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Questions and Answers

A patient presents with chronic lower back pain and stiffness, particularly in the morning. Imaging reveals sacroiliitis. Which of the following conditions is the most likely diagnosis?

  • Spondylolisthesis
  • Ankylosing spondylitis (correct)
  • Rheumatoid arthritis
  • Gout

Which lifestyle modification would be LEAST appropriate for managing a patient's acute gout flare-up?

  • Reducing alcohol consumption
  • Initiating a high-intensity exercise program (correct)
  • Achieving and maintaining a healthy weight
  • Increasing daily water intake

A physician suspects a meniscal tear in a patient following a knee injury. Which imaging modality is MOST suitable for evaluating soft tissue damage in this scenario?

  • X-ray
  • Ultrasound
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI) (correct)

A patient taking bisphosphonates for osteoporosis reports experiencing persistent heartburn and chest pain. Which of the following instructions is MOST important to provide this patient regarding their medication?

<p>Take the medication on an empty stomach and remain upright for at least 30 minutes. (C)</p> Signup and view all the answers

Which of the following pathophysiologic responses is LEAST likely to be directly induced by smoking?

<p>Decreased Blood Clotting Tendency (D)</p> Signup and view all the answers

A patient presents with edema, weight loss, and diminished functional capacity. Which nutritional deficiency is MOST likely contributing to these symptoms?

<p>Protein (C)</p> Signup and view all the answers

Which of the following mechanisms describes the intrinsic healing process in a tendon?

<p>Vascular internal response resulting in fibroblast proliferation from intrinsic blood supply (A)</p> Signup and view all the answers

Which of the following factors involved in mechanical tissue injury is MOST directly related to the number of times a tissue is subjected to a stress?

<p>Repeated bouts of moderate load (B)</p> Signup and view all the answers

Following a viral infection, a cell undergoes direct injury due to the virus's presence. Which type of virus is MOST likely responsible for this direct effect?

<p>RNA virus due to its direct cytopathic effect (A)</p> Signup and view all the answers

Which of the following is the MOST accurate description of necrosis?

<p>The endpoint of a pathological process resulting in cell death (A)</p> Signup and view all the answers

Prolonged ischemia deprives tissues of oxygen, potentially leading to irreversible cell injury. Which of the following processes is MOST likely to occur as a direct result of irreversible cell injury?

<p>Apoptosis (B)</p> Signup and view all the answers

A patient is diagnosed with neuropathy due to a nutritional deficiency. Which specific vitamin deficiency is MOST likely the cause?

<p>Vitamin B12 (C)</p> Signup and view all the answers

Which factor is MOST important when considering the likelihood of a mechanical injury to a tissue?

<p>Tissue tolerance to the applied load (A)</p> Signup and view all the answers

What is the MOST critical factor influencing the degree of tendon healing following an injury?

<p>The severity of the injury and the subsequent management (surgical vs. non-surgical, mobilization vs. immobilization). (A)</p> Signup and view all the answers

During which stage of tendon healing is the tendon repair the WEAKEST, making it most vulnerable to re-injury?

<p>7-10 days post injury (C)</p> Signup and view all the answers

Why is complete unloading or overloading detrimental to tendon healing?

<p>Unloading prevents proper alignment of collagen fibers, while overloading can cause rupture. (B)</p> Signup and view all the answers

Which of the following rehabilitation approaches would be MOST beneficial for flexor tendon healing?

<p>Early passive motion exercises. (B)</p> Signup and view all the answers

What is the primary reason intra-articular ligaments, such as the ACL, often do not heal spontaneously after a complete tear?

<p>There is a lack of direct contact between the torn ligament ends, hindering the formation of a stable fibrin clot. (A)</p> Signup and view all the answers

After an MCL tear, what is the rationale behind applying progressive, controlled stress during the remodeling phase of healing?

<p>To orient scar tissue formation along the lines of stress, thereby increasing the ligament's tensile strength. (A)</p> Signup and view all the answers

A researcher is determining the LD50 of a new analgesic in mice. After administering various doses, they observe that 50% of the mice die at a dose of 150mg/kg. What does this LD50 value indicate?

<p>The dose at which 50% of the mice in the study died. (D)</p> Signup and view all the answers

Which of the following represents an extra-articular ligament?

<p>Medial Collateral Ligament (MCL). (A)</p> Signup and view all the answers

A patient with a history of cardiovascular disease is experiencing mild to moderate pain and inflammation due to osteoarthritis. Considering the risks and benefits, which analgesic would be the MOST appropriate initial choice?

<p>Acetaminophen (Tylenol), due to its lower risk of cardiovascular side effects. (D)</p> Signup and view all the answers

What is the MOST important consideration when managing a patient with a ligament injury to ensure optimal healing and remodeling?

<p>Balancing protection against excessive forces with the application of progressive, controlled stress. (D)</p> Signup and view all the answers

A patient taking NSAIDs for chronic pain management develops persistent heartburn and epigastric pain. What is the MOST likely cause of these symptoms and what should be considered to mitigate it?

<p>The patient is experiencing NSAID-induced gastrointestinal ulceration; consider a proton pump inhibitor. (D)</p> Signup and view all the answers

Which of the following beneficial effects is UNIQUE to NSAIDs compared to acetaminophen (Tylenol)?

<p>Reduction of inflammation. (D)</p> Signup and view all the answers

A patient is diagnosed with osteomyelitis caused by a bacterial infection. What is the MOST important pharmacological intervention that should be initiated?

<p>Systemic high-dose antibiotics targeting the identified bacteria. (A)</p> Signup and view all the answers

A patient undergoing long-term glucocorticoid treatment for myositis is MOST at risk for developing which of the following adverse effects?

<p>Osteoporosis and increased susceptibility to infections. (C)</p> Signup and view all the answers

A patient being treated for osteomyelitis with fluoroquinolone antibiotics reports sudden pain and swelling in their Achilles tendon after a routine walk. What is the MOST appropriate course of action?

<p>Immediately discontinue the fluoroquinolone and switch to a different antibiotic class. (C)</p> Signup and view all the answers

A patient with myositis is prescribed a glucocorticoid. Which potential side effect should be closely monitored to prevent further complications?

<p>Hyperglycemia (B)</p> Signup and view all the answers

When evaluating a conventional radiograph of a joint, a narrowed joint space suggests a potential issue with which of the following structures?

<p>Intervening cartilage thickness (C)</p> Signup and view all the answers

A patient presents with localized increased bone density visible on a radiograph. This finding is most indicative of:

<p>Osteoblastic activity (C)</p> Signup and view all the answers

During the reparative phase of fracture healing, which of the following processes primarily contributes to the stabilization of the fracture site?

<p>Callus formation (B)</p> Signup and view all the answers

A patient reports pain and limited range of motion after twisting their ankle. Examination reveals ecchymosis and moderate instability but no complete loss of function. This injury is most likely classified as what type of sprain?

<p>Second degree (D)</p> Signup and view all the answers

Which of the following imaging modalities would be MOST appropriate for visualizing subtle changes in soft tissue structures, such as ligaments and tendons, in detail?

<p>Magnetic Resonance Imaging (MRI) (C)</p> Signup and view all the answers

A radiograph reveals a distinct, smooth margin at the epiphyseal plate with an adjacent sclerotic band. This finding is MOST indicative of:

<p>Normal skeletal maturity (B)</p> Signup and view all the answers

Which of the following is the MOST radiopaque substance?

<p>Heavy Metal (A)</p> Signup and view all the answers

A patient with a chronic injury displays pain symptoms disproportionate to the physical findings and reports significant discomfort regardless of position. This presentation may indicate:

<p>Emotional or psychological overlay (B)</p> Signup and view all the answers

A patient presents with a high fever, sudden drop in blood pressure, vomiting, diarrhea, confusion, and a rash resembling sunburn. Which condition is MOST likely indicated by these symptoms?

<p>Toxic Shock Syndrome (TSS) (C)</p> Signup and view all the answers

Why do drugs administered sublingually bypass first-pass metabolism?

<p>Absorption occurs via mucous membranes directly into systemic circulation. (A)</p> Signup and view all the answers

Which route of drug administration provides the MOST rapid onset of action?

<p>Intravenous (IV) (A)</p> Signup and view all the answers

What is a primary disadvantage of the oral route of drug administration?

<p>It is subject to the first-pass effect. (C)</p> Signup and view all the answers

Which pharmacokinetic process involves the removal of the drug from the body?

<p>Excretion (C)</p> Signup and view all the answers

A drug has a half-life of 4 hours. If the initial plasma concentration is 200 mg/L, how long will it take for the concentration to reach 50 mg/L?

<p>8 hours (A)</p> Signup and view all the answers

What does the therapeutic index (TI) represent in drug safety?

<p>The drug's safety margin. (D)</p> Signup and view all the answers

Which route of administration is MOST suitable for achieving a prolonged drug release and steady plasma levels?

<p>Transdermal patch (D)</p> Signup and view all the answers

A patient is prescribed a drug that is extensively metabolized by the liver. How might this affect the drug's bioavailability?

<p>It will decrease the drug's bioavailability. (C)</p> Signup and view all the answers

Which route of drug administration is MOST likely to cause irritation of the rectal mucosa?

<p>Rectal (D)</p> Signup and view all the answers

If a drug is administered intravenously, what percentage of the drug is considered bioavailable?

<p>100% (C)</p> Signup and view all the answers

A patient develops redness, swelling, pain, and warmth at the site of a skin infection, along with pus drainage. This presentation is MOST indicative of which condition?

<p>Skin infection (D)</p> Signup and view all the answers

Why is the intramuscular (IM) route suitable for depot drugs?

<p>It allows for slow-release of the drug. (A)</p> Signup and view all the answers

What factor MOST significantly limits the use of transdermal drug delivery?

<p>Drug solubility. (A)</p> Signup and view all the answers

A drug has a TD50 of 100 mg/kg and an ED50 of 10 mg/kg. What is its therapeutic index?

<p>10 (C)</p> Signup and view all the answers

A patient with rheumatoid arthritis (RA) is prescribed a DMARD. What is the PRIMARY goal of initiating DMARD therapy in this patient?

<p>To slow the progression of the disease and modify the underlying immune response. (B)</p> Signup and view all the answers

A patient taking glucocorticoids reports experiencing proximal muscle weakness and easy fatigability. Which of the following adverse effects is MOST likely contributing to these symptoms?

<p>Muscle atrophy (B)</p> Signup and view all the answers

Which of the following mechanisms describes how glucocorticoids exert their anti-inflammatory effects in the treatment of rheumatoid arthritis (RA)?

<p>Inhibiting COX-2 to reduce the synthesis of prostaglandins. (C)</p> Signup and view all the answers

A physical therapist is working with a patient who has been taking NSAIDs long-term for osteoarthritis. Which of the following potential side effects should the therapist be MOST aware of during treatment sessions?

<p>Gastrointestinal discomfort or ulcer development. (B)</p> Signup and view all the answers

Which of the following interventions is MOST important for a physical therapist to emphasize when treating a patient with a metabolic bone disorder?

<p>Weight-bearing activities to promote bone density. (A)</p> Signup and view all the answers

A patient with osteoarthritis is considering viscosupplementation. What is the PRIMARY goal of this intervention?

<p>To increase synovial fluid viscosity, improving joint lubrication. (D)</p> Signup and view all the answers

A patient with rheumatoid arthritis (RA) has been prescribed glucocorticoids. Which potential side effect requires the MOST vigilant monitoring by the physical therapist during rehabilitation?

<p>Muscle and ligament weakness. (B)</p> Signup and view all the answers

A patient taking NSAIDs for chronic pain management develops hypertension. What is the MOST likely mechanism by which NSAIDs contribute to increased blood pressure?

<p>Inhibition of COX-2 in the kidneys, leading to sodium and water retention. (A)</p> Signup and view all the answers

A physical therapist is treating a patient with mild knee osteoarthritis who is taking NSAIDs for pain management. Which of the following adverse effects is MOST important for the therapist to monitor during treatment sessions?

<p>Gastrointestinal distress, such as abdominal pain or heartburn (B)</p> Signup and view all the answers

A child recovering from a viral infection is prescribed medication for a persistent fever. Knowing the potential risks, which of the following medications should be AVOIDED due to the risk of Reye's syndrome?

<p>Aspirin (C)</p> Signup and view all the answers

A patient taking ciprofloxacin develops Achilles tendon pain after starting a running program. What is the MOST appropriate initial management strategy?

<p>Immediately cease weight-bearing and use a walking boot with crutches. (C)</p> Signup and view all the answers

A patient with a history of myocardial infarction (MI) is prescribed a non-opioid analgesic for chronic back pain. Which of the following considerations is MOST important when selecting a medication?

<p>Lowest possible dose and shortest duration of NSAID use due to cardiovascular risks (B)</p> Signup and view all the answers

Ms. Valhalla, a 58-year-old female, reports shoulder pain that is aggravated by overhead reaching and relieved by Meloxicam. Given this information, what is the MOST important next step in her evaluation?

<p>Inquire about the changing nature of her pain and obtain a more thorough history. (B)</p> Signup and view all the answers

A patient reports taking NSAIDs for pain relief but is concerned about potential side effects. Which statement BEST explains how NSAIDs exert their effects on inflammation and pain?

<p>NSAIDs block the cyclooxygenase (COX) enzymes, reducing the production of prostaglandins that contribute to inflammation, pain, and fever. (B)</p> Signup and view all the answers

Ms. Valhalla reports new pain between her shoulder blades and intermittent tingling in her left hand, which she attributes to walking her dog. What is the MOST appropriate interpretation of this new information?

<p>The new symptoms are likely related to a cervical spine issue, consider further investigation. (D)</p> Signup and view all the answers

During a physical therapy session, a patient on long-term NSAIDs reports sudden onset of severe abdominal pain. What is the MOST appropriate immediate action for the physical therapist?

<p>Immediately refer the patient to a medical professional due to potential gastrointestinal complications. (D)</p> Signup and view all the answers

Which of the following aspects of Ms. Valhalla's medical history presents a potential yellow flag warranting further consideration?

<p>All of the above. (F)</p> Signup and view all the answers

A patient with a known hypersensitivity to aspirin needs an over-the-counter medication for fever and mild pain. Which of the following is the MOST appropriate recommendation?

<p>Acetaminophen, as it does not have anti-platelet effects. (C)</p> Signup and view all the answers

A patient with osteoarthritis is taking NSAIDs to manage pain and inflammation. Which of the following statements BEST describes how NSAIDs alleviate these symptoms?

<p>NSAIDs block COX enzymes, reducing prostaglandin production and subsequent inflammation. (D)</p> Signup and view all the answers

Considering Ms. Valhalla's medical history, which medication presents the GREATEST potential to delay tendon healing should she sustain a tendon injury?

<p>All of the above (D)</p> Signup and view all the answers

A physical therapist is treating a patient on NSAIDs who reports easy bruising and prolonged bleeding after minor injuries. Which of the following mechanisms BEST explains this side effect of NSAIDs?

<p>NSAIDs inhibit the production of prostaglandins and thromboxanes, affecting platelet aggregation and increasing bleeding risk. (D)</p> Signup and view all the answers

For a patient with a suspected Achilles tendon issue related to fluoroquinolone use, what is the MOST critical aspect of the physical examination?

<p>Evaluating the integrity of the tendon via the Thompson test. (A)</p> Signup and view all the answers

Which of the following pieces of information gathered from Ms. Valhalla's history is MOST indicative of a potential systemic or non-musculoskeletal issue contributing to her shoulder pain?

<p>Pain between her shoulder blades. (B)</p> Signup and view all the answers

What is the PRIMARY reason to limit weight bearing and immobilize the affected limb in the initial management of tendinopathy induced by fluoroquinolones?

<p>To minimize tensile stress on the weakened tendon and prevent rupture. (D)</p> Signup and view all the answers

A patient diagnosed with osteomalacia is prescribed supplements. Which combination would be MOST appropriate?

<p>Calcium and Vitamin D (B)</p> Signup and view all the answers

Which of the following mechanisms of action is associated with bisphosphonates in the treatment of osteoporosis?

<p>Inhibiting osteoclast activity to slow bone resorption (C)</p> Signup and view all the answers

A patient with Paget's disease is prescribed medication to manage their condition. Besides calcium supplementation, which of the following medications is MOST likely to be included in their treatment plan?

<p>Bisphosphonates (D)</p> Signup and view all the answers

Which of the following describes the primary mechanism by which bacteriostatic drugs inhibit bacterial growth?

<p>Limiting bacterial proliferation (B)</p> Signup and view all the answers

A patient taking penicillin develops signs of CNS dysfunction and anemia. Which aspect of penicillin administration is MOST likely responsible for this?

<p>Allergic hypersensitivity reaction (B)</p> Signup and view all the answers

Why is it crucial to inquire about a patient’s current medications, especially antibiotics, during a physical therapy evaluation?

<p>To monitor certain drug side effects that could impact the POC (D)</p> Signup and view all the answers

A patient taking ciprofloxacin reports Achilles pain and inflammation. Given this information, which of the following modifications to the physical therapy plan of care is MOST appropriate?

<p>Implement gentle range of motion and avoid exercises that place high stress on the Achilles tendon. (A)</p> Signup and view all the answers

A patient with a suspected bacterial infection is prescribed a broad-spectrum antibiotic. What is the PRIMARY advantage of using a broad-spectrum antibiotic compared to a narrow-spectrum one?

<p>Effective against a wide range of bacterial species (C)</p> Signup and view all the answers

A patient presents with diffuse bone pain, muscle weakness, and a history of multiple fractures. Lab results reveal low vitamin D levels and radiographic imaging shows decreased bone density. Which of the following conditions is the MOST likely diagnosis?

<p>Osteomalacia (B)</p> Signup and view all the answers

A patient with Paget's disease is MOST likely to exhibit which combination of signs and symptoms?

<p>Bone pain, skeletal deformities, fatigue, and enlarged clavicles (A)</p> Signup and view all the answers

A physical therapist is treating a patient with osteomalacia. Which of the following interventions is MOST appropriate to address the musculoskeletal implications of this condition?

<p>Muscle strengthening exercises and fall prevention strategies (A)</p> Signup and view all the answers

Why is it MOST important to refer a patient with recurrent arthritic symptoms and a previous diagnosis of gout back to their physician?

<p>To monitor for disease progression and adjust medication (D)</p> Signup and view all the answers

Which of the following signs or symptoms should prompt a physical therapist to immediately refer a patient with diabetes for further medical evaluation?

<p>New onset of confusion and lethargy (C)</p> Signup and view all the answers

A patient presents with acute joint pain, swelling, and redness, accompanied by fever and chills. Which of the following metabolic disorders is MOST likely indicated by these signs and symptoms?

<p>Gout (D)</p> Signup and view all the answers

Which combination of factors would place a patient at the HIGHEST risk for developing osteoporosis?

<p>Female, age 70, Asian descent, early menopause. (B)</p> Signup and view all the answers

A patient with suspected osteoporosis reports a gradual loss of height and increased rounding of their upper back. Which of the following is the MOST likely underlying cause?

<p>Vertebral compression fractures. (B)</p> Signup and view all the answers

Which statement BEST describes the primary difference between osteoporosis and osteomalacia?

<p>Osteoporosis involves a decrease in bone mass, while osteomalacia involves a softening of the bones. (A)</p> Signup and view all the answers

A physical therapist is reviewing a patient's imaging results for hip osteoarthritis. The radiograph reveals a positive finding for mild osteoarthritis, but the physician wants to evaluate cartilage integrity. Which imaging modality is MOST appropriate in this scenario?

<p>MR Arthrography of the hip (C)</p> Signup and view all the answers

A patient is undergoing initial screening for osteoporosis. Which imaging technique is considered the MOST appropriate for assessing bone density in the lumbar spine and hips?

<p>DXA of the lumbar spine and hips. (D)</p> Signup and view all the answers

A patient with known low bone density has several risk factors for osteoporosis progression. Which imaging technique is MOST appropriate for monitoring changes in bone density over time?

<p>DXA of the lumbar spine and hips (C)</p> Signup and view all the answers

Which of the following additional findings on a radiograph would warrant further investigation into potential metabolic bone disease?

<p>Evidence of a recent bone fracture from a minor fall. (C)</p> Signup and view all the answers

A patient presents with bone pain, muscle weakness, and a history of fractures. Lab results reveal vitamin D deficiency. Which condition is MOST likely?

<p>Osteomalacia (C)</p> Signup and view all the answers

A physical therapist is treating a patient with osteomalacia. Which intervention is MOST appropriate given the musculoskeletal implications?

<p>Low-impact weight-bearing exercises and balance training. (D)</p> Signup and view all the answers

A patient presents with acute joint pain, swelling, and redness, accompanied by fever and chills. Which of the following conditions is MOST likely indicated by these signs and symptoms?

<p>Gout (D)</p> Signup and view all the answers

A patient reports a gradual loss of height and increased rounding of their upper back. Which of the following is the MOST likely underlying cause, assuming osteoporosis is present?

<p>Compression fractures in the vertebrae due to decreased bone mass (A)</p> Signup and view all the answers

A physical therapist is reviewing a patient's imaging results for hip osteoarthritis. The radiograph reveals a positive finding for mild osteoarthritis, but the goal is to determine cartilage integrity. Which imaging modality is MOST appropriate in this scenario?

<p>MR arthrography hip (A)</p> Signup and view all the answers

Which cellular adaptation involves an increase in the number of cells in a tissue?

<p>Hyperplasia (B)</p> Signup and view all the answers

What cellular adaptation is exemplified by the thickening of the endometrium during the menstrual cycle?

<p>Hyperplasia (A)</p> Signup and view all the answers

A chronic smoker's respiratory system undergoes a change where ciliated pseudostratified columnar cells are replaced by stratified squamous epithelial cells. Which type of cellular adaptation does this represent?

<p>Metaplasia (C)</p> Signup and view all the answers

Which cellular adaptation is considered preneoplastic due to altered cell morphology, increased cell number, and loss of histological organization as a result of prolonged sublethal stress?

<p>Dysplasia (A)</p> Signup and view all the answers

In acute inflammation, which type of leukocyte is primarily involved in the initial response to injury?

<p>Neutrophils (D)</p> Signup and view all the answers

Which of the following is a key characteristic of acute inflammation?

<p>Exudation of fluid and plasma proteins (D)</p> Signup and view all the answers

What is a defining feature of chronic inflammation compared to acute inflammation?

<p>Prolonged vascular reaction (A)</p> Signup and view all the answers

A patient presents with signs of edema, decreased activity tolerance, and weight loss. Which of the following nutritional deficiencies is MOST likely contributing to these signs and symptoms?

<p>Protein malnutrition (B)</p> Signup and view all the answers

Which cells are predominant in chronic inflammation?

<p>Lymphocytes and macrophages (C)</p> Signup and view all the answers

Which of the following psychosocial factors may have the GREATEST effect on an individual's tissue adaptation and injury thresholds?

<p>Persistent anxiety and tension (D)</p> Signup and view all the answers

Following an acute injury, a patient exhibits redness, swelling, and pain. Which of the following underlying mechanisms is the PRIMARY cause of the redness (rubor) observed?

<p>Vasodilation due to histamine and prostaglandins (C)</p> Signup and view all the answers

A patient presents with swelling (tumor) following an ankle sprain. What is the PRIMARY mechanism contributing to this swelling?

<p>Shift of protein and water from circulation to interstitial spaces (A)</p> Signup and view all the answers

A patient reports pain in the tissues surrounding a joint after an injury. Pressure on the tissue exacerbates the pain. Which type of pain is the patient MOST likely experiencing?

<p>Mechanical pain (B)</p> Signup and view all the answers

Which sequence accurately describes the vascular events leading to edema formation during acute inflammation?

<p>Vasodilation → increased vascular permeability → exudate formation (C)</p> Signup and view all the answers

A patient with localized inflammation exhibits increased temperature in the affected area. Which physiological process primarily contributes to this increase in temperature (calor)?

<p>Increased blood flow from the body's core to the affected area (B)</p> Signup and view all the answers

Several days post-injury, a patient reports throbbing pain that seems disproportionate to the minor swelling observed. Which factor is MOST likely contributing to the patient’s heightened pain perception?

<p>Increased pressure due to edema on a tissue (C)</p> Signup and view all the answers

Which of the following mechanisms primarily contributes to transudate formation?

<p>Elevated hydrostatic pressure or reduced osmotic pressure in blood vessels. (A)</p> Signup and view all the answers

A patient with left-sided congestive heart failure is likely to develop which type of fluid accumulation as a result of increased hydrostatic pressure?

<p>Pulmonary edema in the lungs. (A)</p> Signup and view all the answers

Which characteristic is MOST indicative of exudate rather than transudate?

<p>High protein and leukocyte content. (C)</p> Signup and view all the answers

Which of the following is MOST associated with the vasodilation and increased vascular permeability seen in inflammatory exudate?

<p>Inflammation (C)</p> Signup and view all the answers

A patient presents with a superficial skin wound that is draining a thin, clear, watery fluid. Which type of exudate is MOST likely present?

<p>Serous exudate. (C)</p> Signup and view all the answers

A patient with a deep wound develops an abscess filled with thick, cloudy fluid containing dead cells and leukocytes. This type of exudate is BEST described as:

<p>Purulent. (A)</p> Signup and view all the answers

Which type of exudate is MOST likely to be found in the nasal passages of a patient experiencing an upper respiratory infection?

<p>Cattarhal exudate. (B)</p> Signup and view all the answers

Systemic inflammation, referred to as septicemia, is PRIMARILY characterized by:

<p>A widespread inflammatory response throughout the body due to infection or toxins in the blood. (C)</p> Signup and view all the answers

Which type of fracture fixation is LEAST likely to disrupt the medullary blood supply, promoting primary endosteal healing?

<p>Fine wires in a circular fixator across the subchondral metaphysis (C)</p> Signup and view all the answers

A fracture treated with a rigidly applied internal fixation device is MOST likely to heal via which mechanism?

<p>The combination of endosteal callus and primary cortical union (A)</p> Signup and view all the answers

What is the PRIMARY function of the threaded screw holes in locking plates used for fracture fixation?

<p>To enable the screws to thread to the plate, creating a fixed-angle scaffold (B)</p> Signup and view all the answers

Intramedullary nailing provides relative stability but may have rotational and angular instability unless:

<p>The nail is locked proximally and distally with tight fixation at the fracture site. (D)</p> Signup and view all the answers

Which statement BEST describes the effect of intramedullary nailing on bone healing?

<p>It blocks endosteal healing but allows periosteal callus formation. (C)</p> Signup and view all the answers

Compared to splinting or bracing, casting is MORE effective at:

<p>Maintaining the reduction of unstable fractures. (A)</p> Signup and view all the answers

Which of the following is the PRIMARY goal of skeletal traction in fracture management?

<p>To overcome shortening forces of muscles across the fracture site (B)</p> Signup and view all the answers

Which of the following statements BEST describes the current role of skeletal traction in fracture management?

<p>Its use is declining due to advancements in surgical reduction and internal fixation. (C)</p> Signup and view all the answers

Why does prolonged immobilization lead to cartilage degeneration in joints?

<p>Reduction in matrix proteoglycans and cartilage softening. (B)</p> Signup and view all the answers

Following a period of immobilization, how do connective tissues (CTs) typically respond to stress compared to normal tissues?

<p>CTs are more prone to deformation and breakdown under similar stress amounts. (B)</p> Signup and view all the answers

How does immobilization affect bone density, and what is the underlying mechanism?

<p>Immobilization decreases bone density by inhibiting osteogenesis due to the absence of mechanical forces. (D)</p> Signup and view all the answers

How does immobilization typically affect muscle tissue, and what characterizes this response?

<p>Immobilization leads to muscle atrophy, which is an imbalance between protein synthesis and degradation. (B)</p> Signup and view all the answers

How does the location of a muscle (one-joint vs. two-joint) influence its response to immobilization?

<p>General muscle atrophy typically occurs in one-joint muscles because two-joint muscles are 'less' immobilized. (A)</p> Signup and view all the answers

Which type of muscle fibers (Type I or Type IIa) is more susceptible to atrophy during immobilization, and why?

<p>Type I fibers are more susceptible because they are more reliant on constant activity. (C)</p> Signup and view all the answers

How does injury to the joint capsule primarily contribute to joint instability?

<p>By damaging the connective tissue, leading to decreased mechanical stability and decreased synovium. (A)</p> Signup and view all the answers

What role do tendons play in joint motion, and what is their primary structural composition?

<p>Tendons attach muscle to bone, transmit tensile loads to produce joint motion, and are made of Type I regular collagen. (A)</p> Signup and view all the answers

What is the PRIMARY reason intra-articular ligaments, like the ACL, often require surgical intervention to heal?

<p>Fibrin clot formation is disrupted by the intra-articular environment. (D)</p> Signup and view all the answers

Why is progressive, controlled loading crucial to ligament healing?

<p>To orient scar tissue formation along lines of stress. (A)</p> Signup and view all the answers

What is a potential consequence of improperly managed ligament injuries?

<p>The ligament may not heal properly, resulting in biomechanical inferiority. (A)</p> Signup and view all the answers

How does a collagen-coated FiberTape assist in ligament repair, and what is its main impact on rehabilitation protocols?

<p>It immediately strengthens the repair, allowing for more aggressive rehabilitation and earlier return to activity. (C)</p> Signup and view all the answers

During the fibroplasia and repair phase of ligament and tendon healing (3-4 weeks), what precaution is MOST crucial?

<p>Minimizing direct stresses to the healing tissue through bracing or orthotics. (C)</p> Signup and view all the answers

Why might synovial fluid surrounding an injured intra-articular ligament interfere with healing?

<p>It dilutes clot formation due to fibrolytic enzymes. (D)</p> Signup and view all the answers

When is surgical intervention MOST likely required for ligament injuries?

<p>For most intra-articular ligament injuries, especially in high-performance athletes. (B)</p> Signup and view all the answers

What is the PRIMARY benefit of using FiberTape augmentation in ligament repair regarding postoperative management?

<p>It allows for immediate strengthening postoperatively, which allows for a more aggressive rehab protocol. (A)</p> Signup and view all the answers

Flashcards

Imaging ABCS

Alignment, Bones, Cartilage, Soft Tissue. A systematic approach to image interpretation.

Ankylosing Spondylitis

Inflammatory arthritis affecting the spine, causing stiffness and fusion.

Gout & Lifestyle

Arthritis caused by uric acid crystal buildup; lifestyle changes (weight loss, hydration, avoid alcohol) are key.

CT vs. X-ray

X-rays use radiation for bones; CT scans use radiation for cross-sectional images.

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Smoking Impact

Smoking causes impaired vascular function and increased clotting risks, leading to vascular damage.

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Acute Tendon Healing

Hemostasis, inflammation.

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Subacute Tendon Healing

Repair and healing phase.

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Chronic Tendon Healing

Maturation and remodeling.

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Cast Immobilization & Tendons

Beneficial for tendon-to-bone healing, detrimental for flexor tendon healing.

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Passive Motion & Tendons

Beneficial for flexor tendon healing, detrimental for tendon-to-bone healing.

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Weakest Tendon Repair

7-10 days.

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Intra-articular Ligaments

ACL, PCL.

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Extra-articular Ligaments

MCL, LCL.

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Ischemia

Reduced or absent blood flow, leading to hypoxia or anoxia.

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Bacterial Infection (Cell Injury)

Cell injury and death due to the inflammatory response from a bacteria.

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Immune Reactions (Cell Injury)

Cell injury or death caused by hypersensitivities or autoimmune disorders.

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Chemical Factors (Cell Injury)

Cell injury caused by exposure to substances like carbon monoxide, heavy metals, or free radicals.

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Physical/Mechanical Factors (Cell Injury)

Cell injury due to mechanical trauma, temperature extremes, radiation, or electricity.

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Nutritional Factors (Cell Injury)

Cell injury due to vitamin B12, calcium, or protein deficiencies.

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Necrosis

Cell death; the endpoint of a pathological process.

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Apoptosis

Programmed cell death; a natural process.

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Density Contrast in Imaging

Density differences help distinguish cortical from cancellous bone and bone from soft tissue.

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Joint Space Width

Indicates cartilage thickness; can be seen on imaging.

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Radiodensity Order

(From least to most radiodense): Cancellous bone, cortical bone, heavy metal.

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Radiodense Appearance

High-density structures appear bright on imaging.

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Radiolucent Appearance

Low-density structures appear dark on imaging.

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Fracture Healing Phases

  1. Inflammation, 2. Reparative, 3. Remodeling (phases overlap).
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Strain

Stretching or tearing of a muscle or tendon unit.

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Sprain

Injury to the ligamentous structures supporting a joint.

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LD50

Dose of a drug at which 50% of animals die.

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NSAIDs: Risks

Block pain and inflammation, but increase risk of heart and stomach issues.

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NSAIDs: Benefits

Treat pain, inflammation, and fever; may have protective effects against blood clots and colon cancer.

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Tylenol: Risks

Treats fever/pain but can cause liver damage at high doses.

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Tylenol: Benefits

Treats fever and pain, but NOT inflammation.

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Osteomyelitis

Inflammation of the bone caused by an infection.

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Antibiotic Side Effects

Allergies, GI upset, light sensitivity, and tendon issues.

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Myositis

Inflammation of muscle tissue.

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Staph Skin Infection Symptoms

Redness, swelling, pain, pus, or boils on the skin.

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Endocarditis Symptoms

Fever, chills, fatigue, and shortness of breath, potentially damaging heart valves.

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Toxic Shock Syndrome (TSS)

High fever, low blood pressure, vomiting, diarrhea, confusion, and rash potentially leading to organ failure.

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Enteral Drug Administration

Administration via the alimentary canal, such as oral or rectal.

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Pros of Oral Administration

Convenient, noninvasive, cost-effective, and allows self-administration.

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Cons of Oral Administration

Slow onset, first-pass metabolism, and affected by food and gastric pH.

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Pros of Sublingual Administration

Rapid absorption, bypasses first-pass metabolism, useful for emergency meds.

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Cons of Sublingual Administration

Taste, limited to certain drugs, not for sustained release.

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Parenteral Drug Administration

Administration bypassing the GI tract, such as IV or IM.

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Pros of IV Administration

Immediate effect, 100% bioavailability, precise dosage control.

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Cons of IV Administration

Requires sterile technique, risk of infection, difficult to reverse.

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Absorption (Pharmacokinetics)

Transfer of a drug from the administration site to the bloodstream.

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Bioavailability

Extent to which a drug reaches the systemic circulation.

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First-Pass Effect

Drug metabolism by the liver or gut wall before reaching systemic circulation.

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Therapeutic Index (TI)

Ratio of toxic dose (TD50) to effective dose (ED50).

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Non-Opioid Agents: Action

Analgesia, anti-inflammatory, and antipyretic effects by reducing prostaglandin formation.

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Non-Opioid Agents: Indications

Mild to moderate pain, fever, inflammation (except Acetaminophen), reduce MI risk (aspirin only).

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Non-Opioid Agents: Side Effects

GI issues, N&V, abdominal pain, ulcer formation, Reye's Syndrome in kids (aspirin only).

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Non-Opioid Agents & PT

Monitor for masked pain, refer out for stomach pain.

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Acetaminophen (Tylenol)

Analgesic and antipyretic, but not anti-inflammatory or anticoagulant.

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Reye's Syndrome

Drop in blood sugar, rise in ammonia, liver swelling, brain swelling, seizures, from aspirin use during viral infection.

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NSAIDs & Prostaglandins

NSAIDs interfere with prostaglandin production, impacting inflammation, pain, fever, clotting, and blood pressure.

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Cyclooxygenase (COX)

Facilitates prostaglandin production from arachidonic acid; target of NSAID action.

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Fluoroquinolone Tendinopathy

Damage to tendons, possibly leading to rupture (especially Achilles), caused by fluoroquinolone antibiotics.

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Tendon Off-loading

Restricting weight-bearing and using assistive devices to protect an injured tendon and promote healing.

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Aggravating Factors

Factors or activities that worsen a patient's symptoms.

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Easing Factors

Factors or activities that alleviate or reduce a patient's symptoms.

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Red/Yellow Flags

Uncommon symptoms or findings that may indicate a more serious underlying condition requiring further investigation.

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Interscapular Pain

Pain felt between the shoulder blades.

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Paresthesia

Abnormal sensations like tingling or prickling, often caused by nerve irritation or compression.

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Ms. Valhalla's History

Diabetes mellitus Type II, high blood pressure (HTN), osteoarthritis, previous neck pain, and hysterectomy.

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NSAID Adverse Effects

Common side effects include GI discomfort/ulcers and increased blood pressure.

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Rheumatoid Arthritis (RA)

Autoimmune disorder causing systemic destruction of articular cartilage and bone erosion.

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DMARD Action

They slow RA progression by modifying the pathology and inhibiting the immune response.

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DMARD Side Effects

Nausea, headache, joint pain, liver toxicity, GI issues, sore throat, fever, hair loss

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Glucocorticoid Action

Reduce inflammation and promote vasoconstriction, affecting articular and systemic diseases.

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Glucocorticoid Side Effects

Muscle atrophy, GI issues, Cushing's, weakened tissues, hypertension, immunosuppression

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Osteoarthritis (OA)

Primarily local cartilage destruction due to trauma and stress.

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Viscosupplementation

Injections of hyaluronic acid to increase synovial fluid viscosity.

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Osteoporosis Treatment

Calcium and vitamin D supplements; may also use bisphosphonates to reduce bone breakdown.

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Bisphosphonates

Inhibit osteoclasts to reduce bone resorption; watch for rare side effects like jaw necrosis.

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Antibacterial Actions

Drugs will either kill bacteria directly OR limit their growth without killing them.

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Antibacterial Mechanisms

Damage cell walls, interfere with protein synthesis, or disrupt DNA/RNA replication.

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Antibacterial Side Effects

GI distress and allergic reactions are common side effects.

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Antibiotic Resistance

Bacteria evolve to resist drugs, reducing treatment effectiveness.

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Fluoroquinolone Risk

Pain and potential rupture associated with fluoroquinolone use.

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Ciproflaxin Achilles Tendon Advice

Hold treatment, contact physician and treat pain symptoms.

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Osteomalacia

Softening of bones due to vitamin D deficiency.

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Paget's Disease

Disordered bone remodeling due to inflammation, causing larger but less dense bones.

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Osteomalacia Symptoms

Bone pain, fractures, skeletal deformity, muscle weakness.

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Paget's Symptoms

Bone pain, stiffness, fractures & deformity, muscle weakness & fatigue, bowing of legs, head enlargement, OA, large clavicles.

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Potassium Depletion Signs

Muscle weakness, cramping, and fatigue.

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Gout

Excessive uric acid levels causing joint pain, swelling, redness, fever, and chills.

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Osteoporosis

A metabolic disorder characterized by decreased bone mass, leading to pain, fractures, kyphosis, and Dowager's hump.

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Osteoporosis Risk Factors

Caucasian/Asian women, age > 65, early menopause, and family history.

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Osteoporosis S&S

Back pain, fracture, height decrease (> 1 inch), kyphosis, Dowager's hump, early satiety.

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Initial OA Imaging

Radiography

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Initial Osteoporosis Screening

DXA of lumbar spine and hips

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Osteomalacia Definition

Softening of the bones due to vitamin D deficiency, leading to insufficient mineralization.

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Paget's Disease Definition

Disordered bone remodeling, resulting in larger but less dense bones due to inflammation.

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Osteoporosis definition

A disease where bone mass decreases, increasing fracture risk.

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Dowager's Hump

Advanced curvature of the upper spine, often seen in osteoporosis.

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Osteoporosis Symptoms

Back pain, height loss, and fractures.

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Osteoporosis Screening

Dual-energy X-ray absorptiometry of spine and hips.

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Neuropathy (B12 Deficiency)

Nerve damage or injury from Vitamin B12 deficiency.

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Protein Malnutrition

Weight loss & edema caused by low blood protein levels.

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Inflammation Clinical Signs

Redness, swelling, heat, pain, decreased function.

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Rubor

Redness due to increased blood flow from vasodilation.

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Calor

Heat as a result of increased blood flow to tissue.

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Tumor (Inflammation)

Swelling due to fluid shift into interstitial spaces.

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Dolor (Inflammation)

Pain due to pressure or chemical irritation.

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Mechanical Pain (Inflammation)

Pain from swelling/edema pressing on tissues.

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Atrophy

Reduced cell, tissue, or organ size due to decreased cell size and/or number.

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Hypertrophy

Increased size of cells, tissues, or organs.

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Hyperplasia

Increase in the number of cells in a tissue or organ.

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Metaplasia

Change in cell morphology from one type to another due to a persistent stimulus.

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Dysplasia

Altered cell morphology and histology with increased cell number and loss of organization; pre-cancerous.

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Acute Inflammation

Exudation of fluid/proteins and neutrophil migration to injury site.

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Chronic Inflammation

Inflammation that persists over time or involves repeated acute episodes with lymphocytes and macrophages.

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Chronic Inflammation: Vascular Reaction

Fluid seepage, blood vessel proliferation, and immune cell invasion in a prolonged vascular reaction.

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Effusion

Fluid leakage into an anatomical space.

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Transudate

Fluid movement due to intact capillary imbalances, NOT associated with inflammation. Characterized by clear fluid with few plasma proteins or leukocytes.

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Exudate

Fluid leakage due to inflammation, resulting in higher protein and leukocyte content.

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Sanguineous Exudate

Bloody drainage, like a hematoma.

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Serous Exudate

Thin, clear, watery fluid containing plasma proteins and immunoglobulins, common in early inflammation, like a blister.

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Serosanguinous Exudate

Blood-tinged fluid; a mix of serous fluid and blood.

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Catarrhal Exudate

A thin, clear mucus-like liquid usually within mucous membranes.

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Purulent Exudate

Viscous, cloudy, pus-filled fluid with leukocytes and dead cell debris; an example is an abscess.

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Threaded Traction Pins

Pins inserted into bone to reduce and stabilize fractures using external carbon fiber bars.

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Circular Fixator

Fixation using wires across the subchondral metaphysis, preserving medullary blood supply.

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Open Reduction Internal Fixation (ORIF)

Anatomical reduction with rigid internal fixation leading to endosteal callus and primary cortical union.

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Locking Plates

Plates with threaded screw holes acting as a fixed-angle scaffold

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Intramedullary Nailing

Nail inserted into the medullary canal of a bone for fracture fixation.

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Splints/Fracture Braces

Devices applied to immobilize or passively correct stable fractures; usually temporary.

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Casting

Rigid circumferential support for fracture immobilization, useful for maintaining reduction.

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Skeletal (Buck’s) Traction

Traction applied manually or via weights/pulleys to overcome muscle shortening at the fracture site.

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Cartilage Degeneration (Immobilization)

Atrophic changes in cartilage due to reduced proteoglycans, leading to softening and vulnerability.

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Ligament Weakness (Immobilization)

Increased vulnerability to deformation and breakdown under stress after immobilization.

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Bone Density Decrease (Immobilization)

Mechanical forces stimulate bone growth; absence leads to bone density loss.

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Muscle Atrophy (Immobilization)

Imbalance between protein synthesis and degradation, leading to muscle size and strength loss.

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Ligaments, Capsules, & Tendons Role

Connect, surround, & stabilize joints; do NOT produce active motion.

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Ligaments & Joint Capsules Function

Provide mechanical stability and prevent excessive joint motion.

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Tendon Function

Attach muscle to bone and transmit tensile loads to produce joint motion.

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Joint Capsule Composition

Type 1 dense irregular collagen to resist loads in multiple directions. Injury can cause joint laxity.

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Ligament Contact

Ligament ends must physically touch for proper healing.

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Progressive Loading

Scar tissue aligns correctly with controlled stress during healing.

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Ligament Protection

Protection is needed to avoid re-rupture of healing ligaments.

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Surgery Decision Factors

Decision depends on injury severity and involvement of surrounding tissues.

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ACL Healing

Intra-articular ligaments often need surgery due to environment disrupting clot formation.

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MCL Healing

Extra-articular ligaments can heal with conservative treatment based on the extent of injury.

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FiberTape Benefits

FiberTape strengthens repair allowing quicker, more aggressive rehab.

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Ligament Protection Timeline

Ligament repairs are heavily protected for 3-4 weeks after surgery.

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Study Notes

  • Cell injury can be reversible or irreversible
  • Reversible injuries occur when the cell can restore homeostasis
  • Irreversible injuries result in cell death, known as necrosis
  • In irreversible cell injury, intracellular proteins denature and autolysis occurs.
  • The cell swells, ruptures, and releases lysosomal enzymes.
  • Reversible cell injury increases intracellular ions, interstitial fluids merge into the cytosol, cell volume increases, and the cell membrane blebs.
  • Ischemia means blood flow is insufficient or absent.
  • Causes include circulatory issues, metabolism problems, inadequate respiratory transport, and cardiovascular transport issues.
  • Infections can cause cell injury; the most common are bacterial and viral.
  • Immune reactions caused by hypersensitivities or autoimmune disorders can also injure cells.
  • Bacterial infections can invade the host, triggering an inflammatory response and producing endotoxins and exotoxins
  • Endotoxins induce cytokines and systemic symptoms of sepsis
  • Exotoxins damage host cells directly.
  • Viral infections can be RNA or DNA viruses, affecting cells directly or indirectly.
  • RNA viruses disrupt cell integrity
  • DNA viruses signal the cell's destruction.
  • Chemical factors causing cell injury include carbon monoxide, ammonia, heavy metals, alkylating agents, and free radicals.
  • Carbon monoxide and ammonia cause most injuries and death
  • Free radicals damage cell membranes and are linked to cancer, atherosclerosis, Alzheimer's, and Parkinson's.
  • Physical factors of cell injury will include blunt trauma, temperature extremes, radiation and electricity
  • Mechanical factors of physical injury are different from increased stress from exercise
  • Nutritional causes example, Vitamin B12 deficiency leads to neuropathy.
  • Neuropathy is a general term for injuries that cause nerve death or injury.
  • Calcium deficiency leads to poor bone quality
  • Protein malnutrition leads to weight loss due to low protein levels.
  • Psychosocial factors impact activity level and participation, influencing thresholds for tissue adaptation and injury.
  • Inflammation cardinal signs include:
    • Redness: Vasodilation increases blood flow due to histamine and prostaglandins.
    • Heat: Increased blood flow from the body's core.
    • Swelling: Capillary fluid shift mechanism causes protein and water movement.
    • Pain: Mechanical pain is caused by swelling and edema pressing on tissues
    • Biochemical pain: inflammatory mediators at the site irritate bare nerve endings.
  • Necrosis is the endpoint of a pathological process; involves cell death due to injury
  • Apoptosis is programmed cell death that does not require triggers
  • Adaptations can take place within cells due to injury and can alter their functions
  • Adaptation cellular includes:
  • Atrophy: reduced organ size
  • Bone loss, muscle wasting, brain cell loss
    • Hypertrophy: cell organ increases in size such in the tissue
      • Increase endometrium
    • Hyperplasia: increases cell numbers in the tissue
      • Callous when underr mechanical pressure
    • Metaplasia: change in cell morphology
      • Smoking
  • Acute inflammation major components: exudation of fluid and plasma proteins and the migration of leukocytes, primarily neutrophils, to the injury site
  • Chronic inflammation major component: inflammation does not resolve, but persists over time
  • Vascular reactions in the area where :
  • Accumulation is exudation
  • General muscle atrophy typically occurs in one-joint muscles, as two-joint muscles are less immobilized by typical immobilization methods
  • Immobilization of a joint causes atrophic changes in articular cartilage by reducing matrix proteoglycans and cartilage softening
  • Three components: Load deprivation results which - loss in ligament strength - Deterioration in ligament biochemical and mechanical properties - Atrophy (decreas of mass)
  • Main key features of joint capsules
    • Connect and the joint with ligaments and tendons
      • Transmit muscle to bones during jointing motions
        • By producing joint motions and ligaments to protect the parallel allignment
  • Joint capsules: resists loads innjury </existing_notes>

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