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98 Cards in this Set
- Front
- Back
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Hemopoiesis
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Blood cell production - performed by the marrow
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What is a function of bones that I don't know much about?
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Detoxification
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Most bone mass in an adult is?
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Compact bone - which is extremely strong organized bone
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What is the structural unit of bone?
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The haversian system --- concentric layers of lamellae
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Trabecular bone
-aka -structure -includes |
Spongy bone
No haversian system - instead lamellae form irregular meshwork Spaces filled with red bone marrow |
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Osteoblasts function
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Form new bone
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Osteocytes
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osteoblasts that become incorporated in the new bone
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Osteoclasts
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Resorptive cells - break down bone
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Two functions of osteocytes
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-Help calcify bone
-Help concentrate nutrients into the matrix of bone |
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How often is a bone entirely remodeled?
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q3-4 mo.
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Five phases of bone remodeling
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1. Resting
2. Activation 3. Resorption 4. Reversal 5. Formation |
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Activation phase of bone remodeling
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Osteoclasts move to the surface of bone
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Resorption phase of bone remodeling
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Osteoclasts eat the osteocytes
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Reversal phase of bone remodeling
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Osteoclasts are destroyed by apoptosis
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Formation phase of bone remodeling:
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Osteoblasts lay a new layer on the bone
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Extracellular composition of bone
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35% organic (collagen)
65% inorganic (Ca & phosphate) |
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What do collagen fibers do for bone?
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Give it strength to bear weight
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Fibrous joints, in short; two examples
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Have no mobility
-Teeth -Skull |
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Cartilaginous joints, in short; two examples
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Have mobility in that they are flexible & made of cartilage
-Symphesis pubis -Intervertebral discs |
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Synovial joints, in short
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This is the classic joint: stability and mobility
Always has synnovial fluid and membrane |
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Striated muscles include
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All skeletal and cardiac muscles
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Smooth muscles found in:
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Viscera and blood vessels
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What cation do striated and smooth muscles depend on?
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Calcium in the cytoplasm
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Ligament
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Joins bone to bone
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Tendon
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Joins muscle to bone
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Bursa
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Small fluid-filled sack for cushion
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Skeletal muscles
-Nucleus -Membrane |
Multinucleated
Has no cell membrane |
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Actin vs. myosin
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Actin = thin
Myosin = thick with heads |
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Muscle unit
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Sarcomere
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Motor unit
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When an efferent nerve synapses on a muscle - its dendrites stimulate different portions of the muscle, and together these portions make up the motor unit (because they are stimulated by the same motor neuron)
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How many subunits can make up a motor unit?
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12.0-15,000
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Most common MSK issues for children: (3)
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1. Trauma
2. Congenital defect 3. Sequella of illness |
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Most common MSK issues for adolescents: (3)
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1. Growth delay
2. Epiphyseal injury 3. Bone lesions (tumors) |
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Most common MSK issues for adults (3)
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1. Imbalance of modeling
2. Trauma 3. Repetitive stress |
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Most common MSK issues for old ppl (4)
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1. bone loss
2. joint degeneration 3. falls 4. drug therapy |
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What type of drug therapy may cause MSK problems for old ppl?
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Glucocorticoids may cause osteoporosis when used chronically
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Pathologic causes of fractures (4)
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Tumors
Osteoporosis Infections Metabolic bone disorders |
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Transchondral fracture
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Something to do with both the cartilage and bone
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How does body repair a fracture? Steps 1 & 2
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1. Blood at site forms a clot
2. Necrosis of local tissue causes inflammatory response |
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Steps 3 & 4 of fracture repair
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3. Inflammation increases blood flow to site
4. Osteoblasts are activated --- form collagen and matrix |
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What activates the osteoblasts in fracture repair?
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Cytokines of inflammation
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Does bone repair cause scar formation?
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No
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What is the first step to treating fracture?
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Splint ASAP to prevent contracture of muscle
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Dislocation
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Displacement of a bone from its position in a joint
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Subluxation
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Partial loss of contact between a bone and its joint position
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Manifestations of dislocation:
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Pain
Swelling Loss of ROM Joint deformity |
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Sprain
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A tear in a ligament OR tendon
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Type I sprain
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Ligaments/tendons stretched
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Type II sprain
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Slight tear
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Type III sprain
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Complete tear
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Body response to sprain (3)
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1. Inflammation --- edema/granulation
2. Collagen formation 3. Vascular fibrous tissue fuses new and old tissue |
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Does a sprain cause an internal scar?
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Yes
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Epicondylitis
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Inflammation of a tendon at its origin
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Tendonitis pathophysiology (4 steps)
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1. Fluid accumulates
2. Inflammation causes thickening of the sheath--- limits movement 3. Microtears-- bleeding and edema 4. Calcium deposits after repeated inflammation |
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Bursitis
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Inflammation causes the bursa to be engorged
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Is tendonitis always symptomatic?
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NO
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Main characteristics of tendonitis
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Localized pain worse with movement, difficulty moving
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Classic signs of bursitis
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Pain with limited movement of joint
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Rhabdomyolysis
-General cause -Problem |
When a muscle trauma results in myoglobinuria.
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Myoglobinuria
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A muscle protein released into blood and then filtered by kidney -- very toxic to kidney.
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More specific causes of rhabdomyolysis
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Physical insult to muscle
Muscle ischemia Excess strain Thermal injury Electrical injury |
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Signs of rhabdomyolysis (4)
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1. Dark reddish urine
2. High levels of muscle enzymes in urine 3. Myalgia 4. Altered electrolytes |
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Complications of rhabdomyolysis (4)
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High fever
Renal failure Tachycardia/dysrhythmia Metabolic/respiratory acidosis |
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Pathogenesis of rhabdomyolysis
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Compartment syndrome--- ischemia--- infarction--- myoglobinemia--- renal failure
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Treatment of rhabdomyolysis
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Furosemide
Fluids Short-term dialysis |
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What if affected muscle of rhabdomyolysis is over 30 mm hg?
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Need fasciotomy (cut open to relieve pressure) & debridement of muscle
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Osteoporosis
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Decreased bone density
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Osteomalacia
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Inadequate and delayed mineralization of bone
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Paget disease
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State of increased metabolic activity in bone (excessive remodeling)
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Osteoarthritis
-Which joints? - |
Synovial, mainly load-bearing
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Characteristics of osteoarthritis (4)
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1. Loss/damage of articular cartilage
2. New bone formation at joint edges 3. Mild synovitis 4. Thickening of joint capsule |
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Risk factors of osteoarthritis
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Trauma
Long-term mechanical stress Joint instability Drugs/steroids Obesity |
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What happens to cartilage in osteoarthritis?
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It's lost from enzymatic breakdown
Weakened by water content increase in cartilage |
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What else besides enzymes breaks down cartilage?
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Inflammatory cytokines from leukocytes and macrophages
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What do chondrocytes do?
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Produce cartilage
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What activities help OA? Which activity doesn't?
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Weight bearing helps
Swimming does not |
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RA
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A systemic autoimmune disease that causes chronic inflammation in multiple joints
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Which parts of joints are affected by RA? (4)
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Synovial membrane
Articular cartilage Fibrous joint capsule Surrounding ligaments and tendons |
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RA
-cause -women or men? |
Unknown cause
Affects more women |
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What triggers RA?
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Infection
Environmental exposure Genes Hormones |
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Rheumatoid factors
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Normal antibodies that have been converted to autoantibodies
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What do the RFs do?
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Bind to their self-antigens in the blood and synovial membrane
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Pathophysiology of RA
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- Triggering event
- Immune response - Cytokines - Activation of B lymphoctyes |
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What do B lymphocytes do in RA?
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They cause the formation of rheumatoid factor, which forms the antigen/antibody complexes, which gets deposited in joint tissue and causes damage
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Role of cytokines in RA?
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Cause fibroblasts, chondrocytes, and synovial cells to proliferate --- causes joint destruction
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What is the role of fibroblasts in RA?
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Release enzymes that cause joint dysfunction
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T cell role in RA
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Stimulate synovial macrophages and fibroblasts--- activates RANKL--- activates osteoclasts, which cause joint destruction
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Pannus
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Granulation tissue formed in RA cartilage healing
It leads to scaring and immobilizaiton |
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Clinical signs of RA
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Slow onset
Systemic signs of inflammation Joint deformity Classic arthritis symptoms Rheumatoid nodules |
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How do you diagnose RA?
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- Blood test for RF and immune complexes
- Xray |
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Diagnostic criteria for RA (7)
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4+ of the following:
Morning stiffness 1+ hour Arthritis of 3+ joints Arthritis of hand joints Symmetric arthritis Rheumatoid nodules Serum RF abnormal Radiographic changes |
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Ankylosing spondylitis
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Chronic inflammatory disease of the spine and sacroiliac joints causing stiffness and fusion
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Who is mainly affected by ankylosing spondylitis? Sex and age
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Men 3:1, peak age = 20
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Cause of ankylosing spondylitis
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Unknown
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Signs of ankylosing spondylitis
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Chronic lower back pain
Peripheral joint problems Pain with breathing Kyphosis |
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Gout
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Disease created by buildup of uric acid crystals which are deposited on articular cartilage of joints, tendons, and tissues--- causes inflammatory reaction
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Signs of gout
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Sudden excruiciating pain of joint
Joint shows 4 signs of inflammation Low grade fever Renal stones may occur |
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Treatment of gout
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Antiinflammatory drugs
Ice Take weight off it Low purine diet |
