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Pathophysiology
Musculoskeletal Exam 3
| Question | Answer |
|---|---|
| ___ is the most common metabolic bone disease. IT affects ___ in ___ women & __ in ___ men? | Osteoporosis is the most common metabolic bone disease. It affects 1 in 2 women & 1 in 5 men. |
| When does osteoporosis occur? | It occurs when the rate of bone resorption is greater than that of bone formation. |
| In ___ normal osteoblast & osteoclsatic balance is disurpted? | osteoporosis |
| In ____ minreal & protein matrix compnonets decrease and trabecula decrased amount (cells that resopnd to stress) on the bone) decrased with & bone mass leading to ____. | osteoporosis leading to fragile bones |
| WHO defines osteoporosis as "bone marrow densitiy (BMD) of ? | > 2.5 std. dev below peak BMD |
| Bone loss is influenced by age, genetics,& estrogen. What are the risk factors for osteoporosis? | family Hx, menopause (normal bone loss accelerated), small frame, caucasion or asian race, early surgical menopause use of corticosteroids, decrease Ca & Vit D diets, inactivity, increase ETOH, chronic renal disease, chronic inflammtory disease, abnormal |
| What is gout? | Gout is a heterogenous disorder where disturbanes of uric acid metabolism leads to deposition of monosodium urate salts in articular, periarticular, & subcutanous tissue. |
| ___ is characterized by hyperuricemia & urate crystals and can induce arthritis? | Gout |
| How is gout caused? | It is caused because of lack of enzyme uricase & the inability to oxidize uric acid to a soluble compound. |
| ___ is a normal waste product of ___ metabolism filtered by the kidneys, when it exceeds normal, ____ results & the deposition of crystaline sodium urate increases. | Uric acid is a normal waste product of purine metabolism filtered by the kidneys, when it exceeds normal, hyperuricemia results & the depostiion of crystalline sodium urate increases. |
| What are triggers of gout? | Traumatic event, surgery, acute illness or ETOH or drug use |
| What is osteoarthritis? | Osteoarthritis (Degenerative Joint Disease [DJD])-most common arthritis worldwide, progressive, inflammatory disease of disarthrodial joints (espec. wt bearing) |
| ___ is characterized by a progressive loss of articular cartilage & by the formation of thick subchondal bone & new bone @ the joint margins. | osteoarthritis |
| In osteoarthritis an initial injury causes release of ___ & ____ enzymes from chondrocytes. | proteolytic & collagenolytic enzymes |
| In osteoarthritis following an initial injury there is a breakdown of the matrix of ___ & ___ occurs decreasing ___ of cartilege that occurs with aging increasing the liklihood of ___ & ___? | In osteoarthritis following an initial injury there is a breakdown of the matrix of prteolycan & collagen occurs. decreasing hydration of cartilege that occurs with aging; increasing the liklihood of wear & damage |
| In osteoarthritis __ & ___ occur with stress of wt bearing | collagen fatigue & microfractures occur with stress of wt bearing |
| In ___ the ability to absorb shock decreases d/t subcortical bone & cartilage microfractures. Breakdown of ___ integrity with repair results in ____? | Osteoarthritis; breakdown of joint integrity with repair results in degenerative des. |
| Structural breakdown of the cartilage involves __,___, &___? Most commen in DJD is ____? | Structural breakdown of the cartilage invovles fissuing, pitting, & erosin. most common in DID is crepitis |
| What are the s/s of osteoperosis? | bony enlargement of joints; pain with moving; distal interphalangial joint enlargement; heberdent protimal bonchaud nodes |
| What is the difference between osteoperosis and Rheumatoid arthritis? | RA systemic/bilateral; OA usually localized/isolated joint or mult joints especially in hands-unilateral |
| ___ is systemic inflammatory disease more commen in women of all races. | RA |
| T/F RA: unknown cause, possibly due to abnormal autoimmune response that does not have a genetic predisposition | False; it is possibly due to an abnormal autoimmune response WITH a genetic predisposition |
| In RA changes occur when immune response locations in synovial tissue by an ___ trigger; __ Cells produce RF antibiodies that act aginst IgG to form ___ that potentially perpetuate inflammation of the joint leading to accumulation of dense aggregetes of _ | In RA changes occur when immune response locations in synovial tissue by an antigen trigger; B cells produce RF antibodies that act against IgG to form immune complexes that potentially perpetuate inflammation in the joint leading to accumulation of dense |
| The accumulation of dense aggregetes of immune cells in RA: infiltration of synovium leads to ___, ___, & ____ of the synoviom. | leads to edema, neovascularization, & proliferation of the synoviom |
| In RA the hypertophied synovium leads to ___ formation (vascularized sour tissue) that can erode & destory articular cartilage, resulting in ___,___ & ___? | This hypertophied synovium leads to paririus formation (vascularized sour tissue) that can erode & destroy articular cartilage, resulting in bone erosion; bone cysts; & fissures |
| What are the 7 s/s of RA? | (1) moving stiffness for 1 hr (2) soft tissue swelling (arthritis) of 3 or more areas on Right & Left (3) swelling of @ least 1 wrist, MLP or PIP joint (4) simlturinem symetric swelling in joints (5) SQ rheumatoid nodules (6) presence of rheumatoid faite |
| How many radiographic erosions must be present for Dx of RA? Name some errosions. | 4 must be presnet for Dx of RA. Malaise, fatigue, pain, ulnar drift, swan neck deformity, bentonriere deformity (see pics pg 129) decreased strength; inability to pinch, boggy wrist; limited movement; no DIP involvement; carpal tunnel syndrome; flexion co |
| iN rICKETS & OSTEOMALACIA are CHARACTERIZED deficites in mineralizets of newly formed ___ with resulting ___? | characterized by deficites in mineralizets of newly fomred bone matrix with resulting soft osteopenic bone. |
| in ___ Vit D deficiency prevents maintence of normal levels of ___ &___. | Rickets/osteomalacia Vit D deficiency prevents maintence of normal levels of Calcium & phosphate |
| In rickets, cartilege that occurs in the growing ___ fails to calcify | epiphagus |
| Cartilege is not replaced by ___ & continues to ___ in Rickets. | Cartilege is not replaced by bone & continues to enlarge |
| Bone is poorly calcified & les rigid in ____? | Rickets |
| Kyphosis, genu valgum (knoch knee) & germ varum (bow leg) are common in what? | Rickets |
| Osteomalacia is the adult conterpart of ___ that is always due to what as a result of what? | Osteomalacia is the adult conterpart of rickets that is always due to inadequate Ca+ or phosphorous concentration in the body as a result of decreased intestial absorption of Ca+, increasing urinary excretion of Ca+, loss of Ca or phosphorous during pregn |
| In the case of Vit D deficiency, calcifications fails to occur and ___ is soft. All ___ are affected, but wt bearing structures may ___ & cause ___? | osteomalacia/rickets; In the case of Vit D deficiency, calcification fails to occur & bone is soft. All bones are affected, but wt bearing structures may collapse & cause compression fype Fractures |
| What is Osteosarcoma? | An extremely malignant bone forming tumor, most common characterized by formation of bone or osteoid by tumor cells. |
| Who would you expect to see osteosarcoma in? | Majority of victims are children, adolescents & young adults 10-30yrs old. 2nd reach b/t 60-70 yrs |
| The most active ephyseal growth areas of osteosarcoma are? | the distal end of femor, protimal end of tibia, fibula & humerous are common involvemnt sites |
| In osteosarcoma lesions can also be seen in flat bones of ___, ___, ___, ___,or ___ | In osteosarcoma lesions can also be seen in flat bones of pelvis, skull, scapula, ribs, or spine |
| What are the s/s of osteosarcoma? | destruction of the cortex of the metaphyseal region predisposes it to pathologic fracture. metastasis to lungs early in development. pain consistent & progressive. joint funtion may be lost/compromised |
| ___ is a chronic, multisystem, inflammatory, autoimmune disease characterized by periods of exacerbations & remissions with multi organ systems being affected at different times. | Systemic Lupus (SLE) |
| What are some environmental factors of SLE? IS it familial? Who is it more common in (what ages) | Familial YES; environmental factos such as sunlight, thermal burns, & physical stress initiate the development of SLE, more common in women b/t 15-40 yrs old |
| ___ is the result of an abnormal reaction of the body against its own tissues, cells & serum proteins? | SLE |
| In what disease does the body have a decrease tolerance to itself? | SLE |
| One of the main mechanisims is the ___ overacting leading to excerssive autoantibodies production in SLE? | B-lymphocyte |
| SLE: As antigen=antibody complexes form, they enter the basement membranes of capillaries specifically in the ___,___,___, ___ & ___. | kidneys, heart, skin, brain & joints |
| Once in kidneys, heart, skin, brain, & joints the immune complexes then activate complement & trigger the ____ which are responsible for tissue distruction in SLE? | Immune complexes then activate complement & trigger the inflammatory responses which are responsible for tissue destruction |
| What are the s/s of SLE? | arthralgias, synovitis in joints, tendons, bones, swelling, tenderness, pain with mvt, moving stiffness, excessive damage leads to contractures, hyperextention of different joints, butterfly rash, latticeive renular skin changes, anemia, seizures, posis |
| ___ comprises of a group of genetically deterous myopathies characterized by progressive muscle weakness & degeneration as muscle tissue is replaced by ___ & ___? | muscular dystrophy; fat & fibrous connective tissue |
| What is the most common form of Muscular dystrophy? In herited as ? d/t what? | Duchenne muscular dystrophy is the most common form, most severe, inherited as an x-linked trait (afflicts ONLY MALES) d/t genetic mutation, muscle cells |
| What are the muscle cells deficient in if a pt has duchenne MD? What does this allow? | muscle cells are deficient in the protein dystrophin, alpa deficiency that weakens the cell membrane & allows extracellular fluid to leak into the cell. |
| Proteases & inflammatory processes are activated leading to ___ necrosis & muscle degeneration begins @ birth, apparent by ___ with intial involvement of pelvic girdle to shoulder girdle. In pts with duchenne MD. | Proteases & inflammatory processes are activated leading to muscle fiber necrosis & muscle degeneration begins @ birth, apparent by 3yrs with intial involvement of pelvic girdle to shoulder girdle. In pts with duchenne MD. |
| What are the s/s of duchenne MD? | calf's enlarged b/c infiltration of fat cells & degeneration of muscle fibers, frequent falling by 5-6yrs, wheelchair by 12-14. |
| In duchenne MD some muscles like hands, face, jaw, pharnx, larynx & eyes are ____? | In duchenne MD some muscles like hands, face, jaw, pharnx, larynx & eyes are spared to the end. |
| IN duchenne MD how is survival & what are the usual COD? | In duchenne MD survival to 20 is rare. Cardiac failure or pulmonary infection is the usual cause of Death |
| ___ is displacement of the bone from its normal posistion to the extent that articulating surfaces lose contact. | dislocation |
| ___ is displacement of a bone from its normal position that it partically loses contact. | subluxation |
| How can dislocation & subluxation occur? | They can occur when forces cause one aspect of th ejoint complex to move beyond its normal anatomical limit. |
| How is the tissue of a dislocation & subluxation? | a considerable amount of tissue damage occurs including possible ligament tear or rupture |
| subluxation = ___ Dislocation =____ | subluxation = partialdislocation = complete |
| ___ FRACTURE occurs in straight line @ 90 degree to longitudinal axis | transverese |
| ___ fractures are the result of rotational forces & cause bone to separate in the form of an "s" along the bones length | spiral |
| ___ fracture split bone along its length | longitudinal |
| ___ fracture result from rotational force, but break along 45degree angle no rotation around the bone | oblique |
| ___ fracture consists of more than 1 fracture line with more than 2 bone fragments that may be shortened or crushed | comminuted |
| ___ fractuer is caused by excessive force that telescopes or dives one fragement into another | impacted |
| ___ fracture is incomplete break, commen in kids, with intact side of the cortex flexed | greenstick |
| ___ fracute -failure of one cortical surface of the bone, often cause by repeitive motion like running | stress fracture |
| ___ fracture is separation of a small fragment of bone at the site of attachment of a ligament or tendon | arulsion fracture |
| What is the epiphyseal plate? | A growth plate |
| Why are epiphyseal fractures a concern? | With epiphyseal injuries, the potential for disruption of growth of the long bone is present. |
| What is necessary in a epiphyseal fracture? Why? | Proper reduction & fixation are necessary to avoid growth distubances |
| Crush injury to the epiphyseal plate commonly leads to what? | leads to premature growth cesation |
| Cancellous bone does not tolerate compression strss, it ___ &___ in epeipyseal plate fractures? | buckles & cracks |
| What to ligaments connect to? | Bone to Bone |
| What do tendons connect? | Muscle to bone |
| Both tendeons & ligaments are made up of what positioned in ___ allignment to provide increase tensile strength. Both provide ___ & ____ | Both are made up of dense connective tissue with collagen fibers positioned in parallel aligment to provide increase tensile strength both provide stability & guide motion |
| ___ are strong, capablie of angulation around bone muscle can pull and change direction & improve leverage | tendons |
| ___ supple, flexible, rigid so they stabilize joint with correct movement | ligaments |
| What is anklyosis spondylitis? | means fusion of inflammed vertebra. It is arthritis of the sacroiliac joints that often involves the entire axial skeleton & some peripherial joints. |
| ___ occurs in males more in late teens to 20's Strong genetic component, HLAB27 thought to be antigen-presenting cells & cross react with self-antigens found in joint tissues. | anklyosis spondylitis |
| Anklyosis spondylitis: Activation of immune-mediated inflammation occurs within the ___ joints of the pelvis & ligaments supporting the vertebral column leads to persistent ____, ___ & ____? | activation of immune-mediated inflammation occurs within the sacroiliac joints of the pelvis & ligaments supporting the vetebral coulum leads to persistent back pain, stiffness, & gradual loss of mobility |
| What are s/s of anklyosis spondylitis? | insidious low back pain that improves with exercise & not relieved by rest, severe morning stiffness > 3 mo, limited mobility, enthesitsis (inflammation @ ligament sites) |
Created by:
jmilbur4
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