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Musculoskeletal disorders Flashcards

1
Q

Difference between dorsiflexion and plantar flexion.

A

Dorsiflexion is pointing toes toward shin. Plantar is pointing toes toward floor.

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2
Q

What is a goniometer used for?

A

Assessing ROM by measuring the angle. Looks like a protractor.

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3
Q

What are some wording for normal assessment of spine?

A

Ordinary spinal curvatures

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4
Q

Wording for normal assessment of muscles.

A

No muscle atrophy or asymmetry.
Muscle strength 5/5.

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5
Q

Wording for normal assessment of joints.

A

No joint swelling, deformity or crepitation.
Full ROM of all joints without pain or laxity.

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6
Q

Wording for normal assessment of palpation of musculoskeletal system.

A

No tenderness on palpation of spine, joints, muscles.

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7
Q

What is stiffness and fixation of a joint called?

A

Ankylosis-(possible cause is joint inflammation and destruction)

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8
Q

What is thickening or scarring of connective tissue called?

A

Fibrosis

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9
Q

Resistance of movement of muscle or joint.

A

Contracture (usually caused by fibrosis of supporting tissue)

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10
Q

Audible crackling sound with palpable grating.

A

Crepitus (fracture, dislocation, TMJ, osteoarthritis)

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11
Q

Exaggerated thoracic curvature

A

Kyphosis (dowagers hump)

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12
Q

Exaggerated lumbar curvature

A

Lordosis (swayback)

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13
Q

What does alkaline phosphatase labs test for? Normal range.

A

Seen as ALP
30-120 U/L
Part of CMP and liver panel.
Indicative of liver dysfunction or bone damage.
Can give false positive if lab draw is hemolyzed.
High in kids during growth spurt.
Many meds that are hard on liver can raise ALP.
Elevated in bone cancers, osteoporosis, healing fractures, Paget disease, osteomalacia and rickets.

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14
Q

What is rheumatoid factor in labs?

A

Indicative of RA, SLE, ankylosing spondylitis, osteoarthritis, psoriatic arthritis
Normal finding should be negative or a titer of less than 1:17

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15
Q

What is acetylcholine receptor antibody test?

A

Seen as AChR test
Lab for myasthenia gravis (remember this a disease that attacks ACh-a neurotransmitter affecting skeletal muscle)
Attacks the ability of ACh to function. Antibodies are indicative of Myasthenia gravis

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16
Q

What is antinuclear antibody test?

A

Seen as ANA in lab
Normal findings are negative to 1:40 dilution
If antibodies are present usually means SLE (present in 95% of SLE)
but can mean RA or scleroderma

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17
Q

What is an anti-DNA antibody test?

A

Most specific marker for SLE
Normal findings are <5 IU/mL

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18
Q

Different types of bone cells and functions.

A

Osteoblasts-build up bone
Osteoclasts-break down bone
Osteocytes-mature bone cells

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19
Q

What is a uric acid lab for?

A

Increased levels in gout

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20
Q

What is C-reactive protein? (CRP)

A

Normal is <1.0 mg/dL
Indicative of inflammation or infection
Increased in SLE and RA

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21
Q

What is an erythrocyte sedimentation rate?

A

Marker for inflammation and infection. Usually this lab is ran with CRP.

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22
Q

What is creatine kinase? (CK)

A

Normal is 20-200 U/L.
Highest concentration in skeletal muscle.
Increased in injury, muscular dystrophy

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23
Q

What are the NSAIDs?

A

Ibuprofen and Naproxen
meloxicam (Mobic)
celecoxib (Celebrex)
diclofenac sodium (Voltaren) gel

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24
Q

What are the injectable steroids?

A

methylprednisolone acetate (Depot-Medrol)
triamcinolone (Aristospan)

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25
What are the oral steroids?
methylprednisolone (Solu-Medrol) dexamethasone prednisone
26
What are biphosphonates used for?
Osteoporosis
27
What are some common DMARDs? (disease modifying anti rheumatic drugs)
methotrexate (Trexall) sulfasalazine (Azulfidine) leflunomide (Arava) penicillamine (Cuprimine) hydroxychloroquine (Plaquenil)
28
What does RICE stand for?
Rest Ice-20 min at time for first 24-48 then warm compresses Compress-wrap from distal to proximal for 30 min, then leave unwrapped for 15 min Elevate-above heart for first 24-48 hours
29
What is difference between ACL and meniscus injury?
ACL-characterized by pivoting or odd positioning of lower limb-tearing of ligament in knee Meniscus-characterized by popping, clicking, tearing sensations in knee. Injury to fibrocartilage
30
What is partial dislocation called?
Sublaxation
31
What is repetitive strain injury?
Injury from prolonged force or repetitive movements. Causes tiny tears in tissues that become chronically inflamed. Also called work related, overuse or cumulative trauma injuries.
32
What is compartment syndrome?
Swelling in limited space leads to decreased blood supply>>necrosis 6 P's that are classic s/sx 1. Pain (uncontrolled and out of proportion) 2. Pressure 3. Parasthesia (numbness and tingling like limb is asleep)--early sign 4. Pallor 5. Paralysis 6. Pulselessness
33
What is fat embolism syndrome?
Fat globules enter bloodstream after a fracture. Collect in lungs and brain.
34
What is rhabdomyolysis?
Damage to skeletal muscles cause breakdown and release of myoglobin in blood. Myoglobin gets stuck in kidney tubules and causes acute kidney injury. Watch for reddish brown urine and low output.
35
What is a Colles fracture?
Fracture of distal radial usually after a fall with outstretched arm. Presents as wrist deformity. Common in people over 50
36
Four ways fractures are classified.
1. Open or closed 2. Complete of incomplete (did it go through the bone completely?) 3. Direction of fracture line. (see another card on details) 4. Displaced or non displaced. (are the ends of break still together?)
37
Different types of directional fracture classifications.
Transverse-straight across Spiral-wraps around Greenstick-one side sticks out like you have broken a popsicle stick Comminuted-broken into small pieces Oblique-across at diagonal Pathologic-spontaneous break of diseased bone Stress-repeated stress (runners toes)
38
What's the difference between a sprain and a strain?
Sprain is injury to ligaments or capsule of joint Strain is injury to tendons or muscles
39
What is an osteotomy?
Removing of a wedge or slice of bone to restore alignment, usually in spine or joint.
40
What is arthroplasty?
Joint replacement or reconstruction
41
What is arthrodesis?
Fusion of joint that cannot be repaired otherwise. Immobilizes joint
42
What are common muscle relaxants given for musculoskeletal disorders?
Carisoprodol (Soma) Cyclobenzaprine (Flexeril) Methocarbamol (Robaxin)
43
Which antibiotic class is commonly used for bone infection?
Cephalosporins
44
What is med term for bowlegs?
Genu Varum- knees apaRt
45
What is med term for knock knees?
Genu Valgum-knees toGether
46
What is Legg-Calve-Perthes disease?
Disease thought to be from a growth disorder Causes the femoral head to die from lack of blood supply. When new bone is laid down it is deformed, flat and larger Children from 4-8 yo, mostly boys. Will be in considerable hip pain. Decreased ability to internally rotate and abduct leg Wasting of muscles in butt and thigh Shortening of extremity
47
What is talipes equinovarus?
Clubfoot- a congenital dysplasia of all tissue below the knee. The most common skeletal birth defect. 1/1000 births. Males twice as likely. Treatment is realignment. Referred to ortho. Treatment is very effective and commonly involves a Ponseti casting method.
48
Info on muscular dystrophy.
Many different types but they all result in same thing. Muscle fibers break down and are replaced by fat and connective tissue. Respiratory and cardiac muscle wasting is cause of death. DMD (Duchennes MD is the most common). Occurs only in males. An X-linked recessive trait. Most have developmental delays. Life expectancy is late teens. Nursing interventions are all aimed at maintaining ambulation as long as possible and support to family.
49
What is achondroplasia?
Most common cause of dwarfism.
50
What is an osteochondroma?
Benign bone tumor. Usually shows up in teens and young adults. Careful monitoring because can turn into cancer later in life.
51
What is an osteosarcoma?
Very aggressive bone cancer. Occurs most often in boys ages 10-25 Pelvis or long bones of arms and legs Pain and swelling the first indicators
52
What is metastatic bone cancer?
Cancer that has metastasized to bone from any location. Fractures occur along weakened bone and hypercalcemia is sign.
53
What is osteomalacia?
Vitamin D deficiency leads to calcium loss and softening of bones Called Rickets in kids
54
What is major drug class in treatment for osteoporosis?
Biphosphonates-take with full glass of water, on empty stomach and 30 min before anything else
55
What is Paget disease?
Called osteitis deformans Chronic skeletal breakdown with replacement of weaker, larger, more disorganized connective tissue More common in men than women Early symptoms are fatigue, waddling gait, headaches. Head becomes larger. Serum Alkaline phosphatase is high.
56
What is osteopenia?
Decreased bone density-weakness that is precursor to osteoporosis
57
What is metatarsus adductus?
Inward turned foot. Occurs in 1/1000 live births. Babies with this are more likely to have hip dysplasia. Usually corrects itself as baby grows
58
What is gout caused by?
Type of arthritis. Caused by increased uric acid in body. Swelling, erythema, tenderness and pain (usually in big toe) uric acid forms crystals in joint
59
What is a positive Gowers Sign?
Sign of Muscular Dystrophy. When standing from sitting on floor they will brace hands on leg to support self
60
What is radicular pain?
Radiates
61
What is referred pain?
Pain in area unrelated to injured area
62
Osteoarthritis facts.
Non inflammatory of synovial joints Formation of osteophytes (bone spurs) in joint Joint pain that worsens with use Joint pain that in worse the first 30 min after waking Stiffness and pain No systemic involvement
63
What types of drugs are commonly used to treat osteoarthritis (OA)?
NSAIDS Diclofenac gel (Voltaren) OTC creams Intraarticular corticosteroid injections
64
Rheumatoid Arthritis info.
Systemic inflammation of connective tissue in synovial joints Remission/flare ups Autoimmune disease Symmetrical involvement and often affects small joints of fingers and toes Morning stiffness of 60 min Ulnar drift (fingers start pointing away from thumb) Swan neck (fingers start to look like have a dip in middle and make fingertip point down) Boutonniere deformity (most distal joint makes finger point toward ceiling)
65
How to diagnose RA?
Diagnosis: Elevated ESR, CRP Synovial fluid analysis reveals cloudy and straw colored synovial fluid, WBCs and MMP-3s (a protein made in synovial joints that is involved in joint destruction in RA) elevated in synovial fluid Tissue biopsy Bone scans
66
Treatments for RA
DMARDs (the earlier the better to prevent joint destruction) Types of DMARDs: 1. Methotrexate (monitor CBCs and blood chem because it lowers platelet and WBC count) 2. Sulfasalazine (Azulfidine) 3. Hydroxychloroquine (Plaquenil) 4. Leflunomide (Arava) (teratogenic) Corticosteroids for short term during flare ups Surgeries: Synovectomy Arthroplasty
67
What is Sjogrens syndrome? ---Pronounced Show-gruns---
Autoimmune disease that targets moisture producing exocrine glands Lymphocytes attack lacrimal and salivary glands (most affected organs) but also involve the stomach, pancreas and intestines Increases risk for non-hodgkins lymphoma
68
Symptoms of Sjogrens syndrome.
Dry mouth (xerostomia) Dry eyes (keratoconjunctivitis sicca) Dry skin (xerosis)
69
Treatments for Sjogrens syndrome.
Artificial tears Surgical punctual occlusion Increase fluids Dental hygiene Increase humidity Pilocarpine ---Pie-lo-CAR-peen-- (increased salivary gland secretion) Cevimeline---Sa-VIM-a-leen--(cholinergic increases salivary gland secretion)
70
Diagnostics in gout.
Synovial fluid inspiration is gold standard (but usually not necessary) Serum uric acid levels may be normal and high levels are not diagnostic of gout Usually diagnosed based on symptoms
71
Treatment for gout.
Colchicine----CALL-cha-seen--- (an antiinflammatory given during flares and given prophalactically) NSAIDS Corticosteroid oral or injection Allopurinol (given prophalactically) Uricosuric (given to increase urinary excretion of uric acid) can't take with aspirin
72
What is systemic lupus erythematosus (SLE)?
Multisystem inflammatory autoimmune Complex factors that cause: Hormones (usually childbearing age women) Genetics (family history) Environment (sun, stress, chemicals or meds) Immune system (after Epstein Barr infection)
73
What are characteristics of SLE?
Affects many body systems Characterized by flares and remission Most commonly affects: Skin--butterfly rash, erythema Muscles--Inflammation Lung lining--Inflammation Cardio--Usually fatal Inflammation-Peri, Myo and Endocarditis Raynaud's (Ray-nose----cold and numb hands) Neuro--neuropathy, CVA (because of coagulation issues) seizures, psychosis, brain fog Kidneys---Ususally fatal inflammation (glomerulonephritis) that decreases kidney function Excessive fatigue Joint Pain Weight loss
74
How to diagnose SLE?
ANA (anti-nuclear antibodies) present in 97% of SLE Increased ESR, CRP Complex to diagnose
75
Treatment for SLE.
NSAIDs Antimalarial drugs Corticosteroids Immunosuppressive drugs Anticoags Topical immunomodulators for skin conditions
76
Lyme disease info.
Borrelia burgdorferi infection transmitted by tick Characteristic bulls eye rash within 1 month in 80% of patients Flu like symptoms Causes widespread inflammation in several symptoms most commonly: Arthritis, Lyme carditis, Bell's palsy (facial nerve palsy creates a muscle weakness on one side of face) Treatment is doxycycline. Long term AB may be needed.
77
What is scleroderma?
Overproduction of collagen of unknown etiology Causes tissue fibrosis and blood vessel occlusion (especially small vessels) Connective tissue disease causing fibrosis, degeneration and sometimes inflammation to several systems.
78
Two types of scleroderma.
Localized (in children) that causes skin changes in a few places. Affects face, fingers, hands, lower arms and legs. Systemic (in adults) that causes internal organ changes. Widespread thickening of skin, especially hands, arms, thighs, chest, abdomen and face. Damages blood vessels, heart, lungs, joints, muscles, esophagus, intestines.
79
What is CREST syndrome and what is it a hallmark of?
Scleroderma C-Calcinosis-Calcium deposits on skin R-Raynauds E-Esophageal dysfunction-usually acid reflux S-Sclerodactyly-thickening and tightening of skin on hands and fingers T-Telangiectasia-dilation of capillaries causing red marks on skin
80
Nursing management of scleroderma.
No finger sticks with Raynauds Moist heat and paraffin Protect hands from cold Watch for infection

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