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Musculoskeletal and Integumentary > Everything > Flashcards

Everything Flashcards

0
Q

Diskogram

A

X-ray of cervical or lumbar intervertebral disk is done after injection of contrast media into nucleus pulposus. Permits visualization of intervertebral disk abnormalities.
Assess for contrast media allergy.

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1
Q

Standard x-ray

A

Determines density of bone. Evaluates structural or functional changes of bones and joints. In anteroposterior view, x-ray beam passes from front to back, allowing one-dimensional view; lateral position provides two-dimensional view.
Avoid excessive exposure of patient and self. Before procedure, remove any radiopaque objects that can interfere with results. Verify patient is not pregnant.

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2
Q

CT scan

A

x-ray beam is used with a computer to provide a three-dimensional picture. It is used to identify soft tissue abnormalities, bony abnormalities, and various musculoskeletal trauma.
Inform patient that procedure is painless. Inform patient of importance of remaining still during procedure. If contrast is being used, assess for allergy. Verify patient is not pregnant.

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3
Q

Myelogram with or without CT

A

Involves injecting a radiographic contrast medium into sac around nerve rootss. CT scan may follow to show how the bone is affecting the nerve roots. Very sensitive test for nerve impingement and can detect very subtle lesions and injuries.
Main risk is potential for spinal headache. Inform pt that HA should resolve in 1-2 days with rest and fluids, but should be reported to HCP. Verify pt is not pregnant.

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4
Q

MRI

A

Radio waves and magnetic field are used to view soft tissue. Especially useful in the diagnosis of avascular necrosis, disk disease, tumors, osteomyelitis, ligament tears, and cartilage tears. Pt is placed inside scanning chamber. Gadolinium might be injected IV to enhance visualization of structures. Open MRI does not require pt to be placed inside a chamber.
Inform pt procedure is painless. Ensure pt has no metal on clothing. Inform pt of importance of remaining still throughout exam. Inform pts who are claustrophobic that they may experience symptoms during exam. Administer anti-anxiety agent if indicated and ordered. Open MRI may be indicated for obese pt or pt with large chest and abdominal girth or severe claustrophobia. Contraindicated in pts with aneurysm clips, metallic implants, paacemakers, electronic devices, hearing aids, and shrapnel.

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5
Q

Dual energy x-ray absorptiometry (DEXA)

A

Measures bone mass of spine, femur, forearm, and total body. Allows assessment of bone density with minimal radiation exposure, used to diagnose metabolic bone disease and to monitor changes in bone density with treatment.
Inform pt that procedure is painless.

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6
Q

Quantitative ultrasound (QUS)

A

Evaluates density, elasticity, and strength of bone using ultrasound rather than radiation. Common area assessed is calcaneus.
Inform pt that procedure is painless.

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7
Q

Bone scan

A

Involves injection of radioisotope (usually technetium-99m) that is taken up by bone. A uniform uptake of the isotope is normal. Increased uptake is seen in osteomyelitis, osteoporosis, primary and metastatic malignant lesions of bone, and certain fractures. Decreased uptake is seen in areas of avascular necrosis.
Explain that a calculated dose of radioisotope is given 2 hr before procedure. Ensure that bladder is emptied before scan. Inform pt that procedure requires 1 hr while pt lies supine and that no pain or harm will result from isotopes. Explain that no follow-up scans are required. Increase fluids after the exam. Verify pt is not pregnant.

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8
Q

Arthroscopy

A

Involves insertion of arthroscope into joint (usually knee) for visualization of structure and contents. Can be used for exploratory surgery (removal of loose bodies and biopsy) and for diagnosis of abnormalities of mensicus, articular cartilage, ligaments, or joint capsule. Other structures that can be visualized through the arthroscope include the shoulder, elbow, wrist, jaw, hip, and ankle.
Inform pt that procedure can be performed in outpatient setting with strict asepsis and that either local or general anesthesia is used. After procedure, cover wound with sterile dressing. Explain any postprocedure activity restrictions.

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9
Q

Alkaline phosphatase for mineral metabolism

A

This enzyme, produced by osteoblasts of bone, is needed for mineralization of organic bone matrix. Elevated levels are found in healing fractures, bone cancers, osteoporosis, ostemalacia, and Paget’s disease. (38-126 U/L)
Blood sample that does not require fasting.

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10
Q

Calcium

A

Bone is primary organ for calcium storage. Calcium provides bone with rigid consistency. Decreased serum level is found in osteomalacia, renal disease, and hypoparathyroidism; increased level is found in hyperparathyroidism and some bone tumors.(8.6-10.2 mg/dL)
Blood test does not require fasting.

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11
Q

Phosphorus

A

Amount present is indirectly related to calcium metabolism. Decreased level is found in osteomalacia; increased level is found in chronic kidney disease, healing fractures, osteolytic metastatic tumor. (2.4-4.4 mg/dL)

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12
Q

Rheumatoid factor

A

Assess presence of autoantibody (rheumatoid factor) in serum. Factor is not specific for rheumatoid arthritis and is seen in other connective tissue diseases, as well as in a small percentage of normal population. Negative or titer <1.17
Does not require fasting. Venipuncture.

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13
Q

Erythrocyte sedimentation rate (ESR)

A

Nonspecific index of inflammation. Measures rapidity with which red blood cells settle out of unclotted blood in one hour. Results are influenced by physiologic factors, as well as diseases. Elevated levels are seen with any inflammatory process (especially rheumatoid arthritis, rheumatic fever, osteomyelitis, and respiratory infections).
No need to fast. Venipuncture.

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14
Q

Antinuclear antibody (ANA)

A

Assesses presence of antibodies capable of destroying nucleus of body’s tissue cells. Finding is positive in 95% of patients with systemic lupus erythematosus and may also be positive in individuals with systemic sclerosis (scleroderma) or rheumatoid arthritis and in a small percentage of normal population. Normal: negative at 1:40 dilution. Non-fasting, venipuncture.

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15
Q

Anti-DNA antibody

A

Detects serum antibodies that react with DNA. Most specific test for systemic lupus erythematosus. Reference interval: <70 IU/mL. Non-fasting venipuncture

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16
Q

Complement, total hemolytic (CH56)

A

Complement, a normal body protein, is essential to both immune and inflammatory reactions. Complement components used in these reactions are depleted. Complement depletions may be found in patients with rheumatoid arthritis or systemic lupus erythematosus. Normal: 75-160 U/mL Non-fasting venipuncture.

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17
Q

Uric acid

A

End product of purine metabolism is normally excreted in urine. Although not specific, levels are usually elevated in gout.
Male: 4.4-7.6 mg/dL
Female: 2.3-6.6 mg/dL
Non-fasting venipuncture.

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18
Q

C-reactive protein (CRP)

A

Used to diagnose inflammatory diseases, infections, and active widespread malignancy. Synthesized by the liver and is present in large amounts in serum 18-24 hours after onset of tissue damage. (6.80-820 mcg/dL)
Non-fasting venipuncture

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19
Q

Human leukocyte antigen (HLA)-B27

A

Antigen present in disorders such as ankylosing spondylitis and rheumatoid arthritis. Non-fasting venipuncture.

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20
Q

Creatine Kinase (CK)

A

Highest concentration found in skeletal muscle. Increased levels found in progressive muscular dystrophy, polymyositis, and traumatic injuries.
Male: 20-200 U/L
Female: 20-180 U/L
Non-fasting venipuncture

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21
Q

Potassium

A

Increased in muscle trauma as cell destruction releases this electrolyte into serum. 3.5-5.0 mEq/L
Monitor trauma patients for cardiac dysrhythmias related to hyperkalemia.

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22
Q

Aldolase

A

Useful in monitoring muscular dystrophy and dermatomyositis.
1.5-8.1 U/L
Non-fasting venipuncture

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23
Q

Arthrocentesis

A

Incision or puncture of joint capsule to obtain samples of synovial fluid from within joint cavity or to remove excess fluid. Local anesthesia and aseptic preparation are used before needle is inserted into joint and fluid aspirated. Useful in diagnosis of join inflammation, infection, meniscal tears, and subtle fractures.
Inform pt that procedure is usually done at bedside or in exam room. Send samples of synovial fluid to lab for exam (if indicated). After procedure apply compression dressing. Observe for leakage of blood or fluid on dressing.

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24
Q

Electromyogram (EMG)

A

Evaluates electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles. Needle probes are attached to leads that feed information to EMG machine. Recordings of electrical activity of muscle are traced on audio transmitter, as well as on oscilloscope and recording paper. Useful in providing information related to lower motor neuron dysfunction and primary muscle disease.
Inform pt that procedure is usually done in EMG lab while pt lies supine on special table. Keep pt awake to cooperate with voluntary movement. Inform pt that procedure involves some discomfort from needle insertion. Avoid administration of stimulants including cafeine and sedatives 24 hours before procedure.

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25
Q

Duplex venous Doppler

A

Ultrasound of the veins, usually of the lower extremities, to detect blood flow abnormalities that could indicate DVT. Procedure is painless and non-invasive.

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26
Q

Thermography

A

Uses infrared detector that measures degree of heat radiating from skin surface. Useful in investigating cause of inflamed joint and in determining pt response to anti-inflammatory drug therapy. Procedure is painless and non-invasive.

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27
Q

Plethysmography

A

Records variations in volume and pressure of blood passing through tissues. Test is nonspecific. Procedure is painless and non-invasive.

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28
Q

Somatosensory evoked potential (SSEP)

A

Evaluates evoked potential of muscle contractions. Electrodes are placed on skin and provide recordings of electrical activity of muscle. Useful in identifying subtle dysfunction of lower motor neuron and primary muscle disease. Measures nerve conduction along pathways not accessible by EMG. Transcutaneous or percutaneous electrodes are applied to the skin and help identify neuropathy and myopahty. Often used during spinal surgery for scoliosis to detect neurologic compromise when pt is under anesthesia.
Similar to EMG except no needles. Electrodes are applied to skin.

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29
Q

Common muscle relaxants include:

A

Carisoprodol (Soma)
Cyclobenzaprine (Flexeril)
Methocarbamol (Robaxin)

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30
Q

Common side effects of muscle relaxants: (7)

A
  1. ataxia
  2. blurred vision
  3. drowsiness
  4. fatigue
  5. GI upset
  6. headache
  7. weakness
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31
Q

Hypersensitivity reactions of muscle relaxants may include (2):

A

skin rash

pruritis

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32
Q

What are the three main muscle relaxers from the chapter?

A

Carisoprodol (Soma)
Cyclobenzaprine (Flexeril)
methocarbamol (Robaxin)

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33
Q

Adverse effects of muscle relaxants include:

A

hypotension
tachycardia
respiratory depression

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34
Q

Most common benign bone tumor; frequently located in metaphyseal portion of long bones, particularly leg, pelvis, or scapula; occurs most often in persons 10-25; malignant transformation may occur.

A

Osteochodroma (malignant = chondrosarcoma)

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35
Q

Arises in cancellous ends of the arm and leg bones; about 10% are locally aggressive and may spread to lungs; high rate of local recurrence after surgery and chemotherapy.

A

Osteoclastoma (giant cell tumor)

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36
Q

Intramedullary cartilage tumor usually found in cavity of a single hand or foot bone; rare malignant transformation can occur; if tumor becomes painful, a surgical resection is done; peak incidence in persons ages 10-20.

A

Endochroma

37
Q

Most common primary bone cancer; occurs mostly in young males between ages 10 and 25; most often in bones of arms, legs, or pelvis.

A

Osteosarcoma

38
Q

Occurs in cartilage most commonly in arm, leg, and pelvic bones of older adults ages 50-70; can also arise from benign bone tumors; wide surgical resection is mostly done as tumor rarely responds to radiation and chemotherapy; survival rate depends on stage, size, and grade of tumor.

A

Chondrosarcoma

39
Q

Develops in medullary cavity of long bones, especially the femur, humerus, pelvis, and tibia; usually occurs in children and teenagers; use of wide surgical resection, radiation, and chemotherapy has greatly improved the 5-yr survival rate to 60%; occurs most often in white people.

A

Ewing’s sarcoma

40
Q

Rare tumor that occurs in base of skull and vertebral bones of older adults ages 50-70; wide surgical resection and radiation are difficult because the spinal cord and nerves may also be involved; chemotherapy may be used for late-stage disease; tumor may recur > 10 yr after treatment.

A

Chordoma

41
Q

Chemotherapeutic agents for bone CA:

A

Methotrexate, doxorubicin (adriamycin), cisplatin (platinol), cyclophosphamide (cytoxan), etoposide (vepesid), bleomycin (blenoxane), daclinomycin (cosmegen), and ifosfamide (Ifex)

42
Q

Biophosphonate drugs that increase total bone mass include:

A 
etidronate (Didronel) 
Risedronate (Actonel)
clodronate (Bonefos) 
alendronate (fosamax) 
Ibandronate (Boniva)
Pamidronate (Aredia) 
tiludronate (Skelid)
43
Q

Side effects of biophosphonate drugs to increase bone mass are:

A

anorexia, weight loss, and gastritis

44
Q

How should biophosphonates be administered?

A

With a full glass of water
30 minutes before food or other medications
Patient should remain upright for 30 minutes after taking

45
Q

It is common to have what type of symptoms when first starting a biophosphonate drug?

A

flu-like symptoms

46
Q

Medication used to treat osteoporosis in men and postmenopausal women at high risk for fractures
How is it administered?

A

Teriparatide (Forteo)

SQ daily

47
Q

Medication used for postmenopausal women at high risk for fractures
How is it given

A

Denosumab

SQ q6months

48
Q

Flat or elevated, dry, hyperkeratotic scaly papule; possibly flat, rough, or verrucous (wartlike); adherent scale, which returns when removed, often multiple; rough scale on red base; often on erythemetaous sun-exposed areas; increase in number with age.

A

Actinic keratosis

Actinic (sun) damage, premalignant skin lesions, common in older white population

49
Q

Often larger than 5 mm; irregular border, possibly notched; variegated color mixture of tan, brown, black, red, or pink within single mole; presence of at least one flat portion; often at edge of mole; frequently multiple; uncommon before puberty; most common site on back, but possible in uncommon mole sites such as scalp or buttocks.

A

Atypical/Dysplastic Nevi

Morphologiccally between common acquired nevi and melanoma; may be precursor of cutaneous malignant melanoma.

50
Q

Nodular and ulcertive: small, slowly enlarging papule; borders semitranslucent or “pearly”, with overlying telangiectasia, erosia, ulceration, and depression of center; normal skin markings lost.
Superficial: erythematous, pearly, sharply defied, barely elevated plaques

A

Basal Cell Carcinoma

Related to excessive sun exposure, genetic skin type, X-ray radiation, scars, and some types of nevi

51
Q

Superficial: Thin, scaly erythematous plaque wihout invasion into the dermis.
Early: Firm nodules with indistinct borders, scaling and ulceration
Late: covering of lesion with scale or horn from keratinization, ulceration; most common on sun-exposed areas such as face and hands.

A

Squamous Cell Carcinoma

52
Q

Irregular olor, surface, and border; variegation of color including red, white, blue, black, gray, brown; flat or elevated; eroded or ulcerated; often under 1 cm in size; most common sites in males are back, then chest; in females are legs, then back

A

Malignant Melanoma

53
Q

Classic presentation involves three stages–patch (early), plaque and tumor (advanced); history of persistent macular eruption followed by gradual appearance of indurated erythematous plaques on the trunk that appear similar to psoriasis, pruritis, lymphadenopathy

A

Cutaneous T-Cell Lymphoma

54
Q

Potassium hydroxide (KOH)

A

Hair, scales, or nails examined for superficial fungal infection. Specimen put on glass slide and 10-20% concentration of potassium hydroxide added

55
Q

Fluid and cells from vesicles examined. Used to diagnose herpes infections. Specimen put on slide, stained, and examined microscopically.

A

Tzanck test (Wright’s and Giemsa’s stain)

56
Q

Culture

A

Test identifies fungal, bacterial and viral organisms. For fungi, scraping or swab of skin performed. For bacteria, material obtained from intact pustules, bullae, or abscesses, For viruses, vesicle/bulla and exudate taken from base of lesion. Use sterile technique to collect.

57
Q

Mineral oil slides

A

To check for infestations, scrapings are plaed on slide with mineral oil and viewed microscopically.

58
Q

Immunofluorescent studies

A

Some skin diseases have specific, abnormal antibody proteins that can b identified by fluorescent studies. Both skin tissue and serum can be examined.

59
Q

Wood’s lamp (black light)

A

Examination of skin with long-wave ultraviolet light causes specific substances to fluoresce (e.g. Pseudomonas organisms, fungal infections, vitiligo)
Darken room lights.

60
Q

Patch test

A

Used to determine whether patient is allergic to specific testing material. Small amount of potentially allergenic material applied, usually to skin on back.
Instruct patient to return in 48-72 hours to remove allergens and preliminary evaluaion at 96 hours.

61
Q

Loss of hair

A

Alopecia

62
Q

Tumor consisting of blood or lymph vessels

A

Angioma

63
Q

Yellow discoloration of skin, no yellowing of sclera, most noticeable on palms and soles. Often caused by eating orange or yellow vegetables.

A

Carotenemia

64
Q

Enlarged hair follicle plugged with sebum, bacteria, and skin ceells; can be open (blackhead) or closed (whitehead).

A

Comedo

65
Q

Dermatitis of overlying surfaces of the skin. Can be caused by moisture, irritation, obesity

A

Intertrigo

66
Q

Benign overgrowth of melanocytes

A

Mole (nevus)

67
Q

Visibly dilated, superficial, cutaneous small blood vessels, commonly found on face and thighs. Can be caused by aging, acne, sn exposure, alcohol, liver failure, corticosteroids, radiation, certain systemic diseases, and skin cancer.

A

Telangiectasia

68
Q

Unilateral distribution

A

asymmetric

69
Q

merging together

A

confluent

70
Q

wide distribution

A

diffuse

71
Q

separate from other lesions

A

discrete

72
Q

diffuse distribution

A

generalized

73
Q

clustor of lesions

A

grouped

74
Q

limited areas of involvement that are clearly defined

A

localized

75
Q

a single lesion

A

solitary

76
Q

bilateral distribution

A

symmetric

77
Q

bandlike distribution along a dermatome

A

zosteriform

78
Q

Linear crack or break from the epidermis to dermis; dry of moist

A

fissure

79
Q

excess, dead epidermal cells produced by abnormal keratinization and shedding

A

scale

80
Q

abnormal formation of connective tissue that replaces normal skin

A

scar

81
Q

Loss of the epidermis and extending into dermis; crater-like, irregular shape

A

ulcer

82
Q

depression in skin resulting from thinning of the epidermis or dermis

A

atrophy

83
Q

areas in which epidermis is missing exposing the dermis (e.g. abrasion)

A

excoriation

84
Q

Circumscribed, flat area with a change in skin color; <0.5 cm in diameter
e.g. freckles, vitiligo, flat nevus, cafe au lait spot

A

Macule

85
Q

circumscribed flat area with a change in skin color; >0.5 cm
examples: vitiligo, cafe au lait spot

A

patch

86
Q

elevated, solid lesion; <0.5 cm in diameter

e.g. wart (verruca), elevated moles, lipoma, basal cell carcinoma

A

papule

87
Q

elevated, solid lesion >0.5 cm in diameter

A

Nodule

88
Q

Circumscribed, elevated, superficial; solid lesion; >0.5 cm in diameter

A

Plaque

89
Q

Firm, edematous, irregularly shaped area; diameter variable

e.g. insect bite

A

wheal

90
Q

Elevated, superficial lesion filled with purulent fluid

e.g. acne, impetigo

A

Pustule

Musculoskeletal and Integumentary (1 decks)

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