Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal > Path 3 > Flashcards

Path 3 Flashcards

1
Q

Most Common Joints in ER?

A

1) Ankle
2) Wrist
3) Knee
4) Hip
5) Shoulder
6) Elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many ankle injuries a year?

A

5 million in US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common type of ankle injury?

A

lateral sprain due to inversion, while walking or running

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to treat an ankle sprain?

A 
PRICE
Protection
Rest
Ice
Compression
Elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ankle Fracture Etiology

A

5,600/year in US

  • equally common in men & women
    • young men
    • late middle-aged women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is ankle fractured?

A

vast majority-malleolar fractures

majority-unimalleolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of Ankle Fractures?

A
  • joint space disruption
  • dislocation
  • soft tissue/skin necrosis
  • nerve injury
  • arterial disruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Loss of arterial blood supply is???

A

a surgical emergency

“dislocation pressuring skin needs reduction as soon as possible to avoid necrosis of overlying skin”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Wrist Injuries: How many?

Most common type?

A
  1. 25 million

- fracture of radius (or ulna or carpal bones) due to fall on outstretched hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Do wrist injuries or ankle injuries cause fractures more?

A

Wrist

1.5 million/year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common type of wrist fracture?

A

Colles fracture, at the distal radial metaphysis, with proximal and dorsal displacement, creating “dinner fork” deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How many knee injuries a year?

A

1 million ER visits

100,000 ACL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hemarthroses

A

blood in the joint

-ligamentous injuries of the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Epidemiology of Hip Fractures

A
  • Common-310,000 in 2003, decrease each year
  • Primarily in elderly (female 77, male 72)
  • 2X more in women
  • 1/3 more common in whites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathophysiology of Hip Fractures

A
  • Weakening of bone with aging 90% of hip fractures in the elderly associated with a simple fall from standing positions
  • Fall because femoral neck breaks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of Hip Fractures

A

sudden onset of hip pain, before or after fall, and inability to bear weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Signs of Hip Fractures

A

leg shortened and externally rotated if fracture displaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hip Fracture Risk

A

deep venous thrombosis in the leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Low Back Pain

A

15 million visits
85% are idiopathic
non-idiopathic: intervertebral disc herniated, spinal mets, spinal infection, epidural abscess, hemorrhage, spinal fracture & ankylosing spondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Lumbar Intervertebral DIsc Herniation

A
  • middle-aged adult 30-50y/o
  • typically with recurring episodes of low back pain
  • 95% have sciatica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sciatica

A

-Syndrome of pain +/- sensorimotor symptoms in the distribution of a sciatic nerve
-Pain in the lower back, buttock & leg, typically sharp and commonly in a single dermatome
+/- leg weakness
+/- numbness or tingling (typically unilateral)

90% due to herniation of lower lumbarsacral intervertebral disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Straight Leg Raise Test

A

-for lower lumbar intervertebral disc herniation
-raise b/w 30-70 deg above level
Positive=pain in the dist. of sciatic nerve
Sen: about 90% Spec: about 25%
-if opposite leg causes pain
sen:25% spec:90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cauda Equina Syndrome

A

-compression causing combo of:
low back pain, sciatica, leg weakness, bladder dysfunctioin, saddle hypo-or anesthesia, fecal incontinence, sexual dysfunction

Bladder dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cauda Equina Syndrome: Signs

A

-bladder distention
-decreased anal tone
-absent ankle, knee, or bulbocavernosus reflexes
-saddle anesthesia
-bilateral sciatica
>500mL urinary retention

NEUROSURGICAL EMERGENCY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Spinal Epidural Abscess

A

Rare

  • risk: spinal surgery, recent trauma, immunosuppression, distal infection, IV drug use, diabetes mellitus & alcoholism
  • 20% no predisposing factor

Back Pain, Fever

26
Q

Drug-Seeking in ER

A

10% of patients

-opioid

27
Q

Necrotizing Fasciitis

A

-rare acute progressive destructive infection of muscle fascia and overlying subcutaneous fat
“flesh-eating bacteria”
1) Infection typically spreads along muscle fascia due to poor blood supply (muscle spared)
2) Overlying tissue can seem unaffected
3) Area of erythema (w/o sharp margins), swelling, warmth, shiny, exquisitely tender
4) Pain out of proportion
5) Type 1 polymicrobial (aerobes + anaerobes)
Type 2 group A strep (or MRSA)

28
Q

Risk Factors for Necrotizing Fasciitis

A 
diabetes
vascular disease
immunosuppression
trauma
surger
29
Q

Microscopic Pathology

A

coagulative necrosis w/acute inflammation (neutrophils & fibrin exudation) starting at the edge, +/- aggregates of bacteria (but not where neutrophils are)
+/- nuclear dust (from neutrophil breakdown)
+/- hemorrhage

30
Q

Necrotizing Fasciitis Over 3-7 days

A

Skin: red to purple to purple with patches of blue-grey

  • 3-5 days: skin breaks down with bullae
  • frank cutaneous gangrene, involved area is anesthetic due to thrombosis of small blood vessels and destruction of superficial nerves
  • anesthesia precedes skin necrosis
31
Q

Top 2 sites for Necrotizing Fasciitis?

A

1st: legs
2nd: perineum

32
Q

Necrotizing Fasciitis Type I

A

subcutaneous gas often present

33
Q

Advanced Necrotizing Fasciitis

A 
fever of 38.9 to 40.5
tachycardia
hypotension
malaise
myalgias
anorexia
diarrhea
34
Q

Diagnosing Necrotizing Fasciitis

A

history and physical

35
Q

Treatment of Necrotizing Fasciitis

A

surgical debribement of necrotic tissue
broad spectrum abx
hemodynamic support

36
Q

Prognosis of Necrotizing Fasciitis

A

bad (40% mortality)

37
Q

Compartment Syndrome

A
  • muscle groups divided into compartments formed by strong unyeilding fascial membranes
  • increased pressure within a compartment compromises the circulation within that space
  • acute, often following trauma
  • chronic, athletes, insidious pain
38
Q

Pathophysiology of Compartment Syndrome

A
  • arteriovenous/arteriointerstital pressure gradient theory: a prerequisite for compartment syndrome is a fascial enclosure that prevents adequate expansion of tissue volume to compensate for an increase in fluid
  • inadequate venous drainage results in tissue edema and a rise in interstitial pressure
  • as compartment pressure rises, venous outflow is reduced and venous pressure rises, decreasing the arteriovenous pressure gradient
  • arterioles collapse when tissue pressure exceeds end-arteriolar pressure, then arteriolar pressure is insufficient to overcome compartment pressure and blood is shunted away from compartmental tissues
39
Q

When Does Acute Compartment Syndrome Occur?

A
  • soon after sig. trauma (long bone fractures-leg/forearm)
  • Nontraumatic: bleeding, thrombosis, vascular disease, nephrotic syndrome, extravasation of IV fluids, injectionof recreational drugs, prolonged limb compression
40
Q

Acute Compartment Syndrome Symptoms

A

1) pain out of proportion to injury
2) persistent deep ache or burning
3) paresthesias (onset within 1/2-2 hours)

41
Q

Acute Compartment Syndrome Signs

A

1) Pain w/passive stretch of muscles in affected compartment (early)
2) Tense comp. with a firm “wood-like” feeling
3) Diminished sensation
4) Muscle weakness (2-4hrs)

42
Q

Normal Compartment Pressure

A

0 to 8mmHg

43
Q

Pain with Compartment Pressure of?

A

20 to 30mmHg

44
Q

Clostridial Myonecrosis

A

“gas gangrene”

-life-threatening necrotizing muscle infection from contiguous are of trauma or hematogenous muscle seeding from GI tract

45
Q

2 Forms of Clostridial Myonecrosis

A

1) Traumatic - C. perfringens

2) Spontaneous - C. septicum

46
Q

C. perfrigens virulence

A

1) alpha toxin - hemolytic

2) theta toxin - cholesterol dependent

47
Q

Pathophysiology of Clostridial Myonecrosis

A

Trauma introduces bacteria/spores into deep tissue

-anaerobic if trauma impairs blood supply (low ox-red potential and acidic pH)

48
Q

How long from trauma to necrosis

A

24-36 hours

49
Q

Are neutrophils present in muscle necrosis?

A

no

50
Q

Clostridial Myonecrosis Micrograph

A
  • large box-car shaped gram + rods

- gram variable

51
Q

Alpha Toxin

A

potent rapid irreversible decline in muscle blood flow and ischemic necrosis due to formation of occlusive introvascular masses of activated platelets, leukocytes, fibrin
-lack of perfusion increase anaerobic environment and contribute to growth
(activation of platelet fibrinogen receptor glycoprotein IIb/IIIa)

52
Q

Skin over Clostridial Myonecrosis

A

-pale then bronze, purple/red
-tense and tender
Bullae form
gas bubbles

53
Q

Clostridial Myonecrosis

A

tachycardia
fever
shock
multiorgan failure

54
Q

Histopathology of Clostridial Myonecrosis

A

absence of inflammatory cells

55
Q

Treatment of Clostridial Myonecrosis

A

aggressive and thouough surgical debridement with clindamycin and penicillin

56
Q

Prognosis of Clostridial Myonecrosis

A

20% mortality - shock at presentation

spon: 67-100% mortality (malignancy/immunocompromised)

57
Q

Rhabdomyolysis

A

condition of muscle necrosis and release of intracellular muscle constituents into circulation

58
Q

Symptoms of Rhabdomyolysis

A

1) muscle pain, weakness, dark urine
2) muscle pain - proximal muscles (thighs shoulders), lower back, calves
3) stiffness/cramping
4) 1/2 have no muscular symptoms
5) malaise, fever, tachycardia, nausea, vomiting, abdominal pain
* **vairy, some asymptomatic

59
Q

Signs of Rhabdomyolysis

A
  • reddish brown urine
  • muscle swelling with rehydration
  • muscle tenderness
  • muscle weakness
  • no signs
60
Q

3 causes of rhabdomyolysis

A

1) Trauma - crush
2) Exertion
3) Miscellaneous - toxins, meds, infection

61
Q

Hallmark of rhabdomyolysis

A

elevation in serum muscle enzymes

creatine kinase

62
Q

myoglobinuria

A

present in 50-75% rhabdomyolysis
+ blood dipstick, no cells in urine
myoglobin clogs renal tubules (acute renal failure)

Musculoskeletal (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions