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Pathophysiology > Unit 14 Chapters 47-50 > Flashcards

Unit 14 Chapters 47-50 Flashcards

1
Q

if a patient has an injury and has a BP of 60 what kind of shock is this

A

hypovolemic

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2
Q

someone could have a severe injury but the BP would be within normal limits, could they still be in shock?

A

yes, sympathetic nervous is working good

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3
Q

since we know someone could have normal BP and still be in shock, what should we do?

A

look at the mechanism of the injury

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4
Q

what does a pelvic fracture look like and how many units of blood is loss

A

the fracture would not break skin so it would be a closed fracture and 4-6 units of blood would be loss

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5
Q

if we have someone who has hypovolemia and we are unable to restore volume and they are not purfusing, why would they develop metabolic acidosis

A

because oxygen is not being delivered to the tissues so they switch from aerobic to anaerobic and is releasing lactic acid

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6
Q

if we have a 20 year old come in with SEVERE leg trauma what shock could he develop at this point in time

A

hypovolemic

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7
Q

if we have that same 20 year old come in with SEVERE leg trauma and we give him an antibiotic, what shock could develop after this

A

anaphlacytic

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8
Q

if we have that same 20 year old come in with SEVERE leg trauma and its 2 weeks after injury what shock could he develop

A

sepsis

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9
Q

if we have that same 20 year old come in with SEVERE leg trauma what would be his first acid base disorder that would develop

A

respiratory alkalosis

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10
Q

if we have that same 20 year old come in with SEVERE leg trauma WHY would he develop respiratory alkalosis as his first acid base disorder

A

chemoreceptors sense low O2 levels
baroreceptors sense low pressure
= accelerated breathing

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11
Q

do closed fractures still result in blood loss

A

yes

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12
Q

why do you get bleeding when you break a bone

A

bone contain hematopoietic connective tissue to form blood cells

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13
Q

bones are a storage reservoir for

A

calcium

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14
Q

where are osteoblasts found

A

periosteum, endosteum, epiphyseal plate

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15
Q

osteoblasts are responsible for

A

formation of bone matrix

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16
Q

2 stages of osteoblasts

A

ossification and calcification

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17
Q

osteoblasts secrete what that is a useful blood test

A

alkaline phosphatase

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18
Q

osteocytes are responsible for what

A

maintaining the bony matrix

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19
Q

osteocytes play an active role in releasing

A

calcium

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20
Q

osteoclasts are responsible for

A

reabsorption of bone matrix and release of calcium and phosphate from bone

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21
Q

what bone cells are the mature ones

A

osteocytes

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22
Q

what bone cells are the building cells

A

oteoblasts

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23
Q

if someone has high amounts of osteoclasts what minerals may they have elevated in their blood

A

calcium and phosphate

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24
Q

cells in the growth plate stop dividing at ____________ at which time the epiphysis and metaphysis fuse

A

puberty

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25
Q

if there is a fracture at the growth plate in a prepubescent child what would happen

A

growth is put in jeprody

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26
Q

red bone marrow contains

A

developing RBC

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27
Q

yellow bone marrow is composed of

A

adipose tissues

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28
Q

in children where is redbone marrow found

A

most bones

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29
Q

in adults where is red bone marrow found

A

vertebrae, ribs, sterum, and ilia

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30
Q

if you have an older patient who needs a bone biopsy where might it get taken from

A

ilia and sternum

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31
Q

since each joint of an extremity is innervated by all the peripheral nerves that cross the articulation- they may experience

A

referred pain from one joint to another

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32
Q

since we know people could exerpeince referred pain with joints what should we do during examination

A

exam joint above and below complained site

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33
Q

a young child comes in and is complaining of knee pain, where should you examine

A

knee, ankle and hip/thigh region

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34
Q

cause of musculoskeletal injuries

A

blunt tissue trauma, disruption of tendons and ligaments, fractures of bony structures

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35
Q

acute injuries in athletic individuals is caused by

A

sudden trauma

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36
Q

acute injuries in athletic individuals is not always bone injuries, what else could it be

A

injury to soft tissues

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37
Q

overuse injuries in athletic individuals is acute/chronic?

A

chronic

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38
Q

what is an example of overuse injuries in athletic individuals

A

stress fracture

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39
Q

contusion

A

skin intact, ecchymotic; an injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a hard object

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40
Q

hematoma

A

large area of local hemorrhage

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41
Q

a large contusion is

A

hematoma

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42
Q

a small hematoma is

A

contusion

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43
Q

laceration

A

skin torn, continuity disrupted

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44
Q

can a laceration be on purpose

A

yes, ex: surgery

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45
Q

strain

A

STRETCHING injury to muscle or musculotendious unit from mechanical overloading

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46
Q

sprain

A

abnormal or excessive movement of joint with disruption to ligaments

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47
Q

sprain will form new collagen within

A

4-5 days

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48
Q

with a sprain the original strength within __ weeks

A

7

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49
Q

repair in soft tissues is accomplished by

A

fibroblasts

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50
Q

in soft tissues healing _____________ infiltrate the injured area during the initial healing process

A

capillaries

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51
Q

in soft tissues healing the formation of long __________ bundles occurs

A

collagen

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52
Q

dislocations

A

loss of articulation of the bone ends in the joint capsule caused by displacement or separation

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53
Q

movement of shoulder relies heavily on support of four relatively small muscles called

A

rotator cuff

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54
Q

anytime a muscle injury occurs always asses neurovasuclar status of area because it can be disrupted
EX: dislocated patella could

A

rupture nearby arteries

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55
Q

rotator cuff injuries occurs due to

A

repetitive movements

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56
Q

rotator cuff injuries are common in

A

pitchers, swimmers, weight lifters

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57
Q

if you have a partial rotator cuff injury will that require surgery

A

no

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58
Q

if you have a full thickness rotator cuff injury will that require surgery

A

yes

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59
Q

WHO ARE MORE AT RISK FOR ROTATOR CUFF INJURIES

A

ATHELETES

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60
Q

classification of fractures is by

A

cause
location
types
pattern of fracture line

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61
Q

cause of fracture classification

A

sudden injury
stress fractures
pathologic fractures

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62
Q

what is a pathologic fracture

A

fracture because of a disease

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63
Q

example of diseases that could cause pathologic fractures

A

cancer, osteogenic imperfecta, osteoporosis

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64
Q

location of fracture classification

A

proximal
midshaft
distal

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65
Q

types of fracture classification

A

open or closed

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66
Q

why would a person with an open fracture get seen faster than a person with a closed fracture

A

because skin integrity is ruined and they are more at risk for infection/sepsis

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67
Q

you do not always know you have a fracture until

A

X-ray

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68
Q

signs and symptoms of a fracture

A

pain, tenderness, swelling, loss of function, deformity, abnormal mobility

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69
Q

after you place a splint what and where should you always check

A

distal pulse

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70
Q

5 stages of bone healing

A
  1. hematoma formation
  2. cellular proliferation
  3. callus formation
  4. ossification
  5. remodeling
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71
Q

during hematoma and cellular proliferation
hematoma facilitates the formation of the _______ ___________ that seals off fracture site and serves as framework for the influx of ___________ cells, ____________ and new _________ ____

A

fibrin meshwork, inflammatory, fibroblasts capillary buds

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72
Q

fibrocartilagnous callus formation
formation of granulation tissue called ___________. _________ proliferate and invade pro callus. Fibroblasts produce a ______________ _____ ________ bridge that connects bone fragments

A

procallus, fibroblasts, fibrocartilaginous soft callus

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73
Q

can you weight bare during the fibrocartilaginous callus formation stage

A

NO WEIGHT BERING YET

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74
Q

during bony callus formation
fibrocartilaginous cartilage is converted to _______ _________, _____________ first deposit bone on outer surface of bone and move inward. begins at ______ weeks after injury

A

bony callus, osteoblasts, 3-4

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75
Q

can you weight bare during bony callus formation

A

yes, this is usually when the cast is removed

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76
Q

remodeling phase
dead portions of bone are removed by _____________ and _______ bone replaces ________ bone.

A

osteoclasts, compact, spongy

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77
Q

is there evidence that you have had a fracture before

A

yes, a thickened area remains

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78
Q

in the remodeling phase are osteoclasts good

A

yes

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79
Q

vasucular anatomy of ________ head is critical

A

femoral

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80
Q

if you have a hip injury the viability of femoral head may lead to

A

avascular necrosis

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81
Q

what is avascular necrosis

A

no blood vessel to rest of leg

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82
Q

what is the most common cause of hip injuries

A

falls

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83
Q

a 200 pound man is travling in a car at 50 miles per hour when he loses control of the vehicle and strokes a telephone pole in a head on collision. Approximately how many pounds of forces was the man subjected to within milliseconds

A

10,000lbs

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84
Q

if you have an open book pelvis fracture in a man, what are they at risk for

A

rupture of urethra

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85
Q

4 complications of fractures

A

development of fat emboli
compartment syndrome
hypovolemic shock
infection

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86
Q

compartment syndrome is tissue compromise from

A

pressure in the muscle compartment

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87
Q

what is the hallmark symptom of compartment syndrome

A

PAIN OUT OF PROPORTION TO THE ORIGINAL INJURY
UNRELENTING PAIN

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88
Q

compartment syndrome can be dangerous because the expanding muscle could compress

A

nerves and arterties

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89
Q

5 P’s of compartment syndrome

A

paresthesia, pallor, proprioception, pain, pulse

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90
Q

why might an individual with compartment syndrome have paresthesia

A

nerve is compressed

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91
Q

why might an individual with compartment syndrome have pallor

A

blood artery is compressed

92
Q

if you wait until an individual with compartment syndrome to have no pulse what might happen

A

loss of the limb

93
Q

what is proprioception

A

tell direction of body when eyes are closed

94
Q

WHAT IS THE FIRST SYMPTOM OF COMPARTMENT SYNDROME

A

UNRELENTING PAIN

95
Q

could compartment syndrome develop with a cast on

A

yes

96
Q

fat embolism refers to a constellation of clinical manifestations resulting from fat droplets in _____ __________ __________ of _____ or other organs after a long bone fracture

A

small blood vessels, lung

97
Q

fat droplets of a fat embolism is released from ________ _____________ or ____________ __________ at fracture site into venous system

A

bone marrow, adipose tissue

98
Q

fat embolism is specific to

A

fracture

99
Q

what might happen if you have a fat embolism

A

respiratory failure, cerebral dysfunction, skin petechiae

100
Q

in a fat embolism will the skin petechiae go away

A

no, does not blanch

101
Q

symptoms of a fat embolism occurs within

A

few hours to 3-4 days

102
Q

initial findings of fat embolism is

A

subtle change in behavior and disorientation

103
Q

how can we prevent fat embolism

A

stabilize fractures early

104
Q

bone infections are caused by

A

miroorganisms

105
Q

microorganisms in the bone

A

proliferate
produce cell death
spread within the bone shaft
chronic inflammatory response

106
Q

osteomyelitis is an acute or chronic

A

infection

107
Q

osteomyelitis is caused by

A

microorganism

108
Q

what is the most common microorganism to cause osteomyelitis

A

staphylococcus

109
Q

sequestrum

A

infected dead bone separated from living bone

110
Q

sequestrum is caused by

A

BACTERIA

111
Q

what is one term that is associated strictly with osteomyelitis

A

sequestrum

112
Q

what disease is sequestrum strictly associated with

A

osteomyelitis

113
Q

osteonecrosis is caused by

A

lack of blood flow

114
Q

what are common disorders that could cause osteonecrosis

A

sickle cell disease, steroid therapy, and hip surgery

115
Q

is sequestrum associated with osteonecrosis

A

NO NO NO ONLY IN OSTEOMYLEITIS

116
Q

what is a neoplasm that is more common with teens

A

osteosarcoma

117
Q

osteosarcoma is more common with _________

A

teens

118
Q

why is osteosarcoma associated with teens

A

teens have maximum growth velocity

119
Q

with osteosarcoma will you have localized or systemic pain and swelling

A

localized pain and swelling

120
Q

with osteosarcoma will you have normal function

A

no, you will have an impairment

121
Q

osteosarcoma is aggressive and highly ___________

A

malignant

122
Q

is osteosarcoma associate with trauma

A

no

123
Q

metastatic bone disease is skeletal metastases that are most common malignancy of ___________ tissue: spine, femur, pelvis, ribs, sternum, humerus, skull

A

osseous

124
Q

in metastatic bone disease 50% of bone must be destroyed before ________ is visible on plain radiograph

A

lesion

125
Q

in metastatic bone disease tumors that frequently spread to skeletal system are

A

breast, lung, and prostate

126
Q

what week does ossification begin

A

9th week

127
Q

separation of the epiphyseal growth plate ruptures the blood vessels that nourish the

A

epiphysis

128
Q

if you have a separation of the epiphyseal growth plate this can cause

A

cessation of growth and shortened extremity length

129
Q

osteogenesis imperfecta is a hereditary disease characterized by

A

defective synthesis of type I collagen

130
Q

definition of scoliosis

A

lateral diviation of the spinal column that may or may not include rotation or deformity of the vertebrae

131
Q

2 most common classifications of scoliosis

A

postural and structural

132
Q

postural scoliosis

A

small curve caused by posture that corrects with bending

133
Q

structural scoliosis

A

fixed deformity that dose not correct with bending

134
Q

what type of classification of scoliosis can be corrected

A

postural

135
Q

osteoblasts and osteoclasts are in homeostatic balance of

A

normal tissue

136
Q

osteopenia is a condition that is common to all _________ bone disease

A

metabolic

137
Q

osteopenia

A

reduction in bone mass or mineral density greater than expected for age, race, or gender

138
Q

in osteopenia are the osteoblasts and osteoclasts are they or are they not balanced

A

they are not balanced

139
Q

how is osteopenia measured

A

by bone density

140
Q

osteopenia causes

A

decrease in bone formation
inadequate bone mineralization
excessive bone deossficiation

141
Q

osteoporosis is most common in what race and age group

A

white women who are postmenopausal

142
Q

osteoporosis definition

A

skeletal disorder characterized by the loss of bone mass and deterioration of the architecture of cancellous bone with a subsequent increase in bone fragility and susceptibility to fractures
in other words
LOSS OF MINERALIZED BONE MASS CAUSES INCREASED POROSITY OF THE SKELETON

143
Q

osteoporosis primary disease

A

postmenopausal women or elderly

144
Q

osteoporosis secondary

A

endocorine or genetic disorer

145
Q

what race is LESS at risk for osteoporosis

A

African american

146
Q

when is the maximal bone mass achieved

A

30

147
Q

how much bone loss occurs per year in menopausal women

A

1%

148
Q

what race is most common for osteoporosis

A

white/asain

149
Q

what is alcohol role in osteoporosis

A

alcohol is a direct inhibitor of osteoblasts and may also inhibit calcium absorption

150
Q

in osteoporosis prolonged use of medications that increase ________ excretion such as antacids and anticonvulsants could be a risk factor

A

calcium

151
Q

in osteoporosis what infants could be at risk

A

premature and low birth weight

152
Q

what specific group is at risk for osteoporosis because of poor nutrition, amenorrhea, estrogen lack

A

female atheltes

153
Q

osteoporosis, can it be drug and disease related

A

yes

154
Q

what is recommended to help prevent osteoporosis

A

regular weight bearing exercise to maintain muscle mass

155
Q

what supplement is recommended for post menopausal women to prevent osteoporosis

A

calcium

156
Q

primary arthritis results from

A

immune response

157
Q

secondary arthritis results from

A

degenerative processes

158
Q

2 types of systemic autoimmune rheumatic diseases

A

rheumatoid arthritis
systemic lupus erythematosus

159
Q

rheumatoid arthritis is it systemic

A

yes

160
Q

rheumatoid arthritis is it inflammatory

A

yes

161
Q

rheumatoid arthritis is it autoimmune

A

yes

162
Q

rheumatoid arthritis leads to destruction of ____________ cartilage and underlying bone

A

articular

163
Q

what gender is most at risk for rheumatoid arthritis

A

women

164
Q

cause of rheumatoid arthritis

A

not established, genetic predisposed and immunologically mediated

165
Q

rheumatoid arthritis may be initiated by activation of

A

CD+4 helper T cells

166
Q

why would rheumatoid arthritis be caused by CD+4 helper cells

A

released of cytokines and antibody formation

167
Q

rheumatoid arthritis fast or slow onset

A

slow (insidious)

168
Q

rheumatoid arthritis what systemic manifestations

A

fatigue, anorexia, weight loss, generalized aching and stiffness, fever

169
Q

rheumatoid arthritis is characterized by exacerbations and remissions, what does this mean

A

series of getting better and then getting significantly worse

170
Q

rheumatoid arthritis could only involve a few joints for brief durations or it may become

A

relentlessly progressive and debilitating

171
Q

rheumatoid arthritis morning stiffness for how long

A

1 hour for at least 6 weeks

172
Q

rheumatoid arthritis swelling of how many joints for how long

A

3 or more for 6 weeks

173
Q

rheumatoid arthritis 70-80% have

A

rheumatoid factor antibody

174
Q

what arthritis is associated with pannus

A

rheumatoid arthritis

175
Q

rheumatoid arthritis name of inflamed synovial membrane with macrophages and fibroblasts

A

pannus

176
Q

T/F rheumatoid arthritis is a condition of individual joint deterioration and breakdown

A

False, rheumatoid arthritis is systemic and affects more than one joint

177
Q

systemic lupus erythematosus is a chronic inflammatory disease affecting

A

any organ system, or multiple

178
Q

systemic lupus erythematosus has a higher incidence in what gender and race

A

females, African American, Latins, asians

179
Q

is systemic lupus erythematosus autoimmune

A

yes

180
Q

systemic lupus erythematosus cause

A

unknown

181
Q

systemic lupus erythematosus is characterized by formation of

A

autoantibodies and immune complexes; B cell hyperactivity and increased antibodies against self

182
Q

systemic lupus erythematosus is known as the great

A

imitator

183
Q

what does it mean to say systemic lupus erythematosus is the great imitator

A

imitates other diseases

184
Q

systemic lupus erythematosus develops what rash

A

butterfly rash

185
Q

systemic sclerosis is an autoimmune disease of connective tissue characterized by excessive ____________ deposition in the skin and ___________ ______

A

collagen, internal organs

186
Q

in systemic sclerosis there is collagen deposits in skin and internal organs meaning there is _________ activation with excessive __________

A

fibroblasts, fibrosis

187
Q

what gender and age does systemic sclerosis most affect

A

females, 35-50

188
Q

what is usually the first presentation of systemic sclerosis

A

limited or diffuse skin presentation

189
Q

systemic sclerosis diffuse or generalized form

A

skin changes involve the trunk and proximal extremities

190
Q

systemic sclerosis limited/CREST variant

A

hardening of the skin is limited to hands and face

191
Q

spondylarthropathies

A

ankylosing spondylitis

192
Q

ankylosing spondylitis is a multisystem inflammatory disorder that affects the

A

axial skeleton, especially the spine

193
Q

ankylosing spondylitis will have inflammation at insertions of

A

tendons and ligaments

194
Q

ankylosing spondylitis what is the pathologic hallmark of the disorder

A

sacroiliac involvement

195
Q

is osteoarthritis systemic

A

no

196
Q

is osteoarthritis inflammatory

A

no

197
Q

is osteoarthritis autoimmune

A

no

198
Q

osteoarthritis is a _______________ joint disease

A

degenerative

199
Q

osteoarthritis is just when _____ joints wear out

A

old

200
Q

do patients with osteoarthritis develop a pannus

A

no

201
Q

do patients with osteoarthritis develop a fever

A

no

202
Q

osteoarthritis is a progressive loss of _________ cartilage and ___________ results from inflammation caused when cartilage attempts to repair itself

A

articular, synovitis

203
Q

osteoarthritis creates _____________/______ which cause joint pain, stiffness, and loss of motion

A

osteophytes/spurs

204
Q

what arthritis is associated with spurs

A

osteoarthritis

205
Q

what arthritis is associated with pannus

A

rheumatoid arthritis

206
Q

what type of arthritis is associated with butterfly rash

A

SLE

207
Q

in osteoarthritis cytokines stimulate production and release of _____________ that are destructive to joint structure

A

proteases

208
Q

osteoarthritis can affect any joint but it most often occurs in the

A

knees hips, spine, and fingers

209
Q

what are the nodes called in someone with osteoarthritis

A

heberdens and bouchards nodes

210
Q

what is a metabolic and endocrine disease associated with joint symptoms

A

gout syndrome

211
Q

expressivity

A

what level or severity of the disease

212
Q

penetrance

A

have it or not

213
Q

2 types of gout

A

primary and secondary

214
Q

primary gout is caused by an _________ defect that results in an over production of __________ _______ or inadequate elimination by kidney

A

enzyme, uric acid

215
Q

in primary gout you have so much uric acid in the kidney that it cannot filter all of it so it ends up in the

A

blood

216
Q

primary gout is characterized by

A

hyperuricemia and gout

217
Q

secondary gout is

A

hyperuricemia but gout is not the main disorder

218
Q

secondary gout can be cause dby

A

increased breakdown of nucleic acids

219
Q

in gout syndrome there is increased serum

A

uric acid

220
Q

uric acid is the end product of

A

purine metabolism

221
Q

in gout syndrome there is ________ or the accumulation of crystalline deposits in ___________ surfaces, ______, __________ ___________ and ______________

A

tophi, articular surfaces bones, soft tissues, cartilage

222
Q

tophi

A

deposits containing monosodium rate crystals

223
Q

gout syndrome could lead to

A

gouty nephroathy or renla impairment

224
Q

what type of kidney stone is found in gout

A

uric acid

225
Q

where is the uric acid stones found

A

kidney or blood

Pathophysiology (44 decks)

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