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musculoskeletal study guide

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2. WHAT IS THE BASIC PATHOS OF GOUT?
a. purine (protein) metabolism is altered & the by-product uric acid accumulates
b. increased uric acid leads to tophi deposits on joints which triggers an immune response which leads to necrosis or fibrosis
3. WHAT IS PRIMARY GOUT?
a. Inherited defect: increased or decreased renal excretion
b. It’s caused by a genetic defect in purine metabolism causing hypercemia or retention of uric acid
4. WHICH POPULATION IS AT RISK FOR PRIMARY GOUT?
a. 30 yrs to 40yrs
5. WHAT IS SECONDARY GOUT?
a. developes during the course of other diseases: obesity, type 2 diabetes, hypertension, renal failure, cancer
b. hematopoeitic, starvation, radiation, chemo, meds: ASA, diueretics, anti-tb
6. WHERE DOES SECONDARY GOUT ACCUMALATE?
a. myocardium, blood, synovial fluid, ears, kidney
7. WHAT IS TOPHI AND WHERE IS IT DEPOSITED?
a. uric acid crystals deposited in connective tissue
8. HOW DO YOU DIAGNOSE GOUT?
a. persistent hyperuricemia, arthrocentesisi: tophi in synovial fluid
9. WHAT ARE 3 THINGS A NURSE MANAGES FOR GOUT?
a. pain control
b. bed rest
c. assistive devices for ambulation
10. WHAT ARE THE PHARMACOLOGICAL TREATMENTS USED TO MANAGE GOUT?
a. pain: NSAIDS
b. inflammation: colchine, corticosteroids injections
c. decrease acid levels: allopurinol, probenecide, indomethicin
11. WHICH MEDICATIONS ARE USED TO LOWER URIC ACID?
a. decrease formation: allopurinol, no for renal failure
b. increase reabsorption and excretion: probenecide, sulfinpyrazone
12. WHAT IS THE MAIN PHARMACOLOGICAL TREATMENT USED TO MANAGE AN ACUTE ATTACK OF GOUT?
a. colchicine: prevents recurrent acute attacks until uric acid is back to normal level
b. q 8 hrs PO/IV
13. WHAT MUST YOU REMEMBER ABOUT COLCHICINE?
a. toxic dose close to therapuetic
14. WHAT ARE THE SIGNS AND SYMPTOMS OF COLCHICINE TOXICITY?
a. nausea, vomiting, diarrhea
15. WHAT ARE THE NON-PHARMACOLOGICAL TREATMENTS USED TO HELP MANAGE GOUT?
a. hot/cold application
b. diet low in purine
c. weight loss
16. WHAT ARE SOME LONG-TERM INTERVENTIONS USED TO MANAGE GOUT?
a. meds
b. avoid alcohol
c. diet low in purines (anchovies, lentils, alcohol)
d. oral fluid
17. WHAT ARE THE LONG-TERM AFFECTS OF INDOCIN AND COLCHICINE?
a. bone marrow suppression
b. alopecia
c. hepatic damage
18. WHAT IS ARTHROPLASTY?
a. replacement of a joint with a prosthetic
19. WHAT IS OSTEOPLASTY?
a. scraping off degenerative bone (OA
20. WHAT WOULD YOU ASSESS THE NEUROVASCULAR SYSTEM FOR WHEN CONSIDERING THE MUSCULOSKELETAL SYSTEM
a. pain
b. pallor
c. temperature
d. pulses
e. capillary refill
f. paresthesia
g. mobility of affected joints: crepitation, muscle shotening, ankylosis
h. sensation and motor function of peripheral nerves: strength aagainst resistence, posture, natural directional movement, balance, coordination, picking things up
21. WHAT ARE THE DIAGNOSTIC/LAB TESTS FOR OA?
a. x-ray: shows narrowing joint space by erosion of cartilage, osteophytes
b. Synovial fluid analysis: rules out inflammatory arthritis (rheumatoid arthritis)
22. WHAT ARE THE LAB TESTS FOR OP?
a. usually made after a fracture, vertebral compression fracture
b. x-ray: vatebral bodies appear flattened, collapsed, wedged
23. WHAT IS ARTHROSCOPY?
a. evaluate the knee by visuliaztion
b. biopsy lg scope can remove articular debris, repair torn meniscus
24. WHAT ARE THE LAB TESTS FOR RA?
a. +RF
b. x-ray: demineralization, soft tissue swelling
c. synovial fluid analysis: increased complement, volume, turbidity
d. –lyme titer
e. ESR elevated
25. WHAT IS OSTEOMYELITIS?
a. bone infection: caused by virus, staph
b. breakdown and decalcification
c. acute, chronic, usually localized
26. IN WHAT PART OF THE BODY DOES OSTEOMYELITIS OCCUR?
a. femur, tibia, sacrum, heels
27. WHICH POPULATIONS ARE AFFECTED BY OSTEOMYELITIS?
a. males
b. rapidly growing boys
28. WHAT ARE THE GENERAL RISK FACTORS FOR SUSCEPTIBILITY OF OSTEOMYELITIS?
a. IV use
b. Diabetes
c. Immunocompramised
d. History of blood stream infection
e. Pressure ulcer, chronic wounds
29. WHAT ARE THE LAB TESTS USED TO ASSESS OSTEOMYELITIS?
elevated WBC, ESR
30. WHAT ARE THE DIAGNOSTIC TESTS FOR OSTEOMYELITIS?
. x-ray
31. WHAT ARE THE WAYS OF MANAGING OSTEOMYELITIS?
surgery, ABs
32. WHAT IS SEPTIC ARTHRITIS?
a. bone infection
b. pyrogenic in synovial membrane: neissra gonorrhea, staph
33. WHAT ARE THE 10 CLINICAL MANIFESTATIONS OF A FRACTURE?
a. deformity
b. swelling
c. bruising
d. muscle spasm
e. pain
f. tenderness
g. loss of function
h. abnormal mobility, crepitus
i. neurovascular changes
j. shock
WHAT ARE THE TREATMENTS FOR MANAGEMENT OF FRACTURES?
a. Assessment, monitor complications
b. reduction, stabilization, immobilization of fracture
c. remobilization, rehabilitation
d. restore alignment: open reduction & internal fixation, casts, splints, traction
35. WHAT ARE THE11 MAJOR COMPLICATIONS AFTER A FRACTURE?
a. nerve injury
b. compartment syndrome
c. volkman’s contracture
d. fat embolism syndrome
e. DVT
f. Infection
g. Cast syndrome
h. Long term: joint stiffness, post-traumatic arthritis
i. Avascular necrosis
j. Unions: non-functional union, malunion, delayed union, non-union, fibrous union
k. Complex regional pain syndrome
40. WHAT ARE THE MAJOR NURSING ASSESSMENTS OF A CLIENT IN A CAST?
a. assessment: neurovascular, pain, cast, complications
b. drying a cast
41. WHAT IS THE LEADING CAUSE OF MORBIDITY/MORTALITY FOR THE OLDER POPULATION?
hip fractures
42. WHAT FACTORS PREDISPOSE ONE TO A HIP FRACTURE?
a.low bone mass
b. increasing age
43. DECREASED BLOOD FLOW TO THE HIP PUTS A PATIENT AT RISK FOR WHAT?
a. necrosis to the hip area
44. WHAT ARE THE DIAGNOSTIC TESTS USED FOR HIP FRACTURES?
a. history
b. x-ray
c. ct
d. mr
i
45. WHAT ARE THE DIFINING CHARACTERSITICS OF OSTEOARTHRITIS?
common, not systemic, chronic
b. stiffness, morning, after exercise
c. achieness weather
d. crepitus, motion
e. narrowed joint space
f. pain/stiffness inc w/activity dec w/rest
g. mild tenderness joint area
h. dec ROM
i. joint enlrg
46. WHICH POPULATIONS ARE AFFECTED BY OSTEOARTHRITIS?
a. symp middle age, progress with age
b. 65yrs <
c. obesity (knees) disability in lower extremities due to effects on lg wt bearing joints
d. PT no hist. of joint inj or disease, nor systemic ill assoc w/arthritis
47. WHAT ARE THE TWO TYPES OF OSTEOARTHRITIS AND WHICH POPULATIONS ARE AFFECTED BY THEM?
a. Primary: (idiopathic) norm aging, mostly women, genetic
b. Secondary: mostly men, pre-disposing event ex. trauma, Paget’s leads to degenerative changes
49. WHAT IS A COMMON REGIMEN USED TO TREAT OA?
a. Exercise-regular, stimulates cartilage growth, protects joints, weight bearing creates support
50. WHAT IS USED TO MANAGE OA AND RHEUMATOID ARTHRITIS?
a. Pain and Inflamation relief
b. Dec joint stress
c. low impact exercise
d. independent ADL
e. Maintain quality of life
f. cane, brace, neoprene, collar, corset
g. apply Heat Cold
51. WHAT MEDICATIONS ARE USED TO HELP MANAGE OA AND RHEUMATOID ARTHRITIS?
a. TYLENOL oa
b. NSAIDS rheumatoid
c. worse oa nsaids w/ misoprostol(cytotec), celebrex(cox2)
d. viscosupplementation (hyaluronan) injection-OA, glucosamine + chrondroitin, sam-e
53. WHAT ARE 4 SURGICAL INTERVENTIONS USED TO HELP MANAGE OA?
a. Osteotomy: bone excision
b. Arthrodesis: bone fusion, laminectomy
c. Arthroplasty: prosthetic, knee hip
54. WHAT ARE THE OA POST-OPERATIVE NURSING RESPOSIBILITIES?
a. pain
b. mobility
c. peripheral neurovascar care
d. prevent: injury, infection, skin breakdown, DVT
e. promote: self care
55. WHAT IS RHEUMATOID ARTHRITIS?
a. degenerative, chronic, progressive, acute episodes of exacerbations
b. similar pathos to OA but SYSTEMIC
auto-immune: complement and attacks muscle/ligaments too
c. synovial effusion common
56. WHICH AREAS OF THE BODY DOES IT AFFECT?
a. small joints PIP, MCP
b. knees, wrists
58. WHICH POPULATIONS ARE AFFECTED BY RHEUMATOID ARTHRITIS?
a. avg/below wt
b. young/mid age
c. women more
d. family history
59. WHAT TREATMENTS ARE USED TO MANAGE RHEUMATOID ARTHRITIS?
a. inflammation reduction, NSAIDs
b. diet exercise
c. hot/cold app
d. sugery
60. WHAT ARE THE CHARACTERISTICS OF OSTEOPOROSIS?
a. bones loose CA+ and PO and become susceptible to fractures
b. diagnoses after fracture, or xray
c. metabolic bone disorder
61. WHAT ARE THE COMPONENTS OF BONE STRENGHT CONSIDERED WITH CONCERNS TO OP?
a. bone density and quality
b. Porous and brittle, re-absorption inc as formation dec
62. WHAT IS OSTEOPENIA?
a. thinning of bone, low density porous and brittle
b. may lead to/first symptoms of osteoporosis
63. THE WHO DEVELOPED 4 LEVELS OF CATEGORIES THAT DETERMINE WHAT?
a. WHO
b. risk of fracture
64. WHICH POPULATIONS ARE AFFECTED BY OP?
a. postmenses white women, US
b. reduction of estrogen
65. WHAT ARE THE RISK FACTORS FOR OP?
a. previous adult fracture, fragile bones, low weight (128), smoking, oral contraceptives
66. WHAT ARE SOME MANIFESTATIONS OF OP?
a. shortened stature
b. kyphosis
c. ab distension
d. bloating
e. restricted RR by rest. Lung expanse
f. chronic pain
g. func. diasbility
67. WHAT ARE THREE MAJOR OP PREVENTIONS AND/OR TREATMENTS?
a. prevent bone loss and fragility fractures:
i. CA+, vit D, reg Weight Bearing exercise, avoid tobacco, alcohol
ii. back brace, exercise
iii. meds: estrogen: hormone replacment therapy
aledronate, raloxifene, risedronate, calcitonin, teriparatide
68. WHAT ARE 6 MAJOR NURSING RESPONSIBILITIES USED TO PROMOTE HEALING AFTER A FRACTURE?
a. manage pain
b. regain mobility and strength
c. promote healing
d. reduce bone loss
e. prevent further fracture
f. limit the disability
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