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Questions and Answers
What is the primary function of osteoclasts?
Which medication is commonly used to treat nerve pain?
What complication is the most common after surgery?
In the context of muscular dystrophy, what differentiates Becker and Duchenne types from others?
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Which is NOT a preventative measure for flexion contracture?
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What is the number one risk factor for surgical amputation?
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What is the NUMBER ONE SIGN of acute osteomyelitis?
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What method is suggested to prevent a flexion contracture post-surgery?
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Which medication is commonly prescribed for osteoporosis?
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What type of osteomyelitis is caused by bacteria entering from the bloodstream?
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Which treatment for plantar fasciitis involves non-pharmacological methods?
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What is the classic manifestation of osteoporosis that typically involves a loss of height?
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Which treatment involves removing inflamed tissue related to fasciitis?
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What is the primary benefit of early ambulation after surgery?
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In the event of a traumatic amputation, what is the recommended initial action regarding the amputated body part?
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How does hypocalcemia primarily occur?
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Which type of muscular dystrophy involves symptoms that typically last longer than four weeks?
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What is an essential assessment after a patient has received a bone graft?
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What type of amputation is characterized as having no prior injury or illness?
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What is the correct order of emergency care steps for a traumatic amputation?
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Which option accurately describes a characteristic of chronic infection in osteomyelitis?
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What is the purpose of PMMA beads in osteomyelitis treatment?
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Which condition may develop during pregnancy due to compression of maternal nerves?
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What is the safest administration method for calcitonin to manage osteoporosis?
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Which condition is most common in females and may require surgical intervention?
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What is a recommended treatment for plantar fasciitis?
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What is a possible outcome if a Gangean cyst is not treated properly?
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Increased TP02 levels indicate what regarding amputation risk?
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Which of the following is NOT considered a modifiable risk factor for osteoporosis?
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What is the role of phosphorus in relation to calcium?
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Which of the following is a common surgical treatment for hammer toe?
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How can chronic low vitamin D impact calcium levels?
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Study Notes
Bone Cells
- Osteoclasts break down bone tissue and reabsorb calcium
- Osteoblasts build new bone tissue
- Osteocytes maintain bone tissue
- Osteogenic cells are stem cells that can differentiate into other bone cells
Medications for Pain
- Lyrica or Neurotin (anticonvulsants) treat nerve pain
- Calcitonin (IV) is used for pain relief
- Antispasmodics (Baclofen) are used to reduce muscle spasms
- **Opioids ** are typically used as a last resort for pain management
- Beta blockers (PROPANALOL) treat dull and aching pain
- **Antidepressants (Cymbolta) ** are used for pain relief
- NMDA medications are used for pain relief
Types of Muscular Dystrophy
- Becker/Duchenne muscular dystrophy is the most critical type, characterized by the absence of dystrophin
- Other types include: Congenital, Distal, Emery-Dreifuss, Myotonic, Humeral, Ocular pharyngeal, Limb-girdle
Common Complications after Surgery
- Bleeding/Hemorrhage is the most common complication, potentially leading to hypovolemic shock
- Infection is another common complication, with risks increased for patients with conditions such as Osteomyelitis, PVD, DM, or being elderly or immunocompromised
- Flexion contracture can occur in the knee, hip, elbow, and shoulder, limiting mobility
- Phantom limb pain is a common complication following amputation
- Body image concerns are common after surgery, especially amputation
- Neuroma is a painful nerve condition, often diagnosed with ultrasound
- Impaired mobility is a significant concern following surgery, requiring early ambulation, physical therapy, occupational therapy, and assistive devices.
Classifications of Osteomyelitis
- Exogenous osteomyelitis occurs due to external factors like an open fracture
- Endogenous osteomyelitis is caused by bacteria entering the bloodstream and affecting the bone, often seen in IV drug users
- Acute osteomyelitis has symptoms lasting less than four weeks, but may require treatment longer than chronic infections
- Chronic osteomyelitis has symptoms persisting for more than four weeks
- Contagious osteomyelitis can infect the skin and surrounding tissue
Prevention of Flexion Contracture
- Range of motion (ROM) exercises
- Splinting the affected extremity
- Avoiding pillows under the affected joint
- Prone positioning for 30 minutes every four hours
- Firm mattress
Hypercalcemia vs. Hypocalcemia
- Hypocalcemia can result from excessive bone buildup
- Hypercalcemia is characterized by high calcium levels and low phosphorus levels
Treatment for Plantar Fasciitis
- Rest
- Ice
- Supportive shoes
- Stretching
- NSAIDs
- Steroids
- Massage
- Endoscopic procedure
- Fasciectomy (surgery to remove inflamed tissue)
Signs and Symptoms of Osteomyelitis
-
Acute osteomyelitis:
- Temperature over 100 degrees Fahrenheit
- Swelling
- Redness
- Heat
- Tenderness
- Pulsating pain
-
Chronic osteomyelitis:
- Sinus tract formation
- Ulceration
- Weeping and drainage of the affected site
Surgical Interventions for Osteomyelitis
- Sequestrectomy: Debridement of necrotic bone tissue to encourage revascularization, often requiring bone grafting
- PMMA beads: Antibiotic beads implanted into the wound that slowly release medication over six weeks before dissolving
- Bone graft: May be required to cover areas of infected bone, with the fibula being a common donor site
- Muscle flap: Used for skin coverage
- Amputation
Risk Factors for Amputation
- Diabetes mellitus
- Peripheral vascular disease
- Atherosclerosis
- Osteomyelitis infection
- Cancer
- Dysfunction
Types of Amputation
- Congenital
- Traumatic
- Surgical or Elective
Calcitonin for Osteoporosis
- Calcitonin moves calcium from the blood back into the bone
- Available as a nasal spray or IV injection
Osteoporosis Manifestations
- Fractures: Most common in the hip, wrist, and lower back
- Height loss: Loss of 2-3 inches in height is a common indication
- Dowager hump: Located in the cervical spine region, often diagnosed with an x-ray
- Reflux
- Respiratory problems
- Back pain
- Constipation
Osteoporosis Medications
- Bisphosphonates are the most common medications
- Raloxifene is a skeletal muscle relaxant that promotes estrogen without increasing breast cancer risk
- PTH analogs stimulate the parathyroid gland; use in short bursts as long-term use decreases calcium levels
Emergency Care for Traumatic Amputation
- ABCs (airway, breathing, circulation)
- Salvage the body part by cleaning, wrapping, and placing in cool water over ice
- Control bleeding
- Promote perfusion by elevating the affected limb
- Transport to a hospital
Pain Disorders
- Carpal tunnel syndrome: Compression of the median nerve often caused by repetitive movements or pregnancy
- Dupuytren's contracture: Affects the hand, common in diabetics and males
- Hallux valgus (bunion): Common in females, treated with a bunionectomy (surgical removal)
- Hammertoe: Requires surgery for correction
- Plantar fasciitis: Inflammation in the foot, treated with RICE (rest, ice, compression, elevation), NSAIDs, steroids, splinting, and stretching
- Ganglion cyst: Benign cyst, often treated with surgical removal and aspiration if removal is unsuccessful
Limb Viability Assessment
- Ankle-brachial index (ABI): Measures blood flow in the legs
- Ultrasound doppler: Evaluates blood flow
- Laser Doppler flowmetry: Measures blood flow in the microvasculature
- Transcutaneous oxygen pressure (TP02): Used to diagnose carpal tunnel syndrome, with decreased TP02 indicating increased amputation risk
Modifiable Risk Factors for Osteoporosis
- Chronic low vitamin D or calcium levels : Important to get adequate dietary intake and sun exposure for vitamin D
- Low body weight with thin frame
- Sedentary lifestyle
- Extreme protein intake (high or low)
- Sex hormone deficiency (estrogen and testosterone)
- Gender confirmation surgery
- High caffeine or calorie intake
- Tobacco use and smoking
Important Considerations
- Phosphorus binds to calcium, therefore high phosphorus levels can interfere with calcium absorption.
- Carbonated seltzers are safe to drink as they do not have high sodium or phosphorus content.
- Estrogen and testosterone play significant roles in bone health. Changes in these hormones can put patients at risk for weaker bones.
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Description
This quiz covers essential topics related to bone cells, including osteoclasts, osteoblasts, and osteocytes, along with various medications for pain management. It also explores different types of muscular dystrophy and common surgical complications. Test your understanding of these vital medical concepts!
