Musculoskeletal

Question 1

What does the integumentary system consist of?

Answer 1

consists of the skin, hair, oil and sweat glands and sensory receptors

Question 2

What is the main function of the integumentary system?

Answer 2

primarily, as a protective membrane between the internal and external environment as part of our innate immune system

Question 3

What are first degree burns?

Answer 3

-Superficial partial thickness burn
-Involves only the outer layers of the epidermis and usually doesn’t include blistering
-The skin maintains its ability as a water vapor and bacterial barrier
-Presents as red or pink discoloration, dry skin and mild-moderate pain
-Self-limiting within 3 to 10 days
-Larger surface area burns may be more problematic in medically fragile population

Question 4

What is a second degree partial thickness burn?

Answer 4

-Involves the epidermis and various degrees of the dermis
-Painful, moist, red and blistered
-Beneath the blisters is weeping bright red/pink skin that is sensitive to temperature changes, air exposure and touch
-The blisters help prevent water loss and may promote wound healing
-Healing process is approximately 1 to 2 weeks

Question 5

What is a second degree full thickness burn?

Answer 5

-Involves the entire epidermis and dermis
-Pain sensors remain in tact - very painful
-Present as mottled pink, red or waxy white areas with blisters and edema
-The blisters resemble flat, dry tissue paper instead of the bullous blisters seen with
second degree partial thickness burns
-Heal within 1 month but may result in permanent scar tissue and some diminished sensations

Question 6

What is a third degree burn?

Answer 6

-A full thickness burn extending into subcutaneous tissue and may involve muscle and bone
-Vary in color from waxy white or yellow to tan, brown, deep red or black
-They are often hard, dry and leathery
-Edema becomes extensive in the burn area and surrounding tissues
-Sensory nerves have been destroyed so these burns are pain free (usually surrounded by second degree burns)

Question 7

What is hemodynamic instability and how is it caused by burns?

Answer 7

-Burn shock can result from massive fluid loss in significant burnt tissue
-Initial vascular damage causes fluid loss leading to hypovolemia
-Fluid shifting (vascular to interstitial) occurs for several reasons
-Membrane permeability decreases when it becomes damaged
-Capillary pressure increases while interstitial pressure decreases

Question 8

What is hypermetabolic response to burns?

Answer 8

-Burn injuries increase metabolic and nutritional requirements causing an increase in secretion of stress hormones like cortisol and catecholamines
-Heat production is increased to counteract heat loss
-Hypermetabolism (increased oxygen/glucose use and protein/fat wasting) peaks approximately 7 to 17 days post injury
-Recovering burn patients require a substantially higher amount of nutritional and metabolic support during the healing process

Question 9

How do burns cause respiratory system dysfunction?

Answer 9

-A very common and serious complication of many burn injuries is smoke inhalation
-May include thermal/chemical airway damage and associated inflammatory response
(endothelial damage, edema, loss of parenchymal tissue)
-Inhaled CO binds to Hb with a stronger affinity than O2
-Other inhaled gas from burning materials can dissociate in the blood stream to form strong acid or alkalis (acidosis/alkalosis)

Question 10

How can burns cause dysfunction of different organ systems?

Answer 10

-Patients with burn shock have decreased perfusion to their vital organs
-This can lead to decreased function in any or all organ systems (renal, cardiac, pulmonary, neurological, etc.)

Question 11

How can burns cause sepsis?

Answer 11

-The destruction of the innate immune system leads the patient open to secondary
infections that can progress to sepsis
-This can be compounded by systemic hypoperfusion

Question 12

What is urticaria?

Answer 12

-Urticaria are pale/red raised itchy papules that occur in the superficial aspect of the dermis
-They tend to blanch with palpation and vary in size
-May or may not be associated with angioedema (swelling in the deeper dermis tissue)
-Histamine release from mast cells and basophils results in an increase in capillary permeability - fluid shifts from intravascular to the interstitial tissue in the skin

Question 13

What is the difference between acute and chronic urticaria?

Answer 13

-Acute urticaria is usually a result of an IgE mediated immune response
-Chronic urticaria is not well understood but may be a sign of underlying disease or an autoimmune disorder mediated by IgG

Question 14

What is necrotizing fasciitis?

Answer 14

An acute bacterial skin and soft tissue infection that causes necrosis of the muscle fascia and subcutaneous tissue

Question 15

What causes necrotizing fascitis?

Answer 15

-The infection travels along the muscle fascia (poor blood supply - no leukocytes)
-The insidious onset allows the infection to spread rapidly before it is detected
-The infection then spreads to the surrounding subcutaneous and muscle tissue causing necrosis

Question 16

What is an arthropod infestation?

Answer 16

-The skin is susceptible to a variety of rashes and disorders as a result of arthropod infestations
-Some common examples include mites, lice, or bedbugs
-The type of rash, lesion or disease is dependent upon the specific arthropod
-Infestations can be very difficult to exterminate once they have made their way into your
home

Question 17

What is the musculoskeletal system?

Answer 17

-The musculoskeletal (msk) system is composed of muscles, bones, and their supporting tissues (tendons, ligaments, bursae, etc)
-It functions to generate movement, protect internal organs, maintain posture and
generate heat and also plays a role in mineral homeostasis (calcium)

Question 18

What is osteomyelitis?

Answer 18

-An acute or chronic infection of the bone
-Any foreign antigen can produce osteomyelitis however it is more commonly caused by
specific bacterial agents
-Infectious process can affect any or all bone tissues (spongy, compact, marrow, etc)

Question 19

What occurs is osteomyelitis?

Answer 19

-Purulent exudate can occur as a result of micro abscesses within the bone tissue
-The rigid structure of the bone leaves very little room for swelling causing the fluid to get under the periosteum
-This can cause reduced blood flow with resultant ischemia and necrosis
-Weakened bone tissue can fracture and resultant wound healing can sequester the infection in place

Question 20

What is arthritis?

Answer 20

-Arthritis is a blanket term describing more than 100 different rheumatic diseases
-The two most prevalent forms of arthritis include: Rheumatoid arthritis and Osteoarthritis

Question 21

What is Rheumatism?

Answer 21

any disease marked by inflammation and pain in the joints, muscles or fibrous tissues

Question 22

What is osteoarthritis?

Answer 22

-Most prevalent form of arthritis characterized by the progressive destruction of articular cartilage in weight-bearing joints and fingers
-Caused by long term wear-and-tear
-With chronic wear and tear, inflammation and destruction of the cartilage occurs, and the composition of ECM is altered
-Cracks in the articular cartilage allow synovial fluid to enter and worsen the damage
-Eventually erodes the articular cartilage completely causing increased friction between the articulating bones
-Bones begin to wear on each other causing damage to the bone tissue

Question 23

What are the clinical manifestations of osteoarthritis?

Answer 23

-Aching active joint pain relieved by rest (worsens with progression)
-Crepitus/grinding during movement

Question 24

What is rheumatoid arthritis?

Answer 24

-Systemic inflammatory disease that occurs more predominantly in the elderly population and targets joint tissues
-Irregular immune response leads to synovial inflammation and destruction of the joint architecture by inflammatory cells
-Due to the chronic inflammatory response, the destructive process is continuous
-The destruction of the join tissue (cartilage, ligaments, bone) leads to pain and a decrease in use
-This can lead to joint instability, muscular atrophy, and loss of elasticity in the ligament

Question 25

What are the clinical manifestations of rheumatoid arthritis?

Answer 25

-Disease progression often starts in the fingers, hands, wrists knees and feet -Joint pain/stiffness and eventually joint deformities -Joint subluxation (incomplete or partial dislocation) -Systemic complications (rare) - fatigue, weakness, anorexia, weight loss, low grade fever

Question 26

What is osteoporosis?

Answer 26

Metabolic bone disease characterized by a loss of mineralized bone mass causing increased porosity of the skeleton and susceptibility to fractures

Question 27

What is gout?

Answer 27

-A group of disorders characterized by increased serum uric acid and urate crystal deposits in the kidneys and joints -Caused by an over-production of uric acid or decreased renal elimination -Commonly associated with alcohol use (one of the metabolites in certain alcohols breaks down into uric acid)

Question 28

What is a sprain

Answer 28

-any degree of traumatic damage to the ligaments in a joint -ligament - flexible bands of fibrous tissue that bind joints together and connects bones or cartilages

Question 29

What is a strain?

Answer 29

-a stretching injury to a muscle and/or tendon(s) -Tendon - fibrous connective tissue that connects muscles to bone

Question 30

What is a dislocation?

Answer 30

-The displacement or separation of the bone ends of a joint with loss of articulation -Often caused by trauma that disrupts the holding ligaments -Subluxation - a partial dislocation in which the bone ends of the joint are still in partial contact with each other

Question 31

What is a fracture?

Answer 31

-A break in the continuity of the bone -Any fracture can be categorized as either open or closed -Open (compound) - bone fragments have broken through the skin -Closed - bone has not broken through the skin -Fractures can also be classified based on its location and the direction or pattern of the fracture line

Question 32

What is a contusion

Answer 32

-aka ecchymosis - a soft tissue injury without a break in the skin, characterized by swelling, discoloration and pain -Caused by disruption of microvessels and resultant hemorrhage within the dermis and/or subcutaneous tissue

Question 33

What is an amputation?

Answer 33

-complete or partial loss of a body part -Abrupt, sharp mechanisms tend to produce less hemorrhage due to traumatic vasospasm -Tearing and crushing mechanisms decrease the ability for compensatory vasospasm and therefore cause more hemorrhage

Question 34

What is compartment syndrome?

Answer 34

A condition of increased pressure within a limited space that compromises circulation and tissue function - a serious complication of extremity trauma

Question 35

What causes compartment syndrome?

Answer 35

-The muscles, nerves, bones and vasculature in an extremity are contained in a muscle compartment -Follow an injury, swelling and internal bleeding may occur -Should the swelling/bleeding sustain, it can increase the pressure within the compartment, eventually reducing the tissue circulation -Reduction in tissue circulation can lead to tissue hypoxia and necrosis -Can be either acute (trauma) or chronic (marathon runners, muscular hypertrophy)

Question 36

What are the clinical manifestations of compartment syndrome?

Answer 36

-Pain (out of proportion to the original injury/passive stretch pain) -Paresthesia (nerve compression) -Poikilothermia -Paralysis -Pulselessness -Pallor

Question 37

What is testicular torsion?

Answer 37

-A twisting of the spermatic cord and loss of blood supply to the ipsilateral testicle -If not treated promptly, can result in necrosis of the affected testicle -Common in adolescents when the spermatic cord is attached to the testicle higher than it should be -The increased weight of the testicle following puberty leads to the torsion -Can also be a birth defect with scrotal attachment that is caught at birth

Question 38

What is an ovarian cyst?

Answer 38

-An ovarian cyst is the most common form of ovarian tumor – usually benign -A sac that may be filled with air, fluid or other material -An ovarian cyst is usually the result of the corpus luteum continuing to grow after ovulation -Typically, these cysts resolve spontaneously but may become twisted or rupture causing hemorrhage

Question 39

What is Polycystic Ovary Syndrome (PCOS)?

Answer 39

-A common endocrine disorder characterized by irregular menses and anovulation (where the ovum doesn’t release from the ovary during ovulation) -Also associated with hyperandrogenism (increased levels of male sex hormones) -Multiple and frequent ovarian cysts result in ovarian enlargement -PCOS is one of the most common causes of female infertility

Question 40

What is an ectopic pregnancy?

Answer 40

-Occurs when a fertilized ovum implants outside the uterine cavity, commonly in the fallopian tube -Represents a true gynecologic emergency with a significant risk for maternal mortality -As the fertilized egg grows, it quickly outgrows the space and its blood supply and will either self-terminate or rupture the fallopian tube -Significant internal hemorrhage can result

Question 41

What is an ectopic pregnancy?

Answer 41

-Occurs when a fertilized ovum implants outside the uterine cavity, commonly in the fallopian tube -Represents a true gynecologic emergency with a significant risk for maternal mortality -As the fertilized egg grows, it quickly outgrows the space and its blood supply and will either self-terminate or rupture the fallopian tube -Significant internal hemorrhage can result

Question 42

What is an ectopic pregnancy?

Answer 42

-Occurs when a fertilized ovum implants outside the uterine cavity, commonly in the fallopian tube -Represents a true gynecologic emergency with a significant risk for maternal mortality -As the fertilized egg grows, it quickly outgrows the space and its blood supply and will either self-terminate or rupture the fallopian tube -Significant internal hemorrhage can result

Question 43

What is a reproductive tract infection?

Answer 43

-Typically, more common in females than males and may affect any area of the reproductive tract -Can be a result of viral, bacterial or fungal infections -Specific presentations will vary depending on the causative agent, but typical signs of infection may be present (fever, malaise, tachycardia, etc)

Question 44

What is a urinary tract infection (UTI)?

Answer 44

-A bacterial infection that may affect any part of the urinary tract from the urethra to the kidneys -Typically, the infections begin in the lower urinary tract and are easily resolved with proper medical care before they spread to the kidneys -Should infection reach the kidneys, it becomes more serious and could lead to sepsis, renal abscesses or renal failure -Females are more predisposed to UTIs than males due to the shorter urethra and proximity to the anus -Cystitis - bladder infection

Question 45

What causes a UTI?

Answer 45

-A variety of different bacteria can cause UTIs and usually enter via the urethra -Usually, the continuous flow of urine prevents colonization of bacteria in the urethra -Certain patients and activities can predispose a patient to developing a UTI including UTI hx, sexual activity, poor hygiene, changes in vaginal flora

Question 46

What are the clinical manifestations of a UTI?

Answer 46

-Polyuria -Dysuria (painful, usually burning) -Odorous urine -Discolored/cloudy urine -Lower abdominal/back discomfort -Children and elderly may also present with fever and associated symptoms (malaise, lethargy, etc.) but young, healthy adults rarely do -Should the infection reach the kidneys, significant flank pain and signs and symptoms of sepsis may result

Question 47

What populations are more likely to get a UTI?

Answer 47

-Pregnant women are at an increased risk for UTI. If left untreated they are more predisposed to development of a serious infection that may disrupt the pregnancy -Young children (mostly females) are also more predisposed to simple UTIs progressing to serious kidney infections -Elderly patients are very susceptible to UTIs and have a greater risk at developing urosepsis -Undx UTI is a very common cause of acute confusion in the elderly

Question 48

What are kidney stones?

Answer 48

-Polycrystalline aggregates composed of materials the kidneys normally excrete in urine -Stones can develop anywhere in the urinary tract, however they most commonly form in the kidneys

Question 49

What causes kidney stones?

Answer 49

-Relays on pH, temperature, solute concentration, and ionic strength -Stone formation begins with small clusters of crystals that form a nucleus -The nucleus then facilitates and promotes further aggregation of crystals as it continues to grow -Different urinary environments lead to different types of stone development -Calcium (majority), magnesium ammonium phosphate, uric acid, cystine

Question 50

What are the clinical manifestations of kidney stones?

Answer 50

-Renal colic - acute, intermittent and excruciating pain in the flank and upper outer quadrant of the abdomen -Pain may radiate to the lower abdomen, bladder, perineum or scrotum -Pale, cool, clammy skin, with nausea, vomiting, and an inability to void -A smaller percentage of stones get logged in the renal calyces or renal pelvis, this produces a more dull, deep ache in the flank or back (non colicky) -Pain varies from mild to severe and is exaggerated by drinking large amounts of fluid

Question 51

What are the clinical manifestations of kidney stones?

Answer 51

-Renal colic - acute, intermittent and excruciating pain in the flank and upper outer quadrant of the abdomen -Pain may radiate to the lower abdomen, bladder, perineum or scrotum -Pale, cool, clammy skin, with nausea, vomiting, and an inability to void -A smaller percentage of stones get logged in the renal calyces or renal pelvis, this produces a more dull, deep ache in the flank or back (non colicky) -Pain varies from mild to severe and is exaggerated by drinking large amounts of fluid

Question 52

What is renal failure?

Answer 52

-Decrease in kidney function can lead to electrolyte abnormalities, pH disorders, fluid imbalances and retention of toxic waste -Kidney failure can be classified as either acute or chronic -Acute Kidney Injuries (AKI) are secondary to another medical problem and are usually reversible if treated appropriately -Chronic Kidney Disease (CKD) is a gradual progression leaving irreparable damage to nephron function

Question 53

What is acute kidney injury/failure?

Answer 53

-Represents a rapid decline in kidney function that happens within a few hours or within a day -Indication for AKI is azotemia and a decreased GFR -Azotemia - accumulation of nitrogenous wastes (urea, nitrogen, uric acid, and creatinine) in the blood -Causes of AKI can be categorized as Prerenal, intrarenal, or postrenal (pre and intra account for up to 95% of all AKI)

Question 54

What is prerenal acute kidney injury?

Answer 54

-The most common form of AKI and is reversible if the cause of decreased renal blood flow is identified and corrected -Causes include anything that decreases renal blood flow -Reduction in blood flow means a reduced GFR -A lower GFR allows more time for toxic and excess substances to be reabsorbed

Question 55

What causes prerenal acute kidney injury?

Answer 55

-Hypovolemia (hemorrhage, dehydration, excessive GI loss, burns) -Decreased vascular filling (anaphylactic shock, septic shock) -Heart failure, cardiogenic shock -Decreased renal perfusion due to sepsis, vasoactive mediators, drugs, and diagnostic agents

Question 56

What is intrarenal acute kidney injury?

Answer 56

-Results from conditions that cause damage to the structures within the kidney (glomeruli, tubules, vessels, or interstitium) -Prerenal AKI, intratubular obstruction -Toxic insult to the tubular structures (most common) -Acute pyelonephritis or glomerulonephritis

Question 57

What is acute tubular injury or necrosis?

Answer 57

-Characterized by destruction of tubular epithelial cells with acute suppression of renal function -Tubular epithelial cells are particularly sensitive to ischemia and toxins -Inflammatory mediators, toxic byproducts from medications, kidney obstruction, toxic substances from sepsis or damaged tissue -Endothelial cell destruction reduces the nephrons ability to perform its function

Question 58

What is acute glomerulonephritis?

Answer 58

Inflammation and damage to the glomerulus usually caused by an infection

Question 59

What causes acute pyelonephritis?

Answer 59

-Bacterial infection causing inflammation of the kidneys -The result of an ascending UTI

Question 60

What is post renal acute kidney injury?

Answer 60

-Results from obstruction of urine outflow from the kidneys causing retrograde pressure through the tubules – ultimately damaging the nephrons -Obstruction can occur in: Ureter (calculi or strictures), Bladder (tumors or neurogenic bladder), Urethra (prostatic hyperplasia)

Question 61

What are the clinical manifestations of post renal acute kidney injury?

Answer 61

-Oliguria (small amounts of urine) or anuria (no urine output) -Fluid retention and back flow -Electrolyte abnormalities -CNS disturbances from toxic build up (irritability, behavior changes, confusion, somnolence, weakness, seizures, coma) -pH imbalances and manifestations

Question 62

What is chronic kidney disease?

Answer 62

-Defined as either kidney damage or decreased GFR for 3 months or longer -Usually, onset of symptoms doesn’t occur until up to 80% of the nephrons stop functioning - remaining nephrons compensate -Several conditions cause CKD and result in permanent loss of nephrons -Hypertension and diabetic kidney disease are the two main causes -Represented by a deterioration in glomerular filtration, tubular reabsorption and endocrine functions of the kidney

Question 63

What are the clinical manifestations of chronic kidney disease?

Answer 63

-Nitrogenous waste buildup (urea, ammonia, uric acid, creatinine) -Fluid, electrolyte and acid-base imbalance -Mineral and skeletal disorders -Anemia and coagulation disorders -HTN and decreased CV function -GI, integumentary, neurologic and immune disorders

Question 64

What is hemodialysis?

Answer 64

-Essentially an external, artificial kidney consisting of three parts: Blood delivery system, dialyzer, a dialysis fluid delivery system -The dialyzer is a hollow cylinder composed of bundles of capillary tubes -The dialysate (dialysis fluid) travels on the outside of the tubes -Capillary tubes consist of a semipermeable membrane that allows for the free flowing of all molecules except blood cells and plasma proteins -Flow according to a concentration gradient between the two substances (blood and dialysate) -Waste products and excess flow from the blood to the solution -Substances required (bicarb, sodium, etc.) can be added to the solution and necessary to flow into the blood

Question 65

What is peritoneal dialysis?

Answer 65

-Peritoneal dialysis occurs within the peritoneal cavity (serous membrane of the peritoneal cavity serves as the semipermeable membrane) -The same principals of diffusion, osmosis and filtration apply -A catheter is surgically implanted in the peritoneal cavity inferior to the umbilicus -1-3L or sterile dialyzing fluid is infused into the peritoneal cavity over approximately 10 minutes -Once the fluid is infused into the cavity, the solution is left to remain there for a prescribed period of time (hours) -Molecules cross the membrane (serous peritoneum) as they would in the nephron -After the prescribed amount of time, the fluid is drained out of the peritoneal cavity -Advanced cases of CKD/renal failure will require hemodialysis