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Patho > Musculoskeletal and Integumentary Systems > Flashcards

Musculoskeletal and Integumentary Systems Flashcards

1
Q

What is a closed (complete) fracture?

A

A fracture in which bone fragments separate completely, are not displaced, and remain beneath overlying tissue.

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2
Q

What is an incomplete fracture?

A

A fracture in which the bone fragments are still partially joined

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3
Q

What is an open (compound) fracture?

A

A fracture of bone that protrudes to the outside of the body

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4
Q

What is a compression fracture?

A

A fracture that consists of the crushing of cancellous bone

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5
Q

What is a transverse fracture?

A

A fracture where parts of the bone are separated but close to each other

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6
Q

What is a stress fracture?

A

A failure of one cortical surface of the bone, often caused by repetitive activity

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7
Q

What is a comminuted fracture?

A

A fracture with more than one fracture line and more than two bone fragments that may be shattered or crushed

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8
Q

What is a spiral fracture?

A

A twisting force to the thigh causes a fracture line that encircles the shaft

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9
Q

What is an avulsion fracture?

A

Separation of a small fragment of bone at the site of attachment of a ligament or tendon

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10
Q

What is an impacted fracture?

A

A fracture in which one part of the fracture is compressed into an adjacent part of the fracture

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11
Q

What is a greenstick fracture?

A

An incomplete break in the bone with the intact side of the cortex flexed (one side is broken and the other is bent); usually seen in children

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12
Q

What does hypocalcemia stimulate in the parathyroid?

A

secretion of parathormone- which activates osteoclasts to break down bone to release calcium

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13
Q

What does hypercalcemia stimulate related to bones?

A

Calcitonin release to suppress osteoclastic activity, blocking excess Ca release from bone. Integrates calcium into the bone.

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14
Q

Osteocyte

A

These are mature osteoblasts that maintain metabolism and nutrient and waste exchange; they are unable to divide.

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15
Q

Osteoclasts

A

function in resorption and degradation of existing bone, the opposite of osteoblasts.

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16
Q

Osteoblasts

A

These bone-forming cells secrete osteoid, which forms the bone matrix. They also begin mineralization and are unable to divide

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17
Q

Which bones are most susceptible to the effects of osteoporosis?

A

hips, wrist, vertebrae

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18
Q

What is a hallmark of OA?

A

osteophyte formation

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19
Q

Consequences of Immobility

A
  • Pressure injury, which leads to skin breakdown and, eventually, wound infection
  • Slowed bowel peristalsis, which leads to constipation
  • Lack of muscle stimulation, which leads to muscle atrophy
  • Lack of aerobic exercise, which leads to deconditioning of the cardiovascular system
  • Lack of weight-bearing activity, which leads to osteoporosis
  • Venous stasis, which predisposes to thromboembolism
  • Slowed urinary excretion, urinary stasis, and precipitation of calcium, which leads to kidney stones
  • Lack of deep breathing, lack of effective coughing, and stasis of secretions, which leads to pneumonia
  • Social isolation and lack of mental stimulation, which leads to depression
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20
Q

Osteoporosis risk factors:

A
  • Female gender
  • Postmenopausal age in female
  • Lack of estrogen in female
  • Lack of testosterone in male
  • Family history
  • Asian and Caucasian women
  • Thin and small-framed women
  • Lack of recommended daily intake of calcium and vitamin D
  • Lack of weight-bearing exercise
  • Excess alcohol consumption
  • Excess caffeine consumption
  • Smoking
  • Long-term use of corticosteroids
  • Excess carbonated soft drink consumption
  • Gastric bariatric surgery
  • Eating disorders such as anorexia
  • Hyperthyroidism or excessive intake of thyroid medication
  • Hyperparathyroidism
  • Anticonvulsant medications
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21
Q

Risk factors for OA

A

aging, obesity, history of participation in team sports, history of trauma or overuse of a joint, and heavy occupational work

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22
Q

What is Denosumab

A

Injectable antirsorptive agent, used if other drugs don’t work. It is a monoclonal antibody that binds to the osteoclastic protein sclerostin, blocking bone resorption by osteoclasts.

Used to prevent fracture in individuals with osteoporosis.

Do not use with hypocalcemia as it can cause painful muscle spasms

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23
Q

OA S/S

A

deep aching joint pain (especially after exercise or weight bearing) join pain during cold weather, stiffness when waking, crepitus of the join during motion, joint swelling, altered gait, limited ROM.

joint deformity and tenderness, decreased ROM

fingers often involved with Heberden’s nodes at distal joints and bouchard nodes in inner joints

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24
Q

RA

A

autoimmune, accompanied by systemic symptoms (fever, elevated WBC count, myalgia, fatigue, other signs of inflammation) joints often not affected symmetrically, great deformity

hands most commonly affected

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25
Q

OA treatment

A

Acetaminophen, NSAIDs, COX-2 inhibitors, glucosamine chondroitin, cortisone injections, hyaluronic acid injections, joint replacement

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26
Q

RA treatment

A

Methotrexate and monoclonal antibody biological agents

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27
Q

Osteoporosis treatment

A

Weight-bearing exercise to strengthen bone by stimulating osteoblastic activity.

Calcium 1,200 mg/daily to strengthen bone.

Vitamin D 400 IU/daily to increase calcium absorption.

Bisphosphonates to inhibit osteoclastic activity.

Calcitonin to decrease bone loss and diminish pain for compression fracture.

Raloxifene, an estrogen-like medication that strengthens bone.

Teriparatide (or PTH) to strengthen bone.

Denosumab, a biological agent.

Vertebroplasty or kyphoplasty to fortify osteoporotic bone.

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28
Q

Rickets s/s

A

Short stature; lack of bone growth.

Deformity of bones caused by hypocalcemia.

Muscle cramping caused by hypocalcemia.

Seizures caused by hypocalcemia.

Tooth hypoplasia.

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29
Q

Rickets physical assessment

A

Short stature.

Deformity of bones.

Muscle cramping.

Seizures.

Tooth hypoplasia.

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30
Q

Rickets diagnosis

A

Serum and ionized calcium, serum alkaline phosphatase, serum phosphorus, 25-hydroxyvitamin D, hydroxyvitamin D, PTH levels, and urine calcium.

X-rays will show varus deformity (bowing) of the legs, costochondral swellings called “rachitic rosary,” lumbar lordosis, widened wrists and knees, and greenstick fractures.

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31
Q

Rickets treatment

A

Vitamin D to increase absorption of calcium from gastrointestinal tract.

Calcium supplement in diet to strengthen bone.

Phosphorus in diet to strengthen bone. Sunlight to activate vitamin D.

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32
Q

Osteomalacia

A

Lack of calcification of bones caused by deficient vitamin D or calcium in adult.

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33
Q

Osteomalacia s/s

A

bone pain

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34
Q

Osteomalacia assessment

A

Tenderness of bone.

Difficulty with ambulation.

35
Q

Osteomalacia diagnosis

A

X-ray, vitamin D level, calcium level, phosphate level.

36
Q

Osteomalacia treatment

A

Vitamin D to increase calcium absorption.

Calcium supplement to strengthen bones.

Phosphorus in diet to strengthen bone.

Sunlight to activate vitamin D

37
Q

Degenerative Disc Disease (DDD)

A

Intervertebral discs dehydrate and collapse, causing malalignment of the discs and vertebral bones. In a herniated disc, the central nucleus pulposus tissue of the disc is squeezed out of place and bulges through the annulus fibrosus, causing impingement on a spinal nerve. Spinal nerve impingement causes inflammation, pain, paralysis, lack of sensation, and paresthesias in region supplied by the spinal nerve. Most common discs involved are L4, L5, and S1.

38
Q

Degenerative Disc Disease (DDD) s/s

A

Pain (cervical or lumbar commonly) with radiation (legs or arms commonly), numbness, paresthesias, difficulty walking if DDD in lower spine.

39
Q

Degenerative Disc Disease (DDD) assessment

A

Tenderness of site of DDD, paraspinal muscle spasm, numbness in arms or legs depending on site of DDD

40
Q

Degenerative Disc Disease (DDD) diagnosis

A

X-ray, CT, or MRI can demonstrate disc collapse and vertebral malalignment. Electromyography can show muscle dysfunction.

41
Q

Degenerative Disc Disease (DDD) treatment

A

Heat to reduce pain and muscle spasm.

NSAIDs to decrease inflammation.

Short-term narcotic to relieve pain of spinal nerve impingement.

Muscle relaxants to reduce muscle spasm.

Antidepressants to decrease neuropathic pain.

Intra-articular injection of glucocorticoid diminishes inflammation.

Physical therapy attempts to realign vertebrae, strengthen muscles, and decrease spasm.

Acupuncture is used for pain relief.

Chiropractic treatments are used to realign discs.

Supportive devices, such as walker or cervical collar, are used to decrease impingement on spinal nerves.

Decompression surgery is used to obliterate the disc impingement on the spinal nerves.

Surgical fusion is used to realign discs and vertebrae with supportive hardware.

42
Q

Lumbar sprain and strain

A

Active strain and sprain of lumbosacral muscles or ligaments with frequent intervertebral disc herniation, causing impingement on spinal nerves.

43
Q

Bursitis

A

Inflammation of the bursa commonly caused by repetitive. motion injury.

44
Q

Hip Fracture

A

Most occur as a fracture through the femoral neck or fracture from greater trochanter to lesser trochanter; intertrochanteric or beneath the trochanters; subtrochanteric. Common sequela of osteoporosis.

45
Q

Vertebral Compression Fracture

A

A thinning of the vertebral body. A 15% to 20% or more decrease in vertebral body height. Common sequela of osteoporosis.

46
Q

Cervical Strain

A

Acceleration-deceleration mechanism of injury causing elongation and tearing of cervical muscles or ligaments with subsequent edema, hemorrhage, and inflammation. Commonly occurs in motor vehicle accidents, while lifting heavy objects, and with abnormal postures.

47
Q

Cervical Strain s/s

A

Suboccipital headache; motion-induced neck pain; shoulder, scapular, or arm pain.

Visual disturbances, dizziness, difficulty sleeping.

Onset of symptoms usually delayed 12 to 72 hours after incident.

48
Q

Cervical Strain assessment

A

Tenderness along cervical spine, paravertebral muscle spasm, swelling.

49
Q

Cervical Strain diagnostic

A

xray

50
Q

Cervical Strain treatment

A

Short-term use of soft cervical collar, muscle relaxants, heat application to area, possibly steroid injections.

Rigid cervical collar or neck brace for more severe injury.

With unstable cervical fracture halo traction is used.

Pain management.

51
Q

Lumbar Strain or Sprain

A

Active strain and sprain of lumbosacral muscles or ligaments with frequent intervertebral disc herniation, causing impingement on spinal nerves.

52
Q

Lumbar Strain or Sprain s/s

A

Sharp pain, stiffness, and tenderness in the lumbosacral region, often with pain radiation down into one leg (called radicular pain or sciatica).

Numbness and tingling along dermatome into lower extremity.

In cauda equina syndrome, bladder and bowel incontinence or saddle paresthesias.

53
Q

Lumbar Strain or Sprain assessment

A

Lumbosacral paravertebral tenderness and swelling.

Lack of sensation in dermatome areas of lower extremity.

Possibly diminished deep tendon reflexes and weakness in lower extremity.

L4–L5 spinal nerve tested with patient’s ability to walk on heels.

L5–S1 tested with patient’s ability to walk on toes.

54
Q

Lumbar Strain or Sprain diagnostic

A

Inspect ROM. Ask patient to touch toes, dorsiflex and plantarflex foot. Straight-leg raising test. Patrick test. Sensory dermatome testing. Test Patella and Achilles DTRs.

55
Q

Lumbar Strain or Sprain treatment

A

Back support belt, periodic stretching exercises (no prolonged sitting or lying), muscle relaxants, heat application to area, possibly steroid injections.

Pain management.

Avoidance of heavy lifting, jogging, climbing.

Physical therapy, TENS, massage, ultrasound treatments, chiropractic treatments.

56
Q

Carpal Tunnel Syndrome

A

Increased pressure on the median nerve in the carpal tunnel in the wrist. The index finger, thumb, and middle finger are commonly affected.

57
Q

Carpal Tunnel Syndrome s/s

A

Numbness, tingling, pain in the hand and proximally in the forearm along the distribution of the median nerve.

58
Q

Carpal Tunnel Syndrome assessment

A

Wrist pain radiation of pain proximal to wrist.

Intermittent paresthesias in the median nerve distribution of hand.

Pain worse at night.

59
Q

Carpal Tunnel Syndrome diagnostic

A

Clinical examination, including finding paresthesias in the median distribution of the hand after Phalen’s sign and Tinel’s sign.

60
Q

Carpal Tunnel Syndrome treatment

A

Rest, splinting, surgical decompression possible.

Pain management.

61
Q

Bursitis

A

Inflammation of the bursa commonly caused by repetitive motion injury

62
Q

Bursitis s/s

A

Pressure and painful motion of joint.

Discomfort at rest.

63
Q

Bursitis assessment

A

Swelling, warmth, tenderness of joint.

Decreased ROM.

64
Q

Bursitis assessment

A

ESR, xray

65
Q

Bursitis treatment

A

Moist heat, immobilization, intrabursal steroid injections, possibly surgery.

Pain management.

66
Q

Hip fracture s/s

A

Pain centered in groin, immobility.

67
Q

Hip fracture assessment

A

An externally rotated and shortened leg.

Motion to the extremity will produce severe pain centered around the affected groin.

Edema and ecchymosis possible.

68
Q

Hip fracture diagnostic

A

X-ray.

69
Q

Hip fracture treatment

A

Surgical reduction and fixation, hip replacement sometimes required.

Anticoagulant therapy caused by high risk for deep venous thrombosis.

Hip fracture indicates osteoporosis is likely; therefore, Ca++/vitamin D supplements needed.

Pain management.

70
Q

Vertebral Compression Fracture s/s

A

Back pain, kyphosis, loss of height.

Pain worsened by ambulation.

71
Q

Vertebral Compression Fracture assessment

A

Tenderness over spine.

Pain with ambulation. Kyphosis.

Paravertebral muscle spasm.

72
Q

Vertebral Compression Fracture diagnostic

A

X-ray and DEXA scan of spine

73
Q

Vertebral Compression Fracture treatment

A

Calcitonin, muscle relaxants, analgesics, external support devices, vertebral surgery; vertebroplasty, kyphoplasty.

Osteoporosis likely in patient; therefore. Ca++/vitamin D supplements needed.

74
Q

Risks factors with immoblization

A

deep venous thrombosis, contracture, and muscle atrophy

75
Q

Compartment Syndrome

A

tissue pressure exceeds perfusion pressure in a closed anatomical space.

76
Q

What is a compartment

A

groups of muscles, nerves, and blood vessels within a space that is contained by a tough fascial membrane. The fascial membrane cannot accommodate swelling or bleeding because it is inflexible

77
Q

Where is the most common location for compartment syndrome?

A

most commonly occurs in the anterior compartment of the leg

78
Q

What is rhabdomyolysis?

A

breakdown of skeletal muscle tissue, can occur in compartment syndrome. Muscle breakdown products (myoglobin) accumulate in the bloodstream. Myoglobin is toxic to kidney and causes renal injury.

79
Q

Rhabdomyolysis s/s

A

myalgia
weakness
myoglobinuria (tea-colored urine) initial presenting symptom

elevated CK level is the most sensitive lab

80
Q

Compartment syndrome s/s

A

Acute pain, decreased or absent pulse distal to injured region paresthesia distal to the injury, delayed cap refill. swollen, tight, pale, shiny

81
Q

Pulmonary embolism

A
82
Q

Virchow’s triad

A

three conditions known to increase susceptibility to DVT:

injury to vessel wall, venous stasis, hypercoagulability of blood

83
Q

ABCDE’s of trauma

A
  • Airway with cervical spine protection
  • Breathing and ventilation
  • Circulation and hemorrhage control
  • Disability and neurological evaluation
  • Exposure and environmental control

Patho (14 decks)

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