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30 Cards in this Set
- Front
- Back
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402. Nonpharmacologic tx options for OA?
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a. Avoid activities that involve excessive use of the joint.
b. Wt. loss is very important c. Physical therapy can be beneficial. d. Goals are to maintain ROM and muscle strength. e. Swimming is an ideal exercise (involves minimal involvement of weight-bearing joints f. Avoid excessive walking g. Use canes and crutches to reduce weight on the joint |
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403. Rx tx of OA?
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a. Acetaminophen is the first-line agent.
b. NSAIDs are just as effective (but GI bleeding is a concern w/long-term use) c. Intra-articular injections of corticosteroids are very helpful, but more than 3-4 injections per year is not recommended. d. Pts may have up to 3 months of pain relief w/each injection. e. Viscosupplementation (series of 3 injections of hyaluronic acid given once a week)- Recent studies show good pain relief, but results are variable. |
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404. Why should total joint replacement for OA be delayed as long as possible?
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a. Bc a revision may be needed in 15-20 yrs.
b. Total hip and knee replacements are among the most successful procedures in orthopaedics w/reliable pain relief. |
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405. Spine surgery for OA?
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a. May be performed for pts w/severe disease, w/intractable pain, or w/neurologic sequelae (nerve root compression) if a prolonged period of nonoperative therapy fails.
b. Surgical options include decompression (laminectomy) w/ or w/o spinal fusion, depending on the pathology. c. Total disc replacement is available but more evidence is needed regarding efficacy. |
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406. Glucosamine and chondroitin sulfate?
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a. Over-the-counter products that many pts claim to improve arthritis symptoms.
b. Well-tolerated with no significant adverse effects. c. A number of studies have shown a decrease in pain, but evidence from randomized controlled trials is not as convincing. |
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407. What factors can contribute to or exacerbate forces on cartilage?
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a. Compromised pain sensation or proprioception
b. Ligament laxity c. Falls to very short distances (because they do not provide ample opportunity for compensatory movements to decrease the impact load) |
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408. Bouchard’s nodes?
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a. Bony overgrowth and significant osteoarthritic changes (i.e., osteophytes) at the PIP joints.
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Heberden’s nodes?
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a. Bone overgrowth and significant osteoarthritic changes (i.e., osteophytes) at the DIP joints.
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410. Where is pain typically experienced w/OA of hips?
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a. Groin region and sometimes radiates to the anterior thigh.
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411. In what hand should the cane be held for left knee pain?
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a. Right hand!!!!
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412. Physical exam for knee pain?
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a. Assess distortion of normal knee contours, irregular bony prominences at the joint margin.
b. Determine presence of effusion! c. Check for muscle atrophy! d. Assess meniscal injury by McMurray and Apley tests e. Determine ROM! f. Test stability of collateral ligaments g. Assess ACL stability via Lachman and anterior Drawer test. h. Assess joint line tenderness (medial or lateral) – meniscus tear or OA. i. Patellar grind test |
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413. How is the patellar grind test performed?
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a. Push down on the patella and ask the pt to raise his or her leg.
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414. Definition of Osteoporosis?
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a. ↓’d bone mass/quality causes increased bone fragility and fracture risk.
b. In osteoporosis, the bone mineral density is at least 2.5 standard deviations below that of young, normal individuals. |
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415. Pathophys of Osteoporosis?
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a. Failure to obtain optimal (peak) bone mass before age 30, or rate of bone resorption exceeds rate of bone formation after peak bone mass is attained
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416. 2 types of Primary osteoporosis?
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a. Type I: Most often postmenopausal women 51-75 yrs of age.
b. Type II: Most often in men and women over 70 yrs of age. |
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417. Type I osteoporosis?
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Postmenopausal women 51-75 yrs of age
b. Excess loss of trabecular bone c. Vertebral compression fractures and Colles fractures are common and Colles fractures are common. |
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418. Type II osteoporosis?
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a. Most often in men and women over 70 yrs of age.
b. Equal loss of both cortical and trabecular bone; fractures of femoral neck, proximal humerus, and pelvis most common. |
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419. Secondary osteoporosis?
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a. An obvious cause is present, such as:
1. Excess steroid therapy/Cushing’s syndrome 2. Immobilization 3. Hyperthyroidism 4. Long-term heparin 5. Hypogonadism in men 6. Vit D deficiency |
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420. Note: it is often difficult to differentiate between primary and secondary osteoporosis, and the two may coexist. It is best to attempt to identify any predisposing conditions and eliminate them if possible.
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420. Note: it is often difficult to differentiate between primary and secondary osteoporosis, and the two may coexist. It is best to attempt to identify any predisposing conditions and eliminate them if possible.
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421. Risk factors for osteoporosis?
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1. Oestrogen depletion
2. Female Gender 3. Calcium deficiency/vitamin D deficiency 4. Decreased peak bone mass 5. Heritable risk factors 6. Decreased physical activity (prolonged immobility) 7. Endocrine-hypogonadism in men (w/low testosterone), hyperthyroidism, vit D deficiency. 8. Smoking and alcohol abuse 9. Medications |
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422. Why is Female gender a risk factor for osteoporosis?
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a. Bc women have lower peak bone mass and smaller vertebral end plates.
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423. Heritable risk factors for osteoporosis?
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a. Family hx
b. European or Asian ancestry c. Thinness/slight build |
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424. Endocrine risk factors for osteoporosis?
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a. Hypogonadism in men (w/low testosterone)
b. Hyperthyroidism c. Vit D deficiency. |
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425. Medications which are risk factors for osteoporosis?
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a. Steroids
b. Prolonged heparin use. |
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426. Clinical features of osteoporosis?
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a. Vertebral body compression fractures (of the middle and lower thoracic and upper lumber spine) are the most common.
b. Colles fracture c. Hip fractures- femoral neck, intertrochanteric fracture. d. Increased incidence of long bone fractures- humerus, femur, tibia. |
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427. Symptoms of vertebral body compression fracture?
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i. Result in pain and deformity, including kyphosis lumbar lordosis.
ii. Severe back pain after minor trauma. iii. Restricted spinal movement, loss of height. |
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428. Colles fracture?
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a. Distal radius fracture
b. Usually due to fall on outstretched hand c. More common in postmenopausal women. |
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429. Gold standard for diagnosing osteoporosis?
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a. Dexa scan
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430. Utility of DEXA scan?
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a. Very precise for measuring bone density
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431. When should DEXA be performed?
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a. At menopause
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