Orthopedic Nurse Certification Exam 234 Questions with Verified Answers
Dermatomyositis - CORRECT ANSWER chronic systemic immunological disease
... [Show More] involving inflammation of the skin, connective tissue, and muscles,
causes widespread skin rash and permanent bumps underneath skin
Polymyositis/Dermatomyositis S/S - CORRECT ANSWER -Muscle weakness
-Red or purple symmetric rash (heliotrope)
-Scaly, smooth, or raised rash on knuckles and sides of hand (gottron's papules)
-Joint redness, pain, and inflammation and decreased ROM
-Weakened pharyngeal muscles
Polymyositis/Dermatomyositis Care - CORRECT ANSWER -Biopsy for dx
-Long term corticosteroids
-Immunosuppressive drugs
-IV immunoglobulin (hydrate patient well, may get HA)
Fibromyalgia S/S - CORRECT ANSWER *Chronic musculoskeletal syndrome*
-Widespread burning and gnawing, joint and muscle pain, fatigue, "tender points" (↑ sensitivity to touch)
-*Begins with a flu-like viral illness*
-Lower pain threshold
*ABSENCE of inflammation*
-Cognitive difficulties
-RLS
-IBS
Fibromyalgia Diagnosis - CORRECT ANSWER Two criteria are met: pain is experienced in 11 of the 18 tender pints on palpation and a history of widespread pain for at least 3 months
Fibromyalgia treatment - CORRECT ANSWER -Rest
-Lyrica, Cymbalta, Savella
-Antidepressants
-Benzos
-Massage
-Heat and cold packs
-Stretching
-Limit sugar, caffeine, and alcohol
Osteoarthritis (OA) - CORRECT ANSWER -Formation of bone spurs and osteophytes
-Inflammation of the joint
-Breakdown of cartilage
Symptoms of OA - CORRECT ANSWER -Pain & Stiffness: worse in the morning for <30 min, prolonged inactivity or weather changes
-Locking, cracking, grinding, or feeling of giving out of knees
-Swelling, nodules or stiffness of fingers and difficulty gripping, Herberden's nodes, Bouchard's nodes, bowlegged, knock-knees
Goals of management of OA - CORRECT ANSWER -Reduce pain and inflammation
-Maintain joint function
Diagnostics of OA - CORRECT ANSWER -X-ray
-MRI
-Joint aspiration
-CT
Treatment of OA - CORRECT ANSWER -Maintain ROM
-Increase muscle strength
-Reduce stress on joints
-Heat and cold
-Glucosamine
-Stretching
-Weight control
-Topical analgesic-Capsaicin cream, bengay, Icy hot
-Corticosteroid injection: lasts 3-4 weeks
-Viscosupplementation: Lasts 6 months
-Arthroscopy
Salicylate - CORRECT ANSWER -Aspirin
-Anti-inflammatory, Analgesic, Antipyretic
-Administer with food or full glass of water
-Monitor for bleeding
NSAIDs - CORRECT ANSWER -Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac, celecoxib
-Anti-inflammatory, Analgesic, Antipyretic
-Administer with food
-Monitor for signs of bleeding or GI upset
Doxycycline - CORRECT ANSWER -Decreases action of enzymes on cartilage degradation
Minocycline - CORRECT ANSWER -Antirheumatic effect
Capsaicin cream - CORRECT ANSWER -Must be used at regular intervals for maximal effect
-Aloe Vera cream may decrease burning sensation
-Do not use with external heat source
Corticosteroids intraarticular injections - CORRECT ANSWER -Depo-Medrol, Aristospan
-Antiinflammatory, Analgesic
-Joint may feel worse right after injection
-Avoid overusing joint immediately after injection
-Improvement last weeks to months after injection
Systemic Corticosteroids - CORRECT ANSWER -Hydrocortisone, Methylprednisolone, dexamethasone, Prednisone, Triamcinolone
-Antiinflammatory, Analgesic
-Use only with severe exacerbation
-Symptoms return with abrupt withdraw
-Monitor BP, weight, CBC, Serum potassium
-Limit sodium intake
DMARDs - CORRECT ANSWER -Methotrexate: Monitor CBC and hepatic and renal function and for anemia. Teratogenic
-Azulfidine: May cause orange-yellow skin or urine. Take with full glass of water. Continue after symptoms relieved. Monitor CBC
-Arava: Monitor hepatic function. Avoid pregnancy
-Penicillamine: Monitor WBC, platelets, UA. Take 1hr before or 2hrs after eating and an hour away from any med
Gold Compund - CORRECT ANSWER -Rule out pregnancy
-Monitor CBC, UA, hepatic and renal function
-Therapeutic response may take 3-6 months
-Report pruritus, rash, sore mouth, indigestion, metallic taste
Plaquenil - CORRECT ANSWER -Monitor CBC and hepatic function
-May take up to 6 months to work
-Report visual difficulties, muscular weakness, and decreased hearing or tinnitus
Complications after Total Joint Replacement - CORRECT ANSWER PE
DVT
Trendelenburg Sign and Gait - CORRECT ANSWER pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction
(superior gluteal nerve--->gluteus medial and minimus)
Chronic back pain treatment - CORRECT ANSWER -No Bed rest
-Stretching
-ROM
-Non-weight bearing exercises
-Cold for first 48-72 hrs then heat
-TENS
Post op hip precautions - CORRECT ANSWER Anterior approach- no exteral rotation of knees/ankles, no turning towars operative side while walking, no abduction
Posterior approach- no bending >90. Do not sit cross-legged, no internal rotation
Chronic Rotator Cuff Tear - CORRECT ANSWER -OA of shoulder
-Pain increases through time
Rotator Cuff Injury - CORRECT ANSWER -Symptoms: shoulder weakness, pain, decreased ROM, pain with abduction between 60-120 degrees, a positive drop arm test (abducted 90 deg and pt to slowly lower arm, if drops, then posistive)
-Dx: MRI
-Tx: Rest, Ice, and heat, NSAIDs, Corticosteroid injections, and PT, if not effective or a complete tear then surgery, post op a sling and pendulum exercises.
-6 months to recover from surgery
CPM Machine - CORRECT ANSWER -Used to reduce stiffness and for return of ROM
-Applied 6hr out of 24hrs
-If resisted the cycle will stop
Chondromalacia Patellae - CORRECT ANSWER -Patellofemoral syndrome
-Underside or backside of kneecap is roughened
-Causes pain when the kneecap runs over femur
-Caused by heavy use of joint, trauma, week thighs or quads
Bunions - CORRECT ANSWER -Hallux Valgus
-Lateral deviation of the MTP(metatarsal phalangeal) of great toe
-Due to poor fitting shoes
-Tx: wider fitting shoes, shoe inserts, anti-inflammatory and analgesics
spondylolisthesis - CORRECT ANSWER -Pain worse with waist movements and lifting
-Can radiate to leg and if severe cause bowel and bladder changes
Herniated disc - CORRECT ANSWER -Pain sudden, radiates to leg and is worse with sitting, bending forward and sneezing
-May have sensory changes and strength in extremity
Spinal Stenosis - CORRECT ANSWER -Pain is worse when back is straight or extended lying supine or when walking
-Pain can radiate to both legs
narrowing of the spinal canal with compression of nerve roots
Low back pain Conservative therapy - CORRECT ANSWER -Nsaids
-Muscle relaxer
-Narcotics
-Activity restrictions: No heavy or repetitive lifting, no twisting, no bending at the waist
-No bedrest
-Ice/heat
-Massage
-Stretching
-Topical creams
-PT
Tests for Low back pain - CORRECT ANSWER -Toe-Walk test: If unable to toe walk, S1 problem
-Heel walk: L5 problem
-Patellar reflex decreased: L5 prob
-Achilles reflex decreased: L1 prob
-Straight leg test: nerve entrapment at any lumbar level
C6 Nerve - CORRECT ANSWER -Neck injury or degeneration
-Pain and decreased sensation that radiates down the arm into the thumb
-Muscle weakness in the biceps and wrist extension
brachioradialis reflex decreased
C7 Nerve - CORRECT ANSWER -Pain or numbness that travels to the third finger
-Decreased triceps reflex
Cervical Traction - CORRECT ANSWER -Used at home to decrease pain
-Used in hospital to immobilize pre or postsurgical
Cervical collar - CORRECT ANSWER -Used to immobilize neck
-OA
-Cervical spondylosis
-Whiplash injuries
DIP joint - CORRECT ANSWER -Distal interphalangeal joint
-Finger joint most distal from the body
PIP joint - CORRECT ANSWER -Proximal interphalangeal joint
-Finger joint closest to the body
MCP - CORRECT ANSWER -Metacarpophalangeal joint
-Finger joint that connects the metacarpal bones to the phalanges
-Proximal to the PIP joints
Herberden's nodes - CORRECT ANSWER -Bony growth at the DIP joint
-Seen in OA
-Rarely painful and not progressive
Bouchard's nodes - CORRECT ANSWER -Bony nodule growth at the PIP joint
-Seen in OA
MTP joint - CORRECT ANSWER -Metatarsophalangeal joint
-Joint at the base of the toes where to toe meets the foot
Hallux Rigidus - CORRECT ANSWER Condition in which degenerative arthritis affects the metatarsophalangeal (MTP) joint at the base of the big toe, causing pain and stiffness
Spondylolisthesis - CORRECT ANSWER Forward slipping of one vertebra over another
herniated nucleus pulposus - CORRECT ANSWER -Herniated disk
-Disc bulges through the spinal canal, narrowing it
Stellate fracture - CORRECT ANSWER A fracture that forms a star-like pattern
Acetabulum - CORRECT ANSWER Hip socket
Gustilo-Anderson classification system - CORRECT ANSWER Type 1-soft tissue damage minimal <1cm
Type 4- High level of amputation
nonunion fracture - CORRECT ANSWER Break in a bone that has failed to unite and heal after 5 months
mallet finger injury - CORRECT ANSWER -Jammed finger
Tx: splint finger for 8 weeks and then splint nightly
Contraindications for Open reduction - CORRECT ANSWER -Infection
-Loss of bone density
-Bony fragments to small for fixation device
-Limited surrounding soft tissue
-Multiple uncontrolled comorbidities
Indications for limb amputation - CORRECT ANSWER -Crush injury with >6hs loss of blood supply
-If main nerve supplying the limb is completely severed
5 stages of fracture healing - CORRECT ANSWER • Stage 1 - Fracture hematoma (24-72 hrs.)
• Stage 2 - occurs in 3 days to 2 weeks when granulation forms at tissue
• Stage 3 - 2 weeks to 6 weeks; new vascularization forms (Callus formation)
• Stage 4 - may take 3 weeks to 6 months callus is resorbed and made to bone (Ossification)
• Stage 5 - 4-5 weeks after fracture up to 1 yr. Consolidation and reformation of bone
Cast care - CORRECT ANSWER -Don't cover until dry, handle with palms of hands, don't rest on hard surfaces,
-Keep above level of heart,
-Check pulses, color , sensation.
-Complication of cast is numbness, tingling, no pulses, bluish color of the skin
Electrical bone growth stimulation - CORRECT ANSWER -Used to facilitate healing process, especially for fracture nonunion or delayed union
-Can be noninvasive or invasive
-Works by increasing calcium uptake of bone and increasing the production
MESS - CORRECT ANSWER Mangles Extremity Severity Score
1. Amount of injury
2. Blood supply affected
3. Amount of shock sustained
4. Age of patient
>7 means amputation
Autoamputation - CORRECT ANSWER The spontaneous detachment of a body part
transcutaneous oxygen pressure determination - CORRECT ANSWER Noninvasive and used to predict healing
Ankle-Brachial Index (ABI) - CORRECT ANSWER Ratio of the ankle systolic pressure to the brachial systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis
An ABI of <1 indicates narrowing of a vessel in the leg
Angiogram - CORRECT ANSWER The radiographic visualization of blood vessels after the injection of radiopaque substance.
Phantom Limb Pain - CORRECT ANSWER -Can be self limiting
-Tx: medication, desensitization, electrical stimulation, counseling, hypnosis, acupuncture, and nerve block
Stump care - CORRECT ANSWER -Once daily washing
-Avoid excessive washing
-Thoroughly dry
-Massage
-If break in the skin then air for 1hr 4 times a day
-Ace bandages
-Shrinker socks
-Rigid dressing
Pelvic Fracture - CORRECT ANSWER -High mortality rate
-Abd may have swelling, tenderness, deformity, unusual pelvic movement and ecchymosis
-Asses bowel and bladder function
Dx: X-ray and CT
Tx: Bed rest with use of pelvic sling for a few days in a stable, nondisplaced fracture. External fixation or ORIF for open or nonstable fracture.
Hip Fracture - CORRECT ANSWER -1 in 5 people die within a year
-S/S: External rotation, muscle spasm, shortening of affected extremity, severe pain around fracture site
Interventions: Buck's traction before surgery, surgery
Stable Vertebral Fracture - CORRECT ANSWER -Logrolling
-Monitor signs of spinal cord involvement
-Brace
-Possible Vertebroplasty or balloon kyphoplasty
Syme's amputation - CORRECT ANSWER the removal of the foot at the ankle
Guillotine amputation - CORRECT ANSWER Limb or portion of a limb is severed from the body, and the wound is left open; a type of open amputation.
Osteomyelitis - CORRECT ANSWER -Infection of the bone
-Sequestra (dead bone separated from living bone) form and blood supply is cut off from it
-Involucrum (new bone growth from new blood supply) forms
Osteomyelitis S/S - CORRECT ANSWER -Bone pain
-Swelling
-Tenderness
-Warmth
-Restricted movement
-Fever
-Night sweats
-Chills
-Restlessness
-Nausea
-Malaise
-Pus at site
Osteomyelitis Diagnostics - CORRECT ANSWER -Biopsy
-Elevated WBC, CRP, and ESR
-CT
-MRI
Osteomyelitis Treatment - CORRECT ANSWER -IV antibiotics after culture drawn
-I&D
-Oral Cipro for chronic osteomyelitis
-Antibiotic beads
-Wound vac
-Hyperbaric O2
-If severe then amputation
Gentamicin Considerations - CORRECT ANSWER -Used for osteomyelitis
-Effects renal function
-Toxicity causes inner ear problems
Tobramycin and neomycin reactions - CORRECT ANSWER -Hearing deficit
-Impaired renal function
-Neurotoxicity
Cephalosporins reactions - CORRECT ANSWER -Hives
-Watery diarrhea
-Blood in stools
-Throat or mouth sores
Levaquin reaction - CORRECT ANSWER Tendonitis or tendon rupture
Arthrodesis - CORRECT ANSWER Surgical fusion of a joint which stabilizes but immobilizes the joint
Disarticulation - CORRECT ANSWER Amputation through a joint
Colles fracture - CORRECT ANSWER -Fracture of the distal radius at the wrist
-Tx: immobilization, open or closed reduction with a sugar-tong splint, Ice, Elevation, anti-inflammatories
-Confirmed with x-ray and repeat x-ray in one week, if improved then apply short-arm cast 4-6 weeks
Diaphyseal or shaft fracture - CORRECT ANSWER -Fracture of the middle of the shaft of humerus
-Closed reduction is common with cast or splint and sling
Anatomic neck fracture - CORRECT ANSWER -Break at the metaphysis of the humerus
-Sling application and rehab
Surgical neck fracture - CORRECT ANSWER -Fracture below the anatomic neck or below the metaphysis
-Closed reduction and sling application
Scaphoid fracture - CORRECT ANSWER -A break in the scaphoid bone in the thumb
-X-ray may not show fracture
-Tenderness in the anatomical snuff box
-Tx: immobilization with a radial gutter splint or ventral splint with thumb spica, possible open reduction and screw placement
Boxer's fracture - CORRECT ANSWER -5th metacarpal fracture
-X-ray is diagnostic
-Ulnar gutter splint extending distal to PIP joint
Anatomical Snuff box - CORRECT ANSWER Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus
Subluxation - CORRECT ANSWER partial dislocation
Avulsion fracture - CORRECT ANSWER fragment of bone chipped away from the main bone
greenstick fx - CORRECT ANSWER incomplete fx
impacted fracture - CORRECT ANSWER fracture in which one bone fragment is pushed into another
Torus fracture - CORRECT ANSWER -Buckle fracture
-Buckles on one side of bone and other side is unaffected
Occult Fracture - CORRECT ANSWER a bone fracture that cannot be detected by X-ray until several weeks after the injury ('occult' means 'hidden')
Nonunion - CORRECT ANSWER Fracture fails to heal despite treatment. No x-ray evidence of callus formation.
Malunion - CORRECT ANSWER Fracture heals in expected time but in unsatisfactory position, possibly resulting in deformity or dysfunction.
Angulation - CORRECT ANSWER Fracture heals in abnormal position in relation to midline of structure (type of malunion)
Pseudoarthrosis - CORRECT ANSWER Type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at site.
Traction Puposes - CORRECT ANSWER -Reduce pain and muscle spasm
-Immobilize
-Reduce a fracture or dislocation
-Treat a pathologic joint condition
-Promote active and passive exercise
-Expand a joint space during procedure
Myositis Ossificans - CORRECT ANSWER Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury
Autogenous bone - CORRECT ANSWER Bone graft taken from the patient, usually iliac crest
Allographic bone - CORRECT ANSWER Cadaver bone is used for fracture
Synthetic bone substitute - CORRECT ANSWER Substitutes include ceramics and sea coral
Bioactive cells and proteins - CORRECT ANSWER Used for nonunion fractures
Shin splints - CORRECT ANSWER -Medial tibial stress syndrome
-Stress on the tibia
-Seen most in runners, basketball or tennis
-Risk factors: training too hard, not stretching, flat feet, -improper fitting shoes
-Tx: Rest, stretching program, slow return to activity, ice, compression, orthotics
-Preventions: Stretching and elevation of legs after workout, changing footwear every 6 months or 400 miles
Sprain - CORRECT ANSWER injury to a ligament caused by joint trauma but without joint dislocation or fracture
Strain - CORRECT ANSWER Muscle or tendon group is overstretched or over contracted without trauma
weekend warrior - CORRECT ANSWER -Person who does no regular physical activity on most days of the week but then does a lot of activity on one day
-At risk for Achilles tendonitis or tear
Achilles tendinitis - CORRECT ANSWER -A painful inflammation of the Achilles tendon caused by excessive stress being placed on that tendon
-Risk factors: improper fitting shoes, overuse, inadequate stretching, tight or weak calf muscles, running on hard surfaces or hills, flat feet, sharp plant and pivot activities
tennis elbow - CORRECT ANSWER -Lateral epicondylitis
-Tx: Rest, ice, stretching, massage, strengthening, anti-inflammatory meds, splints/braces at the wrist and proximal forearm, surgery rare
Ankle sprain - CORRECT ANSWER 1st degree: mild pain and swelling, normal rage of motion and minimal gait impairment, return to activity no sooner than 10 days after tx
2nd degree: moderate pain and swelling, decreased range of motion and positive finding in the ankle exam, return to activity wit ankle support 2 weeks after tx
3rd degree: severe pain and swelling and all ankle tests are positive, unable to weight bear initially, return to activity 4 weeks after tx with continued ankle bracing
golfer's elbow - CORRECT ANSWER -Medial epicondylitis
T-x: Rest, ice, stretching, massage, strengthening, anti-inflammatory meds, forearm brace or compression, steroid injection and proximal forearm, surgery rare
Turf toe - CORRECT ANSWER -Hyperextension of the great toe
-Tx: Rest, avoid competitive sports up to 6 weeks, ice elevation, toe splint insert, anti-inflammatories, and if severe a walking boot
Anterior Drawer Test - CORRECT ANSWER -Assesses the integrity of the anterior talofibular ligament
-Stabilize the lower leg and pull the heel anteriorly.
-Positive if there is significant laxity or a sharp endpoint is felt
Talar Tilt Test - CORRECT ANSWER -Inversion and eversion of the foot to determine the stability of the ankle joint
-Positive if there is laxity compared to the unaffected ankle and if there is a tight endpoint in either direction
Squeeze Test - CORRECT ANSWER -Assess damage to the medial ankle compartment made up of several ligamentous structures.
-Positive if there is pain in the ankle when the middles of the tibia and fibula are squeezed together
Plantar fasciitis - CORRECT ANSWER -An inflammation of the plantar fascia on the sole of the foot
-Risk factors: Extended exposure on hard surfaces, extreme foot arch, obesity, diabetes, age, pregnancy, footwear with poor arch support, arthritis
-Tx: RICE, stretching, weight loss, orthotics, steroid injections
Metatarsalgia - CORRECT ANSWER -Pain in the bones of the foot or ball of the foot
-Caused by high-impact trauma such as jumping
-Risk factors: Intense training, poorly fitting shoes, obesity, age, high foot arch, hammertoe, bunions, Morton' neuroma
rotator cuff tendinitis - CORRECT ANSWER -An inflammation of the tendons of the rotator cuff
-Swimmer's shoulder
-Tx: RICE, slings, stretching, strengthening, technique evaluation, anti-inflammatory and analgesic, steroid injections and possible surgery, Arthroscopy or open repair
Heat cramps - CORRECT ANSWER -Muscle spasms that result from a loss of large amounts of salt and water through perspiration
-Most often experienced in the abdomen or legs
-Tx: electrolyte replacement
Heat exhaustion - CORRECT ANSWER -Condition resulting from exposure to heat and excessive loss of fluid through sweating
-Cool and clammy skin
-Tx: Cool drinks, rest and cooling devices
Heat stroke - CORRECT ANSWER -A dangerous condition in which the body loses its ability to cool itself through perspiration
-Skin will be dry, red and hot, vitals abnormal, change in LOC
-Tx: medical emergency, IV fluids and external cooling
ACL Injury treatment and diagnostics - CORRECT ANSWER -Nonsurgical: If stable with daily activities, secondary injury is absent, patient will stop with sports activities. Include: RICE, PT, activity modification, knee brace
-Surgery: if the above conditions are not met
-Diagnostics: Lachman's test, Pivot shift test
Lachman's test - CORRECT ANSWER -Apply posterior pressure on the distal thigh and pulling the proximal lower leg anteriorly while the knee is slightly flexed.
-Positive if increased laxity compared to uninjured knee
Pivot shift test - CORRECT ANSWER -Internal rotation of the ankle combined with medial force to assess the stability of the ACL
-Positive if subluxation occurs
Meniscal Injury - CORRECT ANSWER -Painful popping and locking
-Diagnostics: McMurray test and MRI
-Tx: Ice, immobilization, crutches with WBAT, knee brace, Meniscectomy(NSAIDs and PT post op)
McMurray Test - CORRECT ANSWER -Compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus
-Positive if it elicits a pain or pop
PCL Injury - CORRECT ANSWER -Sustained when knee is forcefully hyperextended or anterior forced is applied to a flex knee
-Diagnostics: Posterior drawer test and quadricep active drawer test, MRI
Osteochondritis dissecans - CORRECT ANSWER -Fragment of cartilage and underlying bone is
detached from articular surface.
-Tx: resting (6 weeks) and immobilization, NSAIDs or analgesics, PT, Surgery if conservative treatment unsuccessful
Little Leagures Elbow - CORRECT ANSWER -Tendonitis of the elbow
-Pain and or knot in elbow, locking and decreased ROM
-Tx: RICE and PT
Burner or stinger - CORRECT ANSWER Pinched nerve from stretch or compression to brachial plexus
Osgood-Schlatter disease - CORRECT ANSWER -Inflammation or irritation of the tibia at its point of attachment with the patellar tendon
-Self-limiting upon skeletal maturity
Shoulder dislocation treatment - CORRECT ANSWER Closed reduction followed by immobilization. PT to strengthen surrounding musculature
Osteoporosis - CORRECT ANSWER loss of bone density
Osteoporosis risk factors - CORRECT ANSWER ->50 years old
-Women
-White or Asian
-Consumption of alcohol or caffeine
-Smoking
-Low BMI
-Steroids
-Excessive use of thyroid, heparin, sedatives, Antiseizure meds
-Decreased weight bearing activity
-Decreased calcium intake
-Amenorrhea
Osteoporosis treatment - CORRECT ANSWER -Calcium 1200mg/day( Calcium carbonate: take with food, Calcium citrate)
-Vitamin D supplementation
-Weight-bearing exercise
-Bisphosphonates (Fosamax and Actonel)
-Calcitonin: Inject at night, alternate nasal site
-Fluoride
-Evista: Side effects are leg cramps, hot flashes and blood clots
-Forteo: Subcutaneous injection daily, side effects are leg cramps and dizziness
Bisphosphonates Considerations - CORRECT ANSWER -Fosamax, Boniva, Actonel, Reclast
-Take with full glass of water
-Take 30 min before food or other meds
-Remain upright for 30 min after taking
-Side effects: Anorexia, weight loss, Gastritis, Osteonecrosis of jaw
Osteoporosis Symptoms - CORRECT ANSWER -No symptoms until bone fracture occurs
-Decrease height
-Kyphosis
-Dowager's hump
-DEXA scan measures bone mineral density (BMD)
Dowager's hump - CORRECT ANSWER -Forward curvature of the spine resulting in a stoop, typically in women with osteoporosis, caused by collapse of the front edges of the thoracic vertebrae.
Foods high in Calcium - CORRECT ANSWER -Milk
-Cheese
-Dark green veggies
-Dried figs
-Soy
-Legumes
Foods high in vitamin d - CORRECT ANSWER Fortified and full fat dairy products; fish oil; synthesized in skin when exposed to sunlight
Foods high magnesium - CORRECT ANSWER Vegetables, nuts, fish, meat, grains
Gout - CORRECT ANSWER -Hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints
-S/S: Swollen, red, acutely painful joint, Podagra, kidney stones, tophi
Podagra - CORRECT ANSWER Gout in the big toe
Gout risk factors - CORRECT ANSWER -Male sex
-Increasing age
-High intake of alcohol, red meat, and fructose
-Drugs: Diuretics, Aspirin, B-complex vitamins, chemo
-Obesity
-HLD
Gout treatment - CORRECT ANSWER -Prophylactic drugs: colchicines, probenecid, allopurinol
-Acute attacks: Indomethacin (take with food), NSAIDS
Paget's disease - CORRECT ANSWER -Osteitis deformans
-Increased bone breakdown and then remodeling
-S/S: Bone pain, fatigue, waddling gait, shortening, head enlarging, HA, Dementia, Visual deficits, loss of hearing, spinal cord compression
-Dx: Elevated serum alkaline phosphatase, X-ray
-Tx: manages disease but does not cure, PT thermotherapy, stretching and medications (bisphosphonate, Anti-inflammatories and analgesics)
osteomalacia - CORRECT ANSWER -Decrease in the mineral composition of the bone causing softening of the bone
-Caused by decreased Vitamin D (seizure drugs and fluoride can cause this)
-Bone pain, muscle pain, fractures
-Can be reversed with vitamin D and calcium, intake eggs, meat and oily fish, Weight bearing exercise and sunlight exposure
-Lab findings: Decreased serum calcium or phosphorus, decreased serum 25-hyroxyvitamin D, and elevated serum alkaline phosphatase
Hypoparathyroidism - CORRECT ANSWER -Deficient production of parathyroid hormone
-Marked by hypocalcemia- vague pain symptoms, anxiety, muscle rigidity, increased deep tendon reflexes, muscle spasm, muscle cramps, paresthesia, muscle twitching.
-X-ray may show increased bone density
Hyperparathyroidism - CORRECT ANSWER -Excessive levels of parathyroid hormone
-Pulls calcium from bone into the blood
-Symptoms: Hypercalcemia, fractures, decreased muscle tone, muscle weakness, pain, decreased bone density on x-ray
-Tx: same as osteoporosis with correction of hypercalcemia
Rickets - CORRECT ANSWER -Vitamin D deficiency
-Symptoms: Failure to thrive, bowing of long bones, forehead protrusion, palpable knots between the ribs,
-X-ray show increased epiphyseal space
Chvostek's sign - CORRECT ANSWER Hypocalcemia (facial muscle spasm upon tapping)
Trousseau's sign - CORRECT ANSWER A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.
rheumatoid arthritis - CORRECT ANSWER -A chronic autoimmune disorder in which the joints and some organs of other body systems are attacked
-Usually affects bilaterally
-Positive RF
Rheumatoid Arthritis Treatment - CORRECT ANSWER -goal of tx: reduce inflammation and pain, promote joint function, and prevent joint destruction and deformity
-Pharmacological management includes NSAIDs to reduce inflammation and pain
-Corticosteroid meds may be desirable during severe flare-ups or when the patient's condition is not responding to NSAIDs
-COX-2 inhibitors
-Plaquenil
-Disease-modifying antirheumatic meds (DMARDs) are slow-acting and take weeks or months to become effective, however, they have the ability to slow the progression of joint destruction and deformity
-PT interventions include passive and active ROM, heating and cooling agents, splinting, patient education, energy conservation, body mechanics, and joint protection techniques
rheumatoid arthritis symptoms - CORRECT ANSWER Slow onset of:
-Fatigue
-Symmetrical swollen, stiff, painful joints
-Worse in morning and better with activity
-Boutonniere fingers (PIP flexion, DIP extension)
-Swan fingers (PIP extension, DIP flexion)
-Ulnar deviation
-Subcutaneous nodules (over bony prominences and tendons)
-Dry eyes and mouth
-Dilated nail capillaries
-Interstitial lung disease
Juvenile Rheumatoid Arthritis (JRA) - CORRECT ANSWER -Disorder similar to adult-onset RA, with earlier onset and more severe symptoms
-Most grow out of it but damage sustained is permanent
-Morning stiffness
Juvenile Rheumatoid Arthritis (JRA) Types - CORRECT ANSWER 1. pauciarticular: Does not affect more than 4 joints. If developed before age 6, chronic eye disease possible
2. polyarticular: 5 or more joints, sudden and severe onset, at risk for permanent joint deformity
3. systemic: Recurring spiking fevers and truncal rash, pericarditis possible
Systemic lupus erythematosus (SLE) - CORRECT ANSWER -Chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs
-S/S: Butterfly rash over cheeks, discoid lesions, vascular changes in the digits, erythematous plaques, splinter hemorrhages in nail bed, thinning of scalp hair, in the joints decreased mobility redness and swelling, Jaccoud's deformity
Polymyositis - CORRECT ANSWER -Idiopathic inflammatory myopathy
-Inflammation of many muscles
-Leads to atrophy
-Diagnosis: history of muscle weakness, creatine kinase levels, EMG testing and biopsy
-Tx: oral corticosteroids
-Complications: neck muscle weakness causing swallowing difficulties and difficulty breathing
Ankylosing Spondylitis (AS) - CORRECT ANSWER -Inflammatory response that causes degenerative changes in the spinal vertebrae; sacroiliac joints; connective tissues such as tendons and ligaments in the hips, shoulders, knees, feet, and ribs; and tissues of the lungs, eyes, and heart valves
-Does not affect joints symmetrically and RF is negative
Ankylosing Spondylitis Treatment - CORRECT ANSWER TREATMENT
-Physical therapy and exercise
-NSAIDs (e.g., indomethacin) for pain
-Tumor necrosis factor (TNF) inhibitors or sulfasalazine can be used in refractory cases.
Bursitis - CORRECT ANSWER -Inflammation of a bursa
-Pain, warmth, limited ROM, and inflammation of joints
-Tx: Stretching, warm-up, RICE, anti-inflammatories, aspiration of bursa, injection with steroid, removal of bursa
ankylosing spondylitis tests - CORRECT ANSWER 1. Wright-schober test: positive if lumbar spin flexion is < 5cm
2. Respiratory excursion test: positive if distance between the nipples does not increase by at least 3cm
3. Cervical kyphosis- cannot touch back of head to wall while rest of body is against the wall
Psoriatic arthritis - CORRECT ANSWER -An inflammatory arthritis associated with psoriasis of the skin
-Tx: Appropriate footwear, Topical tx of skin lesions, anti-inflammatories, aspirin, DMARDs, biological modifiers, and steroids, sea salts, massage, acupuncture, glucosamine, SAM-e and magnet therapy
systemic sclerosis - CORRECT ANSWER -A diffuse connective tissue disease that may involve any system causing inflammation, degeneration, and fibrosis
-Softens bone and causes atrophy
-Carpal tunnel is likely to develop
Scleroderma - CORRECT ANSWER an autoimmune disorder in which the connective tissues become thickened and hardened, causing the skin to become hard and swollen
Swan neck deformity - CORRECT ANSWER hyperextension of PIP joint and flexion of DIP joint
Boutonniere deformity - CORRECT ANSWER flexion of PIP joint and hyperextension of DIP joint
Duchenne muscular dystrophy - CORRECT ANSWER -A condition with symmetrical weakness and wasting of pelvic, shoulder, and proximal limb muscles
-Toe walking, clumsiness, large calf muscles, positive Gower's sign, ankle reflexes greater then knee reflexes
-Diagnostics: muscle biopsy, EMG testing, elevated CPK levels and MRI
-Management: PT, orthotic brace, corticosteroids
Benign Tumors - CORRECT ANSWER -Osteochondroma: May turn into malignant
-Osteoclastoma
-Enchondroma
Malignant Tumors - CORRECT ANSWER -Osteosarcoma
-Chondrosarcoma: Wide surgical resection done as it rarely responds to radiation and chemo
-Ewing's sarcoma
Carpal tunnel Syndrome - CORRECT ANSWER -Compression of the median nerve
-S/S: Weakness, pain, numbness, impaired sensation, clumsiness, Tinel's sign, Phalen's sign
-Tx: Rest, Splints to keep in neutral position, PT, Corticosteroid injection, Carpal tunnel release
Tinel's sign - CORRECT ANSWER A distal tingling sensation on percussion of median nerve of the inner wrist; characteristic of carpal tunnel syndrome
Phalen's sign - CORRECT ANSWER The patient flexes the wrists maximally and holds position for up to 60 seconds by pushing both wrists together.
Positive sign is tingling into the first 3 digits of the hand indicating carpal tunnel syndrome
Spinal stenosis - CORRECT ANSWER -Narrowing of the spinal canal
-S/S: Low back pain that radiates to the buttock and leg, pain worse with walking or prolonged standing, Numbness, tingling, weakness, and heaviness in legs and buttocks, pain relief when bending forward or sitting
L3-L4 Disc Herniation symptoms - CORRECT ANSWER -Pain Back to buttocks to posterior thigh to inner calf
-Patellar Reflex affected
-Motor function of Quadriceps and anterior tibialis affected
-Sensation of inner aspect of lower leg and anterior part affected
L4-L5 Disc Herniation symptoms - CORRECT ANSWER -Pain Back to buttocks to dorsum of foot and big toe
-Motor function of anterior tibialis, extensor hallucis longus, and gluteus Medius affected
-Sensation of Dorsum of foot and beg toe affected
L5-S1 disc herniation symptoms - CORRECT ANSWER -Pain back to buttocks to sole of foot and heel
-Achilles reflex affected
-Motor function of Gastrocnemius, hamstring, gluteus maximus, affected
-Sensation affected of heel and lateral foot
Diagnostic Studies of DDD - CORRECT ANSWER -X-rays
-MRI
-Myelogram
-CT
-Epidural venogram or diskogram
-EMG of extremities
Degenerative Disc Disease (DDD) - CORRECT ANSWER progressive degeneration that is a normal process of aging; results in the intervertebral discs losing their elasticity, flexibility, and shock-absorbing capabilities.
DDD management - CORRECT ANSWER -Limit extreme spinal movement by wearing a brace
-Local ice or heat
-Ultrasound
-Massage
-Traction
-TENS
-NSAIDS
-Oral corticosteroids
-Opioids
-Muscle relaxants
-Antiseizure drugs
-Epidural corticosteroid injections
-Back exercises
-Possible surgery
Post-Op Vertebral Disc Surgery care - CORRECT ANSWER -Pillow under thighs when lying supine
-Pillow in-between knees when side-lying
-Opioids
-Valium
-Monitor for CSF leakage (high glucose in CSF)
-Monitor for incontinence due to nerve damage
-Thoracic-lumbar-sacral orthosis (TLSO) for spinal fusion
-Monitor respiratory distress and neuro status of upper extremities for a cervical surgery
Hallux Valgus - CORRECT ANSWER -Bunion
-Tx: Wearing wide forefoot shoes, surgical removal of bursal sac and correction of lateral angulation of great toe
Hallux rigidus - CORRECT ANSWER -Painful stiffness of first MTP joint caused by osteoarthritis or local trauma
-Tx: Intraarticular corticosteroid injections and passive manual stretching of joint
Hammer and Claw Toes - CORRECT ANSWER -Hammer toe is a deformity of PIP joint on 2nd to 5th toes causing toe to be permanently bent, resembling a hammer
-Claw toe is a similar deformity with dorsiflexion of the proximal phalanx on the MTP joint combined with flexion of both PIP and DIP joints.
-Complaints include burning on bottom of foot and pain and difficulty walking when wearing shoes
-Conservative treatment includes passive manual stretching of PIP joint and use of metatarsal arch support.
-Surgical correction consists of resection of base of middle phalanx and head of proximal phalanx, bringing raw bone ends together
-Kirschner wire maintains straight position
Morton's Neuroma - CORRECT ANSWER -Neuroma in web space between 3rd and 4th metatarsal heads, causing sharp, sudden attacks of pain and burning sensations
-Tx: surgical excision
Gower's sign - CORRECT ANSWER Difficulty rising to standing position; has to walk up legs using hands; occurs in Muscular dystrophy
Cerebral Palsy - CORRECT ANSWER -A loss or deficiency of motor control with involuntary spasms caused by permanent brain damage present at birth
-TX: Physical therapy, Speech therapy, assistive devices, muscle relaxers for muscle spasms
Developmental dysplasia of the hip (DDH) - CORRECT ANSWER -S/S: asymmetrical gluteal and thigh folds. limited abduction of hips. Barlow and ortolani tests given. Trendelenburg sign used in toddler. complaint of clicking sound with diaper changes
-Tx: Closed reduction. Pavlik harness used in newborns. Closed reduction with anesthesia if harness unsuccessful followed by cast. If diagnosed beyond two years old then open surgical reduction followed by placement of body Spica cast
Ortolani's sign - CORRECT ANSWER -TESTING: congenital dislocation of hip of infant
-POSITION: (supine) flex infant's hips and grasp legs so thumbs are against the insides of the knees and thighs and the fingers are placed along the outsides of the thighs to the buttocks; thighs are abducted and pressure is applied against the greater trochanters; resistance will begin to be felt to abduction and lateral rotation at approximately 30- 40 deg
(+) TEST: feel a "click" or "jerk"
***only valid for the first few weeks after birth
Barlow's sign - CORRECT ANSWER w/ baby supine the hips and knees are flexed, with the thumb on the lesser trochanter in the grown and the middle finger of the same hand on the greater trochanter laterally, gently apply pressure down on the knee while simultaneously applying lateral pressure with the thumb
the dislocatable hip becomes displaced with a palpable clunk as the head slips over the posterior aspect of the acetabulum; this is a provocative test which actively dislocates an unstable hip
Pes Cavus - CORRECT ANSWER -Abnormally high arch of the foot
-"Clawfoot"
-May indicate a neuromuscular disorder, muscle spasm, spinal etiology
-Tx: orthotics and arch supports, possible surgery
Congenital Torticollis - CORRECT ANSWER characterized by a unilateral contracture of the sternocleidomastoid muscle. causative factors include malposition in utero, breech position and birth trauma. usually dx'd within first three weeks of life. lateral flexion to same side as contracture, rotation toward opposite side. treatment conservative for the first year with emphasis on stretching, active ROM, position and caregiver education. possible surgery.
Pigeon Toe - CORRECT ANSWER -A condition which causes the toes to point inward when walking
-Under the age of 2 self limiting
-Age 3 and above need surgery
talipes equinovarus - CORRECT ANSWER -(clubfoot) congenital deformity of the foot in which it is plantar flexed and inverted
-Neuromuscular disease and hip dysplasia
-Tx: manual manipulation followed by splinting or casting. prognosis good with early treatment
Bowlegs - CORRECT ANSWER -Genu varum
-Usually self resolving but if not then bracing.
-Surgery if growth is affected or is asymmetrical
Knock Knees - CORRECT ANSWER genu valgum
Self limiting
Limb length discrepancy (LLD) - CORRECT ANSWER -Treatment only considered if greater 1-inch difference and causes significant gait disturbance and pain.
-Tx: Shoe lefts, leg shortening surgery for the immature, leg lengthening for the mature
Legg-Calve-Perthes Disease - CORRECT ANSWER degeneration of femoral head due to avascular necrosis. disease is self limiting and has 4 phases: condensation, fragmentation, re-ossification and remodeling. presents with pain, decreased ROM, antalgic gait, positive Trendelenburg sign. primary treatment focus is to relieve pain and maintain femoral head in proper position and includes bracing and PT
Spina bifida - CORRECT ANSWER a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it. Four types
1. Occulta
2. Closed-neural tube defect
3. Meningocele
4. Myelomeningocele
myelomeningocele - CORRECT ANSWER -Most severe form of spina bifida in which the spinal cord and meninges protrude through the spine and cause paralysis
-Talipes equinovarus, calcaneus, cavus are common
-Muscle atrophy and loss of bone density in extremities below the level of the spinal cord involvement
Salter-Harris Classification - CORRECT ANSWER SALTER-HARRIS - Physeal Injuries
(SMACK - Same, Metaphysis, Articulation, Continuous, Krush) (SALTR - Same, Above, Lower, Through, Really bad)
1 - fracture through physis
2 - fracture through physis into metaphysis
3 - intra-articular fracture through physis into epiphysis
4 - intra-articular fracture through epiphysis, physis, and metaphysis 5 - crush injury
osteogenesis imperfecta - CORRECT ANSWER -Brittle bone disease; excessively brittle bones due to lack of protein, collagen. Hereditary
-Tx: Prevention of fractures, PT, nutrition
Scoliosis - CORRECT ANSWER -Abnormal lateral curvature of the spine
-Observation in child with less than 20 degree curvature
-Brace with 20-40 degrees
-Surgery with >40 degrees
Osteosarcoma - CORRECT ANSWER -Malignant tumor of the bone
-Metastasis to the lung common
-Causes bone pain, may have palpable mass
-Suspected on x-ray and confirmed by biopsy
-MRI, CT and bone scans used to rule out metastasis
-Tx: Surgical removal and chemo. prognosis good if no metastasis
Soft tissue sarcoma - CORRECT ANSWER -Cancers of the muscle, fat, fibrous tissue, blood and lymphatic vessels, or other supporting tissue, including the synovial tissues that line the cavities of joints
-Typically a visible or palpable growing mass
-Diagnosis by biopsy
metastatic bone disease - CORRECT ANSWER -Cancer originates somewhere else and metastasizes to the bone
-Anemia present
-Diagnosis by MRI and bone scan
-Treatment surgical excision
Multiple Myeloma - CORRECT ANSWER -Malignant tumor of bone marrow cells
-Symptoms: bone pain and anemia, increased calcium, ESR, creatinine, and BUN with decreased platelets
-Diagnosis: biopsy of bone marrow
-Tx: Chemo, bone marrow transplant for younger patients, median survival 2 years
-Complications: skeletal deformity, immunosuppression, fractures, amyloidosis
Intralesional excision - CORRECT ANSWER Used if benign tumor or if total resection not an option
Marginal excision: - CORRECT ANSWER removes the tumor at its border
Wide excision - CORRECT ANSWER the tumor plus a wide margin of normal tissue around it is excised
Radical resection - CORRECT ANSWER procedure to excise a cancerous tumor, as well as all nearby lymph nodes, soft tissue, muscle, and even bone
Compartment syndrome - CORRECT ANSWER Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.
3 types
1. Crush
2. Chronic
3. Acute-Medical emergency
Compartment Syndrome S/S - CORRECT ANSWER -Pain out of proportion to injury or with passive stretch(w/hyperextension)
-Pressure
-Paresthesia
-Pallor
-Paralysis
-Pulselessness
Compartment Syndrome Interventions - CORRECT ANSWER -Relieve anything causing increased pressure
-Notify Dr. of changes in the 6 Ps
-Monitor urine output as AKI can occur from damaged muscles
-Do not elevate extremity
-Do not put ice on it
-Fasciotomy may be performed. Incision is left open until swelling reduces enough to close.
Crush Compartment Syndrome - CORRECT ANSWER Damage to the body compartment from an external source. Damaged muscle release myoglobin which overwhelm kidneys which cause systemic issues as well as the pain and swelling
Fat Embolism Syndrome (FES) - CORRECT ANSWER -Embolization of fat globules that occurs in a small percentage of patients with fractures especially long bone fracture
-S/S: Respiratory changes, change in LOC, petechiae, pallor to cyanosis, and thrombocytopenia
-Tx: Normalize metabolic acidosis and maintain respiratory function, hydrate, cough and deep breath, O2
Prevention: Reposition as little as possible
Chronic compartment syndrome - CORRECT ANSWER -Due to heavy exercise or overuse of limb
-Tx: PT, orthotics, anti-inflammatories, and diuretics, and if needed surgical fasiotomy
Virchow's triad - CORRECT ANSWER Risk factors for DVT: venous stasis, endothelial injury, hypercoagulable state
Malignant hyperthermia - CORRECT ANSWER -A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs.
-Life threatening emergency
-Tx: Oxygen, IV dantrolene, external cooling devices
Ankylosis - CORRECT ANSWER joint stiffness
Epiphysis - CORRECT ANSWER Widened area of the long bone
Diaphysis - CORRECT ANSWER Main shaft of long bone
Metaphysis - CORRECT ANSWER where diaphysis and epiphysis meet
Epiphyseal plate - CORRECT ANSWER cartilaginous area at the ends of long bones where lengthwise growth takes place in the immature skeleton
isometric contraction - CORRECT ANSWER Muscle contracts but there is no movement, muscle stays the same length
Isotonic contraction - CORRECT ANSWER A muscle contraction that pulls on the bones and produces movement of body parts.
Dorsiflexion - CORRECT ANSWER bending of the foot or the toes upward
Plantar flexion - CORRECT ANSWER bends the foot downward at the ankle
Pes Planus - CORRECT ANSWER -Flat foot
-Tx: Longitudinal arch supports, possible surgery
Lordosis - CORRECT ANSWER abnormal anterior curvature of the lumbar spine (sway-back condition)
DXA - CORRECT ANSWER -Dual-energy absorptiometry
-Painless
-Measures bone mineral density
Bone scan - CORRECT ANSWER -The injection of a radioactive substance to enable visualization of a bone via the image produced by emission of radioactive particles
-Radioisotope given 2hrs before scan
-Increase fluids after scan
electromyogram (EMG) - CORRECT ANSWER -Recording of skeletal muscle movements
-Pt lies supine
-Needle insertion
-No stimulants or sedatives for 24hrs before procedure [Show Less]