musculoskeletal part 2 (2)

Question 1

what is avasculer necrosis of the femoral head, where blood supply to the femoral epiphysis is interrupted

Answer 1

legg-calve perthes disease

Question 2

how many stages does legg-calve perthes disease progress through and how long does that take?

Answer 2

4 stages through 1-4 years

Question 3

what ages does legg-calve perthes disease occur in, and what is the average age?

Answer 3

2-12 y.o., average of 7

Question 4

what gender is more likely for legg-calve perthes disease?

Answer 4

boys (5x more)

Question 5

what races doe legg-calve perthes disease mostly effect?

Answer 5

caucasian, least in east asians

Question 6

Case study
hx of…
-breech birth
-low birth weight
-smoker parents
-injury to leg
presents with…
-mild pain anterior thigh
-limp worse with activity
pain/limp relieved with rest

patient probably has…..?

Answer 6

legg-calve perthes disease

Question 7

what stage of legg-calve perthes disease is when injury or coagulation disorder causes loss of blood to femoral head?

Answer 7

prenecrosis

Question 8

what stage of legg-calve perthes disease is the avascular stage, asymptomatic, x rays show normal, femur is intact but avascular?

Answer 8

necrosis (I)

Question 9

what stage of legg-calve perthes disease has pain and limited mvmt, new bone deposits, dead bone reabsorption, fx and deformity of femur can occur. lasts 1-4 years

Answer 9

revascularization (II)

Question 10

what stage of legg-calve perthes disease is where reossification takes place and pain decreases (healing stage)

Answer 10

bone healing (III)

Question 11

what stage of legg-calve perthes disease is where the process is over, there is no pain and improved joint function

Answer 11

remodeling (IV)

Question 12

what is the size difference is a thigh affected wih legg-calve perthes disease?

Answer 12

2-3 cm

Question 13

how long does treatment for legg-calve perthes disease take

Answer 13

2 years

Question 14

what will a child with legg-calve perthes disease be placed in?

Answer 14

traction and bracing

Question 15

what kind of meds are people with legg-calve perthes disease on

Answer 15

anti-inflammatory

Question 16

what is important to tach abot in legg-calve perthes disease

Answer 16

skin care

Question 17

case study…
david 14 y.o. obese
-hx of mild aching pain in right hip for 4 weeks, pain in right knee, recent growth spurt, limps, dec. ROM right hip

what is the diagnosis?

Answer 17

slipped capital femoral epiphysis (SCFE)

Question 18

how is slipped cpital femoral epiphysis (SCFE) diagnosed?

Answer 18

history and xray

Question 19

what classifies chronic SCFE?

Answer 19

longer than 3 weeks

Question 20

what happend after a SCFE disgnosis?

Answer 20

becomes an emergency! need to keep weight off

Question 21

which of the following best describes SCFE?
1. Pain caused by sudden growth of the bone during a growth spurt
2. A congenital malformation of the hip joint
3. The femoral had is displaced from the femoral neck
4. avascular necrosis of the femoral head

Answer 21

3

Question 22

between what ages is SCFE seen in?

Answer 22

adol. growth spurt, 10-16 in boys

Question 23

What gender is SCFE seven more in?

Answer 23

boys

Question 24

Which races is SCFE more seen in?

Answer 24

Black, Hispanic, Pacific Islanders

Question 25

what things increase the risk for SCFE?

Answer 25

Overweight, injured, other trauma, radiation or endocrine disease

Question 26

describe stable versus unstable SCFE?

Answer 26

stable = can walk
unstable= cant walk

Question 27

Which of the following are complications of SCFE?
1. Synovial membrane becomes inflamed, edematous, and painful
2. callous formation can occur
3. hip deformity develops
4. limited rom of hip

Answer 27

all!

Question 28

how is SCFE usually treated? (stable vs. unstable)

Answer 28

stable = 1 screw outpatient
unstable = more screws

Question 29

nurse care post-op for SCFE

Answer 29

• adequate nutrition (inc. protein)
• med admin
• traction management

Question 30

which of the following may be phyically observed in scoliosis?
1. uneven shoulders/hips
2. prominent scapula
3. truncal asymmetry
4. one sided rib hump

Answer 30

all

Question 31

what is a lateral c or s shaoed curve of the spine usually associsted with roatational deformityof spine/ribs

Answer 31

scoliosis

Question 32

what are the 2 classifications of scoliosis?

Answer 32

idiopathic or compensatory

Question 33

curves of the spine greater than what degree are abnormal?

Answer 33

10°

Question 34

what is the dignosis for scoliosis?

Answer 34

• radiology
• screening (5-7 grade)
• standing up
• adams test

Question 35

what is the adams test for scoliosis

Answer 35

forward bend, arms togehter

Question 36

what degree classifies mild scoliosis

Answer 36

10-20

Question 37

non surgical treatment for scoliosis?

Answer 37

exercise for posture/miscle tone. maintain or decrease degree of curvature

Question 38

goal of scoliosis treatment

Answer 38

build strength on outside of curve while stretching the inside

Question 39

what is worn 23 hours a dayafter diagnosis of scoliosis to maintain spinal curvature

Answer 39

boston brace

Question 40

what stimulates msucles to contract to help correct spinal curvature, is used overnight instead of boston brace

Answer 40

electrical stimulation

Question 41

what degree of curvature is severe scoliosis

Answer 41

40°-50°

Question 42

Realignment or straightening of the spine with internal fixation or instrumentation combined with bony fusion of the realigned spine

Answer 42

spinal fusion with instrumentation

Question 43

what is a huge downside of spinal fusion with instrumentation surgery for scoliosis

Answer 43

lots of blood loss

Question 44

when and how do you turn a patient after scoliosis surgery

Answer 44

log roll q2h, prevent twisting

Question 45

how long is activity limited for after scoliosis surgery depending on the doc?

Answer 45

6-8 months