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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
fracture complication: delayed healing
-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
26
malunion
unequal stretch of muscle pull causing improper alignment **ex of cause: starting weight bearing too soon**
27
non union
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
fracture complication: impaired bone growth
-peds -fracture through epiphyseal plate which can delay future bone growth
29
fracture complication: compartment syndrome
-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
compartment syndrome symptoms
edema loss or weakened pulses **extreme pain** fat embolism
31
treatment for compartment syndrome
fasciotomy
32
fat embolism
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
fracture complication: osteomyelitis
an acute or chronic pyogenic (pus producing) infection of the bone **needs immediate treatment -> weeks of abx & wound vac**
34
risk factors of osteomyelitis
recent trauma diabetes hemodialysis IV drug use splenectomy
35
route of contamination for osteomyelitis: direct
open wound gunshot puncture surgery
36
route of contamination for osteomyelitis: indirect
from bloodstream (most common) bacteremia
37
osteomyelitis clinical manifestations
local: tenderness, warmth, redness, wound drainage, restricted movement, spontaneous fracture systemic: fever, positive blood culture, leukocytosis
38
arthropathy
a joint disorder -> when the disorder involves inflammation of one of more joints it is then called arthritis
39
osteoarthritis (OA)
-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
common joints affected by OA
cervical spine lumbosacral spine hip knee hands big toe
41
what joints are typically spared from OA
wrist, elbow and ankles
42
OA risk factors
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
OA etiology
stresses applied to joint (wt bearing) degeneration of cartilage: excessive loading of healthy joint, normal loading of previously injured joint
44
OA pathophysiology
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
what is a hallmark of OA
osteophytes -> bone spurs that are caused by osteoblasts
46
OA clinical manifestations
-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
OA physical exam findings
-joint deformity -joint tenderness -decreased range of motion -weird finger things (the nodes)
48
herbeden's nodes
distal interphalangeal joint
49
bouchard's nodes
proximal interphalageal joint
50
treatment for OA
-**manage pain** -maintain mobility -minimize disability
51
what are dietary supplements for OA
chondroitin sulfate and glucosamine
52
degenerative disc disease (DDD)
-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
DDD sx: lumber
-worse when sitting, bending, lifting or twisting -better when walking -numbness, tingling or weakness in the legs -foot drop
54
DDD sx: cervical
-chronic neck pain that radiates -numbness or tingling in the arm or hand -weakness of the arm or hand
55
DDD can lead to
herniated or ruptured discs
56
RA definition
-**systemic** autoimmune disease -type III hypersensitivity -inflammatory disease of synovium
57
type III hypersensitivity of RA
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
RA risk factors
-age: 40-60s -women -tobacco use -family hx -genetics (+a trigger)
59
immune cells involved in RA
**B cells** lymphocytes and macrophages -> secrete cytokines that further attract WBCs -the immune cells produce rheumatoid factor (RF) **during phagocytosis tissues are damaged**
60
rheumatoid factor
antibody against the body's own antibodies (IgG) formation of immune complex
61
RA progression
intensifying inflammatory response -> cartilage is destroyed by osteoclasts and scar tissue forms (pannus) **very hard on the tissues**
62
pannus
inflammation and exuberant proliferation of synovium (hypertrophied synovium) -> leads to bone erosion, bone cysts, fissure development
63
clinical manifestations of RA
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
RA assessment
-systemic so check joints and everything else (esp <3 and eyes) -can cause Sjorgrens syndrome and rheumatoid nodules
65
Sjorgrens syndrome
destruction of moisture producing glands (salviary and lacrimal) **dry itchy eyes**
66
rheumatoid nodules
immune mediated granulomas, developed around inflamed joints, subcutaneous and firm, sometimes painful

ABSN (210 decks)

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