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124 Cards in this Set

  • Front
  • Back
Immovable joint?
Synarthrosis
Joint with limited movement?
Amphiarthrosis
Freely movable joint?
Diarthrosis
Shaft of bone?
Diaphysis
Ends of bone?
Epiphysis
Location of Osteocytes?
Lacunae
Osteoclasts location?
Howship’s lacuna
4 Regulating factors of bone formation and maintenance?
Stress and weight bearing

Vitamin D

Parathyroid hormone and calcitonin

Blood supply
What do increased Ca2+ levels result in?
Lowered PO4 3-
What connects bone to bone?
Ligaments
What is angiogenesis?

What role does it play?
Growth of new vasculature from pre-existing vasculature

Plays a role in bone healing
What is a fasciculation?
Small muscle spasm
Thoracic spine abnormality?
Kyphosis
Lumbar spine abnormality?
Lumbar
What is CMS?
Circulation-pulses Mobility Sensation (pain)
What is the clinical significance of Sed rate (ESR)?
Can find generalized inflammation which is indicative of rheumatoid arthritis
What is the difference in changes of ESR in rheumatoid vs osteo arthritis?
ESR increases in rheumatoid

No change in osteo
What major factor increases osteoclastic activity?
Hormones/steroids
What is compartment syndrome?
Compression of nerves & blood vessels within an enclosed area; results in impaired blood flow (muscle and nerve damage)
S/s of compartment syndrome?
Severe pain not relieved by analgesics

Decreased or no pulses

White cool extremity
What causes delayed union or nonunion of fractures?
Improper mobilization and/or nutritional issues
What are the 5 P's in neurovascular status?
Pain, pulselessness, pallor, paralysis, & polar (cold)

Also parasthesia
What is key in the treating of wounds on skin to be cast?
Must be treated before application of cast
What is important in the use of weights in traction?
Not removed unless intermittent traction is supplied
What are the 4 purposes of traction? When is it used?
Reduce muscle spasms
–Reduce, align, and immobilize fractures
–Reduce deformity
–Increase space between opposing forces

Short-term until other txs can be used
What are 2 hallmark signs of Rheumatoid?
Ulnar deviation & "Swan-Neck" deformity
What consideration must be given to the ropes and weights used for traction?
Ropes must be unobstructed and weights must hang
freely
What 2 directions does traction need?
The lines
of pull are “vectors of force.”The result of the pulling force
is between the two lines of the vectors of force.
What is a major complication of traction?
DVT
4 potential complications of traction?
Pneumonia, atelectasis, anorexia, urinary stasis
3 important education matters for preventing hip dislocation after replacement surgery?
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)
How long does it take a hip replacement pt to walk with assistance p/s?
within a day
What are the 3 time frames for hip replacement infection?
within 3 months, 4-24 months (delayed), 2+ years (spread from another site)
2 p/s interventions for knee prosthesis?
Encourage active flexion exercises

Use of continuous passive motion (CPM) device
Specific questions to ask pre-op for orthopedic surgery?
Cold? Dental problems? UTIs? Other infx w/i 2 weeks
P/s problems for replacements?
DVT/PE, hypovolemic shock
What should be done before PT for pts p/s replacements?
Give pain meds
What shouldn't be given to orthopedic pts on bed rest?
Lg amts of milk; can create a lot of phlegm
Prevention of pulmonary complications p/s for replacements?
Encourage deep breathing exercises and coughing

Use incentive spirometry
Important considerations in PE of pt w/ lower back pain
Deep Tendon Reflexes, back & limb symmetry, spinal curvature
When do carpal tunnel symptoms usually occur?
At night
What population is Dupuytren's contracture (fingers can't be straightened) common?
Alcoholics
What are loose bodies?
pieces of articulation from joints
What is a hallux valgus?
bunion
Pes planus?
flat feet
Critical p/s intervention for foot surgery:
Assess welling and neurovascular status q1-2h for the first 24 hrs
What is the underyling patho of osteoporosis?
Osteoclastic activity becomes greater than osteoblastic activity
How much Vitamin D & Ca should pts at risk for osteoporosis have in diet?
1200-1500 mg Ca

400-800 IU of D
What exercise won't prevent osteoporosis?
Swimming
4 classes of pharm tx for osteoporosis?
Biphosphonates, selective estrogen receptor modulators (SERMs), Calcitonin, & Teraparatide
Major biphosphonate? What must be done when taking?
Alendronate (Fosamax)

Pt cannot lie down for 1 hr post-admin
Major biphosphonate? What must be done when taking?
Alendronate (Fosamax)

Pt cannot lie down for 1 hr post-admin
Major biphosphonate? What must be done when taking?
Alendronate (Fosamax)

Pt cannot lie down for 1 hr post-admin
What drug is a SERM? SEs?
Evista

hot flashes, leg cramps, DVT
What drug is a SERM? SEs?
Evista

hot flashes, leg cramps, DVT
Calcitonin formulations? SE?
nasal spray, SQ, & IM

Facial flushing
Calcitonin formulations? SE?
nasal spray, SQ, & IM

Facial flushing
What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
Parathyroid hormone; qd; helps in building bone

Bone pain, nausea
What causes parathyroid hormone to be released?
Low serum Ca2+
What drug is a SERM? SEs?
Evista

hot flashes, leg cramps, DVT
Calcitonin formulations? SE?
nasal spray, SQ, & IM

Facial flushing
What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
Parathyroid hormone; qd; helps in building bone

Bone pain, nausea
What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
Parathyroid hormone; qd; helps in building bone

Bone pain, nausea
What causes parathyroid hormone to be released?
Low serum Ca2+
What causes parathyroid hormone to be released?
Low serum Ca2+
Major biphosphonate? What must be done when taking?
Alendronate (Fosamax)

Pt cannot lie down for 1 hr post-admin
What drug is a SERM? SEs?
Evista

hot flashes, leg cramps, DVT
Calcitonin formulations? SE?
nasal spray, SQ, & IM

Facial flushing
What is teriparatide (Forteo)? How often is it given? What does it do? What are the SEs?
Parathyroid hormone; qd; helps in building bone

Bone pain, nausea
What causes parathyroid hormone to be released?
Low serum Ca2+
What is osteomalacia?
"Adult rickets"; metabolic bone d/o characterized by inadequate bone mineralization
Effects of osteomalacia?
Softening and weakening of the long bones causes pain,
tenderness, and deformities caused by the bowing of
bones and pathologic fractures
Tinel's sign?
Used for dx carpal tunnel syndrome
Patho of osteomalacia?
Deficiency of activated vitamin D causes lack of bone
mineralization and low extracellular calcium and
phosphate
Etiology of osteomalacia?
gastrointestinal disorders, severe renal
insufficiency, hyperparathyroidism, and dietary
deficiency
What is Paget's diseases and what is it AKA?
A structural defect

osteitis deformans
Patho and etiology of Paget's?
d/o of localized bone turnover

dysfunction of osteoclastic and osteoblastic activity
What is bone structure like in Paget's? What bones does it affect?
disorganized, weak, & highly vascular

Cranial bones (can damage CN VIII [hearing loss]), facial bones, long bones
Population at higher risk? Incidence in over 50?
Men

2-3 %
Pharms for Paget's?
Calictonin, biphosphonate (Didronel), & plicamycin (ABX used for refractory Paget's)
What is Paget's diseases and what is it AKA?
A structural defect

osteitis deformans
Patho and etiology of Paget's?
d/o of localized bone turnover

dysfunction of osteoclastic and osteoblastic activity
What is bone structure like in Paget's? What bones does it affect?
disorganized, weak, & highly vascular

Cranial bones (can damage CN VIII [hearing loss]), facial bones, long bones
Population at higher risk? Incidence in over 50?
Men

2-3 %
Pharms for Paget's?
Calictonin, biphosphonate (Didronel), & plicamycin (ABX used for refractory Paget's)
What is Paget's diseases and what is it AKA?
A structural defect

osteitis deformans
Patho and etiology of Paget's?
d/o of localized bone turnover

dysfunction of osteoclastic and osteoblastic activity
What is bone structure like in Paget's? What bones does it affect?
disorganized, weak, & highly vascular

Cranial bones (can damage CN VIII [hearing loss]), facial bones, long bones
Population at higher risk? Incidence in over 50?
Men

2-3 %
Pharms for Paget's?
Calictonin, biphosphonate (Didronel), & plicamycin (ABX used for refractory Paget's)
Osteomyelitis etiology?
Infection r/t spread of soft-tissue infx, direct bone contamination, & bloodborne spread from other site of infx(generally in traumatized bone)
Major Osteomyelitis causative agent?
S. Aureus (70-80 %)
What is critical in treating Osteomyelitis?
Early intervention
What is the best meanst of controlling Osteomyelitis?
prevention
What can be a characteristic of fevers r/t chronic Osteomyelitis?
May be low grade and occur in afternoon/evening
What is a major concern of Osteomyelitis r/t the integument?
There can be a fistula formation
What is Osteomyelitis often comorbid with?
squamous skin cancer
What vitamin is critical in tx of Osteomyelitis?
C
Difference bet contusion & strain?
Contusion occurs as a result of blunt force trauma; strain occurs due to a pulled muscle
Diff bet strain & sprain?
Former is injury to muscle

Latter is injury to a ligament (and supporting muscle fiber) around a joint
Tx for most injuries of the MS system (non-bone)?
ice for 1st 24-72 hrs, then heat
Dif bet simple vs compound/complex fracture?
If there is skin breakage;
former has none (closed); latter does (open)
What population do you see greenstick fractures?
Peds
What population is at risk for compression fracture and what is a common site?
Elderly w/ osteoporosis

Vertabrae
CMS?
Circulation, movement, & sensation
4 Specific complications of fractures?
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)
What should not be done in a clavicular fracture?
Arm should not be elevated above shoulder for 6 weeks
Volmann's contracture?
Compartment syndrome specific to elbow fractures.
Colles' fracture location and population?
Wrist; pts w/ osteoporosis
Hip fracture tx?
Similar to hip replacement

Don't angle more than 90 deg

Assess for pain (could be dislocation)

Adduction/abduction
PT for femoral shaft fractures?
Lower leg, foot, and hip exercises (muscle & vascular)

Early ambulation

Active & passive knee exercises ASAP
Common complication of femoral shaft fractures?
Avascular necrosis (usually occurs at head of femur)
Purpose of spica wrap?
So you don't have to tape directly to skin
Buck's traction ix? When can it be used?
For hip fractures; can be used pre-op
What do trochanter rolls do for hip fractures?
prevent external rotation of the hip
What does a trapeze do for pts w/ hip fractures?
Helps maintain upper body strength
Potential complications of amputation?
Post-op hemorrhage, infection, & skin breakdown
SCD: what is it and what is it used for?
Sequential compression device;
often used for hip fracture rehab
Why should you keep a post-op amputee in the prone position and what do you use to do this?
To prevent hip contracture

Sandbags
How long should pt be put in prone position post-op for amputation?
At least a few hours
What pts do you see Heberden's nodes and where are they located?
Pts w/ osteoarthritis

Located in the DIP joint (distant interphalangeal joint)
How should you treat an itch r/t a cast?
By using a blow dryer on cool setting (causes vasoconstriction, limiting sensory transmission)
What is gout?
Uric acid deposits in joints
When caring for a pt with a BKA, what do you consider when turning?
Try to put them in prone position