Unit 14 Chapters 47-50 Flashcards
(225 cards)
1
Q
if a patient has an injury and has a BP of 60 what kind of shock is this
A
hypovolemic
2
Q
someone could have a severe injury but the BP would be within normal limits, could they still be in shock?
A
yes, sympathetic nervous is working good
3
Q
since we know someone could have normal BP and still be in shock, what should we do?
A
look at the mechanism of the injury
4
Q
what does a pelvic fracture look like and how many units of blood is loss
A
the fracture would not break skin so it would be a closed fracture and 4-6 units of blood would be loss
5
Q
if we have someone who has hypovolemia and we are unable to restore volume and they are not purfusing, why would they develop metabolic acidosis
A
because oxygen is not being delivered to the tissues so they switch from aerobic to anaerobic and is releasing lactic acid
6
Q
if we have a 20 year old come in with SEVERE leg trauma what shock could he develop at this point in time
A
hypovolemic
7
Q
if we have that same 20 year old come in with SEVERE leg trauma and we give him an antibiotic, what shock could develop after this
A
anaphlacytic
8
Q
if we have that same 20 year old come in with SEVERE leg trauma and its 2 weeks after injury what shock could he develop
A
sepsis
9
Q
if we have that same 20 year old come in with SEVERE leg trauma what would be his first acid base disorder that would develop
A
respiratory alkalosis
10
Q
if we have that same 20 year old come in with SEVERE leg trauma WHY would he develop respiratory alkalosis as his first acid base disorder
A
chemoreceptors sense low O2 levels
baroreceptors sense low pressure
= accelerated breathing
11
Q
do closed fractures still result in blood loss
A
yes
12
Q
why do you get bleeding when you break a bone
A
bone contain hematopoietic connective tissue to form blood cells
13
Q
bones are a storage reservoir for
A
calcium
14
Q
where are osteoblasts found
A
periosteum, endosteum, epiphyseal plate
15
Q
osteoblasts are responsible for
A
formation of bone matrix
16
Q
2 stages of osteoblasts
A
ossification and calcification
17
Q
osteoblasts secrete what that is a useful blood test
A
alkaline phosphatase
18
Q
osteocytes are responsible for what
A
maintaining the bony matrix
19
Q
osteocytes play an active role in releasing
A
calcium
20
Q
osteoclasts are responsible for
A
reabsorption of bone matrix and release of calcium and phosphate from bone
21
Q
what bone cells are the mature ones
A
osteocytes
22
Q
what bone cells are the building cells
A
oteoblasts
23
Q
if someone has high amounts of osteoclasts what minerals may they have elevated in their blood
A
calcium and phosphate
24
Q
cells in the growth plate stop dividing at ____________ at which time the epiphysis and metaphysis fuse
A
puberty
25
if there is a fracture at the growth plate in a prepubescent child what would happen
growth is put in jeprody
26
red bone marrow contains
developing RBC
27
yellow bone marrow is composed of
adipose tissues
28
in children where is redbone marrow found
most bones
29
in adults where is red bone marrow found
vertebrae, ribs, sterum, and ilia
30
if you have an older patient who needs a bone biopsy where might it get taken from
ilia and sternum
31
since each joint of an extremity is innervated by all the peripheral nerves that cross the articulation- they may experience
referred pain from one joint to another
32
since we know people could exerpeince referred pain with joints what should we do during examination
exam joint above and below complained site
33
a young child comes in and is complaining of knee pain, where should you examine
knee, ankle and hip/thigh region
34
cause of musculoskeletal injuries
blunt tissue trauma, disruption of tendons and ligaments, fractures of bony structures
35
acute injuries in athletic individuals is caused by
sudden trauma
36
acute injuries in athletic individuals is not always bone injuries, what else could it be
injury to soft tissues
37
overuse injuries in athletic individuals is acute/chronic?
chronic
38
what is an example of overuse injuries in athletic individuals
stress fracture
39
contusion
skin intact, ecchymotic; an injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a hard object
40
hematoma
large area of local hemorrhage
41
a large contusion is
hematoma
42
a small hematoma is
contusion
43
laceration
skin torn, continuity disrupted
44
can a laceration be on purpose
yes, ex: surgery
45
strain
STRETCHING injury to muscle or musculotendious unit from mechanical overloading
46
sprain
abnormal or excessive movement of joint with disruption to ligaments
47
sprain will form new collagen within
4-5 days
48
with a sprain the original strength within __ weeks
7
49
repair in soft tissues is accomplished by
fibroblasts
50
in soft tissues healing _____________ infiltrate the injured area during the initial healing process
capillaries
51
in soft tissues healing the formation of long __________ bundles occurs
collagen
52
dislocations
loss of articulation of the bone ends in the joint capsule caused by displacement or separation
53
movement of shoulder relies heavily on support of four relatively small muscles called
rotator cuff
54
anytime a muscle injury occurs always asses neurovasuclar status of area because it can be disrupted
EX: dislocated patella could
rupture nearby arteries
55
rotator cuff injuries occurs due to
repetitive movements
56
rotator cuff injuries are common in
pitchers, swimmers, weight lifters
57
if you have a partial rotator cuff injury will that require surgery
no
58
if you have a full thickness rotator cuff injury will that require surgery
yes
59
WHO ARE MORE AT RISK FOR ROTATOR CUFF INJURIES
ATHELETES
60
classification of fractures is by
cause
location
types
pattern of fracture line
61
cause of fracture classification
sudden injury
stress fractures
pathologic fractures
62
what is a pathologic fracture
fracture because of a disease
63
example of diseases that could cause pathologic fractures
cancer, osteogenic imperfecta, osteoporosis
64
location of fracture classification
proximal
midshaft
distal
65
types of fracture classification
open or closed
66
why would a person with an open fracture get seen faster than a person with a closed fracture
because skin integrity is ruined and they are more at risk for infection/sepsis
67
you do not always know you have a fracture until
X-ray
68
signs and symptoms of a fracture
pain, tenderness, swelling, loss of function, deformity, abnormal mobility
69
after you place a splint what and where should you always check
distal pulse
70
5 stages of bone healing
1. hematoma formation
2. cellular proliferation
3. callus formation
4. ossification
5. remodeling
71
during hematoma and cellular proliferation
hematoma facilitates the formation of the _______ ___________ that seals off fracture site and serves as framework for the influx of ___________ cells, ____________ and new _________ ____
fibrin meshwork, inflammatory, fibroblasts capillary buds
72
fibrocartilagnous callus formation
formation of granulation tissue called ___________. _________ proliferate and invade pro callus. Fibroblasts produce a ______________ _____ ________ bridge that connects bone fragments
procallus, fibroblasts, fibrocartilaginous soft callus
73
can you weight bare during the fibrocartilaginous callus formation stage
NO WEIGHT BERING YET
74
during bony callus formation
fibrocartilaginous cartilage is converted to _______ _________, _____________ first deposit bone on outer surface of bone and move inward. begins at ______ weeks after injury
bony callus, osteoblasts, 3-4
75
can you weight bare during bony callus formation
yes, this is usually when the cast is removed
76
remodeling phase
dead portions of bone are removed by _____________ and _______ bone replaces ________ bone.
osteoclasts, compact, spongy
77
is there evidence that you have had a fracture before
yes, a thickened area remains
78
in the remodeling phase are osteoclasts good
yes
79
vasucular anatomy of ________ head is critical
femoral
80
if you have a hip injury the viability of femoral head may lead to
avascular necrosis
81
what is avascular necrosis
no blood vessel to rest of leg
82
what is the most common cause of hip injuries
falls
83
a 200 pound man is travling in a car at 50 miles per hour when he loses control of the vehicle and strokes a telephone pole in a head on collision. Approximately how many pounds of forces was the man subjected to within milliseconds
10,000lbs
84
if you have an open book pelvis fracture in a man, what are they at risk for
rupture of urethra
85
4 complications of fractures
development of fat emboli
compartment syndrome
hypovolemic shock
infection
86
compartment syndrome is tissue compromise from
pressure in the muscle compartment
87
what is the hallmark symptom of compartment syndrome
PAIN OUT OF PROPORTION TO THE ORIGINAL INJURY
UNRELENTING PAIN
88
compartment syndrome can be dangerous because the expanding muscle could compress
nerves and arterties
89
5 P's of compartment syndrome
paresthesia, pallor, proprioception, pain, pulse
90
why might an individual with compartment syndrome have paresthesia
nerve is compressed
91
why might an individual with compartment syndrome have pallor
blood artery is compressed
92
if you wait until an individual with compartment syndrome to have no pulse what might happen
loss of the limb
93
what is proprioception
tell direction of body when eyes are closed
94
WHAT IS THE FIRST SYMPTOM OF COMPARTMENT SYNDROME
UNRELENTING PAIN
95
could compartment syndrome develop with a cast on
yes
96
fat embolism refers to a constellation of clinical manifestations resulting from fat droplets in _____ __________ __________ of _____ or other organs after a long bone fracture
small blood vessels, lung
97
fat droplets of a fat embolism is released from ________ _____________ or ____________ __________ at fracture site into venous system
bone marrow, adipose tissue
98
fat embolism is specific to
fracture
99
what might happen if you have a fat embolism
respiratory failure, cerebral dysfunction, skin petechiae
100
in a fat embolism will the skin petechiae go away
no, does not blanch
101
symptoms of a fat embolism occurs within
few hours to 3-4 days
102
initial findings of fat embolism is
subtle change in behavior and disorientation
103
how can we prevent fat embolism
stabilize fractures early
104
bone infections are caused by
miroorganisms
105
microorganisms in the bone
proliferate
produce cell death
spread within the bone shaft
chronic inflammatory response
106
osteomyelitis is an acute or chronic
infection
107
osteomyelitis is caused by
microorganism
108
what is the most common microorganism to cause osteomyelitis
staphylococcus
109
sequestrum
infected dead bone separated from living bone
110
sequestrum is caused by
BACTERIA
111
what is one term that is associated strictly with osteomyelitis
sequestrum
112
what disease is sequestrum strictly associated with
osteomyelitis
113
osteonecrosis is caused by
lack of blood flow
114
what are common disorders that could cause osteonecrosis
sickle cell disease, steroid therapy, and hip surgery
115
is sequestrum associated with osteonecrosis
NO NO NO ONLY IN OSTEOMYLEITIS
116
what is a neoplasm that is more common with teens
osteosarcoma
117
osteosarcoma is more common with _________
teens
118
why is osteosarcoma associated with teens
teens have maximum growth velocity
119
with osteosarcoma will you have localized or systemic pain and swelling
localized pain and swelling
120
with osteosarcoma will you have normal function
no, you will have an impairment
121
osteosarcoma is aggressive and highly ___________
malignant
122
is osteosarcoma associate with trauma
no
123
metastatic bone disease is skeletal metastases that are most common malignancy of ___________ tissue: spine, femur, pelvis, ribs, sternum, humerus, skull
osseous
124
in metastatic bone disease 50% of bone must be destroyed before ________ is visible on plain radiograph
lesion
125
in metastatic bone disease tumors that frequently spread to skeletal system are
breast, lung, and prostate
126
what week does ossification begin
9th week
127
separation of the epiphyseal growth plate ruptures the blood vessels that nourish the
epiphysis
128
if you have a separation of the epiphyseal growth plate this can cause
cessation of growth and shortened extremity length
129
osteogenesis imperfecta is a hereditary disease characterized by
defective synthesis of type I collagen
130
definition of scoliosis
lateral diviation of the spinal column that may or may not include rotation or deformity of the vertebrae
131
2 most common classifications of scoliosis
postural and structural
132
postural scoliosis
small curve caused by posture that corrects with bending
133
structural scoliosis
fixed deformity that dose not correct with bending
134
what type of classification of scoliosis can be corrected
postural
135
osteoblasts and osteoclasts are in homeostatic balance of
normal tissue
136
osteopenia is a condition that is common to all _________ bone disease
metabolic
137
osteopenia
reduction in bone mass or mineral density greater than expected for age, race, or gender
138
in osteopenia are the osteoblasts and osteoclasts are they or are they not balanced
they are not balanced
139
how is osteopenia measured
by bone density
140
osteopenia causes
decrease in bone formation
inadequate bone mineralization
excessive bone deossficiation
141
osteoporosis is most common in what race and age group
white women who are postmenopausal
142
osteoporosis definition
skeletal disorder characterized by the loss of bone mass and deterioration of the architecture of cancellous bone with a subsequent increase in bone fragility and susceptibility to fractures
in other words
LOSS OF MINERALIZED BONE MASS CAUSES INCREASED POROSITY OF THE SKELETON
143
osteoporosis primary disease
postmenopausal women or elderly
144
osteoporosis secondary
endocorine or genetic disorer
145
what race is LESS at risk for osteoporosis
African american
146
when is the maximal bone mass achieved
30
147
how much bone loss occurs per year in menopausal women
1%
148
what race is most common for osteoporosis
white/asain
149
what is alcohol role in osteoporosis
alcohol is a direct inhibitor of osteoblasts and may also inhibit calcium absorption
150
in osteoporosis prolonged use of medications that increase ________ excretion such as antacids and anticonvulsants could be a risk factor
calcium
151
in osteoporosis what infants could be at risk
premature and low birth weight
152
what specific group is at risk for osteoporosis because of poor nutrition, amenorrhea, estrogen lack
female atheltes
153
osteoporosis, can it be drug and disease related
yes
154
what is recommended to help prevent osteoporosis
regular weight bearing exercise to maintain muscle mass
155
what supplement is recommended for post menopausal women to prevent osteoporosis
calcium
156
primary arthritis results from
immune response
157
secondary arthritis results from
degenerative processes
158
2 types of systemic autoimmune rheumatic diseases
rheumatoid arthritis
systemic lupus erythematosus
159
rheumatoid arthritis is it systemic
yes
160
rheumatoid arthritis is it inflammatory
yes
161
rheumatoid arthritis is it autoimmune
yes
162
rheumatoid arthritis leads to destruction of ____________ cartilage and underlying bone
articular
163
what gender is most at risk for rheumatoid arthritis
women
164
cause of rheumatoid arthritis
not established, genetic predisposed and immunologically mediated
165
rheumatoid arthritis may be initiated by activation of
CD+4 helper T cells
166
why would rheumatoid arthritis be caused by CD+4 helper cells
released of cytokines and antibody formation
167
rheumatoid arthritis fast or slow onset
slow (insidious)
168
rheumatoid arthritis what systemic manifestations
fatigue, anorexia, weight loss, generalized aching and stiffness, fever
169
rheumatoid arthritis is characterized by exacerbations and remissions, what does this mean
series of getting better and then getting significantly worse
170
rheumatoid arthritis could only involve a few joints for brief durations or it may become
relentlessly progressive and debilitating
171
rheumatoid arthritis morning stiffness for how long
1 hour for at least 6 weeks
172
rheumatoid arthritis swelling of how many joints for how long
3 or more for 6 weeks
173
rheumatoid arthritis 70-80% have
rheumatoid factor antibody
174
what arthritis is associated with pannus
rheumatoid arthritis
175
rheumatoid arthritis name of inflamed synovial membrane with macrophages and fibroblasts
pannus
176
T/F rheumatoid arthritis is a condition of individual joint deterioration and breakdown
False, rheumatoid arthritis is systemic and affects more than one joint
177
systemic lupus erythematosus is a chronic inflammatory disease affecting
any organ system, or multiple
178
systemic lupus erythematosus has a higher incidence in what gender and race
females, African American, Latins, asians
179
is systemic lupus erythematosus autoimmune
yes
180
systemic lupus erythematosus cause
unknown
181
systemic lupus erythematosus is characterized by formation of
autoantibodies and immune complexes; B cell hyperactivity and increased antibodies against self
182
systemic lupus erythematosus is known as the great
imitator
183
what does it mean to say systemic lupus erythematosus is the great imitator
imitates other diseases
184
systemic lupus erythematosus develops what rash
butterfly rash
185
systemic sclerosis is an autoimmune disease of connective tissue characterized by excessive ____________ deposition in the skin and ___________ ______
collagen, internal organs
186
in systemic sclerosis there is collagen deposits in skin and internal organs meaning there is _________ activation with excessive __________
fibroblasts, fibrosis
187
what gender and age does systemic sclerosis most affect
females, 35-50
188
what is usually the first presentation of systemic sclerosis
limited or diffuse skin presentation
189
systemic sclerosis diffuse or generalized form
skin changes involve the trunk and proximal extremities
190
systemic sclerosis limited/CREST variant
hardening of the skin is limited to hands and face
191
spondylarthropathies
ankylosing spondylitis
192
ankylosing spondylitis is a multisystem inflammatory disorder that affects the
axial skeleton, especially the spine
193
ankylosing spondylitis will have inflammation at insertions of
tendons and ligaments
194
ankylosing spondylitis what is the pathologic hallmark of the disorder
sacroiliac involvement
195
is osteoarthritis systemic
no
196
is osteoarthritis inflammatory
no
197
is osteoarthritis autoimmune
no
198
osteoarthritis is a _______________ joint disease
degenerative
199
osteoarthritis is just when _____ joints wear out
old
200
do patients with osteoarthritis develop a pannus
no
201
do patients with osteoarthritis develop a fever
no
202
osteoarthritis is a progressive loss of _________ cartilage and ___________ results from inflammation caused when cartilage attempts to repair itself
articular, synovitis
203
osteoarthritis creates _____________/______ which cause joint pain, stiffness, and loss of motion
osteophytes/spurs
204
what arthritis is associated with spurs
osteoarthritis
205
what arthritis is associated with pannus
rheumatoid arthritis
206
what type of arthritis is associated with butterfly rash
SLE
207
in osteoarthritis cytokines stimulate production and release of _____________ that are destructive to joint structure
proteases
208
osteoarthritis can affect any joint but it most often occurs in the
knees hips, spine, and fingers
209
what are the nodes called in someone with osteoarthritis
heberdens and bouchards nodes
210
what is a metabolic and endocrine disease associated with joint symptoms
gout syndrome
211
expressivity
what level or severity of the disease
212
penetrance
have it or not
213
2 types of gout
primary and secondary
214
primary gout is caused by an _________ defect that results in an over production of __________ _______ or inadequate elimination by kidney
enzyme, uric acid
215
in primary gout you have so much uric acid in the kidney that it cannot filter all of it so it ends up in the
blood
216
primary gout is characterized by
hyperuricemia and gout
217
secondary gout is
hyperuricemia but gout is not the main disorder
218
secondary gout can be cause dby
increased breakdown of nucleic acids
219
in gout syndrome there is increased serum
uric acid
220
uric acid is the end product of
purine metabolism
221
in gout syndrome there is ________ or the accumulation of crystalline deposits in ___________ surfaces, ______, __________ ___________ and ______________
tophi, articular surfaces bones, soft tissues, cartilage
222
tophi
deposits containing monosodium rate crystals
223
gout syndrome could lead to
gouty nephroathy or renla impairment
224
what type of kidney stone is found in gout
uric acid
225
where is the uric acid stones found
kidney or blood
