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Musculoskeletal69

UNIT II

QuestionAnswer
How many bones in the human body? 206 (80 axial/126 appendicular)
What are 5 functions of bone? Support, Protection, Movement, RBC formation, Mineral storage.
Increased Calcium reabsorption from the GI tract? Vitamin D
Synarthrosis? Immovable Joint (Skull)
Amphiarthrosis? Vertebral Joints and Symphysis Pubis (Limited movement)
Freely Movable Joints? Diarthrosis
Increase the tension within a muscle but do not produce movement? Isometric Contractions
Shorten a muscle to produce movement? Isotonic Contractions
Involuntary contractions of skeletal muscles? Tetany due to Decreased Calcium levels.
Attach muscle to bone? Tendons
Attach bone to bone? Ligaments
what are some musculoskeletal disorders with genetic predisposition? RA, Systemic Lupus Erythematosus, OA, Gout, Osteoporosis, Scoliosis.
Essential diet for a healthy, intact musculoskeletal system? Vitamins C, D, Calcium and Protein
Head to Toe exam? Cephalopedally
ROM is most accurately assessed with this? Goniometer
Is performed on the supine pt. with sciatica or leg pain? Straight-leg- raising Test (+L4-5, or L5-S1)
Stiffness and fixation of a joint? Ankylosis
Shortened gait with as little weight bearing as possible on the affected side? Antalgic Gait (Due to Trauma)
Typical deformity in RA and psoriatic arthritis? Boutonnière Deformity and Swan Neck Deformity
Partial dislocation of a joint? Subluxation
Poliomyelitis, congenital deformity, arthritis, knees together? Valgum Deformity
Arthritis, Congenital Deformity? Varum Deformity
Used to directly examine the interior of a joint cavity? Arthroscopy
Enzyme, produced by osteoclasts of bone, is needed for mineralization of organic bone matrix(Increased w/ Fx, bone CA, Osteoporosis)? Alkaline Phosphatase (38-126)
Normal Calcium levels? 8.6-10.2
Indirectly r/t Calcium, increased w/ CKD, Healing fx? Phosphorus (2.4-4.4)
End product of purine metabolism is normally excreted in urine? Uric Acid(4.4-7.6)
Joint aspiration is usually performed for a synovial fluid analysis? Arthrocentesis
An injury to the ligament structures surrounding a joint? Sprain
Excessive stretching of a muscle? Strain
Injur: ligament pulls loose a fragment of bone? Avulsion Fx
Recovery time for a sprain or strain? 3-6wks
Instructions for ice application for soft tissue injury? 20-30min/application, NO direct skin contact.
Instructions for soft tissue injuries? RICE (24-48hrs post injury)
Bone cell death as a result of inadequate blood supply? Avascular Necrosis
Indicate a probable intraarticular Fx? Fat cells in the capsule
Terms used to describe injuries resulting from prolonged force, or repetitive movements? Cumulative Trauma Disorder
Condition caused by compression of the median nerve? Carpal Tunnel Syndrome (CTS)
Physical s/s of CTS? Tinel's sign and Phalen's sign
Can be elicited by tapping over the median nerve? Tinel's Sign
Recovery period for torn ACL? 6-8 Months
First stage f Fx healing, hematoma formation ;occurs in the initial 72hrs? Fx Hematoma
Second stage of Fx healing, active phagocytosis absorbs products of local necrosis; osteoid formation (3-14 days post injury)? Granulation Tissue
Third stage of Fx healing, minerals, new bone matrix, appears by the end of second wk? Callus Formation
Fourth stage of Fx Healing occurs 3wks-6months post injury, pt allowed limited mobility and/or cast removal? Ossification
Fifth stage of Fx Healing, callus cont. to develop, Radiologic Union may be present, occurs up to a yr following injury? Consolidation
Final stage of Fx Healing, excess bone tissue is reabsorbed, union is complete; radiologic union Present? Remodeling
Type of non-union occurring at Fx site in which a false joint is formed with abnormal movement at the site? Pseudoarthrosis
Deposition of Calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury? Myositis Ossificans
Can be used to stimulate bone healing in some situations of nonunion or delayed wound union? Pulsed Electromagnetic Fields (PEMF's) use 10-12hrs/day sleep.
Used for intraarticular Fx (involving joint surface), early initiation of ROM of the joint is indicated? Open Reduction w/Internal Fixation (ORIF)
What are some purposes of traction? Decrease Pain, Muscle Spasms, Immobilize, Decrease Fx/Dislocation, Expand joint space pre Sxg.
Is used for short-term Tx (48-72hrs) until skeletal traction or Sxg is possible? Skin Traction
Traction weight? For skin traction? 5-10 lbs
Used for longer periods of time, used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia? Skeletal Traction
Traction weight for skeletal traction? 5-45lbs
Most commonly used traction for Fx of the hip and Femur? Bucks's Traction
How long does it take or a cast to set? Sets 15min & weight bearing 24-72hrs post application.
Metal pins that are inserted into the bone and attached to external rods to stabilize the Fx while it heals? External Fixation
Fx heals in expected time but in unsatisfactory position? Malunion
Antibiotics used for open Fx? Cefazolin, Kefzol (Ancef)
Characterized by excessive pain, pallor, paresthesia (6"p")? Compartment Syndrome
Late s/s of Compartment Syndrome? Paralysis and Pulselessnes
How do you assess motor function of he peroneal and tibial nerves? Dorsiflexion and Plantar Flexion
How is sensory innervation evaluated for the peroneal nerve? Dorsal foot, web space great and 2nd toe.
Is performed by stroking the plantar surface (sole) of the foot? Tibial Nerve
Do not elevate if this is present? Compartment Syndrome
Recommended fluid intake for bone Fx? 2500ml/day
May be recommended to acidify urine and prevent Calcium precipitation in urine? Cranberry juice or Ascorbic Acid
If you have a PCA? Only pt can push it & have Narcan bedside.
Callus formation on a X-Ray indicates? Ok weight bearing
Fat embolism characteristics? Petechiae on Chest
Itching under a cast instructions? Hair dryer on cool settings
Proper way to hold a cane? Opposite the involved extremity (unless contraindicated)
Major complications of Fx? DVT, Infection, Bleeding.
Happens in younger people 2ry to overweight or obese? Total Knee Arthroplasty
Use this post Sxg to increase joint mobility? Cont. Passive Motion Machine
Most common sites for compartment syndrome? Distal Humerus and Proximal Tibia
What are the 6 "P"'s? Pain, Pallor, Paresthesia, Pressure, Paralysis, Pulselessness.
One of the 1st indications of compartment syndrome? Pain unrelieved by drugs.
Late s/s of compartment syndrome? Paralysis & Pulselessness
Surgical decompression for compartment syndrome? Fasciotomy
Clinical manifestations of FES? Changes in LOC, Petechiae on chest, neck, axilla, (24-48hrs)
Fx that occurs within the hip joint capsule? Intracapsular Fx
Fx of the head of the femur? Capital Fx
Fx just below the neck of the femur? Subcapitol Fx
Fx of the neck of the femur? Transcevical Fx
Decreased pain; binds and opens C.Fiber receptors, which causes extra Calcium to enter nerve cells? Capsaicin
Most common type of primary malignant bone tumor with 50% occuring in the distal femur (10-30y/o)? Osteosarcoma or Osteogenic Sarcoma
Pain felt in the amputated part immediately after Sxg? Phantom Limb Pain (usually AKA)
Biomarker with effected bones/CA? Alkaline Phosphatase
Teaching for AKA/BKA? ROM, Prone position Q3-4hrs for 20-30min, Trapeze.
Risk factors for Osteoporosis? F, Older, Family Hx, White/Asian, Menopause, Alcohol.
"Silent Disease" 1st s/s are back pan, spontaneous Fx? Osteoporosis
Loss of bone r/t a Vit D deficiency, Lack of sunshine? Osteomalacia
Specific test for making diagnosis of Lupus? Anti-Smith test.
Clinical manifestations of hip Fx? External Rotation, and Shortening of Leg.
Relieves muscle spasms and is used for up to a maximum of 24-48hrs? Bucks Traction
Avoid these positions with a posterior approach Sxg? NO Crossing legs, >90 degrees of flexion, abduction or internal rotation.
This approach generally results in a more stable hip in the postoperative period with a lower rate of complications? Anterior Approach
Full weight bearing is restricted until what is seen? X-Ray Evidence of Union
Vertebral compression devices are most often due to this? Osteoporosis
Post-op management of mandibular Fx? Side lying, Head UP, Wire Cutters, Trach tray, Patent Airway.
Is a form of disarticulation at the ankle? Syme Amputation
The goal of amputation Sxg? Preserve Length, Function and Remove Damage.
Often called the "Guillotine Amputation", indicated control of actual or potential infection? Open Amputation
Occurs in 90% of amputees, limb feels present after Sxg? Phantom Limb Sensation
Time required to bear full weight on prosthesis? 3months
Teaching to prevent flexion contractures? Prone 30min x3-4/day
May be the best choice for pts who have had amputations AKA or BEA, older adults, and those with infections? Delayed Prosthetic Fitting
Is delayed for above-the-elbow amputee? Prosthetic Fitting
Is used as a prophylactic measure and as a palliative Tx of Rheumatoid Arthritis (RA)? Synovectomy
Performed by removing a wedge or slice of bone to change alignment? Osteotomy
The reconstruction or replacement of a joint to relieve pain, improve or maintain ROM and correct deformity? Arthroplasty
Replacement of part of a joint? Hemiarthroplasty
Are recommended for less active, older adults w/ compromised bone density? "Cementless" Arthroplasty
Is the Sxg fusion of a joint, used hen joint replacement or reconstructive Sxg fails? Arthrodesis
Stiffening and Fusion of spinal and saroiliac joints 2ry to scar formation from inflammation? Ankylosing Spondylitis (Tx w/ Osteotomy)
A non-inflammatory joint disease, present after 50y/o, affecting weight bearing joints? Osteoarthritis
Occur in men later in life and increases the process of bone loss? Decreased Testosterone
A severe infection of the bone, bone marrow & surrounding soft tissue? Osteomyelitits
Teaching for pts on Gentamicin (Garamycin)? Visual changes, hearing, urinary and dehydration.
How is osteomyelitis drug therapy monitored? Bone scans and ESR tests.
Used over the site of infection and may be used to draw the wound together? Negative Pressure (Wound VAC)
Tendon rupture (especially the Achilles tendon) can occur with use of these fluoroquinolone antibiotics? Cipro & Levaquin
Must be carefully monitored throughout the course of therapy to avoid adeverse effects? Peak & Trough Levels
Primary benign bone tumor, characterized by an overgrowth of cartilage and bone near the end of the bone at the growth plate? Osteochondroma
Primary bone tumor that is extremely aggressive and rapidly metastasizes to distant site (10-25y/o arms, legs, pelvis)? Osteosarcoma
Occurs in cartilage most commonly in arm, leg, and pelvic bones of older adults ages 50-70y/o? Chondrosarcoma
Develops in medullary cavity of long bones, femur, humerus, pelvis and tibia; teenagers;white people? Ewing's Sarcoma
Rare tumor that occurs in the base of the skull and vertebral bones? Chordoma
Arises in cancellous ends of the arm and leg bones? Osteoclastoma
Intramedullary cartilage tumor usually found in cavity of a single hand or foot bone 10-20y/o? Endochroma
Warning s/s of bone CA? Swelling, unexplained pain, limited joint function, changes in skin temp.
Genetically transmitted diseases characterized by progressive symmetric wasting of skeletal muscles w/o evidence of nero involvement? Muscular Dystrophy (MD)
Increase bone reabsorption, new bone is larger, disorganized and structurally weaker? Paget's Disease
Pain that lasts 4wks or less? Acute Low Back Pain
Pain lasts more than 3 months or is a repeated incapacitating episode? Chronic Back Pain
Contributes to osteoarthritis of the spine by the formation of osteophytes (bone spurs)? Degenerative Disk Disease (DDD)
Most common traditional surgical procedure for lumbar disk disease? Laminectomy
Common type of surgical procedure that helps decompress the nerve root? Diskectomy
May be used if an unstable bone mechanism is present? Spinal Fusion
Chronic progressive metabolic bone disease, porus bone; Fragile bone disease; “Silent Thief”? Osteoporosis
These drugs ↑ bone loss and inhibit new bone formation (for osteoporosis)? Dilantin, Corticosteroids, Heparin, Thyroid Hormones.
BMD study measures bone density in the spine, hip, and forearm; Osteoporosis? DEXA (Dual-energy X-ray absorptiometry).
Used to maintain the spine in proper alignment after a Fx or Tx of a vertebral Fx? Thoracic-lumbar-sacral Orthosis (TLSO)
Minimally invasive procedures that are used to treat osteoporotic vertebral Fx? Vertebroplasty and Kyphoplasty
Biphosphonates inhibit total bone mass and BMD by 5%? Didronel, Fosamax, Aredia, Actonel, Boniva.
Instructions for Biphosphinates? Full Glass, 30min before food or meds, Upright 30min.
Selective estrogen receptor modulator for Osteoporosis? Raloxifene (Evista)
Tx for osteoporosis stimulates new bone formation? Teriparatide (Forteo)
The most common complication of Paget’s disease and may be the first indication of the disease? Pathologic Fx
Given to decrease Calcium reabsorption? Calcitonin(Cibacalcin)
Used as a SubQ or IM injection for Tx of Paget’s disease? Salmon Calcitonin(Calcimar)
Inflammation of a joint? Arthritis
Involves inflammation of bones, muscles, and joints? Rheumatic Disease
A slowly progressive non-inflammatory disorder of the diarthrodial (synovial) joints? Osteoarthritis
These drugs stimulate collagen-digesting enzymes in joint synovium? Indomethacin (Indocin), Colchicine, and Corticosteroids.
Seen commonly w/ OA on the distal interphalangeal joints of the fingers (overgrowths)? Heberden’s Nodes
Important distiction between OA and RA? Fatigue, Fever, Organ involvement not present in OA.
Mild-moderate joint pain from OA may be relieved by these drugs? Tylenol, Capsaicin Cream (Zostrix)
Contributes to early pain and stiffness from OA? Inflammatory change
Tx for early morning stiffness usually resolves w/in 30min? Warm Shower
Where are Heberden’s Nodes located? DIP joints (Distal interphalangeal)
Biomarkers of choice for RA? +RF (80%), ESR, CRP, ANA, Anti-CCP.
Synovial fluid color in early RA? Straw colored w/ Fibrin Flecks
Tx for early RA, rapid anti-inflammatory ↓ s/s in days -weeks? Methotrexate(Rheumatrex)
Are given to ↓ risk of irreversible joint changes that can occur in the 1st year of RA? Disease-Modifying Antirheumatic Drugs (DMARD’s)
Appear Sub Q as firm, non-tender, granuloma-type masses? Rheumatoid Nodules
Happens w/ RA; ↓ lacrimal and salivary gland secretion, dry mouth, burning gritty itchy eyes? Sjögren’s Syndrome
Possible risk factors linked to OA? ↓ Estrogen, Genetics, Obesity
Multi-system inflammatory autoimmune disease? Systemic Lupus Erythematosus (SLE)
The most common environmental trigger for SLE? Sun Exposure and Sun burns
Most common effected tissues in SLE? Skin, muscle, lungs, heart kidneys, nervous tissue.
Rash over the cheeks and bridge of the nose occurs in 50% of pts w/ SLE? Butterfly Rash
Occurs in more than 90% of pts w/ SLE? Arthritis
Tests that are most specific for SLE? Anti-double-stranded DNA, and Anti-Smith(Sm) Tests
Antimalarial agent used to treat fatigue and moderate skin and joint problems? Hydroxychloroquine(Plaquenil), see Ophthalmologist Q6-12 months.
Recommended for pts w/ RA who are taking Methotrexate Therapy? Folic Acid
SLE effects this organ the most? Renal (I&O’s, BUN/Creatinine)
With Gout Sodium Urate crystals (Tophi) deposit in these areas of the body=inflammation/pain? Great toe, hands, ears, kidney(stones)
Drugs to Tx gouty attack? Allopurinol, Colchicine, and NSAID’s
Chronic disorder; nonarticular musculoskeletal pain, fatigue, w/ multiple tender points? Fibromyalgia Syndrome (FMS)
Diagnosis for FMS? Experience 11 of 18 tender points; >3months
What are 3 soft tissue Rheumatic Syndromes? Myofascial pain, Fibromyalgia & Chronic Fatigue Syndrome
Is a disorder of central processing w/ neuroendocrine neurotransmitter dysregulation? Fibromyalgia Syndrome (FMS)
Created by: BOjangles1006