Unit VII part 2 COPY Flashcards Preview

► Med Misc 49 > Unit VII part 2 COPY > Flashcards

Flashcards in Unit VII part 2 COPY Deck (184)
1

Initial infection or an infection lasting less than one month

Acute infection

2

What classification of infection has a high incidence with children less than 12 years old

Acute infection

3

Infection lasting longer than one month or that has failed the initial course of antibiotic therapy for acute osteomyelitis

Chronic infection

4

What classification of infection is seen mostly in adults

Chronic infection

5

What is the most common single pathogen

Staphylococcus aureus

6

What kind of invasion by an organism is caused by open fx, surgery, trauma, GSW?

Direct or exogenous invasion

7

What kind of invasion by an organism is caused by hematogenous, infection from a distal site, usually sen in long bones

Indirect or endogenous invasion

8

What kind of invasion by an organism is caused by soft tissue, decubitus or diabetic ulcers
(surrounding areas)

Extension or contiguous invasion

9

What type of invasion most frequently affects growing bones in young boys (

Indirect

10

What are the most common sites of indirect injury in children

Distal femur
Proximal tibia
Humerus
Radius

11

What are the most common sites of infection because they are vascular

Pelvis & vertebrae

12

Direct entry can occur at any age when there is?

An open wound

13

Metaphysis

Growth plate

14

Where do the microorganisms lodge themselves in the bone

Metaphysics

15

Area of devitalized bone seperates from living bone and forms

Sequestra

16

Part of the periosteum that continues to have blood supply forms new bone

Involucrum

17

Sequestrum

Dead bone

18

Pathophysiology of osteomyelitis

Bacteria enters bone
Inflammation occurs
Purulent material collects within bone
Increased pressure ->pain
Ischemia & vascular
compromise->decrease O2
Bone dies & Sequestrum form
Involucrum grows around Sequestrum

19

Why is Sequestra a haven for bacteria

Unreadable by antibiotics or leukocytes due to pus enclosure

20

Complications of osteomyelitis

Fractures
Chronic infection
Sepsis
Deformities
Brodie's abscess
Amputation

21

What can develop at the epipysis of the bone

Brodie's abscess

22

Where is the most common place for a Brodie's abscess

Tibia

23

S/S acute osteomyelitis

Fever
Chills
Malaise nausea
Restlessness
Bone pain that's unrelieved with rest
Swelling, tenderness & warmth at infection site
Restricted movement of affected part

24

S/S of chronic osteomyelitis

Constant bone pain & swelling
Drainage sinus tract
Local signs more common

25

What are some diagnostic tests done for osteomyelitis

Wound and blood cultures
H & P
Increase WBC (infection)
Increase ESR (inflammation)
Bone scan
X-ray
MRI
CT

26

What is the best tool to use for early diagnosis of osteomyelitis

Bone scan

27

What is the best treatment for osteomyelitis

Vigorous & prolonged IV antibiotic therapy

28

Decompression surgery

Saucerization

29

Use of one drain coming in one going out for continuous or intermittent irritations

Closed wound

30

What kind of wound would you use dressing changes for Debridement
Used for invasion of anerobic organisms

Open wound

31

Are amputations more common in males or females

Males

32

Most puts toons occur where

Lower extremity

33

Lower extremity amputations are caused by ?

PVD (diabetes, atherosclerosis)

34

Upper extremity amputations are caused by?

Trauma
Accidents
Burns
Frostbite

35

Goal of prosthesis

To preserve the most distal level that will heal, try to preserve elbow & knee joints

36

To preserve the most distal level that will heal, try to preserve elbow & knee joints

Goal of prosthesis

37

The level of amputation is determined by

Amount of circulation and presence of infection

38

Are all pt's candidates for prosthesis ?

No

39

Who expends more energy for ambulation amputees or non amputees

Amputees

40

The longer the residual limb, the _______ the energy costs for the amputee

Lower

41

Amputation through a joint

Disarticulation

42

Occurs through ankle @ level of foot, take both malleoli

Syme's amputation

43

BKA

Below knee amputation

44

AKA

Above knee amputation

45

Lower extremity amputation including half of pelvis is removed

Hemipelvectomy

46

Entire shoulder & arm amputated

Forequarter amputation

47

Type of amputation that has actual or potential infection, stump left open for drainage

Open or guillotine

48

Type of amputation that allows weight bearing, no infection present, may or may not have drains

Closed or myoplastic or flap

49

When is a total contact rigid dressing placed on pt

During surgery

50

Aluminum rod that is attached to the ankle piece which is attached to a rigid dressing

Pylon

51

What is a disadvantage of immediate post op prosthesis

Unable to visualize operative site
(infection risk)

52

Delayed prosthesis that decreases edema & begins stump molding for prosthesis

Compression dressing

53

Aching, tingling, or itch in a amputated limb

Phantom sensation

54

Phantom sensation is more frequent in

AKA

55

4 stages of adjustment to loss of body part

Impact
Retreat
Acknowledgement
Reconstruction

56

In what stage does the pt show despair, discouragement, passive acceptance

Impact

57

In what stage of loss does the reality of the amputation become apparent & acute grief is seen

Retreat

58

In what stage does the pt show a willingness to participate in care & rehab

Acknowledgement

59

In what stage does the pt try to reach maximum rehab potential

Reconstruction

60

Most frequent complication of amputations is

Contracture for above the joint amputations

61

What would you do to help prevent deformities

Place the pt prone 3-4 times a day for 30 minutes

62

How long does it take to shrink the stump for a permanent prosthesis

2-3 months

63

What do you want to avoid with amputations to avoid contractures

Dangling
Elevating limb after first 24 hours

64

What are complications of amputations

Injury
Skin breakdown
Pneumonia
Thrombophlebitis

65

More Bone cancer cases each year are found in?

Men

66

More deaths per year from bone cancer occur in

Men

67

Bone cancer effects who more often?

More children then adults

68

Arise in a particular tissue
Originates in the bone

Primary tumor

69

Cancer that spreads to another tissue from the original site

Secondary tumor

70

Is primary or secondary tumor the most common bone cancer?

Secondary tumor

71

What is the most common malignant primary bone tumor seen in adults

Osteosarcoma

72

Osteosarcoma is usually seen in what bones

Distal femur, proximal tibia & proximal humerus (long bones)

73

S/S of osteosarcoma

Pain
Local tenderness
Enlargement of part affected
Limited joint movement

74

Diagnostic studies for osteosarcoma

MRI shows sunburst
Bone scan
Biopsy
Increased calcium & alkaline phosphatase

75

Treatment of osteosarcoma

Radiation
Chemotherapy
Possible amputation

76

Osteosarcoma can metastasis to?

Lungs

77

Tumor of cartilage

Chondrosarcoma

78

Common age group for those diagnosed with chondrosarcoma

30-60 years

79

Chondrosarcoma is usually found where

Pelvis
Proximal femur
Proximal humerus

80

Diagnostic tests for chondrosarcoma

X ray or CT will show thinned bone cortex, bone destruction

81

S/S of chondrosarcoma

Dull pain
Edema
Deformity

82

Treatment for chondrosarcoma

Surgery
Occasional radiation

83

What is the most malignant bone tumor

Ewings sarcoma

84

Rapid growth within the medullary cavity of long bones

Ewings sarcoma

85

Malignant giant cell tumor
Bone destruction & expansion of bone ends

Osteoclastoma

86

Tumor bearing bone is resected & replaced with a cadaver allograft or a custom made prosthesis

Limb salvage

87

Treatment for primary tumors

Chemotherapy

88

Plasma cell myeloma
White blood cell cancer
Produces osteolytic lesions throughout the skeletal system

Multiple myeloma

89

What is common in metastatic cancer to bone
Excessive calcium release as tumor destroys bone
Can lead to heart dysrythmias

Hypercalcemia

90

What is the treatment for hypercalcemia

Diuresis
Flush extra Ca+ out of the body

91

Study of rheumatology

Study of rheumatic disease

92

Any disease or condition involving the muscular skeletal system

Rheumatic disease

93

Inflammation of joint

Arthritis

94

3 types of arthritis

Inflammatory
Degenerative
Metabolic

95

Osteoarthritis

Degenerative disease
Wear & tear disease
Ages 50-70
Disease of articulate cartilage
Cartilage becomes thinner
Joint pain/stiffness 30 min/asymmetrical

96

Osteophyte formation on DIP joints

Heberden's nodes

97

Red, swollen tender nodes on the PIP joints

Bouchard's nodes

98

Remove bits of broken cartilage or bone

Arthroscopy

99

Realignment

Osteotomy

100

Fusion

Arthrodesis

101

Joint replacement

Arthroplasty

102

Rheumatoid arthritis

Inflammatory
Symmetrically
Stiffness 60 minutes

103

Inflammation of the tendon and it's sheath

Tenosynovitis

104

A chronic systematic disease characterized by inflammation of connective tissue in the diarthrodial joints

RA

105

Deformity of hand towards ulnar side

Ulnar drift

106

Flexing of fingers

Boutonnière deformity

107

Deformity of great toe

Hallux vagus
Bunion

108

Hyper extension of joint in fingers

Swan neck deformity

109

Diminished lacrimal and salivary gland secretion

Sjögren syndrome

110

Inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease, blood dyscrasias

Felty syndrome

111

Tissue biopsy

Arthroscopy

112

Anti inflammatory analgesic

Corticosteroid

113

Why can you not stop corticosteroids suddenly

Cause adrenal crisis

114

Anti inflammatory drug
Inhibits synethesid of prostaglandin

NSAIDS

115

Cytoxic agents
Suppression of bone marrow to decrease immune response

Immunosuppressants

116

Decrease inflammatory response
Prevents progression of RA

Disease modifying anti rheumatic drugs (DMARDs)

117

Used for prestant RA
Slows progression of RA
4-6 months to work

Antimalarials

118

Deposit in the pigment layer of retina cause irreversible rental degeneration

Retinopathy

119

Anti inflammatory
IM injection given 5 months

Gold salts

120

Chronic progressive metabolic bone disease characterized by porous bone, low bone mass, structural deterioration of bone tissue

Osteoporosis

121

Why is osteoporosis more common in women than men

Lower calcium intake
Loss body mass
Bone reabsorption begins earlier & increase with menopause
Pregnancy/breast feeding
Women live longer than men

122

Patho of osteoporosis

Bone reabsorption exceeds bone deposition

123

What's the most common osteoporosis diagnostic study

Duel energy X-ray absorptiometry
DEXA

124

T score

1.0- to -1.0 normal bone density
-1.0 to -2.5 low bone density
Osteopenia
-2.5 to -4.0 osteoporosis

125

Measures trabecular & cortical bones at hip & lumbar spine

DEXA
DUAL ENERGY X-RAY ABSORPTIOMETRY

126

Low dose radiation scanner

Single photon absorptiometry

127

How much Ca is needed for Pre menopausal women

1000mg/day

128

How much Ca is needed for post menopausal women

1500mg/day

129

If too much Ca is taken what can happen

Kidney stones

130

Inhibit osteoclasts activity
Mediated bone reabsorption

Biophosphonates

131

Good for pt's with fx helps decrease pain

Calcitonin

132

Treatment for vertebral compression fx

Bed rest
Position of comfort
Muscle relaxant
Local heat
Log roll
OOB ASAP to decrease Ca loss

133

Inadequate mineralization of bone
Vit D deficiency
Bone become abnormally soft

Osteomalacia

134

Ribbons of decalcification in bone
Classic sign of osteomalacia

Loosers transformation zones

135

Chronic bone disease excessive bone reabsorption followed by excessive & abnormal bone replacement
Increase vascularity with bone

Paget's disease

136

When you have an Increase of Alkaline phosphatase it is because of

Excessive bone building

137

Chronic progressive inflammatory disease of the spine & sacroiliac joint
Found in men more

Ankylosing spondylitis

138

Inflammation of spine

Spondylitis

139

Fuse

Ankylosis

140

Kyphosis

Round back

141

A genetic marker found in AS

HLA B27
Human leukocyte antigen

142

Treatment goal of Ankylosing spondylitis

Maintain maximal skeletal mobility

143

Self limiting disease associated with arthritis, urethritis & conjunctivitis

Reiters syndrome

144

Invasion of synovial membranes with micro organisms
Septic arthritis

Bacterial arthritis

145

Joint aspiration

Arthrocentesis

146

Result of prolonged hyperuricemia
Increase uric acid

Gout

147

Inflammation of great toe

Podagra

148

Multiple joint involvement with deposites of sodium irate crystals

Chronic gout

149

Irate crystals

Tophi

150

Prevent future gout attacks

Avoid etoh, high purine food

Chicken, sardines, organ meats

151

Disorder of the connective tissue characterized by fibrotic degenerative & inflammatory changes in skin, blood vessels, synovium skeletal muscle & internal organs

Scleroderma

152

Skin thickening on the trunk face and proximal & distal extremities

Diffuse scleroderma

153

Thick skin limited to sites distal to the elbow & knees but also involves face & neck

Limited scleroderma

154

CREST

Calcinosis (Ca deposits)
Raynauds phenomenon red white blue
Esophageal desmotility
Sclerodactyly scleroderma of digits
Telangiectasis benign tumor of blood vessels

155

Chronic progressive inflammatory multi system disease of connective tissue

Lupus

156

Classic sign of lupus

Butterfly rash

157

Inflammatory disease involving voluntary muscles also a
Degeneration of muscle fibers

Polymyositis
Proximal muscles are affected first

158

Dusky red rash on face neck shoulders anterior chest upper back & arms

Dermatomyositis

159

Autoimmune response
Inflammation & dysfunction of the exocrine glands
Salivary & lacrimal glands

Sjögren syndrome

160

What allows for NWB ambulation

Crutches

161

What provides solid support helps with balance problems

Walkers

162

What hand do you hold the cane in

Opposite the involved extremity

163

Cane should be where?

Top of the greater trochanter

164

Crutches up/down the steps

Up with good
Down with bad

165

Joint movement

Isotonic

166

Muscle setting exercise

Isometric

167

Goals of surgery

Relieve pain
Improve joint motion
Remove debris
Correct deformity

168

Insertion of endoscope into a joint for direct visualization of joint

Arthroscopy

169

Removal of synovial membrane

Synovectomy

170

Cutting a bone to change its alignment

Osteotomy

171

Removal of degenerative debris

Debridement

172

Surgical fusion of joint

Arthrodesis

173

Joint exploration

Arthrotomy

174

Cutting tendon

Tenotomy

175

Movement of a tendon insertion to improvement function

Tendon transfer

176

Reconstruction or replacement of joint

Arthroplasty

177

Replacement of part of a joint

Hemiarthroplasty

178

Peak time for fat embolus

4th post op day 72 hours

179

Closed wound drainage system

Hemovac

180

What is the most complex joint in the body

Ball & socket

181

A body part that has been totally severed from the body by trauma, surgery or a congenital abnormality

Amputation

182

What can help with arthritic joints

Exercise
Balanced nutrition
Weight loss
Drug therapy
Hot/cold therapy
Rest
Joint protection

183

Sublaxation

Partial dislocation

184

Infection of bone and/or bone marrow
Direct or indirect invasion by an organism

Osteomyelitis