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

Osteoporosis&Foot Neuropathy Flashcards

(82 cards)

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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: What medications put you at high risk for osteoporosis? (3)
1. Steroids 2. Aromatase inhibitors 3. Androgen deprivation therapy
17
Q: What are the mortality rates 1 and 5 years after amputation?
40%, 80%
19
Q: What is FRAX?
Fracture Risk Assessment Tool
20
Q: When does bone mass begin to decline?
Around 50 yo
21
Content: Charcot Arthropathy (4)
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
22
Q: How many million individuals in the US are affected by osteoporosis?
10 million
23
Content: Exercise recommendations for foot neuropathy
At least 30 min most days - consider foot integrity
25
Content: Vitamin D supplementation (5)
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
26
Content: Assessment - Low Risk Foot Neuropathy (4)
1. Preserved sensation 2. No defromity 3. Intact circulation 4 Tx: Annual foot exam, education, good footwear
28
T/F: For every standard deviation below the norm, the risk of fractures triples.
False: doubles
29
Content: Goals of the foot exam (4)
1. Est. history/diagnostic factors 2. Identify risks 3. Intervention 4. Education
30
Content: Assessment - High Risk Foot Neuropathy (6)
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
Content: Education (4)
1. General diabetes self care 2. Foot/skin care 3. Daily skin checks 4. Proper footwear (breathable, adjustable, wide toe box, good support)
31
Diagram: Identify the Deformity
Claw toes
32
Q: What habit can increase your risk of neuropathy?
smoking (current or past)
33
Content: Risk factors for Osteoporosis (10 - general idea)
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
Content: Sensation assessment (2)
1. Semmes Weinstein Monofilament (10 locations) 2. Vibratory sensation (128 Hz tuning fork, latency \> 10 sec = sensory loss)
35
Diagram: Identify the Deformity
Hammer toe
37
Content: Types of Bisphosphonates (4)
1. Alendronate -wkly 2. Risedronate - wkly/moly 3. Ibandronate - moly/IV every 3 mo 4. Zolendronic Acid - IV annually
38
T/F: Neuropathy is implicated in 25% of non-traumatic amputations.
False, 50-75%
39
Content: Toenails (3)
1. Thickened 2. Deformed 3. Ingrown
41
Content: Primary Osteoporosis (2)
1. unrelated to chronic illness 2. Related to aging and decreased gonadal function
41
Q: What is HbA1c?
Average blood sugar over a peroid of 3 months
42
Defn: Hammer toe
Hyperextension of MTP and DIP
43
Content: glycemic control recommendations for foot neuropathy
HbA1c goal of \< 6.5-7
44
Q: When does bone mass peak?
Between 20-25 yo
45
Q: What type of training increased spine BMD?
Resistance
46
Content: Causes of neuropathy (6)
1. Diabetes 2. Tumor, trauma 3. Autoimmune disease 4. Vitamin B, E, niacin deficiency 5. Exposure to toxins 6. Infection
47
Content: OE for foot neuropathy (5)
1. Condition of skin, hair, toenails 2. Deformities 3. Pulses 4. Sensation 5. Shoe wear
48
Diagram: Identify the Deformity
Hallux Valgus
49
Content: Nutrition recommendations for foot neuropathy (4)
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: What imaging is often used to identify osteoporosis?
DEXA
51
Q: For bone health how often should bone density be evaluated?
On treatment = every 1-2 years Not on treatment = every 2 years
53
Defn: Z-score
number of standard deviations from age matched mean density
55
Content: TUG (5)
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
Content: Offloading (5)
1. Total contact casts (change ever 1-2 wks) 2. Orthotics/walking boots 3. Surgical shoes 4. Dressings 5. Cutouts
57
Q: How should you elevate a pts. heels?
With pillow under calves
59
Content: SE for foot neuropathy (7)
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
Content: Ulcer intervention (4)
1. Debulk callus 2. Control moisture 3. Decrease infection risk 4. Edema management
62
T/F: WB activities decrease BMD.
False
64
Q: What T-score indicated osteopenia?
-1 to -2.5
65
Q: What is BMD?
Body mass density - comes from a DEXA test
66
Q: How much Ca is in 8 oz of milk?
300 mg
67
Cotent: ABI Scale (6 parts)
\> 1.2 = vessels are incompressible, consider toe brachial indexes 1. 0-1.2 = normal 0. 9-0.99 = acceptable \< 0.9 = arterial disease 0.5-0.8 = intermittent claudication \< 0.5 = severe arterial disease
68
Defn: T-score
number of standard deviations from the young adult mean density
69
Content: Hair
May be present or absent
70
T/F: FRAX is the treatment decision making tool in previously treated pts.
False, untreated
71
T/F: Menstraul cycle effects gains in BMD.
True
72
Q: When does the z-score apply for osteoporosis?
pre-menopausal females and males \< 50
73
Content: Calcium citrate
Can be taken with or without food
74
Content: Calcium supplements (2)
1. Limit to ~500 mg in a dose 2. May cause constipation
75
Q: Who will be referred to PT for osteoporosis type treatment?
Those at increased risk or fall, unstable gait, weakness
76
Q: What % of those with diabetes will develop neuropathy?
50%
77
Q: What type of training increased hip BMD?
high impact
78
Content: Secondary osteoporosis (2)
1. Secondary to chronic illnesses/meds that cause accelerated bone loss 2. Ex. glucocorticoid use, hyperthyroidism
80
Content: 4 types of neuropathy
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: Who could you refer pts. with foot neuropathy to? (4)
1. Podiatry 2. Wound care 3. Nurse educator 4. Dietician
82
Content: Denosumab (3)
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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