Number of uninsured up in 2001 due to unemployment - includes continuing education examination on "Bernese periacetabular osteotomy for hip dysplasia in young adults" - Statistical Data Included

AORN Journal, April, 2002 by Craig A. Gillett

The large number of job layoffs in 2001 added more than two million people to the ranks of the uninsured, according to a Feb 12, 2002, news release from Families USA. In 2000, 39 million Americans were uninsured, a number that exceeds the total population of 22 states plus the District of Columbia. In 2001, more than 2.2 million Americans lost health insurance coverage due to increased unemployment, causing the number of uninsured to exceed the population of 23 states plus the District of Columbia. This represents the largest increase in the number of uninsured Americans in any one year since 1992.

Approximately half of the increase due to layoffs occurred between September and December 2001, indicating the impact of the Sept 11, 2001, attack on the World Trade Center. Other causes of health insurance loss, such as increased health care costs or cutbacks in state Medicaid programs, are not reflected in these numbers. Thus, the actual number of uninsured Americans likely is higher.

Families USA and other health care and business organizations have formed a coalition to seek solutions to the problems of the uninsured. The "Covering the Uninsured" campaign aims to make expanded health coverage a top national priority to prevent millions of people from deferring needed health care.

2 Million Americans Lost Their Health Insurance in 2001: Largest One-year Increase in Nearly a Decade (news release, Washington, DC: Families USA, Feb 12, 2002) http://www.families.usa.org/medio/press/2002/insurance _loss.htm (accessed 26 Feb 2002).

Examination

BERNESE PERIACETABULAR OSTEOTOMY FOR HIP DYSPLASIA IN YOUNG ADULTS

1. The term dysplasia describes

a. weakening or degeneration of muscle.

b. abnormality in performing voluntary muscle movements.

c. abnormal development of tissue.

d. strong, involuntary, painful muscle spasms.

2. An association has been shown to exist between developmental dysplasia of the hip (DDH) and the development of pelvic carcinoma.

a. true

b. false

3. If left untreated, -- of people affected with DDH may suffer from osteoarthritis by age 50.

a. 10% to 20%

b. 20% to 35%

c. 35% to 45%

d. 25% to 50%

4. The hip is a ball and socket or -- joint.

a. enarthrosis

b. synarthrotic

c. amphiarthritic

d. hinge

5. The -- nerves combine to form the lumbar plexus, which lies in the posterior portion of the psoas muscle.

a. first through fifth thoracic

b. first through fourth sacral

c. first through fifth lumbar

d. first through fourth lumbar

6. The femoral nerve is located on the anteromedial side of the iliopsoas muscle and passes under the -- ligament as it enters the thigh.

a. femoral

b. iliac

c. inguinal

d. obturator

7.The abdominal aorta divides at the fourth lumbar vertebra into the right and left -- arteries.

a. internal carotid

b. common iliac

c. brachial

d. vertebral

8.The acetabulum receives its blood supply from branches of the -- artery.

a. internal iliac

b. external iliac

c. internal lumbar

d. median sacral

9. The majority of patients with DDH primarily have an abnormality on the -- side of the joint.

a. femoral

b. acetabular

c. inguinal

d. obturator

10. Risk factors for DDH include all of the following except

a. breech presentation birth.

b. gender.

c. lower limb deformity.

d. fetal alcohol syndrome.

11. Physical signs may include all of the following except

a. restricted range of motion in the affected hip.

b. pelvic obliquity.

c. intermittent claudication in the affected leg.

d. leg length discrepancy.

12. In a positive Trendelenburg's test, the iliac crest on the side opposite the defective weight-bearing leg will drop.

a. true

b. false

13. All of the following are steps of the apprehension test except

a. the patient lies on the affected hip.

b. the affected leg hangs over the end of the examination table.

c. the unaffected hip is flexed and held by the patient.

d. the examiner passively rotates the affected hip externally and hyperextends it simultaneously.

14. Preoperative x-rays of the patient should include

a. false profile, bilateral long leg standing, and functional hip radiographs.

b. anterior/posterior (AP) view of the pelvis and chest and functional hip radiographs.

c. AP of the hip, false profile, and functional hip radiographs.

d. false profile, bilateral long leg standing, and functional hip radiographs.

15. Conservative nonsurgical management may include

a. weight loss, ultrasonic heat treatments, and using a variety of anti-inflammatory and analgesic medications.

b. weight loss, physical therapy for gait correction, and modification of activities.

c. use of a cane, ultrasonic heat treatments, and physical therapy for gait correction.

d. use of a cane and anti-inflammatory and analgesic medications and modifying activities.

16. A total hip arthroplasty is the best surgical option for young, physically active patients.

a. true

b. false

17. Patients with DDH are a high risk for developing early osteoarthritis because

a. the femoral head of the affected hip necrotizes.

b. there is poor blood supply to the articular cartilage in the acetabulum.

c. the weight supported by the hip joint is concentrated over a smaller surface area.