Bones

Question 1

When do women start to lose more bone loss?

Answer 1

postmenopausal

Question 2

osteoporosis

Answer 2

Bone density 2.5 standard deviations below peak bone mass
- actual breaks in the trabecular matrix

Question 3

Osteopenia

Answer 3

thinning trabecular matrix of bone; btwn -1 and -2.5 standard deviations below peak bone mass

Question 4

Severe osteoporosis

Answer 4

osteoporosis with history of a FRAGILITY fracture

Question 5

How is osteo diagnosed

Answer 5

DEXA scan; measure with T score

Question 6

Char of osteoporosis

Answer 6

• low bone mass
• microarchitecture deterioration
• bone fragility and sus to fractures
• structural deterioration
• low bone mass
• ACTUAL breaks in the trabecular matrix

Question 7

Risks for osteoporosis

Answer 7

aging, white or asian, fem, hx of frac as an adult, fam hx (first degree), low body weight (under 127 lb), smoking, alcohol , steroids

Question 8

Smaller risk for osteo

Answer 8

thin frame, lack weight bearing exercises, lack Ca on vit D, ED, gastric bypass, lack est and T, excess caffeine

Question 9

Osteo patho

Answer 9

• inc bone resorption, dec living tissue, inc osteoclast activity
• dec bone formation and dec osteoblast
• can’t make new bone and too much bone resorption

Question 10

CM of osteoporosis

Answer 10

• none early
• later - fracture, pain, lose height, kyphosis, HIP FRACTURES

Question 11

Comps of hip fracture

Answer 11

Clots, PNA, sepsis
- inc risk of mortality!
- often proximal third of femur

Question 12

High risk for hip fractures

Answer 12

65+ and female

Question 13

CM of hip fracture

Answer 13

Sudden hip pain before or after a fall
- can’t walk
- severe groin pain–displaced fracture, ext rotate and shortened leg
- tender
- little bruise bc encapsulated
- insuff or fragility frac
- no obvious hx but vague knee, butt, groin, or thigh pain

Question 14

Best tx for osteoporosis

Answer 14

Prevent fractures

Question 15

Primary prevention of osteoporosis

Answer 15

• Ca supp
• vit D to inc Ca abs

Question 16

Two pharm methods to tx osteoporosis

Answer 16

inc formation or dec resorption

Question 17

Which drugs are not used much anymore for osteoporosis?

Answer 17

HRT (bc risk of clots and cancers) and calcitonin (less effective)

Question 18

Fracture

Answer 18

Any break in bone from more stress than the bone is able to absorb

Question 19

Causes of fractures

Answer 19

Trauma (fall), muscle ctx, pathologic (weakness), endurance fatigue, repeated stress

Question 20

Open fractures

Answer 20

aka compound fractures
- break in skin

Question 21

Closed fractures

Answer 21

aka simple fracture
- no break in skin

Question 22

transverse fracture

Answer 22

straight line, 90 degree horizontal

Question 23

spiral fraction

Answer 23

twisted shape

Question 24

comminuted fraction

Answer 24

more than two frac line or broken into at least 3 places

Question 25

Impacted fraction

Answer 25

from heights

Question 26

greenstick fraction

Answer 26

bone bends (in kids)

Question 27

CM of fractures

Answer 27

Pain
Edema
Deformity

Question 28

What to do when fracture occurs

Answer 28

try to keep straight and go to ED

Question 29

Phases of bone healing

Answer 29

• inflam (hematoma)
• reparative (fibrous cartilage and callous, ossification)
• remodeling

Question 30

delayed healing of fractures (3 types)

Answer 30

• 3M to 1Y post-frac
• delayed union–bone pain and tenderness
• malunion–uneven stress causes improper alignment
• nonunion–no heal w/i 4-6M due to poor blood supply, DM, or stress

Question 31

Risks for delayed healing

Answer 31

tobacco, old, anemia, uncontrolled DM, low vit D, hypothyroidism, poor nutrition, infx, comp breaks

Question 32

Common population and cause of impaired bone growth

Answer 32

• kids
• frac in epiphyseal plate–delayed growth
• can delay future bone growth

Question 33

Compartment syndrome

Answer 33

• inc pressure w/i limited space causes compressed nerves and vessels, necrosis and pain
• tourniquet effect causing edema at the frac site and pressure on soft tissue (tissue hypoxia of muscle and nerve)

Question 34

what type of injuries cause compartment syndrome

Answer 34

crush injuries, too tight cast, bleed/swell in cast

Question 35

sx of compartment syndrome

Answer 35

RAPID edema, PAIN, loss or weak pulse

Question 36

tx for compartment syndrome

Answer 36

Fasciotomy - pack and let ooze

Question 37

Fat embolism

Answer 37

• fat mol from marrow traumatized tissue breaks free from LONG BONE fracture and travels to the lungs and block BV
• fine to resp dep QUICK

Question 38

Fat embolism CM

Answer 38

hypoxemia, dec LOC, petechiae (fat mol in capillaries), and rash (last)

Question 39

Fat embolism tx

Answer 39

Supportive, embolism is self-limiting if can sustain life
- may need ecmo or vent

Question 40

Osteomyelitis

Answer 40

• acute or chronic pyogenic infx of bone
• from bac - S. aureus trapped in skin

Question 41

Osteomyelitis patho

Answer 41

• pressure inc on the bone
• local artery collapses
• dec access of oxygen, nutrients, immune cells and ABX
• impaired healing

Question 42

Risks for osteomyelitis

Answer 42

Recent trauma, DM, IDU, HD, splenectomy

Question 43

Osteomyelitis CM

Answer 43

• local tenderness, redness, drainage, dec mvt, spontaneous frac
• systemic fever, pos blood, leukocytosis

Question 44

Tx for osteomyelitis

Answer 44

• positive blood culture
• Nafcillin, cefazolin, vanc
• empiric abx (continuous or infused with abx)
• bacteria-specific
• may be 2W IV or 2 oral or longer

Question 45

Routes of contamination for osteomyelitis

Answer 45

Direct–open wound - frac, shot, stab, surgery (sternotomy)
Indirect–bloodstream infx to bone, bacteremia