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Pathophysiology > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

What are the purposes of the skeletal system?

A

-Gives body form
-Supports tissues (keeps things in place)
-Permits movement
-Protects organs like the brain, spinal cord, heart, and lungs
-Mineral storage

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2
Q

____ bone is a dense shell that defines the shape of the bone and makes up 85% of skeletal tissue; gives our bones strength and covers the inside of the bone

A

Compact

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3
Q

____ bones gives bone a lattice framework; contains red and yellow marrow

A

Spongey

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4
Q

____ is the covering of the bone; it has two layers, the inner layer anchors to the bone and the outer layer carries blood vessels to penetrate all layers of the bone

A

Periosteum

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5
Q

____ is the lining for soft bone

A

Endosteum

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6
Q

____ are the bone-building cells

A

Osteoblasts

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7
Q

____ maintain the bony matrix and facilitate nutrient extraction from the blood

A

Osteocytes

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8
Q

____ are involved in the resorption of bone and contain hydrolytic enzymes that are especially active after a bone break or with the release of parathyroid hormone

A

Osteoclasts

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9
Q

____ is the formation of pre-bone

A

Ossification

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10
Q

____ describes the process of depositing minerals into bone; minerals bind to collagen fibers in the bone to give tensile and compression strength

A

Calcification

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11
Q

The bone ____ is the extracellular elements of bone tissue

A

Matrix

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12
Q

_____ fibers are synthesized by osteoblasts

A

Collagen

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13
Q

Collagen fibers are formed as ____ ____, and three of them twist into a fibril; fibrils will form crossing patterns with holes where minerals will be deposited

A

Alpha chains

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14
Q

Collagen fibers provide tensile ___ and ____

A

Strength and support

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15
Q

____ is a mineral deposited into the bones for storage and strength

A

Calcium

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16
Q

____ exist in the bony matric and shuttle calcium around and form a network between fibrils to strengthen bone

A

Proteoglycans

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17
Q

____ binds to calcium and inhibits calcium-phosphorus precipitation; it recruits osteoclasts

A

Osteocalcin

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18
Q

Osteonectin binds to ____ in bone as well and promotes bone growth

A

Calcium

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19
Q

____ stimulates neurite and axon growth and stimulates the bony membrane

A

Laminin

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20
Q

Bone ____ transports elements like calcium and electrolytes into the bone

A

Albumin

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21
Q

Alpha _____ binds to calcium and activates osteoclasts

A

Glycoprotein

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22
Q

____ marrow is the site of hematopoiesis and is biologically active

A

Red

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23
Q

____ marrow is made up of fat tissue

A

Yellow

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24
Q

A bone ____ is a break in the continuity of the bone

A

Fracture

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25
Q

Who are at the highest risk for bone fractures?

A

-Young males
-Elderly (have thinner matrix)
-Individuals with bone or calcium disorders

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26
Q

A ____ (simple) fracture is non-communicating between skin and bone

A

Closed

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27
Q

An ____ (compound) fracture is communicating between the skin and bone (bone pokes through the skin)

A

Open

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28
Q

A ____ fracture causes multiple bone fragments (eggshell)

A

Comminuted

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29
Q

____ fractures are parallel to the long axis of the bone

A

Linear

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30
Q

____ fractures are horizontal fractures of the bone and are usually more serious than linear

A

Transverse

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31
Q

____ fractures are all the way through the bone

A

Complete

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32
Q

_____ fractures are not all the way through the bone, and are more common in flexible, growing bones of children

A

Incomplete

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33
Q

____ fractures occur when part of the bone that is attached to a ligament breaks off

A

Avulsion

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34
Q

____ fracture is when a bone breaks due to weakening from disease, commonly with weak force (occurs with tumors, osteoporosis, infection, and metabolic bone disorders)

A

Pathologic

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35
Q

____ fractures are incomplete microfractures due to low-impact stress

A

Stress

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36
Q

____ fractures are a break only in the cortex (outer layer) of bone and are more common in kids

A

Greenstick

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37
Q

Manifestations of bone fractures vary by site and type, but commonly include…

A

-Unnatural alignment
-Swelling
-Tenderness, muscle spasms
-Pain
-Impaired sensation (pinched nerve, severed nerve)
-Impaired function and crepitus (air pockets in the skin that sounds like bubble wrap)

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38
Q

What are the four phases of fracture healing?

A

-Hematoma formation if vessels have been damaged (hours)
-Inflammatory phase (1-2 days)
-Reparative phase (1 week to months)
-Remodeling phase (several weeks and beyond)

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39
Q

What happens during the first phase of fracture healing, hematoma formation?

A

-Fibrin and platelet entry
-Surrounding bone death
-Cytokine entry
-Inflammatory process is initiated

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40
Q

What happens during the second phase of fracture healing, the inflammatory phase?

A

-Cytokines, enzymes, and growth factors enter the site
-Vasodilation (leukocyte and mast cell entry)
-Osteoblast entry
-Procallus formation
-Cartilage and collagen formation

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41
Q

What happens during the third phase of fracture healing, the reparative phase?

A

-Osteoblasts form membranous bone, “callus”
-Phosphate content is increases
-Callus is replaced by bone

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42
Q

What happens in the fourth phase of fracture healing, the remodeling phase?

A

-Periosteum/endosteum remodeling to give shape and strength to the bone so it can function normally
-Weight-bearing and motility

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43
Q

Factors that affect healing of bone:

A

-Nature of the injury
-Immobilization and realignment (traction)
-Infection
-Hormones, growth factors, vitamin D, calcium

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44
Q

What are some complications of healing?

A

-Union
-Fat emboli syndrome
-Compartment syndrome
-Osteomyelitis

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45
Q

With a ____, there is a failure of the bone to grow together when it heals

A

Nonunion

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46
Q

With a _____ union, it takes longer than normal for the fracture to heal

A

Delayed

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47
Q

With a ____, the bones don’t join up correctly

A

Malunion

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48
Q

Fat emboli syndrome occurs when there is _____ to long bones

A

Trauma

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49
Q

Mechanism of fat emboli syndrome:

A

-Abnormal fat metabolism
-A piece of fat from the marrow moves out into the bloodstream and then there is fat traveling through the lungs which eventually causes an embolism

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50
Q

Fat emboli syndrome is most common in ____ or ____ fractures and there is increased risk if the injury is not properly immobilized

A

Femur or pelvis

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51
Q

When the fat is traveling to the lungs, ____ adhere to it and it causes acute respiratory distress syndrome

A

Platelets

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52
Q

Manifestations of fat emboli syndrome:

A

-Hypoxia on ABG
-Low hemoglobin
-Thrombocytopenia
-Fat in blood clots

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53
Q

Compartment syndrome causes abnormal increases in ____ within a confined anatomic space, resulting in impaired circulation, nerve injury, and loss of muscle

A

Pressure

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54
Q

Compartment syndrome usually occurs in someone in a ____ or constrictive dressing

A

Cast

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55
Q

Pathogenesis of compartment syndrome:

A

-Increased pressure
-Lack of blood flow
-Nerve damage
-Muscle death

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56
Q

Compartment syndrome risk is increased with…

A

-Casting
-Infection
-Burns
-Repeat stress

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57
Q

Mechanism of compartment syndrome:

A

-Weight of limb cases cell damage
-Cell damage causes edema
-Edema increases pressure
-Tamponade effect
-Muscle/nerve cell infarction and death
-Myoglobin release
-Further edema

58
Q

Manifestations of compartment syndrome:

A

-Pain
-Paresthesias
-Pressure > 30mmHg (pulselessness)
-Release of myoglobin
-Elevated creatinine kinase

59
Q

Compartment syndrome is treated with ____

A

Fasciotomy

60
Q

_____ is an infection of the bone

A

Osteomyelitis

61
Q

What are two possible etiologies of osteomyelitis?

A

-Direct contamination (exogenous): someone has an open fracture and it gets infected at the time of the injury (common with gut shot wounds and bites)
-Hematogenous (endogenous): blood to bone; infectious agent moves from the blood to the bone, seen when someone has an infection anywhere in the body that moves to the bone

62
Q

Manifestations of osteomyelitis:

A

-Varies with age, site, organism, and source
-Inflammation
-Fever
-Malaise
-Anorexia
-Weight loss
-Septicemia
-Swelling, erythema, tenderness
-Pain
-WBC elevation or not

63
Q

Complications of osteomyelitis:

A

-Arthritis
-Pathological fractures
-Chronic osteomyelitis
-Bone cancer

64
Q

____ ____ increases serum calcium and is released when there is low blood calcium and stimulates osteoclasts to break down and increases kidney resorption of calcium

A

Parathyroid hormone

65
Q

____ decreases serum calcium, decreases osteoclast activity, decreases renal absorption of calcium (more excreted in urine), and overall has the opposite effect of PH

A

Calcitonin

66
Q

Vitamin ____ needs to be metabolized to be active; it is heavily regulated by parathyroid hormone and helps to maintain calcium

A

D

67
Q

____ is a disease that causes a higher rate of bone resorption than bone formation, which leads to decreased density of bone tissue

A

Osteoporosis

68
Q

We are able to build bone through our ____, and things like exercise and healthy diet with calcium and vitamin D can help

A

30s

69
Q

We have ___% bone loss every year after age 40, and 1% per year in menopausal women

A

0.5

70
Q

Osteoporosis is uncommon in ____ ____

A

African Americans

71
Q

_____ are a drug that break down bones by inhibiting osteoblasts

A

Corticosteriods

72
Q

Osteoporosis is ____ in men

A

Secondary

73
Q

What are some causes of osteoporosis?

A

-Estrogen (decreased levels after menopause, overstimulated osteoclasts)
-Dietary (decreased dietary intake of calcium, magnesium, vitamin D; phosphate binds calcium and makes it inactive and promotes osteoclasts)
-Exercise can help keep and maintain bone mass
-Smoking cessation may help (smoking decreases estrogen)
-Hormones
-Drugs

74
Q

What are some pathological changes seen with osteoporosis?

A

-Loss of organic matrix and the mineral content of bone
-Loss of spongey (cancellous) bone
-Decreased thickness of bone cortex
-Slower cycle of bone remodeling (we normally replace bone every 40 days, but it would take 2 years with osteoporosis)
-Menopause: decreased estrogen

75
Q

Manifestations of osteoporosis:

A

-Pain
-Fractures
-Kyphosis (slumping of spine)
-Fatal complications include fat or pulmonary emboli, hemorrhage, shock

76
Q

____ provide stability where bones meet

A

Joints

77
Q

_____ are immovable joints like in the skull or between the tibia and fibula

A

Aynarthroses

78
Q

_____ are slightly moveable joints like where the rib meets the sternum or the pubic bones

A

Amphiarthrosis

79
Q

____ are a fibrous joint capsules supported by cartilage like the elbow and shoulder

A

Diarthroses

80
Q

The ____ cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints

A

Articular

81
Q

The ____ ____ is the inner lining of the joint

A

Synovial membrane

82
Q

The ___ ___ acts as lubricant for joints

A

Synovial fluid

83
Q

____ ____ is an autoimmune, systemic inflammatory disease which causes inflammation of connective tissue, primarily in the joints

A

Rheumatoid arthritis

84
Q

Rheumatoid arthritis affects 1-2% of the population, and is much more common in what gender (3:1)?

A

Women

85
Q

Peak incidence age is between ___-___ for rheumatoid arthritis (peak onset is between age 30-50)

A

40-60

86
Q

What are three possible causes of rheumatoid arthritis?

A

-Genetics
-Viral infection earlier in life (EBV) or possibly even bacterial infection
-Hormones (estrogen-androgen imbalance

87
Q

___ ___ is an auto-antibody that attacks the host connective tissue

A

Rheumatoid factor

88
Q

Rheumatoid factor gets into the joints and activates the ____ cascade to cause massive inflammation in the joint

A

Compliment

89
Q

The massive inflammation in the joint causes ____ enzymes to develop in the joint which destroys the cartilage

A

Lysosomal

90
Q

Once the cartilage is destroyed, there is ____ formation which limits mobility and eventually leads to immobility of the joint

A

Pannus

91
Q

Manifestations of rheumatoid arthritis are variable, seasonal, and systemic, but some systemical manifestations may include…

A

-Inflammation
-Weight loss, anorexia, fatigue
-Aching, stiffness
-Raynaud’s syndrome
-Respiratory dysfunction
-Hearing difficulties
-Kidney problems

92
Q

What joints are usually affected by rheumatoid arthritis?

A

-Fingers
-Hands
-Wrists
-Feet

93
Q

What symptoms does rheumatoid arthritis cause in the joints?

A

-Pain, stiffness (especially in the morning)
-Swelling
-Mobility
-Cyst formation/rupture

94
Q

One example of a degenerative joint disease is ____

A

Osteoarthritis

95
Q

Risk of osteoarthritis increases with ____ and is more likely to affect those over 40 years old

A

Age

96
Q

Primary osteoarthritis is ____ and affects all joints in the body

A

Idiopathic

97
Q

Secondary osteoarthritis is more ____, and has known risk factors

A

Common

98
Q

Osteoarthritis is more common in what gender?

A

Men

99
Q

The cause of osteoarthritis is joint instability which can be caused by…

A

-Genetics
-Repetitive impact loading (sports=most common cause)
-Congenital
-Trauma
-Other disorders
-Certain drugs

100
Q

Mechanism of osteoarthritis:

A

-Progressive loss of cartilage
-Thickening and hardening of bone ends
-Bone spur formation
-Cyst formation

101
Q

Manifestations of osteoarthritis:

A

-Severe joint pain (aggravated by weight bearing)
-Stiffness
-Limitation of motion
-Joint instability
-Deformity
-Synovitis

102
Q

____ is caused by an increased level of uric acid, which leads to an inflammatory response

A

Gout

103
Q

The cause of primary gout is unknown, but secondary gout can be caused by…

A

Hyperuricemia-producing drugs or disorders

104
Q

Males and females are both affected by gout, but the ____ of onset differs between genders since estrogen may be protective

A

Age

105
Q

Gout can be caused by ____ or ____ factors

A

Genetics or environmental

106
Q

Mechanism of gout:

A

-Purine metabolizes to uric acid
-Uric acid builds up, forming monosodium urate crystals
-Crystals deposit in joints, stimulating inflammation
-Neutrophil involvement
-Phagocytosis of crystals, phagocytes burst

107
Q

Manifestations of gout:

A

-Increased uric acid (uricemia)
-Deposition of monosodium urate, neutrophils, and phagocytes (recurrent attacks of pain)
-Joint pain
-Renal disease (kidney stones)
-Tophi development (uric acid in the skin)

108
Q

What are the three stages of gout?

A

-Asymptomatic
-Acute gouty arthritis: one attack of gout, maybe a second one much later
-Chronic tophaceous arthritis: progressive inability to excrete uric acid (deposit in joints and soft tissue)

109
Q

The ____ is the connective tissue that gives form to the muscle

A

Fascia

110
Q

The epimysium connects ____ to ____ (tendons)

A

Muscle, bone

111
Q

The ____ is the middle layer of the muscle tissue; it creates smaller bundles of fibers

A

Perimysium

112
Q

The _____ surrounds individual fascicles

A

Endomysium

113
Q

____ are individual muscle fibers

A

Fascicles

114
Q

The motor unit is the individual ___ ___ cell (lower motor neuron) and the muscle it innervates

A

Anterior horn

115
Q

There are many ___ ___ that form a neuron

A

Motor units

116
Q

Muscle fibers are innervated by ____ ____ neurons

A

Lower motor

117
Q

Muscles contract as a _____ and there are many motor units in a single muscle

A

Whole

118
Q

_____ units/receptors of the muscle cell bring sensory information into the muscle to get the right amount of contraction for the desired function

A

Sensory

119
Q

____ are mechanoreceptors that sense stretch, they lie within the muscle fibers

A

Spindles

120
Q

____ ____ organs are nerve cells that terminate on the tendon (gives us dynamic information about the stretch)

A

Golgi tendon

121
Q

____ run the length of the muscle fiber and are the basic contractile unit of the muscle

A

Sarcomeres

122
Q

Muscle function is an “___ __ ___” mechanism

A

All or nothing

123
Q

Steps of muscle function:

A

-Activation: depolarization
-Coupling: calcium release
-Contraction: calcium binds to troponin and causes tropomyosin to move to allow for actin/myosin to contract
-Relaxation: calcium absorption
-Smoothing

124
Q

____ contraction does not change the length of the muscle (no limb or joint movement occurs)

A

Isometric

125
Q

____ contraction does change the length of the muscle (produces limb movement)

A

Isotonic

126
Q

Symptoms of alterations in muscular function:

A

-Pain, tenderness
-Weakness
-Muscle wasting
-Fatigue and/or exercise intolerance

127
Q

_____ is muscle cell loss

A

Rhabdomyolysis

128
Q

Rhabdomyolysis can be caused by…

A

-Crush syndrome
-Compartment syndrome
-Immobilitty
-Viruses
-Drugs
-Tetanus
-Heat stroke
-Electrolyte disturbances

129
Q

Pathophysiology of rhabdomyolysis:

A

-Weight of extremity generates pressure
-Ischemia
-Edema increases pressure in the compartment
-Eventual tamponade causes infarction, nerve damage, and cell death
-Muscle tissue death releases myoglobin
-Myoglobin damages kidneys

130
Q

Manifestations of rhabdomyolysis:

A

-Regional effects (compartment syndrome)
-Renal syndrome (myoglobin in the urine)
-Systemic effects (high creatinine)

131
Q

____ disorders affect the thyroid, which regulates muscle protein synthesis and electrolyte balance

A

Endocrine

132
Q

____ ____ is a myophosphorylase deficiency (lack of muscle phosphorylase)

A

McArdle disease

133
Q

Myophosphorylase is an enzyme that assists in ____ breakdown in tissue, so McArdle disease can cause energy failure and symptoms like fatigue and muscle intolerance

A

Glycogen

134
Q

____ ____ deficiency causes abnormal glycogen metabolism and an accumulation of glycogen

A

Acid mutase

135
Q

____ disease is an infant version of acid mutase deficiency

A

Pompei

136
Q

____ deficiencies also lead to energy failure since our muscles need fat

A

Lipid

137
Q

What are two examples of inflammatory muscle disorders?

A

-Myositis
-Polymyosititis

138
Q

Myositis is a viral, bacteria, or parasitic infection of the ____; can be caused by Trichinosis

A

Myositis

139
Q

____ is an autoinflammatory disorder that leads to the accumulation of B, Th, and Tc cells in muscle cells

A

Polymyositis

140
Q

Impact of age on bones:

A

-Become brittle
-Impact is greater in women than men
-Decreased height

141
Q

Impact of age on joints:

A

-Stiffness due to cartilage changes
-Decreased range of motion

142
Q

Impact of age on muscle:

A

-Sarcopenia (age-related muscle loss)
-Decreased muscle strength
-Reduced oxygen intake, metabolic rate, and lean body mass

Pathophysiology (18 decks)

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