Unit 14 Chapters 47-50 Flashcards
if a patient has an injury and has a BP of 60 what kind of shock is this
hypovolemic
someone could have a severe injury but the BP would be within normal limits, could they still be in shock?
yes, sympathetic nervous is working good
since we know someone could have normal BP and still be in shock, what should we do?
look at the mechanism of the injury
what does a pelvic fracture look like and how many units of blood is loss
the fracture would not break skin so it would be a closed fracture and 4-6 units of blood would be loss
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
because oxygen is not being delivered to the tissues so they switch from aerobic to anaerobic and is releasing lactic acid
if we have a 20 year old come in with SEVERE leg trauma what shock could he develop at this point in time
hypovolemic
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
anaphlacytic
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
sepsis
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
respiratory alkalosis
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
chemoreceptors sense low O2 levels
baroreceptors sense low pressure
= accelerated breathing
do closed fractures still result in blood loss
yes
why do you get bleeding when you break a bone
bone contain hematopoietic connective tissue to form blood cells
bones are a storage reservoir for
calcium
where are osteoblasts found
periosteum, endosteum, epiphyseal plate
osteoblasts are responsible for
formation of bone matrix
2 stages of osteoblasts
ossification and calcification
osteoblasts secrete what that is a useful blood test
alkaline phosphatase
osteocytes are responsible for what
maintaining the bony matrix
osteocytes play an active role in releasing
calcium
osteoclasts are responsible for
reabsorption of bone matrix and release of calcium and phosphate from bone
what bone cells are the mature ones
osteocytes
what bone cells are the building cells
oteoblasts
if someone has high amounts of osteoclasts what minerals may they have elevated in their blood
calcium and phosphate
cells in the growth plate stop dividing at ____________ at which time the epiphysis and metaphysis fuse
puberty
if there is a fracture at the growth plate in a prepubescent child what would happen
growth is put in jeprody
red bone marrow contains
developing RBC
yellow bone marrow is composed of
adipose tissues
in children where is redbone marrow found
most bones
in adults where is red bone marrow found
vertebrae, ribs, sterum, and ilia
if you have an older patient who needs a bone biopsy where might it get taken from
ilia and sternum
since each joint of an extremity is innervated by all the peripheral nerves that cross the articulation- they may experience
referred pain from one joint to another
since we know people could exerpeince referred pain with joints what should we do during examination
exam joint above and below complained site
a young child comes in and is complaining of knee pain, where should you examine
knee, ankle and hip/thigh region
cause of musculoskeletal injuries
blunt tissue trauma, disruption of tendons and ligaments, fractures of bony structures
acute injuries in athletic individuals is caused by
sudden trauma
acute injuries in athletic individuals is not always bone injuries, what else could it be
injury to soft tissues
overuse injuries in athletic individuals is acute/chronic?
chronic
what is an example of overuse injuries in athletic individuals
stress fracture
contusion
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
hematoma
large area of local hemorrhage
a large contusion is
hematoma
a small hematoma is
contusion
laceration
skin torn, continuity disrupted
can a laceration be on purpose
yes, ex: surgery
strain
STRETCHING injury to muscle or musculotendious unit from mechanical overloading
sprain
abnormal or excessive movement of joint with disruption to ligaments
sprain will form new collagen within
4-5 days
with a sprain the original strength within __ weeks
7
repair in soft tissues is accomplished by
fibroblasts
in soft tissues healing _____________ infiltrate the injured area during the initial healing process
capillaries
in soft tissues healing the formation of long __________ bundles occurs
collagen
dislocations
loss of articulation of the bone ends in the joint capsule caused by displacement or separation
movement of shoulder relies heavily on support of four relatively small muscles called
rotator cuff
anytime a muscle injury occurs always asses neurovasuclar status of area because it can be disrupted
EX: dislocated patella could
rupture nearby arteries
rotator cuff injuries occurs due to
repetitive movements
rotator cuff injuries are common in
pitchers, swimmers, weight lifters
if you have a partial rotator cuff injury will that require surgery
no
if you have a full thickness rotator cuff injury will that require surgery
yes
WHO ARE MORE AT RISK FOR ROTATOR CUFF INJURIES
ATHELETES
classification of fractures is by
cause
location
types
pattern of fracture line
cause of fracture classification
sudden injury
stress fractures
pathologic fractures
what is a pathologic fracture
fracture because of a disease
example of diseases that could cause pathologic fractures
cancer, osteogenic imperfecta, osteoporosis
location of fracture classification
proximal
midshaft
distal
types of fracture classification
open or closed
why would a person with an open fracture get seen faster than a person with a closed fracture
because skin integrity is ruined and they are more at risk for infection/sepsis
you do not always know you have a fracture until
X-ray
signs and symptoms of a fracture
pain, tenderness, swelling, loss of function, deformity, abnormal mobility
after you place a splint what and where should you always check
distal pulse
5 stages of bone healing
- hematoma formation
- cellular proliferation
- callus formation
- ossification
- remodeling
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 _________ ____
fibrin meshwork, inflammatory, fibroblasts capillary buds
fibrocartilagnous callus formation
formation of granulation tissue called ___________. _________ proliferate and invade pro callus. Fibroblasts produce a ______________ _____ ________ bridge that connects bone fragments
procallus, fibroblasts, fibrocartilaginous soft callus
can you weight bare during the fibrocartilaginous callus formation stage
NO WEIGHT BERING YET
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
bony callus, osteoblasts, 3-4
can you weight bare during bony callus formation
yes, this is usually when the cast is removed
remodeling phase
dead portions of bone are removed by _____________ and _______ bone replaces ________ bone.
osteoclasts, compact, spongy
is there evidence that you have had a fracture before
yes, a thickened area remains
in the remodeling phase are osteoclasts good
yes
vasucular anatomy of ________ head is critical
femoral
if you have a hip injury the viability of femoral head may lead to
avascular necrosis
what is avascular necrosis
no blood vessel to rest of leg
what is the most common cause of hip injuries
falls
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
10,000lbs
if you have an open book pelvis fracture in a man, what are they at risk for
rupture of urethra
4 complications of fractures
development of fat emboli
compartment syndrome
hypovolemic shock
infection
compartment syndrome is tissue compromise from
pressure in the muscle compartment
what is the hallmark symptom of compartment syndrome
PAIN OUT OF PROPORTION TO THE ORIGINAL INJURY
UNRELENTING PAIN
compartment syndrome can be dangerous because the expanding muscle could compress
nerves and arterties
5 P’s of compartment syndrome
paresthesia, pallor, proprioception, pain, pulse
why might an individual with compartment syndrome have paresthesia
nerve is compressed
why might an individual with compartment syndrome have pallor
blood artery is compressed
if you wait until an individual with compartment syndrome to have no pulse what might happen
loss of the limb
what is proprioception
tell direction of body when eyes are closed
WHAT IS THE FIRST SYMPTOM OF COMPARTMENT SYNDROME
UNRELENTING PAIN
could compartment syndrome develop with a cast on
yes
fat embolism refers to a constellation of clinical manifestations resulting from fat droplets in _____ __________ __________ of _____ or other organs after a long bone fracture
small blood vessels, lung
fat droplets of a fat embolism is released from ________ _____________ or ____________ __________ at fracture site into venous system
bone marrow, adipose tissue
fat embolism is specific to
fracture
what might happen if you have a fat embolism
respiratory failure, cerebral dysfunction, skin petechiae
in a fat embolism will the skin petechiae go away
no, does not blanch
symptoms of a fat embolism occurs within
few hours to 3-4 days
initial findings of fat embolism is
subtle change in behavior and disorientation
how can we prevent fat embolism
stabilize fractures early
bone infections are caused by
miroorganisms
microorganisms in the bone
proliferate
produce cell death
spread within the bone shaft
chronic inflammatory response
osteomyelitis is an acute or chronic
infection
osteomyelitis is caused by
microorganism
what is the most common microorganism to cause osteomyelitis
staphylococcus
sequestrum
infected dead bone separated from living bone
sequestrum is caused by
BACTERIA
what is one term that is associated strictly with osteomyelitis
sequestrum
what disease is sequestrum strictly associated with
osteomyelitis
osteonecrosis is caused by
lack of blood flow
what are common disorders that could cause osteonecrosis
sickle cell disease, steroid therapy, and hip surgery
is sequestrum associated with osteonecrosis
NO NO NO ONLY IN OSTEOMYLEITIS
what is a neoplasm that is more common with teens
osteosarcoma
osteosarcoma is more common with _________
teens
why is osteosarcoma associated with teens
teens have maximum growth velocity
with osteosarcoma will you have localized or systemic pain and swelling
localized pain and swelling
with osteosarcoma will you have normal function
no, you will have an impairment
osteosarcoma is aggressive and highly ___________
malignant
is osteosarcoma associate with trauma
no
metastatic bone disease is skeletal metastases that are most common malignancy of ___________ tissue: spine, femur, pelvis, ribs, sternum, humerus, skull
osseous
in metastatic bone disease 50% of bone must be destroyed before ________ is visible on plain radiograph
lesion
in metastatic bone disease tumors that frequently spread to skeletal system are
breast, lung, and prostate
what week does ossification begin
9th week
separation of the epiphyseal growth plate ruptures the blood vessels that nourish the
epiphysis
if you have a separation of the epiphyseal growth plate this can cause
cessation of growth and shortened extremity length
osteogenesis imperfecta is a hereditary disease characterized by
defective synthesis of type I collagen
definition of scoliosis
lateral diviation of the spinal column that may or may not include rotation or deformity of the vertebrae
2 most common classifications of scoliosis
postural and structural
postural scoliosis
small curve caused by posture that corrects with bending
structural scoliosis
fixed deformity that dose not correct with bending
what type of classification of scoliosis can be corrected
postural
osteoblasts and osteoclasts are in homeostatic balance of
normal tissue
osteopenia is a condition that is common to all _________ bone disease
metabolic
osteopenia
reduction in bone mass or mineral density greater than expected for age, race, or gender
in osteopenia are the osteoblasts and osteoclasts are they or are they not balanced
they are not balanced
how is osteopenia measured
by bone density
osteopenia causes
decrease in bone formation
inadequate bone mineralization
excessive bone deossficiation
osteoporosis is most common in what race and age group
white women who are postmenopausal
osteoporosis definition
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
osteoporosis primary disease
postmenopausal women or elderly
osteoporosis secondary
endocorine or genetic disorer
what race is LESS at risk for osteoporosis
African american
when is the maximal bone mass achieved
30
how much bone loss occurs per year in menopausal women
1%
what race is most common for osteoporosis
white/asain
what is alcohol role in osteoporosis
alcohol is a direct inhibitor of osteoblasts and may also inhibit calcium absorption
in osteoporosis prolonged use of medications that increase ________ excretion such as antacids and anticonvulsants could be a risk factor
calcium
in osteoporosis what infants could be at risk
premature and low birth weight
what specific group is at risk for osteoporosis because of poor nutrition, amenorrhea, estrogen lack
female atheltes
osteoporosis, can it be drug and disease related
yes
what is recommended to help prevent osteoporosis
regular weight bearing exercise to maintain muscle mass
what supplement is recommended for post menopausal women to prevent osteoporosis
calcium
primary arthritis results from
immune response
secondary arthritis results from
degenerative processes
2 types of systemic autoimmune rheumatic diseases
rheumatoid arthritis
systemic lupus erythematosus
rheumatoid arthritis is it systemic
yes
rheumatoid arthritis is it inflammatory
yes
rheumatoid arthritis is it autoimmune
yes
rheumatoid arthritis leads to destruction of ____________ cartilage and underlying bone
articular
what gender is most at risk for rheumatoid arthritis
women
cause of rheumatoid arthritis
not established, genetic predisposed and immunologically mediated
rheumatoid arthritis may be initiated by activation of
CD+4 helper T cells
why would rheumatoid arthritis be caused by CD+4 helper cells
released of cytokines and antibody formation
rheumatoid arthritis fast or slow onset
slow (insidious)
rheumatoid arthritis what systemic manifestations
fatigue, anorexia, weight loss, generalized aching and stiffness, fever
rheumatoid arthritis is characterized by exacerbations and remissions, what does this mean
series of getting better and then getting significantly worse
rheumatoid arthritis could only involve a few joints for brief durations or it may become
relentlessly progressive and debilitating
rheumatoid arthritis morning stiffness for how long
1 hour for at least 6 weeks
rheumatoid arthritis swelling of how many joints for how long
3 or more for 6 weeks
rheumatoid arthritis 70-80% have
rheumatoid factor antibody
what arthritis is associated with pannus
rheumatoid arthritis
rheumatoid arthritis name of inflamed synovial membrane with macrophages and fibroblasts
pannus
T/F rheumatoid arthritis is a condition of individual joint deterioration and breakdown
False, rheumatoid arthritis is systemic and affects more than one joint
systemic lupus erythematosus is a chronic inflammatory disease affecting
any organ system, or multiple
systemic lupus erythematosus has a higher incidence in what gender and race
females, African American, Latins, asians
is systemic lupus erythematosus autoimmune
yes
systemic lupus erythematosus cause
unknown
systemic lupus erythematosus is characterized by formation of
autoantibodies and immune complexes; B cell hyperactivity and increased antibodies against self
systemic lupus erythematosus is known as the great
imitator
what does it mean to say systemic lupus erythematosus is the great imitator
imitates other diseases
systemic lupus erythematosus develops what rash
butterfly rash
systemic sclerosis is an autoimmune disease of connective tissue characterized by excessive ____________ deposition in the skin and ___________ ______
collagen, internal organs
in systemic sclerosis there is collagen deposits in skin and internal organs meaning there is _________ activation with excessive __________
fibroblasts, fibrosis
what gender and age does systemic sclerosis most affect
females, 35-50
what is usually the first presentation of systemic sclerosis
limited or diffuse skin presentation
systemic sclerosis diffuse or generalized form
skin changes involve the trunk and proximal extremities
systemic sclerosis limited/CREST variant
hardening of the skin is limited to hands and face
spondylarthropathies
ankylosing spondylitis
ankylosing spondylitis is a multisystem inflammatory disorder that affects the
axial skeleton, especially the spine
ankylosing spondylitis will have inflammation at insertions of
tendons and ligaments
ankylosing spondylitis what is the pathologic hallmark of the disorder
sacroiliac involvement
is osteoarthritis systemic
no
is osteoarthritis inflammatory
no
is osteoarthritis autoimmune
no
osteoarthritis is a _______________ joint disease
degenerative
osteoarthritis is just when _____ joints wear out
old
do patients with osteoarthritis develop a pannus
no
do patients with osteoarthritis develop a fever
no
osteoarthritis is a progressive loss of _________ cartilage and ___________ results from inflammation caused when cartilage attempts to repair itself
articular, synovitis
osteoarthritis creates _____________/______ which cause joint pain, stiffness, and loss of motion
osteophytes/spurs
what arthritis is associated with spurs
osteoarthritis
what arthritis is associated with pannus
rheumatoid arthritis
what type of arthritis is associated with butterfly rash
SLE
in osteoarthritis cytokines stimulate production and release of _____________ that are destructive to joint structure
proteases
osteoarthritis can affect any joint but it most often occurs in the
knees hips, spine, and fingers
what are the nodes called in someone with osteoarthritis
heberdens and bouchards nodes
what is a metabolic and endocrine disease associated with joint symptoms
gout syndrome
expressivity
what level or severity of the disease
penetrance
have it or not
2 types of gout
primary and secondary
primary gout is caused by an _________ defect that results in an over production of __________ _______ or inadequate elimination by kidney
enzyme, uric acid
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
blood
primary gout is characterized by
hyperuricemia and gout
secondary gout is
hyperuricemia but gout is not the main disorder
secondary gout can be cause dby
increased breakdown of nucleic acids
in gout syndrome there is increased serum
uric acid
uric acid is the end product of
purine metabolism
in gout syndrome there is ________ or the accumulation of crystalline deposits in ___________ surfaces, ______, __________ ___________ and ______________
tophi, articular surfaces bones, soft tissues, cartilage
tophi
deposits containing monosodium rate crystals
gout syndrome could lead to
gouty nephroathy or renla impairment
what type of kidney stone is found in gout
uric acid
where is the uric acid stones found
kidney or blood
