NR 283 Quiz 4
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Chamberlain University
NR-283: Pathophysiology
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Date
Quiz 4 Concept List:
Chapter 9 – Musculoskeletal System Disorders
What is the pathophysiology of osteoporosis?
Osteoporosis is characterized by an imbalance where bone resorption surpasses bone formation, leading to a loss of compact bone mass. This condition weakens the skeletal structure, increasing the risk of compression fractures, especially in the vertebrae, wrist, and hip. Diagnostic confirmation typically involves bone density scans. Structural changes in the spine such as kyphosis and scoliosis may develop due to vertebral compression.
What are the risk factors associated with osteoporosis?
Several factors increase the risk of osteoporosis, including:
- Age over 50 years
- Sedentary lifestyle or reduced mobility
- Hormonal imbalances such as excessive corticosteroids or parathyroid hormone, and decreased estrogen or testosterone
- Nutritional deficiencies involving calcium, vitamin D, and protein
- Cigarette smoking
- Small and light bone structure, often found in individuals of Asian or European descent
- Excessive caffeine intake, which may interfere with calcium absorption
Muscular Dystrophy
What is the pathophysiology of muscular dystrophy and its common manifestations?
Muscular dystrophy involves a progressive degeneration of skeletal muscle tissue. Duchenne muscular dystrophy, the most prevalent form, follows an X-linked inheritance pattern primarily affecting males between ages 2 and 3. The disease progresses in an ascending pattern starting from the feet upwards, with early signs including motor weakness and pelvic girdle muscle impairment, which leads to a waddling gait and difficulties climbing stairs. The Gower maneuver, where the child uses their hands to push themselves upright, is a hallmark sign. Tendon reflexes diminish, and deformities such as kyphoscoliosis develop. Respiratory infections and cardiac myopathy are common complications due to muscular weakness.
Osteoarthritis
What is osteoarthritis and how does it develop?
Osteoarthritis is a degenerative joint disease primarily caused by chronic wear and tear, often exacerbated by increased weight-bearing activities or repetitive lifting. Research indicates a genetic predisposition to the disease. Pathologically, the articular cartilage becomes roughened and worn, releasing enzymes that accelerate cartilage destruction. The subchondral bone can become exposed, resulting in cysts and osteophytes (bone spurs). As cartilage and osteophytes break off, the joint space narrows, secondary inflammation occurs, and joint motion becomes limited. Pain typically worsens with weight-bearing.
What clinical signs and symptoms characterize osteoarthritis?
Patients typically experience aching pain with joint movement and weight-bearing, restricted range of motion, and functional limitations. Walking becomes difficult, increasing the risk of falls. Temporomandibular joint involvement can cause difficulty with chewing and speech. Bony enlargements are often noted at the distal interphalangeal joints.
NR 283 Quiz 4
How is osteoarthritis managed clinically?
Management aims to reduce pain and improve joint function:
- Physical therapies such as massage, physiotherapy, acupuncture, and occupational therapy
- Use of adaptive devices like canes and braces to reduce joint stress
- Mild, regular exercise programs to maintain joint mobility
- Orthotic shoe inserts to support gait
- Nutritional supplements such as glucosamine and chondroitin
- Injection of synthetic synovial fluid to lubricate joints
- Pharmacological treatments including NSAIDs and analgesics
- Surgical intervention may be necessary in advanced disease
Rheumatoid Arthritis (Swan Neck Deformity)
What is the pathophysiology of rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by synovitis with intense inflammation and cellular proliferation. Granulation tissue known as pannus invades and erodes cartilage, destabilizing the joint. The process leads to fibrosis and calcification, which can obliterate the joint space, and ultimately ankylosis, or joint fixation, with deformity if left untreated.
NR 283 Quiz 4
What are the typical clinical manifestations of rheumatoid arthritis?
Initial symptoms include redness, swelling, and tenderness in the fingers and wrists, with joint stiffness and impaired movement. Muscle atrophy and shifting bone alignment occur over time. Muscle spasms often arise due to pain and inflammation. TMJ involvement may cause malocclusion. Systemic symptoms include fatigue, depression, malaise, anorexia, low-grade fever, and iron deficiency anemia resistant to standard treatment.
Chapter 16 – Endocrine System Disorders
Type 1 Diabetes Mellitus
What causes type 1 diabetes and what is its pathophysiology?
Type 1 diabetes is an autoimmune condition leading to destruction of pancreatic beta cells and absolute insulin deficiency. Typically developing in childhood, this disease necessitates lifelong insulin therapy. Genetic factors contribute to its development.
What are the major complications associated with type 1 diabetes?
One critical complication is diabetic ketoacidosis (DKA), characterized by catabolism of fats and proteins, ketone production, metabolic acidosis, and ketonuria. Without prompt treatment, DKA can be life-threatening.
What clinical symptoms indicate diabetes mellitus?
The hallmark symptoms include:
- Hyperglycemia
- Excessive glucose in urine (glycosuria)
- Polyuria leading to dehydration
- Polydipsia due to thirst from dehydration
- Polyphagia because insulin deficiency impairs glucose utilization
How is diabetes diagnosed?
Diagnosis relies on:
- Fasting blood glucose measurement
- Glucose tolerance tests
- Hemoglobin A1C test for long-term glycemic control monitoring
What are the primary treatment approaches for type 1 diabetes?
Treatment combines:
- Controlled diet and regular exercise to improve glucose utilization
- Oral hypoglycemic agents in some cases
- Lifelong insulin replacement therapy
Hypoglycemia (Insulin Shock)
What causes hypoglycemia in diabetic patients and what are the symptoms?
Hypoglycemia often results from excess insulin, oral hypoglycemics, strenuous exercise, missed meals, vomiting, or dosing errors. Symptoms include disorientation, anxiety, altered behavior, low blood pressure, rapid heart rate, and decreased consciousness. Immediate treatment is critical to prevent brain damage.
How is hypoglycemia treated in emergencies?
If the patient is conscious, administer quick-absorbing carbohydrates like fruit juice or candy. If unconscious, intravenous administration of 50% glucose is necessary.
Diabetic Ketoacidosis (DKA)
What triggers DKA and what are its clinical signs?
DKA results from insufficient insulin, often precipitated by infection, stress, dosing errors, dietary changes, alcohol, or exercise. Clinical signs include dry mouth, rapid weak pulse, hypotension, reduced urine output, acetone breath, deep Kussmaul respirations, lethargy, and decreased responsiveness.
How is diabetic ketoacidosis managed?
Treatment requires prompt insulin administration and fluid and electrolyte replacement to restore metabolic balance.
Chronic Complications of Diabetes
What are the long-term complications of diabetes?
Chronic diabetes damages blood vessels of all sizes:
- Microangiopathy affects small capillaries leading to tissue necrosis, neuropathy, retinopathy (blindness), and kidney failure
- Macroangiopathy affects large arteries, increasing risks of heart attacks, strokes, and peripheral vascular disease
- Ulcers and infections on the feet may lead to gangrene and require amputation
Diabetes Insipidus and Syndrome of Inappropriate ADH (SIADH)
| Disorder | Cause | Symptoms | Treatment |
|---|---|---|---|
| Diabetes Insipidus | Deficiency of ADH due to adenoma, injury, or genetic causes | Excessive urination, thirst | ADH replacement therapy |
| SIADH | Excessive ADH secretion, possibly tumor or stress-induced | Fluid retention, hyponatremia | Diuretics, sodium supplements |
Thyroid Disorders
What are the features of hyperthyroidism?
Hyperthyroidism is characterized by hypermetabolism and sympathetic nervous system overactivity. Patients may present with toxic goiter, exophthalmos, increased body temperature, sweating, soft silky hair, weight loss, insomnia, and hyperactivity.
What causes hypothyroidism and what are its symptoms?
Hypothyroidism may arise from iodine deficiency, autoimmune Hashimoto thyroiditis, tumors, or surgical removal of the gland. Congenital hypothyroidism (cretinism) results in short stature and severe developmental delay. Symptoms include goiter (in iodine deficiency), cold intolerance, weight gain, fatigue, decreased appetite, and in severe cases, myxedema, characterized by facial edema and a thickened tongue. Untreated severe hypothyroidism can cause myxedema coma, a life-threatening state.
Chapter 25 – Immobility and Associated Problems
What are the systemic effects of prolonged immobility?
| Body System | Effects |
|---|---|
| Urinary | Urine stasis leading to kidney stones and UTIs; residual urine increasing infection risk |
| Gastrointestinal | Constipation, weakened defecation muscles, reduced appetite, delayed healing |
| Cardiovascular | Reduced venous return, orthostatic hypotension, edema, thrombosis risk |
| Respiratory | Reduced chest expansion, accumulation of secretions, increased pneumonia and atelectasis risk |
| Musculoskeletal | Muscle atrophy, decreased flexibility and ROM, bone demineralization leading to osteoporosis |
| Neurological/Psychological | Nerve spasms, pain-related psychological effects |
Chapter 28 – Environmental Hazards and Associated Problems
What are the effects of heavy metal toxicity?
Heavy metals such as lead and mercury accumulate in body tissues after prolonged exposure. Lead exposure, often from industrial sources, lead pipes, batteries, and lead-based paint, is especially harmful.
What are the toxic effects of lead exposure?
Lead toxicity causes hemolytic anemia, inflammation and ulceration of the digestive tract, kidney tubule inflammation, and nervous system damage. Neurological symptoms include neuritis, encephalopathy, seizures, developmental delays, intellectual impairment, and potentially irreversible brain damage.
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). (2021). Muscular dystrophy information.
American College of Rheumatology (ACR). (2021). Musculoskeletal system disorders and endocrine system disorders.
NR 283 Quiz 4
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2020). Diabetes overview.
World Health Organization (WHO). (2023). Environmental health: Heavy metal toxicity.
Mayo Clinic. (2022). Osteoporosis: Causes and risk factors.