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NUNP 547 - Older Adult > MSK - Final > Flashcards

MSK - Final Flashcards

1
Q

Two main factors that predispose elderly ppl to foot problems

A

PAD and neuropathy

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2
Q

What does Romberg test for?

A

Proprioception

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3
Q

Cerebellar exam (8)

A

Scanning speech
Nystagmus
Finger to nose & finger to finger test
Rapid alternating movements
Rebound phenomenon (of Stewart & Holmes)
Heel to shin test
Hypotonia
Gait (Acute Cerebellar Ataxia)

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4
Q

All of the following are signs and symptoms of:

paresthesia
sensory impairment of pain/temperature
motor weakness
decreased or lost achilles/patellar reflexes
decreased vibration sense
loss of proprioception
anihydrosis

A

diabetic neuropathy

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5
Q

Loss of the plantar metatarsal fat pad can be a sign of what?

A

PVD

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6
Q

WHO definition of OP

A

T score 50 years

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7
Q

WHO definition of osteopenia

A

T score -1.0 to -2.5

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8
Q

Self reported height loss of > ___ cm is associated with OP

A

3cm

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9
Q

Common exam findings for OP include height loss of > _____, rib-pelvis distance < _____ and inability to touch _______ to ______ when standing with heels to the wall

A

Common exam findings for OP include height loss of > 4 cm , rib-pelvis distance < 2 fingerbreadths and inability to touch occiput to wall when standing with heels to the wall

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10
Q

BMD screening is recommended for women at what ages and with what risk factors?

A

> 65 years OR postmenopausal < 65 years with RF ie. low body weight, prior #, use of high risk medications (corticosteroids) or conditions associated with bone loss (RA)

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11
Q

BMD screening is recommended for MEN at what ages and with what risk factors?

A

> 70 years or < 70 years with RF

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12
Q

T/F FRAX can be used with or without BMD results

A

True

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13
Q

T/F
Duration and dose of corticosteroid use and smoking use are included in FRAX score

A

False

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14
Q

Ongoing monitoring for OP

A

Yearly height measurement –> Vertebral imaging if > 2cm loss in height
BMD testing every 1-3 years after initiating therapy (controversial)
Treatment compliance and SE

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15
Q

Duration of oral biphosphonates
Duration of IV biphosphonates

A

Oral - up to 5 years
IV - up to 3 years

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16
Q

What medication for OP should not be discontinued for a drug holiday and is associated with rapid decline in bone density in first year after discontinuation?

A

Denosumab

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17
Q

T/F Older adults with inflammatory arthritis are more likely to die from CV condition than the MSK condition

A

True

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18
Q

When do PMR patients experience relief after starting oral steroid therapy?

A

2-4 weeks

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19
Q

If prednisone doses exceed 7.5mg/d for >/= 3 months with PMR what therapy is indicated?

A

OP prevention with biphosphonates

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20
Q

Two complications of steroid therapy for GCA

A

OP and pneumocystis pneumonia

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21
Q

All of the following are risk factors for OP EXCEPT: (multiple)
A) parental hip #
B) use of glucocorticoids dose >7.5mg daily for 3+ months
C) Alcohol intake > 3 per day
D) Kyphosis
E) Chronic back pain
F) Previous smoker
G) Major weight loss (10% below body weight at age 25)

A

D
E
F - only current smokers

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22
Q

What screener should be used for general patient population (50-64 years) to determine BMD testing? What results would warrant BMD testing?

A

Osteoporosis self-assessment tool
OST < 10 indicating moderate risk –> BMD
OST >/= 10 is low risk and requires reassessment with screener in 5 years

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23
Q

What BW is indicated to rule out secondary causes of OP?

A

Calcium, corrected for albumin
CBC
Creatinine
Alk Phos
TSH
Serum protein electrophoresis (for pts with vertebral #)

DO NOT ORDER 25-hydroxyvitamin D unless specific indication

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24
Q

Non-pharm OP Mgmt

A
  • smoking cessation
  • Vitamin D 1000 IU/d (MORE IS NOT BETTER)
  • Calcium 1200mg/day from all sources
  • Exercise
  • Fall prevention
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25
Q

SE of IV biphosphonate

A

Self-limiting flu like illness

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26
Q

SE of oral biphosphonates

A

Esophagitis
ONJ
AFF

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27
Q

Max duration of biphosphonate use

A

10 years

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28
Q

What is the best next step if patient has known diagnosis of OP and has CKD?

A

Refer to specialist

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29
Q

True/false
Bisphosphonates are not recommended in patients with EGFR less than 30 due to lack of clinical experience.

A

True

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30
Q

What time on the TUG test indicates increased risk of frailty?

A

> 10 seconds

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31
Q

Bone resorption

A

OsteoCLASTS breakdown bone

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32
Q

Bone formation

A

OsteoBLASTS form new bone

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33
Q

PTH and effect on bone

A

Responds to low levels of serum calcium and increases bone resorption or breakdown by osteoclasts to increase serum ca

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34
Q

Calcitonin

A

Produced by thyroid gland in response to high serum calcium, increasing bone formation and decreasing bone resorption (countering effects of PTH)

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35
Q

Vitamin D effect

A

Promotes Ca+ absorption in gut, increasing serum calcium, decreasing bone resporption and increase building of bone

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36
Q

Findings on diagnostics for osteporosis

A

Fewer trabeculae (spongy bone) and thinning of cortical bone (outside)

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37
Q

Factors that decrease bone mass

A

Low estrogen (menopause)
low calcium
Substance use - EtOH, smoking
Meds - glucocorticoids (decrease Ca+ absorption from gut), thyroid hormone and heparin,
Physical inactivity
Conditions: DM, etc.

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38
Q

Most common type of fractures in OP

A

Femoral fracture
Vertebral fractures

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39
Q

Treatment options (pharm) for OP

A

HCTZ
Denosumab - inhibits ostoclasts
Biphosphonates
etc.

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40
Q

White people are at higher risk for osteoporosis. T/F?

A

True

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41
Q

Daily alcohol consumption >______ and caffeine intake > ____ increase the risk of osteoporosis

A

Daily alcohol consumption >3 units and caffeine intake >4 cup/day

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42
Q

Corticosteroids (>/= _______ of prednisone >/= _______ mg per day) increases the risk of osteoporosis

A

Corticosteroids (>/= 3 months of prednisone >/= 7.5 mg per day)

43
Q

Fill in the blanks: all of the following are risk factors for osteoporosis

Prospective height loss > ____cm
Historical height loss >______ cm
Rib-pelvis distance ≤ _____fingers
Occiput-wall distance > ______ cm

A

Prospective height loss > 2 cm
Historical height loss > 6 cm
Rib-pelvis distance ≤ 2 fingers
Occiput-wall distance > 5 cm

44
Q

Most men under 70 and women under age 65 probably DO/DO NOT need DXA scan?

A

DO NOT

45
Q

Younger women and men ages _____ to _____ should consider the test if they have risk factors for serious bone loss. Risk factors include:

Breaking a bone in a minor accident.
Having rheumatoid arthritis.
Having a parent who broke a hip.
Smoking.
Drinking heavily.
Having a low body weight.
Using corticosteroid drugs for three months or more.
Having a disorders associated with osteoporosis.

A

50 to 69

46
Q

Frax score < 10 when is the follow up expected

A

in 3-5 years

47
Q

Frax score Mod 10-20% interventions

A

lifestyle + consider pharm, LAT x-ray r/o vertebral #, BMD in 1-3 years

48
Q

High OP risk > 20% OR prior fragility fracture of hip/spine OR > 1 fragility fracture interventions

A

→ lifestyle + pharm + falls prevention education

49
Q

True/False
Order BMD for:
o Chronic back pain (aiming to rule out vertebral fractures)
o Kyphosis (best investigated using lateral thoracic spine X-rays to rule out anterior
compression fractures)
o Menopause, in the absence of risk factors

A

False

50
Q

BW to consider for OP

A

** When thinking calcium think kidneys, albumin and thyroid **

o Calcium, corrected for albumin
o Complete blood count
o Creatinine
o Alkaline phosphatase
o Thyroid-stimulating hormone
o Serum protein electrophoresis (for patients with vertebral fractures)

51
Q

S&S of MDS

A

C alcium increased
R enal dysfunction
A nemia
B one pain

Bence jones proteins + in urine electrophoresis

52
Q

True/False
For oral bisphosphonates re-assess risk and need for continued therapy after five years. Consider extending therapy to a maximum 10 years of therapy in patients at high fracture risk (e.g., previous fragility
fracture or risk >20%).

A

True

53
Q

True/False
Refer to specialist if OP and CKD < 30

A

True

54
Q

T/F
In the absence of RF, do not screen all people > 50 for osteoporosis self assessment

A

False, do that!

55
Q

All of the following are concerning side effects of what medication class?
jaw/ear pain
swelling of joints/hands/ankles/feet
increased or severe bone/joint/muscle pain
new or unusual hip/thigh/groin pain
black/tarry stools
vomit that looks like coffee grounds

A

Biphosphonates

56
Q

When to order x ray for back pain?

A

Presence of red flags or persistence of symptoms > 6 weeks despite treatment

57
Q

What nerve root is being tested with the following:
Heel walking

A

L4-5

58
Q

What nerve root is being tested with the following: Toe walking

A

S1

59
Q

What nerve root is being tested with the following: Patellar reflex

A

L3-4

60
Q

What nerve root is being tested with the following: Great toe extension

A

L5

61
Q

What nerve root is being tested with the following: Great toe flexion

A

S1

62
Q

What nerve root is being tested with the following: Saddle sensation testing

A

S2, 3, 4

63
Q

Continuous back dominant pain that is relieved by extension

A

Disc pain

64
Q

Intermitted back dominant pain that is relieved by flexion

A

Facet joint pain

65
Q

Constant leg dominant pain

A

Compressed nerve

66
Q

Intermittent leg dominant pain relieved with forward flexion

A

Spinal stenosis

67
Q

What age and comorbidity is most commonly associated with spinal stenosis?

A

OA and > 60 years

68
Q

True/False
Weakness in legs is a sign of spinal stenosis

A

True

69
Q

T/F
ASA will help with claudication associated with spinal stenosis

A

False

70
Q

All of the following are possible signs of what condition:
Weakness to L5 (great toe extension) and S1 (great toe flexion)
Wide-based gait and/or + Romberg (90% specificity)
+/- absent ankle(43%) and knee (18%) DTR
SLR may be +

A

Spinal stenosis

71
Q

When walking, the patient will hold his or her arm to one side and drags his or her affected leg in a semicircle (circumduction)

A

hemiplegic gait

72
Q

Gait where he or she will be stooped with the head and neck forward, with flexion at the knees. The whole upper extremity is also in flexion with the fingers usually extended. The patient walks with slow little steps known at marche a petits pas (walk of little steps).

A

Parkinsonian Gait

(Festinating Gait, Propulsive Gait)

73
Q

this gait is described as clumsy, staggering movements with a wide-based gait. While standing still, the patient’s body may swagger back and forth and from side to side, known as titubation. Patients will not be able to walk from heel to toe or in a straight line.

A

Ataxic Gait

(Cerebellar)

74
Q

If you have weakness on one side, this will lead to a drop in the pelvis on the contralateral side of the pelvis while walking

A 
Myopathic Gait
(Waddling Gait)/Trendeleburg sign
75
Q

Seen in patients with foot drop (weakness of foot dorsiflexion), the cause of this gait is due to an attempt to lift the leg high enough during walking so that the foot does not drag on the floor.

A

Neuropathic Gait

(Steppage Gait, Equine Gait)

76
Q

Quad muscle weakness is associated with RA. T/F?

A

False, it is associated with OA

77
Q

Which type of RA has a bimodal distribution in 30’s and 70’s

A

RA

78
Q

T/F? Inflammatory arthritis pain improves with exercise

A

True

79
Q

What are the 3 most frequent joints affected by RA

A

PIP, MCP and wrist

80
Q

T/F?
RF can be elevated in sjogrens, lupus, sarcoidosis and hep B?

A

True

81
Q

What does this indicate:
X-ray - joint space narrowing, osteophytes, subchondral sclerosis, cystic changes

A

OA

82
Q

What does this indicate: X-ray - loss of articular space, multiple erosions, juxta articular osteopenia and ulnar deviation

A

RA

83
Q

All of the following are SE of what medicaiton for RA?

  • Myelosuppression
  • Hepatotoxicity/hepatic fibrosis/cirrhosis
  • Pulmonary fibrosis/infiltrates
  • Oral lesions (daily folic acid to prevent)
  • Nausea
  • Alopecia
A

Methotrexate

84
Q

What medication for RA requires Ophthalmic exam Q6-12 months?

A

Hydroxychloroquine due to retinal deposits

85
Q

Negative RF is found in psoriatic arthritis. T/F?

A

True

86
Q

Out of pocket expense: Anti-CCP testing
through primary care currently costs the
patient $75 in BC.
T/F?

A

True

87
Q

What BW may indicate a + diagnosis of SLE?

A

ANA

88
Q

two causes of PMR

A

Genetic or environmental (Parvovirus or adenovirus)

89
Q

T/F
A normal CRP is an effective “rule out” test for GCA?

A

False

90
Q

headache, jaw claudication and visual symptoms are a sign of what and what is the most appropriate treatment

A

GCA
Low dose prednisone oral STAT prednisone 40-60 mg OD and EMERGENTLY send for biopsy

91
Q

What concurrent treatment is recommended for PMR patients?

A

Osteoporosis treatment with biphosphonates

92
Q

Treatment of PMR

A

Initiate Prednisone 15-20 mg PO once daily (expect improvement in 1 week). Taper over 1 year (1mg taper Q4 weeks).

93
Q

Normal flexion of the knee is which of the following?

> 110 degrees

> 90 degrees

> 130 degrees

A

> 130 degrees

94
Q

All four parts of the quadriceps muscle insert into the tibial tuberosity where the quadriceps tendon becomes the __________ ligament.

A

patellar

95
Q

What is the name of the deformity that has the following features:

Hyperextension of the MTP and DIP joints with DIP flexion of toes 2, 3, 4, and 5
Associated with hallux valgus
Pain associated with wearing foot wear
Often associated with helomas (corns)

A

Hammer toes

96
Q

The Deltoid muscle is supplied by the C5-6 root and which of the following nerves?

Radial nerve

Musculocutaneous

Axillary nerve

A

Axillary nerve

97
Q

Which nerve runs superficially and laterally around the knee and is at risk of injury from surgery or trauma (ie. fracture of fibula, with a resultant footdrop? Common _________ nerve.

A

The common peroneal nerve runs along lateral surface of the knees and divides into the superficial peroneal nerve and the deep peroneal nerves. The most common site of compression is at the lateral knee, where the common peroneal nerve is compressed between fascial structures and the fibula.

The superficial peroneal nerve innervates the peroneus longus and brevis muscles & the skin over the antero-lateral aspect of the leg along with the greater part of the dorsum of the foot (with the exception of the first web space, which is innervated by the deep peroneal nerve). Symptoms of peroneal nerve injury include:

Sensory dysfunction: : Decreased sensation, numbness, or tingling on the dorsum of the foot or the lateral aspect of the upper or lower leg.

Motor dysfunction: Drop foot, “slapping gait”, weakness of ankles and feet Compression of the peroneal nerve branches is most common in patients with neuropathy (e.g. DM), a knee injury, and knee surgery.

98
Q

Which of the following muscles make up the quadriceps femoris?

Rectus femoris, vastus lateralis, vastus medialis & gracilis

Rectus femoris, vastus lateralis, vastus medialis, & vastus intermedius.

Vastus lateralis, vastus medialis, sartorius

Rectus femoris, vastus lateralis, vastus, medialis, & iliopsoas

A

Rectus femoris, vastus lateralis, vastus medialis, & vastus intermedius.

99
Q

Which of the following are bones of the hand & wrist?

Atlas & Axis

Cuboid & Cuneiform

Trapezium & Trapezoid

Hamate & Talus

A

Trapezium & Trapezoid

100
Q

T/F?

Uric acid stones do not show on plain radiographs as they are radiolucent. Ultrasound or Non-contrast CT scans are required for detection.

A

True

101
Q

Toxic effects of colchicine are increased if given to patients on which of the following medications?

Clarithromycin

All Answers are Correct

Ciclosporin

Rosuvastatin

Verapamil

A

All Answers are Correct

102
Q

RA is more common in women 3:1 and is often seen in people with other autoimmune diseases. New onset can occur at any age, but peak age of onset is________ to _____ years

A

20-40 years

103
Q

Drugs that are implicated in development of secondary gout include all of the following EXCEPT:

Ascorbic Acid

Levodopa

Tacrolimus

Hydrochlorothiazide

Low Dose Aspirin

A

Ascorbic Acid

NUNP 547 - Older Adult (19 decks)

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