Clinical patterns Flashcards
Paget’s disease epidemiological features
European descent, over 55 yo.
Paget’s disease aetiology
unknown
Paget’s disease proposed pathophysiology/pain mechanism
excessive osteoclastic bone resorption / increased osteoblastic bone formation - dull or aching pain or no pain
Paget’s disease differential diagnoses
osteomalacia
Paget’s disease symptoms
pain + aching of bones / pain worse after lying or sitting
hearing loss
paraethesia
Paget’s disease mechanism of injury
can have OA in surrounding joints
Paget’s disease contributing factors
suspected environmental + genetic factors
Paget’s disease physical exam findings
misshapen bones, affected bones warmer
Paget’s disease tests for condition
X ray or bone scan
Paget’s disease diagnostic interventions
alkaline phosphatase (enzyme for bone growth) present
Paget’s disease precautions/contraindications
high impact PA
Paget’s disease prognosis
excellent if diagnosed + treated early before hearing loss etc. occurs
Paget’s disease physiotherapy management options
can help maintain muscle strength, flexibility + joint ROM
Paget’s disease other management
PA
healthy diet
heat + cold packs
Paget’s disease medical management options
bisphosphonates - slow progression by controlling bone building process
pain killers
surgery
Osteoporosis epidemiological features
post menopausal women
older men
Osteoporosis aetiology
low BMD / micro-architectural deterioration of bone tissue
Osteoporosis pathophysiology + pain mechanisms
low bone mineral density
no pain unless spinal compression fracture
Osteoporosis differential diagnoses
osteomalacia
infection
osteonecrosis
Osteoporosis symtpoms
silent disease
Osteoporosis contributing factors
smoking/alcohol abuse
decreased PA
decreased calcium, vitamin D, protein intake
some drugs
Osteoporosis screening questions
early menopause?
history of smoking?
Osteoporosis tests for condition
scanning axial skeleton w/ dual energy x-ray absorptiometry (DXA)
Osteoporosis diagnostic investigatiosn
T score of 2.5 or less on DXA
Osteoporosis precautions/contraindications
some medications
Osteoporosis prognosis
15+ years after diagnosis if take medication + make lifestyle changes
Osteoporosis physio management options
measures to prevent falls, improving vision, aids for daily living, promoting exercise
Osteoporosis other management
limit alcohol/stop smoking
take vit. d + calcium
increase weight bearing + maintain optimal body weight
Osteoporosis other medical management
boniva, reclast
Rheumatoid arthritis epidemiological features
female - onset 40s + 50s
male onset 80s
Rheumatoid arthritis aetiology
genetic contribution
exposure to certain antigen
Rheumatoid arthritis pathophysiology + pain mechansim
- synovitis + synovial hyperplasia
- various cytokines, effector cells + signalling pathways
- proliferation of synovial tissue, infiltration of inflammatory factors
Rheumatoid arthritis prognosis
significant disability + early mortality if left untreated
Rheumatoid arthritis main problem
inflammation of joints / polyarticular pain + swelling
Rheumatoid arthritis area of symptoms
PIP joints (fingers), MCP joints, wrists, knees, ankles, MTP joints
Rheumatoid arthritis characteristics of symptoms
ache + stiffness
Rheumatoid arthritis behaviour of symptoms
- stiffness worse after inactivity or vigorous exercise
- morning stiffness over 30 mins
Rheumatoid arthritis typical activity restriction
cessation of work
Rheumatoid arthritis typical history/mechanism of injury
insidious without incident
multiple joints affected
Rheumatoid arthritis contributing factors
genetic
Rheumatoid arthritis screening questions
personal/family history of autoimmune diseases
Rheumatoid arthritis physical examination features
- swelling/redness around joint
- atrophy
- active/passive movements limited
- reduced strength in hands
- muscle length X reducing ROM
Rheumatoid arthritis tests for condition
x rays, arthocentesis
Rheumatoid arthritis diagnostic investigations
IgM antibodies present in blood tests
Rheumatoid arthritis precautions + contraindications
quit smoking
avoid certain food eg. red meat
Rheumatoid arthritis physio management options
suggest exercise program
Rheumatoid arthritis other management options
assistive devices, home mods
Rheumatoid arthritis medical management
surgery, medications eg. analgesics, NSAIDs, corticosteroids, DMARDs
Osteoarthritis epidemiological features
female
1 in 3 over 65
Osteoarthritis aetiology
obesity, inactivity, past joint injury, muscle weakness
Osteoarthritis pathophysiology + pain mechanisms
- degradation of articular cartilage
- thickening of subchondral bone
- inflammation of synovium
pain = tenderness when pressed
Osteoarthritis prognosis
joint damage X be undone - increased mortality if untreated
Osteoarthritis differential diagnoses
fibromyalgia, rheumatoid arthritis, psoriatic arthritis
Osteoarthritis main problem
joint pain
Osteoarthritis characteristics of symptoms
stiffness, aching, tenderness
Osteoarthritis behaviour of symptoms
better in warmer weather
Osteoarthritis contributing factors
past injury, sedentary, overweight, history of trauma
Osteoarthritis physical examination findings
functional movement issues
limited active/passive movement
muscle strength + length decrease in muscles around joint
Osteoarthritis tests
X rays + MRIs
Osteoarthritis diagnostic investigation findings
osteophytes, loss of joint space, bone oedema, bone cysts, capsular thickening
Osteoarthritis physio management options
suggest exercise program
Osteoarthritis other management options
maintain healthy weight + diet etc.
Osteoarthritis medical management options
corticosteroid use
Heart failure epidemiological features
old age
Heart failure aetiology
heart attack
coronary heart disease
chronic conditions - hypertension, arrhythmias, cardiomyopathy, myocarditis
Heart failure pathophysiology + pain mechanisms
when contracting/relaxing action of heart is inadequate b/c heart muscle is weak/stiff
- chest pain/stomach pain
Heart failure differential diagnoses
COPD, hypertension
Heart failure prognosis
only 50% alive 5 years later
Heart failure main problem
bloated stomach, chest pain, coughing, shortness of breath
Heart failure behaviour of symptoms
worse when lying down
Heart failure contributing factors
unhealthy lifestyle
obesity
drug + alcohol abuse
low PA
Heart failure tests
ECG
chest x ray
plasma b-type natriuretic peptide
transthoracic echocardiogram
Heart failure diagnostic intervention findings
high levels of BNP
Heart failure precautions/contraindications
NSAIDs
Heart failure physio management
education re knowing how to recognise worsening symptoms / when action is required
Heart failure other management
- treating disorder causing heart failure
- making lifestyle changes
Heart failure medical management
drugs or surgery
Coronary heart disease epidemiological features
- male / post menopausal women
- maori or south asian descent
- old age
Coronary heart disease aetiology
unhealthy diet
inactive
overweight / diabetic
high BP + cholesterol
smoker
Coronary heart disease pathophysiology
coronary arteries become less patent b/c of build up of plaque in lining
- insufficient blood to heart muscle -> pain = angina
Coronary heart disease prognosis
long life if detected + managed early
Coronary heart disease differential diagnoses
- msk system -> spine, ribs, muscles
- heartburn
- lung issues
Coronary heart disease main problem
tightness
pressure
burning
breathlessness
sweating
Coronary heart disease area of symptoms
chest
chin/jaw
upper back
shoulders
Coronary heart disease characteristics of symptoms
stable angina = assoc w/ exertion / worse after meal
unstable angina = unexpected, occurs at rest, X ease w/ rest or medication
Coronary heart disease contributing factors
family history
lifestyle factors
Coronary heart disease special tests
Coronary angiogram = catheter inserted into heart, dye injected -> shows narrowing
ECG
chest x ray
Coronary heart disease precautions + contraindications
avoid certain drugs eg. NSAIDs
Coronary heart disease physio management
pre + post surgery
Coronary heart disease other management options
lifestyle changes
pharmacological management
surgery
Diabetes epidemiological features
type 1 = before 18 yrs old
type 2 = developed after 40 b/c of obesity, poor diet + lack of exercise
Diabetes aetiology
build up of glucose in bloodstream
Diabetes pathophysiology
type 1 = little/no insulin production by pancreas b/c beta cells destroyed by immune system
type 2 = reduction in body’s ability to use insulin
Diabetes prognosis
incurable - type 2 diabetics may not need medication if change lifestyle
Diabetes differential diagnoses
- drug induced signs + symptoms eg. corticosteroids
- infection
- endocrinopathies eg. hyperthyroidism
Diabetes main problem
fatigue
polydipsia
polyuria
polyphagia
weight loss (type 1)
Diabetes contributing factors
type 1 = genetics, viral infections, vaccines, toxins, early cessation of breast feeding
type 2 = age, ethnicity, family history, weight, PA levels, diet, smoking
Diabetes diagnostic investigations
- random blood test -> glucose above 11mmol/L
- fasted blood test -> 7mmol/L
- haemoglobin -> 6.5% or above
Diabetes precautions + contraindications
excessive exercise
certain foods
Diabetes physio management
exercise prescription
Diabetes other management
diet + lifestyle
Diabetes medical management
insulin replacement
Falls + fractures aetiology
fall from height that shouldn’t cause fracture
osteoporosis
Falls + fractures main problem
NOF + Colle’s fractures
Falls + fractures physio management
exercise prescription
Falls + fractures other management
home safety interventions
vision + podiatry assessment
Stroke epidemiological features
> 40 yrs old
regional area
Stroke aetiology
hypertension
high cholesterol
atrial fibrillation
diabetes
age, gender + fam history
Stroke pathophysiology
ischaemic stroke = acute loss of blood flow to brain b/c of infarct (blockage of artery by thrombus or embolus)
haemorrhage stroke = rupture of blood vessel in brain causing brain cells to die b/c of low O2
Stroke prognosis
rapid recovery in days following
long recovery in general - better outlook if rehab good
Stroke symptoms
face dropped
arms X be lifted
slurred or confused speech
Stroke contributing factors
poor diet
low PA
age, gender + fam history
Stroke PT Mx
resistance training
things to increase cardioresp fitness
task specific practice
Stroke other Mx
must be mobilised in 48hrs unless contraindicated
Stroke med Mx
treated by multi D team in stroke unit -> antithrombotic surgery/therapy
Parkinson’s epidemiological features
60-65 years old
male
gene-environment interactions
Parkinson’s aetiology
genetically inherited or sporadic (idiopathic)
Parkinson’s pathophysiology
neurological degeneration of dopamine producing neurons in substantia nigra -> basal ganglia X coordinate movement
Parkinson’s prognosis
can live long + rewarding life
Parkinson’s differential diagnosis
multiple system atrophy
progressive supranuclear palsy
basal degeneration
lewy body dementia
Parkinson’s symptoms
postural instability
tremors
rigidity
bradykinesia
Parkinson’s specific tests
none, suspected if cardinal signs present
Parkinson’s diagnostic investigations
MRI + CT scan to rule out other conditions
PET scans w/ fluoro dopa - low levels in striatum
SPECT scans w/ radioisotope
L dopa challenge
Parkinson’s physio mx
prevent loss of:
- flexibility
- postural control
- limb ROM
Parkinson’s medical Mx
dopamine replacement via levodopa
dopamine agonists
COMT inhibitors
anticholinergics
deep brain stimulation
COPD epidemiological features
1 in 7 over 40 have some form
COPD aetiology
smoking
asthma
genetics
exposure to environmental irritants
COPD pathophysiology
changes in large + small airways
increased normal inflammatory response
increased number of activated polymorphonuclear leukocytes -> release elastases in manner X counteracted by proteases = lung destruction
COPD prognosis
quality of life can be maintained if managed properly
COPD symtpoms
worsening dyspnea + exercise intolerance
chronic bronchitis = progressive card/resp failure + weight gain, productive cough + pulmonary infection
emphysema = long standing dyspnea + late onset non-productive cough, cachexia + resp. failure
COPD objective exam
chronic bronchitis = obese, frequent cough, use of accessory muscles in resp, wheezing, cyanosis
emphysema = thin w/ barrel chest, breathing assisted w/ pursed lips + accessory muscles, chest hyperresonance
COPD tests
spirometry before + after meds
COPD physio Mx
action plan to treat exacerbation early through resp physio
COPD med Mx
pharmacology or O2 therapy
Ankylosing spondylitis epidemiological features
males
15-45 onset
Ankylosing spondylitis aetiology
genetic contribution
Ankylosing spondylitis pathophysiology
inflammatory arthritis affecting spine + large joints
ossification of ALL.s -> bamboo spine
Ankylosing spondylitis prognosis
progressive flexed spinal posture -> secondary breathing difficulties
Ankylosing spondylitis dif. diagnoses
rheumatoid arthritis
Ankylosing spondylitis symptoms
pain + stiffness in back, buttocks + neck
tendon + lig pain in chest, heel, under foot = enthesitis
eye inflammation
Ankylosing spondylitis behaviour of symptoms
inflammation improves w/ exercise
am stiffness >45 mins / improves w/ rest
Ankylosing spondylitis tests
X rays
blood tests - HLA-B27, IL23R + ARTS1 genes
Ankylosing spondylitis physio Mx
aquatic therapy for spine
Ankylosing spondylitis other Mx
rheumatologist to learn about AS
Ankylosing spondylitis med Mx
analgesics, NSAIDs, corticosteroids, DMARDs
