PPT1: Classification and Mechanisms of Injury

Question 1

What is the difference between primary and secondary injury?

Answer 1

Primary = direct result of initial, immediate trauma
Secondary = additional; result of primary injury

Question 2

Types of Primary Injury: Extrinsic, Intrinsic, or Over-use?
A. Force of injury transmitted to another body part where trauma is concentrated
B. Occurs at point of impact
C. Acute or chronic repetitive friction/microtrauma

Answer 2

A. Indirect/Intrinsic
B. Direct/Extrinsic
C. Overuse

Question 3

Time frames for Secondary Injury: Short or long term?
A. Increases total quantity of tissue damage, healing time
B. Results from sequelae of injury, if not managed properly
C. Affects uninjured cells on periphery of primary lesion
D. Over time may lead to degenerative conditions

Answer 3

A. Long-term
B. Short term
C. Short term
D. Long-term

Question 4

Secondary Injury: Enzymatic or Hypoxic?
A. Cell membrane loses integrity and polarity
B. Cells swells; death
C. Failure of vasculature to supply enough blood
D. Inadeuate ATP; Membrane ion pump failure

Answer 4

A. Enzymatic
B. Both
C. Hypoxic
D. Hypoxic

Question 5

Which type of secondary injury is thought to be most important?

Answer 5

Secondary hypoxic (ischemic) injury

Question 6

Ischemia comes from

Answer 6

Damaged blood vessels
hemostasis/clotting
inflammation induce hemoconcentration
poorer flow of thicker blood
Increased extravascular pressure from expanding hematoma
pain induced muscle spasm
swelling of injured cells

Question 7

Three physiologic problems caused by ischemia?

Answer 7

Hypoxia
Inadequate supply of nutrients, e.g. glucose
Inadequate removal of waste

Question 8

Tension compression shearing torsion bending or stretching?
A. strain, cramp (pulling)
B. spiral or greenstick fracture
C. vertebral disc injuries

Answer 8

A. Tension
B. Bending
C. Shearing

Question 9

Tension compression shearing torsion bending or stretching?
A. Twisting or turning force
B. contusion, fracture
C. strain, sprain (elongation)

Answer 9

A. Torsion
B. Compression
C. Stretching

Question 10

Tendons, Bones, Ligaments or Discs?
A. Resist tensile forces
B. Resist compressive forces
C. Resist tension, compression, shear, and torsion

Answer 10

A. Ligaments and tendons
B. Bones
C. Discs

Question 11

Injury: Cramp, Spasm, Hypertonicity, or Spasticity?
A. Increase in muscle tone at rest, increased resistance to passive stretch, exaggerated DTR, possibly clonus
B. Increased muscle tone w/out nerve/muscle pathology
C. A reflex muscle contraction caused by acute trauma

Answer 11

A. Muscle spasticity
B. Hypertonicity
C. Muscle spasm

Question 12

Injury Bruise, Contusion, Cramp, or Spasm?
A. Acute compression causing hemorrhage of muscle
B. Compression that causes bleeding under the skin
C. Acute painful involuntary muscle contraction

Answer 12

A. Contusion
B. Bruise
C. Muscle cramp

Question 13

Injury: Cramp, Spasm, Hypertonicity, or Spasticity?
A. Serves to protect or guard an area
B. Caused by electrolyte imbalance or dehydration
C. Result of upper motor neuron lesion (UMNL)

Answer 13

A. Muscle spasm
B. Muscle cramp
C. Muscle spasticity

Question 14

Sprain or Strain?
A. Acute stretch, tear, or rip in the muscle or tendon
B. Stretching or tearing damage to a ligament
C. Decreased active range of motion with pain
D. Decreased passive range of motion with pain

Answer 14

A. Strain
B. Sprain
C. Both
D. Sprain

Question 15

Sprain or Strain?
A. Normal passive range of motion w/o pain til end range
B. Isometric muscle contraction causes no pain
C. Isometric muscle contraction most provocative for pain
D. May have pain on weight bearing and joint instability

Answer 15

A. Strain
B. Sprain
C. Strain
D. Sprain

Question 16

Cause for Strain or Sprain?
A. Repetitive overload (keyboard/typing)
B. Sudden load or direct blow
C. Sustained postural overload
D. Sudden contraction (most likely) or sudden stretch

Answer 16

A. Sprain
B. Sprain
C. Both
D. Strain

Question 17

Grades of Sprains: Grade 1, 2 or 3?
A. Stability of joint is intact; no abnormal motion
B. Surgical repair is probably indicated; severe instability
C. Moderate joint instability present

Answer 17

A. Grade 1 (0-20%)
B. Grade 3 (20-75%)
C. Grade 2 (>75%)

Question 18

Grades of Strains: Grade 1, 2, or 3?
A. Surgical repair probably indicated; palpable deformity
B. Muscle function intact but painful; decreased strength
C. Muscle function painful and limited; moderate tearing

Answer 18

A. Grade 3 (>50%)

B. Grade 1 (

Question 19

Residual Effects: Sprain or Strain?
A. Fibrosis, subluxation, atrophy
B. Myositis Ossificans, Myofascial Trigger Points (MFTPs)
C. Proprioceptive & coordination/control problems
D. Instability

Answer 19

A. Both
B. Strain
C. Both
D. Sprain

Question 20

Synovial Joint Injury: Acute Synovitis, Dislocation, Subluxation, or Separation?
A. Incomplete separation between two articulating bones
B. Complete separation between two articulating bones
C. Inflammation of the synovial membrane
D. Increase in joint space betwn two articulating surfaces

Answer 20

A. Subluxation
B. Dislocation
C. Acute Synovitis
D. Separation

Question 21

Synovial Joint Injury: Types of INTRA-articular injury
A. Avascular degeneration of articular cartilage
B. Inflammation of tendon-bone junctions
C. Degenerative changes of bone epiphysis or apophysis
D. Inflammation; thickness of synovium; crepitis, grating

Answer 21

A. Osteochondritis dissecans
B. Apophysitis
C. Osteochondrosis
D. Traumatic arthritis

Question 22

Synovial Joint Injury: Types of EXTRA-articular injury
A. Inflammation of a bursa
B. Inflammation of a joint capsule
C. Degeneration of collagen matrix of a tendon
D. Inflammation of the outside of a tendon/tendon sheath

Answer 22

A. Bursitis
B. Capsulitis
C. Tendinosis
D. Paratenonitis

Question 23

Nerve Injuries: Peripheral
A. Inflammation of nerve cells
B. Compression primarily of the median nerve
C. Tumor of a neuron in the foot
D. Irritation and pain from nerve traction or stretching

Answer 23

A. Neuritis
B. Carpal Tunnel syndrome
C. Mortons neuroma
D. Burner

Question 24

Nerve Injury: Neuropraxia, Axonotmesis, Neurotemesis?
A. Transient physiologic block; ischemia, pressure/stretch
B. Wallerian degeneration occurs
C. Internal structure of nerve preserved; axons damaged
D. Nerve structure destroyed by cutting, scarring, or compression

Answer 24

A. Neuropraxia
B. Axonotmesis
C. Axonotmesis
D. Neurotmesis