Prosthetics Exam 1

More amputations occur among ______ than _______. Some studies suggest the ratio of men to women for amputations related to trauma is _:_ and for amputations related to disease is _______. The majority of amputations are due to __________, approximately 70% (82%). The highest percentage of disease related amputations occurs in the __________ year of age population. Most of these are ______ extremity amputations, which are performed 11 times more frequently than ________ extremity amputations. - Correct Ans-men; women; 9:1; 2.5:1; disease; 61-70; lower; upper The disease that is most frequently related to amputation is _________ ___________ _________ (____) and complications of neuropathy. Although this and neuropathy are frequently associated with long-term adult onset (type II) diabetes, it is important to note that vascular disease also occurs independently of diabetes. Of disease related amputations, _________ are attributed to complications of diabetes. The projected increased frequency of amputation for PVD may be a reflection of the increased growth in the ______ population. - Correct Ans-peripheral vascular disease (PVD); 50-70%; older The second leading cause of amputation is _______. This accounts for _____% of the amputations and is most common in the ______ adult population. The incidence of traumatic amputation is dropping because of the implementation of new safety regulations. - Correct Ans-Trauma; 33% (16.4%); young Amputations related to tumors accounted for ______% of amputations. The tumor most commonly cited was ______________, which primarily affects children and adolescents. Currently, with the development of new surgical techniques, amputation is no longer the primary intervention for this. The incidence of amputation secondary to cancers and tumors is expected to __________. - Correct Ans-4.5% (0.9%); osteosarcoma; decline Congenital limb deficiencies and the amputations used to adjust or correct them, are relatively rare. Approximately _____% of the amputations are related to this etiology and that number is expected to remain _____. - Correct Ans-2.8% (0.8%); stable Amputations can be performed as a _____________ of a joint or as a __________ of a long bone. The level of amputation is usually named by the joint or long bone through which the amputation is made. - Correct Ans-disarticulation; transection The levels of amputation surgery that are most commonly preformed at present involve the ______________________________ accounting for approximately _____% of all amputations. This high percentage reflects the prevalence of _______ of the lower extremity. - Correct Ans-LE below the knee; 70%; PVD Transfemoral amputations account for approximately _____% of all amputations. Because PVD typically affects both lower extremities, a _____________ number of individuals will eventually undergo amputation of both lower extremities. Between ________% of persons with amputations have had amputations of both lower extremities, most often at the __________ level. - Correct Ans-27; significant; 25-45%; transtibial Causes of amputation are divided into these 6 categories - Correct Ans-1. PVD 2. Diabetes 3. Trauma 4. Infections 5. Tumors 6. Limb deficiencies Narrowing and occlusion of the arterial lumen of the large arteries, associated with hypertension and coronary artery disease (CAD) - Correct Ans-PVD Etiology of PVD (7) - Correct Ans--50 years and older -Males females -Tobacco -Obesity -HTN -Hyperlipidemia -Sedentary lifestyle Symptoms of PVD (7) - Correct Ans--Intermittent claudication -Decreased pedal pulses -Dry skin and hair loss -Clubbing toe-nails -Ischemia -Ulceration -Pain relieved with standing _________________ is the leading cause of occlusive arterial disease of the lower extremities. This is also a leading cause of death and disability in the developed world. The term is derived from the Greek ________, which refers to the thickening of the arterial intima and ______, the accumulation of lipid that characterizes the typical lesion (Latin, literally meaning porridge). These lesions affect _______ and _______-sized arteries. Despite the familiarity of this disease, some of its fundamental characteristics remain poorly recognized and understood. - Correct Ans-Atherosclerosis; sclerosis; athero; large and medium Pathophysiology of PVD: ________ ___________ is an early event in atherogenesis and it occurs when influx and deposition of cholesterol into the arterial wall exceed efflux. Development of an atherosclerotic lesion can be divided into 3 stages in which the following form: 1)______________ 2)______________ 3)______________ - Correct Ans-lipid deposition; 1) fatty streak; 2) fibrous plaque; 3) complicated lesion The ______________ stage involves the formation of lipid-filled smooth muscle cells in the tunica intima, and it is believed to be reversible. No obstruction is present in the affected vessel. - Correct Ans-fatty-streak During the second stage of ________ __________ _________, lipid-laden smooth muscle cells are surrounded by collagen, elastic fibers, and mucoprotein matrix. The lesion can protrude into the lumen of the artery and cause obstruction. This lesion occurs at the level of the tunica intima, and it may also involve the muscular tunica media. Frequently, the lesion is located at arterial bifurcations. - Correct Ans-fibrous plaque formation In the third stage, a __________ _________ ensues when fibrous plaques are altered over time by hemorrhage, calcification, and mural thrombus. The intimal surface may become ulcerated as the lipid-laden plaque enlarges and hardens, and this can lead to embolism. This lesion is often a cause of vessel obstruction. - Correct Ans-complicated lesion Epidemiology of PVD: In the US: Based on ankle-brachial blood-pressure ratios, the prevalence of lower-extremity peripheral arterial disease (LEPAD) is approximately ____% in people younger than 60 years. The prevalence increases to _____% in people older than 70 years. - Correct Ans-3%; 20% The mortality associated with PVD results from associated cardiovascular and cerebrovascular pathology. The mortality rate in patients with LEPAD is ____ times higher than that of age-matched control subjects, and it is almost exclusively the result of death due to myocardial infarction and stroke. The 10-year survival rate decreases from _____% to _____% in healthy individuals (average age, 66 y) compared with patients with symptoms of LEPAD. - Correct Ans-6; 80% to 55% Morbidity in PVD is usually the limitation of physical activities because of _____ (claudication), _______, or ________. The most frequent complications include unhealed ulcer, gangrene, and eventual amputation. - Correct Ans-pain; ulceration; amputation -Race: No racial predilection exists for the development of LEPAD. -Sex: Males and females have an _______ risk of LEPAD; however, atherosclerosis of the lower extremities is seen most frequently in elderly _____. -Age: The highest incidence occurs in those aged ____-____ years. - Correct Ans-equal; men; 50-70 Although the most common site of occlusion is the distal superficial _________ _________ (at the level of the adductor canal), more than 1 location usually is involved at the same time. The ________ artery alone is less likely to be involved. The ________ _________ artery is involved primarily in patients with diabetes. - Correct Ans-femoral artery; popliteal; anterior tibial The most common presenting symptom in patients with peripheral vascular disease is __________ ____________. The patient complains of pain, cramping, or muscle fatigue, which occurs during exercise and is relieved by rest. The site of claudication is _______ to the location of the narrowed (stenotic) vessel. With progression of the disease, _______ pain develops. At this stage, patients complain of pain or numbness of the foot, which frequently occurs at night while the foot is not in a __________ position. Symptoms improve when the foot is placed in a dependent position. With more severe disease, resting pain may be present continuously. - Correct Ans-Intermittent claudication; distal; resting; dependent Signs of peripheral vascular disease encountered on physical examination include the following: __________ or _________ distal pulses; ______ over a tightly narrowed artery; hair ______; _________ nails; ________ skin; a ___________ appearance; pallor on _________; rubor on __________; and, in advanced disease, ______ and ________. - Correct Ans-decreased or absent; bruit; loss; thickened; shiny; skeletonized; elevation; dependency; ulcers and gangrene Finally, the progression of PVD is closely associated with __________ __________ and ________ ________. Smoking cessation improves the patient's symptoms, especially the pain. Also, along with diabetic control, smoking cessation slows the progression of the disease. - Correct Ans-cigarette smoking; and diabetes mellitus The first step in assessing a PVD patient is to record pulse-volume (plethysmography) and blood pressure measurements in the upper and lower extremities to compare the pressures. An ________-_______ ________ (____) is determined. This index is usually calculated by dividing the ______ _______ measurement in the ________ extremity by the measurement in the _______ extremity on the same side. An ABI of less than ______ is a strongly predictive sign of lower-extremity perfusio