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Pathophysiology > Week 14: MS/Immobility > Flashcards

Week 14: MS/Immobility Flashcards

1
Q

Hemiplegia -Paralysis on ____________ of the body

A

one side

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2
Q

Paraplegia -Paralysis of the __________ body half

A

lower

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3
Q

Quadriplegia - Paralysis of trunk and ___________________

A

all four limbs

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4
Q

Diplegia - _____________ paralysis in any area of the body

A

Symmetrical

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5
Q

Inactive muscle
- Loss of strength, endurance, and mass
-Muscle ____________
- Prolonged bed rest may lead to loss of ______ of the muscle strength.
- Correct positioning
- Essential for inactive muscles and joints

A
  • Loss of strength, endurance, and mass
    -Muscle atrophy
  • Prolonged bed rest may lead to loss of half of the muscle strength.
  • Correct positioning
  • Essential for inactive muscles and joints
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6
Q

Loss of bone mass
- Lack of weight-bearing activity and ________ action
* Reduces ______________ activity
* Osteoclastic activity continues.

A
  • Lack of weight-bearing activity and muscle action
  • Reduces osteoblastic activity
  • Osteoclastic activity continues.
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7
Q

Tendon and ligaments
- Require ________________to maintain structure and function
- Days of __________________ will shorten these connective tissue structures, and density increases.
* Results in limited flexibility and range of motion

A
  • Require movement to maintain structure and function
  • Days of immobility will shorten these connective tissue structures, and density increases.
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8
Q

Factors that promote skin breakdown
- Poor general circulation or ___________
- Edema
- Inadequate subcutaneous tissue in older adults or disabled persons
- Loss of sensation
- Mechanical irritation or friction
-Excessive _____________ from perspiration or urine
-Inadequate personal hygiene
-inadequate nutrition or hydration
-Trauma to the skin

A
  • Poor general circulation or anemia
  • Edema
  • Inadequate subcutaneous tissue in older adults or disabled persons
  • Loss of sensation
  • Mechanical irritation or friction
    -Excessive moisture from perspiration or urine
    -Inadequate personal hygiene
    -inadequate nutrition or hydration
    -Trauma to the skin
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9
Q

Cardiovascular Effects of immobility

Full immobilization—initially
- Blood pools in _________
- Venous return may increase.

Prolonged immobility
- Venous return and cardiac output reduced
- Orthostatic __________________ —at change of position
* Short periods of dizziness
* Fainting
* Pallor and sweating
* Rapid pulse

A

Full immobilization—initially
- Blood pools in trunk
- Venous return may increase.

Prolonged immobility
- Venous return and cardiac output reduced
- Orthostatic hypotension—at change of position
* Short periods of dizziness
* Fainting
* Pallor and sweating
* Rapid pulse

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10
Q

Patient becomes mobile after long bed rest
- May take _________ for cardiovascular reflex controls to return to normal

A

weeks

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11
Q

Blood pooling—stasis
- Increased ____________ pressure and edema
-Promotes thrombus formation in veins
* Particularly in deep leg veins
- Blood clotting in patients with dehydration or cancer
* May be encouraged by increased venous pressure or damage to blood vessels

  • Thrombi may break away with ____________ or massage
  • Pulmonary embolus
  • Venous stasis, hypercoagulability, and blood vessel damage, increase the chance of deep vein thrombosis.
A
  • Increased capillary pressure and edema
    -Promotes thrombus formation in veins
  • Particularly in deep leg veins
  • Blood clotting in patients with dehydration or cancer
  • May be encouraged by increased venous pressure or damage to blood vessels
  • Thrombi may break away with movement or massage
  • Pulmonary embolus
  • Venous stasis, hypercoagulability, and blood vessel damage, increase the chance of deep vein thrombosis.
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12
Q

Respiratory Effects of immobility

-Decreased ______________
- Respiration ________ and shallow
-Deep breathing and coughing more difficult

*Drugs
-Sedatives and analgesics
* Depress neuromuscular activity and respiratory control center

*Increased ______________ in the lungs
-Pneumonia
-Atelectasis

A

-Decreased metabolism
- Respiration slow and shallow
-Deep breathing and coughing more difficult

*Drugs
-Sedatives and analgesics
* Depress neuromuscular activity and respiratory control center

*Increased secretions in the lungs
-Pneumonia
-Atelectasis

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13
Q

Gastrointestinal Effects of immobility

-____________ dietary intake
-Appetite reduced
- Negative nitrogen imbalance
* Protein deficit
- ______________caused by muscle inactivity and body position
- Reduced food, fiber, fluid intake
- Obesity when prolonged immobility occurs & caloric intake exceeds energy need

A

-Decreased dietary intake
-Appetite reduced
- Negative nitrogen imbalance
* Protein deficit
- Constipation caused by muscle inactivity and body position
- Reduced food, fiber, fluid intake
- Obesity when prolonged immobility occurs & caloric intake exceeds energy need

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14
Q

Urinary Effects of immobility

__________ of urine In kidneys or bladder
* Normal drainage by gravity impeded
- Infection
* Stasis of urine and calculi are predisposing factors.
-Renal calculi (stones)
* More likely in people with hypercalcemia
-Bladder infection
* Common if catheters are used
- Increase in diuresis, resulting in dehydration
* Variety of causes

A

Stasis of urine In kidneys or bladder
* Normal drainage by gravity impeded
- Infection
* Stasis of urine and calculi are predisposing factors.
-Renal calculi (stones)
* More likely in people with hypercalcemia
-Bladder infection
* Common if catheters are used
- Increase in diuresis, resulting in dehydration
* Variety of causes

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15
Q

Neural and Psychological Effects of immobility

Neural effects
- Continuous pressure on skin and underlying tissue will stimulate mechanoreceptors, pain receptors and others.
- _________ may occur because of nerve damage, and therefore muscle innervation may ensue.

Psychological effects
-Effects of pain and lack of control over the environment
* May cause _____________ and health-related problems

A

Neural effects
- Continuous pressure on skin and underlying tissue will stimulate mechanoreceptors, pain receptors and others.
- Spasms may occur because of nerve damage, and therefore muscle innervation may ensue.

Psychological effects
-Effects of pain and lack of control over the environment
* May cause depression and health-related problems

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16
Q

Effects of Immobility on Children

Immobilized for extended period of time
-Normal growth and development often ___________
- Contractures and loss of muscle tone may affect:
* Hips
* Spine
* Hands and feet

Mobility returns.
- ____________ growth possible

A

Immobilized for extended period of time
-Normal growth and development often delayed
- Contractures and loss of muscle tone may affect:
* Hips
* Spine
* Hands and feet

Mobility returns.
- Catch-up growth possible

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17
Q

Bone tissue consists of:
- Matrix
-Mature bone cells (osteocytes)
- Bone-producing cells (_____________)
- Bone-resorbing cells (_____________)

A
  • Matrix
    -Mature bone cells (osteocytes)
  • Bone-producing cells (osteoblasts)
  • Bone-resorbing cells (osteoclasts)
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18
Q

Types of bone tissue
- ______________ —outer covering of bone
- Cancellous (____________)—interior of bone

A
  • Compact—outer covering of bone
  • Cancellous (spongy)—interior of bone
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19
Q

Other bone structures
- Periosteum—connective tissue covering ___________________
- Endosteum—osteoblast-rich lining of medullary cavity

A
  • Periosteum—connective tissue covering over the bone
  • Endosteum—osteoblast-rich lining of medullary cavity
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20
Q

Functions of Skeletal Muscle

  • Facilitate body ____________.
  • Maintain body position.
  • __________ joints.
  • Produce ______.
A
  • Facilitate body movement.
  • Maintain body position.
  • Stabilize joints.
  • Produce heat.
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21
Q

Characteristics of Skeletal Muscle

  • Usually under ______________ control
  • Bundles of protein fibers covered by connective tissue
  • Well supplied with nerves and blood vessels
  • Stimulation occurs at myoneural junction
  • Myoglobin stores _____________ in fibers.
    -Glycogen stored for energy
  • Attachments—directly to periosteum or by tendon
  • Cells do not undergo mitosis after birth.
A
  • Usually under voluntary control
  • Bundles of protein fibers covered by connective tissue
  • Well supplied with nerves and blood vessels
  • Stimulation occurs at myoneural junction
  • Myoglobin stores oxygen in fibers.
    -Glycogen stored for energy
  • Attachments—directly to periosteum or by tendon
  • Cells do not undergo mitosis after birth.
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22
Q

Connective Tissue Coverings of Skeletal Muscle

Epimysium
- Connective tissue surrounding the _____________

Perimysium
- Connective tissue surrounding ___________________

Endomysium
- Connective tissue around _____________________

A

Epimysium
- Connective tissue surrounding the entire muscle

Perimysium
- Connective tissue surrounding muscle fascicles

Endomysium
- Connective tissue around individual muscle fibers

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23
Q

Motor unit
- __________________ in the spinal cord and all muscle fibers innervated by the neurons

A
  • Motor neuron in the spinal cord and all muscle fibers innervated by the neurons
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24
Q

Neuromuscular junction
- Synapse between the motor neuron nerve fiber and ________________
* Neurotransmitter—acetylcholine (ACh)
* Breakdown of Ach by cholinesterase; anticholinesterases interfere with breakdown of ACh.

A
  • Synapse between the motor neuron nerve fiber and muscle fiber
  • Neurotransmitter—acetylcholine (ACh)
  • Breakdown of Ach by cholinesterase; anticholinesterases interfere with breakdown of ACh.
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25
Q

Neuromuscular Transmission and Muscle Contraction steps

  • Arrival of the _______________
  • Depolarization of the presynaptic terminal
  • __________ influx
  • Exocytosis of the neurotransmitter (Ach)
  • Diffusion of neurotransmitter to postsynaptic receptors—attachment
    -Generation of muscle action potential
  • Release of calcium from ________________________
  • Power stroke—contraction of ___________ fiber
A
  • Arrival of the action potential
  • Depolarization of the presynaptic terminal
  • Calcium influx
  • Exocytosis of the neurotransmitter (Ach)
  • Diffusion of neurotransmitter to postsynaptic receptors—attachment
    -Generation of muscle action potential
  • Release of calcium from sarcoplasmic reticulum
  • Power stroke—contraction of muscle fiber
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26
Q

Joints are classified by degree of movement:

  • Synarthroses—_____________ (e.g., cranial sutures)
  • Amphiarthroses—__________ movable (e.g., ribs to sternum)
  • Diarthroses (synovial)—____________ movable (e.g.,shoulder)
A
  • Synarthroses—immovable (e.g., cranial sutures)
  • Amphiarthroses—slightly movable (e.g., ribs to sternum)
  • Diarthroses (synovial)—freely movable (e.g.,shoulder)
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27
Q

Structure of Synovial Joint

Articular cartilage—covering over ____________ bones

A

ends of

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28
Q

Structure of Synovial Joint

Synovial membrane—produces _________________ that fills space between ends of bones

A

synovial fluid

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29
Q

Structure of Synovial Joint

-Articular capsule—consists of ____________ membrane, a fibrous capsule

-Ligaments—reinforces capsule, links bones, ____________ joint

A

-Articular capsule—consists of synovial membrane, a fibrous capsule

-Ligaments—reinforces capsule, links bones, supports joint

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30
Q

Structure of Synovial Joint

-Menisci - lateral _______ in some joints to stabilize

  • Bursae—____________________ to add extra cushion
A

-Menisci - lateral pads in some joints to stabilize

  • Bursae—fluid-filled sacs to add extra cushion
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31
Q

Musculoskeletal Diagnostic Tests

-Bone disorders: radiography, _______ scanning

-Muscular disorders: electromyography (EMG), __________

-Joint disorders: radiography, arthroscopy, magnetic resonance imaging (MRI), examination of synovial fluid

A

-Bone disorders: radiography, bone scanning

-Muscular disorders: electromyography (EMG), biopsy

-Joint disorders: radiography, arthroscopy, magnetic resonance imaging (MRI), examination of synovial fluid

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32
Q

A fracture is a __________ in the integrity of a bone.

  • Fractures occur because of trauma, neoplasms, or increased stress on bones.
  • Fractures are charted using the ___ sign
A
  • Fractures occur because of trauma, neoplasms, or increased stress on bones.
  • Fractures are charted using the # sign
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33
Q

Classification of Fractures

Complete: bone broken, forming __________ pieces
Incomplete: bone only __________ broken

A

Complete: bone broken, forming separate pieces
Incomplete: bone only partially broken

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34
Q

Classification of Fractures

Open (compound): skin _________
Closed: skin not broken

A

broken

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35
Q

Classification of Fractures

  • Simple: _________ break, maintaining alignment and position
  • Comminuted: ___________ fractures and bone fragments
  • Compression: bone crushed or collapsed into ________ pieces
A
  • Simple: single break, maintaining alignment and position
  • Comminuted: multiple fractures and bone fragments
  • Compression: bone crushed or collapsed into small pieces
36
Q

Fractures [other types]

  • Impacted—one end forced into adjacent ______
  • Pathologic—results from weakness; occurs with little stress
  • Stress—fatigue fractures
  • Depressed—skull fractured and forced into ________
A
  • Impacted—one end forced into adjacent bone
  • Pathologic—results from weakness; occurs with little stress
  • Stress—fatigue fractures
  • Depressed—skull fractured and forced into brain
37
Q

Fractures initiate an inflammatory response and hemostasis.

-Bleeding
- Edema causes stretching of periosteum (if intact) and swelling of soft tissues → severe pain
- Release of bradykinin and other chemical mediators also contributes to pain
- ______ forms at the fracture site
-Systemic signs of _____________ may occur

A

-Bleeding
- Edema causes stretching of periosteum (if intact) and swelling of soft tissues → severe pain
- Release of bradykinin and other chemical mediators also contributes to pain
- Clot forms at fracture site
-Systemic signs of inflammation may occur

38
Q

Healing of Bone Fracture

-________________ —fibrin network is formed.
-Phagocytic cells remove debris.
- _______________ lay down new collagen fibers.
- _______________form new cartilage.
- Formation of procallus (fibrous collar).
- ________________ generate new bone.
- Procallus is replaced by bony callus.
- Remodeling of bone, with return to use

A

-Hematoma—fibrin network is formed.
-Phagocytic cells remove debris.
- Fibroblasts lay down new collagen fibers.
- Chondroblasts form new cartilage.
- Formation of procallus (fibrous collar).
- Osteoblasts generate new bone.
- Procallus is replaced by bony callus.
- Remodeling of bone, with return to use

39
Q

Factors Affecting Bone Healing

-Amount of local ____________
- Proximity of bone ends
-Presence of foreign material or infection
- _________ supply to fracture site
- Systemic factors, such as age, nutrition, anemia

A

-Amount of local damage
- Proximity of bone ends
-Presence of foreign material or infection
- Blood supply to fracture site
- Systemic factors, such as age, nutrition, anemia

40
Q

Treatments of Fractures

  • Closed reduction—_____________ to restore bone position
    -Open reduction— ______________to align and/or Insert pins, screw rods, or plates to align
A
  • Closed reduction—pressure to restore bone position
    -Open reduction—surgery to align and/or Insert pins, screw rods, or plates to align
41
Q

Compartment Syndrome

  • _________ within one area of compartment of limb that is between layers of dense CT (fascia)
  • Ischemia and infarction of tissue may occur because of compression of arterial blood supply.
  • Dead tissue may become gangrenous, requiring ______________ .
  • A tight ______ can cause compartment syndrome!
A
  • Edema within one area of compartment of limb that is between layers of dense CT (fascia)
  • Ischemia and infarction of tissue may occur because of compression of arterial blood supply.
  • Dead tissue may become gangrenous, requiring amputation.
  • A tight cast can cause compartment syndrome!
42
Q

Dislocations

-Separation of two ________ at a joint, with loss of contact between articulating surfaces
- Usually accompanied by significant soft tissue damage to ligaments and tendons
- Distortion of joint usually evident
- May recur repeatedly, requiring surgery

A

-Separation of two bones at a joint, with loss of contact between articulating surfaces
- Usually accompanied by significant soft tissue damage to ligaments and tendons
- Distortion of joint usually evident
- May recur repeatedly, requiring surgery

43
Q

Sprains and Strains

-Sprain—a tear in a ____________
- Strain—a tear in a ___________

  • Avulsion—ligaments or tendons completely separated from bony attachments
  • Immobilization often used to prevent tissue damage and promote healing
A

-Sprain—a tear in a ligament
- Strain—a tear in a tendon

  • Avulsion—ligaments or tendons completely separated from bony attachments
  • Immobilization often used to prevent tissue damage and promote healing
44
Q

Other Joint Injuries

Overuse injuries
- _________ tears

_____________ strain injuries—injuries that develop over a period of time in which the same movement is repeated
- Scaling
- Massage
- Keyboard, mouse use
- Running or jogging

A

Overuse injuries
- Muscle tears

Repetitive strain injuries—injuries that develop over a period of time in which the same movement is repeated
- Scaling
- Massage
- Keyboard, mouse use
- Running or jogging

45
Q

Muscle Tear can occur as a result of a trauma or overextension or _____________ of the muscle
-Repeated injuries will result in __________ scar tissue replacing normal structures.

A

Muscle Tear can occur as a result of a trauma or overextension or overstressing of the muscle
-Repeated injuries will result in fibrous scar tissue replacing normal structures.

46
Q

Three degrees of muscle tears:

First degree
* Involves only a _______________ of muscle fibers

Second degree
* Involves ________ of the muscle but is not a complete tear

Third degree
* A ___________ tear across the width of the muscle

A

First degree
* Involves only a small percentage of muscle fibers

Second degree
* Involves much of the muscle but is not a complete tear

Third degree
* A complete tear across the width of the muscle

47
Q

Treatment of Joint Injuries

_______
-Rest, Immobilization, Compression, Elevation

-Nonsteroidal anti-inflammatory drugs (NSAIDs)
-Physiotherapy
-______________ of surrounding tissue

A

RICE
-Rest, Immobilization, Compression, Elevation

-Nonsteroidal anti-inflammatory drugs (NSAIDs)
-Physiotherapy
-Massage of surrounding tissue

48
Q

Bone Disorders—Osteoporosis
-Decrease in bone _______ and density

-Occurs in two forms:

Primary
* Idiopathic
* Age 50+ years
* Decreased sex hormones
* Decreased ___________ intake

Secondary
* As a complication of ______________

A

-Decrease in bone mass and density

-Occurs in two forms:

Primary
* Idiopathic
* Age 50+ years
* Decreased sex hormones
* Decreased calcium intake

Secondary
* As a complication of another disorder

49
Q

Osteoporosis Pathophysiology
- Bone ____________ exceeds formation.
- Results in loss of ___________ bone
- Diagnosed with bone density scans
- Can cause compression fractures of vertebrae, wrist, or hip
- Can lead to kyphosis and scoliosis

A
  • Bone resorption exceeds formation.
  • Results in loss of compact bone
  • Diagnosed with bone density scans
  • Can cause compression fractures of vertebrae, wrist, or hip
  • Can lead to kyphosis and scoliosis
50
Q

Osteoporosis predisposing factors
-Age ___ + years
- Decreased mobility or ____________ lifestyle
-Hormonal factors
* Excess corticosteroids or parathyroid hormone (PTH)
* Deficit of estrogen or testosterone
- Deficits of calcium, vitamin D, or protein
- Cigarette smoking
- __________ BMI
- Asian or European ancestry
- Excessive caffeine intake

A

-Age 50+ years
- Decreased mobility or sedentary lifestyle
-Hormonal factors
* Excess corticosteroids or parathyroid hormone (PTH)
* Deficit of estrogen or testosterone
- Deficits of calcium, vitamin D, or protein
- Cigarette smoking
- Lower BMI
- Asian or European ancestry
- Excessive caffeine intake

51
Q

Osteoporosis Treatment
- ___________ supplements
- Weight-bearing exercise
- Physiotherapy to reduce pain and maintain function
- Bisphosphonates
- Calcitonin
- Human _____________ hormone

A

-Dietary supplements
- Weight-bearing exercise
- Physiotherapy to reduce pain and maintain function
- Bisphosphonates
- Calcitonin
- Human parathyroid hormone

52
Q

Rickets and Osteomalacia

Result from deficit of vitamin ___ and phosphates
- Causes—dietary deficits, malabsorption, intake of phenobarbital, lack of sun exposure
- In children, leads to weak ______ and other skeletal deformities
- In adults, may lead to soft _______, resulting in compression fractures

A

Result from deficit of vitamin D and phosphates
- Causes—dietary deficits, malabsorption, intake of phenobarbital, lack of sun exposure
- In children, leads to weak bones and other skeletal deformities
- In adults, may lead to soft bones, resulting in compression fractures

53
Q

Paget’s Disease

  • Occurs in adults older than ___ years
  • Exact cause has not yet been established.
  • Bone destruction replaced by fibrous ________
  • Pathologic fractures are common.
  • In vertebrae—can result in compression fractures and kyphosis
  • In skull—increased pressure > headaches & compression of cranial nerves → severe pain
A
  • Occurs in adults older than 40 years
  • Exact cause has not yet been established.
  • Bone destruction replaced by fibrous tissue
  • Pathologic fractures are common.
  • In vertebrae—can result in compression fractures and kyphosis
  • In skull—increased pressure > headaches & compression of cranial nerves → severe pain
54
Q

Osteomyelitis

  • Bone ___________ caused by bacteria or fungi

Signs and symptoms
- Local inflammation and bone pain
- Fever, sweating, Chills, malaise

Treatment
- Antibiotics
- ___________ may be required.

A
  • Bone infection caused by bacteria or fungi

Signs and symptoms
- Local inflammation and bone pain
- Fever, sweating, Chills, malaise

Treatment
- Antibiotics
- Surgery may be required.

55
Q

Abnormal Curvatures of the Spine

Lordosis
- Swayback—curving inward at the ________ back

Kyphosis
-Hunchback or humpback—abnormally rounded _________ back

Scoliosis
-___________ -shaped—sideways curve to the spine

A

Lordosis
- Swayback—curving inward at the lower back

Kyphosis
-Hunchback or humpback—abnormally rounded upper back

Scoliosis
-S- or C-shaped—sideways curve to the spine

56
Q

Osteosarcoma—most common primary _____________ of bone
- Occurs in the shaft of long bones of the _____
- Common in children, adolescents, and young adults
- Bone pain at rest is a warning sign for this cancer!

A

Osteosarcoma—most common primary neoplasm of bone
- Occurs in the shaft of long bones of the leg
- Common in children, adolescents, and young adults
- Bone pain at rest is a warning sign for this cancer!

57
Q

Chondrosarcomas—arise from _______________ cells; more common in adults

  • Ewing’s sarcoma is common in adolescents and usually occurs in the shaft of long bones.
A

Chondrosarcomas—arise from cartilage cells; more common in adults

  • Ewing’s sarcoma is common in adolescents and usually occurs in the shaft of long bones.
58
Q

Bone Tumors
- Tumors metastasize to ________ early in the course of the disease.

Treatment
-Excision of tumor if possible
- Surgical amputation if excision is not feasible
- Chemotherapy to reduce metastasis

A

Bone Tumors
- Tumors metastasize to lungs early in the course of the disease.

Treatment
-Excision of tumor if possible
- Surgical amputation if excision is not feasible
- Chemotherapy to reduce metastasis

59
Q

Muscular Dystrophy (MD)
- Group of autosomal recessive disorders
- Degeneration of __________ __________ over time
-Duchenne’s MD or pseudohypertrophic MD most common type; affects young boys

A
  • Group of autosomal recessive disorders
  • Degeneration of skeletal muscle over time
    -Duchenne’s MD or pseudohypertrophic MD most common type; affects young boys
60
Q

Muscular Dystrophy Signs and symptoms
-With Duchenne’s MD—early _________ weakness
-Weakness in pelvic girdle—waddling gait, difficulty climbing stairs
- Gower maneuver—pushing up to erect position
- Tendon reflexes reduced
- Deformities develop, such as kyphoscoliosis
-Respiratory infections common
- Cardiac myopathy occurs commonly.

A

-With Duchenne’s MD—early motor weakness
-Weakness in pelvic girdle—waddling gait, difficulty climbing stairs
- Gower maneuver—pushing up to erect position
- Tendon reflexes reduced
- Deformities develop, such as kyphoscoliosis
-Respiratory infections common
- Cardiac myopathy occurs commonly.

61
Q

Muscular Dystrophy Treatment
-No ____________ treatment available
- Moderate ______________ to maintain motor function
- Supportive appliances
- Physiotherapy and occupational therapy to maximize function and adaptation
- Massage—reduces pain and stiffness
- Ventilator—in case of respiratory failure
- Research being done on genetic therapies

A

-No curative treatment available
- Moderate exercise to maintain motor function
- Supportive appliances
- Physiotherapy and occupational therapy to maximize function and adaptation
- Massage—reduces pain and stiffness
- Ventilator—in case of respiratory failure
- Research being done on genetic therapies

62
Q

Fibromyalgia

Syndrome characterized by:
-_______ in soft tissues
- Stiffness affecting muscles, tendons, and soft tissue
- No obvious inflammation or atrophy
- Sleep disturbance and severe ___________
- Anxiety and/or depression may be present.

Cause is not known but hypothesized to be imbalance in _____________ and other neurotransmitters or increased production of substance P

A

Syndrome characterized by:
-Pain in soft tissues
- Stiffness affecting muscles, tendons, and soft tissue
- No obvious inflammation or atrophy
- Sleep disturbance and severe fatigue
- Anxiety and/or depression may be present.

Cause is not known but hypothesized to be imbalance in serotonin and other neurotransmitters or increased production of substance P

63
Q

Fibromyalgia Predisposing and aggravating factors
- Onset is higher in women age ____ to 50 years.
- History of physical or psychological _________ or chronic pain
- Sleep deprivation
- Stress
- Fatigue

A
  • Onset is higher in women age 20 to 50 years.
  • History of physical or psychological trauma or chronic pain
  • Sleep deprivation
  • Stress
  • Fatigue
64
Q

Fibromyalgia Treatment
- _________ avoidance or reduction
- Regular ______________ in the morning
- Pace activity and rest as needed.
- Applications of heat or massage
- Analgesic drugs
- Low doses of antidepressants
- NSAIDs
- New drugs—pregabalin (Lyrica)

A
  • Stress avoidance or reduction
  • Regular exercise in the morning
  • Pace activity and rest as needed.
  • Applications of heat or massage
  • Analgesic drugs
  • Low doses of antidepressants
  • NSAIDs
  • New drugs—pregabalin (Lyrica)
65
Q

Osteoarthritis
- Degenerative—wear and tear joint disease
-May be the result of increased weight-bearing or lifting
- Incidence increasing
-Genetic component identified in research with mice

A
  • Degenerative—wear and tear joint disease
    -May be the result of increased weight-bearing or lifting
  • Incidence increasing
    -Genetic component identified in research with mice
66
Q

Osteoarthritis Pathophysiology
- Articular cartilage is damaged.
- Surface of cartilage becomes rough and worn
- Tissue damage causes release of _____________, accelerating disintegration of cartilage.
- Subchondral bone may be exposed.
- Cysts, osteophytes, or new bone spurs develop.
- Osteophytes and cartilage break off.
- Joint space becomes ______________.
- Secondary inflammation of surrounding tissue
- Loss of normal range of joint motion
- Pain with weight-bearing and use

A
  • Articular cartilage is damaged.
  • Surface of cartilage becomes rough and worn
  • Tissue damage causes release of enzymes, accelerating disintegration of cartilage.
  • Subchondral bone may be exposed.
  • Cysts, osteophytes, or new bone spurs develop.
  • Osteophytes and cartilage break off.
  • Joint space becomes narrower.
  • Secondary inflammation of surrounding tissue
  • Loss of normal range of joint motion
  • Pain with weight-bearing and use
67
Q

Osteoarthritis Causes
- Primary form—weight-bearing, _________, aging
- Secondary form—follows ________ or repetitive use
- Genetic factors thought to play a role
- Weight-bearing joints most frequently affected but __________ joints also involved

A
  • Primary form—weight-bearing, obesity, aging
  • Secondary form—follows trauma or repetitive use
  • Genetic factors thought to play a role
  • Weight-bearing joints most frequently affected but finger joints also involved
68
Q

Osteoarthritis Signs and symptoms
- __________ pain with weight-bearing and movement
- _________ movement is limited.
- Recreational and social activities become limited because of pain.
-Walking is difficult.
- Predisposition to falls
- In temporomandibular joint (TMJ) syndrome, mastication and speaking are difficult.
- Bony enlargement of distal interphalangeal joints

A
  • Aching pain with weight-bearing and movement
  • Joint movement is limited.
  • Recreational and social activities become limited because of pain.
    -Walking is difficult.
  • Predisposition to falls
  • In temporomandibular joint (TMJ) syndrome, mastication and speaking are difficult.
  • Bony enlargement of distal interphalangeal joints
69
Q

Osteoarthritis Treatment
-Stress on joint minimized by use of adaptive devices such as a _______
- Pacing activity
- Mild ____________ program to maintain fitness and joint function
- Supports such as hand brace to facilitate movement
- Orthotic Inserts in shoes

  • Massage therapy
  • Physiotherapy
  • Acupuncture
  • Occupational therapy
  • Glucosamine chondroitin supplements
  • Injection of synthetic synovial fluid (hyaluronic acid)
  • NSAIDs
  • Analgesics
  • Arthrotomy to stabilize joint
  • Surgical joint replacement
A

-Stress on joint minimized by use of adaptive devices such as a cane
- Pacing activity
- Mild exercise program to maintain fitness and joint function
- Supports such as hand brace to facilitate movement
- Orthotic Inserts in shoes

  • Massage therapy
  • Physiotherapy
  • Acupuncture
  • Occupational therapy
  • Glucosamine chondroitin supplements
  • Injection of synthetic synovial fluid (hyaluronic acid)
  • NSAIDs
  • Analgesics
  • Arthrotomy to stabilize joint
  • Surgical joint replacement
70
Q

Rheumatoid Arthritis
- Considered an _________ disorder
- Causes chronic systemic inflammatory disease
-Higher incidence in ___________________
- Affects all age groups

A
  • Considered an autoimmune disorder
  • Causes chronic systemic inflammatory disease
    -Higher incidence in women than in men
  • Affects all age groups
71
Q

Rheumatoid Arthritis Pathophysiology
- Synovitis—marked _______________ , cell proliferation
- Pannus formation—granulation tissue spreads.
- ___________ erosion—creates unstable joint
- Fibrosis—calcifies and obliterates joint space
- Ankylosis—joint fixation and deformity develop if untreated.

A
  • Synovitis—marked inflammation, cell proliferation
  • Pannus formation—granulation tissue spreads.
  • Cartilage erosion—creates unstable joint
  • Fibrosis—calcifies and obliterates joint space
  • Ankylosis—joint fixation and deformity develop if untreated.
72
Q

Joint Disorders: Rheumatoid Arthritis Systemic effects
- Marked ____________
- Depression
- Malaise
- Anorexia
- Low-grade fever
- Iron deficiency anemia that is _____________ to iron therapy

A
  • Marked fatigue
  • Depression
  • Malaise
  • Anorexia
  • Low-grade fever
  • Iron deficiency anemia that is resistant to iron therapy
73
Q

Rheumatoid Arthritis Cause
- Exact __________ not known
- ___________ factor is present.
- Familial predisposition
- Some links to viral infections

A
  • Exact cause not known
  • Genetic factor is present.
  • Familial predisposition
  • Some links to viral infections
74
Q

Rheumatoid Arthritis Signs and Symptoms
- Affected joints are extremely __________.
- Stiffness of joints
- Redness and swelling of joints
- Joint involvement includes small joints and is often bilateral.
- Joint ___________ impaired
- Eventually, the joint becomes fixed and deformed

A
  • Affected joints are extremely painful.
  • Stiffness of joints
  • Redness and swelling of joints
  • Joint involvement includes small joints and is often bilateral.
  • Joint movement impaired
  • Eventually, the joint becomes fixed and deformed
75
Q

Rheumatoid Arthritis Treatment
- Balance between rest and moderate activity
- _______ and cold applications
- Physical and occupational therapy
- NSAIDs
- _________________ for severe inflammation
- Analgesia for pain
- Disease-modifying antirheumatic drugs, such as gold salts, methotrexate, hydroxychloroquine
- ____________ response–modifying agents, such as infliximab, rituximab, anakinra

A
  • Balance between rest and moderate activity
  • Heat and cold applications
  • Physical and occupational therapy
  • NSAIDs
  • Glucocorticoids for severe inflammation
  • Analgesia for pain
  • Disease-modifying antirheumatic drugs, such as gold salts, methotrexate, hydroxychloroquine
  • Biological response–modifying agents, such as infliximab, rituximab, anakinra
76
Q

Juvenile Rheumatoid Arthritis (JRA)
- Several different types
- Onset more _________ than adult form
- _________ joints frequently affected

A
  • Several different types
  • Onset more acute than adult form
  • Large joints frequently affected
77
Q

Juvenile Rheumatoid Arthritis (JRA)

  • Still’s disease (___________ form)—fever, rash, lymphadenopathy, hepatomegaly, joint involvement
  • Second form of JRA causes polyarticular _______________
  • Third form of JRA involves four or fewer joints but causes : _____________________________________
A
  • Still’s disease (systemic form)—fever, rash, lymphadenopathy, hepatomegaly, joint involvement
  • Second form of JRA causes polyarticular inflammation
  • Third form of JRA involves four or fewer joints but causes uveitis (inflammation of iris, ciliary body, and choroid of eye)
78
Q

Infectious Arthritis AKA septic arthritis
- Develops in ________ joint
- Joint is red, swollen, painful, with decreased movement

Causes
- Direct introduction of __________ into joint, such as trauma, nonsterile injection, surgery
- Secondary infection because of bacteremia

Treatment with _______________ over sustained period; often requires IV administration

A
  • Develops in single joint
  • Joint is red, swollen, painful, with decreased movement

Causes
- Direct introduction of bacteria into joint, such as trauma, nonsterile injection, surgery
- Secondary infection because of bacteremia

Treatment with antimicrobials over sustained period; often requires IV administration

79
Q

Gout - Also known as gouty arthritis
- Results from deposits of ___________________ in the joint, causing inflammation
- Formation of tophus—large hard nodule of urate crystals
- Tophi cause local inflammation and occur after the first attack of gout.

A
  • Results from deposits of uric acid and crystals in the joint, causing inflammation
  • Formation of tophus—large hard nodule of urate crystals
  • Tophi cause local inflammation and occur after the first attack of gout.
80
Q

Gout (Cont.)
-Uric acid and crystals form because of inadequate _______________, chemotherapy, metabolic abnormality, and/or genetic factors.
- Inflammation causes redness, swelling, and pain.
- Treated by reducing _____________ levels with drugs and dietary changes
-Diagnosed by examination of synovial fluid and blood tests
- NOTE: Use of NSAIDs prior to blood tests will cause a false-negative result.

A

-Uric acid and crystals form because of inadequate renal excretion, chemotherapy, metabolic abnormality, and/or genetic factors.
- Inflammation causes redness, swelling, and pain.
- Treated by reducing uric acid levels with drugs and dietary changes
-Diagnosed by examination of synovial fluid and blood tests
- NOTE: Use of NSAIDs prior to blood tests will cause a false-negative result.

81
Q

Ankylosing Spondylitis
- Chronic, progressive, inflammatory condition
- Affects sacroiliac _________, intervertebral spaces, costovertebral joints
- More common in _______ age 20 to 40 years
- Cause has not yet been determined—thought to be an ______________ disorder with a genetic basis

A
  • Chronic, progressive, inflammatory condition
  • Affects sacroiliac joints, intervertebral spaces, costovertebral joints
  • More common in men age 20 to 40 years
  • Cause has not yet been determined—thought to be an autoimmune disorder with a genetic basis
82
Q

Ankylosing Spondylitis (Cont.)
- Signs—______________ pain, morning stiffness, pain when lying down, spine becomes rigid
- Systemic signs—fatigue, fever, weight loss, uveitis
- Treated by drugs to relieve _______ , daily exercise, physiotherapy, occupational therapy

A
  • Signs—lower back pain, morning stiffness, pain when lying down, spine becomes rigid
  • Systemic signs—fatigue, fever, weight loss, uveitis
  • Treated by drugs to relieve pain, daily exercise, physiotherapy, occupational therapy
83
Q

Bursitis
- Inflammation of the ________ associated with bones, muscles, tendons, and ligaments of various joints
- Most common cause- Repetitive __________ on a particular joint

Diagnosis
- Physical examination
- Ultrasound and/or MRI

Treatment options
- Rest
- Anti-inflammatory drugs

A
  • Inflammation of the bursae associated with bones, muscles, tendons, and ligaments of various joints
  • Most common cause- Repetitive motion on a particular joint

Diagnosis
- Physical examination
- Ultrasound and/or MRI

Treatment options
- Rest
- Anti-inflammatory drugs

84
Q

Synovitis
- Inflammation of the ___________________
- Movement of joint is restricted and painful

Diagnosis
- Swollen, red, and warm joint
- Analyzing synovial _______ (for signs of infections)

Treatment
- Anti-inflammatory drugs
- Identification and treatment of underlying cause

A
  • Inflammation of the synovial membrane
  • Movement of joint is restricted and painful

Diagnosis
- Swollen, red, and warm joint
- Analyzing synovial fluid (for signs of infections)

Treatment
- Anti-inflammatory drugs
- Identification and treatment of underlying cause

85
Q

Tendinitis
- Irritation or inflammation of the _________
- Manifestation- Dull ache and mild ____________

Cause- Single trauma or repetitive motion

Diagnosis
- Made by physical examination

Treatment
- Rest, application of ice
- Pain relievers—maybe anti-inflammatory drugs
- Physical therapy

A
  • Irritation or inflammation of the tendon
  • Manifestation- Dull ache and mild swelling

Cause- Single trauma or repetitive motion

Diagnosis
- Made by physical examination

Treatment
- Rest, application of ice
- Pain relievers—maybe anti-inflammatory drugs
- Physical therapy

Pathophysiology (23 decks)

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