What is the difference between an open and closed fracture? Open: the skin is broken Closed: The skin is intact What is the difference between complete and incomplete fracture? Complete: Bone is broke all the way through Incomplete: Bone is fractured but not all the way What is a 45 degree fracture to long axis of a bone? Oblique fracture What two things cause an oblique fracture Angulation Compressive force What type of fracture is described as a break in 2 or more fragments Comminuted A pt reports to the clinic and you suspect they have a fracture, what symptoms lead you to this conclusion? Unnatural alignment Swelling Muscle spasm Tenderness Pain Impaired sensation What is it called when there is a dislocation in which contact between the surfaces are only partially lost? Subluxation Where are subluxations most common The spinal column What is the difference between a strain and a sprain Strain is a tear in the tendon Sprain is a tear in the ligament What is painful inflammation of the tendon Tendonitis What is painful inflammation of the bursae? Bursitis At what age is Bursitis most common and what causes it? Middle age Repeated trauma (softball players) What is bursae? A fluid-like sac that acts as a cushion at joints What is a degradation of collagen fibers that results from trauma and repetitive stress? Tendonosis What is complete separation of a tendon or ligament from its attachment Avulsion What is another name for Tennis elbow Epicondylitis What is inflammation of tendon where it attaches to a bone (olecranon process - elbow) Epidondylitis What is it when there is a sudden, forceful motion causing the muscle to become stretched beyond its normal capacity Muscle strain What is a complication of localized muscle injury caused by scar tissue calcification and subsequent ossification? Myositis Ossificans What is a life-threatening complication caused by severe muscle trauma manifested by excess myoglobin, and intracellular muscle protein in the urine? Rhabdomyolosis/Myoglobinuria What is the most severe form of rhabdomyolosis Crush syndrome WHat can cause rhabdomyolosis Drug overdose and Long term immobility What disease what first seen in injuries after london air raids in WWII Rhabdomyolosis What is a less severe and more localized form of myoglobinuria which can lead to Volkmann ischemic contracture of forearm or leg Compartment syndrome What precipitating factors can lead to osetoporosis Decreased estrogen/testosterone Reduced physical activity Inadequate Vit C and D Insufficient dietary Ca+ and Mg+ What diseases is characterized by reduced bone mass or density and imbalance of bone resorption and formation Osteoporosis What disease is characterized by inadequate and delayed mineralization, causing radiolucent bands and bone fractures? Can cause Vertebral collapse? Osteomalacia What is osteomalacia in children called Rickets What does deficiency in Vitamin D lead to in osteomalacia decreased calcium absorption from intestines and low serum phosphate What bacteria is the most common cause of osteomyelitis Staph What 3 things cause Osteomyelitis Staph Contaminated open wound Hematogenous Bone Infection What can osteomyelitis lead to and why? Necrosis due to impaired blood supply Name 5 places bone tumors may originate from Bone cells Cartilage Fibrous Tissue Marrow Vascular tissue What type of tumors destroy small areas of bone, tend to be limited to anatomical confines, has a uniform and well defined border with a geographic pattern easily separated from normal bone Benign What type of tumors have a moth eaten pattern with permeative pattern bone destruction that is not easily separated from normal bone and has the adjacent areas partially destroyed Malignant Name four common types of bone tumors Osteosarcoma Chondrosarcoma Fibrosarcoma Giant Cell Malignant bone-forming tumor found in the marrow that is large and destructive and has a moth-eaten pattern Osteosarcoma What type of bone tumor is common in middle-aged and older adults chondrosarcoma What malignant collagenic bone tumor is found in middle aged adults Fibrosarcoma What type of bone tumor is from myelogenic tissue that occurs between ages 20 and 40? Giant Cell What is the pathology of shock Cells are not receiving adequate oxygenation or are unable to use the oxygen Name 3 compensatory mechanisms that happen when there is no glucose available for cells to use for energy Glycogenolysis Gluconeogenesis Lypolysis What is the breakdown of glycogen to glucose Glycogenolysis What is glycogen formation from fatty acids and proteins rather than from glucose Gluconeogenesis What is fat breakdown used for alternative for fuel generation? Lypolysis Describe the pathophysiology of cardiogenic shock An injury to the heart muscle causes decreased cardiac output which causes back-up in blood flow leading to pulmonary congestion. Because the blood is not being pumped out of the heart effectively, the cells are deprived of oxygen. What is the number one cause of cardiogenic shock? MI Describe the pathology of hypovolemic shock Due to a loss in blood or fluids, the heart has less oxygen to eject to the rest of the body leading to cell deprivation of oxygen What can cause blood loss that leads to hypovolemic shock Hemorrhage What can cause fluid loss that leads to hypovolemic shock Dehydration Burns Third spacing (Liver/Renal failure) What does someone with hypovolemic shocks skin feel like and why? cool and clammy, pale due to blood being shunted to the critical organs and subsequently away from the skin Pt comes into the clinic c/o chest pain and difficulty breathing. Upon assessment you note JVD, cool, clammy skin, and crackles in the lung fields. BP measures 90/47. HR is 112. What type of shock do u suspect the pt has and why? Cardiogenic shock, The tale tale sign is crackles and JVD as these indicate fluid overload which is consistent with this type of shock. What type of history would a man suspected of having cardiogenic shock most likely have? Hx of: MI, valve issues, arrhythmias, atherosclerosis, and heart infections Describe the pathophysiology of neurogenic shock Nervous system malfunction leads to decreased vascular tone which causes blood to pool. What things can lead to neurogenic shock Brain injury and SCI What is the NUMBER ONE symptom that differentiates neurogenic shock from all other types of shock and why Bradycardia because the nervous system is also responsible for stimulating the heart to beat effectively, with it being impaired, the heart rate slows dramatically What is the skin like for a person suffering from neurogenic shock and why warm and flushed. With neurogenic shock, all the vessels in the body are dilated causing blood rush to the skin Name two different mechanisms that can lead to shock and examples of each <answer> 1. Cells are starved, so all available oxygen is taken by the tissues and very little is returned to the heart. (Cardiogenic/Hypovolemic) 2. Oxygen has a hard time getting to the tissues due to inflammation or other barriers, so most of the oxygen returns to the heart (Distributive: Anaphylactic, septic) </answer> What cellular compensatory mechanisms occur to counteract decreased oxygenation? Aerobic switches to anaerobic leading to increased lactic acid production which decreases the pH and causes increased respiration What is progressive failure of 2 or more organ systems caused by SIRS after a severe illness or injury MODS Name the four different parameters in which there needs to be at least 2 apparent to diagnose SIRS Temp <96.8 or >100.5 HR >90 RR >20 or PaCo2 <32 WBC <4000 or >10,000, Bands >10% What criteria must be met for a pt to be diagnosed with Sepsis 2 criteria of SIRS and confirmed infection What criteria must be met for severe sepsis to be diagnosed Sepsis + Sx of end stage organ damage + Hypotension <90 + Lactate >4 mmol What criteria is needed for a person to be in septic shock Sepsis + Hypotension that is unrelieved by fluids + Organ damage + Lactate >4 mmol When does a person transition from Septic shock to MODS When there is severe septic shock, organ FAILURE, and a build up of metabolic waste (due to liver failure) What type of burn affects only the epidermis? First degree What type of burn affects the epidermis and dermis but tactile and pain sensors stay intact Second Superficial Partial Thickness What type of burn affects the epidermis and dermis but the tactile and pain sensors are diminished Second Deep Partial Thickness What type of burn affects the epidermis, dermis, and subq tissue, tactile and pain sensors are absent 3rd degree Full thickness What does a first degree burn look like? When does the symptom appear Blisters may be present within 24 hrs What does a second degree superficial partial thickness burn look like and when does the symptom appear Blisters present within minutes What does a second degree deep partial thickness burn look like Blisters may or may not appear Flat, dehydrated layer lifts off in sheets What does a third degree burn look like Blisters are rare A flat dehydrated layer lifts off easily Describe cellular and cardiovascular response to a major burn injury Within minutes, capillary beds open There's an increase in capillary permeability There is an increase in hypermetabolic state Hypercoagulable state develops What can Increased capillary permeability lead to for a burn patient Hypovolemic shock and massive edema Why does a burn patient have a persistent elevated body temperature? Due to the hypermetabolic state What will the labs look like for a burn patient Elevated fibriniogen Decreased PT and PTT Besides hypovolemic shock, what other type of shock is a burn patient at risk for and why Septic, due to the ability for microbes and endotoxins to translocate across intestinal wall, the complement system is deactivated which decreases opsonization and the body can no longer tell self from nonself allowing bacteria to multiply What is Small unmyelinated C polymodal nociceptors responsible for Transmission of diffuse burning or aching sensations (slow pain) What is Medium-sized A-delta fibers responsible for Carrying well-localized sharp pain important in initiating rapid reactions to stimuli (fast pain) What is responsible in the spinal cord for regulating transmission of pain impulses that proceeds cephalad for further processing and interpretation in the brain? Gate What needs to be stimulated in order to close pain gates? Large, fast, heavy myelinated Alpha-Beta fibers Where are large, fast, heavy myelinated Alpha-Beta fibers located synapse at dorsal horn of spinal cord along with their nociceptive Alpha-Delta and C counterparts What two neurotransmitters located in the medulla and pons contribute to pain modulation Norepinephrine and Serotonin What are morphine-like neuropeptides that act as transmitters by binding to one or more opioid receptors? Endogenous Opioids What do endogenous opioids do?? Inhibit transmission of pain impulses in brain and spinal cord Name 4 types of endogenous opioids Enkephalins Endorphins Dynorphins Endomorphins Name 3 types of acute pain Somatic Visceral Referred What type of acute pain is near on on the surface of the skin that is sharp and localized Somatic What type of acute pain is located in the internal organs, abdomen, and skeleton Visceral Pain What type of acute pain is an area removed or distant from point of origin Referred How does pain get referred in the body Cutaneous and visceral neurons converge on same ascending neuron and brain cannot distinguish between the two Describe the process of thermoregulation <answer> Hypothalamus > TSH-RH Anterior Pituitary > TSH Thyroid > Thyroxine Adrenal Medulla > Epinephrine = Vasconstriction, Glycolysis, Increased Metabolic Rate </answer> How does fever occur? <answer> Introduction of Exogenous pyrogens/endotoxins Phagocytes engulf bacteria IL-1, IL-6, interferons, and TNF released Raises Set point of hypothalamus </answer> What is a potential complication of fever? Heat stroke What occurs during a heat stroke Regulatory center ceases to function Sweating ceases causing rapid increase of body temp Skin if dry and flushed due to vascular collapse Altered LOC due to cerebral edema, degeneration of CNS, and Renal tubular necrosis At what temperature is someone at risk for heat stroke 105 degrees What does hypothermia do to the body Slows chemical reactions Increases blood viscosity Slows blood flow Facilitates blood coagulation Stimulates profound vasoconstriction At what temperature a person at risk for hypothermia? 95 degrees What are sx of hypothermia Shivering Decreased HR, RR, CO Decreased coordination Moderate to severe acidosis What is consciousness Alertness with orientation to person, place, and time What is altered perception of stimuli (time, then place, then person) Confusion What is orientated X 3 but slow vocalization and decreased motor skills Lethargy What LOC occurs when pt awakens in response to stimulation, continous stimulation is needed for arousal, and eyes are usually closed Obtundation What LOC does a pt exhibit who only responds to painful stimuli Stupor What LOC is a pt who has no arousal to any stimulus but brainstem remains intact Coma Name the components of the diencephalon thalamus and hypothalamus What occurs in the diencephalon as a person progresses into nonresponsiveness agitated, dull, lethargic, obtundation Pupils respond briskly Dolls eyes No Caloric posturing What is caloric posturing When there is no eye movement in direction on or after injection of hot/cold water in ear canal What three things take place in the midbrain as a person become unresponsive Stupor/coma Neurogenic hyperventilation Midposition fixed pupils (MPF) What is the difference between brain death and cerebral death Brain death is when cardiac and resp cannot be maintaned (death of brainstem/cerebellum) Cerebral death is an irreversible coma but brain stem is not yet affected so brain can maintain cardiac and resp function What is caused by abnormal excessive hypersynchronous discharges of CNS neurons characterized by sudden transient alterations of brain functions seizures Name and describe two types of partial seizures simple: Motor, sensory, somatosensory sx (aura) Complex: Loss of consciousness w/ automastisms What type of seizure has a partial onset and evolves into a generalized seizure Secondary generalized What type of seizure is bilaterally symmetric, without local onset, and loss of consciousness Generalized Define clonic phase in seizure Alternating contraction/relaxation of muscles Define tonic phase of seizure Muscle contraction with excessive muscle tone What is the occurrence of a second, third, of multiple seizures before the person has fully regained consciousness from preceding seizure causing cerebal hypoxia Status Epilepticus What phase of seizure follows tonic-clonic seizure usually involving sleeping Postictal What disease is charecterized by loss of neurotransmitter stimulation by choline acetyltransferinase Alzheimers What is late-onset FAD linked to? a defect on chromosome 19 What is an accumulation of insoluble amyloid beta peptides that is also a protein found in AD Senile plaques What is neurofibrillary tangles? Twisted and distorted protein fibers in the neurons Where is neurofibrillary tangles more concentrated cerebral cortex and hippocampus What is the inability to perform coordinated acts in addition to cognitive Dyspraxias What is the difference between blunt and open brain injuries Blunt - closed - dura remains intact Open - penetrating - Break in dura What can cause Blunt force trauma head strikes hard surface or rapidly moving object strikes head What does open brain injury result to Focal brain injury What involves specific, grossly observable brain lesions seen in cortical contusions, epidural hemorrhage, subdural hemorrhage, intracerebral hematoma, and open head trauma Focal Brain Injury What is a bruise on the brain from force of impact Contusion What is coup in regards to brain injury direct impact area What is an area that lies opposite of the line of force, lesions where brain strikes hard tissue on the opposite side counter-coup What is the most common source of bleeding for an extradural hematoma artery What is the tearing of bridging veins major cause of rapid and subacute development Subdural hematoma What can subdural hematoma lead to Herniation due to blood filling subdural space What type of hematoma is caused from small blood vessels traumatized by shearing forces Intracerebral hematoma What results from inertial force to the head associated with high levels of acceleration and deceleration leading to memory loss, dizziness, HA, anxiety, and mood disorders Diffuse brain injury or diffuse Axonal injury (DAI) What type of DAI has decerebrate or decorticate posturing, prolonged stupor, or restlessness (concussion) Mild What type of DAI has a prolonged coma that lasts days or weeks with incomplete recovery most often Moderate What type of DAI leads to immediate autonomic dysfunction (brainstem signs) that resolves in a few weeks. ICP appears 4-6 days after injury Severe Where do most spinal cord injuries appear? C1-C2 C4-C7 T12-L2 What is caused by normal activity of SC cells at or below level of injury ceasing because of lack of continuous clonic discharges from brain or brainstem and impulses inhibited immediately after injury characterized by complete loss of reflex at or below level of lesion spinal shock How long does spinal shock usually last after onset symptoms? 7-20 days What is associated with massive, uncompensated CV response to stimulation of the SNS usually occurring at T6 or above Autonomic hyperreflexia What is autonomic hyperreflexia usually in response to? bladder or rectum distention What is the biochemical and biomechanical alterations of the tissue that comprise the intervertebral disk Degenerative disk disease What is a structural defect that involves the lamina (neural arch of the veterbra Spondylolysis Where is spondylolysis most common Lumbar spine What is caused when a vertebra slides forward in relation to an inferior vertebra Spondylolisthesis Where is spondylolythesis most common? L5-S1 What is a protrusion of part of the nucleus pulposus through a tear in the fibrous capsule that encloses the gelatinous center of the disk Herniation of vertebral disk What causes pain in lumbosarcral area that radiates along the sciatic nerve over the buttocks and into the calf and ankle Herniated intervetebral disk Name some risk factors for CVA HTN, Cigarettes, elevated LDL, DM, hyperchromocysteinemia What type of stroke is caused by arteries supplying the brain and is most frequently attributed to atherosclerosis and inflammatory disease processes that damage arterial walls Thrombotic stroke What is thrombotic particles that cause an intermittent blockage of circulation? TIA What causes neuro deficits in TIA focal disturbance of brain or retinal ischemic lasting less than an hour without an infarction What type of stroke involves fragments that break from a thrombus that was formed outside of the brain? Emoblic stroke What common sites are associated with embolic stroke heart: MI, Afib, Endocarditis, Rheumatic heart disease, aorta, common carotid artery What type of stroke is most commonly associated with HTN, ruptured aneurysms, arteriovenous malformation, and bleeding disorders Hemorrhagic What types of symptoms does hemorrhagic stroke cause HA, stiff neck, loss of consciousness, blood in CSF What is a lacunar stroke very small and only involves small arteries What is a cerebral infarction when an area of the brain loses blood What do nociceptors respond too mechanical, thermal, and chemical Describe the pathway of nociceptors to the brain Tissue injury > Substance P, Acetylcholine, Serotonin, and Prostaglandins > Nociceptor > Dorsal root ganglion > Spinothalamic Pathway > Thalamus > Somatosencory Cortex > pain Name two afferent fibers that transmit pain signals from free nerve endings into the CNS Myelinated A-delta fibers and Unmyeliated C fibers Describe how myelinated A-Delta fibers transmit pain. Myelinated A-Delta fibers is responsible for pain related to mechanical and thermal injury (fast pain), they respond to nociceptors and quickly relay the message to the dorsal root of ganglia where it travels through the neospinothalamic tract and onto the thalamus ending at the primary somesthetic cortex Describe how unmyelinated C fibers respond to pain? Unmyelinated C fibers respond to chemical stimuli or persistent mechanical or thermal injury and takes the paleospinothalamic tract to the brain stem (RAS) and onto the primary somesthetic cortex What is the PAG (Periaqueductal grey region) of the midbrain referred to? Endogenous Analgesic Center What pathway is fast pain (sharp, stabbing) associated with? Neospinothalamic tract What pathway is slow pain (dull, aching) associated with Paleospinothalamic tract What is the main biological difference between acute and chronic pain (besides the obvious)? Acute involves Autonomic response Chronic involves Psychological response What type of pain is a more diffuse and throbbing pain that originates in structures such as muscles, bones, tendons, and radiates to surrounding tissues Deep Somatic Pain What type of pain is diffuse and poorly defined pain that results from stretching, distention, or ischemia of tissues in a body organ Visceral Pain What pain originates at a visceral site but is perceived as originating in the part of the body wall that is innervated by neurons entering the same segment of the nervous system? Referred pain What gland is responsible for temperature regulation? Hypothalamus Describe the 5 steps to fever 1. Release of PGE2 or cytokines from inflammatory cells 2. Resetting of thermostat set point 3. Vasoconstriction, shivering, Piloerection, Increased metabolism 4. Core body temperature reaches new set point 5. Once temperature has been met, vasodilation, sweating, and increased ventilation occur to return temperature to normal set point Name and describe the four successive stages of fever Prodromal: HA, fatigue, achy Second (chill): Shaking, cold Third: Flush, skin warm and red Fourth: (devervescence): sweating What disease is pathologically characterized by cerebral cortex atrophy and enlargement of ventricles Alzheimers What are the hallmark symptoms of alzheimers Short term memory loss Denial Disorientation Impaired abstract thinking Apraxias Behavior changes What is the main difference between focal and diffuse brain injury Focal: neuro deficit without loss of consciousness Diffuse: Almost always includes loss of consciousness What is characterized by flaccid paralysis, loss of tendon reflexes below the sit of injury, absence of somatic and visceral sensations below the site of injury, and loss of bowel/bladder function? Spinal Shock What are two types of SCI and describe them Primary neurological injury: occurs at time of mechanical injury and is irreversible Secondary injuries: Progressive neuronal damage following a primary injury that promotes the spread of injury What is a temporary disturbance in cerebral bloodflow (lasting less than 1 hr) which reverses before infarction occurs TIA Name the steps that take place in MODS from Ischemic injury to Massive Systemic Immune/Inflammatory response 1. Ischemic Injury 2. <microcirculation, organ hypoperfusion 3. Macrophages release inflammatory mediators which damage endothelium systemically 4. Activation of complement, coagulation, fibrinolytic, kilkrein/kenin system 5. Massive systemic immune/inflammatory response What causes hypoperfusion of tissue in MODS Vasodilation, Increased capillary permeability, selective vasoconstriction, and microvascular thrombi cause a maldistribution of systemic and organ blood flow What causes an increase in oxygen and substrate demand in MODS Due to the immune/inflammatory response, the body goes into a hypermetabolic state and hyperdynamic circulation which leads to increased oxygen and substrate demands What is the end result of increased oxygen and substrate demand as well as tissue hypoperfusion in MODS There is now an oxygen supply/demand imbalance which leads to tissue hypoxia and eventually organ dysfunction How does body fluids try to compensate for decreased cardiac output in regards to shock? Due to intravascular deficits, there is vasodilation to allow fluids from the interstitial space to sequester into the vessels. Since there is now decreased interstitial fluid and oxygen, the body is forced to switch to anaerobic glycolysis which increases lactic acid, leading to acidosis How does the heart and vessels respond to decreased cardiac output and intravascular deficits in regards to shock? What clinical manifestations would appear as a result? Heart: Pumps harder - weak, fast pulse Peripheral Vessels: constrict - cool, clammy skin Arterioles: dilate, Veins constrict: blood pools - increased clots Blood is shunted to critical organs Kidneys fail to eliminate H+ ions - oliguria Name 6 stages of fracture healing process 1. Impact 2. Induction: Clot and bruise (1st stage-heal) 3. Inflammation: Cartilage formation 4. Soft Callous: bridge two bones together 5. Ossification: Callous turns to bone 6. Remodeling