Ch. 39 Alterations of Musculoskeletal Function Flashcards
(148 cards)
1
Q
Is a closed fracture complete or incomplete?
A
Complete
2
Q
Is an open fracture complete or incomplete?
A
Complete
3
Q
Is a comminuted fracture complete or incomplete?
A
Complete
4
Q
Is a linear fracture complete or incomplete?
A
Complete
5
Q
Is an oblique fracture complete or incomplete?
A
Complete
6
Q
Is a spiral fracture complete or incomplete?
A
Complete
7
Q
Is a transverse fracture complete or incomplete?
A
Complete
8
Q
Is a pathologic fracture complete or incomplete?
A
Complete
9
Q
Is a greenstick fracture complete or incomplete?
A
incomplete
10
Q
Is a torus fracture complete or incomplete?
A
incomplete
11
Q
Is a bowing fracture complete or incomplete?
A
Incomplete
12
Q
Is a stress fracture complete or incomplete?
A
Incomplete
13
Q
Is a transchondral fracture complete or incomplete?
A
incomplete
14
Q
A ____ is a break in the continuity of a bone
A
fracture
15
Q
Two types of fracture healing
A
Direct and indirect
16
Q
Explain direct fracture healing
A
Most often occurs when surgical fixation is used to repair a broken bone. NO callus formation
17
Q
Is there callus formation in direct healing of fracture?
A
No
18
Q
Explain indirect fracture healing
A
Most often observed when a fracture is tx with a cast or non-surgical method. Callus formation is hallmark. Remodeling of solid bone
19
Q
Is there callus formation with indirect healing of fractures?
A
Yes
20
Q
Patient presents with swelling, muscle spasm, and impaired sensation of wrist. Pt most likely has a
A
bone fracture
21
Q
List manifestations of bone fracture
A
Unnatural alignment. Swelling. Muscle spasm. Tenderness. Pain. Impaired sensation. Decreased mobility.
22
Q
Dx of bone fracture
A
X ray or bone scan
23
Q
Tx
A
- Immobilization 2. Realignment 3. Internal/external fixation
24
Q
______ of a bone fracture is closed manipulation, traction, and open reduction
A
Realignment (closed manipulation si where the doctor pulls and straightens the fracture without opening the skin.
25
Example of internal and external fixation
i.e with shoulders or torn ligaments. Dislocated shoulder...doctors pushes back into place
26
List three main complications of fracture
1. Nonunion 2. Delayed 3. Malunion
27
\_\_\_\_\_ is a complication of a fracture where there is failure of union
Non-union
28
\_\_\_\_\_ is a fracture complication. Delayed by 8 to 9 months
Delayed
29
\_\_\_\_ is a fracture complication where the healing is in a incorrect position
Malunion
30
\_\_\_\_\_ is displacement of one or more bones in a joint
dislocation
31
\_\_\_\_\_\_ is loss of contact between articular cartilage
Dislocation
32
\_\_\_\_\_ is where contact between articular surfaces is only partially lost
Subluxation
33
Which two types of trauma are associated with fractures, muscle imbalance, rheumatoid arthritis, or other joint instability.
Dislocation and subluxation
34
What is possible with dislocation and subluxation?
damage to adjacent tissue can occur
35
What would you see in a patient with dislocation or subluxation
Pain, swelling, limited motion....joint deformity. Complications: interrupted circulation and nerve compression
36
Tx of dislocation and subluxation
Reduction with immobilization
37
List the three main injuries of support structures
1. strain 2. sprain 3. avulsion
38
\_\_\_\_\_\_ is tearing or stretching to a tendon or muscle
strain
39
\_\_\_\_\_ is a tear or injury to a ligament
sprain
40
\_\_\_\_\_ is a complete separation of a tendon or ligament from its bony attachment site
avulsion
41
T or F: a sprain is injury to a tendon
False; ligament
42
Pt presents with swelling and pain in the knee. Tests reveal the ligament has completely separated from the bone. Dx?
Avulsion
43
Pathophysiology of tendon and ligament injuries
-Inflammatory exudate...release of growth factors. granulation. Collagen formation.
44
\_\_\_\_ and ____ injuries usually lack sufficient strength to withstand some stress for 4-5 weeks after the injury
Tendon and ligament
45
Dx of tendon and ligament injuries besides xrays
Arthroscopy
46
Tx of tendon and ligament injuries
PRICE, brace...and rehabilitation is CRUCIAL to regaining good function
47
\_\_\_\_\_ strain is the sudden, forced motion causing the muscle to become stretched beyond normal capacity
Muscle strain
48
Can muscle strain be acute or chronic
Yes
49
Does muscle strain involve tendons sometime?
Yes
50
Name the three healing phases of muscle strain
1. Destruction 2. Repair 3. Remodeling
51
\_\_\_\_\_\_: the healing phase of muscle strain with contraction and necrosis of damaged myofibers. Inflammatory response.
Destruction
52
\_\_\_\_\_: healing phase of muscle strain with phagocytosis and new capillary formation
Repair
53
\_\_\_\_\_ is the phase of muscle strain with myofiber maturation and contractile formation
remodeling
54
Dx of muscle strain
Physical exam; maybe MRI
55
Tx of muscle strain
ICe, rest, exercises
56
\_\_\_\_\_\_ is the rapid breakdown of muscle
Rhabdomyolysis
57
What's happening with the rapid breakdown of muscle
myocytes burst
58
\_\_\_\_\_\_ is the rapid breakdown of muscle that causes the release of intracellular contents, including protein pigment \_\_\_\_\_\_, into the extracellular space and bloodstream.
Rhabdomyolysis and myoglobin
59
Rhabdomyolysis can result in \_\_\_\_\_\_\_, or acute renal failure
Hyperkalemia (intracellular K+)
60
What is the triad of manifestations of rhabdomyolysis
1. Muscle pain 2. Weakness 3. Dark urine (myoglobin)
61
How would you diagnose rhabdomyolsis
Blood test....when CPK is level five to 10x upper limit of normal (1000 units/L). Renal failure also indicated Rhabd.
62
Tx goals of rhabdomyolysis
-preventing kidney failure, maintaining urinary output, and hemodialysis if necessary
63
\_\_\_\_\_\_ syndrome is a result of increased pressure within a muscle fascial compartmnet
Compartment syndrome
64
What causes compartment syndrome
By any condition that disrupts the vascular supply to an extremity
65
\_\_\_\_ ___ causes edema, rising compartment pressure, tamponade, and ultimately leads to M.I and neural injury
Muscle ischemia
66
Manifestations of compartment syndrome....6 P's
Pain, pressure, pallor, parasthesia, paresis, and pulselessness
67
What is the complication of unrecognized compartment syndrome
Volkmann ischemic contracture
68
Dx of compartment syndrome
Measure the intra-compartmental pressure
69
Tx of compartment syndrome
-Relieve external pressure (tight bandage) -Surg. intervention (fasciotomy) when pressure reaches 30mmHg
70
At which pressure is surgical intervention necessary for Compartment Syndrome
30mmHg
71
What is the name of the surgical procedure to relieve compartment syndrome
Fasciotomy
72
\_\_\_\_\_\_ ______ is a hypermetabolic reaction to certain anesthetics or muscle relaxants (used in the OR)
Malignant hyperthermia
73
What type of disorder is Malignant Hyperthermia
Autosomal dominant
74
The pathophysiology of malignant hyperthermia is a ______ in the ryanodine receptor of skeletal muscle RyR1. It's responsible for the majority of cases
Mutation
75
What is the name/abbreviation of the ryanodine receptor that can have the mutation for malignant hyperthermia
RyR1
76
Malignant hyperthermia causes continuous muscle contractions that eventually causes hypermetabolism. What causes this?
Uncontrolled calcium release
77
What occurs after hypermetabolism of the muscles (associated with malignant hyperthermia)
Muscle spasm/rigidity, high body temp, Rhabdomyolysis, and death if not treated quickly enough
78
Best way to avoid M.H?
Pre-op evaluation. Family history and can be predicted with a muscle-contracture test.
79
treatment of M.H?
Dantrolene sodium infusion to relax muscle spasm (also called Dantrium). Manage symptoms.
80
\_\_\_\_\_\_ is defined as decreased bone mineral density \< 2.5 SD from the mean
Osteoporosis
81
What is the range for osteopenia(weak but not bad enough to be considered osteoporosis)
-1.0 to -2.49 SD
82
After age 30, bone resorption exceeds what?
Bone formation
83
Because bone resorption exceeds bone formation after age 30, what do you see with mineral density over time in aging adults?
Decreasing bone mineral density
84
Is osteoporosis found in all older adults?
No
85
Pathophysiology of Osteoporosis
-increase in osteoclast activity compared to osteoblasts. -results in bones that are less dense, thinner, more porous, and increased risk of fractures
86
Who is at risk for osteoporosis
Women: caucasian and asian. Small frame size.
87
The _____ hormone is a potential cause for osteoP
Parathyroid
88
Which medication is a potential cause for osteoP
Corticosteroids
89
Does tobacco and excessive ethanol use increase the risk of osteoP
Yes
90
What is a major complication of osteoP
Fractures
91
Who is more at risk for osteoP, someone with high physical activity or low?
low
92
What are the two important types of osteoP
Postmenopausal and Glucocorticoid-induced
93
Is glucocorticoid-induced osteoP primary or secondary?
Secondary
94
This type of osteoporosis improves osteoclast survival, inhibiting osteoblast formation and function
glucocorticoid-induced
95
This type of osteoP is caused by estrogen deficiency associated with increased bone resorption.
Postmenopausal
96
Kyphosis is commonly seen in patients with osteoporosis. T or F
True
97
Vertebral and green stick fractures are commonly seen in patients with osteoP
False; vertebral and long bone fractures
98
How to diagnose osteoP
-Peripheral DXA of heel and wrist is the screening recommendation. -The gold standard is the DXA of hip and spine. -Trabecular bone score (TBS) evaluates pixel variations in gray-level areas of lumbar spine images from DXA scans
99
OsteoP prevention and management?
-Weight bearing physical activity -Adequate calcium and vitamin D intake -Bisphosphonates and biologics -fracture prevention strategies
100
\_\_\_\_\_\_\_ is inadequate or delayed mineralization of osteoid, the organic component of bone
Osteomalacia
101
\_\_\_\_\_ results in soft, deformed bones due to vitamin D deficiency (calcification/ossification does not occur)
Osteomalacia
102
Where do you see Osteomalacia
Third world countries
103
Tx of osteomalacia?
Calcium and vitamin D supplementation
104
What is another name for Paget disease
Osteitis deformans
105
\_\_\_\_\_ disease is a chronic accelerated remodeling of spongy (trabecular) bone
Paget
106
\_\_\_\_\_ disease enlarges and softens affected bones. Increases risk for fractures and bone tumors
Paget
107
Which disease has an increased risk of bone tumors
Paget
108
Which disorder is genetic
Malignant Hyperthermia
109
Paget disease mostly affects which areas?
Vertebrae, skull, sacrum, sternum, pelvis, and femur
110
A patient presents with an enlarged bony prominence of the neck that feels soft to the touch and recently had a viral infection. What can the patient possibly have
Paget disease
111
How to evaluate for paget disease?
X-rays and bone scans
112
Tx of paget disease?
Pain relief and fracture prevention
113
\_\_\_\_\_\_\_ is a bone infection often caused by bacteria, specifically _____ \_\_\_\_\_\_
Osteomyelitis; S. aureus
114
Osteomyelitis is usually caused by S. aureus. What is the route the pathogen takes that manifests as cutaneous, sinus, ear, and dental infections?
-Hematogenous origin(carried in blood stream) -insidious onset -vague symptoms
115
What are the symptoms of osteomyelitis
Fever, malaise, anorexia, weight loss, and pain
116
What is the route of pathogen, when considering osteomyelitis, where the infection spreads to an adjacent bone...notably open fractures, penetrating wounds, and surgical procedures
Contiguous origin
117
A patient is in the hospital one week post op from knee surgery. Patient has a low grade fever, is losing weight, and complaining of radiating pain in her knee up to her thigh. The incision had been healing well when she left the hospital last week but now the tissue appears to be dying. Patient likely has
Osteomyelitis of contiguous origin from contracting S. aureus during her knee surgery or afterwards during wound care. S. aureus is common in hospitals. swelling and low grade fever indicate contiguous origin.
118
\_\_\_\_\_ provokes an inflammatory response, abscesses can form, and the disrupted blood supply results in necrosis
Osteomyelitis
119
For ______ osteomyelitis, you would see lymphadenopathy, local pain, swelling, and a low grade fever in patients
contiguous
120
Which type of osteomyelitis do you see Brodie abscesses (circumscribed lesions in the ends of long bones)
Contiguous
121
Tx of osteomyelitis
Antibiotics, debridement, surgery, and hyperbaric oxygen therapy
122
\_\_\_\_\_\_\_ is the loss and damage of articular cartilage with subchondral bone changes
Osteoarthritis
123
Thickening of the joint capsule that ultimately leads to narrowed joint space and bone spurs is \_\_\_\_\_\_\_
osteoarthritis
124
Prevalence of osteoarthritis increases with....
age
125
Risk factors of osteoarthritis
Age, joint trauma, long term mechanical stress, and obesity
126
Pathophysiology of osteoarthritis
-Enzymes break down cartilage, and abnormal subchondral bone remodeling occurs
127
Manifestations of osteoarthritis
-Pain (worsens with activity) -Stiffness (diminishes w activity) -Tenderness -limited motion -muscle wasting
128
Dx of osteoarthritis
Radiologic studies
129
What is the conservative treatment of osteoarthritis
Exercise and weight loss. Analgesics and anti-inflammatories
130
What is the surgical treatment of osteoarthritis
-surg to improve joint movement, -new joint with artificial implants
131
What is classic inflammatory joint disease
Inflammatory damage or destruction in the synovial membrane or articular cartilage
132
CIJD can be infectious or noninfectious in origin. T or F
True
133
What are the three CIJD
Rheumatoid arthritis, ankylosing spondylitis, and gout
134
\_\_\_\_ ____ is an inflammatory autoimmune disease: systemic autoimmune damage to connective tissue
R A (rheumatoid A)
135
Cause of RA?
Unknown. multifactorial with strong genetic predisposition
136
Vasculitis can be caused by RA. T or F
True
137
\_\_\_\_ is a syndrome caused by either overproduction or underexcretion of uric acid
Gout
138
Manifestation of gout?
High levels of uric acid in the blood and other body fluids. Uric acid crystallizes and precipitates in body tissues (joints, subcutaneous tissues, kidneys)
139
Risk factors for gout
Male sex, age, high intake of alcohol, red meat, fructose, and drugs
140
\_\_\_\_\_\_ is linked to abnormal purine metabolism
Gout
141
In ______ \_\_\_\_, neutrophils and other cells in synovial fluid become activated
R.A
142
Inflammatory cytokines induce enzymatic breakdown of cartilage and bone. T cells also interact with synovial fibroblasts through TNF-alpha, converting synovium into a thick, abnormal layer of granulation tissue. This is all seen with which CIJD
R.A
143
Normal antibodies morph into auto-antibodies IgM and IgG called _______ factors
Rheumatoid
144
Does rheumatoid arthritis have an insidious onset?
yes
145
Rheumatoid nodules cause ______ syndrome
Caplan
146
What would you see in a patient with RA
Inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness. Painful, tender, and stiff joints. Joint formalities. Rheumatoid nodules
147
Diagnostics for RA?
Joint involvement, serology--presence of auto-antibodies, acute-phase reactants
148
Tx for RA
Early treatment with disease-modifying antirheumatic drugs. Goal is to delay disease progression. Joint destruction.
