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Pathophysiology 210 > Chapter 43 > Flashcards

Chapter 43 Flashcards

1
Q

Explain a contusion/bruise

A

Results from direct trauma, skin is intact, blood/cell damage

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2
Q

What is a hematoma?

A

Blood accumulation, localized

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3
Q

What is a strain?

A

Partial tear of the muscle/tendon

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4
Q

Risk of strain?

A

Increased age (fibres less elastic)

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5
Q

Manifestation of strains?

A

Pain, stiffness, swelling, tenderness (usually no sign unless inflammation)

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6
Q

What is a sprain?

A

Tearing/ rupture of supporting ligament (bone-bone) due to abnormal/excess joint movement

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7
Q

Can you detect sprains on x-ray?

A

No- unless bone fragments

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8
Q

Manifestation of sprains?

A

Pain, swelling (limits movement), discoloration

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9
Q

Treatment of strains/ sprains

A

RICE

C- give support, reduces swelling

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10
Q

In sprain healing, what do capillaries do? fibroblasts?

A

Capillaries bring oxygen/ nutrients

Fibroblast produce collagen (collagen bundles strengthen over time)

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11
Q

What are complications in sprain healing?

A

contraction can pull healing apart and result in lengthened position, adhesions

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12
Q

What are dislocations? What is a subtype of a dislocation?

A

Abnormal displacement of two joining (articulating) surfaces
Subluxation (partial dislocation)

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13
Q

What are common joints for dislocations?

A

Shoulder, Acromioclaviular, glenohumeral

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14
Q

What are the 3 types of dislocations?

A
  1. Congenital (hip or knee)
  2. Traumatic (MVA, hip, shoulder, knee, wrist, ankle)
  3. Pathologic (complication of infection, rheumatoid arthritis, neuromuscular disease)
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15
Q

How can you diagnosis dislocations?

A

History, assessments, x-rays

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16
Q

Manifestations of dislocations?

A

Pain, deformity, limited movement

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17
Q

What is the treatment of dislocations?

A

Spontaneous, manipulation, surgery, physiotherapy

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18
Q

What three bones does the shoulder include?

A

Clavicle, humerus, scapula

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19
Q

What is the function of the rotator cuff?

A

Stabilizes the humeral head against the glenoid

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20
Q

T/F: Shoulder joints are stable?

A

False

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21
Q

What do rotator cuff injuries result from?

A

Direct blow or stretch, excessive use, increasing age

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22
Q

What are common conditions associated with rotator cuff injuries?

A

Tendinitis, Subacromial bursitis, partial/complete tears

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23
Q

Manifestations of rotator cuff injuries?

A

Pain, tenderness, difficulty moving arm, muscle atrophy, inflammation

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24
Q

How are shoulder/rotator cuff injuries diagnosed and treated?

A

Assessment of active/passive ROM, history is important, MRI, Arthroscopic exam

Anti-inflammatories, corticosteroids, physiotherapy, surgery

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25
Q

Knee Ligamentous injuries are the most serious. What is the cause of them? and what are the manifestations?

A

Forceful stress or pop

Swollen due to hemorrhage, pain, inability to weight bear

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26
Q

Knee meniscus injuries result from sudden rotation. What are the manifestations and complications?

A

Pain, edema, instability, locking d/t loose fragments

osteoarthritic changes limiting movement

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27
Q

Knee patellar subluxation & dislocation is partial dislocation of the knee cap usually sports related. What are some manifestations?

A

Weakness, swelling, crepitus (cracking, grating), stiffness, loss of ROM

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28
Q

Knee patellofemoral pain syndrome is the most common cause of anterior knee pain. What are the causes? and manifestation?

A

Imbalance of force controlling patellar, contact with femur, running, jumping, sitting

Pain, weakness, absence of edema

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29
Q

What is chondromalacia and its causes? *

A

Inflammation of the underside of the patella

Sports, knee overuse in older adults

Treatment is RICE, anti-inflammatories, physio

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30
Q

What is the cause of a hip injury dislocation? What is there a disruption in?

A

Trauma

Blood and nerve supply- a complication of this is avascular necrosis***

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31
Q

What are risk factors for hip fractures?

A

Age, woman, inactivity, alcohol excess, pyychotropic medications, institutionalization, visual impairments, polypharmacy, osteoporosis

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32
Q

What are surgical options for hip fractures?

A

Total hip replacement, hemi-arthroplasty, ORIF (open reduction internal fixation), Revision

33
Q

What are the 3 categories fractures can be divided into?

A
  1. Sudden injury
  2. Stress fractures
    - Fatigue fracture (any weight bearing bone)
  3. Pathologic fracture
    - Bone is weakened due to previous disease/tumor
    - normal stress to bone
34
Q

How are fractures classified?

A 
A. Position on bone 
- proximal,midshaft, distal 
-head or neck 
B. Communication with outside environment 
- open/compound or closed
C. Degree of break
35
Q

What is greenstick in relation to fractures?

A

Young, soft, immature bone
Partial break in continuity
Can be complete or imcomplete

36
Q

What are 4 characteristics of fracture pieces?

A
  • Comminuted: multiple pieces of bone everywhere, can move into tissue
  • Compression: crushing of 2 bones
  • Impacted: fragments are wedged together
  • Butterfly: triangular bone piece is broken off
37
Q

What are 4 directions of breaks in fractures?

A
  • Transverse: all the way through the bone
  • Oblique: at an angle
  • Spiral: going in a circular fashion
  • Twist, torque: pressure with the torque (the bone will have cracks all along it)
38
Q

Manifestations of fractures?

A

Pain, tenderness, swelling, loss of mobility, deformity (damage tissue, shortening of extremities, rotational issues, crepitus, blood loss if open)

39
Q

What is local shock in fractures?

A

Numbness and flaccid muscles

40
Q

How are fractures diagnosed?

A

Assessment (history, physical), X-ray

41
Q

What is the treatment for fractures?

A

Reduction of fracture (moving pieces back together, can be closed or open), immobilization (splint, cast, external fixation), preservation and restoration, physio

42
Q

What are the 4 stages of bone healing?

A

Hematoma-> callus -> ossification -> remodelling

43
Q

Stage 1 of bone healing: hematoma formation

A

First 1-2 days, tone blood vessels, fibrin clot forms (clotting factors remain in injured area, new capillary beds, provided foundation for inflammatory cells)

44
Q

Stage 2 of bone healing: fibrocartilaginous callus formation

A

Fibroblasts begin repair of the bone, takes 2-3 weeks, fibroblasts produce collagen that connect bones together

45
Q

Stage 3 of bone healing: ossification

A

osteoblasts form; calcium salts deposit, mature bone replaces callus, fracture heals firm and this begins 3-4 weeks after injury

46
Q

Stage 4 of bone healing: remodelling

A

dead cells are removed, compact bone replaces spongy bone, possible “scarring”, reabsorption of excess bony callus

47
Q

In relation to bone healing, what is delayed union, malunion, nonunion?

A
  • Delayed union: failure to heal in usual time, but will
  • Malunion: heals but does not heal in the right way and results in deformity (does not mean physical)
  • Nonunion: Failure to heal, but not able to heal (characterized by mobility of fracture site and pain on weight bearing)
48
Q

A complication of bone healing is fracture blisters. What are these? and what can decrease your chance of getting blisters?

A

epidermal necrosis with separation of epidermis and dermis d/t fluid (do not want blisters to break because you can get infection of epidermis

clear blister- fluid
black blister- hemorrhagic

early surgical interventions

49
Q

A complication of bone healing is compartment syndrome. What is this?

A

Increased intraosseus pressure within a limited space. (The increased pressure compromises the circulation and function of tissue)

50
Q

What is compartment syndrome due to?

A

Decreased size
- constrictive dressing, casts, burns

Increased volume of contents
-trauma, fluid/edema, vascular injury/bleeding, venous obstruction
Or both

51
Q

What is the amount of pressure in compartment syndrome dependent upon?

A

Duration, metabolic rate, vascular tone, B/P

52
Q

Result of increase pressure in compartment syndrome are?

A

Compression of vessels=ischemia, necrosis

Compression of nerves= parenthesis, paralysis

53
Q

Compartment syndrome manifestations?

A

Severe pain, burning, numbness, tingling, decreased reflexes and motor function, peripheral pulses are normal

54
Q

What are the 6 P’s in a neurovascular Assessment

A

Pain, pulses, paralysis, parasthesia, polar, pallor,

-pressure

55
Q

What is Fat embolism syndrome (FES)?

A

Complication of fractures, fat droplet from bones and adipose tissue circulate though small veins

56
Q

What are manifestations of fat embolism syndrome?

A 
Respiratory failure (dyspnea, cyanosis, angina, tachycardia, diaphoresis) 
cerebral dysfunction (mentation/behavior change, focal deficit, seizures) 
skin/ mucosa petechiae (rash 2-3 days post event)
57
Q

What is osteomyelitis? *

A

Infection of bone and marrow d/t direct contamination, through blood, or via. skin lesions

58
Q

What is the most common type of infection is osteomyelitis?

A

staphylococcus aureus (it adheres to bone and attacks cells, evades host defences and colonizes)

59
Q

Explain hematogenous osteomyelitis in children

A

Starts in the metaphyseal plate, affects long bones, purulent exudate inside bones, damages artery supply, may penetrate skin or joints (form a draining sinus)

60
Q

Explain hematogenous osteomyelitis in adults

A

Affects joint space, causes destruction of endplate/ajoining disk/ contiguous vertebral body

61
Q

Manifestations of hematogenous osteomyelitis

A

Signs of bacteria, fever, chills, malaise, pain on movement, tenderness, erythema, edema

62
Q

Explain chronic osteomyelitis

A

Usually in adults, secondary to open wound, difficult to detect if near joint
infected dead bone separates from living-> a sheath of new bone forms around infected bone

63
Q

What is osteonecrosis?

A

Bone destruction d/t interruption in blood flow (rather than infection)

64
Q

What are osteonecrosis manifestations (depend on site and extent)

A

Chronic pain (not d/t movement), predisposes patient to severe secondary osteoarthritis

65
Q

What is the treatment of osteonecrosis?

A

immobilization, anti-inflammatories, exercise, limitation in weight bearing, surgery is often needed for hip and knee involvement (total joint replacement)

66
Q

What are benign bone tumors?

A

Confined to bone, well defined boarders, hardly cause fractures, hardly needs treatment

67
Q

What is an osteoma?

A

Bony tumor on a bone surface

68
Q

What are the 2 types of benign tumors?

A

Fibrous and cartilaginous

69
Q

Explain fibrous tumors

A

Common in growing bones, usually no symptoms, resolve in 2-3 years

70
Q

Explain the 2 types of cartilaginous tumors?

A

Chondroma- made of cartilage (short bones, single lesions, onset is 20-40 years, usually no symptoms or painful, and can cause fractures)
Osteochondroma- cartilage capped (common, low growing, single mass, knee is common, bony stalk attached it to bone, can be painful)

71
Q

Another type of benign tumor is a osteroclastoma. Explain what this is.

A

Giant cell tumor (behaves like it is malignant. May invade bone/cause destruction, knee is common, can be removed if catched before it invades, 20s-40s

72
Q

What are the 3 types of malignant tumors?

A

Osteosarcoma, chrondrosarcoma, Ewing sarcoma

73
Q

Explain osteosarcoma tumors

A

In areas of fast bone growth, UKE but increased osteoblast activity, peaks before age 20, men > woman, metastasizes early (to lung), aggressive, grows in a ball like mass, deep/localized pain, swelling effects bone, skin may be stretched/shiny/warm, ROM may be restricted, treatment includes: surgery, amputation, chemo.

74
Q

Explain chondrosarcoma

A

Usually central, can arise from previous benign cart. tumors, mid-late adulthood, slow growing, late metastasis, responds to early excision

75
Q

Explain Ewing sarcoma

A

Densely packed cells, children and young adults, men>woman, harder to detect, white>black people, pain, decreased ROM, tenderness, fever, decreased weight, treatment: chemo, radiation, surgery

76
Q

What is metastatic bone disease?

A

Skeletal metastasis is the most common bone cancer, most cancers metastasize to bone (in trunk bones like femur, ribs, sternum), spread to breast, prostate, lung, kidney

77
Q

Manifestations of metastatic bone disease

A

Pain, pathological fracture, hypercalcemia d/t bone destruction

78
Q

Manifestations of bone cancer

A
  • Changes in organ function (organ damage, inflammation, failure)
  • Local effects (compression of nerves, stretching of periosteum, pain and weakness)
  • Nonspecific signs of tissue breakdown (protein wasting, bone breakdown, calcium release, hypercalcemia)

Pathophysiology 210 (3 decks)

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