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Module 16: Alterations of the musculoskeletal system

Module 16: Alterations of the musculoskeletal system Chapters 36 and 37
STUDY
PLAY
Inflammation of a tendon where it attaches to the bone at its origin is called:
epicondylitis
A partial tear of a ligament is called a:
second-degree strain
The displacement of two bones in which the articular surfaces partially lose contact with each other is called:
subluxation
Patients with osteoporosis are at risk for which of the following problems?
Pathologic bone fractures
Which disorder presents with significant bone demineralization from a vitamin D deficiency and usually results in skeletal pain?
Osteomalacia
In osteomyelitis, the area of necrotic bone at the site of the infection is called the
sequestrum.
The pathophysiology of osteomalacia involves:
abnormal calcium crystallization.
The cause of most cases of endogenous osteomyelitis is (are):
blood-borne bacteria.
The chief pathologic feature of degenerative joint disease is:
degeneration of articular cartilage.
Risk factors for osteoarthritis include all of the following:
older age, obesity, orthopedic injury
Synovial joint problems in rheumatoid arthritis are due to which of the following pathologies?
Articular cartilage is lost through enzymatic breakdown.
In addition to joint pain, rheumatoid arthritis often manifests with which of the following systemic symptoms?
Fever, Malaise, Lymphadenopathy
Ankylosing spondylitis results in:
vertebral joint fusion
The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called:
tophaceous gout.
Episodes of gout are often triggered by all of the following factors:
alcohol, drugs, trauma
A characteristic feature of fibromyalgia is:
trigger point pain
Pain in fibromyalgia is attributed to:
decrease in pain tolerance
Severe muscle trauma from crush injuries can result in which of the following complications?
Rhabdomyolysis
Myoglobinuria (rhabdomyolysis) can result in failure of which of the following organs?
kidneys
Phase 1 of the bone remodeling cycle involves:
bone cell activation
A bone breaks in a place where there was pre-existing disease. What type of fracture is being described?
pathological
All of the following events occur following a bone fracture:
development of a blood clot beneath the periosteum.
leukocyte infiltration into bone tissue.
blood vessel growth at the fracture site.
A torus fracture occurs when:
the cortex of the bone buckles.
A fracture in which the bone breaks into two or more fragments is termed a
comminuted fracture.
Complications that can occur as a fractured bone heals include all of the following:
malunion.
nonunion.
delayed union
Which of the following structures prevents reflux of stomach contents into the esophagus?
Lower esophageal sphincter
Saliva contains all of the following:
water.
IgA.
amylase.
The chief cells of the gastric glands secrete:
pepsinogen
Mucus production in the stomach is blocked by medications that block the release of:
prostaglandins.
Pepsin is necessary for the digestion of which of the following nutrients:
proteins
The following structures are part of the small intestine:
Ileum
Duodenum
Jejunum
The majority of the small intestine receives splanchnic blood flow from which artery?
Superior mesenteric
Which sphincter controls the release of pancreatic enzymes and bile into the duodenum?
Oddi
Parasympathetic stimulation of the digestive system results in:
increased gastric and pancreatic secretions
The cells of the liver lobules that synthesize and release bile are called:
hepatocytes
Bilirubin in bile comes from:
phagocytosis of aged red blood cells.
Functions of the liver include all of the following:
storage of vitamins.
synthesis of plasma proteins.
metabolic detoxification
Common causes of constipation include all of the following except:
inadequate fluid intake.
a low-fiber diet.
medications
Which of the following types of diarrhea can be caused by an inability to digest lactose in dairy products?
Osmotic
The presence of digested dark blood in the stool is called:
melena
The following conditions can cause dysphagia:
Hiatal hernia
Achalasia
Gastroesophageal reflux
Reflux esophagitis is defined as:
an inflammatory response to gastroesophageal reflux.
Common manifestations of gastroesophageal reflux disease (GERD) include:
heartburn, dysphagia, and pain within one hour of eating.
Complications associated with gastroesophageal reflux disease (GERD) include which of the following?
Esophageal ulcerations
Esophageal cancer
Esophageal strictures
A hiatal hernia is a protrusion of the _____ through the ______.
stomach; diaphragm
Paralytic ileus often occurs after:
abdominal surgery
Intestinal obstruction can lead to all of the following complications
dehydration.
peritonitis.
perforation
The classic symptoms of a small bowel obstruction are:
vomiting, severe abdominal pain, and abdominal distension
The most common cause of chronic gastritis is:
bacterial infection
Individuals with chronic gastritis are at risk for developing which of the following problems?
Gastric cancer
Achlorhydria
Gastrointestinal bleeding
How does a chronic infection with Helicobacter pylori (H. pylori) lead to duodenal ulcers?
H. pylori produces substances that are toxic to the duodenal mucosa.
Which type of ulcer is a stress ulcer that is associated with burn injuries?
Curling
Severe trauma can result in stress ulcers that often first manifest with:
severe bleeding.
Gastrectomy surgery commonly leads to a vitamin B12 deficiency anemia because:
decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum
Which disorder is characterized by night blindness, osteopathy, and clotting disorders?
Bile salt deficiency
Which disorder is characterized by the inability to digest all nutrients?
Pancreatic insufficiency
Which of the following factors are known causes of ulcerative colitis?
Genetic predisposition
Autoimmune injury
Inflammation
Common characteristics of Chron disease include which of the following?
Vitamin B12 deficiency
Diverticula are:
outpouchings of the colon's mucosa.
Diverticulosis can be related to which of the following dietary problems?
Diet high in refined foods
What is the most common cause of acute mesenteric (vascular) insufficiency?
emboli
Which of the following types of hepatitis is acquired from ingesting contaminated food and manifests acutely with fever, abdominal pain, and jaundice, but does not usually result in fulminant liver failure?
Hep A
Cholelithiasis is:
the accumulation of gallstones in the gallbladder.
The most common cause of portal hypertension is:
liver cirrhosis.
Which of the following statements explains why portal hypertension leads to ascites?
Back-up of blood in the intra-abdominal veins occurs
Cheyne-Stokes resirations are characterized by:
Rapid respirations alternating with periods of apnea
Apneic spells alternating with hyperventilation are called Cheyne-Stokes respirations and often occur with neurologic injury or profound metabolic alterations.
Hypertrophy of the nail beds due to chronic hypoxemia is called:
Clubbing
Clubbing is manifested by enlargements at the base of the fingernails.
Hypoventilation results in:
Hypercapnia
Hypoventilation results in increased PaCO2, a condition called hypercapnia.
Respiratory acidosis can result from:
Reduced tidal volumes
Low tidal volumes (hypoventilation) result in C02 retention and respiratory acidosis.
Which of the following conditions causes a decreased drive to breathe that results in hypoxemia and hypercapnia?
Cental nervous system disorders
Central nervous system disorders result in a decreased drive to breathe due to damage to the respiratory centers.
A decrease in tidal volume results in a decrease in:
Minute ventilation
Tidal volume, or the volume of air inspired, is directly related to ventilation. A decrease in tidal volume results in a direct decrease in minute volume and minute ventilation.
Which of the following alterations in serum lab values would indicate that a patient is hyperventilating?
High pH
Rapid ventilation increases CO2 removal from the blood and results in a low PaCO2 and elevated pH (respiratory alkalosis).
Which of the following diseases will result in a ventilation/perfusion (V/Q) mismatch?
Asthma, pulmonary edema and emphysema
All three pulmonary diseases result in V/Q mismatches due to decreased ventilation and/or impaired diffusion of gases at the alveolar/capillary membrane.
The collapse of a previously inflated area of lung tissue is called:
Atelectasis
The collapse of a previously inflated area of lung tissue is called atelectasis.
Coal miners or individuals exposed to asbestos often develop a chronic respiratory condition called:
Pneumoconiosis
Severe inflammation and scarring in the pulmonary tissue due to prolonged exposure to coal dust, asbestos, and other inhaled toxins is called pneumoconiosis.
In acute respiratory distress syndrome (ARDS), alveolar damage and impaired surfactant secretion lead to each of the following problems except:
Air trapping
Alveolar damage and altered surfactant production have no direct effect on the bronchi and therefore cannot cause air trapping.
Why does airway obstruction in chronic lung disease cause hypercapnia?
Airway obstruction causes air trapping
With airway obstruction, air enters the alveoli but has difficulty escaping during exhalation. Air becomes trapped in the alveoli, and expiration must be more forceful and prolonged. When air is trapped, tidal volumes are reduced, causing hypercapnia.
When exposed to inhaled allergens, a child with asthma produces large quantities of:
IgE
During an allergic response (type I hypersensitivity reaction), plasma cells produce large quantities of IgE.
In individuals with asthma, exposure to an allergen leads to which of the following pathophysiological events?
Bronchoconstriction and airway edema
Exposure to an allergen results in mast cell degranulation and release of inflammatory mediators that cause bronchoconstriction and airway edema.
When conducting a physical assessment of an individual during an acute asthma episode, you would expect to observe all of the following except:
Loss of pulsus paradoxus
During an acute asthma episode, pulsus paradoxus increases.
The loss of alpha1-antitrypsin in emphysema results in:
The destruction of alveolar septa and the loss of elastic recoil
The destruction of alveolar septa and the loss of elastic recoil in emphysema lead to the loss of alveolar surface area and the collapse of airways during expiration.
A frequent complication of chronic bronchitis related to the hypersecretion of mucus is:
Recurrent infections
Mucus provides a hospitable enviroment for bacterial colonization.
Pneumonia leads to hypoxemia due to:
The accumulation of exudates and fibrin deposition
The inflammatory response to lung infection results in the accumulation of fibrous exudates, which cause ventilation/perfusion (V/Q) mismatching and impair the diffusion of oxygen at the alveolocapillary membrane.
All of the following physical and laboratory findings are indicative of a bacterial pneumonia except:
a dry cough
A dry cough may occur with viral pneumonia. Bacterial pneumonia usually manifests with a productive cough.
Staff at an inner-city homeless shelter send 46-year-old Henry Ship by ambulance to a local hospital after he begins coughing up blood. On arrival at the emergency room, he is feverish and says that he has felt very fatigued for several weeks. He also reports experiencing night sweats. Mr. Ship's symptoms are most likely caused by:
Tuberculosis
All of Mr. Ship's symptoms are typical of tuberculosis infection (TB). Being homeless and living in a shelter are risk factors for TB since the bacteria are easily transmitted from person to person.
Risk factors for TB include:
Immunosuppression
Immunosuppressed individuals, such as those with HIV, are at high risk for TB, which is easily transmitted by personal contact with infected individuals.
Severe acute respiratory distress syndrome (SARS) is transmitted via which of the following mechanisms?
Droplet inhalation
The particular strain of the coronal virus responsible for SARS is transmitted via inhaled droplets containing the virus or via contact with infected bodily (respiratory) fluids.
What is the World Health Organization's major concern regarding the avian flu, which is caused by the H5N1 virus?
The virus may mutate to a form that can be easily transmitted from person to person.
To date, the H5N1 virus has only been transmitted from birds to humans. If the virus develops an ability to be transmitted among humans, there is a grave fear of a pandemic.
Which of the following patients is at highest risk for developing a pulmonary embolism?
a 67-year-old male hospitalized with a deep vein thrombosis in the femoral vein
The presence of deep vein thrombosis in the lower limb is the most important risk factor for pulmonary embolism. Older age is also risk factor.
Chronic pulmonary hypertension can eventually cause which of the following complications?
Chronic obstructive pulmonary disease
Increased right ventricular afterload from pulmonary hypertension can lead to right ventricular failure. Right ventricular failure due to respiratory disease is also known as "cor pulmonale."
Common sites of metastasis for lung cancer include all of the following except:
The kidneys
Although it may be possible for lung cancerd to metastasize to the kidneys, it is not one of the common sites.
Metaplastic changes to bronchial epithelial tissues are frequently caused by:
Cigarette smoking
Cigarette smoking is the most common stimulus for metaplastic changes in the bronchial epithelium. Although metaplasia is generally reversible, the metaplastic cells can become cancerous if an individual continues to smoke.
Signs and symptoms of dyspnea include:
Feeling short of breath
Dyspnea is the sensation of feeling short of breath.
A high ventilation/perfusion (V/Q) ratio can be caused by:
Obstruction to pulmonary blood flow
Obstruction to pulmonary blood flow results in decreased perfusion and a high V/Q ratio.
Respiratory failure is defined by which one of the following laboratory alterations?
High PaCO2
Respiratory failure results in CO2 retention and elevated PaCO2.
Lung injury that results in diffuse pulmonary inflammation and infiltrates and that is followed by development of a hyaline membrane at the alveolocapillary interface is a condition known as:
Acute respiratory distress syndrome (ARDS)
ARDS involves a lung-wide inflammatory response to direct or indirect lung injury and manifests with diffuse pulmonary infiltrates and the development of a hyaline membrane.
Non-cardiogenic pulmonary edema most often is caused by:
Systemic infection (sepsis)
Inflammation present with systemic infections and sepsis is the main cause of non-cardiogenic pulmonary edema (i.e., acute respiratory distress syndrom, or ARDS).
Pulmonary edema is an example of ________ pulmonary disease.
Restrictive
Pulmonary edema restricts alveolar or lung expansion.
Air that enters the pleural space during inspiration and is unable to exit during expiration creates a condition called:
Tension pneumothorax
A tension pneumothorax can collapse the lung because the pressure of the air in the pleural cavity exceeds the atmospheric pressure in the alveoli.
Which of the following characteristics is not typical of asthma?
Asthma causes alveolar collapse
The pathophysiology of asthma does not involve alveolar collapse.
A life-threatening complication of asthma is:
Status asthmaticus
Status asthmaticus is prolonged, severe bronchospasm that can be life-threatening if not reversed.
Airway obstruction in chronic bronchitis is generally the result of:
Thick mucus secretions and smooth muscle hyperplasia
Inspired irritants stimulate inflammation, mucus secretion, and bronchospasm, which can lead to smooth muscle thickening in the airways. All of these factors contribute to airway obstruction in chronic bronchitis.
Individuals who have recently developed chronic bronchitis often present with all of the following except:
a barrel chest
The symptoms that lead individuals with chronic bronchitis to seek medical care include decreased exercise tolerance, wheezing, shortness of breath and chronic productive cough.
The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by:
Increased residual lung volumes
Increased residual lung volumes are a result of air trapping in obstructive lung disease and cause expansion of the chest wall.
Which of the following measures is most effective for preventing pulmonary emboli in patients who are recovering from major surgery?
Ambulate patients frequently to prevent blood clot formation
Venous stagnation, a major risk factor for deep vein thrombosis and pulmonary embolism formation, can be prevented by frequent ambulation after surgery.
Familial pulmonary hypertension usually is caused by:
a genetic mutation
Increased pulmonary vascular resistance from pulmonary emboli causes secondary pulmonary hypertension.
_______ is a term that signifies right-sided heart failure secondary to pulmonary hypertension.
Cor pulmonale
Cor pulmonale is right-sided heart failure secondary to pulmonary hypertension.
Alveolar edema in pneumococcal pneumonia is caused by:
Inflammatory cytokines
The infectious process in pneumococcal pneumonia results in the release of inflammatory mediators that cause alveolar edema.
________ atelectasis is the collapse of lung tissue caused by external pressure exerted by a tumor, fluid, or air.
Compression
Compression atelectasis occurs when a lung tumor, pulmonary edema, pleural effusion, or pneumothorax creates external pressures that collapse alveoli.
Pain on inspiration (pleuritic) is associated with which of the following disorders?
Pleural inflammation
Inflammation of the pleura often manifests with pain on inspiration, fever, and chills.
What is a fracture?
a break in the continuity of a bone
-↑ incidence in males 15-24, greater than 65

classifications:
-complete or incomplete (open or closed)
-comminuted (multiple bone & fragments)
-linear (parallel to long axis of bone)
-oblique
-spiral (wrapping around bone)
-transverse (90 degrees to long axis)
greenstick fracture
a partial fracture of a bone (usually in children)
-fracture of 1 side of cortex & spongy bone splinters
torus fracture
Buckling of the cortex of a long bone from trauma (usually radius or ulna)
bowing fracture
bone in pairs: 1 breaks, other bends
pathologic fracture
fracture caused by diseased or weakened bone
stress (microfracture)
2 types:
fatigue & insufficiency (new activity vs. fatigue fracture in abnormal bone)
transchondral fracture
fragmentation and separation of a portion of the articular cartilage that covers the end of a bone at a joint
bone fractures
a broken bone can cause damage to the surrounding tissue, the periosteum (which is a vascular membrane covering bones) and the blood vessels in the cortex & marrow
hematoma formation
-1st stage in bone fracture healing
-clot forms at damaged edges of bone
what is the second stage of bone fracture healing?
bone tissue destruction triggers an inflammatory response (fractured ends of bone decalcify)
procallus formation
invasion by osteoblasts, calcium deposition
callus formation
-mineralized new bone built up
-osteoclasts destroy dead bone
remodeling
excess callus resorbed & trabecular bone laid down

Remember:
bone (like liver) will form new bone not scar tissue when healing
what are the steps in callus formation?
A.) hematoma formation
B.) organization of hematoma
C.) invasion of osteoblasts, deposition of calcium
D.) callus formation
E.) remodeling
What are the manifestations of bone fractures?
unnatural alignments, swelling, muscle spasm, tenderness, pain, impaired sensation, & possible muscle spasms
What are the treatments for bone fractures?
-closed manipulation (most), traction (maintain reduction w/ force), open reduction (surgery)
-internal (screws) and external fixation (bars)
What can happen if bone fracture is not treated properly?
improper reduction or lack of immobilization: need to keep bone from moving or nonunion occurs
nonunion
ends of bone does not grow together
delayed union
prolongation of expected healing time for a fracture: 8-9 months
malunion
Occurs when the fracture heals in a position that does not resemble the original anatomical form of the bone and alters the mechanical function of the bone.
dislocation fracture
-temporary displacement of 2 bones
-loss of contact between articular cartilage
sublaxtion fracture
contact between articular surfaces is only partially lost
dislocation & subluxation fractures
are associated with fractures, muscle imbalance (weight lifters), rheumatoid arthritis, or other forms of joint instability
- < 20 years old
-shoulder, elbow, wrist, hip, knee
dislocations of hip
-Anterior (rare): land on feet after falling
-Posterior: auto accident- knee hits dashboard

may disrupt circulation → necrosis of the joint → hip replacement (Bo Jackson)

Rx: reduction
what is a strain?
tear or injury to a tendon
-1st (least severe, 2nd, 3rd degree (most severe)
What is a sprain?
tear or injury to a ligament
What is an avulsion?
complete separation of a tendon or ligament from its bony attachment site
What is the treatment for a support structure injury?
suture together (min 8 weeks healing)
what is tendinitis?
acute inflammation of a tendon due to new activity
-resolves w/ rest, ice, & anti-inflammatories
What is tendinosis?
painful degradation of collagen fibers due to repeated trauma
what is bursitis?
inflammation of a bursa (small sacs filled with synovial fluid located between tendons & muscles)
-skin over bone, skin over muscle, & muscle & tendon over bone
-caused by repeated trauma
-septic bursitis is caused by a wound infection
What is epicondylitis?
inflammation of a tendon where it attaches to a bone in the elbow
tennis elbow
lateral epicondylitis
golfer's elbow
medial epicondylitis
What is a muscle strain?
a sudden, forced motion causing the muscle to become stretched beyond its normal capacity
-local muscle damage
-muscle strains can also involve the tendons
-6 weeks healing time
What is Myositis Ossificans?
-complication of local muscle injury
-inflammation of muscular tissue w/ subsequent CALCIFICATION & ossification of the muscle

-"rider's bone" in equestrians (adductor in thigh)
-"drill bone" in infantry soldiers (pectoral m.)
-thigh muscles in football players
What is Rhabdomyolysis?
is a life-threatening complication of severe muscle trauma w/muscle cell necrosis: myoglobinemia → myoglobinuria → KIDNEY TOXICITY
What are the causes of Rhabdomyolysis?
-crush syndrome (most severe presentation)
-compartment syndromes - local- (caused by limb ischemia, local trauma, excessive muscular activity, or heat stroke):
(Volkmann) ischemia contracture- flexion contracture of fingers/wrist due to ischemia of forearm
What are the treatments for compartment syndrome?
1.) Fasciotomy (of anterior & posterior compartments) to relieve pressure
2.) "flush" kidneys w/ diuretics (build up of myoglobin)
osteoporosis
-porous bone
-poorly mineralized bone
-bone density (peaks at 35 years old), then resorption → formation (osteoclasts begin to do more work than osteoblasts)
-Remember: quantity & QUALITY (decrease)

-demonstrated by reduced bone mass/density (DEXA scan) & is an imbalance between bone resorption & formation

-* bone histology is usually normal but it lacks structural integrity

-by age 50: 55% of people have osteoporosis or ↓ bone mass
-by age 90: 17% males, 32% females have hp fracture

-Women: complete loss of trabeculae
-Men: form more bone on outer surface

-Kyphosis
Quality (osteoporosis)
the microarchitecture of bone
-crystal size & shape
-brittleness
-integrity of trabecular network
-ability to repair tiny cracks (don't get repaired)
potential causes of osteoporosis
-decreased levels of estrogen (especially w/ women) and testosterone
-decreased activity level (example: astronauts)
-inadequate levels of vitamins D & C, or Mg (vit D increases absorption of calcium from intestines & kidney)
latrogenic osteoporosis
heparin, glucocorticoids
regional osteoporosis
disuse or immobilization of limb
postmenopausal osteoporosis
↓ estrogen/androgen

-age-related bone loss begins in 40's
clinical manifestations of osteoporosis
-pain
-bone deformity
-fractures
prevention of osteoporosis
1.) adequate intake of Ca/Vit D
2.) weight bearing exercise
3.) no tobacco/alcohol
4.) avoidance of glucocorticoids
evaluation of osteoporosis
DEXA scan (dual energy x-ray absorptiometry)
-30% of bone tissue already lost when 1st detected by regular x-ray
treatment of ↓ bone loss
- ↑ Ca intake to 1500mg/day w/ 800 IU vit D
- ? estrogen/progesterone (breast cancer, DVT, heart disease complications)
Osteomalacia (rickets in kids)
deficiency of Vitamin D lowers the absorption of calcium from the intestine
-inadequate or delayed mineralization
-bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones
-pain, bone fractures, vertebral collapse, bone malformation
osteomyelitis (inflammation of the bone)
is most often caused by a staph infection
-most common cause is open wound (exogenous); also can be from a blood bourne (endogenous) infection (skin, ear, dental, sinus infection)
factors of osteomyelitis
-many small channels in bone inaccessable to body defenses
-microcirculation of bone vulnerable to damage
-limited capacity of osteoblasts to replace infected bone
manifestations of osteomyelitis
acute & chronic inflammation (intermittent), fever, pain, necrotic bone (can be very insidious)
-bone infection is so bad since not a good blood supply
evaluation of osteomyelitis
bone scan, CT, MRI (most common)
treatment of osteomyelitis
-antibiotics
-debridement
-surgery
-hyperbaric oxygen therapy
-remove infected prosthesis
inflammatory vs. noninflammatory joint disease: differentiated by...
-absence of synovial membrane inflammation
-lack of systemic signs & symptoms
-normal synovial fluid analysis
inflammatory joint disease
commonly called arthritis (inflammation of a joint)
-characterized by inflammatory damage or destruction in the synovial membrane or articular cartilage & by systemic signs of inflammation (fever, leukocytois, malaise, anorexia, & hyperfibrinogenemia)
-infectious or noninfectious causes (typically non infectious)
osteoarthrits (degenerative joint disease)
-degeneration & loss of articular cartilage, sclerosis of bone underneath cartilage, & formation of bone spurs (osteophytes)
-also referred to as degenerative joint disease
-incidence increase w/ age (>40 years old)
-primary disease is idiopathic (don't know what causes it)
-secondary disease due to ↑ stress on joints (athletes)

is characterized by local areas of damage & loss of articular cartilage, new bone formation of joint margins, subchondrial bone changes (beneath articular cartilage), & variable degrees of mild synovitis & thickening of the joint capsule

-erosion of cartilage is primary defect
-"bone on bone" no articular cartilage

-Bouchard= proximal
-Heberden= distal

-Varus deformity of knee (buckles out)
manifestations of osteoarthritis
-pain
-stiffness
-enlargement of the joint
-tenderness
-limited motion
-deformity
Rheumatoid arthritis
-inflammatory joint disease (2% of adults, female 3:1 ratio, 5% > 70 years old)
-systemic AUTOIMMUNE damage to connective tissue, primarily in the joints (synovial membrane 1st to be involved; 1st thing that goes/gets damaged): antibodies against your own antibodies
-similar symptoms to osteoarthrits
-distal (small) joints most involved
-presence of rheumatoid factors (RA or RF test); antibodies (IgG & IgM) against their own antibodies (draw blood to detect)
-joint fluid presents w/ inflammatory exudate

-"ulnar drift"
evaluation of rheumatoid arthritis: 4 or more of the followin...
- morning joint stiffness lasting at leat 1 hour
-arthritis of 3 or more joint areas
-arthritis of the hand joints
-symmetric arthritis
-Rheumatoid nodules (in sub Q tissue over extensor surfaces: fingers & elbows)
-abnormal amounts of serum rheumatoid factor
-radiographic changes
treatment for rheumatoid arthritis
-Non surgical: rest, hot/cold packs, PT, non steroidal anti-inflammatory's, steroids (typically), gold salts

-Surgical: synovectomy, joint replacement
ankylosing spondylitis (rheumatoid arthritis of backbone)
inflammatory joint disease of the spine or sacroiliac joints causing stiffness & fusion of the joints
-systemic, auto-immune inflammatory disease (not antibodies against antibodies)
-primary proposed site is the ENTHESIS: site where ligaments, tendons, & the joint capsule are inserted into the bone
-cause unknown, but there is a strong association w/ HLA-B27 antigen

-begins with the inflammation of fibrocaritlage, particularly in the vertebrae & sacroiliac joint
-inflammatory cells infiltrate & erode fibrocartilage
-as repair begins, the scar tissue ossifies & calcifies; the joint eventually fuses

-early symptoms: low back pain, stiffness, pain, & restricted motion
-patient demonstrates loss of normal lumbar curvature

-spine is straight up & down
Gout
-metabolic disorder that disrupts the body's control of uric acid PRODUCTION or EXCRETION
-gout manifestations high levels of uric acid in the blood & other body fluids
-occurs when the uric acid concentration increases to high enough levels to crystallize

-cyrstals deposit in connective tissues throughout the body
-when these crystals occur in the synovial fluid, the inflammation is know as "gouty arthritis"

- gout is related to purine (adenine & guanine) metabolism (URIC ACID is a breakdown product of purines)
-affected patients can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys

-mechanics for crystal deposition: lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, & trauma (promotes uric acid crystal precipitation)

-50% initial attacks in great toe (a condition known as PODOGRA)
-RENAL STONES 1000X more prevalent in individuals w/ gout
clinical stages of gout
-asymptomatic hyperuricemia
-acute gouty arthritis
-tophaceous gout (chronic stage)
contracture
-muscle fiber shortening w/out an action potential
-caused by failure of the sarcoplasmic reticulum) calium pump) even w/ available ATP
Stress-induced muscle tension
-neck stiffness, back pain, clenching teeth, hand grip, & headache
-associated w/ chronic anxiety
disuse atrophy
-reduction in the normal size of muscle cells as a result of prolonged inactivity: bed rest, trauma, casting, or nerve damage
treatment for disuse atrophy
isometric movements & passive lengthening exercises
fibromyalgia
-chronic widespread joint & muscle pain
-vague symptoms: increased sensitivity to touch, absence of inflammation, fatigue, & sleep disturbances
-*MOST EXPERTS FEEL IT IS A DECREASE IN PAIN TOLERANCE DUE TO FUNCTIONAL ABNORMALITIES OF THE CNS
possible factors of fibromyalgia
-flu-like viral illness, chronic fatigue syndrome, HIV infection, Lyme disease, medications, physical or emotional trauma
-scientific studies are unclear
polymyositis & dermatomyositis
-collectively described by the term myositis (inflammatory changes in the skeletal muscle)
-viral, bacterial, & parasitic myositis: Staph Aureus infections; Trichinosis (Trichinella infection); Toxoplasmosis
Polymyositis
generalized muscle inflammation
Dermatomyositis
polymyositis accompanied w/ skin lesions
toxic myopathies
the most common cause of toxic myopathy is ALCOHOL ABUSE
-acute attack of muscle weakness, pain, & swelling
-chronic weakness in a drinker of long duration
-necrosis of individual muscle fibers
-disturbance of energy turnover, gene dysregulation, & initiation of apoptosis
Bone tumors
-may originate from bone cells, caritlage, fibrous tissue, marrow, or vascular tissue
(osteogenic, chondrogenic, collagenic, & myelogenic)

-fibroblast: bone cell cartilage; osteoblast (bone cell), chondroblast (cartilage cell), fibroblast (collagen producing cell)
-Reticulum: Bone marrow
malignant bone tumors
increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, a prominent nucleolus, & in an increase in the mitotic rate
Osteosarcoma
-most common malignant bone tumor
-***38% of bone tumors***** (usually end of long bone)
-predominant in adolescents & young adults; occurs in seniors of they have a history of radiation therapy
-contain masses of osteoid (abnormal cells): "streamers" noncalcified bone matrix & callus
-located in the metaphyses of long bones: 50% occur around the knees

-requires amputation
Chondrosarcoma
-cartilage forming
-tumor of middle-aged & older adults
-infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones
-the tumor contains lobules of HYALINE CARTILAGE that expand & enlarge the bone
-causes erosion of the cortex & can expand into the neighboring soft tissue
Fibrosarcoma
-firm, fibrous mass of collagen, malignant fibroblasts, & osteoclast-like cells
-usually affects metaphysis of the femur or tibia
-metastasis to the lungs is common
Rhabdomyosarcoma
-malignant tumor of striated muscle
-usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva & heart
-highly malignant w/ rapid metastasis
-types: pleomorphic, emryonal, & alveolar
Which cells have the capability of dissolving bone tissue and releasing the stored calcium into the bloodstream?

A) Osteoblasts
B) Osteoclasts
C) Osteocytes
D) Osteoids
B) Osteoclasts
Spongy (cancellous) bone is found in which of the following locations?

A) Diaphysis of long bones
B) Epiphysis of long bones
C) Cortical bone areas
D) All of the above
B) Epiphysis of long bones
The component(s) of the bone matrix that gives bone compressive strength is (are):

A) collagen.
B) glycoproteins.
C) the periosteum.
D) hydroxyapatite.
D) hydroxyapatite.
Which of the following molecules form the crystalline structure of hydroxyapatite?

A) Calcium and magnesium
B) Phosphate and calcium
C) Albumin and phosphate
D) Magnesium and hydrogen
B) Phosphate and calcium
Which of the following structures is present in spongy bone and absent in compact bone?

A) Trabeculae
B) Lacunae
C) Lamellae
D) Haversian canals
A) Trabeculae
Which of the following bones belongs to the appendicular skeleton?

A) Sternum
B) Sacrum
C) Mandible
D) Ilium
D) Ilium
In children, growth in long bones primarily takes place at the:

A) ends of the epiphyses.
B) middle of the diaphysis.
C) medullary cavity.
D) epiphyseal plate.
D) epiphyseal plate.
Phase 1 of the bone remodeling cycle involves:

A) secondary bone formation.
B) bone cell activation.
C) bone tissue resorption.
D) trabeculae configuration.
B) bone cell activation.
Which muscle delivers the power stroke during the cross-bridge cycle of muscle contraction?

A) Calcium
B) Myosin
C) Actin
D) Tropomyosin
B) Myosin
Which molecule prevents a muscle contraction from occurring when the muscle is at rest?

A) Troponin
B) Calcium
C) Actin
D) Myosin
A) Troponin
Which of the following are both types of fibrous joints?

A) Sutures and syndesmoses
B) Symphyses and synchondroses
C) Gomphoses and symphyses
D) Diarthroses and amphiarthroses
A) Sutures and syndesmoses
The main energy source or fuel for skeletal muscle contraction is:

A) calcium.
B) albumin.
C) ATP.
D) actin.
C) ATP.
The epimysium, perimysium, and endomysium in the body of a skeletal muscle are made of:

A) thin sheets of cartilage.
B) simple epithelial tissue.
C) stratified epithelial tissue.
D) fascia.
D) fascia.
Which structure is the contractile subunit of the myofibril in a skeletal muscle cell?

A) Sarcoplasmic reticulum
B) Sarcomere
C) Myosin
D) Motor end plate
B) Sarcomere
Which of the following ions is released from the sarcoplasmic reticulum to initiate a muscle contraction?

A) Sodium
B) Potassium
C) Magnesium
D) Calcium
D) Calcium
A bone breaks in a place where there was pre-existing disease. What type of fracture is being described?

A) Transchondral
B) Pathological
C) Stress
D) Fatigue
B) Pathological
All of the following events occur following a bone fracture except:

A) development of a blood clot beneath the periosteum.
B) leukocyte infiltration into bone tissue.
C) blood vessel growth at the fracture site.
D) an increase in the number of osteoclasts at the fracture site.
D) an increase in the number of osteoclasts at the fracture site.
A torus fracture occurs when:

A) the injury occurs at the epiphyseal growth plate.
B) the cortex of the bone buckles.
C) the spongy bone is damaged without affecting the cortical bone.
D) a long bone splinters into many fragments.
B) the cortex of the bone buckles.
A fracture in which the bone breaks into two or more fragments is termed a(n):

A) comminuted fracture.
B) open fracture.
C) greenstick fracture.
D) occult fracture.
A) comminuted fracture.
Which of the following fractures involves fragmentation of the articular cartilage and generally occurs in adolescents?

A) Greenstick
B) Stress
C) Transchondral
D) Insufficiency
C) Transchondral
Which of the following pairs of symptoms is likely to manifest following a femoral fracture?

A) Chest pain and shortness of breath
B) Low blood glucose and seizures
C) Pain and swelling in the thigh
D) Limb paralysis and referred pain
C) Pain and swelling in the thigh
Complications that can occur as a fractured bone heals include all of the following except:

A) malunion.
B) nonunion.
C) disunion.
D) delayed union.
C) disunion.
Which of the following substances prevent proper bone healing?

A) Vitamins C and E
B) Alcohol and nicotine
C) High-protein diet
D) Dehydration
B) Alcohol and nicotine
A tear in a tendon is commonly known as a:

A) fracture.
B) sprain.
C) strain.
D) subluxation.
C) strain.
Inflammation of a tendon where it attaches to the bone at its origin is called:

A) epicondylitis.
B) arthritis.
C) delta lesions.
D) bursitis.
A) epicondylitis.
A partial tear of a ligament is called a:

A) first-degree strain.
B) second-degree strain.
C) first-degree sprain.
D) second-degree sprain.
B) second-degree strain.
An avulsion occurs when:

A) the synovial capsule is torn.
B) the body of a ligament is torn.
C) a tendon is torn off its bony attachment.
D) a tendon becomes inflamed.
C) a tendon is torn off its bony attachment.
The displacement of two bones in which the articular surfaces partially lose contact with each other is called:

A) subluxation.
B) subjugation.
C) sublimation.
D) dislocation.
A) subluxation.
Patients with osteoporosis are at risk for which of the following problems?

A) Rhabdomyolysis
B) Osteomyelitis
C) Osteomalacia
D) Pathologic bone fractures
D) Pathologic bone fractures
Factors contributing to the development of osteoporosis in older women include:

A) decreased estrogen levels.
B) increased androgen levels.
C) excessive dietary calcium.
D) strenuous exercise.
A) decreased estrogen levels.
Known causes of osteoporosis include all of the following except:

A) family history.
B) late menopause.
C) smoking.
D) anorexia.
B) late menopause.
The best screening test for osteoporosis is:

A) an x-ray.
B) a bone biopsy.
C) a dual energy x-ray absorptiometry (DEXA) scan.
D) a thorough physical exam.
C) a dual energy x-ray absorptiometry (DEXA) scan.
Which of the following disorders presents with significant bone demineralization from a vitamin D deficiency and usually results in skeletal pain?

A) Osteomalacia
B) Osteopenia
C) Osteomyelitis
D) Osteoporosis
A) Osteomalacia
In osteomyelitis, the area of necrotic bone at the site of the infection is called the:

A) periosteum.
B) involucrum.
C) drainage tract.
D) sequestrum.
D) sequestrum.
The pathophysiology of osteomalacia involves:

A) increased osteoclast activity.
B) collagen breakdown in the bone matrix.
C) crowding of cells in the osteoid.
D) abnormal calcium crystallization.
D) abnormal calcium crystallization.
Which of the following diseases is characterized by osteomalacia in the growing bones of children?

A) Rickets
B) Osteosarcoma
C) Paget disease
D) Rhabdomyoma
A) Rickets
Which of the following disorders in characterized by enlargement and softening of the bones?

A) Osteomyelitis
B) Osteoporosis
C) Paget disease
D) Rickets
C) Paget disease
The cause of most cases of endogenous osteomyelitis is (are):

A) fungal skin infection.
B) viral pneumonia.
C) parasitic infection of the gastrointestinal tract.
D) blood-borne bacteria.
D) blood-borne bacteria.
Which of the following musculoskeletal tumors usually forms in the bone marrow?

A) Rhabdosarcoma
B) Liposarcoma
C) Osteosarcoma
D) Chondrosarcoma
C) Osteosarcoma
Which of the following cancers involves the proliferation of plasma cells in the bone marrow, causing skeletal pain?

A) Myeloma
B) Leukemia
C) Lymphoma
D) Osteosarcoma
A) Myeloma
The chief pathologic feature of degenerative joint disease is:

A) stress fractures of the epiphysis.
B) loss of synovial fluid.
C) degeneration of articular cartilage.
D) thinning of the joint capsule.
C) degeneration of articular cartilage.
Risk factors for osteoarthritis include all of the following except:

A) low calcium intake.
B) older age.
C) obesity.
D) orthopedic injury.
A) low calcium intake.
The primary manifestation of osteoarthritis is:

A) joint fusion.
B) joint pain.
C) hypermobility of joints.
D) contractures.
B) joint pain.
Rheumatoid arthritis results from joint inflammation caused by:

A) bacterial infection.
B) trauma.
C) autoimmune injury.
D) congenital hypermobility.
C) autoimmune injury.
Synovial joint problems in rheumatoid arthritis are due to which of the following pathologies?

A) Articular cartilage is lost through enzymatic breakdown.
B) Free radicals attach to the synovial membrane and articular cartilage.
C) Neutrophils and inflammatory cytokines cause damage to articular cartilage.
D) Cysts develop in the subchondral bone and create fissures in the articular cartilage.
A) Articular cartilage is lost through enzymatic breakdown.
In addition to joint pain, rheumatoid arthritis often manifests with which of the following systemic symptoms?

A) Fever
B) Malaise
C) Lymphadenopathy
D) All of the above
D) All of the above
Ankylosing spondylitis results in:

A) vertebral joint fusion.
B) instability of synovial joints.
C) costal cartilage degeneration.
D) temporomandibular joint degeneration.
A) vertebral joint fusion.
Pain and inflammation associated with gout are caused by crystallization of _____ in the tissues.

A) amino acid
B) uric acid
C) ketones
D) hyaluronic acid
B) uric acid
The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called:

A) tophaceous gout.
B) monarticular arthritis.
C) complicated gout.
D) asymptomatic hyperuricemia.
A) tophaceous gout.
Episodes of gout are often triggered by all of the following factors except:

A) alcohol.
B) drugs.
C) high-fat diet.
D) trauma.
C) high-fat diet.
Individuals with gout are 1000 times more likely to develop which of the following problems?

A) Coronary artery disease
B) Osteoarthritis
C) Contractures
D) Renal stones
D) Renal stones
A characteristic feature of fibromyalgia is:

A) trigger point pain.
B) headache.
C) permanent shortening of muscles.
D) muscle atrophy.
A) trigger point pain.
Pain in fibromyalgia is attributed to:

A) inflammation.
B) autoimmune destruction of muscle tissue.
C) decrease in pain tolerance.
D) increased levels of peripheral neurotransmitters.
C) decrease in pain tolerance.
Severe muscle trauma from crush injuries can result in which of the following complications?

A) Myotonia
B) Rhabdomyolysis
C) Myocarditis
D) Fibromyalgia
B) Rhabdomyolysis
Myoglobinuria (rhabdomyolysis) can result in failure of which of the following organs?

A) Liver
B) Lungs
C) Kidneys
D) Pancreas
C) Kidneys
Unnatural alignment
What is a definite sign of a fracture?
Myeloma
What is a malignant proliferation of plasma cells, has a poor prognosis and infiltrates the bone marrow?
Rheumatoid arthritis
What begins with the destruction of the synovial membrane and subsynovial tissue?
Toxic Myopathy
What is associated with alcohol abuse and manifested by mm weakness and pain?
Rheumatoid Arthritis
What is a systemic inflammatory disease associated with joint pain?
Rhabdomyosarcoma
What is a malignant tumor of the striated mm called?
Dermatomyositis
What is inflammation of the connective tissue and mm fibers that results in extensive necrosis and destruction of mm fibers called?
Salmenilla
What is the most common cause of hematogenous osteomyelitis in sicke cell patients?
S. Auireus
What is the most common hematogenous cancer?
Tendinosis
What is degration of collagen fibers called?
impaired motor function
What is the clinical manifestation of Paget disease?
Chronic Bursitis
What results from repeated trauma and occurs between tendons and mm?
Osteomalacia
What is inadequate and delayed mineralization in mature compact bone called?
Chrondrosarcoma
What is the 2nd most commons primary malignant bone tumor and infiltrates the trabeculae of spongy bone?
Tendinopathy
What is pain over the entire tendon called?
Osteoarthritis
What is a common age related disorder of synovial joints called?
Gout
What syndrome is caused by an inflammatory response to uric acid production?
Comminuted fracture
What kind of fracture is a bone breaking into 2 or more fragments called?
Giant cell tumor
What kind of tumor is common in females and is the 6th most common bone tumor?
Fibromyalgia
What is a chronic musculoskeletal syndrome with vague symptoms associated with it called?
Geographic, moth eaten, permeative patterns
What are the 3 patterns of bone destruction?
Avulsion
What is the complete seperation of a tendon from the bony attachment site called?
Transverse fracture
What type of fracture occurs straight across the bone?
Linear fracture
What type of fracture runs parallel to the long axis of the bone?
Greenstick, Torus, Bowing
What are the 3 types of incomplete fractures?
Greenstick
What type of fracture occurs when 1 side of a bone breaks and splinters spongy bone?
Torus
What type of fracture occurs when the cortex buckles but doesnt break a bone?
Bowing
What type of fracture occurs when longitudinal force is applied to bone?
Fatigue stress fracture
What type of fracture is caused by abnormal stress applied to a bone with normal ability to recover?
Transchondral stress fracture
What type of fracture is caused by seperation of a portion of articular cartilage that covers the end of a bone at a joint?
Pathologic and Stress
These types of fractures are classified by the cause:
Fatigue, insufficiency and transchondral
What are the 3 types of stress?
Insufficiency fractures
This is a type of stress fracture that occurs in bones lacking the normal ability to deform and recover; can be as a result of normal weight bearing or activity.
Hematoma formation
What is it called when a broken bone causes damage to the surrounding tissue, the eriostemon and the blood vessels in the cortex and marrow?
Procallus formation
Bone tissue distruction triggers an inflammatory response called what?
Open reduction
This is a surgical procedure that exposes the fracture site, and the fragments are brought into alinment under direct visualization
Reduction
Treatment of a displaced fracture that involves realigning of the bone fragments is called what?
Immobilization
Holding the bone fragments in place so the bone union can occur is called what?
Nonunion, delayed union or malunion
Improper reduction or immobilization is called what?
Dislocation
Temporary displacement of two bones or loss of contact between articular cartilage is called what?
Subluxation
When contact between articular surfaces is only partially lost, it is called what?
Tendinitis
What is the inflammation of a tendon called?
Tendinosis
What is the painful degradation of collagen fibers called?
Bursitis
What is the inflammation of a bursa caused by repeated trauma commonly found in the shoulder, hip, knee and elbow called?
Septic Bursitis
What is caused by wound infections or bacterial infections of the skin overlaying the bursae?
Muscle strain
What is it called when sudden, forced motion of a mm becomes stretched beyond its normal capacity and can involve the tendons?
Rhabdomyolysis
Also called myoglobinuria, this is a life thretening complication of severe mm trauma with muscle cell loss
Crush Syndrome
What is the most severe form oof myoglobinuria?
Volkmann Ischemic Contracture (in the forearm)
What is less severe and localized forms of myoglobinuria?
Osteoporosis
This is a disease in which the porous bone tissue is normally mineralized but the mass of bone is decreased and the structural integrity of orbicular bone is impaired
Iatrogenic Osteoporosis
What type of osteoporosis develops temporarilly in individuals receiving large doses of heparin, because heparin promotes bone reabsorption by decreasing synthesis or collagen breakdown?
Regional Osteoporosis
What type of osteoporosis is confined to a region or segment of the appendicular skeleton and usually has no cause?
Post menopausal Osteoporosis
What type of osteoporosis is bone loss that occurs in middle aged and older women?
Glucocorticoid induced osteoporosis
What is characterized by increased bone reabsorption and decreased bone formation?
Kyphosis
What diminishes height and is caused by a vertebral collapse?
Osteomalacia
This is a metabolic disease characterized by inadequate and delayed mineralization of osteoid in mature compact spongy bone
Paget Disease
This is also known as Osteitis deformans, and can cause abnormal bone curvature, brain compression, impaired motor function, deafness and atrophy of the optic nerve.
Osteomyelitis
This is a type of bone infection that is most often caused by a staphylococcal infection
Synovial cavity and joints
What type of joints separate articulating bones and is freely moveable (diarthroses)?
Articular cartilage
This type of cartilage reduces friction and absorbs shock
Inflammatory joint disease
Commonly called Rheumatoid arthritis, this is characterized by inflammatory damage or distruction in the synovial membrane or articular cartilage and by systemic signs of inflammation.
Non inflammatory osteoarthritis
What is degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage and formation of bone spurs called?
Osteoarthritis
What is characterized by local areas of damage and loss of articular carilage, new bone formation of joint margins, secondary bone changes and miild synovitis?
Rheumatoid factors
What are transformed antibodies in Rheumatoid arthritis called?
IgM and IgG; sometimes IgA and higher cases in woman
Rheumatoid factors usually consist of these two callses of Ig antibodies
Enthesis
What is the site called where ligaments, tendons and the joint capsule are inserted into the bone?