Musculoskeletal Flashcards
(26 cards)
DEXA
Definitive test for osteoporosis
Assess in non dominant arm but hip is more accurate
Detects as little as 1-3% loss
Non invasive
Lupus
Autoimmune
Dry scaly red raised butterfly rash on face or upper body
Fever
Anorexia
Alopecia
Photosensitive reaction
Need at least 4 symptoms to be diagnosed
Who should stay away from live vaccines
Ra patients and lupus patients
Both patients also go through steroid therapy
Gout
Primary : 90% inborn error of purine metabolism affects more males
Inspect goat only ; too painful to touch
First will have asymptomatic hyperuricemia then acute gouty attack with severe pain especially to great toe (may be swollen or red)
Gout diet
Low purine diet
Avoid organ meat Shellfish Oily fish with bones (sardines) Limit protein Avoid food that seems to trigger attacks (gravy, anchovies, spinach , mushrooms and alcohol)
Increase fluid intake
Osteoporosis drug
Vitamin d
Bisphosphonates : has to be sitting up or standing, take with full glass of water and can’t lay down for atleast 30 mins
Fosamax be careful for esophageal erosion
Paget’s disease
Disorder of bone remodeling in which bone resorption or loss results in bone deposits that are weak, enlarged and disorganized
Will have : bone and joint pain Long bone bowing ( have a short stature) Enlarged thick skull ( sensory deficits ) Pathological fractures (without trauma) Flushed warm skin
Pain worse with weight bearing, in the am, achy
Unpredictable recovery of fractures
Drugs for pagets
NSAIDs
Bisphonates
Calcitonin
Can also use heat Massage Exercise program Pt Orthotic device
Osteomyelitis
Bacteremia usually from cat bites
Will have increased wbc
Need blood culture
Iv antibiotics for few weeks
Contact precautions
May have surgery to minimize disfigurement usually for chronic cases
Osteosarcoma
50% of cases occur in the distal femur followed in decreasing order occurrence by the tibia and humerus
Large tumor causing acute pain and swelling
Center of tumor is hard and around it is soft
Typically metastasizes causing death spreads quickly and aggressively
Involved areas are warm because the blood flow to the site increases
Can happen without Paget’s disease
Carpal tunnel syndrome
Common median nerve becomes compressed in wrist causing pain weakness and numbness
Cts etiology
Excessive hand exercise
Hand burns
Synovitis
Lengthy computer use
Edema
Cts assessments
Pain description (burning that’s worse at night )
Numbness
Paresthesia (painful tingling)
Clumsiness
Fine movement difficulty
Phalens wrist test maneuver and tinels sign
Phalens test and tinels sign
Flex wrist for 60 sec if you feel pain or tingling it’s a positive sign
Tap median nerve and see if there is pain or inflate a bp cuff
Acute compartment syndrome
From internal or external pressure
Internal pressure is blood or fluid accumulation and external pressure is a tight bulky cast
There’s extreme pain her that doesn’t go away with meds
Increased pressure reduces circulation to area
Common place is in tibia and arm
Assess pain, pallor, pulselessness, paralysis, parasythesia and coolness
Fracture intervention
Closed reduction : manipulation of bony ends to realign fracture, anesthesia or analgesia used ; X-ray to verify bone set
Incision site care : aseptic technique with any wound care
Frequent vs, monitor for infection
High protein high calorie diet for healing vitamin supplements high calcium and high iron
Principles of traction
Weights should be hanging freely always
Continuous traction unless something else was ordered
Maintain and assess 4ps : pounds (correct weight) pulleys (rope), pull (straight pull) pressure (every clamp is in tact)
Amputation
Self esteem and body image effected
The higher the level of amputation, the more energy required for ambulation
Etiology of amputation
Usually by trauma
Beta blockers and antidepressants work better than opioids for phantom pain
Sprain
Excessive stretching or tearing of a ligament
Twisting motions usually
Pain and swelling immediately
RICE
heat 2 days later to relieve spasms and help vasodilation
Back pain interventions
Discectomy: can be done with or without fusion ; removes offending portion of disc
Laminectomy : removal of one or more laminae of disc with osteophytes and herniated pulpososes
Drugs for Ra
NSAIDS steroids Biologic response modifiers DMARDS : imuran (immunosuppressant) Remicade Arava Enbrel Humira Rituxan
Fibromyalgia
Chronic fatigue, muscle aches especially at pressure points,
Pregabalin (lyrica)
Help relive pain and helps patient sleep better
Have to be careful with sedation
Bone cancer assessment
Pallor
Fatigue
Anxiety
Fear
