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PTRS 746 Exam 1 Combined and Randomized > Osteoporosis&Foot Neuropathy > Flashcards

Osteoporosis&Foot Neuropathy Flashcards

1
Q

Q: What T-score indicates osteoporosis?

A

< -2.5

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1
Q

Content: Life choices and bone health (5)

A
  1. Adequate Ca intake (~1200 mg/day)
  2. Optimal Vit D levels
  3. WB exercise
  4. Avoid tobacco use
  5. Avoid excessive alcohol use
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1
Q

Content: Foot Care Education (6)

A
  1. Check feet daily
  2. ALWAYS wear shoes
  3. No lotion/oil between toes
  4. Keep nails clipped
  5. Manage calluses
  6. Report changes immediately
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2
Q

Diagram: Mechanism of Action of Bisphosphonates - Osteoclasts are targets

A
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3
Q

Content: Side Effects of Bisphosphonates (6)

A
  1. Upper GI irritation
  2. Osteonecrosis of the jaw
  3. Severe musculoskeletal pain
  4. HypoCa
  5. Scleritis
  6. Atypical femur fractures
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3
Q

Content: Foot Examination (3)

A
  1. comprehensive foot exam should be completed at LEAST annually
  2. those with neuropathy should have feet visualized every medical visit
  3. those with diabetes should check their feet each day
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4
Q

Q: Osteoporosis is a problem of _________ peak bone _____ and _____________ bone _____.

A

decreased, mass, increased, loss

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4
Q

Q: What does FRAX calculate?

A

10 year fracture risk, for things like hip fracture and osteoporosis fractures

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5
Q

Content: Secondary Evaluation of Osteoporosis (7)

A
  1. Comprehensive metabolic panel
  2. CBC
  3. 24 hour urine for Ca, creatinine, Na
  4. 25-Hydroxy Vit D
  5. TSH
  6. SPEP/UPEP if anemic
  7. PTH
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6
Q

Q: What calcium supplements are available?

A
  1. Calcium carbonate
  2. Calcium citrate
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8
Q

Content: 3 ways to define osteoporosis.

A
  1. Microarchitectural deterioration of bone tissue leading to decreased bone mass
  2. Bone fragility
  3. Susceptibility to fracture
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9
Q

Content: Four neuropathy deformities (4)

A
  1. Prominent metatarsal heads
  2. Hammer/claw toes
  3. Hallux Valgus/bunions
  4. Charcot Foot
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10
Q

T/F: High impact WB exercise increased BMD by 1-2% at the spine and hip.

A

True

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11
Q

Q: What is the recommendation for exercise to prevent osteoporosis?

A

30 min, most days of running, walking, or elliptical + muscle stregnthening and balance exercises

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11
Q

Q: What are pharmacologica treatment options for low bone mass? (4)

A
  1. Bisphosphonate
  2. Teriparatide
  3. Denosumab
  4. Selective Estrogen Receptor Modulators
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11
Q

Content: Teriparatide (2)

A
  1. Anabolic (bone building agent)
  2. Daily injection
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11
Q

Q: What 3 pulses should you check during a foot exam?

A
  1. Posterior tibilais
  2. Dorsal pedis
  3. Ankle brachial index (ABI)
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12
Q

Q: _________ involvement in foot neuropathy is __________.

A

Early, crucial

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13
Q

Content: Calcium carbonate (2)

A
  1. Needs stomach acid for absorption
  2. Taken with meals
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14
Q

Diagram: Vit D formation

A
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15
Q

Content: Skin (3)

A
  1. Think, shiny, brawny and/or frail
  2. Dry
  3. Calluses/wounds
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15
Q

Diagram: Identify the Deformity

A

Upper = corn

Lower = callus

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15
Q

Defn: Claw toe

A

Hyper extension of MTP with PIP/DIP flexion

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16
Q

Q: How do you assess fall risk?

A

TUG - Timed get up and go

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16
Q

Q: What medications put you at high risk for osteoporosis? (3)

A
  1. Steroids
  2. Aromatase inhibitors
  3. Androgen deprivation therapy
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17
Q

Q: What are the mortality rates 1 and 5 years after amputation?

A

40%, 80%

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19
Q

Q: What is FRAX?

A

Fracture Risk Assessment Tool

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20
Q

Q: When does bone mass begin to decline?

A

Around 50 yo

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21
Q

Content: Charcot Arthropathy (4)

A
  1. Progressive bone destruction and ligament damage leading to arch colllapse and impaired skin integrity
  2. Affects abot 9% of those with diabetes
  3. Unclear if etiology is neurotraumatic, neurovascular, or both
  4. Generally treated with complete immbolizations in a total contact cast with protected WB
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22
Q

Q: How many million individuals in the US are affected by osteoporosis?

A

10 million

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23
Q

Content: Exercise recommendations for foot neuropathy

A

At least 30 min most days - consider foot integrity

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25
Q

Content: Vitamin D supplementation (5)

A
  1. Vit D2 - ergocalciferol
  2. Vit D3 - cholecalciferol
  3. supplementation guided by 250HD value
  4. Can be taken with or without food
  5. Safe upper limite = 2,000IU
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26
Q

Content: Assessment - Low Risk Foot Neuropathy (4)

A
  1. Preserved sensation
  2. No defromity
  3. Intact circulation

4 Tx: Annual foot exam, education, good footwear

28
Q

T/F: For every standard deviation below the norm, the risk of fractures triples.

A

False: doubles

29
Q

Content: Goals of the foot exam (4)

A
  1. Est. history/diagnostic factors
  2. Identify risks
  3. Intervention
  4. Education
30
Q

Content: Assessment - High Risk Foot Neuropathy (6)

A
  1. Sensory loss
  2. Deformity
  3. Vascular disease
  4. Callus formation
  5. Hx of ulcer or amputation
  6. Tx: comprehensive assessment, education, diabetic shoe
30
Q

Content: Education (4)

A
  1. General diabetes self care
  2. Foot/skin care
  3. Daily skin checks
  4. Proper footwear (breathable, adjustable, wide toe box, good support)
31
Q

Diagram: Identify the Deformity

A

Claw toes

32
Q

Q: What habit can increase your risk of neuropathy?

A

smoking (current or past)

33
Q

Content: Risk factors for Osteoporosis (10 - general idea)

A
  1. Genetics
  2. Low Ca intake
  3. Low vitamin D stores
  4. Tobacco and alcohol us
  5. Prior history of fracture
  6. Medications
  7. Malabsorpation
  8. Excessive urinary calcium
  9. Overactive thyroid gland
  10. Other medical conditions
34
Q

Content: Sensation assessment (2)

A
  1. Semmes Weinstein Monofilament (10 locations)
  2. Vibratory sensation (128 Hz tuning fork, latency > 10 sec = sensory loss)
35
Q

Diagram: Identify the Deformity

A

Hammer toe

37
Q

Content: Types of Bisphosphonates (4)

A
  1. Alendronate -wkly
  2. Risedronate - wkly/moly
  3. Ibandronate - moly/IV every 3 mo
  4. Zolendronic Acid - IV annually
38
Q

T/F: Neuropathy is implicated in 25% of non-traumatic amputations.

A

False, 50-75%

39
Q

Content: Toenails (3)

A
  1. Thickened
  2. Deformed
  3. Ingrown
41
Q

Content: Primary Osteoporosis (2)

A
  1. unrelated to chronic illness
  2. Related to aging and decreased gonadal function
41
Q

Q: What is HbA1c?

A

Average blood sugar over a peroid of 3 months

42
Q

Defn: Hammer toe

A

Hyperextension of MTP and DIP

43
Q

Content: glycemic control recommendations for foot neuropathy

A

HbA1c goal of < 6.5-7

44
Q

Q: When does bone mass peak?

A

Between 20-25 yo

45
Q

Q: What type of training increased spine BMD?

A

Resistance

46
Q

Content: Causes of neuropathy (6)

A
  1. Diabetes
  2. Tumor, trauma
  3. Autoimmune disease
  4. Vitamin B, E, niacin deficiency
  5. Exposure to toxins
  6. Infection
47
Q

Content: OE for foot neuropathy (5)

A
  1. Condition of skin, hair, toenails
  2. Deformities
  3. Pulses
  4. Sensation
  5. Shoe wear
48
Q

Diagram: Identify the Deformity

A

Hallux Valgus

49
Q

Content: Nutrition recommendations for foot neuropathy (4)

A
  1. Montior BMI - stable or weight loss
  2. Fresh fruits/veggies
  3. Pre meal glucose 90-130 mg/dl
  4. Post meal glucose 180 mg/dl
51
Q

Q: What imaging is often used to identify osteoporosis?

A

DEXA

51
Q

Q: For bone health how often should bone density be evaluated?

A

On treatment = every 1-2 years

Not on treatment = every 2 years

53
Q

Defn: Z-score

A

number of standard deviations from age matched mean density

55
Q

Content: TUG (5)

A
  1. Stand from a seated position
  2. Walk ~10 ft
  3. Turn around
  4. Return to seated position in chair
  5. Normal time < 10 seconds
56
Q

Content: Offloading (5)

A
  1. Total contact casts (change ever 1-2 wks)
  2. Orthotics/walking boots
  3. Surgical shoes
  4. Dressings
  5. Cutouts
57
Q

Q: How should you elevate a pts. heels?

A

With pillow under calves

59
Q

Content: SE for foot neuropathy (7)

A
  1. Contributing diagnosis
  2. PMH/social factors
  3. Medications
  4. Complications
  5. Hx of LE surgery, ulcer, amputation
  6. Current or past smoker
  7. HbA1c (diabetes)
60
Q

Content: Ulcer intervention (4)

A
  1. Debulk callus
  2. Control moisture
  3. Decrease infection risk
  4. Edema management
62
Q

T/F: WB activities decrease BMD.

A

False

64
Q

Q: What T-score indicated osteopenia?

A

-1 to -2.5

65
Q

Q: What is BMD?

A

Body mass density - comes from a DEXA test

66
Q

Q: How much Ca is in 8 oz of milk?

A

300 mg

67
Q

Cotent: ABI Scale (6 parts)

A

> 1.2 = vessels are incompressible, consider toe brachial indexes

  1. 0-1.2 = normal
  2. 9-0.99 = acceptable

< 0.9 = arterial disease

0.5-0.8 = intermittent claudication

< 0.5 = severe arterial disease

68
Q

Defn: T-score

A

number of standard deviations from the young adult mean density

69
Q

Content: Hair

A

May be present or absent

70
Q

T/F: FRAX is the treatment decision making tool in previously treated pts.

A

False, untreated

71
Q

T/F: Menstraul cycle effects gains in BMD.

A

True

72
Q

Q: When does the z-score apply for osteoporosis?

A

pre-menopausal females and males < 50

73
Q

Content: Calcium citrate

A

Can be taken with or without food

74
Q

Content: Calcium supplements (2)

A
  1. Limit to ~500 mg in a dose
  2. May cause constipation
75
Q

Q: Who will be referred to PT for osteoporosis type treatment?

A

Those at increased risk or fall, unstable gait, weakness

76
Q

Q: What % of those with diabetes will develop neuropathy?

A

50%

77
Q

Q: What type of training increased hip BMD?

A

high impact

78
Q

Content: Secondary osteoporosis (2)

A
  1. Secondary to chronic illnesses/meds that cause accelerated bone loss
  2. Ex. glucocorticoid use, hyperthyroidism
80
Q

Content: 4 types of neuropathy

A
  1. Peripheral - UE/LE
  2. Autonomic - CVS, temp reg, bowel/bladder
  3. Proximal - thigh, hip, core mm
  4. Focal - sudden loss in one n. or group of n.
81
Q

Q: Who could you refer pts. with foot neuropathy to? (4)

A
  1. Podiatry
  2. Wound care
  3. Nurse educator
  4. Dietician
82
Q

Content: Denosumab (3)

A
  1. Inhibits osteoclast function
  2. Decreases bone resorption
  3. Consider in pts. with kidney dysfunction

PTRS 746 Exam 1 Combined and Randomized (7 decks)

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