelling of the joint – caused by presence of osteocyte fragments in synovial cavity, drainage from cysts, or trauma to joint that results in hemorrhage and inflammation of synovial cavity
79
S+S of fibromyalgia? What gender is it more commonly seen in?
S&S – almost always women
Chronic generalized pain and fatigue
Cognitive dysfunction, changes in mood (think of changes in mood due to chronic pain)
Diagnosis comes from ruling out other potential causes -
80
What is a greenstick fracture?
Perforates one cortex and splinters the spongy bone
-Bone is bent sharply, the outer surface is disrupted, but the inner surface remains intact
Break in one cortex of the bone with splintering of the inner bone surface; commonly occurs in children and older persons
81
Scute Vs Subacute Vs Chronic Osteomyeltits?
Acute is diagnosed 2 weeks after symptom onset
Subacute has been present for 1 – several months
Chronic disease has been present for several months to years
82
Risk factors for osteoarthritis?
Trauma
Mechanical stress – repetitive physical tasks
Inflammation in the joint
Joint instability due to damage to supporting structures
Neurological, blood, or endocrine disorders
Congenital deformities
Medications
83
Where is RA most commonly seen?
Most common – fingers, feet, wrist, elbows, ankles, and knees
Frequency decreases with age
84
what population is Contiguous osteomyelitis seen more in? what gender is it more commonly seen in?
In children and adults – men are more affected than women
85
Where can gout crystals form? What can they lead to?
When can crystal deposits occur?
Crystals can form in other parts of the body – heart, earlobes, kidneys
Deposits of crystals can occur years before diagnosis – early diagnosis is important to prevent complications
Gout occurs intermittently, but can lead to chronic disability, HTN, & renal disease
86
What is osteoporosis?
Decreased bone density with an increased risk of fractures
Chronic disease
Progresses silently for decades – not necessarily related to aging
Old bone is being absorbed faster than new bone is being made
87
1st degree burn characteristics?
What kind of systemic symptoms might one feel?
How long does it take to heal?
First Degree – no treatment required may have nausea and vomiting – vulnerable groups – young and old may experience dehydration – heal within 3-5 days – no scarring – skin is pink and blanches
88
Osteoarthritis is initially? What will resting the joint do? where is the pain located?
Initially asymptomatic – pain in a load bearing joint – typically the knee is usually the first site
Resting the joint initially will relieve the pain
89
What is osteomyelitis? What is it caused by?
infection of the bone – most often caused by bacteria (staph aureus), but can also be caused be virus, fungi, or parasites
90
Risk factors of gout?
Risk factors - Male gender, increasing age, high intake of alcohol, red meat, and fructose, increasing BMI
91
Patho process behind osteomyelitis?
Initial infection - inflammatory response – forms biofilms that adhere to surfaces – increase antibiotic resistance – small terminal vessels thrombose and exudate seals the bone canaliculi – exudate extends into the marrow cavity – blood flow is disrupted which leads to necrosis and death producing sequestrum – osteoblasts lay down new bone over infected bone –Openings in the involucrum allow exudate to escape to surrounding tissues and through to skin by sinus tracts.
92
Populations at risk for Cellulitis?
Diabetics, cirrhosis, renal failure and malnourishment
Immunocompromised, cancer, and alcohol and drug abusers
93
2nd degree burn characteristics?
(What remains intact?)
Second Degree – superficial partial thickness– fluid filled blisters – develop within minutes of injury – pain sensors remain intact – wound heal in 3- 4 weeks – scarring is unusual
- deep partial thickness - waxy white look – takes weeks to heal – necrotic tissue may be present and will need to be surgically removed – followed by graph of own skin – hypertrophic scarring
94
S+S of contiguous osteomyelitis?
inflammatory exudate in soft tissues – abscesses form, low grade fever, lymphadenopathy, local pain, and swelling of puncture wound
– going to have the normal signs and symptoms of infection due to this
-More common in men then women
-Anyone with diabetes or auto immune disease
95
Adhesions Vs Contractures?
Adhesions on the inside of the body contractures are on the outside
96
What is a Dupuytern's contracture? What is it caused by?
caused by a connective tissue in palm thickens and become scar-like – not painful, but restricts movements of fingers –
97
What kind of sensations are patients feeling with subluxations and dislocations? What can they lead to?
Numbness, tingling, paralysis, can lead to permanent disability
98
3rd degree burn characteristics?
(whats been destroyed and lost, what do we do to prevent compartment syndrome, what's the appearance)
Third Degree – full thickness – dry leathery appearance – loss of dermal elasticity – may compromise circulation due to edema if entire limb is involved – requires escharotomies – cutting through burned skin to release pressure and prevent compartment syndrome – all nerve endings have been destroyed
99
What gender is Scoliosis more common in?
More common in girls than boys
100
Necrotizing fasciitis is an infection of?
Infection of Streptococcus pyogenes
101
What happens/where does the blood flow shift to in burn shock?
The blood is shunted away from liver, kidney, and gut – ‘ebb phase’ – first 24 hours – keeping fluids at the brain and heart
After approximately 24 hours – longer for some there is a restoration of capillary integrity, edema starts to resolve and burn shock ends.
102
Patho behind osteoarthritis
Articular cartilage breaks down, can flake off and develop longitudinal fissures, underlying unprotected bone become sclerotic, as the articular cartilage breaks down, osteophytes will try to build new bone forming bone spurs – into the synovial cavity, these spurs can break off into the synovial cavity increasing the irritation and volume of the joint – contributes to immobility. All components of the joint are affected, cartilage, bone, and synovial fluid.
103
What is burn shock? what do we see?
– combination of cardiovascular hypovolemia and cellular hypovolemia
- Massive fluid losses – shift of fluids to interstitial spaces – increased capillary permeability
See decreased cardiac contractility and decreased blood volume – cardiac isn’t able to pump then the vascular problems follow
104
What areas of the body does osteoarthritis most commonly affect?
most commonly affects joints in your hands, knees, peripherally and hips and spine centrally
105
what is a dislocation?
Dislocation (a complete disruption of the joint) joint surfaces lose contact with each other
106
Risk factors for pressure ulcers?
prolonged pressure – dependent areas of the body – ankles, heals, sacrum - bony prominences
Immobilization – quadriplegics, trauma, surgery, stretchers in ER, x-ray tables, OR beds
Exposure to moisture –diaphoresis
Fractures or contractures
Sedation
Friction or shearing forces – moving patients in bed or in chairs
Bed sheets,
Inadequate care taker
Knowledge deficit
107
Risk factors for osteoporosis?
Alcohol
Sedentary lifestyle
smoking
Post menapausal women
108
What is diffuse atrophy?
muscle wasting – reduction in normal size of muscle fibres after prolonged inactivity from bed rest, trauma, or local nerve damage. – losing 3% of muscle mass a day without excersing it
109
Transverse Vs Linear fracture?
Transverse runs through the bone – linear runs parallel to the bone
110
What is Rheumatoid Arthritis? What do we typically see?
Inflammatory arthritis is a chronic autoimmune disease in which your immune system misidentifies your own body tissues as harmful germs or pathogens and attacks them – focusing on joints.
Typically see joint swelling and tenderness – destruction of synovial joints – disability and in some cases premature death
Combination of genetic factors interacting with inflammatory mediators
111
Common sites for strains?
Most common – hands, feet, knees, upper arm, thigh, ankle, and heal
112
What kind of onset does Juvenile Idiopathic Arthritis have? what are some symptoms?
Systemic onset:
Fever, rash, hepatosplenomegaly, anemia, leukocytosis
113
6 P's of compartment syndrome?
Pain – beyond what is expected from injury
Pressure – swelling or tenseness felt over affected area
Pallor – decreased blood flow to extremity
Paresthesia – numbness or tingling due to nerve impingement
Paresis – muscle weakness
Pulselessness – inadequate blood perfusion
114
What do we do when rewarming a cold injury?
Initially skin is rewarmed using temperatures of own body – hand on own skin
No rubbing or massaging
Warm water – not hot – used to rewarm limbs
115
S+S of gout?
Pain, inflammation of joints – specifically the great toe
Kidney stones
Joint enlargement – crystals harden, eroding bone and cartilage
Back pain – pain in kidneys due to excess buildup of uric acid
116
What are the 3 forms of Juvenile Idiopathic Arthritis?
Oligoarthritis – < 3 joints – less then 3 joints – “a little bit of arthities”
Polyarthritis - > 3 joints – more than 3
Still disease – severe systemic onset – systemic inflamtion
117
4th degree burn characteristics? What do they require?
Fourth Degree – involve joints and burns - require skin grafting or reconstructive surgery follow the rule of 9s for estimating total body surface
Both 3rd and 4th degree burns are considered medical emergencies
118
What is compartment syndrome caused by?
Caused by bleeding within the compartment or increased pressure outside of the compartment or a combination of both
Severe burns, bleeding, crush injuries, bites, tight casts or bandages
119
Characteristics of Necrotizing fasciitis?
*Severe form of cellulitis*
Rapidly spreading – destroys skin, fat, fascia, muscles – unusual pain – die if infection goes into the internal organs
Unusual levels of pain – pain that is off the chart
120
With burns, what kind of reaction are we going to have with the more area that is burned?
The more area that’s burnt the more of a systemic reaction you are going to have
121
What areas of the body is osteoporosis most commonly seen in?
Most commonly seen in spine vertebrae, but also seen in femoral neck, and wrist
Can be generalized – affecting major portions of skeleton
Regional affecting one segment
122
What is gout also refers to as? What is happening with the concentration of uric acid?
Concentration of uric acid increases to the point where it crystalizes – insolvable precipitates deposited in connective tissue
Crystallization in synovial fluid results in painful inflammation of the joint.
Also referred to as gouty arthritis
123
What is Chilblains?
2nd stage of cold injury
– partial thickness frostbite – tissue becomes white – can develop chronic vasculitis if skin is constantly exposed to cold – reversible at this time/stage – no crystal formation at this stage
124
Most common sites for strains?
Major trauma or tear can rupture tendons at any site in the body.
-Tendons of hands, feet, knee, upper arm, thigh, ankle, and heel are most commonly injured
