Week 4 - Musculoskeletal and Skin Disorders Flashcards

1
Q

Functional assessment

A

evaluation of ongoing medical comorbidities, premorbid functional status, current function, living situation and equipment, caregiver support, and patient functional goals

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2
Q

Lawton IADL scale

A

The Lawton IADL scale was developed by Lawton and Brody in 1969 to assess the more complex ADLs necessary for living in the community
- shopping
- cooking
- finances
- driving

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3
Q

Domains of geriatric care

A

mental, physical, functional, socio-economic

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4
Q

Nutritional assessment should be triggered if a patient has how much weight loss?

A

more than 5% in 6 months

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5
Q

Geriatric screening tools

A
  • International Prostate Symptoms Score – for diagnosing urinary obstruction
  • Patient Health Questionnaire–2 – screening for depression (all patients)
  • If + use Patient Health Questionnaire–9 or the 15-item Geriatric Depression Scale
  • Katz index for ADLs10 and the Lawton scale for IADLs.11
  • Clinician’s Guide to Assessing and Counseling Older Drivers1
  • AD-8 – changes in behavior which may indicate cognitive problems
  • Neuropsychiatric Inventory Questionnaire (NPI-Q)
  • Montreal Cognitive Assessment (MoCA
  • Snellen chart 20/40 is visual impairment
  • o Timed Up and Go (TUG) test18 is an assessment of gait and lower leg function – if more than 12 seconds, high fall risk
  • Cognitive screening tools
  • mini-cog (3-item recall and clock drawing1
  • if mini cog is +  MoCA, Mini Mental State Exam (MMSE) – requires training
  • Short Form-36 Health Survey22 (SF-36), - quality of life tool
  • Mini nutritional assessment
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6
Q

Gout

A

Iinflammatory reaction to monosodium urate (MSU) crystals deposited in the joint, is associated with hyperuricemia

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7
Q

Gout s/s

A

Pain, heat and swelling in one or more joints. Usually big toe, non-symmetrical.

First metatarsal phalangeal join- more likely to involve small joints and develop tophi more rapidly and in unusual locations

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8
Q

Gout treatments

A

NSAIDs, colchicine allopurinol, steroids or intraarticular injection. Diet low in red meats and seafood (purines).

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9
Q

Diagnostic criteria for gout

A
  1. an SU level >7 mg/dL in men or >6 mg/dL in women
  2. the presence of tophi;
  3. the presence of MSU crystals in SF or tissues;
  4. a history of painful joint swelling with abrupt onset and remission
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10
Q

S/S of Osteoporosis

A
  • height loss >4 cm,
  • rib-pelvis distance <2 finger-breadths
  • inability to touch the occiput to the wall when standing with heels to the wall.
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11
Q

Risk factors for Osteoporosis

A
  • DM
  • Corticosteroid use
  • Radiation
  • smoking
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12
Q

DXA results for osteoporosis

A

T-score of ≤2.5 standard deviations below the mean of a young reference group is positive for osteoporosis

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13
Q

DXA results for osteopenia

A

T-score between 1.0 and 2.5

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14
Q

Non pharmacological treatment for osteoporosis

A
  • Supplementation with Ca and Vit D
  • Exercise
  • Fall prevention
  • Adequate caloric intake
  • 1000mg of Calcium to age 50 (women) or 70 (men), 1200mg daily over those ages
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15
Q

Osteoporosis management is recommended for which patients?

A
  • Pts with hip or vertebral fracture
  • BMD T-scores ≤−2.5,
  • BMD T-scores between −1.0 and −2.5 and a 10-year probability of hip fracture >3% or 10-year probability of major osteoporotic fracture >20%
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16
Q

Pharmacological treatments for Osteoporosis

A

Antiresorptive agents AKA bisphosphonates – slow the remodelling process to increase bone density –> continue treatment for 5 years
* (alendronate, risedronate, ibandronate)
* Zolendronic acid- once yearly dose
 Anabolic agents (teriparatide, abaloparatide)
 Other (raloxifene, estrogen,)

17
Q

How to monitor patients with osteoporosis

A
  • Regular height measurements
  • DXA scans 1-3 years
  • Fracture risk assessment
  • assessment for treatment compliance and side effects.
18
Q

Signs and symptoms of OA

A
  • Asymmetrical joint swelling
  • Hebreden and bouchards nodes
  • joint pain and stiffness for 10-15 min after rest
  • DIP, PIP, hips, knees, neck, back
19
Q

Treatment for OA

A
  • Weight loss
  • Exercise
  • Brace/splinting
  • Tai Chi/Qi Gong
  • Acupunture
  • Tyelnol
  • NSAIDS – for hand, knee hip
  • Steriod injections
20
Q

Labs for OA

A
  • ANA - negative
  • RF - negative
  • ESR - normal
  • CRP - normal
21
Q

Imaging for OA

A

Xrays show joint space narrowing, osteophytes, subchondral sclerosis, and cystic changes

22
Q

Signs and symptoms of RA

A

Joints affected symmetrically Warmth and swelling at joints
Joint pain and stiffness in the morning for 2-3 hours

23
Q

Labs for RA

A

ANA - positive RF - positive (32-89%) ESR - elevated at onset

24
Q

Treatment for RA

A

Disease modifying antirheumatic drugs (DMARDS) – can do triple therapy, requires lab testing every 8-12 weeks for monitoring
* Methotrexate
* Sulfasalazine
* Hydroxychloroquine (avoid in macular degeneration)

Biologicals (can reactivate hep B and C and TB)
* Humira (adalimumab)
* Enbrel (etanercept)

25
Q

Xray findings for RA

A

Loss of articular space, multiple erosions, juxtaarticular osteopenia, and ulnar deviation.

26
Q

Treatment of gout

A

Uric acid lowering therapy with 2-3 acute attacks, renal complications or presence of tophi  xanthine oxidase inhibitors – uric acid less thatn 6mg/dL

Lifestyle
* Avoid alcohol, avoid purines (shellfish and organ meats)

Pharmacological
* Allopurinol (safe to titrate up despite renal insufficiency) urate lowering
* Febuxostat if no response to allopurinol

Prophylaxis
o Colchicine 0.6mg daily
o Low dose steroids

27
Q

Pseudogout

A

calcium pyrophosphate dehydrate (CPPD) crystal deposition in joints

28
Q

Treatment for pseudogout

A

NSAIDs, intraarticular steroids

29
Q

Timed up and go test

A

Stand up from chair, walk 10 feet and return to chair.

An older adult who takes ≥12 seconds to complete the TUG is at risk for falling.

30
Q

Onset of herpes zoster

A

Prodrome of unilateral pain or pruritus followed by corresponding dermatomal vesiculopustular eruption within days to a week

31
Q

Is someone with herpes zoster contagious?

A

The host is contagious during the prodrome (via respiratory route) and through direct contact until the lesions become dried and crusted

32
Q

Diagnosis for herpes zoster

A

Clinical presentation
- Polymerase chain reaction (PCR) is a rapid, sensitive, and specific assay

33
Q

Vaccines for herpes zoster

A

For patients over 50:
* Zostavax (attenuated live virus - not for immunocomprimised patients)
* Shingrix (recombinant, 2-doses)

34
Q

Treatment for herpes zoster

A
  • Antiviral therapy within 72 hours of rash onset
  • Caution with CKD
  • IV therapy with ocular involvement, immunosuppression, suspected meningitis or sepsis
  • Acyclovir, famciclovir, valcyclovir
35
Q

Post herpetic neuralgia

A

PHN is a debilitating chronic neuropathic pain condition that can persist for months to years after zoster rash resolution. PHN occurs most commonly in older patients with zoster, probably as a function of immunosenescence.

Treatment with gabapentin and lyrica.

36
Q

All treatments for OA

A
  • acetaminophen
  • Topical capsaicin
  • Referral to physical therapy
  • Referral to occupational therapy
  • Referral to orthopedics
  • Follow-up with NP in one month
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Low-impact exercises
37
Q

All treatment for RA

A
  • Referral to rheumatology
  • Low-dose oral corticosteroids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Low-impact exercises