patho final Flashcards
what is immediate response to MSK injury
generalized inflammation
vascular, chemical and cellular events that prepare for repair
what is preclinical disability? how would it present?
progressive and detectable but unrecognizable decline in physical function
increased time to complete a task / decrease in frequency in which a task is performed
what causes fibrinogen clots
vasoconstriction
what is margination
when WBCs move to the periphery of the vessel
what is diapedesis
allowance of WBC to squeeze through the blood vessel wall
what is chemotaxis
WBC being guided to the site of injury beyond the blood vessel walls
what is the inflammatory response in steps
fibrinogen clots
margination
diapedesis
chemotaxis
phagocytosis
what is sarcopenia
age related loss in muscle mass, strength and endurance
how to treat sarcopenia
high resistance training exercise
functional measures or specific weights rather than MMT
what can lead to decreased flexibility in aging populations
a build up of fibrinogen/collagen in joints due to lack of motion
what cells provide proprioception
mechanoreceptors
strength training in older adults
program of 1-2x weekly
improved neuromuscular performance
ACSM recommendation for strength training in aging pop
up to 15 reps performed a minimum of twice per week
generally = 2-3 sets of 8-12 reps for 8-10 major muscle groups
ACSM recommendation for cardiovascular health in aging pop
> 85+ = 2x/week with intensity of 40-60% of HRR for more than 20 min
what chemicals make up bone
calcium and phosphate
- mixed with water forming hydroxyapatite
% of bone composition
20% - trabecular
80% - cortical
what is the % comp of cortical bone and trabecular bone is calcified
80-90 = cortical
15-25 = trabecular
what does BMD represent
mineral content of bone in grams/square cm
what % of bone loss on an x-ray is significant
30% must occur before the abnormalities can be seen
what standard dev are associated with osteoperosis or penia
perosis - >2.5 SD below normal peak bone mass
penia - 1-2.5 SD
modifiable risk factors for osteoperosis
calcium intake
smoking / drinking
low body weight (<127)
exercise
caffeine / soda
what medications can cause osteoperosis
corticosteroids
loop diuretic
immunosuppressants
anticonvulsants
what diseases are associated with osteoperosis
hyperparathyroidism
cushings disease
anorexia nervosa
female athlete triat
hyperthyroidism
injuries related to osteoperosis
hip / spine fractures
radius / femur
ribs
vertebral bodies
treatment of osteoperosis
weight bearing exercises
aerobics / yoga / pilates
what to avoid if diagnosed with osteoperosis
vertebral osteo - anything with a major component of spinal flexion, side bending, or rotation
things that are nonweightbearing
what is osteomalacia?
lack of mineralization of new bone matrix results in a softening of bone without loss of the present bone matrix
what are the two main causes of osteomalacia
insufficient intestinal calcium absorption
increased renal phosphorus losses
what is an osteoid
bone that has not matured/calcified
what is milkman syndrome
moderately severe form of osteomalacia
How is bone remodeling affected with Paget disease?
increased bone resorption and excessive, unorganized new bone formation caused by activated osteoclasts
diagnostic s/s of milkman syndrome
looser zones that occur due to healing of multiple microstress fractures causing aching, fatigue, weight loss
what is the result of paget’s disease in the bone
Bone resorption is so rapid that osteoblastic activity cannot keep up, and fibrous tissue replaces the bone.
Bone is enlarged/weak with chaotic woven pattern
what neuro complications can be seen with paget’s disease
headache, radicular, osteoarthritic, muscular or other skeletal pain
hearing loss, tinnitus and vertigo
how will bone look in those with paget’s disease
fuzzy / like a cotton ball
what enzyme is used to diagnose paget’s disease
alkaline phosphate is over produced in paget disease
what are avoided in paget disease
jogging, running, jumping or anything promoting bone growth
what bacteria is associated to exogenous osteomyelitis
staphylococcus aureus
what region of the body is osteomyelitis more common in adults vs children
adults - lumbar spine
children - metaphyseal areas of long bones
symptoms of myelitis in adults
back pain
radiculopathy / myelopathy
symptoms of myelitis in children
high fever, intense pain, local manifestations
primary cause of prosthetic failure
implant infection
routes of infection in prosthetic joints
hematogeneous - 30%
contiguous - 70%
3 categories of prosthetic joint infections and time of onset
early - develops <3 mo after surgery
delayed - 3 to 24 mo after surgery
late - > 24 months after surgery
diskitis symptoms in adults
spinal pain and severe radiation of pain into LE
diskitis symptoms in children
back pain / refusal to walk
pain with hip extension
s/s of septic arthritis
infection s/s - temp, swelling, redness infection
most common sites of septic arthitis
adults - knee or hip
children - ankle or elbow
treatment of septic arthritis
medical emergency
admission to hospital with specific IV
3 forms of myositis
dermatomyositis
polymyositis
inclusion body myositis
symptoms of myositis
dropfoot/tripping
weak grip
difficulty swallowing
muscle atrophy
weakness
treatment of dermatomyostitis
immunosuppressive therapy / corticosteroids
treatment of polymyostitis
immunosuppressive therapy / corticosteroids
treatment of inclusion body myostitis
no established treatment
common causes of hand infections
60% trauma
25% human bites
15% animal bites
s/s of hand infections
pain, loss of function, swelling, cellulitis
finger maintained in slight flexion, pain on extension with tenderness on tendon sheath
what organ systems can be affected by extrapulmonary tuberculosis
pulmonary
genitourinary
MSK
lymphatic
what is pott disease
lower thoracic / lumbar spine extrapulmonary TB caused by mycobacterium tuberculosis
what physical s/s are associated with down syndrome
muscle hypotonia
cognitive delay
abnormal facial features
what abnormal facial features are seen in down syndrome
flat nasal bridges
eye shape
short limbs
mild/moderate hypotonia
what are the testing procedures for down syndrome detection
alpha fetoprotein gonadotropin
unconjugated estrogen
ultrasound identification of nuchal translucency
what may cause high mortality rate in those with DS
congenital malformations in heart and GI system
decreased respiratory expansion - upper tract infection
how is scoliosis named
depending upon the convexity of the curvature
point toward the name
what degree of curvature is significant in scoliosis
> 45 - neuro symptoms and needs surgery
<45 - conservative care
what nerual tube defects affect neurologic dysfunction
myelomeningocele
main difference between myelo and meningocele
myelo - meninges and spinal cord
mening - just meninges
what forms of developmental hip dysplasia are there
unstable
subluxation/incomplete
complete
how is developmental hip dysplasia diagnosed in newborn
ROM asymmetry
buttock/glute fold asymmetry
leg length discrepenc
how is developmental hip dysplasia diagnosed in ambulating child
trendelenburg
flexion contracture due to posterior displacement
what is barlow test
dislocation test - hip flex and IR
what is ortolani test
reduction test
hip IR
what is galeazzi test
leg length discrepancy
knees bent, check for shorter knee
complication of developmental hip dysplasia
avascular necrosis
premature physeal arrest
protein associated with muscular dystrophy
dystrophin
common muscular weaknesses associated with muscular dystrophy
difficulty getting up, falling frequently, climbing stairs
waddling gait and increased lumbar lordosis
what is type 1 spinal muscular atrophy
werdnig hoffman - severe
respiratory failure and early death
what is type 2 spinal muscular atrophy
intermediate
significant functional impairment and reliance on power mobility
what is type 3 spinal muscular atrophy
mild - kugelberg welander
relatively slow progression, learn how to walk with assistance
what muscle is involved with torticollis? what happens
SCM - tilt to affected side with rotation to opposite side
what is osteogenesis imperfecta
congenital disorder of collagen synthesis affecting bones and CT
making too little type 1 collagen or defective collagen
what is the beighton scale
assesses joint hypermobility, especially with those who have Ehlers-Danlos syndrome
sections of the beighton scale
1 - passive extension of pinky finger past 90 (1 pt for each hand)
2 - passive opposition of thumb to flexor surface of forearm (1pt for each hand)
3 - elbow hyperextension >10 deg (1pt for each arm)
4 - knee hyperextension > 10 deg (1 pt for each knee)
5 - forward flexion of trunk w/ knees extended and hands resting flat on the floor
1pt
positive ehlers-danlos scores
adults - >5
child - >6
which soft tissues may tumors origninate in
muscle
cartilage
nerve
collagen
adipose
lymph or blood vessel
skin
what variations are associated with slow vs fast growing tumors
slow - well defined borders with sclerotic borders
fast - permeated/moth eaten borders
what is codman’s triangle
triangle shaped area of reactive bone formed when neoplasm has eroded the cortex
what is a bone island
oval sclerotic lesions of bone
well defined/developed haversian canal (<1cm)
what is osteoid osteoma
found in cortex of long bones near the end of diaphysis - will not be in skull
area of immature bone surrouned by prominent osteoblast/clasts
treatment of osteoid osteoma
excision
full recovery
no potential for malignant transformation
where are osteoblastomas found
spine
sacrum
flat bones
how are osteoblastomas diagnosed / what is the treatment
radiography, surgery with wider excision due to high recurrence rate
chemo/radiation
what anotomical sites are most commonly affected by osteosarcoma
long bones
distal femur
common in codman’s triangle
what is repiphysis prostheses
pediatric osteosarcoma
expandable metal rod that relaces long bones, will not have repeated procedureswh
what is rotationplasy
using the remaining bottom segment of the leg and ankle joint as the new knee
what is tibial turn up
tibia fused to femur allowing for longer limb with an above knee prosthesis
what is the functional motor assessment? what is it used with?
osteosarcoma
pain, function, support, satisfaction with walking quality, participation, endurance
what is ewing sarcoma
malignant, nonosteogenic primary tumor or bone/soft tissue
s/s of ewing sarcoma
soft, viscous tumor with hemorrhagic necrosis caused by tumor out pacing blood supply
onion skin
local bone pain
where does ewing sarcoma typically manifest
long bones and pelvis
what is a lipoma
superficial/subcutaneous tumor made of mature fat cells
asymptomatic
what is ganglia
benign tumor in joint capsule/tendon sheath
what can a ganglia lead to
pressure on a nerve
where are ganglia most common
wrist - between scaphoid and lunate
what is a baker/popliteal cyst
subtype of ganglion cyst that communicates with joint space
what is a neurofibroma
single lesion/greater number as a part of schwann cell build up
what is a schwannoma
coverage of peripheral/cranial nerves that stays on the outside of the nerve
what anatomical region is most often associated with metastatic bone cancer
spine
how can cancer metastisize
blood
lmyph
direct expansion
what is a sprain
injury to ligamentous structures around a joint
first degree strain
mild tear
stretching / minor tearing of a few fibers without loss of integrity
second degree strain
moderate tear
partial tearing of tissue with clear loss of function
what is a third degree tear
severe tear
complete loss of structural / biomechanical integrity
surgical repair necessary
common sites of compartment syndrome
lower leg
forearm
thigh
foot
symptoms of compartment syndrome
ischemia pain out of proportion
what may occur with compartment syndrome
sensory deficit or paresthesia
heterotropic ossifican
bone formation in non-osseous tissue
hallmark s/s of heterotropic ossificans
progressive loss of joint motion when post-traumatic inflammation should be resolving
pain and loss of ROM
sites of heterotropic ossificans
hip
elbow
knee
shoulder
TMJ
treatment of heterotropic ossificans
NSAID
low dose external bema radiation
comprehensive rehab
what is rhabdomyolysis? what can it lead to
breakdown of skeletal muscle
large amount of creatinine phosphokinase enzymes
acute renal failure - color change in urine
fatal heart arrythmias
hallmark signs of myofascial pain syndrome
taut, palpable band that is very tender
reproducible referred pain pattern
treatments of myofascial pain syndrome
injection
ice
PT
laser
what chemical leads to trigger points
ACh
what joint is most commonly affected by chondrolysis
hip
can affect knee, shoulder and ankle
prominent sign of OA
inflammation
soft tissue edema
stiffness of <30 min
treatment of OA
moderate exercise
maintaining appropriate body weight
what are s/s of disc protrusion/herniation
centralization of radiating pain
what is cauda equina syndrome’s s/s
pain in upper sacrum
paresthesia of buttocks
possible b/b incontenince
saddle distribution of pain
what is rheumatoid arthritis
systemic, bilateral symptoms
more destructive than OA
occurs in multiple joints
what is lhermitte sign? what is the test?
joint rheumatoid arthritis
positive test - shock like sensation and numbness down arms with forward flexion of head
what is ankylosing spondylitis
inflammatory arthropathy of axial skeleton
lead to fibrosis, calcification, ossification with fusion of involved joints
what is classic s/s of ankylosing spondylitis
chronic, non granulomatous inflammation at the area where ligamnets attach to vertebrae
typical in lumbar spine then SI
s/s of ankylosing spondylitis
insidous onset of LBP for atleast 3 months
what is gout
elevated levels of serum uric acid
deposition of urate crystals in the joint, soft tissue, and kidney
fracture repair process
formation of acute hematoma and early inflammatory response (48hr)
granulation tissue
recruitment
proliferation
differentiation of osteogenic cells
matrix formation
mineralization
remodeling
fracture healing timeline
children - 4 to 6 weeks
adolescent - 6 to 8 week
adult - 10 to 18 week
malunion fracture
correct timing, unsatisfactory position with residual bony deformity
delayed union fracture
may heal but takes longer than should
non-union fracture
may fail to heal – may lead to psuedoarthrosis
psuedoarthrosis fracture
resultant formation of fibrous union or false joint
what is osteochondritis dissecans
disorder of ossification sites - recalcification that affects the subchondral bone and articular cartilage
what population is osgood-schlatter found in
adolescent boys 10-15
girls 8-13
