Musculoskeletal Flashcards
Define CMS.
Circulation, motion, sensation; neurovascular check
Which physiologic changes normally occur with age?
Muscle atrophy, decreased bone density, muscle weakness, decreased synovial fluid, decreased tissue over bony prominences, slower nerve reaction time
Define osteoporosis.
Chronic metabolic disease characterized by decreased bone density.
Where does hematopoeisis take place?
In the red marrow
Which part of the bone stores fat cells?
Yellow marrow
What is one major life-threatening complication caused by a break in a bone?
Fat embolism syndrome (FES); can occur when the yellow marrow is exposed
Define osteoclasts.
Bone-destroying cells
Define osteoblasts.
Bone-forming cells
Define kyphosis.
Curvature of the thoracic (upper) vertebrae
Define lordosis.
Curvature of the lumbar (lower) vertebrae
Define scoliosis.
A lateral (S-shaped) curve of the vertebrae
By what age is peak bone mass usually achieved?
30
Where is the most common site for musculoskeletal injury?
Joints with synovial fluid
In Gordon’s Functional Health Patterns, what does a level 0 represent?
Patient is able to provide full self-care
In Gordon’s Functional Health Patterns, what does a level 4 represent?
Patient is dependent and does not participate in self-care
In Lovett’s muscle scale, what does a level 0 represent?
No joint motion with no evidence of muscle contractility
In Lovett’s muscle scale, what does a level 5 represent?
ROM is unimpaired against gravity with full resistance
For a patient with osteoporosis, which lab value abnormalities would you expect to see?
Decreased calcium
For a patient with osteomalacia, which lab value abnormalities would you expect to see?
Decreased calcium, decreased vitamin D, decreased phosphorus, elevated alkaline phosphatase (ALP)
For a patient with paget’s disease, which lab value abnormalities would you expect to see?
Elevated alkaline phosphatase (ALP)
For a patient with muscular dystrophy, which lab value abnormalities would you expect to see?
Elevated creatine kinase (CK), elevated aspartate aminotransferase (AST), elevated lactic dehydrogenase (LDH), elevated aldolase (ALD)
For a patient with bone cancer, which lab value abnormalities would you expect to see?
Elevated calcium, elevated alkaline phosphatase (ALP)
For a patient with bone fractures in the healing stage, which lab value abnormalities would you expect to see?
Elevated calcium, elevated phosphorus
For a patient with muscle trauma, which lab value abnormalities would you expect to see?
Elevated creatine kinase (CK), elevated aspartate aminotransferase (AST)
Why would a CT or MRI with contrast be contraindicated?
If the patient has an allergy to shellfish or iodine
Why would an MRI be contraindicated?
If the patient has any irremovable metal in the body(eg. pacemaker, metal hip implant)
Define osteoporosis.
Loss of bone density
Define osteomalacia.
Demineralized bone
Which blood markers may indicate osteoporosis?
N-teleopeptide (NTX) and C-teleopeptide (CTX)
What is the single most effective exercise for osteoporosis prevention?
Walking for 30 minutes 3-5 times per week
What types of foods containing calcium and vitamin D can you recommend to a person who is lactose intolerant?
Soy and fortified rice products
What type of supplement is oscal?
Calcium supplement
What type of patient teaching is essential for a patient taking oscal?
Drink lots of water (to prevent kidney damage)
Why would a patient be prescribed a bisphosphonate such as Fosamax, Boniva or Actonel?
For prevention and treatment of osteoporosis
What type of patient teaching is necessary for a patient taking a bisphosphonate?
Drink lots of water (to prevent kidney damage), take early in morning, sit up for 30-60 minutes after taking (to prevent esophageal irritation)
What serious complications are related to Aredia and Reclast?
Osteonecrosis (jaw bone death)
What contraindication is applied to selective estrogen receptor modulators (SERMs)?
Hx of thromboembolism
What is Forteo and what is it indicated for?
Bone-building agent for treatment of osteoporosis of post-menopausal women with high risk of fracture
What is calcitonin?
A thyroid hormone that inhibits osteoclastic activity
What foods type of foods are good sources of vitamin D?
Eggs, chicken, liver, dairy
What is ergocalciferol?
Vitamin D supplement
Define exogenous osteomyelitis.
Infection of the bone from an outside source (eg. from stab wound)
Define endogenous osteomyelitis.
Infection of the bone from an inside source (eg. from uti)
Define contiguous osteomyelitis.
Infection of the bone from an adjacent tissue
Which lab value abnormalities would you expect to see in a patient with osteomyelitis?
Elevated ESR, elevated WBC, elevated CRP
In which populations might you see a muted reaction to osteomyelitis?
Immune compromised (HIV, RA), elderly
How is osteomyelitis treated?
With antibiotics or hyperbaric oxygen (for special cases only)
Which symptoms would you expect to see in a patient with osteosarcoma?
Leukocytosis, fever, anemia
Which serious complication can be seen in crush syndrome?
Kidney failure; rhabdomyolosis (release of myoglobin from muscles to circulation) can occlude distal renal tubules and cause kidney failure
Which symptoms are seen in a patient with fat embolism syndrome (FES)?
Altered mental status (earliest symptom), followed by respiratory distress and petechiae on the upper body (late symptom)
Which lab value abnormalities would you expect to see in a patient with rheumatoid arthritis?
Positive ANA, positive rheumatoid factor
What is the earliest sign of infection in elderly patients?
Change in mentation
What effect does immunesuppressive agents (eg. methotrexate) have on the body?
They suppress bone marrow to reduce the immune response
What effect do corticosteroids (eg. prednisone) have on the body?
They decrease inflammatory and immune responses by decreasing the WBC count
