MS pathologies pt. 3 ( infection/trauma)

Question 1

Osteomyelitis pahto ?

Answer 1

Bacterial or fungal infection in bone

Question 2

Osteomyelitis routes ?

Answer 2

hematogenous

exogenous ( surgery or trauma)

contiguous ( soft tissue infection nearby )

Question 3

Osteomyelitis – 
ACUTE hematogenous patho ?

Answer 3

Bacteria lodge in end artery of metaphysis and multiply below periosteum

**rarely goes into the joint and cause septic arthritis cause the epiphyseal is a barrier ** - can see its not in the joint cause the epiphyseal plate

Question 4

Osteomyelitis – 
ACUTE hematogenous Hx ?

Answer 4

Have history of infection, e.g. strep throat, skin, UTI

Question 5

Osteomyelitis – 
ACUTE hematogenous sxs ?

Answer 5

pain, malaise, anorexia, vomiting, fever ( vague)

Question 6

Osteomyelitis – 
ACUTE hematogenous dx ?

Answer 6

blood culture (+/-)

Question 7

Osteomyelitis – 
ACUTE hematogenous pathologic organisms ?

Answer 7

S. aureus, Hemolytic strep, H. flu

Question 8

Osteomyelitis – 
ACUTE hematogenous Tx ?

Answer 8

IV antibiotics, possibly surgical drainage

Question 9

Osteomyelitis – CHRONIC patho ?

Answer 9

Occurs when acute infection is untreated or tx fails

Fragment of necrotic bone gets walled off – sequestrum

May lie quiet for months-years

Question 10

Osteomyelitis - Chronic facts ?

Answer 10

More sequestra form, bone gets deformed

Diabetics more prone cause they do not heal well cause circulation

Multiple organisms common

Question 11

Osteomyelitis - Chronic tx ?

Answer 11

surgical debridement, bone reconstruction

Question 12

Sprains – ligamentous injury 1st degree ?

Answer 12

minimal pain, no joint instability

Question 13

Sprains – ligamentous injury 2nd degree ?

Answer 13

moderate pain, min. joint instability, partial ligament rupture

Question 14

Sprains – ligamentous injury 3rd degree ?

Answer 14

severe pain, completely unstable joint, complete ligament tear

**later angle injuries are more common more inversion injuries **

**tuning fork on it - hurts? then yes fracture but it does not hurt if the ligament is tore etc **

Question 15

Strains – muscle injury 1st degree ?

Answer 15

– mildly or slightly pulled muscle, pain, spasm, swelling, ecchymosis

Question 16

Strains – muscle injury 2nd degree ?

Answer 16

– moderately pulled, pain, spasm, swelling, torn muscle fibers

Question 17

Strains – muscle injury 3rd degree ?

Answer 17

– severely pulled, loss of muscle function, palpable defect, ruptured muscle or tendon. Possibly avulsion fx at tendinous attachment ( ecchymosis, spasms, and prolongs liability)

Question 18

Compartment syndrome causes and patho ?

Answer 18

Fx, crush injury, hemorrhage, burn, edema –

increased pressure in fascial compartment on arteriole walls

Compromises circulation in that space

**not diffusely the whole limb just a compartment and the blood is taking up space and it causes pressure o the arterial wall ( distal pulses are okay)

no risk of whole limb ischemia just the compartment ischemia **

Question 19

Compartment syndrome Red Flags ?

Answer 19

Pain is out of proportion to injury

Pain is persistent & progressive

Weakness or paralysis of muscle

Tense compartment on palpation

Distal pulses remain intact

**casting should make them feel better but if in a cast and still pain then this is a problem and it is probably this

distal pulses are still okay

pain that is unrelieved with rest **

Question 20

Compartment syndrome dx ?

Answer 20

check compartment pressure with monitor

Question 21

Compartment syndrome tx ?

Answer 21

fasciotomy ASAP, with partial closure ( slices through the tissue and let compartment breath again)

**which compartment has a higher pressure **

they will do a partial closure and wait for swelling to go down ( and maybe need to go back to the OR to get all the other stuff out of there)

Question 22

Fibromyalgia Syndrome etiology ?

Answer 22

Etiology unknown

Question 23

Fibromyalgia Syndrome sxs and PE ?

Answer 23

Widespread muscle pain, worst in AM

No limitation of movement but stiffness

Trigger points – symmetric, often neck, shoulders, hands, back, knees

Question 24

Fibromyalgia Syndrome own notes ?

Answer 24

bilateral above and below the waits

need 11/18 tender with no sxs. pressure points positive to dx or 6 with ass. sxs.

these patients are hypersensitive and have a lower pain threshd

paints dont sleep well and are very fatigued

Question 25

Fibromyalgia patho ?

Answer 25

Unpredictable pattern of spread Maybe aberrant pain signaling and amplification

Question 26

Fibromyalgia triggers ?

Answer 26

Triggers – immobility, overuse, cold temps. No edema, but TTP

Question 27

Fibromyalgia dx ?

Answer 27

Dx of exclusion

Question 28

Fibromyalgia tx ?

Answer 28

some what physically active but do not over due it

Question 29

Polymyalgia Rheumatica (PMR) etiology ?

Answer 29

UKN

Question 30

Polymyalgia Rheumatica (PMR) age and gender ?

Answer 30

+50 years, F>M ( middle age women)

Question 31

Polymyalgia Rheumatica (PMR) locations ?

Answer 31

Hip, shoulders, neck, symmetric

Question 32

Polymyalgia Rheumatica (PMR) sxs ?

Answer 32

Sudden or gradual onset Worst in AM Chronic, but ultimately self-limiting Associated malaise, depression, weight loss No true weakness * *muscle pain not the joints * *

Question 33

Polymyalgia Rheumatica (PMR) dx ?

Answer 33

no dx test so we treat sxs.

Question 34

Most common metabolic bone disease in US ( and preventable) ?

Answer 34

Osteoporosis

Question 35

Osteoporosis gender ?

Answer 35

Females>Males ( cause estrogen loss after menopause)

Question 36

Osteoporosis etiology ?

Answer 36

↓ estrogen, chronic us of steroids, hyperthyroidism not well controlled, immobilization, smoking, malignancy 50% of postmenopausal women sustain an osteoporosis-related fracture **alot of patient education here **

Question 37

Osteoporosis risk factors ?

Answer 37

Postmenopausal +50 years Weight<154 lbs Low dietary calcium Vita D deficiency - no sunlight Tobacco and ETOH use Fx in a first degree relative Use of corticosteroids Medical conditions Medications Inflammatory disorders **thin petite people dietary supplemets are a much better source celiacs disease etc cause no absorptions ( this is alot of risk fcto5rs ) **

Question 38

Osteoporosis: increased bone resorption ?

Answer 38

osteoclast

Question 39

Osteoporosis: normal bone formation ?

Answer 39

osteoblasts

Question 40

Osteoporosis have a high risk of ?

Answer 40

Fx **ridges are fragile and susceptible to breaking down ** **susceptible to compression fractures as they get older ( grandma getting shorter) loss of muscle bulk too **

Question 41

Osteoporosis PE, signs?

Answer 41

Decreased height Usually asymptomatic until fx **susceptible to compression fractures as they get older ( grandma getting shorter) loss of muscle bulk too **

Question 42

Osteoporosis dx ?

Answer 42

DEXA scan, check bone density

Question 43

Osteoporosis: DEXA screening ?

Answer 43

Screen at 65, younger if at risk | unless they have been VD defficeicnt for a long time to on steroid for a long time you can check earlier

Question 44

Osteoporosis sxs. ?

Answer 44

usually asxs, until fracture

Question 45

Osteoporosis Tx ?

Answer 45

prevention! Dietary calcium (better than supplements) - 1200 mg a day ( but need VD for absorption) Vitamin D – sun, food, supplements ( havent seen a benefit of supplements after 5 years ( max out effectiveness) ) Weight-bearing exercise Bisphosphonates – Fosamax, Actonel, Boniva (decrease osteoclastic activity) Risk of osteonecrosis of the jaw - rare but dramatic when you see it ( side effect of bisphosphonates)

Question 46

Bisphosphonates side effects ?

Answer 46

Risk of osteonecrosis of the jaw - rare but dramatic when you see it ( side effect of bisphosphonates)

Question 47

Metastatic bone disease hx ?

Answer 47

Hx of a primary cancer in prostate, breast, lung, thyroid, kidney

Question 48

Metastatic bone disease sxs. ?

Answer 48

nocturnal pain, unrelieved with rest, weight loss, hx of CA

Question 49

Metastatic bone disease what may be the first sign ?

Answer 49

Pathologic fx may be first sign – from minor event, due to thin bones **first sing might be a fracture bone from a minor event like hitting it on the door or sneeze and break a rib **

Question 50

Metastatic bone disease dx ?

Answer 50

bone scan, looking for “hot spots” of increased activity - ↑ serum alk phos **hot spot - increase uptake in dye ( no definitive - could just be more activity there but a good clue) **

Question 51

Ehlers-Danlos Syndrome saying ?

Answer 51

“damn that girl is lose”

Question 52

Ehlers-Danlos Syndrome patho ?

Answer 52

Hereditary connective tissue disorder (autosomal dominant or recessive trait)

Question 53

Ehlers-Danlos Syndrome prevalence ?

Answer 53

1/10000 to 1/25000 20,000-50,000 EDS patients in the US

Question 54

Ehlers-Danlos Syndrome signs and sxs. ?

Answer 54

joint hypermobility skin hyper extensibility tissue fragility pain recurvatum of the knees **runs in families and not common and they are in alot of pain no opioids they need to learn to cope with it **

Question 55

Ehlers-Danlos Syndrome vascular types prevalence ?

Answer 55

5%

Question 56

Ehlers-Danlos Syndrome vascular types ?

Answer 56

deficit of collagen TIII decreased /absent collagen synthesis or abnormalities in collagen secretion

Question 57

Ehlers-Danlos Syndrome prognosis ?

Answer 57

poor prognosis most severe subtype ( vascular) life threatening vascular ruptures Anuerysm formation