Musculoskeletal System Flashcards
1
Q
What are the purposes of the skeletal system?
A
-Gives body form
-Supports tissues (keeps things in place)
-Permits movement
-Protects organs like the brain, spinal cord, heart, and lungs
-Mineral storage
2
Q
____ bone is a dense shell that defines the shape of the bone and makes up 85% of skeletal tissue; gives our bones strength and covers the inside of the bone
A
Compact
3
Q
____ bones gives bone a lattice framework; contains red and yellow marrow
A
Spongey
4
Q
____ is the covering of the bone; it has two layers, the inner layer anchors to the bone and the outer layer carries blood vessels to penetrate all layers of the bone
A
Periosteum
5
Q
____ is the lining for soft bone
A
Endosteum
6
Q
____ are the bone-building cells
A
Osteoblasts
7
Q
____ maintain the bony matrix and facilitate nutrient extraction from the blood
A
Osteocytes
8
Q
____ are involved in the resorption of bone and contain hydrolytic enzymes that are especially active after a bone break or with the release of parathyroid hormone
A
Osteoclasts
9
Q
____ is the formation of pre-bone
A
Ossification
10
Q
____ describes the process of depositing minerals into bone; minerals bind to collagen fibers in the bone to give tensile and compression strength
A
Calcification
11
Q
The bone ____ is the extracellular elements of bone tissue
A
Matrix
12
Q
_____ fibers are synthesized by osteoblasts
A
Collagen
13
Q
Collagen fibers are formed as ____ ____, and three of them twist into a fibril; fibrils will form crossing patterns with holes where minerals will be deposited
A
Alpha chains
14
Q
Collagen fibers provide tensile ___ and ____
A
Strength and support
15
Q
____ is a mineral deposited into the bones for storage and strength
A
Calcium
16
Q
____ exist in the bony matric and shuttle calcium around and form a network between fibrils to strengthen bone
A
Proteoglycans
17
Q
____ binds to calcium and inhibits calcium-phosphorus precipitation; it recruits osteoclasts
A
Osteocalcin
18
Q
Osteonectin binds to ____ in bone as well and promotes bone growth
A
Calcium
19
Q
____ stimulates neurite and axon growth and stimulates the bony membrane
A
Laminin
20
Q
Bone ____ transports elements like calcium and electrolytes into the bone
A
Albumin
21
Q
Alpha _____ binds to calcium and activates osteoclasts
A
Glycoprotein
22
Q
____ marrow is the site of hematopoiesis and is biologically active
A
Red
23
Q
____ marrow is made up of fat tissue
A
Yellow
24
Q
A bone ____ is a break in the continuity of the bone
A
Fracture
25
Who are at the highest risk for bone fractures?
-Young males
-Elderly (have thinner matrix)
-Individuals with bone or calcium disorders
26
A ____ (simple) fracture is non-communicating between skin and bone
Closed
27
An ____ (compound) fracture is communicating between the skin and bone (bone pokes through the skin)
Open
28
A ____ fracture causes multiple bone fragments (eggshell)
Comminuted
29
____ fractures are parallel to the long axis of the bone
Linear
30
____ fractures are horizontal fractures of the bone and are usually more serious than linear
Transverse
31
____ fractures are all the way through the bone
Complete
32
_____ fractures are not all the way through the bone, and are more common in flexible, growing bones of children
Incomplete
33
____ fractures occur when part of the bone that is attached to a ligament breaks off
Avulsion
34
____ fracture is when a bone breaks due to weakening from disease, commonly with weak force (occurs with tumors, osteoporosis, infection, and metabolic bone disorders)
Pathologic
35
____ fractures are incomplete microfractures due to low-impact stress
Stress
36
____ fractures are a break only in the cortex (outer layer) of bone and are more common in kids
Greenstick
37
Manifestations of bone fractures vary by site and type, but commonly include...
-Unnatural alignment
-Swelling
-Tenderness, muscle spasms
-Pain
-Impaired sensation (pinched nerve, severed nerve)
-Impaired function and crepitus (air pockets in the skin that sounds like bubble wrap)
38
What are the four phases of fracture healing?
-Hematoma formation if vessels have been damaged (hours)
-Inflammatory phase (1-2 days)
-Reparative phase (1 week to months)
-Remodeling phase (several weeks and beyond)
39
What happens during the first phase of fracture healing, hematoma formation?
-Fibrin and platelet entry
-Surrounding bone death
-Cytokine entry
-Inflammatory process is initiated
40
What happens during the second phase of fracture healing, the inflammatory phase?
-Cytokines, enzymes, and growth factors enter the site
-Vasodilation (leukocyte and mast cell entry)
-Osteoblast entry
-Procallus formation
-Cartilage and collagen formation
41
What happens during the third phase of fracture healing, the reparative phase?
-Osteoblasts form membranous bone, "callus"
-Phosphate content is increases
-Callus is replaced by bone
42
What happens in the fourth phase of fracture healing, the remodeling phase?
-Periosteum/endosteum remodeling to give shape and strength to the bone so it can function normally
-Weight-bearing and motility
43
Factors that affect healing of bone:
-Nature of the injury
-Immobilization and realignment (traction)
-Infection
-Hormones, growth factors, vitamin D, calcium
44
What are some complications of healing?
-Union
-Fat emboli syndrome
-Compartment syndrome
-Osteomyelitis
45
With a ____, there is a failure of the bone to grow together when it heals
Nonunion
46
With a _____ union, it takes longer than normal for the fracture to heal
Delayed
47
With a ____, the bones don't join up correctly
Malunion
48
Fat emboli syndrome occurs when there is _____ to long bones
Trauma
49
Mechanism of fat emboli syndrome:
-Abnormal fat metabolism
-A piece of fat from the marrow moves out into the bloodstream and then there is fat traveling through the lungs which eventually causes an embolism
50
Fat emboli syndrome is most common in ____ or ____ fractures and there is increased risk if the injury is not properly immobilized
Femur or pelvis
51
When the fat is traveling to the lungs, ____ adhere to it and it causes acute respiratory distress syndrome
Platelets
52
Manifestations of fat emboli syndrome:
-Hypoxia on ABG
-Low hemoglobin
-Thrombocytopenia
-Fat in blood clots
53
Compartment syndrome causes abnormal increases in ____ within a confined anatomic space, resulting in impaired circulation, nerve injury, and loss of muscle
Pressure
54
Compartment syndrome usually occurs in someone in a ____ or constrictive dressing
Cast
55
Pathogenesis of compartment syndrome:
-Increased pressure
-Lack of blood flow
-Nerve damage
-Muscle death
56
Compartment syndrome risk is increased with...
-Casting
-Infection
-Burns
-Repeat stress
57
Mechanism of compartment syndrome:
-Weight of limb cases cell damage
-Cell damage causes edema
-Edema increases pressure
-Tamponade effect
-Muscle/nerve cell infarction and death
-Myoglobin release
-Further edema
58
Manifestations of compartment syndrome:
-Pain
-Paresthesias
-Pressure > 30mmHg (pulselessness)
-Release of myoglobin
-Elevated creatinine kinase
59
Compartment syndrome is treated with ____
Fasciotomy
60
_____ is an infection of the bone
Osteomyelitis
61
What are two possible etiologies of osteomyelitis?
-Direct contamination (exogenous): someone has an open fracture and it gets infected at the time of the injury (common with gut shot wounds and bites)
-Hematogenous (endogenous): blood to bone; infectious agent moves from the blood to the bone, seen when someone has an infection anywhere in the body that moves to the bone
62
Manifestations of osteomyelitis:
-Varies with age, site, organism, and source
-Inflammation
-Fever
-Malaise
-Anorexia
-Weight loss
-Septicemia
-Swelling, erythema, tenderness
-Pain
-WBC elevation or not
63
Complications of osteomyelitis:
-Arthritis
-Pathological fractures
-Chronic osteomyelitis
-Bone cancer
64
____ ____ increases serum calcium and is released when there is low blood calcium and stimulates osteoclasts to break down and increases kidney resorption of calcium
Parathyroid hormone
65
____ decreases serum calcium, decreases osteoclast activity, decreases renal absorption of calcium (more excreted in urine), and overall has the opposite effect of PH
Calcitonin
66
Vitamin ____ needs to be metabolized to be active; it is heavily regulated by parathyroid hormone and helps to maintain calcium
D
67
____ is a disease that causes a higher rate of bone resorption than bone formation, which leads to decreased density of bone tissue
Osteoporosis
68
We are able to build bone through our ____, and things like exercise and healthy diet with calcium and vitamin D can help
30s
69
We have ___% bone loss every year after age 40, and 1% per year in menopausal women
0.5
70
Osteoporosis is uncommon in ____ ____
African Americans
71
_____ are a drug that break down bones by inhibiting osteoblasts
Corticosteriods
72
Osteoporosis is ____ in men
Secondary
73
What are some causes of osteoporosis?
-Estrogen (decreased levels after menopause, overstimulated osteoclasts)
-Dietary (decreased dietary intake of calcium, magnesium, vitamin D; phosphate binds calcium and makes it inactive and promotes osteoclasts)
-Exercise can help keep and maintain bone mass
-Smoking cessation may help (smoking decreases estrogen)
-Hormones
-Drugs
74
What are some pathological changes seen with osteoporosis?
-Loss of organic matrix and the mineral content of bone
-Loss of spongey (cancellous) bone
-Decreased thickness of bone cortex
-Slower cycle of bone remodeling (we normally replace bone every 40 days, but it would take 2 years with osteoporosis)
-Menopause: decreased estrogen
75
Manifestations of osteoporosis:
-Pain
-Fractures
-Kyphosis (slumping of spine)
-Fatal complications include fat or pulmonary emboli, hemorrhage, shock
76
____ provide stability where bones meet
Joints
77
_____ are immovable joints like in the skull or between the tibia and fibula
Aynarthroses
78
_____ are slightly moveable joints like where the rib meets the sternum or the pubic bones
Amphiarthrosis
79
____ are a fibrous joint capsules supported by cartilage like the elbow and shoulder
Diarthroses
80
The ____ cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints
Articular
81
The ____ ____ is the inner lining of the joint
Synovial membrane
82
The ___ ___ acts as lubricant for joints
Synovial fluid
83
____ ____ is an autoimmune, systemic inflammatory disease which causes inflammation of connective tissue, primarily in the joints
Rheumatoid arthritis
84
Rheumatoid arthritis affects 1-2% of the population, and is much more common in what gender (3:1)?
Women
85
Peak incidence age is between ___-___ for rheumatoid arthritis (peak onset is between age 30-50)
40-60
86
What are three possible causes of rheumatoid arthritis?
-Genetics
-Viral infection earlier in life (EBV) or possibly even bacterial infection
-Hormones (estrogen-androgen imbalance
87
___ ___ is an auto-antibody that attacks the host connective tissue
Rheumatoid factor
88
Rheumatoid factor gets into the joints and activates the ____ cascade to cause massive inflammation in the joint
Compliment
89
The massive inflammation in the joint causes ____ enzymes to develop in the joint which destroys the cartilage
Lysosomal
90
Once the cartilage is destroyed, there is ____ formation which limits mobility and eventually leads to immobility of the joint
Pannus
91
Manifestations of rheumatoid arthritis are variable, seasonal, and systemic, but some systemical manifestations may include...
-Inflammation
-Weight loss, anorexia, fatigue
-Aching, stiffness
-Raynaud's syndrome
-Respiratory dysfunction
-Hearing difficulties
-Kidney problems
92
What joints are usually affected by rheumatoid arthritis?
-Fingers
-Hands
-Wrists
-Feet
93
What symptoms does rheumatoid arthritis cause in the joints?
-Pain, stiffness (especially in the morning)
-Swelling
-Mobility
-Cyst formation/rupture
94
One example of a degenerative joint disease is ____
Osteoarthritis
95
Risk of osteoarthritis increases with ____ and is more likely to affect those over 40 years old
Age
96
Primary osteoarthritis is ____ and affects all joints in the body
Idiopathic
97
Secondary osteoarthritis is more ____, and has known risk factors
Common
98
Osteoarthritis is more common in what gender?
Men
99
The cause of osteoarthritis is joint instability which can be caused by...
-Genetics
-Repetitive impact loading (sports=most common cause)
-Congenital
-Trauma
-Other disorders
-Certain drugs
100
Mechanism of osteoarthritis:
-Progressive loss of cartilage
-Thickening and hardening of bone ends
-Bone spur formation
-Cyst formation
101
Manifestations of osteoarthritis:
-Severe joint pain (aggravated by weight bearing)
-Stiffness
-Limitation of motion
-Joint instability
-Deformity
-Synovitis
102
____ is caused by an increased level of uric acid, which leads to an inflammatory response
Gout
103
The cause of primary gout is unknown, but secondary gout can be caused by...
Hyperuricemia-producing drugs or disorders
104
Males and females are both affected by gout, but the ____ of onset differs between genders since estrogen may be protective
Age
105
Gout can be caused by ____ or ____ factors
Genetics or environmental
106
Mechanism of gout:
-Purine metabolizes to uric acid
-Uric acid builds up, forming monosodium urate crystals
-Crystals deposit in joints, stimulating inflammation
-Neutrophil involvement
-Phagocytosis of crystals, phagocytes burst
107
Manifestations of gout:
-Increased uric acid (uricemia)
-Deposition of monosodium urate, neutrophils, and phagocytes (recurrent attacks of pain)
-Joint pain
-Renal disease (kidney stones)
-Tophi development (uric acid in the skin)
108
What are the three stages of gout?
-Asymptomatic
-Acute gouty arthritis: one attack of gout, maybe a second one much later
-Chronic tophaceous arthritis: progressive inability to excrete uric acid (deposit in joints and soft tissue)
109
The ____ is the connective tissue that gives form to the muscle
Fascia
110
The epimysium connects ____ to ____ (tendons)
Muscle, bone
111
The ____ is the middle layer of the muscle tissue; it creates smaller bundles of fibers
Perimysium
112
The _____ surrounds individual fascicles
Endomysium
113
____ are individual muscle fibers
Fascicles
114
The motor unit is the individual ___ ___ cell (lower motor neuron) and the muscle it innervates
Anterior horn
115
There are many ___ ___ that form a neuron
Motor units
116
Muscle fibers are innervated by ____ ____ neurons
Lower motor
117
Muscles contract as a _____ and there are many motor units in a single muscle
Whole
118
_____ units/receptors of the muscle cell bring sensory information into the muscle to get the right amount of contraction for the desired function
Sensory
119
____ are mechanoreceptors that sense stretch, they lie within the muscle fibers
Spindles
120
____ ____ organs are nerve cells that terminate on the tendon (gives us dynamic information about the stretch)
Golgi tendon
121
____ run the length of the muscle fiber and are the basic contractile unit of the muscle
Sarcomeres
122
Muscle function is an "___ __ ___" mechanism
All or nothing
123
Steps of muscle function:
-Activation: depolarization
-Coupling: calcium release
-Contraction: calcium binds to troponin and causes tropomyosin to move to allow for actin/myosin to contract
-Relaxation: calcium absorption
-Smoothing
124
____ contraction does not change the length of the muscle (no limb or joint movement occurs)
Isometric
125
____ contraction does change the length of the muscle (produces limb movement)
Isotonic
126
Symptoms of alterations in muscular function:
-Pain, tenderness
-Weakness
-Muscle wasting
-Fatigue and/or exercise intolerance
127
_____ is muscle cell loss
Rhabdomyolysis
128
Rhabdomyolysis can be caused by...
-Crush syndrome
-Compartment syndrome
-Immobilitty
-Viruses
-Drugs
-Tetanus
-Heat stroke
-Electrolyte disturbances
129
Pathophysiology of rhabdomyolysis:
-Weight of extremity generates pressure
-Ischemia
-Edema increases pressure in the compartment
-Eventual tamponade causes infarction, nerve damage, and cell death
-Muscle tissue death releases myoglobin
-Myoglobin damages kidneys
130
Manifestations of rhabdomyolysis:
-Regional effects (compartment syndrome)
-Renal syndrome (myoglobin in the urine)
-Systemic effects (high creatinine)
131
____ disorders affect the thyroid, which regulates muscle protein synthesis and electrolyte balance
Endocrine
132
____ ____ is a myophosphorylase deficiency (lack of muscle phosphorylase)
McArdle disease
133
Myophosphorylase is an enzyme that assists in ____ breakdown in tissue, so McArdle disease can cause energy failure and symptoms like fatigue and muscle intolerance
Glycogen
134
____ ____ deficiency causes abnormal glycogen metabolism and an accumulation of glycogen
Acid mutase
135
____ disease is an infant version of acid mutase deficiency
Pompei
136
____ deficiencies also lead to energy failure since our muscles need fat
Lipid
137
What are two examples of inflammatory muscle disorders?
-Myositis
-Polymyosititis
138
Myositis is a viral, bacteria, or parasitic infection of the ____; can be caused by Trichinosis
Myositis
139
____ is an autoinflammatory disorder that leads to the accumulation of B, Th, and Tc cells in muscle cells
Polymyositis
140
Impact of age on bones:
-Become brittle
-Impact is greater in women than men
-Decreased height
141
Impact of age on joints:
-Stiffness due to cartilage changes
-Decreased range of motion
142
Impact of age on muscle:
-Sarcopenia (age-related muscle loss)
-Decreased muscle strength
-Reduced oxygen intake, metabolic rate, and lean body mass
