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124 Cards in this Set
- Front
- Back
Immovable joint?
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Synarthrosis
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Joint with limited movement?
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Amphiarthrosis
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Freely movable joint?
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Diarthrosis
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Shaft of bone?
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Diaphysis
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Ends of bone?
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Epiphysis
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Location of Osteocytes?
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Lacunae
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Osteoclasts location?
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Howship’s lacuna
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4 Regulating factors of bone formation and maintenance?
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Stress and weight bearing
Vitamin D Parathyroid hormone and calcitonin Blood supply |
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What do increased Ca2+ levels result in?
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Lowered PO4 3-
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What connects bone to bone?
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Ligaments
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What is angiogenesis?
What role does it play? |
Growth of new vasculature from pre-existing vasculature
Plays a role in bone healing |
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What is a fasciculation?
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Small muscle spasm
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Thoracic spine abnormality?
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Kyphosis
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Lumbar spine abnormality?
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Lumbar
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What is CMS?
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Circulation-pulses Mobility Sensation (pain)
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What is the clinical significance of Sed rate (ESR)?
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Can find generalized inflammation which is indicative of rheumatoid arthritis
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What is the difference in changes of ESR in rheumatoid vs osteo arthritis?
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ESR increases in rheumatoid
No change in osteo |
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What major factor increases osteoclastic activity?
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Hormones/steroids
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What is compartment syndrome?
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Compression of nerves & blood vessels within an enclosed area; results in impaired blood flow (muscle and nerve damage)
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S/s of compartment syndrome?
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Severe pain not relieved by analgesics
Decreased or no pulses White cool extremity |
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What causes delayed union or nonunion of fractures?
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Improper mobilization and/or nutritional issues
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What are the 5 P's in neurovascular status?
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Pain, pulselessness, pallor, paralysis, & polar (cold)
Also parasthesia |
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What is key in the treating of wounds on skin to be cast?
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Must be treated before application of cast
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What is important in the use of weights in traction?
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Not removed unless intermittent traction is supplied
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What are the 4 purposes of traction? When is it used?
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Reduce muscle spasms
–Reduce, align, and immobilize fractures –Reduce deformity –Increase space between opposing forces Short-term until other txs can be used |
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What are 2 hallmark signs of Rheumatoid?
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Ulnar deviation & "Swan-Neck" deformity
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What consideration must be given to the ropes and weights used for traction?
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Ropes must be unobstructed and weights must hang
freely |
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What 2 directions does traction need?
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The lines
of pull are “vectors of force.”The result of the pulling force is between the two lines of the vectors of force. |
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What is a major complication of traction?
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DVT
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4 potential complications of traction?
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Pneumonia, atelectasis, anorexia, urinary stasis
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3 important education matters for preventing hip dislocation after replacement surgery?
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Affected leg shouldn't cross center of body
Hip should not bend more than 90 deg Affected leg should not turn inward (position in abduction) |
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How long does it take a hip replacement pt to walk with assistance p/s?
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within a day
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What are the 3 time frames for hip replacement infection?
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within 3 months, 4-24 months (delayed), 2+ years (spread from another site)
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2 p/s interventions for knee prosthesis?
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Encourage active flexion exercises
Use of continuous passive motion (CPM) device |
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Specific questions to ask pre-op for orthopedic surgery?
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Cold? Dental problems? UTIs? Other infx w/i 2 weeks
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P/s problems for replacements?
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DVT/PE, hypovolemic shock
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What should be done before PT for pts p/s replacements?
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Give pain meds
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What shouldn't be given to orthopedic pts on bed rest?
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Lg amts of milk; can create a lot of phlegm
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Prevention of pulmonary complications p/s for replacements?
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Encourage deep breathing exercises and coughing
Use incentive spirometry |
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Important considerations in PE of pt w/ lower back pain
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Deep Tendon Reflexes, back & limb symmetry, spinal curvature
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When do carpal tunnel symptoms usually occur?
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At night
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What population is Dupuytren's contracture (fingers can't be straightened) common?
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Alcoholics
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What are loose bodies?
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pieces of articulation from joints
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What is a hallux valgus?
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bunion
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Pes planus?
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flat feet
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Critical p/s intervention for foot surgery:
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Assess welling and neurovascular status q1-2h for the first 24 hrs
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What is the underyling patho of osteoporosis?
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Osteoclastic activity becomes greater than osteoblastic activity
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How much Vitamin D & Ca should pts at risk for osteoporosis have in diet?
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1200-1500 mg Ca
400-800 IU of D |
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What exercise won't prevent osteoporosis?
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Swimming
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4 classes of pharm tx for osteoporosis?
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Biphosphonates, selective estrogen receptor modulators (SERMs), Calcitonin, & Teraparatide
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Major biphosphonate? What must be done when taking?
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Alendronate (Fosamax)
Pt cannot lie down for 1 hr post-admin |
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Major biphosphonate? What must be done when taking?
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Alendronate (Fosamax)
Pt cannot lie down for 1 hr post-admin |
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Major biphosphonate? What must be done when taking?
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Alendronate (Fosamax)
Pt cannot lie down for 1 hr post-admin |
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What drug is a SERM? SEs?
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Evista
hot flashes, leg cramps, DVT |
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What drug is a SERM? SEs?
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Evista
hot flashes, leg cramps, DVT |
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Calcitonin formulations? SE?
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nasal spray, SQ, & IM
Facial flushing |
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Calcitonin formulations? SE?
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nasal spray, SQ, & IM
Facial flushing |
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What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
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Parathyroid hormone; qd; helps in building bone
Bone pain, nausea |
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What causes parathyroid hormone to be released?
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Low serum Ca2+
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What drug is a SERM? SEs?
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Evista
hot flashes, leg cramps, DVT |
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Calcitonin formulations? SE?
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nasal spray, SQ, & IM
Facial flushing |
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What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
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Parathyroid hormone; qd; helps in building bone
Bone pain, nausea |
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What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
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Parathyroid hormone; qd; helps in building bone
Bone pain, nausea |
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What causes parathyroid hormone to be released?
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Low serum Ca2+
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What causes parathyroid hormone to be released?
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Low serum Ca2+
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Major biphosphonate? What must be done when taking?
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Alendronate (Fosamax)
Pt cannot lie down for 1 hr post-admin |
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What drug is a SERM? SEs?
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Evista
hot flashes, leg cramps, DVT |
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Calcitonin formulations? SE?
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nasal spray, SQ, & IM
Facial flushing |
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What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
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Parathyroid hormone; qd; helps in building bone
Bone pain, nausea |
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What causes parathyroid hormone to be released?
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Low serum Ca2+
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What is osteomalacia?
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"Adult rickets"; metabolic bone d/o characterized by inadequate bone mineralization
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Effects of osteomalacia?
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Softening and weakening of the long bones causes pain,
tenderness, and deformities caused by the bowing of bones and pathologic fractures |
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Tinel's sign?
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Used for dx carpal tunnel syndrome
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Patho of osteomalacia?
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Deficiency of activated vitamin D causes lack of bone
mineralization and low extracellular calcium and phosphate |
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Etiology of osteomalacia?
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gastrointestinal disorders, severe renal
insufficiency, hyperparathyroidism, and dietary deficiency |
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What is Paget's diseases and what is it AKA?
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A structural defect
osteitis deformans |
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Patho and etiology of Paget's?
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d/o of localized bone turnover
dysfunction of osteoclastic and osteoblastic activity |
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What is bone structure like in Paget's? What bones does it affect?
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disorganized, weak, & highly vascular
Cranial bones (can damage CN VIII [hearing loss]), facial bones, long bones |
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Population at higher risk? Incidence in over 50?
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Men
2-3 % |
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Pharms for Paget's?
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Calictonin, biphosphonate (Didronel), & plicamycin (ABX used for refractory Paget's)
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What is Paget's diseases and what is it AKA?
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A structural defect
osteitis deformans |
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Patho and etiology of Paget's?
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d/o of localized bone turnover
dysfunction of osteoclastic and osteoblastic activity |
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What is bone structure like in Paget's? What bones does it affect?
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disorganized, weak, & highly vascular
Cranial bones (can damage CN VIII [hearing loss]), facial bones, long bones |
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Population at higher risk? Incidence in over 50?
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Men
2-3 % |
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Pharms for Paget's?
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Calictonin, biphosphonate (Didronel), & plicamycin (ABX used for refractory Paget's)
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What is Paget's diseases and what is it AKA?
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A structural defect
osteitis deformans |
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Patho and etiology of Paget's?
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d/o of localized bone turnover
dysfunction of osteoclastic and osteoblastic activity |
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What is bone structure like in Paget's? What bones does it affect?
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disorganized, weak, & highly vascular
Cranial bones (can damage CN VIII [hearing loss]), facial bones, long bones |
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Population at higher risk? Incidence in over 50?
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Men
2-3 % |
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Pharms for Paget's?
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Calictonin, biphosphonate (Didronel), & plicamycin (ABX used for refractory Paget's)
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Osteomyelitis etiology?
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Infection r/t spread of soft-tissue infx, direct bone contamination, & bloodborne spread from other site of infx(generally in traumatized bone)
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Major Osteomyelitis causative agent?
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S. Aureus (70-80 %)
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What is critical in treating Osteomyelitis?
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Early intervention
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What is the best meanst of controlling Osteomyelitis?
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prevention
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What can be a characteristic of fevers r/t chronic Osteomyelitis?
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May be low grade and occur in afternoon/evening
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What is a major concern of Osteomyelitis r/t the integument?
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There can be a fistula formation
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What is Osteomyelitis often comorbid with?
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squamous skin cancer
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What vitamin is critical in tx of Osteomyelitis?
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C
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Difference bet contusion & strain?
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Contusion occurs as a result of blunt force trauma; strain occurs due to a pulled muscle
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Diff bet strain & sprain?
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Former is injury to muscle
Latter is injury to a ligament (and supporting muscle fiber) around a joint |
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Tx for most injuries of the MS system (non-bone)?
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ice for 1st 24-72 hrs, then heat
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Dif bet simple vs compound/complex fracture?
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If there is skin breakage;
former has none (closed); latter does (open) |
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What population do you see greenstick fractures?
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Peds
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What population is at risk for compression fracture and what is a common site?
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Elderly w/ osteoporosis
Vertabrae |
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CMS?
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Circulation, movement, & sensation
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4 Specific complications of fractures?
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Shock (since bones are vascular)
Fat embolism (usually in long bones, since marrow is fatty; can become PE) Avascular necrosis (often in hip fractures) Heterotrophic ossification (abnormal bone growth) |
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What should not be done in a clavicular fracture?
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Arm should not be elevated above shoulder for 6 weeks
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Volmann's contracture?
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Compartment syndrome specific to elbow fractures.
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Colles' fracture location and population?
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Wrist; pts w/ osteoporosis
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Hip fracture tx?
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Similar to hip replacement
Don't angle more than 90 deg Assess for pain (could be dislocation) Adduction/abduction |
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PT for femoral shaft fractures?
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Lower leg, foot, and hip exercises (muscle & vascular)
Early ambulation Active & passive knee exercises ASAP |
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Common complication of femoral shaft fractures?
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Avascular necrosis (usually occurs at head of femur)
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Purpose of spica wrap?
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So you don't have to tape directly to skin
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Buck's traction ix? When can it be used?
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For hip fractures; can be used pre-op
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What do trochanter rolls do for hip fractures?
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prevent external rotation of the hip
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What does a trapeze do for pts w/ hip fractures?
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Helps maintain upper body strength
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Potential complications of amputation?
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Post-op hemorrhage, infection, & skin breakdown
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SCD: what is it and what is it used for?
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Sequential compression device;
often used for hip fracture rehab |
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Why should you keep a post-op amputee in the prone position and what do you use to do this?
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To prevent hip contracture
Sandbags |
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How long should pt be put in prone position post-op for amputation?
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At least a few hours
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What pts do you see Heberden's nodes and where are they located?
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Pts w/ osteoarthritis
Located in the DIP joint (distant interphalangeal joint) |
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How should you treat an itch r/t a cast?
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By using a blow dryer on cool setting (causes vasoconstriction, limiting sensory transmission)
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What is gout?
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Uric acid deposits in joints
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When caring for a pt with a BKA, what do you consider when turning?
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Try to put them in prone position
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