MCR I Class

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  1. What type of disorder is Gouty Arthritis
    Purine metabolism disorder.
  2. What disorder is hyperuricemia associated with? Define hyperuricemia. If you have hyperuricemia, does it mean will you get the disorder?
    • - Gouty Arthritis
    • - elevated serum uric acid levels
    • - No.
  3. What is the incidence of Gouty Arthritis? What body part is mainly involved?
    male to female 20:1. over 40 y.o. 1st MTPJ
  4. What is the etiology of Gouty Arthiritis?
    • -family history in 50% of patients
    • - infection, ETOH use, rich (high protein and purine) foods, injury, exposure to cold
  5. What is the pathophysiology of gouty arthritis?
    sodium monorate crytals accumulate in the synovial membrane. Leukocytes atttack the crystals, but release an enzyme that produces severe inflammation in the joint.
  6. What are the signs and symptoms of gouty arthritis?
    intense pain w/ increase AROM, marked tenderness, redness, and swelling. Possibly fever and cellulites (inflammation of overlying skin).

    tophi: after attacks, not all crystals get reabsorbed, the residual crystal tend to form subcutaneous clusters aka tophi. Tophi can exist in the synovial membrane, cartilage, subchondral bone, synovial sheaths of tendons. Tophi develop in about 1/2 of people with gout.
  7. What are the interventions of gouty arthritis?
    avoid purine rich foods (organ meats, scrapple), anti-inflammatory drugs, and possible long term medications to control uric acid production in the body (people who over produce it)

    It's either you make too much or your body can't get rid of it efficiently.
  8. What is the etiology of sceroderma? course of disease?
    • - unknown
    • - course is variable and unpredictable
  9. What is the incidence of scleroderma?
    4:1 female
  10. What is the signs and symptoms of scleroderma?
    • - diffuse fibrosis and degenerative changes in skin, joints, and internal organs
    • - thickening of skin in face and hands
    • - cardiac / pulmonary probs: arrhthymias, pericarditis, lung fibrosus, pleurisy, and pulmonary hypertension.
    • - polyarthralgias (joint aches)
    • - GI disturbances and renal hypertension
  11. What are the interventions of scleroderma?
    • - steroids for acute episodes
    • - meds for specific organ involvement
  12. What is the etiology of fibromyalgia (fibromyositis)?
    • - idiopathic (unknown)
    • - factors: stress, trauma, other rheumatoid disorders, and injection
    • - disturbed sleep cycles: less then normal "beta" sleep; body can't heal of the daily stress on tissues
  13. What is the signs and symptoms of fibromyalgia (fibromyositis)?
    • - achy, diffuse pain that "moves around" from one area or joint to another over time.
    • - localized tenderness or spasm that may change location
    • - pain provoked by overuse or activity
  14. What are interventions of fibromyalgia (fibromyositis)?
    • - may spontaneously resolve but can be chronic
    • - aeobic exercise: gets rid of stress
    • - anti-inflammatory drugs, analgesics used as needed
    • - sleep disorders: SSRI's (anti-depressant); zoloft/paxil
    • - local symptoms treated w/modalities, massage but you might "chase" them
  15. What is the etiology of Paget's disease (osteitis deformans? it is inflammatory?
    • - not truely inflammatory
    • - unclear; could be viral orgin
    • - disseminated bone disorder
  16. What is the pathophysiology of Paget's disease (osteitis deformans)?
    excessive osteoblast and osteoclast activity leading to huge bones, deformities, DJD, and pathologic fractures
  17. What are the signs and symptoms of Paget's disease (osteitis deformans)?
    • - thickening of tibia, femur, skull, pelvis, and vert. bodies
    • - pain / functional limitations
  18. What is the interventions of Paget's disease (osteitis deformans)?
    • - meds for osteoclast activity
    • - specific interventions (immobilization after a fracture)
  19. What is systemic lupus erthematosus? Etiology?
    • - chronic inflammatory connective tissue disease
    • - unknown
  20. What does systemic lupus erthematosus affect?
    • - joints, kidneys, vessel walls
    • - patients experience exacerbations and remissions
  21. What is incidence of systemic lupus erthematosus?
    90% females
  22. What are the symptoms and complications of systemic lupus erthematosus?
    • - fever, malaise, headache, polyarthralgias, malar butterfly erythema (butterfly rash on face)
    • - lesions of skin of face, alopecia, pleurisy, pericarditis, CNS, renal disorders
  23. What ar the interventions of systemic lupus erthematosus?
    meds: immunosuppressive drugs, steriods, anti-inflammatories
  24. Definition of an inflammatory disorder.
    any disease or condition that involves inflammation
  25. What are the signs of inflammation?
    • - heat (warmth)
    • - erythemia (redness)
    • - swelling
    • - pain (due to increase pressure of tissue from swelling)
    • - loss of function
  26. What are the causes of inflammation?
    • - metabolic disorder
    • - infection
    • - disease process
    • - trauma (macrotrauma / microtrauma)
  27. Incidence of acute hematogenous osteomyelitis
    • -usually children
    • -more male
  28. Etiology of acute hematogenous osteomyelitis
    bacterial infection from abrasions, pimples, upper respiratory infections, local trauma to bone play a role in location
  29. pathophysiology of acute hematogenous osteomyelitis. what does it mainly affect?
    if untreated, pressure # in bones; development of subperiostial abscess; necrosis

    puss increases pressure --> pain

    spreads --> septic --> bloodborn infection

    affects growing (metabollically active) bones in metaphyseal region
  30. Signs and symptoms of acute hematogenous osteomyelitis
    50% of time: local trauma, severe constant pain, tenderness, malaise, fever, soft tissue swelling on surface
  31. Intervention of acute hematogenous osteomyelitis
    antibiotics, rest, analgesics, surgical decompression (abcess, necrotic dead bone to remove it)
  32. Complications of acute hematogenous osteomyelitis
    bone destruction and septicemia, pathological fx, joint contracture, overgrowth or cessation of bone growth, death
  33. Incidence of chronic hematogenous osteomyelitis
    occurs when the acute version goes untreated
  34. Pathophysiology of acute hematogenous osteomyelitis
    sequestrum (piece of bone) maybe spontaneously extruded
  35. Signs and symptoms of acute hematogenous osteomyelitis
    creates draining sinus, PAIN, swelling, tenderness
  36. intervention of acute hematogenous osteomyelitis
    bed rest, antibiotics, surgical excision and. or drainage
  37. complications of acute hematogenous osteomyelitis
    chronic draining sinus, contracture, pathological fx, septicemia, malignant changes in epidermis
  38. What is the goal of Tx for osteomyelitis?
    patient is pain free and FWB
  39. Where and who is osteomyelitis of the spine usually found?
    younger children (lower TS/ upper LS) or in immunosuppressed individuals
  40. signs and symptoms of osteomyelitis of the spine
    pain, spasm, tenderness
  41. interventions of osteomyelitis of the spine
    antiobiotics, bed rest, excision, drain insertion
  42. what is / Incidence of acute septic arthritis.
    • -bacterial infection of synovial joint
    • - children
  43. etiology of acute septic arthritis.
    associated w/hematogenous osteomyelitis if the metaphysis is intracapsular
  44. pathophysiology of acute septic arthritis.
    purulent exudate destroys cartilage, body forms pannus
  45. what is pannus?
    a sticky membrane that deprives nutrition, diffusion of synovial fluid
  46. signs and symptoms of acute septic arthritis.
    joint effusion, severe pain with weight bearing or movement, spasm, tenderness
  47. what type of infection is osteomyelits and septic arthirits 2 degree to wounds?
  48. what are the sources of exogenous infections?
    • puncture wound
    • open fx
    • trauma that broke skin
    • surgical technique that aren't sterile
  49. intervention of osteomyelits and septic arthirits 2 degree to wounds
    careful wound cleaning, debridement, drain; antibiotics
  50. Signs and symptoms of tuberculosis osteomyelitis
    back pain, tenderness, spasm
  51. pathophysiology of tuberculosis osteomyelitis
    progressive bone destruction, pathological fx
  52. What other disease is tuberculosis osteomyelitis associated with and what is its symptoms?
    • Pott's Disease
    • spine kyphosis
  53. Intervention of tuberculosis osteomyelitis
    antibiotics for tuberculosis, surgery
  54. complications of tuberculosis osteomyelitis
    SCI (paraplegia), cauda equina syndrome (pressure on nerve roots), spread of abcess into pleura or psoas
  55. Signs and symptoms of tuberculosis arthritis
    pain esp with wt bearing and motion, swelling
  56. pathophysiology of tuberculosis arthritis
    pannus formation, synovial membrane hypertrophy forming an effusion, cartilage necrosis
  57. intervention of tuberculosis arthritis
    • antibiotics
    • rest
    • ice
    • elevation
    • synovectomy
  58. what is rheumatic disease? What is RA?
    pain and stiffness in musculoskeletal tissue, include various forms of arthritis and skin diseases

    inflammatory polyarthritis; cycles of exacerbation and remission; more cyles = more deformity progresses; disability progress
  59. RA incidence? Usually involves what body part?
    1.5% of adults; 3:1 female; age 20-40

    distal joint first; symmetrical
  60. RA etiology
    not known; viral? exxagerated normal immune mechanism?
  61. RA pathophysiology
    inflammation of synovial membrane, pannus formation, jt destruction (autoimmune response)
  62. RA signs and symptoms
    effusion, periarticular swelling, contractures/adhesion withing joint, fatigue, pain, stiffness, ruptured tendons
  63. RA interventions
    • pharmocological: corticosteroids
    • protective positioning and splinting
    • therapeutic exercise
    • thermal agents
    • surgery (synovectomy, arthroplasties, tendon repairs/grafts/transfers
    • athrodesis in upper CS
  64. Juvenile RA
    • pauciarticular vs polyarticular
    • systemic (joints and organ systems involved)
    • intervention same as RA
  65. what is Ankylosing spondylitis aka marie-strumpell disease
    bony ankylosis of spine and proximal joints
  66. incidence of Ankylosing spondylitis aka marie-strumpell disease
    onset late teens and 20s
  67. etiology of Ankylosing spondylitis aka marie-strumpell disease
    genetic, unknown cause
  68. pathophysiology Ankylosing spondylitis aka marie-strumpell disease
    facet/iv joints become fused; bamboo spine; whole spine maybe fused
  69. signs and symptoms Ankylosing spondylitis aka marie-strumpell disease
    vague spine pain, spine pain at night, may feel temporarily better with exercise, tenderness; spasm
  70. interventions Ankylosing spondylitis aka marie-strumpell disease
    • pharmacological: corticosteroids
    • orthopedic apliances: spinal brace (fuse in good posture)
    • therapeutic exercise
    • surgery: correction of deformity- spinal osteotomy and or reconstruction
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MCR I Class
MCR Exam II packet 2
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