Term
| How does parathyroid hormone regulate calcium levels? |
|
Definition
1. Initiation of calcium release from bone.
2. Conservation of calcium by the kidney,
3. Enhanced intestinal absorption of calcium through activation of vitamin D |
|
|
Term
| What are the 2 forms of vitamin D? |
|
Definition
1. D2-Ergocalciferol
2. D3-Cholecalciferol |
|
|
Term
| What are the two sources of vit. D in the body? |
|
Definition
| Intestinal absorption and skin production. |
|
|
Term
| Where does intestinal absorptoion mainly occur? |
|
Definition
| In the jejunum (includes D2 and D3) |
|
|
Term
| What is the action of calcitonin on the body? |
|
Definition
| It lowers blood calcium levels. |
|
|
Term
| What are the three major categories fractures are grouped into? |
|
Definition
1. Caused by sudden injury
2. Fatigue or stress fractures
3. Pathological fractures |
|
|
Term
| Which of the major 3 categories is the most common cause of fracture? |
|
Definition
| Those resulting from sudden injury are the most common! |
|
|
Term
| What are the four stages in bone healing? |
|
Definition
1. Hematoma formation
2. fibrocartilaginous callus development
3. ossification
4. Remodeling |
|
|
Term
| When does hematoma formation occur after a fracture? |
|
Definition
| During the 1st 1 to 2 days after a fracture. |
|
|
Term
| When does blood clot formation happen after a fracture? |
|
Definition
| 2 to 5 days after the fracture this occurs. |
|
|
Term
| What begins to occur peripheral to the blood clot after a fracture? |
|
Definition
|
|
Term
| When is most of the clot organized by invasion of blood vessels and early fibrosis? |
|
Definition
| By the end of the 1st week. |
|
|
Term
| What is thought to be necessary for the initiation of the cellular events essential to bone healing? |
|
Definition
|
|
Term
| When does ossification usually begin, and what defines ossification? |
|
Definition
| Ossification usually begins around the third to 4th week of fracture healing and represents the deposition of mineral salts in to the callus. |
|
|
Term
| Discuss the increase in risk of incidence of hip fracture with age and gender. |
|
Definition
| Risk of hip fracture doubles every 10 years after 50 years old. It is two to three times hier in women than men. |
|
|
Term
| What 2 categories of hip fractures account for 90% of hip fractures? |
|
Definition
| Femoral neck fractures and intertrochanteric fractures. They occur in approximately equal proportions. |
|
|
Term
| What is the most urgent type of hip fracture and why? |
|
Definition
| Femoral neck fractures, because they often disrupt the blood supply to the femoral head and are associated with an increased incidence of complications (nonunion and avascular necrosis). |
|
|
Term
| Where do congenital dislocations normally be occurin'? |
|
Definition
|
|
Term
| What is true of each recurrent dislocation of a joint? |
|
Definition
| They recur with the same motion, but require less and less force. |
|
|
Term
| When has acute osteomyelitis considered to have become chronic? |
|
Definition
| When the infection persists beyond 6 to 8 weeks! |
|
|
Term
| What is a hallmark feature of chronic osteomyelitis? |
|
Definition
| A sequestrum, or piece of dead bone that has separated from the surrounding living bone. |
|
|
Term
| What forms around a sequestrum in chronic myelitis? |
|
Definition
| The involucrum, a sheath of new bone, forms around the dead bone. |
|
|
Term
| When is amputation indicated with osteomyelitis? |
|
Definition
| When osteomyelitis with vascular insufficiency is present with inadequate oxygen tension. |
|
|
Term
| What are the most common sites for infection with tuberculosis of the bone or joint? |
|
Definition
| The spine (especially the thoracic and lumbar vertebrae), followed by the hips and the knees. |
|
|
Term
| What is a less common site of infection with tuberculosis osteomyelitis? |
|
Definition
| The joints and soft tissues. |
|
|
Term
| What is a characteristic of abscess associated with tuberculosis osteomyelitis as opposed to pyogenic osteomyelitis? |
|
Definition
| Formation tends to be more destructive and resistant to control than in pyogenic osteomyelitis. |
|
|
Term
|
Definition
| An apparent lack of bone mass seen on x-rays. It is not a diagnosis in itself. |
|
|
Term
| What are the manifestations of postmenopausal osteoporosis? |
|
Definition
| A loss of cancellous bone and a predisposition to fractures of the vertebrae and distal radius. |
|
|
Term
| When is the loss of bone mass greatest during menopausal osteoporosis? |
|
Definition
|
|
Term
| Why is loss of bone mass greatest in early menopause? |
|
Definition
| Estrogen levels are withdrawing. |
|
|
Term
| What is another word for cancellous bone? |
|
Definition
|
|
Term
| A decrease in estrogen results in an increase in which WBC component? |
|
Definition
|
|
Term
| Why does an increase in cytokines lead to an increased loss of bone mass? |
|
Definition
| Because cytokines stimulate the production of osteoclast precursors. |
|
|
Term
| With estrogen deficiency, what happens to osteoclast production? |
|
Definition
| Osteoclast differentitation through the rank receptor pathway and the inhibition of osteoclasts through production of OPG is lessened. More bone is then resorbed by osteoclasts. |
|
|
Term
| What are common sites of fractures in oldies? |
|
Definition
| The spine and femoral neck, where the greatest amounts of spongy bone are located. Spongy bone is affected more by bone loss. |
|
|
Term
| Alcoholism, use of certain medications, endocrine disorders, malabsorption disorders and malignancies are all associated with what? |
|
Definition
|
|
Term
| Which endocrine disorders put a person at higher risk for the development of osteoporosis? |
|
Definition
| Hyperthyroidism, hyperparathyroidism, and cushing syndrom. |
|
|
Term
| What is multiple myeloma's role in perpetuating osteoporosis? |
|
Definition
| Some malignancies secrete osteoclast-activating factor, causing significant bone loss. |
|
|
Term
| What is alcohol's role in perpetuating osteoporosis? |
|
Definition
| Alcohol is a direct inhibitor of osteoblasts and may also inhibit calcium absorption. |
|
|
Term
| What medicines can perpetuate bone loss? |
|
Definition
| Corticosteroids and aluminum-containing antacids are the two major ones. Also, people being treated with antiretroviral therapy (HIV & AIDS) also may have a lower bone density and signs of osteoporosis. |
|
|
Term
| Why is osteoporosis being seen increasingly in female athletes? |
|
Definition
| Because of increased prevalence of eating disorders and amenorrhea. |
|
|
Term
| What areas of bone to oseteoporotic changes most often occur in? |
|
Definition
| The diaphysis and metaphysis of bone. |
|
|
Term
| The outer supporting cortex becomes thinner in osteoporosis due to what age-related change in bone structure? |
|
Definition
| The diameter of the bone enlarges with age, causing the outer supporting cortex to become thinner. |
|
|
Term
| What is the significance of phenobarbital and phenytoin in osteomalacia? |
|
Definition
| Anticonvulsant medications, such as these can induce hepatic hydroxylases that accelerate breakdown of the active forms of vitamin D. |
|
|
Term
| What is a cardinal difference between osteoporosis and osteomalacia/rickets? |
|
Definition
| Osteomalacia and rickets cause defective mineralization but no the loss of the bone matrix. |
|
|
Term
| What is the name of the destrictive vascular granulation tissue which grows in the synovial membrane of those with Rheumatoid arthritis? |
|
Definition
| Pannus. This is what differentiates RA from other forms of inflammatory arthritis. |
|
|
Term
| Discuss the difference in limitations of joint movement in early progression of rheumatoid arthritis as opposed to late progression of the condition. |
|
Definition
| Early in the disease, limitation of movement is usually due to pain. late in the condition, it is usually due to fibrosis. |
|
|
Term
| What is the characteristic involvement of the spinal cord in Rheumatoid arthritis? |
|
Definition
| It is usually limited to the cervical region. |
|
|
Term
| What the hell is "swan neck" deformity? |
|
Definition
| Occurs in rheumatoid arthritis. It is hyperextension of the proximal interphylangeal joint and partial flexion of the distal interphylangeal joint. After this condition becomes fixed, severe loss of function occurs because the person can no longer make a fist. |
|
|
Term
| Which diagnostic test involves milking fluid from the lateral to the medial side of the patella? |
|
Definition
|
|
Term
| What is genu valum and what condition might it be a manifestation of? |
|
Definition
| Knock knee. It might be a manifestation of rheumatoid arthritis. |
|
|
Term
| What is a "baker cyst", where does it occur, and what condition might it be a manifestation of? |
|
Definition
| An enlargement of the bursa. Usually occurs in the popliteal area behind the knee of those with rheumatoid arthritis. |
|
|
Term
| Extra-articular manifestations are most likely to occur in which rhematoid arthritis sufferers? |
|
Definition
| Those with the Rheumatoid factor. |
|
|
Term
| What is commonly elevated during inflammatory procceses in those with rheumatoid arthritis and what has it been found to correlate with? |
|
Definition
| Erytrocyte sedimentation rate (ESR) has been found to correlate with the amount of disease activity. |
|
|
Term
| What are granulomatous lesions that develop around small blood vessels, commonly found over pressure points in RA patients? |
|
Definition
|
|
Term
| Which 4 of the 7 criteria for classification of Rheumatoid arthritis MUST be present in order to make a diagnosis. |
|
Definition
1. Radiographic changes trpical of rheumatoid arthitis on hand or wrist radiographs
2. Serum rheumaroid factor identified by a method that is positive in less than 5% in normal subjects.
3. Rheumatoid nodules
4. Symmetric joint swelling for 6 or more weeks. |
|
|
Term
|
Definition
|
|
Term
| Are radiologic findings a good diagnostic marker for RA? Why or why not? |
|
Definition
| No, because joing erosions often are not seen ion radiographic images in the early stage of the disorder. |
|
|
Term
| What are the characteristics of a synovial fluid analysis that is positive for RA? |
|
Definition
| The synovial fluid has a cloudy appearance the white blood cell count is elevated as a result of inflammation, and the complement components are decreased. |
|
|
Term
| When is the peak incidence of gout? |
|
Definition
| between the fourth and sixth decades of life. |
|
|
Term
| Do most people with hyperuricemia develop gout? |
|
Definition
| No. Hyperuricemia is a laboratory finding and not a disease. Most people with it do not develop gout. |
|
|
Term
| What is the general healing time for fractures in children? |
|
Definition
|
|
Term
| What is the average healing time in adolescents for fractures? |
|
Definition
|
|
Term
| What is the average healing time for fractures for adults? |
|
Definition
|
|
Term
| What is the main determinant of joint integrity? |
|
Definition
| The health of chondrocytes. |
|
|
Term
| What is the articular cartilage injury that occurs in osteoarthritis thought to result from? |
|
Definition
| Release of cytokines such as IL-1 and TNF. They stimulate production and release of proteases (enzymes) that are destructive to joint structures. |
|
|
Term
| What happens to chondrocytes after cytokines stimulate production of descructive protease in osteoarthritis? |
|
Definition
| The resulting damage predisposes the chondrocytes to more injury and impairs their ability to repair the damage by producing new collagen and proteoglycans. |
|
|
Term
| What are the earliest structural changes in osteoarthritis? |
|
Definition
| Enlargement and reorganization of the chondrocytes in the superficial part of the articular cartilage. |
|
|
Term
| After a period of immobilization in persons with osteoarthritis, what is important to remember in terms of activity after the immobilization? |
|
Definition
| Impact exercise during the period of remobilization can prevent reversal if the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury. |
|
|
Term
| What generally happens when a single weight bearing joint is affected by osteoarthritis? |
|
Definition
| Other joints often become affected because of the additional stress placed on them while trying to protect the original joint. |
|
|
Term
| How do the joints normally feel in osteoarthritis as opposed to how they feel with rheumatoid arthritis? |
|
Definition
| The joint will feel hard, as opposed to rheumatoid arthritis, with which the joint feels spongy and soft. |
|
|
Term
| What is joint enlargement usually attributed to in osteoartritis? |
|
Definition
| New bone formation. This is why the joint feels hard! |
|
|
Term
| What is usually the result of lab findings with osteoarthritis? |
|
Definition
| They are usually normal because the disorder is not a systemic disease. If inflammation is present, however, there may be a slight elevation in WBC count. |
|
|
Term
|
Definition
| Large, hard nodules that have irregular surfaces and contain crystalline deposits of monosodium urate. |
|
|
Term
| Where are tophi most commonly found? |
|
Definition
| Most commonly in the synovium, olecranon bursa, achilles tendon, subchondral bone, and extensor surface of the forearm and may be mistaken for theumatoid nodules. |
|
|
Term
| When do tophi normally occur in relation to the 1st gout attack? |
|
Definition
| Usually not until 10 years or more after the first gout attack. |
|
|
Term
| What are the characteristics of chronic tophaceous gout? |
|
Definition
| More frequent a prolonged attacks, which often are polyarticular. |
|
|
Term
| If you wanted to give a diagnostic test to a patient to determine if suspected gout was related to overexcretion of uric acid, you would know that the docotor would normally order what? |
|
Definition
| Measurement of serum uric acid levels and collection of a 24-hour urine sample for determination of urate excretion in the urine. |
|
|
Term
|
Definition
| Is is a manefestation of hematogenous ostemelitus. Characterized by fever, chills, malaise, pain on movement of the affected extremety, loss of movement, and local tenderness. |
|
|
Term
| With compartment syndrome, is the pulse pressure affected? Why? |
|
Definition
| Pulse pressure is not normally affected because arteries do not run through muscles. However, edema in the area may cause the pulse to be harder to find. |
|
|
Term
| Where do osteosarcomas most commonly develop? |
|
Definition
| Although they can develop in any bone, osteosarcomas most commonly arise in the vicinity of the knee. |
|
|
Term
| Discuss the prevalence of osteosarcoma of the hands, feet, skull, and jaw. |
|
Definition
| These locations are less frequently affected and are usually seen in persons older than 25 years old. |
|
|
Term
| What are the common sites of bone tumors in the elderly? |
|
Definition
| They are more common in hte humerus, pelvis, and proximal femur. |
|
|
Term
| What are the common sites of primary osteosarcoma tumor in younger persons? |
|
Definition
| In the sites associated with maximum growth velocity, such as the distal femur, proximal tibia, and proximal humerus. |
|
|
Term
| What two genes are related to the development of osteosarcoma? |
|
Definition
| Retinoblastoma gena and p53 gene. |
|
|
Term
| What is the usual movement of metastysis in osteosarcoma? |
|
Definition
| They normally move from the metaphysis of the bone out into the periosteal surface, with subsequent spread to adjacent soft tissues. The tumor does not often metastasize to lymph nodes because the cells are unable to grow in the nodes. |
|
|
Term
| What is the primary symptom of osteosarcoma? |
|
Definition
| Deep localized pain with nighttime waking and swelling in the affected bone. |
|
|
Term
| What is the commonality of Ewing sarcoma in chi'ren? |
|
Definition
| It is the second most common type of primary bone tumor in children and adolescents, but rarely presents in asian and black children. |
|
|
Term
| The three major features of malignant bone tumors is what? |
|
Definition
1. Pain
2. Loss of function
3. Presence of mass or hard lump. |
|
|
Term
| What is the most frequent site for ewing sarcoma? |
|
Definition
| The femur, usually in the diaphysis. |
|
|
Term
| What is the second most common form of malignant bone tumor in general? |
|
Definition
|
|
Term
| What is a condition that can sometimes arise from underlying benign lesions such as osteochondroma, chondroblastoma, or fibrous dysplasia? |
|
Definition
|
|
Term
| Why is early diagnosis important in chodrosarcoma? |
|
Definition
| Because chondrosarcoma responds well to early radical surgical excision, and is usually resistant to radiation therapy and available chemotherapeutic agents. |
|
|
Term
| What does the foot progression angle describe? |
|
Definition
| Describes the angle between the axis of the foot and the line of progression. |
|
|
Term
| Femoral anteversion is the most common finding of what? |
|
Definition
|
|
Term
| What is a common congenital defomtity characterized by adduction of the forefoot with a normal hindfoot, giving the foot a kidney-shaped appearance? |
|
Definition
|
|
Term
| Why is treatment not usually instituted until the infant is 6 months of age in metatarsus adductus? |
|
Definition
| Because the condition often corrects itself spontaneously. |
|
|
Term
| How is the severity of metatarsus adductus assessed? |
|
Definition
By assessing the flexibility of the foot and using a heel bisection line.
Mild-Flexible foot, line crosses third toe.
Moderate-foot less flexible, line falls between third and fourth toes.
Severe-Foot is more rigid and the line crosses between the fourth and fifth toes. |
|
|
Term
| What is the most common cause of intoeing in children younnger than 2 years of age? |
|
Definition
| Internal tibial torsion. It is secondary to normal in utero positioning. |
|
|
Term
| How do you know when to use night splints with internal tibial torsion? |
|
Definition
| Night splints are of no value and should be avoided. Improvement occurs when the child begins to pull up to stand and walk independently. |
|
|
Term
| How is hip rotation measured in femoral torsion? |
|
Definition
| At the pelvic level with the child in the prone position and the knees flexed at a 90-degree angle. |
|
|
Term
| Children with internal femoral torsion are encouraged to sit how? |
|
Definition
| Cross-legged or in the so-called "tailor position." |
|
|
Term
| When might surgical intervention be needed for correction of internal femoral torsion? |
|
Definition
| In children 10 years of age or older. |
|
|
Term
| When might a child with genu varum require bracing? |
|
Definition
| If there is a large separation between the knees of greater than 15 degrees after 2 years of age. |
|
|
Term
| Name the deformity in which there is decreased space between the knees. and the ankles can't be brought in contact with each other when the knees are touching? |
|
Definition
| Genu valgum or knock-knees. |
|
|
Term
| Genu valgum is most frequently seen in children between what ages? |
|
Definition
|
|
Term
| When should genu valgum resolve? |
|
Definition
|
|
Term
| What is genu valgum usually the result of? |
|
Definition
| Lax medial collateral ligaments of the knee. |
|
|
Term
| Sitting in which position may cause genu valgum to be exacerbated? |
|
Definition
|
|
Term
| Genu valgum can be ignored until age ______ years, unless it is more then ______degrees, _______, or associated with _____ ______. |
|
Definition
| 7, 15, unilateral, short stature |
|
|
Term
| If genu varum or genu valgum persists and is uncorrected, what may develop in adulthood and why? |
|
Definition
| Osteoarthritis, as a result of abnormal intra-articular stress. |
|
|
Term
| Which growth disorder in children can cause sublusation and recurrent dislocation of the patella, with a predisposition to chodromalacia and joint pain and fatigue? |
|
Definition
|
|
Term
| What growth disorder in children can cause gait awkwardness and increased risk of sprains and fractures? |
|
Definition
|
|
Term
| Why is the left hip involved three times more frequently than the right hip in infant hip dislocation? |
|
Definition
| Because of the left occipital intrauterine positioning of most infants. |
|
|
Term
| What is the incidence of developmental dysplasia of the hips in white children? |
|
Definition
| It normally occurs in first born and is 6 times more frequent in females than males. |
|
|
Term
| What is the increased frequency of congenital hip displacement in girls thought to be attributed to? |
|
Definition
| It is thought to result from their susceptibility to maternal estrogens and other hormones associated with pelvic relaxation. |
|
|
Term
| Why is early diagnosis of a developmental dysplasia important? |
|
Definition
| because treatment is easiest and most effective if begun durning the first 6 months of life. |
|
|
Term
| When assessing the gluteal folds in an infant during inspection for congenital hip dysplasia, what does asymmetry of the gluteal folds indicate? |
|
Definition
| The need for further evaluation. |
|
|
Term
| When the foot is inverted at the heel, what is this called? |
|
Definition
|
|
Term
| When the foot is everted at the heel, what is it called? |
|
Definition
|
|
Term
| What is it known as when on plantarflexion, the toes are lower than the heel (clubfoot)? |
|
Definition
|
|
Term
| When upon dorsiflexion, the heel is below the toes, what is this known as? |
|
Definition
|
|
Term
| What is the primary pathologic feature of Legg-cave-perthes disease? |
|
Definition
| Avascular necrosis of the bone and marrow involving the epiphyseal growth center in the femoral head. |
|
|
Term
| Why is the age of onset so important in Legg-Calve-perthes disease? |
|
Definition
| Because young children have a greater capability for remodeling of the femoral head and acetabulum, so less flattening of the femoral head occurs. |
|
|
Term
| Which condition involves microfractures int he area where the patellar tendon inserts into the tibial epiphysis? |
|
Definition
|
|
Term
| What is the incidence age of osgood-schlatter? |
|
Definition
| occurs most frequently in boys between the ages of 11 and 15 years and in girls between 8 and 13 years. |
|
|
Term
| What are 3 conditions that can cause neuromuscular scoliosis? |
|
Definition
| Cerebral palsu, myelodysplasia, and poliomyelitis |
|
|
Term
| What is the most common type of idiopathic scoliosis and when does it occur? |
|
Definition
| Adolescent, and it occurs in children 11 and older. |
|
|
Term
| What is the most common curve in idiopatic scoliosis? |
|
Definition
| Right thoracic curve, which produces a rib prominence on the convex side and hypokyphosis from rotation of the vertebral column around its long axis as the spine begins to curve. |
|
|
Term
| What is the pain in scoliosis usually caused from? |
|
Definition
| Pressure on the ribs or on the crest of the ilium. |
|
|
Term
| What is a complication of untreated scoliosis? |
|
Definition
| Compromised cardiopulmonary function and risk for neurologic complications. |
|
|
Term
| What are the three classifications of headaches according to the international headache society? |
|
Definition
1. Primary headaches
2. Headaches secondary to other medical conditions
3. Cranial neuralgias and facial pain. |
|
|
Term
| What type of inheritant trait is the incidence of migraine headaches? |
|
Definition
|
|
Term
| Which type of migraine is most common? |
|
Definition
| Migraine without aura. It accounts for 85% of migraine headaches. |
|
|
Term
| Which migraine is characterized by diplopia, due to a transient paralysis of the muscles that control eye movement, and localized pain around they eye? |
|
Definition
|
|
Term
| Pain in the liver is usually referred to: |
|
Definition
| The right side of the neck and right midback. |
|
|
Term
| Pain from the lung and diaphragm is usually referred to: |
|
Definition
| The left side of the neck. |
|
|
Term
| Pain from the heart is usually referred to: |
|
Definition
| The left arm and mid upper back. |
|
|
Term
| What are 2 names for pain manifested by facial tics or grimaces and characterized by stabbing, paroxysmal attacks of pain that usually are limited to the unilateral cheek area? |
|
Definition
| Trigeminal neuralgia or tic douloureaux |
|
|
Term
| What should a nurse suspect if a young person presents with trigeminal neuralgia? |
|
Definition
|
|
Term
| This develops in 10% to 70% of patients with shingles. |
|
Definition
|
|
Term
| What is described as the presence of pain more than one month after the onset of herpes zoster? |
|
Definition
|
|
Term
| Diagnosis or migrains in children is based on at least three of the following symptoms or associated findings (name them): |
|
Definition
| Abdominal pain, nausea or vomiting, throbbing headache, unilateral location, associated aura, relief during sleep and a positive family history. |
|
|
