Musculoskeletal part 1

Question 1

normal bone mineral density

Answer 1

T score: -1 or greater

Question 2

osteopenia

Answer 2

thinning of the trabecular matrix of the bone before osteoporosis
low bone mass
T score: between -1 and -2.5

Question 3

osteoporosis

Answer 3

porous bone
T score: less than or equal to -2.5

Question 4

severe osteoporosis

Answer 4

osteoporosis with a history of a fragility fracture
T score: less than or equal to -2.5

Question 5

osteoporosis characteristics

Answer 5

-low bone mass
-micro architectural deterioration
-increase in bone fragility
-susceptibility to fracture high

Question 6

osteoporosis

Answer 6

-actual breaks in the trabecular matrix have occurred
-usually bones in the hips, vertebrae, and wrists (trabecular bones)

Question 7

major risk factors: osteoporosis

Answer 7

-aging
-female
-caucasian
-history fracture as adult
-family history
-body weight <127 lbs
-smoking
-alcohol
-corticosteroid therapy and immunosuppressive drugs

Question 8

minor risk factors: osteoporosis

Answer 8

-thin, small frame
-lack of weight bearing exercise
-lack of calcium/vitamin D
-eating disorders
-gastric bypass surgery
-lack of estrogen/testosterone
-excessive caffeine consumption

Question 9

osteoporosis patho

Answer 9

-increased bone resorption- osteoCLAST activity increased
-decreased bone formations-osteoBLAST activity decreased
-problem can be: failure to make new bone; too much bone resorption

Question 10

manifestations of osteoporosis

Answer 10

early: none
-late: fractures, pain, loss of height, stooped posture (kyphosis)

Question 11

complications of osteoporosis: hip fractures

Answer 11

-more common in those over 65
-more common in women
-most common location: proximal third of the femur

Question 12

hip fracture clinical presentation

Answer 12

-sudden onset of hip pain before or after a fall
-inability to walk
-severe groin pain
-tenderness
-affected leg is externally rotated and shortened

Question 13

fractures: definition and causes

Answer 13

-any break in the continuity of bone that occurs when more stress is placed on the bone that it is able to absorb
-traumatic- fall
-fatigue- repeated, prolonged stress
-pathologic- weakened bone, possibly spontaneous (highest risk in elderly)

Question 14

closed vs. open fracture

Answer 14

-closed (simple): does not break through the skin
-open (compound)- fractured bone penetrates skin

Question 15

fracture orientations:

Answer 15

-transverse: traumatic falls
-spiral: twisting injury
-comminuted: more than 1 fracture line and more than 2 bone fragments
-greenstick: incomplete break; mostly children
-stress: repeated use

Question 16

clinical manifestations of fractures

Answer 16

-pain
-edema
-deformity: loss of function, abnormal mobility

Question 17

3 phases of bone healing

Answer 17

1. inflammatory- hematome
2. reparative- fibrous cartilage, callous, ossification
3. remodeling

Question 18

complications of fractures

Answer 18

-delayed healing
-bone growth impairment
-compartment syndrome
-fat embolism syndrome

Question 19

compartment syndrome

Answer 19

-seen with: crush injuries and cast
-results from increased pressure within limited anatomic space
-“tourniquet” effect- edema at fracture site puts intense pressure on soft tissue
-can lead to tissue hypoxia of muscles and nerves
-manifestations: edema, loss or weakened pulses, PAIN

Question 20

fat embolism syndrome

Answer 20

-fat molecules in lung following: long bone fractures and major trauma
-how do they get there?
-fat molecules from bone marrow or traumatized tissue
-released into blood stream
-hypoxia, altered LOC, and petechiae (last symptom to occur)

Question 21

osteomyelitis

Answer 21

-acute or chronic pyogenic (pus producing) infection of bone
-usual cause: bacteria- staph aureus

Question 21

osteomyelitis risk factors

Answer 21

-recent trauma- open compound fracture
-diabetes
-hemodialysis
-IV drug use
-splenectomy

Question 22

route of contamination: direct

Answer 22

-open wound
-open fracture
-gunshot
-puncture
-surgery
-surgery/insertion of meta plates or screws

Question 23

route of contamination: indirect

Answer 23

-blood stream- most common
-bacteremia

Question 24

osteomyelitis patho

Answer 24

-pressure increases within the bone
-causes local arteries to collapse
-decreases or eliminates supply of: oxygen, nutrition, immune cells, ANTIBIOTICS
-leads to impaired healing
-difficult to treat

Question 25

osteomyelitis manifestations

Answer 25

-local: tenderness, warmth, redness
-wound drainage, restricted movement, spontaneous fracture
-systemic: fever, positive blood culture, leukocytosis

Question 26

osteomyelitis pharm:

Answer 26

-obtain culture
-empiric antibiotic therapy: nafcillin, cefazolin, vancomycin
-bacteria specific therapy