Geriatric Musculoskeletal Pre-Op Care

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Questions and Answers

Which of the following is the MOST important goal of pre-operative care for a geriatric patient undergoing musculoskeletal surgery?

  • Optimizing surgical outcomes. (correct)
  • Preventing surgical site infections.
  • Reducing post-operative pain.
  • Minimizing the length of hospital stay.

A 75-year-old patient is scheduled for a total knee arthroplasty. Which pre-operative assessment is MOST critical in identifying potential risks?

  • Identifying the patient's risk factors. (correct)
  • Measuring calf circumference.
  • Assessing lower extremity edema.
  • Evaluating range of motion.

What is the primary reason for obtaining a detailed medication history during the pre-operative assessment of a geriatric patient?

  • To simplify the medication regimen.
  • To determine the patient's adherence to medication.
  • To educate the patient on their medications.
  • To identify potential drug interactions. (correct)

Which of the following diagnostic tests is routinely performed as part of a pre-operative cardiac evaluation for geriatric patients undergoing musculoskeletal surgery?

<p>Electrocardiogram (EKG). (C)</p> Signup and view all the answers

An appropriate acute care unit for patients should include which of the following ratios?

<p>Ratio of nursing:patient. (D)</p> Signup and view all the answers

What is the primary goal of post-operative care in geriatric musculoskeletal patients?

<p>Returning the patient to the highest possible functional status. (C)</p> Signup and view all the answers

Which of the following interventions is MOST important in preventing pulmonary complications in the post-operative care of a geriatric patient?

<p>Encouraging incentive spirometry exercises. (B)</p> Signup and view all the answers

Which of the following is a common cardiac complication that should be monitored for in the post-operative care of geriatric patients who have undergone musculoskeletal surgery?

<p>Atrial fibrillation. (C)</p> Signup and view all the answers

A 70-year-old patient reports pain that is worse with activity. Radiographs reveal narrowed joint space. This is consistent with what condition?

<p>Osteoarthritis (D)</p> Signup and view all the answers

Which of the following statements BEST describes the typical pain associated with osteoarthritis?

<p>Pain that is worse with activity and better at night. (D)</p> Signup and view all the answers

Which of the following best describes how osteoarthritis affects the joint?

<p>Involvement of the entire joint structure. (D)</p> Signup and view all the answers

An X-ray of a patient's knee with osteoarthritis is MOST likely to reveal which of the following findings?

<p>Presence of osteophytes. (C)</p> Signup and view all the answers

Which treatment is MOST appropriate as an initial intervention for managing osteoarthritis pain?

<p>Weight loss and exercise. (C)</p> Signup and view all the answers

According to the information provided, what percentage of individuals over the age of 70 are affected by osteoarthritis?

<p>25% (A)</p> Signup and view all the answers

A patient with osteoarthritis is prescribed celecoxib. The provider should monitor for which of the following?

<p>Cardiovascular events. (A)</p> Signup and view all the answers

A patient being treated for osteoarthritis is recommended to undergo joint replacement. This should be considered:

<p>Only after conservative treatments have failed. (A)</p> Signup and view all the answers

According to the provided text, which of the following conditions is NOT a common complication of arthritis?

<p>Gout (B)</p> Signup and view all the answers

According to the information provided, in which of the following situations is it MOST appropriate to obtain X-rays of a joint?

<p>The patient has a history of cancer. (B)</p> Signup and view all the answers

A patient is diagnosed with osteopenia, which is characterized by a bone density that is:

<p>-1 to -2.5 s.d. below normal (B)</p> Signup and view all the answers

Which of the following is the MOST accurate method for assessing bone density in a patient suspected of having osteoporosis?

<p>Dual X-ray absorptiometry (DXA). (C)</p> Signup and view all the answers

Which of the following is a modifiable risk factor for osteoporosis?

<p>Low calcium intake. (C)</p> Signup and view all the answers

Which of the following endocrine disorders is associated with secondary osteoporosis?

<p>Hyperthyroidism. (B)</p> Signup and view all the answers

According to the information, when should treatment for osteoporosis begin to prevent fractures and maintain bone health?

<p>In adolescence. (B)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial behavioral recommendation for treating osteoporosis?

<p>Increase calcium and Vitamin D to help with bone production. (B)</p> Signup and view all the answers

Which bisphosphonate can be administered yearly?

<p>Zoledronic acid (Reclast) (B)</p> Signup and view all the answers

A patient with osteoporosis who is prescribed denosumab (Prolia) should be monitored for:

<p>Hypocalcemia. (C)</p> Signup and view all the answers

A patient is diagnosed with hyperkyphosis. This is characterized by kyphosis GREATER THAN:

<p>40 degrees (B)</p> Signup and view all the answers

Which of the following is a potential consequence of hyperkyphosis?

<p>Thoracic pain. (B)</p> Signup and view all the answers

All of the following are aspects of the treatment of hyperkyphosis, EXCEPT:

<p>Flexion exercises (B)</p> Signup and view all the answers

An elderly patient presents with sudden onset hip pain a day after falling. Which of the following mechanisms is MOST likely to be associated with a hip fracture?

<p>A fall directly onto the lateral hip (B)</p> Signup and view all the answers

What is a major risk factor associated with hip fractures?

<p>Osteoporosis and falls (B)</p> Signup and view all the answers

A patient is diagnosed with an intertrochanteric fracture of the hip. This refers to which of the following?

<p>A fracture between the greater and lesser trochanters (B)</p> Signup and view all the answers

Mortality rates from hip fractures may be doubled in men due to what factor?

<p>Higher co-morbidities (B)</p> Signup and view all the answers

An elderly patient presents with hip pain. Claudication is a symptom of which potential cause of hip pain?

<p>Aortoiliac arterial insufficiency (A)</p> Signup and view all the answers

Which of the following exam findings is MOST indicative of a hip fracture?

<p>The leg may appear shortened and externally rotated. (D)</p> Signup and view all the answers

For which type of patient may a nonoperative management be considered for a hip fracture?

<p>Nonambulatory patients. (B)</p> Signup and view all the answers

Vertebral compression fractures commonly occur in which region of the spine?

<p>Thoracic spine (A)</p> Signup and view all the answers

What is a common activity that may lead to compression fractures?

<p>Lifting or twisting (A)</p> Signup and view all the answers

A patient is being evaluated for a possible vertebral compression fracture. Which physical exam finding would MOST strongly suggest a compression fracture?

<p>Pain elicited by percussion of the spinous processes (D)</p> Signup and view all the answers

How long should a brace be worn for treatment of a vertebral compression fracture?

<p>3 months (C)</p> Signup and view all the answers

In which timeframe should kyphoplasty be completed for maximum effectiveness?

<p>Within 2-3 weeks of the fracture. (C)</p> Signup and view all the answers

In a patient who has undergone kyphoplasty, what is a benefit of the procedure?

<p>Out-patient procedure with almost immediate relief of pain (A)</p> Signup and view all the answers

Which of the following questions addresses a patient's social determinants of health?

<p>How will you get your prescription? (A)</p> Signup and view all the answers

In the post-operative care of a geriatric patient, what is the rationale behind elevating the head of the bed to 30 degrees?

<p>To facilitate pulmonary toilet and prevent pulmonary complications. (A)</p> Signup and view all the answers

A 72-year-old female is diagnosed with osteopenia. According to established guidelines, her T-score would likely fall within which of the following ranges?

<p>Between -1.0 and -2.5 SD below the young adult mean. (A)</p> Signup and view all the answers

Which mechanism of injury is MOST likely to result in a hip fracture in an elderly patient?

<p>A direct fall onto the lateral hip. (A)</p> Signup and view all the answers

An elderly patient presents with a suspected vertebral compression fracture. Palpation of the spinous processes elicits significant pain. What does this exam finding suggest?

<p>A vertebral compression fracture. (B)</p> Signup and view all the answers

You are evaluating a patient who has been diagnosed with hyperkyphosis. Which of the following would be the MOST appropriate initial intervention?

<p>Extension exercises. (C)</p> Signup and view all the answers

An 82-year-old woman presents with chronic joint pain that worsens with activity and at night. Imaging confirms osteoarthritis. Which of the following treatments is initially recommended?

<p>NSAIDs and physical therapy (B)</p> Signup and view all the answers

A 75-year-old man presents after a fall. Examination reveals shortened and externally rotated right leg. Which of the following is the most likely diagnosis?

<p>Hip fracture (C)</p> Signup and view all the answers

A 79-year-old female with osteoporosis has acute-onset thoracic pain following a minor fall. Radiography reveals a vertebral compression fracture. What is the most appropriate initial intervention?

<p>Initiate bracing and consider kyphoplasty (B)</p> Signup and view all the answers

During preoperative evaluation, which screening is specifically recommended for elderly patients undergoing elective surgery to reduce postoperative complications?

<p>Chest X-ray and EKG (C)</p> Signup and view all the answers

What is the primary clinical goal in managing postoperative care of a geriatric patient after orthopedic surgery?

<p>Early ambulation to avoid complications (A)</p> Signup and view all the answers

A geriatric patient scheduled for elective orthopedic surgery is undergoing pre-operative evaluation. Which test is specifically indicated for assessing potential postoperative pulmonary complications?

<p>Complete blood count (CBC) (C)</p> Signup and view all the answers

A 72-year-old woman with chronic hip pain due to osteoarthritis asks about non-pharmacologic interventions. Which intervention has the best evidence for reducing pain and improving function in osteoarthritis?

<p>Hot and cold therapy (B)</p> Signup and view all the answers

An 85-year-old man has osteoporosis and presents with an acute thoracic compression fracture. Conservative management is recommended initially. Which intervention is indicated as part of this conservative approach?

<p>Use of spinal brace (D)</p> Signup and view all the answers

A 70-year-old man diagnosed with osteoporosis has a history significant for excessive alcohol use, smoking, and inactivity. Besides calcium and vitamin D supplementation, what additional recommendation is essential in managing this patient's osteoporosis?

<p>Elimination of lifestyle risk factors (A)</p> Signup and view all the answers

An elderly patient reports joint pain worse at the end of the day and with prolonged activity. Which radiographic finding would most likely support a diagnosis of osteoarthritis?

<p>Joint space narrowing and osteophytes (A)</p> Signup and view all the answers

A 69-year-old female patient presents with complaints of difficulty performing household tasks, specifically cleaning and preparing meals. These limitations are best classified as impairment in which area?

<p>Instrumental activities of daily living (IADLs) (D)</p> Signup and view all the answers

Flashcards

Pre-Op Care

Optimize surgical outcomes and provide anticipatory guidance.

Pre-Op Assessment

Benefits must outweigh risks; assess cognition and screen for depression.

Pre-Op Diagnostic Tests

CBC, CMP, U/A, Coags, CXR, and EKG/stress test.

Post-Op Care

Return patients to a high level of function as quickly as possible.

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Post-Op Essentials

Acute care unit; Q2 vitals/neuro checks; monitoring available.

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Post-Op Complications

Pain, delirium, cardiac, and pulmonary complications.

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Osteoarthritis

A prevalent, disabling, and costly disease.

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Osteoarthritis Pain

OA is very common (25% or >70 y/o); the pain is worse with activity.

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OA on X-ray

X-ray: Narrowed joint space, osteophytes (bone spurs).

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OA Complications

Inability to perform ADLs, inactivity, spinal stenosis, radiculopathy.

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OA Treatment

Weight loss, bracing, hot/cold therapy, NSAIDs, topical, joint replacement.

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When to Get X-rays

Age >70, osteoporosis, trauma, cancer, neurological deficit.

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Osteoporosis

Condition of reduced bone mass.

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Osteoporosis Characteristics

Low bone mass, compromised bone strength, bone fragility.

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Osteopenia Value

DXA scan showing -1 to -2.5 s.d. below normal.

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Osteoporosis Value

DXA scan value of <-2.5 s.d. below normal.

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Osteoporosis Risk Factors

Advanced age, sex, race, family history, low calcium, alcohol, smoking.

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Other Osteoporosis Causes

Hypogonadism, hyperprolactinemia, hyperthyroidism, vitamin D deficiency.

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Peak Bone Mass

Peak bone mass by age 25-30 in women.

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Postmenopausal Osteoporosis

Women after menopause but can happen later in men.

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Osteoporosis Treatment

Adequate calcium in adolescence, behavioral changes, fall prevention.

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Osteoporosis Medications

Calcium, Vitamin D, Calcitonin, Estrogens, SERMs, raloxifene, Bisphosphonates.

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Bisphosphonates

Alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast).

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Denosumab (Prolia)

Denosumab for post-menopausal osteoporosis that prevents fractures.

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Hyperkyphosis

Kyphosis >40 degrees.

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Hyperkyphosis Causes

Osteoporosis can cause spine fractures which collapse.

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Hyperkyphosis Treatment

Pain management, extension exercises, calcium supplements.

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Hip Fractures

Associated with serious morbidity and mortality.

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Hip Fracture Risk Factors

Major risk factors for hip fractures include osteoporosis and falls.

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Hip Fracture Mechanism

A fall directly onto the lateral hip or twisting mechanism.

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Types of Hip Fractures

Intracapsular, intertrochanteric, and subtrochanteric fractures of the hip.

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Hip Pain DDX

Rule out fracture, stress fracture of femoral neck with posterior pain.

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Hip Fracture Signs

Sudden onset of hip pain after a fall and inability to walk.

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Hip Fracture Treatment

Nonoperative vs surgical management depending on functional status.

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Vertebral Compression Fractures

Commonly occur in the thoracic spine.

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Vertebral Compression Fractures (Causes)

Occur after lifting or twisting and are severely painful.

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Treatment for Vertebral Compression Fractures

Bracing the back or performing kyphoplasty to correct issues.

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Percuss Spinous Process

Fracture and degeneration = back pain.

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Kyphoplasty

Restores the height of the fracture and bone in the verebrae.

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Social Questions for Patients w/Musculoskeletal issues.

Questions directed toward health.

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OA Initial Treatment

First-line treatment for osteoarthritis, along with physical therapy.

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Vertebral Fracture Treatment

Bracing and kyphoplasty. Kyphoplasty restores vertebral height.

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Elderly Pre-op Evaluation

Includes cardiac (EKG) and pulmonary (CXR) assessments.

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Denosumab Contraindication

Due to risk of severe side effects, like osteonecrosis of the jaw.

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Hyperkyphosis Definition

Thoracic curvature greater than 40 degrees.

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Kyphoplasty Benefits

Kyphoplasty offers rapid pain reduction of vertebral height.

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Acute Compression Fracture Treatment

Conservative treatment includes bracing for 3 months.

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Osteoarthritis (X-ray)

Characterized by joint-space narrowing and osteophytes (bone spurs).

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IADLs Impairment

Activities such as cleaning, prepping meals indicates impairment in IADLs.

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Study Notes

Osteoarthritis

  • Pain is worse with activity and at night.
  • Initial therapy includes NSAIDs, topical therapy, and assistive devices.
  • Non-pharmacologic management of osteoarthritis includes exercise, hot/cold therapy, weight loss, bracing, and physical therapy.
  • Joint space narrowing and osteophytes (bone spurs) are characteristic radiographic findings.

Hip Fractures

  • A shortened, externally rotated leg is a characteristic clinical sign.

Vertebral Compression Fractures

  • Acute vertebral compression fractures are initially treated with bracing or kyphoplasty, which restores vertebral height and reduces pain promptly.
  • Conservative treatment for acute vertebral compression fractures includes bracing; vertebroplasty or kyphoplasty is considered if conservative therapy fails.

Osteoporosis

  • Lifestyle modifications, like cessation of alcohol, smoking, and caffeine, as well as increased physical activity, are crucial alongside calcium/vitamin D for osteoporosis management.
  • Denosumab is contraindicated in hypocalcemia due to the risk of severe side effects like osteonecrosis of the jaw.

Hyperkyphosis

  • Defined as thoracic curvature >40 degrees, associated with osteoporosis and vertebral fractures.

Post-Op Care

  • Early ambulation post-op is essential in geriatrics to minimize complications like delirium, pneumonia, and thromboembolism.

Pre-Op Care

  • Pre-op evaluation in elderly includes cardiac (EKG), pulmonary (CXR), cognition, nutrition, and falls assessment.
  • Pre-operative geriatric evaluation includes cardiac (EKG) and pulmonary (CXR) assessments to minimize postoperative complications.

ADLs

  • Difficulties with complex tasks like house cleaning, meal preparation, and shopping indicate impairment in IADLs (Instrumental Activities of Daily Living).

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