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patho > exam #4 - MSK > Flashcards

exam #4 - MSK Flashcards

1
Q

factors that influence bone growth

A

nutrition - vit D, calcium
age - >30 more growth than destruction
hormones - calcitonin, estrogen (inhibits bone breakdown, stimulates bone formation) testosterone stimulates muscle growth - puts stress on bones, facilitates bone formation

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2
Q

inhibitors of bone growth/ factors that increase risk for fractures

A

smoking, obesity, age, anti-inflammatory or cytotoxic medications, steroids, excess alcohol/caffeine/ carbonated soft drinks, eating disorders, hyperthyroid, hyperparathyroidism (causes excess Ca to be reabsorbed from bone)

hormones - postmeno women - osteoclasts>osteoblasts - steady decrease in bone mass with age

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3
Q

stress fracture

A

repetitive fracture - more stress than bone is able to absorb - no acute trauma. xray may not show fracture first 2-4 weeks

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4
Q

fracture healing - step 1

A

fracture and inflammatory phase - hematoma
bleeding into tissue, inflammation to encourage WBCs
lasts hours to days

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5
Q

fracture healing 2

A

granulation tissue formation. fibrblasts attracted to area, growth of vascular tissue - 2 weeks

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6
Q

fracture healing 3

A

bony callus formation - closed in, well vascularized, spongy bone created healing outside. eventually will be replaced by mature bone. cannot weight bear

3-4 weeks post injury

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7
Q

fracture healing 4

A

lamellar bone deposition - ossification is beginning - callus replaced by lamallae of mineralize bone

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8
Q

fracture healing 5

A

remodeling - bony callus, dead portions of bone removed by osteoclasts, compact bone replaces spongy bone, excess material removed

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9
Q

what determines dx of fractures

A

location, type, direction/pattern
amount of soft tissue damage

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10
Q

complications of fractures

A

bleeding, nerve damage, nonunion/malunion, infection (osteomyelitis), thromboemboli (dvt or PE), fat embolism, compartment syndrome, fracture blister

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11
Q

osteomyelitis

A

bone infection - bacteria (common staph). can be exogenous or endogenous. 3 types

CM - chills, fever, tenderness, erythema, edema, pain without movement of infected extremity, loss of ROM. Dx is difficult

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12
Q

hematogenous osteomyelitis

A

osteomyelitis where bone becomes invaded with bacteria that is present in bloodstream, forms an abscess, bone becomes necrotic

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13
Q

contiguous osteomyelitis

A

direct bacterial infection or extension of an adjacent soft tissue infection - seen with trauma or surgery. common with older adults, PVD, diabetes

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14
Q

chronic osteomyelitis

A

infection persists longer than 6-8 weeks, fails to respond to antibiotic therapy. key feature - development of necrotic bone tissue that distinctly separates from surrounding living bone

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15
Q

DVT

A

Virchows triad - venous stasis, hypercoagulability, injury to vessel wall. common complication of orthopedic surgery

warm, edematous, +homans sign (pain in calf with dorsiflexion)

Dx - d-dimer, prothrombin time, fibrinogen level, ultrasound

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16
Q

Fat embolism

A

travelling fat thought to originate from fracture site
CM: resp failure, cerebral dysfunction, skin and mucosal petechial

within 12-72 hours of long bone/pelvic fracture

dx - ABG

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17
Q

compartment syndrome

A

common in anterior compartment of leg, after surgery or soft tissue injury

tissue pressure exceeds perfusion pressure - generally due to inflammation

5 Ps: pallor, paresthesia, paresis, pulseless, pain
tight and shiny skin
treatment - cut open fascia to allow for swelling

can lead to loss of limb, rhabdo, renal failure, death

18
Q

strain vs sprain

A

strain - overuse/improper use - low back and hamstrings
patho: stretching injury to muscle/tendon - causing spasm

sprain - quick twist or pull or a force that displaces joint from normal alignment- common location ankle
patho: ligament injury - overstretched
3 grades - grade 3 full thickness, 2 partial, 1 stretchin, small tears

19
Q

healing of sprains and strains

A

1) inflammatory exudate
2) granulation tissue frows
3) collagen formation

can take up to 3 months to regain mechanical stability of joint

CM: pain, swelling, changes in tendon or ligament contour, dislocation/subluxation of bones, decreased ROM, instability, weakness

20
Q

tendinopathy

A

aka tendinitis (wrong because inflammation not central to pathological process - instead failed healing from overuse)
patho - failed healing process of tendons, tendon thickening, inflammatory response (minimally present if chronic overuse tendinopathy)

21
Q

rhabdomyalosis

A

eti- crush injuries, burns, drugs, muscular contraction

breakdown of muscle that causes release of protein myoglobin into bloodstream. SO much breakdown clogs kidney -> renal failure. Elevated K+ and phosphate and CK >1000, could be >5000.

CM - pain weakness dark urine

22
Q

osteoarthritis

A

excess pressure + inflammation causes degradation of cartilage causing narrowing of joint space, and exposing bone. Chondrocytes synthesize proteoglycans in repair effort -> excess fluid -> swelling. as disease process goes on, less proteoglycans

slow progressive degenerative inflammatory disease. Risk factors: obesity, athletics, heavy occupational work

common >40yo, equal occurences f/m

23
Q

Osteoporosis

A

low bone density, prolonged negative calcium balance. hormonal disorders or drugs. linked to gender (women>men), genetics, age, nutritional deficiency of calcium or vitamin d

dexa scan/vitamin D test

24
Q

RA

A

Autoimmune - synovial inflammation/destruction of joint cartilage, genetic predisposition

seen in all ages (book says 20-40), differences depending on age (women>men)

worse in the morning, improves with movement
symmetrical involvement
can have systemic manifestations

25
Q

Systemic Lupus Erythematosus (SLE)

A

autoimmune
>women >african americans

autoantibodies & immune complexes -> direct tissue damage

arthralgias/arthritis common early sx, facial butterfly rash

hard to dx

26
Q

Gout

A

inc serum uric acid - deposit in joints and kidneys
primary- overproduction or poor elimination
secondary-due to prior diease (eg. renal failure or cancer)
joint - red, warm swollen (big toe - 80% of flareups)

fluid sample from joint - dx

untreated can lead to chronic arthritis

27
Q

factors that delay wound healing

A

age
tissue oxygen tension/hypoxia
vascular insufficiency
severe anemia
infection
edema
smoking
pain/stress
nutrition deficiencies
bacterial colinization
chronic diseases/DM
Pressure
medications (eg steroids)

28
Q

tissue repair

A
  1. primary intention - no tissue loss
    surgical incision
    infection could turn into secondary intention
  2. secondary intention - tissue loss, increased scar tissue
    burns
    slower healing –> larger scar formation
29
Q

steps of wound healing

A

hemostasis (5-15 minutes)
inflammatory phase (1st 24-48 hrs to 2wks) - platelet derived chemoattractands and growth factors, neutrophils and macrophages (clean, remove debris, release cytokines and growth factors)

prolipherative phase (3-4 days - 21 days) - granulation +angiogenesis

remodeling phase (few days -2 years)- collagen/ECM organization
(key - overlap)

stepwise:
1.bleeding, mast cells and damaged cells release histamine
2. increased blood flow
3. blood clot formed (loosely knit)
4. surface dries/hardens to from scab
5. macophages cleaning up beneath scab
6. formation of granulation tissue/angiogenesis
7. fibroblasts deposit collagen
8. epithelial cells migrate into wound bed beneath scab
9. slough off of scab

ideally acute wound will heal within 3 weeks

acute-> chronic - interuption of inflammatory and/or proliferation phase (inadequate blood supply, stalled immune response, bioburden (excess bacteria), inefficient host response

30
Q

CM of wound infection

A

fever, elevated WBC
inc amount/type wound drainage
inc pain, heat
regression of wound healing
education - nurses tell pts to watch out for after surgery

31
Q

Basal Cell Carcinoma

A

75% of all skin CA
slow growing
wide and deep
rarely metastasize
lesions on face, neck
pearly or ivory, slightly elevated

32
Q

Squamous cell carcinoma

A

tumor of epidermis
more malignant if left untreated
sun exposed areas
premalignant lesions (actinic keratosis), whitish discolored areas

33
Q

Melanoma

A

tumor of the melanocytes, rapid progress malignant
sun/UV exposure, family history (fair freckled skin)
90% on sun exposed skin for white ppl
darker skinned - occur in non sun exposed areas, such as mucous membranes

CM- erythema, inflammation, tenderness, ulcerate, bleed

34
Q

ABCDE

A

asymmetry, border irregularity, color, diameter (1/4 inch), evolution

35
Q

Contact dermatitis

A

type 4 hypersensitivity rxn
caused by synthetics, alloy, poison ivy, medications
cell-mediated, inc in igE - t-cells become sensitized to antigen and release inf. cytokines

CM: erythema, pruritis, edema
dx -patch testing

36
Q

Contact dermititis (irritant)

A

non-immunological inflammation of the skin such as diaper dermatitis - contact with urine, feces, chemicals, soaps, detergents

patho - disruption in epidermal barrier, damage to cell membranes leads to cytotoxic effect of keratinocytes- activates innate immunity - inflammation

dx - patch testing to determine antigen

can look similar to candida albicans, or turn into candida infection if untreated

37
Q

tinnea capitis

A

ringworm! fungal
sharing of combs/brushes, poor hygiene
most common in children 2-10 years
circular lesion

capitis - ringworm of the scalp
tinnea manus, tinnea unguium etc

38
Q

scabies

A

mite - burrows into epidermis
survival several days without blood supply
epi - poverty, malnutrition, sexual promiscuity
folds of skin, nipples, genitalia

39
Q

Lice (pediculosis capitis)

A

large affinity for skin covered by hair
males, black children less affected
female produces 100s of nits every 2 weeks

40
Q

Herpes zoster

A

shingles - reactivation of the varizella zoster virus
>50 yo, stress
zostavax vaccine 50% effective, shingrix 90% effective
travels up nerves
course is 4-5 weeks, along dermatomes, flu-like sx
can cause blindness, damage nerves

patho (4 decks)

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