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ABSN > musculoskeletal - patho E4 > Flashcards

musculoskeletal - patho E4 Flashcards

1
Q

osteoporosis

A

bone mineral density is 2.5 standard deviations below peak bone mass
measured w/ a dexa scan and reported in T scores

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2
Q

osteopenia

A

thinning of the trabecular matrix of the bone before osteoporosis
T score is between -1 and -2.5

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3
Q

osteoporosis characteristics

A

“porous bone”
-common but serious
-low bone density and structural deterioration of the bone (usually in the hips, vertebrae & wrists aka trabecular bone)
actual breaks in trabecular matrix occurs

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4
Q

osteoporosis risk factors : major

A

-aging
-female
-caucasian
-history fracture as adult
-family hx
-body wt <127 lbs
-smoking
-alcohol
-long term steroid use (inhibits osteoblasts)
-immunosuppressive drugs

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5
Q

osteoporosis risk factors : minor

A

-thin, small frame
-lack of weight bearing exercise
-lack of calcium and/or Vit D
-eating disorders
-gastric bypass surgery
-lack of estrogen / testosterone
-excessive caffeine

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6
Q

osteoporosis pathogenesis

A

increased bone resorption (osteoclast activity increased) -> decreased bone formations (osteoblasts)

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7
Q

osteoporosis problems

A

-failure to make new bone (osteoblasts)
-too much bone resorption (osteoclasts)
or both

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8
Q

osteoporosis clinical manifestations

A

early is asym
-factures
-pain
-loss of height
-stooped posture (kyphosis)

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9
Q

what is one of the biggest complications of osteoporosis

A

hip fractures
causes increased risk of mortality d/t sepsis, skin breakdown, immobility, pneumonia, blood clots
not from the break itself

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10
Q

hip fracture clinical presentation

A

-sudden onset of hip pain before or after a fall
-inability to walk
-severe groin pain
-tenderness
-the leg on the hip break side is externally rotated and shortened

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11
Q

what is our pharm goal for osteoporosis

A

reduce fractures by promoting bone formation or decreasing bone resorption

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12
Q

primary pharm therapy for osteoporosis

A

-calcium: 1200 to 2000 mg/d
-vit D: 800 to 1000 IU daily

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13
Q

what is a fragility fracture

A

when the bone is so fragile that it just breaks without a fall or something causing the break

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14
Q

fractures definition

A

any break in the continuity of bone that occurs when more stress is placed on the bone that is able to absorb

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15
Q

fracture causes

A

-traumatic (fall)
-fatigue (repeat, prolong stress like a running stress fracture)
-pathologic (weakened bones, spontaneous)

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16
Q

open fracture

A

compound
fractured bone penetrates skin

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17
Q

closed fracture

A

simple
does not break through the skin

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18
Q

transverse fracture orientations

A

straight line
90 degree angle to the length of the bone
most common w/ falls

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19
Q

spiral fracture orientations

A

a twisting injury
abuse

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20
Q

comminuted fracture orientation

A

more than 1 fracture line & more than 2 bone fragments
ex: people fall on their feet and its a compression fracture

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21
Q

greenstick fracture orientations

A

incomplete break where the bone bends
most common type of break in children

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22
Q

fracture clinical manifestations

A

pain, edema, and deformity (PED)

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23
Q

3 phases of bone healing

A

1) inflammatory -> hematoma
2) reparative -> fibrous cartilage, callous, ossification
3) remodeling

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24
Q

complications of fractures

A

delayed healing
bone growth impairment
compartment syndrome
fat embolism syndrome

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25
Q

fracture complication: delayed healing

A

-dx 3mo to a year after fracture
-pain and tenderness are increasing even tho bone should’ve healed by now
-slowed by infection, smoking, malnut & poor circulation
-can lead to malunion and non union

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26
Q

malunion

A

unequal stretch of muscle pull causing improper alignment
ex of cause: starting weight bearing too soon

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27
Q

non union

A

when fracture has not healed in 4-6months after d/t smoking, older age, severe anemia, uncontrolled diabetes, low vit D levels, hypothyroid, poor nutrition, infection

28
Q

fracture complication: impaired bone growth

A

-peds
-fracture through epiphyseal plate which can delay future bone growth

29
Q

fracture complication: compartment syndrome

A

-seen w/ crush injuries and casts that are too tight
-results from increased pressure within limited anatomic space causing decreased circulation
tourniquet effect -> edema puts intense pressure on the soft tissue causing tissue hypoxia of the muscles & nerves

30
Q

compartment syndrome symptoms

A

edema
loss or weakened pulses
extreme pain
fat embolism

31
Q

treatment for compartment syndrome

A

fasciotomy

32
Q

fat embolism

A

fat molecules in the lung following long bone fracture & major trauma
leads to sudden respiratory distress
Sx: hypoxemia, altered LOC, & petechial rash
tx: self limiting but work to make sure pt remains stable

33
Q

fracture complication: osteomyelitis

A

an acute or chronic pyogenic (pus producing) infection of the bone needs immediate treatment -> weeks of abx & wound vac

34
Q

risk factors of osteomyelitis

A

recent trauma
diabetes
hemodialysis
IV drug use
splenectomy

35
Q

route of contamination for osteomyelitis: direct

A

open wound
gunshot
puncture
surgery

36
Q

route of contamination for osteomyelitis: indirect

A

from bloodstream (most common)
bacteremia

37
Q

osteomyelitis clinical manifestations

A

local: tenderness, warmth, redness, wound drainage, restricted movement, spontaneous fracture

systemic: fever, positive blood culture, leukocytosis

38
Q

arthropathy

A

a joint disorder -> when the disorder involves inflammation of one of more joints it is then called arthritis

39
Q

osteoarthritis (OA)

A

-degeneration of joints caused by aging and stress localized
-most common cause of disability in US
-obesity and longer life expectancy is causing the incidence of OA to increase

40
Q

common joints affected by OA

A

cervical spine
lumbosacral spine
hip
knee
hands
big toe

41
Q

what joints are typically spared from OA

A

wrist, elbow and ankles

42
Q

OA risk factors

A

aging
obesity
hx of participation in team sports
history of trauma or overuse of joints
heavy occupational work
misalignment of pelvis, hip, knee, ankle or foot

43
Q

OA etiology

A

stresses applied to joint (wt bearing)
degeneration of cartilage: excessive loading of healthy joint, normal loading of previously injured joint

44
Q

OA pathophysiology

A

pressure on joint wears away cartilage exposing the bone -> cyst development & destroys the cartilage -> localized inflammation leads to more degradation & chondrocytes synthesize fluid called proteoglycan to try and repair which causes swelling -> osteoblasts activation leads to bone spurs & synovial fluid thickening -> loss of cartilage narrows the joint space

45
Q

what is a hallmark of OA

A

osteophytes -> bone spurs that are caused by osteoblasts

46
Q

OA clinical manifestations

A

-deep, aching joint pain, esp w/ exertion & relived w/ rest
-pain worsens w/ cold weather
-stiffness in the morning
-crepitus of joint during motion
-joint swelling
-altered gait
-limited ROM

47
Q

OA physical exam findings

A

-joint deformity
-joint tenderness
-decreased range of motion
-weird finger things (the nodes)

48
Q

herbeden’s nodes

A

distal interphalangeal joint

49
Q

bouchard’s nodes

A

proximal interphalageal joint

50
Q

treatment for OA

A

-manage pain
-maintain mobility
-minimize disability

51
Q

what are dietary supplements for OA

A

chondroitin sulfate and glucosamine

52
Q

degenerative disc disease (DDD)

A

-most common cause of pain, motor weakness & neuropathy (most often occurs in lumbar or cervical spine)
-usually w/ lifting or twisting motions
-loose the bounce between discs so they lay on each other and compress the nerve

53
Q

DDD sx: lumber

A

-worse when sitting, bending, lifting or twisting
-better when walking
-numbness, tingling or weakness in the legs
-foot drop

54
Q

DDD sx: cervical

A

-chronic neck pain that radiates
-numbness or tingling in the arm or hand
-weakness of the arm or hand

55
Q

DDD can lead to

A

herniated or ruptured discs

56
Q

RA definition

A

-systemic autoimmune disease
-type III hypersensitivity
-inflammatory disease of synovium

57
Q

type III hypersensitivity of RA

A

that body begins to attack the synovial tissue in the joints and immune complexes are deposited which further develops inflammatory processes and destroys the joint

58
Q

RA risk factors

A

-age: 40-60s
-women
-tobacco use
-family hx
-genetics (+a trigger)

59
Q

immune cells involved in RA

A

B cells
lymphocytes and macrophages -> secrete cytokines that further attract WBCs
-the immune cells produce rheumatoid factor (RF)
during phagocytosis tissues are damaged

60
Q

rheumatoid factor

A

antibody against the body’s own antibodies (IgG)
formation of immune complex

61
Q

RA progression

A

intensifying inflammatory response -> cartilage is destroyed by osteoclasts and scar tissue forms (pannus)
very hard on the tissues

62
Q

pannus

A

inflammation and exuberant proliferation of synovium (hypertrophied synovium) -> leads to bone erosion, bone cysts, fissure development

63
Q

clinical manifestations of RA

A

early: very little, maybe joint pain or discomfort + fatigue, anorexia, wt loss
late: pain, stiffness, motion limitation, inflammation
advanced: deformity and disability, joint subluxation
will be symmetrical

64
Q

RA assessment

A

-systemic so check joints and everything else (esp <3 and eyes)
-can cause Sjorgrens syndrome and rheumatoid nodules

65
Q

Sjorgrens syndrome

A

destruction of moisture producing glands (salviary and lacrimal)
dry itchy eyes

66
Q

rheumatoid nodules

A

immune mediated granulomas, developed around inflamed joints, subcutaneous and firm, sometimes painful

ABSN (145 decks)

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