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Musculoskeletal69
UNIT II
| Question | Answer |
|---|---|
| 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
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