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patho > exam #4 - MSK > Flashcards

exam #4 - MSK Flashcards

(40 cards)

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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

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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

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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

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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

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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

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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

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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

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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

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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
Systemic Lupus Erythematosus (SLE)
autoimmune >women >african americans autoantibodies & immune complexes -> direct tissue damage arthralgias/arthritis common early sx, facial butterfly rash hard to dx
26
Gout
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
factors that delay wound healing
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
tissue repair
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
steps of wound healing
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
CM of wound infection
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
Basal Cell Carcinoma
75% of all skin CA slow growing wide and deep rarely metastasize lesions on face, neck pearly or ivory, slightly elevated
32
Squamous cell carcinoma
tumor of epidermis more malignant if left untreated sun exposed areas premalignant lesions (actinic keratosis), whitish discolored areas
33
Melanoma
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
ABCDE
asymmetry, border irregularity, color, diameter (1/4 inch), evolution
35
Contact dermatitis
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
Contact dermititis (irritant)
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
tinnea capitis
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
scabies
mite - burrows into epidermis survival several days without blood supply epi - poverty, malnutrition, sexual promiscuity folds of skin, nipples, genitalia
39
Lice (pediculosis capitis)
large affinity for skin covered by hair males, black children less affected female produces 100s of nits every 2 weeks
40
Herpes zoster
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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