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Intro to Patient Management Flashcards

1
Q

True or False:

Amputation may be controlled with orthotics or prosthetics

A

True

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2
Q

Who is more likely to get an amputation men or women

A

Men

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3
Q

What are the 5 causes of amputation

A
  1. Dysvascular disease
  2. Trauma
  3. Cancer
  4. Limb deficiences
  5. Infection
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4
Q

What is PVD

A

Any abnormal condition affecting the blood vessels peripheral to the heart

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5
Q

What can cause PVD (6)

A
  1. Embolism
  2. Thrombosis
  3. Trauma
  4. Vasospasm
  5. Inflammation
  6. Arteriosclerosis
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6
Q

PVD leads to deficits in what 3 things

A
  1. Arteries
  2. Veins
  3. Lymphatic systems
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7
Q

What are the signs and symptoms of PVD (4)

A
  1. Changes in temp
  2. Perfusion
  3. Swelling
  4. Wounds
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8
Q

Is cyanosis an arterial or venous issue

A

Arterial

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9
Q

Are wounds due to an arterial or venous issue

A

Both! Tricked you fucker

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10
Q

What is the pathophysiology of diabetes

A

The lack of ability to properly maintain levels of glucose

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11
Q

What does the excess glucose due

A

Causes clots and/or damage in vessels

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12
Q

What are the complications that come with diabetes (4)

A
  1. Duration is directly related to morbidity
  2. Macrovascular problems
  3. Microvascular problems
  4. Neurologic problems
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13
Q

What is damaged in macrovascular problems

A

Arteries and veins

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14
Q

What is damaged in microvascular problems

A

Capillaries

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15
Q

What does microvascular problems lead to damage of

A

Nerves, eyes, and kidneys

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16
Q

True or False:

The longer they have the disease the greater the disability regardless of whether or not the disease is controlled

A

True

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17
Q

What age range is most common for trauma

A

Under 45 years old

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18
Q

What are common cancers that could lead to amputation (3)

A
  1. Bone sarcomas
  2. Soft tissue tumors
  3. Metastatic disease
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19
Q

What are the 3 types of limb deficiencies

A
  1. Congenital
  2. Transverse deficiency
  3. Longitudinal deficiency
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20
Q

What is a transverse deficiency

A

Missing the limb after a certain point (example: arm is present up to the elbow and nothing below that)

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21
Q

What is a longitudinal deficieny

A

Shorter limb length but distal limb is present (dwarf limb)

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22
Q

What is Ilizarov-lmb lengthening procedure

A

Used to correct a longitudinal deficiency where they break the bone and apply an external fixator and adjust the space allowing bony callus formation and the patient being upright is extremely important

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23
Q

What is amelia

A

Congenital absence of a limb

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24
Q

What is apodia

A

Congenital absence of a foot

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25
Q

What is adactylia

A

Congenital absence of toes or fingers

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26
Q

What is aphalangia

A

Congenital absence of a single finger or toe

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27
Q

What is phocomelia

A

Lack of proper formation of distal portion of a limb

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28
Q

What is a common cause of phocomelia

A

Thalidamide exposure

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29
Q

What is the most common bacteria in wounds in healthy patients

A

Staphlococcus

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30
Q

What is the most common bacteria found in wounds of immunocompromised patients

A

Pseudomonas

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31
Q

What is the level of amputation determined by (3)

A
  1. Ability to heal successfully at the incision based on adequate circulation
  2. Removal of all nonviable tissues, structures, especially in presence of infection
  3. Achieve long term functional residual limb, restore patient to some level of activity without pain
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32
Q

What is myoplasty

A

Attachment of a muscle to another muscle

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33
Q

What is myodesis

A

Attachment of a muscle to periosteal bone

34
Q

What is a myofascial flap

A

Attachment of muscle to fascia

35
Q

What will amputation of the great toe affect

36
Q

What will amputation of the 2nd toe cause

A

Hallux valgus

37
Q

True or False:

Prosthesis is usually not necessary for phalangeal amputation

38
Q

What is a transmetatarsal amputation (TMA)

A

Amputation through the mid to proximal metatarsal shafts where a myocutaneous plantar flap is used

39
Q

Where is closure with a transmetatarsal amputation

A

Dorsum of the foot

40
Q

What is a lisfranc amputation

A

Amputation at the tarsalmetatarsal joint and involves disarticulation of all 5 metatarsals and digits

41
Q

What is a chopart amputation

A

Disarticulation through the midtarsal joint leaving only the talus and calcaneous remaining

42
Q

What makes up the midtarsal joint

A

Talonavicular and calcaneal cuboid joints

43
Q

What is a syme amputation

A

Ankle disarticulation where the heel pad is kept for distal end weight bearing and the tibia and fibula ends may be shaved to create a narrow end

44
Q

True or False:

With a syme amputation you have the potential to ambulate with and without a prosthesis

45
Q

What is a transtibial amputation

A

Amputation across the tibia and fibula

46
Q

How much shorter than the tibia is the fibula transected in a transtibial amputation

47
Q

True or False:

The anterior surface of the tibia is beveled

48
Q

Where is the surgical closure for a transtibial amputation

49
Q

What are the 4 types of transtibial amputations

A
  1. Very short
  2. Short
  3. Standard
  4. Long
50
Q

What is a short/very short transtibial amputation

A

Less than 20% of the tibial length remains

51
Q

Where does a very short transtibial amputation transect

A

The tibial plateau

52
Q

True or False:
You may choose a knee disarticulation over a very short/short transtibial amputation due to the shorter lever arm making control of the knee difficult

53
Q

What is a standard transtibial amputation

A

20-50% of the tibial length remains

54
Q

What is a long transtibial amputation

A

Greater than 50% of the tibial lengthen is present

55
Q

True or False:

A patient with a long transtibial amputation may have problems with distal limb circulation

56
Q

What is a knee disarticulation

A

The tibia and fibula are removed the patella and patellar tendon are saved

57
Q

What is done with the patellar tendon and hamstrings in a knee disarticulation

A

They are attached to the cruciate ligaments and up through the bone

58
Q

True or False:

Knee disarticulation provides good weight bearing surface and long lever arm

59
Q

True or False:

Cosmesis of the socket is a disadvantage with a knee disarticulation

60
Q

Why is cosmesis of the socket a disadvantage with a knee disarticulation (2)

A
  1. Femoral condyles being wider so prosthetics must be wider

2. Knee height is different than the other intact knee

61
Q

What is a transfemoral amputation

A

Part of the femur is removed and the hamstrings and quadriceps muscles are connected to each other with a myoplasty technique

62
Q

Where is the incision with a transfemoral amputation

63
Q

What is a supracondylar transfemoral amputation

A

Transectio through the femoral condyles

64
Q

True or False:

The patella may be left for distal end bearing with a supracondylar transfemoral amputation

65
Q

True or False:

Adequate healing may be a problem with transfemoral amputation

66
Q

What is a long transfemoral amputation

A

Greater than 60% of the femur length is present

67
Q

True or False:

There is no distal end bearing with a long transfemoral amputation

68
Q

What is a medium or standard transfemoral amputation

A

35-60% of the femur length is present

69
Q

True or False:

With a medium or standard transfemoral amputation a myodesis and myoplasty technique are both used at the distal end

70
Q

What is a short transfemoral amputation

A

Less than 35% of the femoral length is present

71
Q

Where can a short transfemoral amputation be transected up to

A

The lesser trochanter

72
Q

What is a hip disarticulation

A

Removal of all of the femur

73
Q

What is a hemipelvectomy

A

Loss of the LE including any part of the ilium, ischium, or pubis

74
Q

What are common post-op complications (6)

A
  1. Phantom limb pain/sensation
  2. Death
  3. Pulmonary problems/pneumonia
  4. Non healing residual limb
  5. Infection of residual limb
  6. Pulmonary embolus
75
Q

What are common early phase complications (5)

A
  1. Infection
  2. Delayed wound healing
  3. Painful residual limb
  4. Phantom sensations
  5. Pressure sores
76
Q

What are common late phase complications (3)

A
  1. Phantom limb pain
  2. Flexion contractures
  3. Gangrene
77
Q

What are the 2 primary goals of the immediate post-op period

A
  1. Ensure optimal wound healing

2. Early preparation of the limb for prosthetic fitting

78
Q

What are the 3 IPOP steps

A
  1. Application of padding (prep site for prosthetic unit)
  2. Application of rigid dressing
  3. Incorporate prosthetic system
79
Q

What is the rigid dressing

A

Like a cast the provides compression over the pad and allows for earlier WB and decreased swelling

80
Q

What is a risk of the rigid dressing

A

You can’t see the surgical sight

81
Q

What does the rigid dressing need attachments for

A

Pylon and foot

82
Q

What are the 4 factors that influence optimal rehabilitation

A
  1. Level of amputation
  2. Skill of surgical team, shaping optimal limb, and optimal healing
  3. Appropriate post-op care/follow up
  4. Design/fitting of prosthesis, access to comprehensive prosthetic training

Prosthetics (8 decks)

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